SARS-CoV-2 and Adolescent Psychiatric Emergencies at the Tübingen University Hospital: Analyzing Trends, Diagnoses, and Contributing Factors

Psychiatric emergencies have increased in recent decades, particularly with the onset of the SARS-CoV-2 pandemic, and far too little is known about the backgrounds of these emergencies. In this study, we investigated the extent to which the number of psychiatric emergencies changed during and in the aftermath of the SARS-CoV-2 pandemic at the Child and Adolescent Psychiatry (CAP) Tübingen. We considered age and psychiatric diagnoses. Additionally, we evaluated the backgrounds of the emergencies. We applied a mixed- (quantitative and qualitative) methods approach to data on emergency presentations at the CAP Tübingen from the pre-SARS-CoV-2 pandemic period (October 2019-January 2020) to Restriction Phase 1 (October 2020-January 2021), Restriction Phase 2 (October 2021-January 2022), and endemic phase (October 2022-January 2023). The total number of emergencies and those with eating disorders and affective disorders increased, while obsessive-compulsive disorders, expansive disorders and anxiety disorders decreased. The patients presenting in the pre-SARS-CoV-2 pandemic period were younger than those in the subsequent periods. We content-coded the reasons behind the emergency presentations. We also identified four areas of stressors and personality characteristics associated with the emergency presentations. In light of the increasing number of psychiatric emergencies, the long-term aim should be to meet the growing demands and create options for prevention.

Using a Mixed-Method Approach to Explore the Factors Influencing the Family Resilience of Stroke Survivors in China

Background

Stroke is a critical public health issue in China that necessitates a closer examination of family resilience (defined here as the collective capacity of individuals, families and communities to effectively navigate challenges, recover from adverse events and foster positive adaptation). Amid rising stroke incidence, this study addresses the dearth of research on family resilience among stroke survivors in China, aiming to assess its level, identify influencing factors and establish coping strategies for family caregivers.

Methods

This mixed-methods research employed a sequential explanatory design. Questionnaires were distributed to 258 stroke survivors and their family members at outpatient follow-up visits. In the first stage (ie the quantitative research stage), the research tools for data collection included a general demographic sociological data questionnaire, the Family Resilience Assessment Scale (FRAS), the Self-Efficacy for Managing Chronic Disease 6-Item Scale, the Caregiver Burden Scale, the Family Functioning Scale and the Social Support Rating Scale. Quantitative data were analysed using IBM SPSS 26.0 software, utilising descriptive statistics for summarising sociodemographic characteristics and conducting analyses, such as independent-sample t-tests, one-way analysis of variance and Spearman correlation analysis. The second stage (ie the qualitative research stage) involved complementing and validating the data, developing a quantitative-qualitative interview framework and selecting participants for interviews. Colaizzi's seven-step analysis was applied to analyse interview data. In the third stage, the quantitative and qualitative research results were integrated, and a comprehensive analysis was performed to obtain an accurate conclusion.

Results

A total of 242 families responded to the questionnaire (response rate: 93.8%). In total, the mean age of stroke survivors was 61.86 ± 8.76 years old, and 69.8% were male. The quantitative results showed that the FRAS mean score was (185.33 ± 24.78), which was above the medium level. The multiple linear regression analysis confirmed that family function was the strongest influencing factor on family resilience (β = 0.948, p < 0.01). The qualitative analysis revealed four themes of family adaptation experience: loss of independence and certainty, facing threats and challenges, seeking family advantage resources and adopting coping strategies.

Conclusion

This hybrid study sheds light on the adaptation process of the families of stroke survivors, revealing family function as the primary influencer of resilience. Recognising that eliminating risk factors is challenging, our suggestion is for clinical practitioners to emphasise family strengths and implement resilience-oriented interventions. Focusing on enhancing coping abilities and fostering adaptation within families can aid in the rehabilitation process, promoting the well-being and growth of both the family unit and individual members, while alleviating caregiver burden.

Exploring return to work for patients with head and neck cancer

BACKGROUND

The number of survivors of head and neck cancer (HNC) has steadily increased due to major advances in cancer care. However, cancer survivors who experience job loss face different challenges regarding return to work (RTW). Relatively few studies have integrated the experience encountered by patients.

OBJECTIVE

This mixed-methods study aimed to explore the experience and challenges of RTW in patients with HNC.

METHODS

Data were collected with structured questionnaires (n = 120) and semi-structured face-to-face interviews (n = 12).

RESULTS

Relationships were found between patient's physical status, perceived stress, and social support. Patients who continued work, or not, had significant differences in reported physical function and stress. Four themes emerged from the qualitative data, including the perceived meaning of work, challenges for RTW, preparing for RTW, and social support. After diagnosis and treatment, patients perceived the meaning of work, such as personal value, responsibility, and financial need. They faced many challenges to RTW, including declining physical strength, workload, schedule rearrangement, speech difficulty, and changed appearance. In order to RTW, they prepared extensively and needed support from family and friends.

CONCLUSION

This study revealed the experiences and challenges of RTW patients with HNC. The results allowed us to identify patients' concerns and ways that healthcare providers could improve the RTW process. Future studies may develop tailored approaches for RTW in healthcare and government policies.

Going beyond the surface: a mixed-method exploration of infertility-related quality of life of women with endometriosis

Literature about the impact of infertility and endometriosis on Quality of Life (QoL) is scarce and needs further investigation. Our aim was to deeply investigate the QoL of women with diagnoses of both endometriosis and infertility with failed Assisted Reproductive Treatments (ART). We conducted a concurrent mixed-method study composed of both quantitative and qualitative surveys. The quantitative survey included 22 women who completed the FertiQoL. The qualitative survey included 15 of them who provided written answers to open-ended questions aimed at deeply exploring their QoL. Data were initially analyzed separately and then combined in a meta-matrix. From the quantitative survey emerged that women at higher risk for low QoL were those who have experienced previous spontaneous miscarriages and that the domains of the FertiQoL related to fertility treatment (i.e. increased pain severity, disturbed daily life routine, and dissatisfaction with services) were the most critical. From the Interpretative Phenomenological Analysis (IPA) of qualitative survey, narrations about the physical, relational, social, emotional-cognitive, and behavioural impact of the diseases emerged. Mixed findings showed that the QoL of this population was scarce and that different levels (the inner world, the behaviours, the relational context, and the environmental context) are strictly connected and interact between them in influencing QoL. Multi-level preventive or supportive programs (with specific attention to pain experience, coping strategies, quality of services and governmental support) are required for this population.

Understanding the impact of the COVID-19 pandemic on U.S. older adults: self-reported pandemic-related concerns and consequences in a cross-sectional survey study

Background and objectives

The purpose of this study was to explore COVID-19 pandemic-related concerns among a racially and ethnically representative sample of older adults in the U.S.

Research design and methods

Participants were 501 English-speaking adults 60 years and older recruited online nationally across the U.S. from Amazon Mechanical Turk (mTurk) and Prolific Research Platforms during June of 2020. Data comes from a larger cross-sectional survey. We content analyzed open-ended responses about pandemic-related concerns and observed responses to a checklist of items created by the research team to assess for specific physical, social, and financial consequences experienced due to the pandemic.

Results

A majority of the sample (92%) reported at least one pandemic-related concern, with the highest percentage expressing concerns coded as Concern for Others (28%), Physical Health (27%), Socializing (24%), Finance (15%) and Socio-Political-Economic (14%). Participants reported high concern severity (M = 4.03, SD = 1.04) about their concerns mentioned in response to the open-ended concerns question. When prompted with a checklist of items, participants frequently endorsed disruption in social activities as a consequence of the pandemic (83%), disruptions that could impact physical health (45%), and concern over finances as a consequence of the pandemic (41%).

Discussion and implications

Older adults most frequently mentioned concerns about the well-being and behavior of others, one's own physical health, and the impacts of the pandemic and social distancing policies on social activities. Findings align with the Socioemotional Selectivity Theory and point to the importance of supporting older adults to maintain meaningful social engagement under conditions of a pandemic and social distancing policies.

Barriers and facilitators of implementing the practice programme for upright positions in the second stage of labour: A mixed-method study

OBJECTIVE

To explore the possible barriers and facilitators to implementing the Upright Positions in the Second Stage of Labour (UPSSL) programme in Chinese healthcare settings.

DESIGN

A mixed-method convergent design with the guidance of Consolidated Framework for Implementation Research (CFIR).

METHODS

An online survey study and semi-structured interviews were conducted between March and May 2023. Healthcare professionals were recruited from four hospitals in Shijiazhuang, China. One hundred and thirty-one participants completed the survey study, and 23 of them were interviewed individually. Descriptive statistics evaluated the possible barriers and facilitators of implementing the UPSSL programme within the CFIR framework quantitatively. Guided by the CFIR framework, qualitative data were analysed using directed content analysis to summarize healthcare professionals' perspectives on barriers and facilitators of the UPSSL programme.

RESULTS

Multiple intersectional barriers and facilitators were identified from the survey and semi-interviews. Healthcare professionals believed that the UPSSL programme has a scientific evidence base, systematic contents, and possible benefits for women. However, various barriers existed at individual, system, and organizational levels. Major barriers included healthcare professionals and women's safety concerns towards the use of upright positions during childbirth, the healthcare professionals' unfamiliarity with assisting an upright position birth, poor adaptability of the programme protocol, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting.

CONCLUSIONS

To facilitate the implementation of the UPSSL programme in China, tailored antenatal education on upright positions, especially addressing safety-related issues, should be provided to pregnant women, their families, or peers to enhance their understanding of and familiarity with such positions. Healthcare professionals should also be offered adequate training opportunities and necessary facilities. Furthermore, national-level policy changes might be required to address midwifery workforce shortages. Additionally, further research is warranted to select, adapt, and test effective implementation strategies for programme adoption.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

What problem did the study address? The adoption of upright positions during the second stage of labour could promote better maternal and neonatal outcomes and a positive childbirth experience. However, the adoption of upright positions during the second stage of labour is suboptimal in healthcare settings in China. Barriers and facilitators of implementing upright positions during childbirth are unclear. What were the main findings? A range of barriers and facilitators within the CFIR framework to promote upright positions during childbirth from healthcare professionals' perspectives were identified, and the major barriers included safety concerns towards and unfamiliarity with an upright position birth, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting. Where and on whom will the research have an impact? This study will enable a better understanding of the barriers and facilitators to promoting upright positions in the second stage of labour in China. The smooth and effective implementation of the UPSSL programme could help to promote better maternal and neonatal outcomes and improve women's childbirth experiences.

REPORTING METHOD

The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) and Good Reporting of A Mixed Methods Study (GRAMMS) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

In this study, healthcare professionals were involved in refining the topic guides and survey questions. Additionally, findings from the interviews were returned to them for comments and corrections.

Healthcare students' moral concerns and distress during the pandemic

BACKGROUND

During the first wave of the new coronavirus (COVID-19) pandemic, the sudden increase in hospitalised patients put medical facilities in southern Switzerland under severe pressure. During this time, bachelor's degree programs in nursing, physiotherapy and occupational therapy were disrupted, and students in their second year were displaced. Students experienced the continuous reorganisation of their traineeship as healthcare facilities adapted to a climate of uncertainty.

PURPOSE

The aim of this study was to investigate the degree of moral distress and the ethical issues most often encountered by physiotherapy, nursing and occupational therapy students enrolled in a traineeship during the first wave of the COVID-19 pandemic in southern Switzerland.

PARTICIPANTS AND RESEARCH CONTEXT

The sample consisted of 102 participants, and the response rate was 81.6%.

RESEARCH DESIGN

Based on a pragmatic approach, a mixed-method with a convergent design was adopted. Data were collected between 30 April 2020 and 14 May 2020, via a survey administered to all occupational therapy, physiotherapy and nursing students in their fourth semester.

ETHICAL CONSIDERATIONS

Given that no vulnerable persons were involved, the Ethics Committee of Southern Switzerland waived authorisation. However, all measures were put into place to protect participants by guaranteeing their anonymity and confidentiality.

RESULTS AND DISCUSSION

The data analysis showed that the main source for moral distress was 'poor teamwork' and that the moral issues encountered most often by students were related to the appropriateness of care and working conditions, with a clear reference to students' own safety and that of their loved ones; the other concerns reported included the loss of learning opportunities and the perceived lack of technical knowledge and skills.

CONCLUSIONS

This survey offers a faithful overview of physiotherapy, nursing and occupational therapy students' experience during the first pandemic wave. This study also identifies some key recommendations for healthcare professions' education.

Lived experiences of prostate cancer patients in an urban metropolis in North Central, Nigeria

Prostate cancer (PCa) is currently the second most prevalent cancer in the world and the most common type of cancer among Nigerian men. This study explored the lived experiences of patients with PCa at the General Hospital in Ilorin, Kwara State, Nigeria. A mixed-method design was adopted. Purposive and consecutive sampling techniques were employed to recruit 50 and 10 participants for the quantitative and qualitative aspects respectively. Qualitative data was analyzed using thematic content analysis while quantitative data was analyzed using descriptive and inferential statistics. All participants were above the age of 50 years, 72% earned about $100 monthly while 68% were diagnosed in less than five years. Majority of the participants utilized adaptive coping styles and also found the strategies moderately helpful while living with the effects of radical prostatectomy. Participants also found the high cost of treatment severely challenging. Government and other stakeholders may need to subsidize the cost of PCa management thereby encouraging early accessibility to care, improved adherence to treatment and also reduce the economic burden of the disease on patients and their families.

Youth's Experiences of Cyber Violence in Intimate Relationships: A Matter of Love and Trust

Adolescents and young adults are particularly at risk of experiencing or perpetrating cyber dating violence (CDV) in their romantic relationships. However, it remains difficult to understand the motivations behind tolerating or perpetrating CDV in romantic relationships. Romantic attachment and beliefs may be an interesting avenue to explore among youth victims of CDV. The current study aims to 1) document the association between romantic attachment and CDV victimization and perpetration while controlling for age, gender and other forms of DV, and 2) explore beliefs youth attribute to the use of technology in their romantic relationships. A total of 332 self-identified heterosexual youth, with an age range of 14 to 25 years old, completed a survey. A subgroup of 14 youth who reported experiencing cyber dating violence also participated in a semi-structured interview. Logistic regressions were used to assess the contribution of romantic attachment (anxious and avoidant) to each form of CDV (stalking, psychological and sexual CDV) followed by a thematic analysis exploring beliefs about the use of technology in romantic relationships. Anxious attachment significantly predicted psychological CDV as well as stalking victimization and perpetration. Avoidant attachment significantly predicted psychological CDV victimization and perpetration as well as sexual CDV victimization. In their narratives, youth reported that controlling, monitoring, harassing behaviors, especially credentials sharing, constitute proof of love and trust rather than manifestations of CDV. The results support the relevance of developing tailored interventions based on attachment and romantic beliefs, which appears to be a promising avenue for preventing various forms of DV.

What makes people feel loved? An exploratory study on core elements of love across family, romantic, and friend relationships

With research long focusing on distinct characteristics of different love types, little is known about love as a general feeling across relationship contexts. To explore the core elements of love as perceived by laypeople and whether these elements weigh differently in different relationships, grounded theory was used to analyze open-ended responses from 468 individuals about their feeling loved in family, romantic, and friend relationships. Results indicated that the feeling of love is an interpersonal process in which one receives positive responsiveness from the other and experiences an authentic connection with the other, consistently across conditions and time (i.e., in a sense of stability); three core elements were shared across family, romantic, and friend relationships. Chi-square independence tests revealed differentiated weights for love elements in three relationships, which corresponded to the prototypical love definition in family, romantic, and friend relationships. Findings suggested an integrated theoretical conceptualization of love as a shared feeling and asset across relationships, which provided important insights on love conceptualization, assessment, and study design, as well as implications for the treatment of dysfunctional relationships, best practices in daily interpersonal interactions, and improvement in intervention and therapy.

Mixed-methods study protocol for exploring the perception of nurses' resilience in the COVID-19 pandemic: Designing, implementing and evaluation of intervention

BACKGROUND

While the necessity for interventions to build resilient nurses in the COVID-19 pandemic is recognized, there is disagreement about the effective methods for achieving this.

AIM

We present our research protocol that describes plans to design and test an interventional program for promoting nurses' resilience.

DESIGN

This sequential exploratory interventional mixed-methods study is conducted in three phases (qualitative, intervention design, and quantitative).

METHODS

It was funded from May 2021 for 24 months. In phase 1, we explored strategies for promoting resilience in the COVID-19 pandemic from nurses' perspectives (through semi-structured interviews). In phase 2, we will design an interventional program for promoting nurses' resilience (using the qualitative phase and literature review results). We will assess the program's effectiveness on nurses' resilience in a randomized controlled trial in phase 3.

DISCUSSION

Given the different experiences of nurses of resilience in COVID-19, our innovative program can guide future research to enhance nurses' resilience based on specific situations.

Indigenous-Amazonian Traditional Medicine's Usage of the Tobacco Plant: A Transdisciplinary Ethnopsychological Mixed-Methods Case Study

Harmful usage of tobacco is a global public health problem associated with adverse health effects and addiction. Yet, in the Peruvian Amazon, the native region of Nicotiana rustica L., this plant is used in remarkably different manners: it is considered a potent medicinal plant, applied in liquid form for oral ingestion to treat mental health problems, a common and ancient healing practice in this region. Using a transdisciplinary field research approach with mixed ethnopsychological methods, this work aimed to report for the first time a case study in this context. The intervention took place in the Peruvian Amazon (Loreto) and involved ritual tobacco ingestion in a weeklong retreat-like frame, administered by a specialized traditional Amazonian healer. The patient was a 37-year-old woman with diagnosed mood, anxiety, and attention deficit disorders, as well as a chronic somatic condition. We applied qualitative experience-sampling during and quantitative symptom assessments pre- and post-treatment. Our findings offer a detailed description of the experiential therapeutic process during the treatment week and suggest clinically relevant improvements in patient well-being. This work is significant in view of the globally prevalent harmful uses of tobacco and the current scientific trend of revisiting herbal psychoactives (e.g., cannabis, psilocybin) for their therapeutic potentials.

Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: Mixed-methods study

Background

A tailored and integrated technology solution (patient mHealth application and provider dashboard) can provide a 360° view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy that could improve health outcomes and address health inequities.

Objectives

To develop a set of user specifications for the mHealth and dashboard applications, develop prototypes based on user needs, and collect initial impressions of the prototypes to subsequently develop refined tools that are ready for deployment.

Methods

Study activities followed a double-diamond framework with a participatory design mindset. Activities were divided into two phases focused on a qualitative inquiry about participant needs and values (phase 1) and design, development, and usability testing of low and high-fidelity prototypes (phase 2).

Results

We identified themes that exemplified pregnancy experience among Medicaid-enrolled individuals with T2D. Patients (n  =  7) and providers (n  =  7) expressed a core set of expectations for the mHealth and dashboard applications. Participants provided feedback to improve the mHealth and dashboard. For both applications, participants reported scores for the NASA Task load Survey (TLX) that were in the 20th percentile of national TLX scores.

Conclusions

Digital health tools have the ability to transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels, which is a precursor to experiencing a successful pregnancy and birth. Distilling patient and provider needs and preferences-then using them, along with prior studies and theory, to develop applications-holds great potential in tackling complicated health care issues.

Adjustment to disease and quality of life in people with vascular Ehlers-Danlos and Loeys-Dietz syndromes: A mixed-method study

Background

Vascular Ehlers-Danlos (vEDS) and Loeys-Dietz syndromes (LDS) are hereditary disorders of connective tissue having severe vascular complications (HDCTv) which lead to an increased risk of premature death. Little is known about the impact of the disease in patient's daily life.

Method

Sixteen HDCTv patients (vEDS = 9 and LDS = 7), 16 age and sex-matched hypermobile Ehlers-Danlos syndrome patients (hEDS) and 18 healthy subjects (HS), responded to self-questionnaires assessing psychosocial adjustment, quality of life (QoL), anxiety, depression, pain, fatigue and sleep problems. Patients with HDCTv were also interviewed in order to explore qualitatively their experience with the disease.

Results

Compared with HS, patients with HDCTv scored significantly higher on anxiety, depression, fatigue, sleep problems, and lower on QoL. Most HDCTv patients (93.8%) have optimal psychosocial adjustment. In addition, HDCTv patients scored higher on QoL and psychosocial adjustment, but lower in pain, fatigue, sleep problems, and depressive symptoms than hEDS patients. Four main themes were identified in qualitative analyses: living with HDCTv, knowledge/ignorance of the disease, health behaviors/self-care and coping strategies.

Conclusion

Our results suggest that despite the negative impact of HDCTv on the patients' daily lives, overall, they present an optimal disease adjustment which points to appropriate coping strategies. More research in psychosocial aspects of people with these rare diseases are needed to confirm these results and better understand their needs.

Who posted #MeToo, why, and what happened: A mixed methods examination

Objectives

The #MeToo social media campaign raised awareness about sexual harassment. The purpose of the current study was to address three unexplored research questions. First, what factors influenced whether a person posted #MeToo? Second, how did posting (or not) influence participants' wellbeing? Finally, what motivated participants' posting (or not) #MeToo?

Method

This mixed-methods study explores how #MeToo was experienced by full-time employees (N = 395) who could have posted #MeToo (i.e., experienced a sexual harassment event), whether or not they did so. Participants completed surveys in July of 2018 assessing social media use, sexual harassment history, relational variables such as relative power and social support, and job and life satisfaction. Participants also responded to open-ended survey questions about the context of and decisions about #MeToo posting.

Results

Quantitative results indicated that sexual harassment history was the most powerful predictor of #MeToo posting, while power and interpersonal contact also contributed. Qualitative analyses (N = 74) using a grounded theory approach indicated themes associated with decisions to disclose, including feeling a responsibility to post, need for support, and affective benefits. Decisions not to disclose were event-related negative affect, posting-related negative affect, timing of the event, fit with the #MeToo movement, privacy concerns, and fear of consequences.

Conclusion

This study contributes to the literature on sexual harassment disclosure by focusing on informal means of disclosure and drawing on comparisons to formal reporting and implications for workplaces. Online sexual harassment disclosure, in many ways, reflects the impediments to formal reporting procedures. Given the increased use of social media for purposes of disclosure, these findings suggests that organizations should recognize the legitimacy of sexual harassment reports made online and consider the possible failings of their formal reporting systems as reasons for online disclosure.

Supporting immigrant caregivers during the COVID-19 pandemic: Continuous adaptation and implementation of an early childhood digital engagement program

Digital messaging programs have the potential to be a powerful, low-cost, technological tool to support multiple facets of caregivers' knowledge, and implementation of developmentally appropriate caregiver-child activities among diverse immigrant populations. However, involving caregivers and community stakeholders in the cultural and linguistic tailoring of interventions to optimize utilization and engagement may be critical to ensuring messaging programs' usability and acceptability. The purpose of this mixed-method study was to use the dynamic adaptation process (DAP) within an Exploration, Preparation, Implementation, Sustainment (EPIS) framework to examine the implementation of a digital messaging program, developed at the beginning of the COVID-19 pandemic, aimed at providing Spanish-, English-, and Mandarin-speaking immigrant caregivers with caregiver-child activities that supported children's development and caregivers' knowledge. Building upon the EPIS framework, using DAP, we assessed the feasibility and acceptability of a messaging program via short message service or multimedia message service, WeChat, and Remind and webinar program during the COVID-19 pandemic. The study illustrated how a digital messaging program is a feasible mechanism for sharing developmentally and culturally appropriate information with immigrant caregivers. In addition, the use of the DAP and the EPIS framework allowed us to continuously track the process of cultural adaptation, identify barriers and facilitators of the outreach program, and examine how implementation unfolded across all three groups of caregivers.

Opportunities and threats of e-learning in dental education in viewpoints of faculty members: A Mixed method study

BACKGROUND

The aim of the study was to assess the opportunities and threats of e-learning in dental schools and explore the experiences of dental faculty members in the coronavirus disease-19 (COVID-19) epidemic conditions.

MATERIALS AND METHODS

The present study was a sequential exploratory mixed method study (quantitative-qualitative). In the quantitative phase, a survey study was conducted to investigate the perspectives of faculty members regarding the opportunities and threats of e-learning during the COVID-19 epidemic. The data were analyzed by descriptive indicators (frequency, percentage, mean, and standard deviation) and analytical tests (t-test and analysis of variance). In the qualitative phase, data were collected through semi-structured interviews. In the qualitative phase, the inductive content analysis approach of Graneheim and Lundman was used to analyze the interviews.

RESULTS

In this study, 213 faculty members of dental schools of Iran participated; among whom 100 were men (46.9%) and 133 were women (53.1%). The results indicated the mean scores of the perspectives of faculty members regarding the opportunities and threats of e-learning in dentistry (4.05 ± 0.49 out of 5). Experiences of the participants in the qualitative phase were explored in the theme of "ups and downs of e-learning in dentistry" with three categories "unaccountability of e-learning in dental education," "challenges of human resource empowerment in the e-learning process," and "planned education."

CONCLUSION

The majority of the faculty members agreed with the use of e-learning in dental education and considered it as an opportunity. However, educational design for blended learning, creation of appropriate infrastructures, and empowerment of human resources as e-teacher and e-student were emphasized as key requirements for e-learning development in dental schools.

A Mixed-Methods Investigation of Occupational Health Specialists' Knowledge and Application of Pen-and-Paper Observational Methods for Ergonomics Assessment

OCCUPATIONAL APPLICATIONSErgonomic risk assessment is a key step in managing work-related musculoskeletal disorders. Diverse assessment methods exist, and errors may occur if inappropriate methods are selected. Understanding the level of knowledge, how to use methods, and exploring factors affecting erroneous usage of these methods, can provide useful information for health and safety regulatory authorities and decision-makers to identify problems and determine an action plan to eliminate them. We found that Iranian occupational health specialists have little knowledge about the types of pen-and-paper observational methods (OMs), and most of them use a limited number of these methods. Content analysis of interviews identified three main categories of influential factors and 12 subcategories. The main categories were educational, individual, and organizational factors. These results suggest the need for more effort to ensure that practitioners possess better knowledge and skills in the selection and application of pen-and-paper OMs.

Enhancing the caregiving experience of family care partners in Singapore through an arts programme for persons with dementia: an exploratory study

Objectives: Arts-based programmes for persons with dementia have shown promise in alleviating some of the caregiving challenges for family care partners. The present study sought to broaden the sociocultural perspectives of arts-based programmes by investigating the impact of a locally developed Arts & Dementia programme for persons with dementia on their family care partners in Singapore.Methods: Thirty-two family care partners of persons with dementia who participated in the Arts & Dementia programme were recruited. A mixed-methodological study was employed utilising quantitative pre- and post-programme data from the Zarit Burden Interview and Gain in Alzheimer care Instrument, and qualitative data from semi-structured group interviews.Results: Although there were no self-reported short-term changes in perceived caregiving difficulties and gains, semi-structured group interviews revealed potential caregiving benefits. Six overarching themes were identified: (1) contentment and social engagement, (2) re-connecting and developing new interests, (3) positive influence on caregiving, (4) enhancements to the programme, (5) more arts programmes, and (6) more support for families living with dementia.Conclusion: The present study highlights potential benefits of community-based arts activities in enabling caregiving to be a more positive experience for care partners.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2008306'I kept blaming myself for not spending enough time with him. Communication with him is different now. Watching him on the stage, he is happy and with a purpose'. (Gary, male).

Keep it positive: Exploring the relationship between stress, positive affect, wellbeing, and success of entrepreneurs

Entrepreneurs' wellbeing is of unprecedented importance given their crucial role in national economies in terms of job creation and innovation. In this research, we used a mixed methods approach to investigate the direct and indirect mechanisms by which entrepreneurs' wellbeing mediates the effects of stress on perceived entrepreneurial success. We theorize that entrepreneurs experience work-related stress and that the level of perceived wellbeing mediates the relationship between the entrepreneurs' stress and perceived success. We also hypothesize moderation effects by dispositional positive affect. We find that stress has direct negative effects on entrepreneurs' wellbeing and perceived success. However, an experience of positive affect significantly weakens the negative effects of stress by broadening and building entrepreneurs' cognitions. Drawing from our theoretical and empirical findings, we discuss implications for theory and practice in the domain of entrepreneurs' wellbeing.

Using PrEP and Doing it for Ourselves (UPDOs Protective Styles), a Web-Based Salon Intervention to Improve Uptake of Pre-exposure Prophylaxis Among Black Women: Protocol for a Pilot Feasibility Study

BACKGROUND

Multilevel interventions are necessary to address the complex social contributors to health that limit pre-exposure prophylaxis use among Black women, including medical distrust, pre-exposure prophylaxis stigma, and access to equitable health care. Strategies to improve knowledge, awareness, and uptake of pre-exposure prophylaxis among Black women will be more successful if information-sharing and implementation take place within trusted environments. Providing women with information through trusted cultural and social channels can effectively support informed decision-making about pre-exposure prophylaxis for themselves and members of their social networks who are eligible for pre-exposure prophylaxis.

OBJECTIVE

The goal of this project is to improve knowledge, awareness, uptake, and trust of pre-exposure prophylaxis, as well as reduce pre-exposure prophylaxis stigma, among Black women living in the US South.

METHODS

This multilevel, mixed methods study uses a community-engagement approach to develop and pilot test a salon-based intervention. There are three components of this intervention: (1) stylist training, (2) women-focused entertainment videos and modules, and (3) engagement of a pre-exposure prophylaxis navigator. First, stylist training will be provided through two 2-hour training sessions delivered over 2 consecutive weeks. We will use a pre- and posttest design to examine knowledge and awareness improvement of pre-exposure prophylaxis among the stylists. Upon full completion of training, the stylists will receive a certificate of completion and "Ask Me about PrEP" signage for their beauty salons. Second, together with the community, we have codeveloped a 4-part entertainment series (The Wright Place) that uses culturally and socially relevant stories to highlight key messages about (1) HIV, (2) pre-exposure prophylaxis, and (3) Black women's social contributors to health. Quantitative and qualitative measures will be used in a pre- and posttest design to examine pre-exposure prophylaxis knowledge, awareness, risk, stigma, trust, intentions, and women's perceptions of the usability and acceptability of the overall intervention and its implementation strategies. A video blog will be provided after each video. Third, participants will have access through an email or text message link to a pre-exposure prophylaxis navigator, who will respond to them privately to answer questions or make referrals for pre-exposure prophylaxis as requested.

RESULTS

This project was funded in October 2020 by Gilead Sciences and was approved by the Duke University School of Nursing institutional review board in April 2021 (Pro00106307). Intervention components were developed in partnership with community partners in the first year. Data collection for phase 1 began in April 2022. Data collection for phase 2 began in May 2022. The study will be complete by October 2022.

CONCLUSIONS

Multilevel interventions that consider the assets of the community have promise for promoting health among Black women who have influence within their social networks. The findings of this study have the potential to be generalizable to other populations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/34556.

Mixed-Method Evaluation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI)

The community pharmacy antimicrobial stewardship intervention (PAMSI) is multi-faceted and underpinned by behavioural science, consisting of the TARGET Antibiotic Checklist, staff e-Learning, and patient-facing materials. This mixed-method study evaluated the effect of PAMSI on community pharmacy staffs’ self-reported antimicrobial stewardship (AMS) behaviours. Data collection included staff pre- and post-intervention questionnaires, qualitative interviews, and TARGET Antibiotic Checklists. Quantitative data were analysed by a multivariate ordinal linear mixed effect model; qualitative data were analysed thematically. A total of 101 staff participated from 66 pharmacies, and six completed semi-structured interviews. The statistical model indicated very strong evidence (p < 0.001) that post-intervention, staff increased their antibiotic appropriateness checks and patient advice, covering antibiotic adherence, antibiotic resistance, infection self-care, and safety-netting. Staff reported feeling empowered to query antibiotic appropriateness with prescribing clinicians. The TARGET Antibiotic Checklist was completed with 2043 patients. Topics patients identified as requiring advice from the pharmacy team included symptom duration, alcohol and food consumption guidance, antibiotic side-effects, and returning unused antibiotics to pharmacies. Pharmacy staff acknowledged the need for improved communication across the primary care pathway to optimise antimicrobial use, and PAMSI has potential to support this ambition if implemented nationally. To support patients not attending a pharmacy in person, an online information tool will be developed.

The Use of the Exploratory Sequential Approach in Mixed-Method Research: A Case of Contextual Top Leadership Interventions in Construction H&S

Quality and rigour remain central to the methodological process in research. The use of qualitative and quantitative methods in a single study was justified here against using a single method; the empirical output from the literature review should direct the current worldview and, subsequently, the methodologies applied in research. It is critical to gather contextual behavioural data from subject matter experts—this helps establish context and confirm the hypotheses arising from the literature, which leads to the refinement of the theory’s applicability for developing a conceptual model. This paper identified the top leaders in construction organisations as subject matter experts. Nine semi-structured interviews were conducted, representing the South African construction industry grading. The output of the refined hypothesis was followed by a survey that targeted n = 182 multi-level senior leaders to gather further perspectives and validate the conceptual model. The outcome resulting from the rigorous validation process adopted—the analysis process, which included Spearman rank correlation, ordinal logistic regression and multinomial generalised linear modelling—demonstrated that the lack of H&S commitment in top leadership persists, despite high awareness of the cruciality of H&S in their organisations. Contextual competence, exaggerated by the local setting, is one source of this deficiency. This paper provides guidelines for using the exploratory sequential approach in mixed-method research to effectively deal with contextual issues based on non-parametric modelling data in top leadership H&S interventions.

A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient's Care Experience

Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported benefits of consolidated appointments and positive experience in sustained patient–provider relationship, shared-decision making, and family/caregiver engagement in PCMH. Participants may not fully comprehend the concept of integrated care, hindering both the effective communication of the intended care model and perceived benefits such as the provision of multidisciplinary team-based care.

Caring for Psychological Distress of Patients With COVID-19: A Mixed-Method Cross-Sectional Study

Introduction

The 2019-2020 pandemic COVID-19 has become a global health crisis. While many recent studies on COVID-19 pandemic have focused on disease epidemiology and psychological status of patients, few have explored the multi-facet influential factors or combined perspectives from both the patients and healthcare workers. The purposes of this study were to: analyze the influencing factors of psychological distress of COVID-19 patients; and describe the experience of healthcare workers relieving psychological distress.

Materials and Methods

This study uses a mixed-method cross-sectional design, including a quantitative study and a qualitative study, targeting two populations: COVID-19 patient and health workers, respectively. In the quantitative part, we recruited a convenience sample of patients with COVID-19 from five hospitals in Wuhan, Hubei Province from 10 to 15 April, 2020. Besides, we collected data by using participants' socio-demographic information sheet, the Connor-Davidson Resilience Scale-10, the Herth Hope Index, the Distress Thermometer, the Revised Chinese Version of Mishel Uncertainty in Illness Scale, and the Chinese Version of Wake Forest Physician Trust Scale. In the qualitative part, the participants were healthcare workers involved in medical aid missions in Hubei Province, China. Meanwhile, we used sampling with convenient and purposive, data collection with a semi-structured online video interview, and text transcription with Colaizzi's phenomenological method.

Results

The results reveal that 25.7% of patients reported higher level of psychological distress (n = 31, scoring ≥4). After controlling the sociodemographic variables, only severity of COVID-19 (β = 0.282, P = 0.025) and uncertainty in illness (β = 0.345, P = 0.007) shown significant effect on psychological distress in the regression model (F = 10.862, R 2 = 0.222, P < 0.001). The experience of healthcare workers emerged five themes: Particularly needed psychological care, Manifestation of negative emotion, Manifestation of proactive adaptation, Strategies relieving psychological distress, and gains of healthcare workers after delivering effective psychological care.

Conclusion

The 25.7% of patients with COVID-19 still suffered from psychological distress, which should receive timely attention from healthcare workers. And the severity of the disease and disease uncertainty have a significant impact on distress. It is critical to train the healthcare workers on detecting the different manifestation of psychological distress, offering timely disease related information, and applying communication strategies.

Insufficient Supply, Diagnostic Services, and Lack of Trained Personnel in Primary Hospitals in North-West Ethiopia Worsened Trauma Care: A Mixed-Method Study

OBJECTIVE

Although there has been a massive expansion of hospitals in Ethiopia in the last 2 decades, most are primary-level hospitals. Assessing the capability of the hospitals in managing trauma victims is essential to strengthening the hospitals.

METHODS

We employed a mixed-method approach using quantitative descriptive design triangulated with qualitative research. We audited 10 hospitals using WHO essential trauma care checklist. We interviewed 37 health care professionals, 9 hospital managers, and 12 decision-makers using a semi-structured interview guide. We used the COREQ checklist to report the qualitative finding.

RESULTS

The physical structures of the hospitals were good in all cases. Airway, breathing and circulation management were partially available, with a score ranging from 0 - 3. The extent of injury, lack of radiology service, and scarcity of drugs and supplies were common causes for the referral of trauma victims to Gondar University hospital.

CONCLUSION AND RECOMMENDATION

Unavailability of drugs and supplies, lack of diagnostic services, inability to recruit specialist professionals, lack of training, and inconvenient working and living environment were stated as the main barriers to providing trauma care. In the study area, the gaps in trauma care in the primary hospitals can be improved by further commitment of the hospitals, the district, zonal administrators, and the regional health bureau.

Women's Experiences of Physical Features in a Specially Designed Birthing Room: A Mixed-Methods Study in Sweden

Aim:

To explore women’s experiences of physical features in a birthing room designed to be adaptable to personal wishes and needs during labor and birth.

Background:

Childbirth is a central life event influenced by numerous factors, including the healthcare environment; however, there is insufficient knowledge on how the physical design affects women during birth.

Methods:

This study was part of a randomized controlled trial in the Room4Birth research project, including women randomized to receive care in a new birthing room designed with physical features changeable according to personal wishes. Data consisted of responses to two questions analyzed with descriptive statistics (n = 202) and semi-structured interviews analyzed for content (n = 19).

Results:

A total of 93.6% (n = 189) assessed the physical features in the birthing room as meaningful to a very high or high extent. The overall impression of the room was positive and exceeded women’s expectations. They felt welcomed and strengthened by the room, which shifted the focus to a more positive emotional state. The room differed from traditional hospital birthing rooms, contained familiar features that maintained integrity, and had space for companions. The variety of physical features was appreciated. Of nine listed physical features, the bathtub was ranked most important, followed by the projection of nature scenery, and dimmable lighting, but the room as a whole appeared most important.

Conclusions:

When planning and designing hospital-based birthing rooms, it is crucial to offer possibilities to adapt the room and physical features according to personal wishes.

Stand Together by Staying Apart: Extreme Online Service-Learning during the Pandemic

Service-Learning (SL) is an experience that allows students to (a) participate in activities co-designed in partnership by universities and local organizations and (b) reflect on the service activity in such a way as to gain an enhanced sense of responsibility. These experiences represent significant ways to meet and experience real-world contexts for students. The COVID-19 pandemic required Higher Education Institutions to rethink and shift in-presence courses to online platforms. This transition included SL courses as well. This study aimed to explore the responsibility and democratic dimensions elicited by an extreme online Service-Learning (XE-SL) experience and the perceptions of engaging in exclusive online service activities with local communities during the COVID-19 Italian national quarantine. A qualitative driven mixed-method longitudinal approach was chosen to triangulate qualitative (reflexive journal) and quantitative (pre-post questionnaire) data from 20 university students. The findings shed a positive light on the capability of XE-SL to promote a sense of responsibility, civic engagement, and the acquirement of democratic and transferrable competencies, such as perspective-taking, adaptability, cultural background respect, global mindedness, teamwork, leadership, communication, creativity, and organizational competencies. Reflection, connection, and being agents of change for the community were perceived as the major assets of the XE-SL experience, while adapting face-to-face SL experiences to exclusively online activities evoked ambivalent feelings in students. The study suggests a rethinking of the design XE-SL and other forms of eSL with the inclusion of more structured interactive activities within community contexts to favor students’ sense of connection to the community organizations or NGOs.

The Economic Burden and Determinant Factors of Parents/Caregivers of Children with Cerebral Palsy in Malaysia: A Mixed Methods Study

The economic burden is a major concern for parents/caregivers of children with cerebral palsy (CP). This study used the sequential explanatory mixed-method approach to explorethe economic burden on parents/caregivers with a CP child in Malaysia and the factors associated with the economic burden. The study period spanned April 2020 and December 2020. A total of 106 questionnaire respondents were selected for the quantitative part, and 15 were interviewed to obtain qualitative input. A retrospective costing analysis was conducted based on the cost data obtained from the questionnaire. The majority of the children were GrossMotor Function Classification System (GMFCS) Level 5 (71%), quadriplegic (63%), and aged >4 years (90%). The estimated annual median total economic burden on the parents/caregivers per child in 2020 was RM52,540.00 (~USD12,515.03), with indirect cost being the greatest cost (RM28,800.00, ~USD6860.16), followed by developmental cost (RM16,200.00, ~USD3858.84), direct healthcare cost (RM4540.00, ~USD1081.43) and direct non-healthcare cost (RM3000.00, ~USD714.60). The annual household income was identified as a significant determinant factor (p=0.019, 95% CI: 0.04, 0.40) of the economic burden. The participants’ responses during the in-depth interview in the qualitative part of the study supported the premise that socioeconomic factors play a substantial role in determining the total economic burden. Our findings may aid local policymakers when planning the greater provision of support to the affected families in the future, especially for the parents/caregivers of children with CP, who are facing socioeconomic challenges.

A Community Health Volunteer Involvement Program for Glycated Hemoglobin Reduction Among Thai Patients With Uncontrolled Type 2 Diabetes: A Mixed-Method Study

Background:

Diabetes mellitus is increasing and a shortage exists of nurses to care for patients. Community health volunteers (CHVs) pose potential supportive networks in assisting patients to perform healthy behaviors.

Aim:

The study aimed to develop and investigate the effects of a CHV involvement program on reducing glycated hemoglobin (HbA_1c) levels among Thai patients with uncontrolled type 2 diabetes.

Methods:

This sequential mixed-method study was conducted from January to June 2019. Sixty patients with HbA_1c exceeding 7% were recruited from 2 communities assigned as the intervention and comparison groups. Using King’s General Systems Framework as a basis to develop the program, the study initially explored the perceptions of diabetes and its management among patients, family members, and CHVs. Then, a quasi-experimental study with 2 groups pretest-posttest design was conducted and compared with usual care. The intervention included educational sessions, home visits, and activities created by CHVs including a campaign, broadcasting, and health food shops. Quantitative data were collected at baseline and 20-week follow-up and analyzed by descriptive statistics, Independent t-test, and paired t-test.

Results:

The intervention group exhibited a lower mean HbA_1c (p < .001) and reported significant, improvement concerning diabetes knowledge, self-efficacy, perceived support, and behavior compared with the comparison group at the end of the study (Cohen’s d > 1.0, effect size large).

Conclusion:

Applying this framework to develop the program could benefit glycemic control among patients with uncontrolled diabetes residing in communities. Further studies should be conducted on a large sample to demonstrate the efficacy of the program.

COVID-19 risk perception and tourist satisfaction: A mixed-method study of the roles of destination image and self-protection behavior

This study aimed to examine the effects of COVID-19 risk perception on negative destination image and self-protection behavior, and the resultant effects on tourist satisfaction. Hence, this study applied a continuous interpretive mixed-method design combining quantitative and qualitative analyses. A quantitative survey (n = 486) in the cities of Ningbo, Huangshan, and Chengdu, China, and 19 qualitative interviews were conducted online. The results of the quantitative study show that: (1) Risk perception and negative destination image are antecedent variables influencing tourist satisfaction, and (2) there are significant positive correlations between risk perception and negative destination image, risk perception and tourist self-protection behavior, and negative destination image and tourist self-protection behavior. Moreover, (3) negative destination image had a partial mediating effect between risk perception and satisfaction. Furthermore, to supplement the research data and expand the quantitative findings, this study further examined whether the above variables are related to tourist satisfaction, through in-depth interviews with tourists. The findings showed that COVID-19 risk perception, negative destination image, and self-protection behavior all affect tourist satisfaction. The findings provide valuable crisis management suggestions for the government and should contribute to the efforts of tourist destinations to build a healthy and safe image, thereby contributing to the sustainable development of tourism industries in the post-epidemic era.

Correlation Study of Antioxidant Activity with Phenolic and Flavonoid Compounds in 12 Indonesian Indigenous Herbs

The antioxidant activity (AA), total phenolic content (TPC), and total flavonoid content (TFC) of selected Indonesian Zingiberaceae herbs were determined. An optimization extraction procedure was conducted by using Taguchi L₁₆ orthogonal array. Four chemical assays were applied, including 2,2-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity assay, H₂O₂ scavenging activity assay, Folin-Ciocalteau (F-C) assay, and NaNO₂-AlCl₃-NaOH assay, which revealed remarkable differences in AA, TPC, and TFC. The result indicated the diversity of AA composition among the herbs, and C. longa exhibited the highest AA. HPLC-PAD analysis revealed that curcumin was present in five high antioxidant herbs, and the highest amount was in C. longa. Pearson correlation analysis indicated that the identified TPC and TFC were significant contributors to AA, and curcumin was likely the main contributing antioxidant compound. Our approach concluded that C. longa is the greatest source of natural antioxidants among 12 Indonesian indigenous Zingiberaceae herbs. The use of a mixed-method approach to augment the findings of solitary methods might facilitate future researchers to uncover deeper and hidden meanings.

Determinants of Treatment Adherence Among Patients Living With Noncommunicable Diseases: A Mixed-Method Study in a Rural Area of West Bengal

The multisectoral impact of the COVID-19 pandemic can impair treatment adherence of patients with noncommunicable diseases (NCDs). This mixed-method study, conducted from November 2020 to January 2021, assessed the quantum of their treatment adherence and its determinants in rural West Bengal. Quantitative data were collected from 213 NCD patients while qualitative exploration for barriers of treatment adherence was conducted as 6 in-depth Interviews. Treatment adherence was assessed by “Medication Compliance Questionnaire” and “Adherence to Healthy Lifestyle and Follow-up Advice” Questionnaire. A total of 39.4% were nonadherent to medications while 67.1% had nonadherence to healthy lifestyle and follow-up advice. Significant predictors associated with nonadherence were increasing age, female gender, lower socioeconomic status, decreasing patient empowerment, and decreasing trust in the medical profession. Economic crisis, fear of contagion, and nonavailability of investigation facilities were some new emerging barriers in addition to preexisting barriers of treatment adherence. Therefore, measures for improving patient empowerment and patient–provider relationship by motivation and counseling, taking proper care of vulnerable patients affected by the pandemic, and correcting deficiencies at the health-system level should be given utmost priority.

The Influence of Technology on Mental Well-Being of STEM Teachers at University Level: COVID-19 as a Stressor

Stress can result in psychopathologies, such as anxiety or depression, when this risk factor continues in time. One major stressor was the COVID-19 pandemic, which triggered considerable emotional distress and mental health issues among different workers, including teachers, with another stressor: technology and online education. A mixed-method approach is presented in this research, combining a cross-sectional study of university teachers from Ecuador and Spain with a medium of twenty years of working experience (N = 55) and a bibliometric analysis carried out in three databases (161 documents). The levels of anxiety and depression, and therefore the risk of developing them as mental disorders, were high. The lack of training (p < 0.01), time (p < 0.05), or research regarding the use of technology in education (p < 0.01) and stress caused by COVID-19 (p < 0.001) were linked to frequency. The most relevant observational study obtained through the bibliometric analysis (138 citations and over 65% of methodological quality) indicated that previous training and behavioral factors are key in the stress related to technology. The combination of the results indicated that mental health in STEM teachers at university is related to diverse factors, from training to the family and working balance.

Differential Effects of Ethical Education, Physical Hatha Yoga, and Mantra Meditation on Well-Being and Stress in Healthy Participants-An Experimental Single-Case Study

Traditionally, yoga is a multicomponent practice consisting of postures, breathing techniques, meditation, mantras, and ethics. To date, only a few studies have tried to dismantle the effects of each of these components and their combinations. To fill this gap, we examined the incremental effects of ethical education and physical Hatha yoga on mantra meditation using a single-case multiple-baseline design. This study was part of a project evaluating the new mind-body program Meditation-Based Lifestyle Modification. Fifty-seven healthy participants with no regular yoga or meditation practice were randomly assigned to three baselines (7, 14, and 21 days) and four conditions using a random number generator. The conditions were mantra meditation alone (MA), meditation plus physical yoga (MY), meditation plus ethical education (ME), and meditation plus yoga and ethical education (MYE). All the interventions lasted for 8 weeks and were run consecutively according to baseline length. During the baseline and treatment phases, participants received daily questionnaires measuring their well-being (WHO-5 Well-Being Index), stress (Perceived Stress Scale), and subjective experiences. Forty-two participants completed the treatment and were entered in the analyses. We analyzed our data using visual inspection, effect size estimation (Tau-U), and multilevel modeling. Almost all participants showed a longitudinal increase in well-being. Regarding between-group differences, participants who received ethical education exhibited the largest increases in well-being (Tau-U = 0.30/0.23 for ME/MYE), followed by participants in the MY condition (Tau-U = 0.12). Conversely, participants in the MA condition showed no change (Tau-U = 0.07). There was a tendency for the combined treatments to decrease stress. This tendency was strongest in the MY condition (Tau-U = -0.40) and reversed in the MA condition (Tau-U = 0.17). These results emphasize the incremental and differential effects of practicing meditation in combination with other practices from the eight-fold yoga path. This approach is valuable for better understanding the multifaceted practice of yoga. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04252976.

Mixed-method study of women's assessment and experience of childbirth care

AIM

To examine women's evaluations of quality of care from their perspectives.

BACKGROUND

Assessing women's satisfaction with the quality of care they receive during childbirth is an important component of care quality that should be analysed. Evidence suggests that childbirth experience has an important impact on women's health. Therefore, taking into account the perceptions of women about quality is a means to improve care. However, studies examining care quality in this setting remain scarce.

DESIGN

Mixed-methods explanatory sequential design.

METHODS

A national survey with a sample of 1082 participants, and 15 semi-structured interviews. Data collection occurred between January 2017 and January 2019. Quantitative data were obtained through a validated scale, the Quality from the Patient's Perspective-Intrapartal questionnaire, whose score can range from 1 (minimum satisfaction) to 4 (maximum satisfaction). Semi-structured interviews were conducted for qualitative data. Descriptive statistics, group comparison and qualitative content analysis were included in data analysis.

RESULTS

The mean score on the QPP-I tool was high (3.13; SD 0.74). Variables that had the most influence on the experience were type of birth, type of perineal trauma, admission of the baby, time since birth, home-birth, parity and duration of labour. Data from the qualitative interviews identified five themes that explained women's experiences with the quality of care. Previous expectations influence the emotions they have regarding the experience. Relationships with professionals and their social skills are fundamental for the evaluation of quality. The separation of the newborn appears as a factor that worsens the appreciation of women. Good pain management and continuity of care by specialists are also named as key elements of the quality of care.

CONCLUSION

Findings demonstrate that experience with childbirth care is of utmost importance for women. They also show the indisputable need to listen to their opinions and assessments when lines of improvement of quality are identified.

IMPACT

This study provides information that can improve the care that women receive during their childbirths. Using their opinions will make them feel an active part of the system and in this way, we will be closer to achieve excellence in our services.

Barriers and Associated Factors to the Use of Routine Health Information for Decision-Making Among Managers Working at Public Hospitals in North Shewa Zone of Oromia Regional State, Ethiopia: A Mixed-Method Study

BACKGROUND

Routine health information (RHI) systems are vital for the acquisition of data for health sector planning, monitoring, and evaluation, patient management, health education, resource allocation, disease prioritization, and decision-making. Use RHI for decision-making is low in Ethiopia. Thus, the study aimed to assess barriers and associated factors to the use of RHI among managers working at public hospitals in North Shewa, Ethiopia.

METHODS

A facility-based mixed-method study was conducted from May to June 2020. A total of 102 randomly selected managers were included in the survey and six key informant interviews were done. Data were collected using a structured self-administered questionnaire and interview guide by trained data collectors. Data were entered into Epi-info version 7.1 and transferred into SPSS version 23 for further statistical analysis. Both bivariate and multivariable logistic regression analyses were performed. In the multiple logistic regression analysis, a less than 0.05 P-value was considered statistically significant. The odds ratio along with a 95% confidence interval was estimated to measure the strength of the association. Thematic analysis was done for key informant interview data.

RESULTS

In this study, the level of RHI use for decision-making was 71.6% (95% CI: 61.8%, 79.4%). According to the multivariable logistic regression analysis, training on health information system (AOR = 0.28, 95% CI: 0.08-0.98) and supportive supervision (AOR = 0.27, 95% CI: 0.09-0.78) were found significantly associated with the use of RHI for decision-making. Moreover, the lack of staff motivation and computer and data analysis skills were the major reasons for not using RHI.

CONCLUSION

Three-fourth of the managers working at public hospitals used RHI for decision-making. Training on health information systems and supportive supervision were factors associated with the use of RHI. Therefore, training of managers and the provision of supportive supervision were highly recommended.

Working from Home: Is Our Housing Ready?

The COVID-19 pandemic and the precautionary measures applied globally (lockdowns and curfews) have impacted homes, including work. Working from home (WFH) has emerged as a growing trend in the post-pandemic era. The research question was: Are our homes ready for teleworking? To respond, a national prospective mixed approach was launched for Spanish households during the spring 2020 lockdown, using two online questionnaires, one quantitative and the other qualitative. Through a survey, photographs, and narratives, the study evaluates the perceived adequacy of telework spaces and their specific characteristics, the availability of digital resources and the internet. A total of 1800 surveys and over 200 images and texts related to telework environments were obtained. The results suggest that the adequacy of these spaces was insufficient for more than a quarter of the homes. Also, strong relations between the perceived workspace adequacy and a social status or stability of homes were shown and validated, despite other sociodemographic features, the home composition or habitat were not related. Some other variables statistically significant were occupation regime, type and surface of dwellings; their indoor environmental quality; the availability of exclusive spaces for teleworking; quality of digital resources; and the specific space features. The analysis was completed with qualitative insights through photos and texts. Telework, lived in this context as an experiment, needs this reflection from an environmental, resource-availability, and ergonomic point of view.

Habitability, Resilience, and Satisfaction in Mexican Homes to COVID-19 Pandemic

Following the 2020 confinement due to the COVID-19 pandemic, housing has become the only safe place and this has exposed inequity in habitability. This research on the reality of confined households and the perception of their homes in the Mexican republic is based on a mixed participatory study, combining quantitative and qualitative approaches. The online questionnaire consisted of 58 questions in the quantitative approximation. The qualitative part required the provision of an image of the workspace, with testimonies and personal reflections. During the lockdown, all participants saw an increase in overall energy consumption; more than half reported not being in thermal comfort; and a third declared deficiencies in noise insulation. Regarding the perception of the telework/tele-study space, we found the following categories: bedrooms, living/dining rooms, studies and others. In addition, respondents had often adapted the workspace for both individual and shared use. In general, the households were satisfied with the size of their houses but would like landscaped spaces or better views outside. Confinement made housing the protective element against the pandemic. The consequences will have an effect globally, so new architectural design paradigms need to be rethought.

Digital Consultations During COVID-19: A Multiperspective Mixed-Methods Study in an Integrative Medicine Setting in Switzerland

Objective: We evaluated digital consultations at a University Hospital in Switzerland within an integrative medicine outpatient setting. Patients' and treatment providers' (physicians and therapists) evaluated digital conversation-based consultations as well as the digital delivery of practical exercises. Methods: Digital consultations between March 15, 2020 and April 30, 2020 were identified. Between June and July 2020, patients and treatment providers completed online questionnaires addressing challenges and advantages of their digital consultations. Both groups documented their satisfaction and working alliance (Working Alliance Inventory). In addition, semistructured qualitative interviews with treatment providers were conducted. Findings: A total of 82 online surveys (response rate 47%) about the digital consultations were available for analyses, with 60 patients correctly identifying at least one treatment provider, and 9 interviews were performed. Patients and treatment providers overall evaluated the new setting of digital consultation as feasible and an efficient consultation format. Interestingly, the working alliance was rated as good. Technical problems were mentioned as the main challenge and the delivery of practical exercises in digital consultations was seen more challenging than having digital conversation-based consultations. Conclusion: Digital consultations were established with overall positive evaluations and with a good working alliance between patients and providers. For the delivery of practical exercises it might be required to develop more innovative digital settings to overcome shortcomings of the digital format. Hybrid settings that combine the best of both settings could be a good option for future in postpandemic times.

Age differences in cancer-related stress, spontaneous emotion regulation, and emotional distress

OBJECTIVES

Cancer risk increases with age, cancer-related stress is common and devastating to mental health of patients, yet little work has explored age differences in cancer-related stress. This study investigated sources of stress related to cancer diagnosis and treatment and its association with age and emotional health. Though not an a priori aim of the study, adaptive strategies mentioned within discussions of stress-which we classify as spontaneous emotion regulation (ER) - were also investigated.

METHOD

Participants (N = 147, aged 27-88) recruited from the VA (98% male) with oral-digestive cancers participated in semi-structured interviews regarding sources of stress 6-months post-diagnosis (T1) and treatment-related stress at 12-months post-diagnosis (T2). Patients also reported their emotional distress at T2 via the PROMIS-29. Inductive content analysis was used to classify sources of stress and ER into semantic themes and relative frequencies.

RESULTS

The greatest source of stress at diagnosis was psychological; physical symptoms were the greatest source of stress at treatment. Older adults less frequently reported psychological uncertainty, social stress, and situational stress, whereas age groups reported similar rates of physical stress. When describing stress, older adults more often made spontaneous references to emotion regulation (ER). Across age groups, those who reported stress without ER in qualitative comments had higher emotional distress on the PROMIS-29 than those reporting stress with ER or no stress.

CONCLUSION

ER may be key to psychological adjustment to cancer, especially in later-life. implications for assessment of stress at pivotal visits and mental health referral are discussed.

A limited life - a mixed methods study on living with persistent pregnancy-related lumbopelvic pain more than 12 years postpartum in Sweden

PURPOSE

The scope of this study is women's descriptions of symptoms experienced through persistent pregnancy-related lumbopelvic pain (PPLP) as well as their strategies to cope with the condition.

METHODS

This is a mixed-method study based on questionnaire responses and inductive interviews with 12 Swedish women with self-reported PLP during pregnancy 2002 partaking in a 12-year postpartum follow-up questionnaire cohort. Test of statistical differences between the interview cohort and the total cohort was performed and the interviews were analysed through inductive qualitative content analysis.

RESULTS

The questionnaire data showed that the interview sample reported significantly more pain than the questionnaire respondents but resembled the questionnaire respondents on most other characteristics. The theme "Balancing avoidance and activity" and its sub-themes illustrate the strategies the participants used to manage their situation on a daily basis. The pain was a constant reminder that led to evaluation of pros and cons for physical, social, and mental activities as well as the search for therapies and treatments.

CONCLUSIONS

For the women who participated in the interviews, living with persistent pregnancy-related lumbopelvic pain caused limitations and negatively affected various and major parts of life to a far greater extent than previously known.Implications for rehabilitationPersisting pregnancy-related lumbopelvic pain affects various and major parts of life, including working, physical and social activities, and psychological well-being.Rehabilitation should focus on individualized physical activities and effective coping strategies.Effort should be put into helping the patient find fulfilling explanatory reasons for the persisting pregnancy-related lumbopelvic pain.

A Mixed-Method Analysis on the Impacts of a System-Driven Implementation of Multiple Child Evidence-Based Practices on Community Mental Health Providers

Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists.

A Multidisciplinary Exploratory Approach for Investigating the Experience of Older Adults Attending Hospital Services

BACKGROUND

The public areas of the hospital built environment have hardly been investigated for their age-friendliness.

OBJECTIVE

This exploratory, multidisciplinary pilot study investigates the relationship between the physical environment and design of hospital spaces and older people's outpatient experience.

METHODS

Sixteen participants were recruited from a geriatric Outpatient Clinic at a metropolitan public hospital in Australia. Participants were engaged in a concurrent mixed-method approach, comprising a comprehensive geriatric survey, walking observation, semi-structured interview and an independent architectural audit.

RESULTS

Several elements arising from the hospital environment were identified as facilitators and barriers for its utilization and intrinsically related to participants' physical capacity.

DISCUSSION

Age-friendly hospital design needs to consider strategies to remove barriers for older adults of different capacities, thus promoting healthy aging.

Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach

BACKGROUND

Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention's effectiveness, yet how it can be described remains unclear.

AIM

To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT.

DESIGN

Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim.

SETTING/PARTICIPANTS

Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients' notes from each ward who died during admission or within 100 days of discharge.

RESULTS

Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites.

CONCLUSIONS

We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.

International medical students' adaptation to university life in Turkey

OBJECTIVES

The aim of this study is to determine the adaptation process of international medical school students to university life in Turkey.

METHODS

The mixed method design study, including all the international students (n=127) studying at Ege University School of Medicine, is employed. Qualitative data were collected from 23 students selected by purposive sampling technique. Two instruments were utilized for collecting data: Student Adaptation to College Questionnaire (SACQ) and Brief COPE. Focus group interviews were performed for qualitative data collection.

RESULTS

The mean SACQ score of the medical students was found to be 407.44 (SD=68.29). The Academic Adjustment category included the themes of educational goals, different studying habits, accommodation, academic advisor, and scholarship. The Social Adjustment category included the themes of social interaction and support, differences, longing for family, discrimination and its effects on social life. The Personal/Emotional adjustment category included themes of psychological and physiological health problems. The Goal Commitment/Institutional Attachment category included themes of academic and social adaptation as well as the student' communication with education management.

CONCLUSIONS

This study identifies to light critical issues in supporting international students with adaptation problems to university life in Turkey. It is clear that revising the content of education programs to enable international exchange is not sufficient enough by itself to meet the needs of international students.

Self-care status in children with congenital heart disease: A mixed-method study

BACKGROUND

Suffering congenital heart disease leads to physical and mental disabilities in children. Children's self-care can result in appropriate care behaviors for limiting disease-induced problems. Given the ability of children to care for themselves, we investigated self-care statues in children who are suffering from congenital heart disease.

METHOD

This study was conducted using a mixed-method approach and a sequential explanatory design. A cross-sectional study was conducted to assess self-care status in 124 CHD children who were living in Kerman, Iran. In the qualitative phase, the researchers interviewed 13 of these children and three parents using semi-structured in-depth and face-to-face approaches.

RESULTS

The mean of self-care scores in these school-age children was optimal (10/7 ± 2/6). In the qualitative phase, three main themes were extracted: captive to health issues physical and mental sufferings and wishing for peace of mind.

CONCLUSION

The results showed that self-care status in these children was optimal. As the main pillar of patient education, nurses can help enhance self-care behaviors and reduce the complications and problems induced by the disease by implementing educational and support interventions for children with CHD and their families.

Experiences of a Recovery-Oriented Caring Approach to Suicidal Behavior: A Single-Case Study

Research considering the basis for mental health nurses wanting to enable recovery among people who suffer from suicidal behavior is sparse. The aim of this study is to explore and evaluate how a new recovery-oriented caring approach (ROCA) was experienced by a suicidal patient in a context of close relatives and nurses. A single-case study with a qual-quan mixed-method design was chosen. Participants were recruited from a psychiatric clinic in Sweden and consisted of one patient, one close relative to the patient, and three nurses. The results reveal that the ROCA enabled the patient to narrate, bear experiences of hopelessness, and ask for support, rather than view suicide as the only possible solution. ROCA has the potential to support patients, relatives, and nurses to develop a common language, considering the patient's life situation and struggles and to use this as a source for the patient's individual care planning.

Coverage of mass drug administration for elimination of lymphatic filariasis in urban Nagpur, Central India: A mixed method study

BACKGROUND AND AIMS

Mass Drug Administration (MDA) coverage remains an important indicator in elimination of Lymphatic Filariasis (LF), especially in context of recent changes in programme strategies in India, such as incorporation of Ivermectin and involvement of urban Accredited Social Health Activists (ASHAs). This study aimed at assessing the coverage and compliance with MDA of Filariasis as well as exploring perspective of beneficiaries for non-consumption in selected slum area of Nagpur city.

METHODS

Mixed-method study design comprising of quantitative assessment of MDA coverage, followed by qualitative method to explore the reasons of non-compliance was used in selected slum areas of Nagpur city. Using cluster sampling, 240 households were selected and house-to-house visits were made to interview the eligible participants. In-depth interviews were conducted among selected non-compliant participants.

STATISTICAL ANALYSIS

Multivariable logistic regression analysis to identify the factors associated with non-consumption. Thematic analysis was done to obtain the reasons of non-consumption as perceived by the beneficiaries.

RESULTS

Among the 1096 individuals studied, distribution and consumption coverage were 55.2% and 48.5%, respectively. Effective supervised consumption was further low (28.9%). Coverage compliance gap (CCG) was 12.1%. Male sex and younger age (2-5 years) were significant socio-demographic determinants of non-consumption. No repeat visit to houses left in first round, fear of side effects, pill burden, poor understanding about the need were important reasons as revealed by qualitative inquiry.

CONCLUSION

Effective pre-campaign awareness, incorporation of context specific drug delivery strategies and strengthening monitoring system are essential for successful MDA implementation.

Evaluating the Representation and Responsiveness of the United Nations Commission on the Status of Women (CSW) to Diverse Women Populations Worldwide

The United Nations Commission on the Status of Women (CSW) is "the principal global intergovernmental body exclusively dedicated to the promotion of gender equality and the empowerment of women." The continued success of the CSW's mission is critical. Under the guise of needing competent male leaders to protect them, women and girls in many countries nonetheless suffer dire consequences from international conflict and war. While females may send mostly male loved ones into armed conflict, women and girls themselves face economic sanctions, poverty, displacement, and heightened risk of sexual violence, in an environment that already fails to respect their equal human rights with men. It is no accident that in most countries, females are de facto excluded from positions of power where they could try to prevent such conflict (Enloe, 2014), and the CSW is actively working to overcome this reality. In this article, we use a mixed-method approach to evaluate the level of United Nations Commission on the Status of Women (CSW) representation and responsiveness to diverse women populations as reflected in (a) state delegations' participation in formal session, (b) NGO participation, and (c) NGO priorities. We find that the CSW displays a high level of representation and responsiveness to diverse state delegations across UN regions in terms of their speaking time in formal session. The CSW is at best moderately representative of women's NGOs through regional advance consultations, and the level of responsiveness to women's NGOs is low. This is due to: costly barriers to entry to gain ECOSOC status, large underrepresentation of some UN Regions, and the fact that during formal session, women's NGOs participate primarily at parallel off-site events. Although the CSW passed important resolutions, its representation and responsiveness to women's NGO priorities is lower than it should be. We base our evaluation by comparing our surveys of attending and non-attending women's NGOs that showed top priorities that the 2010 CSW did not discuss or pass resolutions on such as: land rights, sex trafficking, internet access for women, and the effects of climate change on women. We contend that during 1970-1994, when World Conferences on Women occurred, parallel transnational advance consultations among women's NGOs in tandem with CSW regional consultations created a broadening of the CSW's agenda. The CSW rationally anticipated different kinds of feminism beyond liberal feminism and a broader set of priority issues for diverse women populations. We therefore argue for a Fifth World Conference on Women to increase the representativeness and responsiveness of the CSW.