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IntroductionSocietal perceptions and lack of understanding of autism spectrum disorder can be stigmatizing for autistic individuals and their families. This may be particularly the case for individuals who meet criteria for profound autism. Despite the considerable service needs of this marginalized group, there is little data on the prevalence of profound autism, nor on the experiences of those with profound autism and their families.MethodsThe current study leveraged a mixed-methods approach to address these gaps. First, the prevalence of profound autism was examined in six samples-three from the United States and three from Western Europe. Second, inductive thematic analysis was used to code interviews from 20 caregivers of profoundly autistic adults.ResultsThe prevalence of profound autism varied widely across the six samples-from 11% to 48%. There were also notable differences between samples in prevalence by gender, race, and ethnicity. Two overarching themes were identified via inductive thematic analysis: Community Perceptions of Autism and Family Support Needs and Advocacy Challenges. Though caregivers were not directly asked about stigmatization during interviews, 85% of caregivers reported at least one instance of perceived stigma.DiscussionFuture research should continue to examine the unique needs and stigmatization experiences of profoundly autistic individuals and their families across the life course.

Background: In Senegalese high-burden regions, the existing package of interventions is insufficient to reach the malaria elimination goal. Asymptomatic carriers of Plasmodium contribute significantly to malaria persistence and are not targeted by current interventions. The systematic treatment of all individuals in a community (mass drug administration, MDA) is a relevant intervention to tackle asymptomatic infections. The intervention can only be effective with a high participation of the population and, therefore, depends largely on its acceptability. This study aims to investigate the prospective acceptability of MDA in the Kedougou region to inform its potential use in a future strategy. Methods: Following a 7-construct theoretical framework, prospective acceptability of MDA implemented in the rainy season was studied. In four villages, a sequential mixed design, from qualitative to quantitative, was used. In November 2021, interviews with healthcare professionals and focus groups with villagers were conducted. Findings from thematic analysis informed the development of a questionnaire administered to individuals aged ≥ 15 years in March 2022. Based on the questionnaire, an acceptability score was constructed and associations with socio-demographic factors were investigated using a linear mixed model. Results: The 7 interviews, the 12 focus groups, and the questionnaire administered to 289 individuals demonstrated a good acceptability of MDA. Two potential barriers were identified: the contradiction of taking a medication without feeling sick and the occurrence of side effects; and four facilitators: the perception of malaria as a burden, a good understanding of MDA, a good perceived effectiveness, and the resulting economic benefits. The average acceptability score was 3.5 (range from -7 to + 7). Young adults aged 15 to 21 had a lower acceptability score compared to the other age groups, indicating an additional barrier to acceptability (β = -0.78 [-1.67;0.1]). Conclusion: MDA is a priori acceptable to communities of Kedougou region in Senegal. Sensitization campaigns co-constructed with the communities, especially targeting young adults, are essential to ensure good acceptability. [ABSTRACT FROM AUTHOR]

Growing concerns for loneliness, social isolation, and the health of young adults point to the importance of the dating context. This study aimed to identify and examine quality dating experience (QDE) and poor dating experience (PDE) relative to the well-being of religious college students identified as members of the Church of Jesus Christ of Latter-day Saints, including gender differences. Focus group (n = 58) and online survey (n = 515) participants came from introductory psychology courses at a large religious institution. A mixed-methods design was used to qualitatively identify quality and poor dating themes and then, using these themes, examine the dating experience using quantitative data from an online survey questionnaire. Focus group thematic analyses revealed patterns of gender similarity (e.g., compatibility, safety concerns, hyper-focus on marriage) and disparity (e.g., monetary value, date activity details) for both QDE and poor dating experience (PDE). Quantitative survey results highlighted substantial relationships between QDE, PDE, and wellness variables including mood, life satisfaction, depressive symptoms, anxiety, stress, loneliness, physical health symptoms, and perceived peer support. Interestingly, men had statistically stronger (p < .05) relationships between PDE and 3 health variables: depressive symptoms, peer support, and interpersonal conflict. This suggests that men may have more adverse health profiles than women when undergoing PDEs in a more traditional religious context. Results supported QDE and PDE as influential variables that go beyond the simple metric of dating frequency to capture a more comprehensive perspective of health among religious college students, including gender differences. [ABSTRACT FROM AUTHOR]

Internships are widely promoted high-impact practices that can have positive impacts on students' academic and post-graduate success, yet how specific features facilitate these outcomes is understudied. Instead, internships are often studied in terms of mere participation, without recognizing that these experiences are complex pedagogic spaces shaped by professional cultures and decisions about instructional design. In this sequential mixed-methods study we use sociocultural learning theory to interpret data from online surveys (n = 435) and focus groups (n = 52) with students at five institutions. Stepwise linear regression analyses of demographic and programmatic variables associated with intern satisfaction, developmental value, and career adaptability indicated that first-generation status, sex, race and income level, and supervisor behaviors were significantly associated with satisfaction and development. Analyses of qualitative data revealed that features of positive (clear communication, availability, feedback) and negative (unavailability, inattention to learning) supervision impacted student experiences. These findings reveal that internships should be designed with careful attention to task scaffolding, student autonomy and supervisor assistance, depending on the professional context and situation. These results highlight the need for colleges and employers to design internships as mentored and culturally shaped learning spaces, provide supervisor training, and consider the cultural backgrounds of students when matching them to internships. [ABSTRACT FROM AUTHOR]

By utilizing a mixed-method approach that combines a quantitative analysis of 10,183 retrieved records of non-uploaded cases, and a qualitative in-depth interview of ten judges and five judge assistants, the current study investigated the pattern of selective uploading, and explored the possible reasons for non-disclosure. We found that the estimated upload rate based on the number of the uploaded and the non-uploaded cases for criminal cases is higher than that reported by previous studies. In addition, there are considerable variations across the type of crimes, the location of courts, and the year of adjudication regarding the patterns of non-disclosure. The in-depth interviews revealed that there are four common scenarios where a case can be assigned to the "Other" group for the reason of non-disclosure: (1) circumstances involving unconcluded cases; (2) cases containing sensitive information that can be used for illegal purposes; (3) cases that involve specially granted circumstances that lead to a mitigated punishment; or (4) simple technical difficulty. [ABSTRACT FROM AUTHOR]

This paper describes the development and validation of the multidimensional Teacher Well-being Inventory underlined by a rational-empirical approach using teacher samples from China. A 20-item multidimensional instrument on teacher well-being was established with good psychometric characteristics. The results yielded five dimensions, which comprises of physical, emotional/psychological, cognitive, social, and spiritual well-being. This concise measurement targets assessing the most salient well-being scenarios of teachers at work. This validated measurement can serve as a more robust gauge for promoting well-being literacy and functioning of individual teachers, students and schools in response to the OECD 2030 agenda of building the wellness society. [ABSTRACT FROM AUTHOR]

Many older adults are increasingly embracing digital technology in the Republic of Korea. This study investigated the relationship between the digital skills of Korean older adults and their perceived health status and digital technology application for health promotion. This mixed-method study comprised a community survey of 434 older adults aged ≥65 in two cities in South Korea, followed by focus group interviews. Five types of digital skills, 'operational internet skills', 'information navigation skills', 'social skills', 'creative skills', and 'mobile skills', were measured using the LSE digital skill measurement instrument. Multivariable analysis identified the influence of digital skills on health-related outcomes. Among them, 'social skills' associated positively with self-rated health (β 0.37, 95%CI 0.08, 0.65). 'Information navigation skills' contributed positively to the use of digital technology and the internet for a healthy lifestyle in terms of improving eating habits (β 0.43, 95%CI 0.09, 0.77), accessing healthcare (β 0.53, 95%CI 0.21, 0.85), and accessing long-term care services (β 0.45, 95%CI 0.11, 0.79). Thematic analysis revealed that the study participants use Korean language-based resources such as Naver and Kakao Talk for social connection to promote a healthy lifestyle. This study concludes that encouraging initial and sustained use of the internet and enhancing digital skills among Korean older adults can promote active and healthy aging. [ABSTRACT FROM AUTHOR]

Background: Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. Objective: The study aimed to assess clients' satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. Methods: A convergent parallel mixed methods design was conducted in Debre Markos town's public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). Result: The quantitative wing revealed that overall, 65% (95% CI: 60–69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23–11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32–17.31, p-value = 0.017), clients' knowledge (AOR: 0.26, 95% CI: 0.12–0.59, p-value = 0.001), and clients' attitude (AOR: 6.43, 95% CI: 3.43–12.03, p-value = 0.000) were significantly associated with CSCCSS. Qualitative result: The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers' skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). Conclusion: According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening. [ABSTRACT FROM AUTHOR]

With increasing diversity of consumers in the marketplace, marketers have begun to embrace inclusive marketing practices. However, there is still a lack of research on the topic, making it difficult for managers to understand how to design and execute effective campaigns. This study aims to fill this gap by identifying the key factors that contribute toward an impactful inclusive marketing campaign. The study used a sequential mixed-methods approach and first conducted interviews with 29 LGBTQIA+ and non-LGBTQ consumers to gain insights into their perceptions of effective inclusive campaigns. In the study's second phase, ten industry experts provided inputs for the Fuzzy DEMATEL method to identify critical factors for an effective campaign. The findings revealed seven essential factors: social acceptance of the community, use of community-specific symbols, authentic communication about community issues, top management's approach, inclusive hiring practices, brand history, and legal market structure, which were then grouped into social, communication-related, brand-related, organization-specific, and other macro-level categories. The study fills an important gap in the inclusive marketing literature and can serve as a practical guide for marketers to design and implement inclusive campaigns. [ABSTRACT FROM AUTHOR]

Purpose: Digital lean implementation can solve the dual problem of stagnating quality and rising costs in healthcare. Although technology adoption in healthcare has increased in the post-COVID world, value unlocking using technology needs a well-thought-out approach to achieve success. This paper provides a prescriptive framework for successfully implementing digital lean in healthcare. Design/methodology/approach: This study uses a mixed-method approach to achieve three research objectives. Whilst it uses a narrative review to identify the enablers, it uses qualitative thematic analysis techniques to categorise them into factors. The study utilises the delphi method for the thematic grouping of the enablers in the broader groups. The study used an advanced ordinal priority approach (OPA) to prioritise these factors. Finally, the study uses concordance analysis to assess the reliability of group decision-making. Findings: The study found that 20 identified enablers are rooted in practice factors, followed by human resource management (HRM) factors, customer factors, leadership factors and technology factors. These results further counter the myth that technology holds the utmost significance in implementing digital lean in healthcare and found the equal importance of factors related to people, customers, leadership and best practices such as benchmarking, continuous improvement and change management. Originality/value: The study is the first of its kind, providing the prescriptive framework for implementing digital lean in healthcare. The findings are useful for healthcare professionals and health policymakers. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has posed significant challenges to nations worldwide, affecting various sectors of society. Women's HIV harm reduction centers, which provide critical services, have also been affected by these difficulties. This study aimed to examine the challenges of the COVID-19 pandemic on the services offered by women's HIV harm reduction centers from the perspective of clients. Methods: A convergent mixed-method design was utilized to gain in-depth insights into the challenges of COVID-19 on the services provided by women's HIV harm reduction centers, counseling centers, and night shelters that cater to women at risk, such as drug users, sex workers, and the homeless population, in three provinces (Tehran, Khuzestan, and Kermanshah) in Iran. The study was conducted from January to May 2023. The quantitative aspect of the study employed a cross-sectional method with a sample size of 430 individuals. A researcher-developed questionnaire was used to assess a range of services. The qualitative part of the study involved traditional content analysis and included 32 individual interviews. The integration of qualitative and quantitative results was performed during the interpretation phase to provide a comprehensive understanding of the challenges of COVID-19 on women's HIV harm reduction centers. Results: In the quantitative phase, the mean age of women was 39.0 ± 10.2 years. 165 women reported a history of COVID-19, which accounts for 38.4% of the total. More than half of them (n = 102, 61.8%) recovering at home. The majority of women (n = 365, 84.9%) mentioned receiving the COVID-19 vaccine. COVID-19 diagnostic tests were conducted for 74.2% (n = 319) of women. Women expressed higher satisfaction with the services (HIV prevention services, and accommodation services) before the COVID-19 pandemic compared to the satisfaction during the pandemic. The qualitative analysis identified emerging challenges related to the COVID-19 pandemic in two categories: personal challenges and mismanagement of services, comprising nineteen subcategories. Conclusion: The findings of this study highlight the adverse impact of the COVID-19 pandemic on the services provided by women's HIV harm reduction centers, in contrast to the pre-pandemic period. To mitigate these negative effects, it is crucial to implement preventive measures and practical solutions. This may involve addressing the personal and management challenges of the centers. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic posed significant challenges for managers overseeing women's harm reduction centers. This study seeks to capture managers' perspectives on the service providing in women's harm reduction centers during the COVID-19 pandemic. Methods: This convergent mixed-method study conducted in three provinces of Iran: Tehran, Khuzestan, and Kermanshah. The study was carried out between January and May 2023. In the quantitative part, the researchers utilized reports from 10 center managers. A researcher-designed questionnaire was employed to collect data on a wide range of services and referrals provided by the centers. The qualitative part of the research involved conventional content analysis and included 12 individual interviews. Two directors from the Ministry of Health and ten managers of women's harm reduction centers participated in the interviews. During the interpretation phase, the researchers compared the quantitative and qualitative findings to obtain a comprehensive understanding of the topic. Results: During the quantitative stage of the study, it was observed that all the managers were women, with an average age of 40.7 ± 7 years. More than half of the managers had obtained a postgraduate education (n = 6, 60%), and a majority of them were married (n = 7, 70%). Additionally, 40% of the managers (n = 4) were working as contractors. During the non-COVID-19 period, there were higher coverage by centers and residents, more referrals of non-injecting drug users and sex workers, and a higher number of group counseling sessions in all three provinces compared to the COVID-19 period. The qualitative analysis revealed two primary themes: "challenges" and "capabilities." Conclusions: During the COVID-19 pandemic, providing some services and client referrals decreased in the centers, and center managers faced increased challenges. Many of these challenges were in the communication, executive, management, structure, education, financial, civilization, facilities, and socio-cultural sectors. Managers used their skills to manage and control these challenges. It is important to focus on these challenges and managerial capabilities to effectively handle future crises. [ABSTRACT FROM AUTHOR]

Background: Electronic portfolios (e-portfolios) are valuable tools to scaffold workplace learning. Feedback is an essential element of the learning process, but it often lacks quality when incorporated in ePortfolios, while research on how to incorporate feedback into an ePortfolio design is scarce. Objectives: To compare the ease of use, usefulness and attitude among three feedback formats integrated in an ePortfolio: open-text feedback, structured-text feedback and speech-to-text feedback. Methods: In a mixed method designed experiment, we tested with 85 participants from different healthcare disciplines, three feedback formats in an ePortfolio prototype. Participants provided feedback on students' behaviour after observing video-recorded simulation scenarios. After this, participants completed a questionnaire derived from the Technology Acceptance Model (TAM). The experiment ended with a semi-structured interview. Results: Structured-text feedback received highest scores on perceived ease of use, usefulness, and attitude. This type of feedback was preferred above open-text feedback (currently the standard), and speech-to-text feedback. However, qualitative research results indicated that speech-to-text feedback is potentially valuable for feedback input on-premise. Respondents would use it to record short feedback immediately after an incident as a reminder for more expanded written feedback later or to record oral feedback to a student. Implications: Structured-text feedback was recommended over open-text feedback. The quality of the speech-to-text technology used in this experiment, was insufficient to use in a professional ePortfolio but holds the potential to improve the feedback process and should be considered when designing new versions of ePortfolios for healthcare education. [ABSTRACT FROM AUTHOR]

This study aims to identify the influence of Generation X and Generation Y on green buying behavior in the Indian context. Based on social cognitive theory and the generational cohort theory, the authors test the impact of Perceived Environmental Responsibility and Social Media Information Sharing on the relationship between Generation X and Y cohorts and their green buying behavior. This study uses the Quan-Qual approach to triangulate the results. A structured questionnaire was used to collect data from 427 respondents, and the hypotheses were tested with covariance-based structural equation modeling using AMOS software (AMOS 26 software). To probe further into the findings, in-depth interviews were conducted with 60 respondents from Gen X and Gen Y cohort groups, and the data were analyzed using NVIVO software. The findings reveal that the Gen X cohort seems to engage more in green buying behavior compared to the Gen Y cohort. Also, Social Media Information Sharing mediates the green buying behavior for Gen X and moderates it for Gen Y. Moreover, the qualitative inquiry confirms that the Perceived Environmental Responsibility of both Gen X and Gen Y cohorts does not significantly impact their green buying behavior. [ABSTRACT FROM AUTHOR]

Background: We implemented a contextualized innovative mentorship program in the Clinical Master in Family Medicine (CMFM) program established in April 2020 at Arabian Gulf University. In this paper, we describe the process of this program and derive the major challenges faced by trainees and related corrective actions and their outcomes on high-risk trainees for optimal performance. Methods: We conducted a mixed-method longitudinal study of 80 trainees, analyzing information extracted from the Moodle learning platform about five key performance indicators as well as the contents (quantitative and qualitative) of mentoring meeting reports submitted through a validated online form between 2020 and 2022. We analyzed frequencies and themes of challenges and compared trainees' performance according to time and level of risk. Results: The follow-up of all 80 trainees in two cohorts (40 for each cohort) shows that most are female (93.75%) and the mean age is 30.00 ± 2.19 years with a ratio of mentors to mentees of 1 to 5. Meetings are conducted through phone calls, virtually, and face-to-face in 62%, 29%, and 8.3% respectively. The mean number and duration of meetings are 30.88 ± 2.31 and 20.08 ± 9.50 min respectively. Time management is the most reported challenge (41.3%), followed by health, social, and psychological-related issues in 7.6%, 4.6%, and 3% respectively. We extracted four main themes related to trainees, settings of training, e-Portfolio, and the COVID-19 pandemic. The mentorship program captured 12 trainees at high risk for low academic progress (12%) of whom six graduated on time and the remaining had to repeat a few courses the following terms. The performance of the program is stable over time (mean GPA of 3.30 (SE = 0.03), versus 3.34 (SE = 0.05) for cohorts 1 and 2 in the two years respectively, (P = 0.33). However, it is slightly lower among high-risk trainees compared to the remaining (GPA = 3.35 (SE = 0.03) versus 3.14 (SE = 0.08), P = 0.043) though above the minimum of the threshold of 3 out of 4, required for the master's degree. Conclusion: The mentorship program captured the struggling trainees and permitted to implement pertinent corrective actions timely, particularly in the context of a two-year intensive CMFM program during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

While some food, agricultural, natural resources, and human science (FANRHS) experts participate in a variety of outreach opportunities, many face barriers to public interaction such as lack of incentive, knowledge, or confidence. This study examined scientists' and Extensionists' outreach experiences as guests on science podcasts. Results showed the guests had minimal formal science communication training yet were highly educated individuals and involved with informal education. Future research should examine how peer-modeling can be used to recruit more scientists to science communication opportunities and how institutions can improve training for outreach such as podcasts. [ABSTRACT FROM AUTHOR]

Purpose: This research addresses the professional logics of street-level managers (SLMs) and bureaucrats (SLBs) working in the Brazilian National Social Security Agency (INSS) through their perceptions of distributive justice and discretion. Since SLMs have the authority to influence SLBs' actions, we investigate whether these two groups hold similar viewpoints. Design/methodology/approach: We integrate the administrative data and survey responses (n = 678) with earlier thematic content analysis (n = 350) in three stages: mean-testing, regression analyses and complementary qualitative analysis, integrated through a mixed-methods matrix. Findings: Whilst no significant differences emerge in distributive justice ideas between groups, SLMs demand wider benefit-granting discretion, praising professionalism whilst adopting managerial posture and jargon. Research limitations/implications: The study adds to the theoretical discussions concerning SLM's influence on SLB's decision-making, suggesting that other factors outweigh it. The finding concerning the managers' demand for wider discretion asks for further in-depth approaches. Practical implications: Findings supply valuable insights for policymakers and managers steering administrative reforms, by questioning whether some roles SLMs play are limited to symbolic levels. Further, SLBs' heterogenous formations might be more relevant to policy divergence than managerial influence and perhaps an underutilised source of innovation. Originality/value: By approaching street-level management professional logics within a Global South welfare state through a mixed-methods approach, this study offers a holistic understanding of complex dynamics, providing novel insights for public sector management. [ABSTRACT FROM AUTHOR]

Valeria Magarotto,1 Julien Thevenon,2 Kate Morgan,3 Silene ten Seldam,3 Wafae Iraqi,4 Xavier Guillaume,5 Marjorie Leclerc,5 Claire Graziani-Taugeron,5 Bleuenn Rault,5 Dahbia Horchi5 1MD, Janssen-Cilag, Cologno Monzese, MI, Italy; 2Medical Affairs, Janssen Pharmaceuticals, Issy-les-Moulineaux, France; 3Myeloma Patients Europe, Brussels, Belgium; 4Patient Engagement, Janssen Pharmaceuticals, Issy-les-Moulineaux, France; 5RWE Data & Analytics, Oracle Life Sciences, Paris, FranceCorrespondence: Xavier Guillaume; Claire Graziani-Taugeron, Oracle France, 198 Avenue de France, Paris, 75013, France, Email xavier.guillaume@oracle.com; claire.graziani-taugeron@oracle.comPurpose: To provide real-world data on patient perceptions and experiences with subcutaneous (SC) versus intravenous (IV) daratumumab.Patients and Methods: This was a cross-sectional, mixed-method (qualitative/quantitative) survey conducted in France, Germany, Spain and the United Kingdom involving multiple myeloma (MM) patients who switched from IV to SC daratumumab in the last 12 months (qualitative phase) or 24 months (quantitative phase [26 months in the UK]) prior to enrollment in the study.Results: Nine patients (mean age 65 years) participated in the qualitative phase and 113 patients (mean age 65.1 years) in the quantitative phase. Qualitative study results provided insights for the quantitative study and highlighted the benefits of switching from daratumumab IV to daratumumab SC as an improvement and a satisfactory change in patients’ treatment journey. Quantitative survey showed that patients were significantly less anxious, stressed and nervous before SC injections than IV infusions (mean score: 1.3, 1.1, 1.4 versus 2.1, 2.0, 2.0 respectively, p< 0.001), and significantly more reassured, ready/well-prepared, usual self and relieved (mean score: 3.8, 4.3, 3.7, 3.6 versus 3.0, 3.6, 3.1, 3.0 respectively, p< 0.001). Immediately after SC first injection, 96.5% patients were feeling well or very well versus 77.9% immediately after IV first infusion (p< 0.001). 97.3% patients were satisfied with their SC treatment versus 89.4% for the IV injection (p< 0.001). Patients spent significantly less time in hospital for an SC injection of daratumumab than for an IV infusion, 1.5 hours and 5.0 hours respectively (p< 0.001). In the UK, the differences between the two administration forms were less visible, likely because of confounding factors including a longer time passed since the switch from the IV to the SC form and administration of the survey.Conclusion: In line with results from other studies, the SC form of daratumumab had less impact on patients’ emotional burden than the IV form.Keywords: multiple myeloma, daratumumab, mode of administration, patients’ emotional burden, mixed method

Abstract Aim To develop a transitional care model for autoimmune rheumatic disease patients based on the needs analysis. Method Mixed Method, Explanatory sequential design (QUAN-qual) has been conducted. Quantitative data were collected through medical record and structured interviews. Qualitative study has been done through Focused Group Discussion (FGD), based on problems met in previous quantitative study. We have done the coding processed, followed by determining categories and themes to reach the intercoder agreement with peer-debriefing. Analysis of the final results of research was assisted by the external auditor to form a model of care. Result The quantitative data collection from 27 patients showed that the transition age was 18–19 year-old, age of onset 4–17 year-old, 23 patients (85, 2%) with SLE, 4 patients (14.8%) with JIA. Two patients (7.4%) had different diagnosis from the pediatric clinic, 1 patient (3.7%) had no diagnosis from previous clinic. Drug switching during transition occurred in 14 patients (51.9%) and 3 patients (11.1%) has no known medication history. Data regarding disease activity at initial diagnosis were not available in 26 patients (96.3%). The combined FGD analysis found several key words related to “the need of change” in RSCM autoimmune rheumatic transitional care. Conclusion A development of transitional care model for autoimmune rheumatic disease consist of documents about service algorithm, transfer documents, systematic work protocols with education check list has been done.

Many older adults are increasingly embracing digital technology in the Republic of Korea. This study investigated the relationship between the digital skills of Korean older adults and their perceived health status and digital technology application for health promotion. This mixed-method study comprised a community survey of 434 older adults aged ≥65 in two cities in South Korea, followed by focus group interviews. Five types of digital skills, ‘operational internet skills’, ‘information navigation skills’, ‘social skills’, ‘creative skills’, and ‘mobile skills’, were measured using the LSE digital skill measurement instrument. Multivariable analysis identified the influence of digital skills on health-related outcomes. Among them, ‘social skills’ associated positively with self-rated health (β 0.37, 95%CI 0.08, 0.65). ‘Information navigation skills’ contributed positively to the use of digital technology and the internet for a healthy lifestyle in terms of improving eating habits (β 0.43, 95%CI 0.09, 0.77), accessing healthcare (β 0.53, 95%CI 0.21, 0.85), and accessing long-term care services (β 0.45, 95%CI 0.11, 0.79). Thematic analysis revealed that the study participants use Korean language-based resources such as Naver and Kakao Talk for social connection to promote a healthy lifestyle. This study concludes that encouraging initial and sustained use of the internet and enhancing digital skills among Korean older adults can promote active and healthy aging.

Abstract Background Satisfaction is defined as the perceived fulfillment of patient or client needs and desires through the delivery of healthcare services. In developed countries, more than 60% of women have been screened for cervical cancer. However, only 12% of women in sub-Saharan Africa have been screened for precancerous cervical lesions. There is limited evidence on client satisfaction with cervical cancer screening services (CSCCSS) in Ethiopia, particularly, there is no study conducted by mixed method in the Amhara region. Objective The study aimed to assess clients’ satisfaction with cervical cancer screening services and influencing factors among women screened in Debre Markos town public health facilities in Northwest Ethiopia, 2022/23. Methods A convergent parallel mixed methods design was conducted in Debre Markos town’s public health facilities from October 10th, 2022 to January 10th, 2023. For the quantitative wing, a total of 401 cervical cancer screening service users were selected using a systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. Clients were interviewed on exit in a private area far from the screening unit and the data were entered into Epi-data version 4.6.0.2, then exported to STATA version 14 for analysis. A binary logistic regression model was fitted to identify factors associated with client satisfaction with cervical cancer screening services. The qualitative data were collected through in-depth and key informant interviews using a semi-structured topic guide. The data were analyzed using a thematic analysis approach with Open code software (version 4.0.2.3). Result The quantitative wing revealed that overall, 65% (95% CI: 60–69) of respondents were satisfied with the cervical cancer screening services they received. Gender of the provider (AOR: 6.11, 95% CI: 3.23–11.55, p-value = 0.000), waiting time (AOR: 4.77, 95% CI: 1.32–17.31, p-value = 0.017), clients’ knowledge (AOR: 0.26, 95% CI: 0.12–0.59, p-value = 0.001), and clients’ attitude (AOR: 6.43, 95% CI: 3.43–12.03, p-value = 0.000) were significantly associated with CSCCSS. Qualitative result The thematic analysis revealed three themes. Theme 1: facility-related barriers (shortage of skilled manpower, shortage of infrastructure, providers’ skill gap, unavailability of full service, leadership problem, long waiting time). Theme 2: client-related barriers (poor knowledge and attitude, gender preference). Theme 3: facility-related facilitators (free service, presence of supportive partners). Conclusion According to the findings of this study, two-thirds of clients were satisfied with cervical cancer screening services, which was lower than the national target of 80%. Long waiting time, male gender of the service provider, unfavorable attitude, and good knowledge of clients were identified as significant factors negatively affecting client satisfaction with cervical cancer screening.

Purposes Aiming at the performance conflict between optimization parameters in prior optimization method, a hybrid optimization model based on MOEA/D is proposed, which integrates CNN and genetic algorithm into MOEA/D framework to balance the correlation and complexity between various objective functions. Methods First, the deep learning method is used as a supplement to the conventional fluid mechanics analysis method to establish a highly reliable CNN response prediction model for airfoil aerodynamic characteristics, which can be used to quickly evaluate the aerodynamic parameters of airfoil. Then, the response model and genetic operator are interpolated into the MOEA/D framework to construct a multi-objective hybrid optimization model based on MOEA/D. And the lift drag ratio and moment coefficient of a NACA high lift airfoil under cruise condition are taken as the optimization objectives for testing. Finally, through the analysis of aerodynamic performance and flow field structure of the airfoil on the Pareto front, the distribution law of different airfoil configurations on the front is studied, which further guides the designer to explore the potential basic airfoil in the airfoil selection.

Abstract Background The COVID-19 pandemic has posed significant challenges to nations worldwide, affecting various sectors of society. Women’s HIV harm reduction centers, which provide critical services, have also been affected by these difficulties. This study aimed to examine the challenges of the COVID-19 pandemic on the services offered by women’s HIV harm reduction centers from the perspective of clients. Methods A convergent mixed-method design was utilized to gain in-depth insights into the challenges of COVID-19 on the services provided by women’s HIV harm reduction centers, counseling centers, and night shelters that cater to women at risk, such as drug users, sex workers, and the homeless population, in three provinces (Tehran, Khuzestan, and Kermanshah) in Iran. The study was conducted from January to May 2023. The quantitative aspect of the study employed a cross-sectional method with a sample size of 430 individuals. A researcher-developed questionnaire was used to assess a range of services. The qualitative part of the study involved traditional content analysis and included 32 individual interviews. The integration of qualitative and quantitative results was performed during the interpretation phase to provide a comprehensive understanding of the challenges of COVID-19 on women’s HIV harm reduction centers. Results In the quantitative phase, the mean age of women was 39.0 ± 10.2 years. 165 women reported a history of COVID-19, which accounts for 38.4% of the total. More than half of them (n = 102, 61.8%) recovering at home. The majority of women (n = 365, 84.9%) mentioned receiving the COVID-19 vaccine. COVID-19 diagnostic tests were conducted for 74.2% (n = 319) of women. Women expressed higher satisfaction with the services (HIV prevention services, and accommodation services) before the COVID-19 pandemic compared to the satisfaction during the pandemic. The qualitative analysis identified emerging challenges related to the COVID-19 pandemic in two categories: personal challenges and mismanagement of services, comprising nineteen subcategories. Conclusion The findings of this study highlight the adverse impact of the COVID-19 pandemic on the services provided by women’s HIV harm reduction centers, in contrast to the pre-pandemic period. To mitigate these negative effects, it is crucial to implement preventive measures and practical solutions. This may involve addressing the personal and management challenges of the centers.

Abstract Background The COVID-19 pandemic posed significant challenges for managers overseeing women's harm reduction centers. This study seeks to capture managers' perspectives on the service providing in women's harm reduction centers during the COVID-19 pandemic. Methods This convergent mixed-method study conducted in three provinces of Iran: Tehran, Khuzestan, and Kermanshah. The study was carried out between January and May 2023. In the quantitative part, the researchers utilized reports from 10 center managers. A researcher-designed questionnaire was employed to collect data on a wide range of services and referrals provided by the centers. The qualitative part of the research involved conventional content analysis and included 12 individual interviews. Two directors from the Ministry of Health and ten managers of women’s harm reduction centers participated in the interviews. During the interpretation phase, the researchers compared the quantitative and qualitative findings to obtain a comprehensive understanding of the topic. Results During the quantitative stage of the study, it was observed that all the managers were women, with an average age of 40.7 ± 7 years. More than half of the managers had obtained a postgraduate education (n = 6, 60%), and a majority of them were married (n = 7, 70%). Additionally, 40% of the managers (n = 4) were working as contractors. During the non-COVID-19 period, there were higher coverage by centers and residents, more referrals of non-injecting drug users and sex workers, and a higher number of group counseling sessions in all three provinces compared to the COVID-19 period. The qualitative analysis revealed two primary themes: "challenges" and "capabilities." Conclusions During the COVID-19 pandemic, providing some services and client referrals decreased in the centers, and center managers faced increased challenges. Many of these challenges were in the communication, executive, management, structure, education, financial, civilization, facilities, and socio-cultural sectors. Managers used their skills to manage and control these challenges. It is important to focus on these challenges and managerial capabilities to effectively handle future crises.

Abstract Background We implemented a contextualized innovative mentorship program in the Clinical Master in Family Medicine (CMFM) program established in April 2020 at Arabian Gulf University. In this paper, we describe the process of this program and derive the major challenges faced by trainees and related corrective actions and their outcomes on high-risk trainees for optimal performance. Methods We conducted a mixed-method longitudinal study of 80 trainees, analyzing information extracted from the Moodle learning platform about five key performance indicators as well as the contents (quantitative and qualitative) of mentoring meeting reports submitted through a validated online form between 2020 and 2022. We analyzed frequencies and themes of challenges and compared trainees' performance according to time and level of risk. Results The follow-up of all 80 trainees in two cohorts (40 for each cohort) shows that most are female (93.75%) and the mean age is 30.00 ± 2.19 years with a ratio of mentors to mentees of 1 to 5. Meetings are conducted through phone calls, virtually, and face-to-face in 62%, 29%, and 8.3% respectively. The mean number and duration of meetings are 30.88 ± 2.31 and 20.08 ± 9.50 min respectively. Time management is the most reported challenge (41.3%), followed by health, social, and psychological-related issues in 7.6%, 4.6%, and 3% respectively. We extracted four main themes related to trainees, settings of training, e-Portfolio, and the COVID-19 pandemic. The mentorship program captured 12 trainees at high risk for low academic progress (12%) of whom six graduated on time and the remaining had to repeat a few courses the following terms. The performance of the program is stable over time (mean GPA of 3.30 (SE = 0.03), versus 3.34 (SE = 0.05) for cohorts 1 and 2 in the two years respectively, (P = 0.33). However, it is slightly lower among high-risk trainees compared to the remaining (GPA = 3.35 (SE = 0.03) versus 3.14 (SE = 0.08), P = 0.043) though above the minimum of the threshold of 3 out of 4, required for the master's degree. Conclusion The mentorship program captured the struggling trainees and permitted to implement pertinent corrective actions timely, particularly in the context of a two-year intensive CMFM program during the COVID-19 pandemic.

Background and objective: Cancer-related fatigue (CRF) affects the quality of life after breast cancer. In a previous study, we developed a 72-item questionnaire that assesses CRF from a holistic point of view; named the Holistic Assessment of CRF (HA-CRF) questionnaire. The current study assessed the face and content validity of the HA-CRF questionnaire. Methods: Using a mixed-method approach, ten breast cancer survivors (BCS) did a cognitive walkthrough of the HA-CRF via an app followed by a semi-structured interview about relevancy and essentiality (qualitative). In addition, ten health care professionals (HCPs) assessed the relevancy, clarity, and essentiality of each item via a questionnaire (quantitative). Results: BCS indicated minor textual improvement for four items and six items were not completely clear. The app was considered easy to use and the HC-CRF was on average completed in 18 minutes. The HA-CRF questionnaire provided openness about fatigue and gave the feeling of being heard. The items were helpful and induced self-awareness. HCPs indicated 71% of items being very clear or minor revisions proposed by the minority, with 64% of items being essential and 92% considered relevant. Conclusions: The HA-CRF showed good face and excellent content validity. Further research is needed to assess its ability to monitor in daily life. [ABSTRACT FROM AUTHOR]

This study investigates the communication skills expected of recent construction engineering graduates as portrayed in job ads and conveyed by employers. A content analysis of 100 job ads showed that teamwork, leadership, and interpersonal communication skills were the specific categories of communication skills listed most frequently. Subsequent interviews with 11 employers showed that although they considered the written communication skills of recent college graduates as sufficient, they found that many recent graduates had insufficient skills in assertiveness, email communication, relationship building, and audience adaptation, indicating that additional coursework or assignments in oral communication skills would benefit construction engineering majors. [ABSTRACT FROM AUTHOR]

Context: Despite the Weekly Iron folic acid supplementation (WIFS) program, the prevalence of anaemia among adolescent girls remains high. Phase 1 Indian Council of Medical Research (ICMR) task force study conducted in 2016 in Kallur showed that the IFA provision rate for adolescent girls was 72% but the consumption rate was only 15% in the Kallur area. The present study was done to identify the gaps for the difference between provision and consumption rate of weekly IFA tablets among adolescent girls using the WHO conceptual framework in home-based settings. Materials and Methods: This crosssectional study with a mixedmethod design was conducted from October 2020 to December 2021. Quantitative data were collected from 972 adolescent girls and their parents using a structured pretested questionnaire, whereas qualitative exploration was done by focus group discussions. Descriptive analysis and bivariate analysis were used to analyse the quantitative data. Qualitative data were analysed and integrated with quantitative results. Results: The overall number of girls who were aware of Iron Folic acid therapy (IFAT) was 704 (72%). However, only 132 (13%) adolescent girls were found to be adherent to IFA therapy. Multivariable regression analysis revealed that side effects encountered on intake of IFAT (Odds ratio (OR) =0.5, P = 0.009) were associated with higher rates of nonadherence, whereas regular supply (OR = 13.6, P = 0.000), health education to parents (OR = 2.76, P = 0.002), and experiencing benefits (OR = 1.72, P = 0.006) were associated with higher rates of adherence. These were substantiated by qualitative findings. Conclusions: Ignorance on the impact of anaemia on adolescent health, fear of side effects, unpleasant effects experienced on intake of Iron folic acid (IFA), and inadequate counselling determines the adherence to weekly IFA supplements among adolescent girls.

Abstract Background Intimate partner violence (IPV) is the most common form of violence against women. Postpartum IPV refers to any type of IPV that occurs up to one year after childbirth and has many adverse impacts on mothers and their children. Considering the lack of sufficient information on the prevalence and factors related to IPV after childbirth in Iran, this study aimed to evaluate the frequency and severity of IPV, its different forms, and psychosocial factors related to IPV, as well as to explore how IPV is perceived among mothers one year after childbirth. Methods An explanatory sequential mixed-methods design was used to conduct this study in two phases. The first phase is a cross-sectional study that will be performed on postpartum mothers who have a one-year-old child referred to health care centers in the southern region of Tehran, Iran, with the aim of determining the prevalence of IPV and its related factors. The second phase is a qualitative conventional content analysis study with the purpose of exploring women’s experiences and perceptions of IPV and its preventive or protective factors. Purposive sampling will be used. Based on the results of the quantitative phase, mothers who are at the two ends of the IPV spectrum (based on their total Conflict Tactics Scale (CTS-2) scores) will be selected, and in-depth and semistructured interviews will be conducted with them. Finally, the researchers will provide an interpretation of the quantitative results using qualitative data. Discussion This is the first study that uses a mixed methods approach to explain different dimensions of IPV, its related factors, and mothers' perceptions of it. By providing a better understanding of this phenomenon, it is hoped that the results of this research will be used by policymakers and officials of educational and cultural systems to plan and provide effective interventions, enact laws, and present educational and cultural programs to prevent IPV after childbirth. Ethical code IR.TUMS.FNM.REC1400.200.

This study scrutinizes India’s growing appeal as a tourist destination, accentuated by government initiatives and innovative tourism policies like the e-visa program, Incredible India Campaign 2.0 and digital advancements in the travel sector. With the diminishing impact of COVID-19, there is a noticeable surge in various forms of tourism – inbound, outbound and domestic. The primary focus is to understand the driving factors behind the choice of India as a destination for inbound tourists. This research delves into these motivations, providing a global perspective on India’s attractiveness. A mixed-method approach was employed, utilizing convenience sampling for data collection. The quantitative analysis was based on a survey, informed by a literature review, comprising 390 respondents from 10 diverse Indian destinations. Additionally, 25 qualitative interviews were conducted, aiming to enrich and triangulate the quantitative findings. Exploratory factor analysis (EFA) revealed five predominant motivations among inbound tourists: culinary interests, spiritual pursuits, budget-consciousness, cultural curiosity and natural allure. These findings were substantiated through thematic analysis. The outcomes have significant practical ramifications for destination managers and tourism policy developers in India. By understanding these key motivators, they can devise targeted strategies for enhancing the appeal of India to these specific tourist segments. This study not only aids in refining tourism promotion efforts but also contributes to the academic discourse on tourist motivation offering a fresh international perspective on India’s image as a tourist destination.

Background and purpose: Health tourism is one of the dimensions of sustainable development to help Mazandarn’s economic dynamic. A strong agreement is doubted in identifying factors influencing the attraction of health tourists. This study was implemented to design a questionnaire to measure the factors influencing the attraction of healthy tourists and investigate its psychometric properties. Materials and methods: This study was done with a combinatorial approach in three steps, including relevant literature and the opinions of experts as long as health tourists' opinions of Mazandaran province were applied to the development of the item pool. Then, content validity, face validity, construct validity, and reliability of the questionnaire were assessed for the psychometric properties of the questionnaire. The final questionnaire was approved after performing 17 interviews and applying professional expertise in the qualitative part. In the first stage of the quantitative part content validity was studied by 10 people from an expert panel, and its face validity, the questionnaire was completed by 10 participants. Finally, the construct validity of the designed instrument was calculated using exploratory factor analysis using SPSS 24 software and confirmatory factor analysis using AMOS 24 software by asking 300 people familiar with health tourism in Mazandaran province. The internal and external validity were determined using Cronbach's alpha and test-retest in 25 people. Results: The results of the literature review and interviews with experts in the first and second stages of the study led to the design of 76 items. In the next step, the changes in the qualitative stage 15 questions did not receive favorite points in Content validity ratio (CVR) and content validity index (CVI) calculation in the quantitative part of content validity. Then face validity was applied and the item effect index for 8 items was lower than 1.5 in the quantitative stage of face validity. Then the questionnaire with 53 items was entered into construct validity. In the exploratory factor analysis, the value of KMO was equal to 0.778. Furthermore, the value of Bartlett's test of significance was less than 5%. Based on the rotated matrix of components, eight factors with positive values were obtained. The results of exploratory factor analysis showed that 7 items had a factor loading of less than 0.4, which were removed from the questionnaire, and finally, 46 items remained. In the confirmatory factor analysis stage, the factor load of all dimensions was in good condition and the P-value was in the acceptable range. Cronbach alpha rate was calculated as 0.831. The external reliability was lower than 0.05 (ICC= 0.90, P

The synergy of neuroleadership and Islamic values is crucial in addressing leadership challenges posed by Generation Z, particularly in combating toxic leadership, negative culture, and turnover. Generation Z's unique behaviors require leaders who combine neuroleadership and Islamic values to inspire and create positive environments. However, a lack of studies in Indonesia, the largest Muslim-majority country, highlights a significant research gap. Using a mixed-method approach, this study investigates how Islamic values and neuroleadership influence leadership skill development. We conducted focus group discussions with 60 participants and surveyed 317 active members of the biggest Islamic organization in Indonesia, aged 17–23, to test the hypotheses. The results show that both neuroleadership and Islamic values affect leadership skills. Among the eight neuroleadership indicators, transfer and caring are the most influential in shaping leadership skills. Additionally, in accordance with Islamic values, fairness and tolerance are key factors for effective leadership. Generation Z seeks to be heard and understood. While they may lack problem-solving skills, they excel in fairness, tolerance, and relationships.

Abstract Background Patient Reported Outcomes Measures (PROMs) are being used increasingly to measure health problems in stroke clinical practice. However, the implementation of these PROMs in routine stroke care is still in its infancy. To understand the value of PROMs used in ischemic stroke care, we explored the patients’ experience with PROMs and with the consultation at routine post-discharge follow-up after stroke. Methods In this prospective mixed methods study, patients with ischemic stroke completed an evaluation questionnaire about the use of PROMs and about their consultation in two Dutch hospitals. Additionally, telephone interviews were held to gain in-depth information about their experience with PROMs. Results In total, 63 patients completed the evaluation questionnaire of which 10 patients were also interviewed. Most patients (82.2–96.6%) found completing the PROMs to be feasible and relevant. Half the patients (49.2–51.6%) considered the PROMs useful for the consultation and most patients (87.3–96.8%) reported the consultation as a positive experience. Completing the PROMs provided 51.6% of the patients with insight into their stroke-related problems. Almost 75% of the patients found the PROMs useful in giving the healthcare provider greater insight, and 60% reported discussing the PROM results during the consultation. Interviewed patients reported the added value of PROMs, particularly when arranging further care, in gaining a broader insight into the problems, and in ensuring all important topics were discussed during the consultation. Conclusions Completing PROMs appears to be feasible for patients with stroke attending post-discharge consultation; the vast majority of patients experienced added value for themselves or the healthcare provider. We recommend that healthcare providers discuss the PROM results with their patients to improve the value of PROMs for the patient. This could also improve the willingness to complete PROMs in the future.

Abstract Background Patients with a stroke often cannot care for themselves after hospital discharge. Assessment of their self-care ability is the first step in planning post-discharge home care. This study aimed to design and validate a measure of perceived self-care ability (PSCA) in stroke patients. Methods A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2020–2021. The qualitative phase involved in-depth semi-structured interviews with 12 participants. Transcripts were content analyzed. The results guided the development of 81 items. psychometric properties such as face validity (Impact Score > 1.5), content validity ratio (CVR > 0.63), content validity index (Item Content Validity Index: ICVI > 0.78, Scale Content Validity Index/Average: SCVI/Ave > 0.8) and Kappa value (Kappa > 0.7), internal consistency (Cronbach’s alpha > 0.7), relative reliability (ICC: inter class correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4–0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assessed. Results Content analysis of the qualitative interviews yielded 5 major categories and 9 subcategories that reflected "Perceptual stability", "Cognitive fluctuations", "Sensory, Motor and Physical health",” The subjective nature" and "The dynamic nature” of PSCA. Results of face and content validity reduced the number of items to 32, capturing three dimensions of PSCA in chronic stroke patients; these dimensions included perceptual ability, threatened health status, and sensory, motor, and cognitive ability. The findings supported the reliability and validity of the measure. Conclusions The PSCA questionnaire was developed and validated within the Iranian culture. It is useful in assessing the self-care of patients with stroke and in informing practice.

Abstract Background Equitable access to quality care after injury is an essential step for improved health outcomes in low- and middle-income countries (LMICs). We introduce the Equi-Injury project, in which we will use integrated frameworks to understand how to improve equitable access to quality care after injury in four LMICs: Ghana, Pakistan, Rwanda and South Africa. Methods This project has 5 work packages (WPs) as well as essential cross-cutting pillars of community engagement, capacity building and cross-country learning. In WP1, we will identify needs, barriers, and facilitators to impactful stakeholder engagement in developing and prioritising policy solutions. In WP2, we will collect data on patient care and outcomes after injuries. In WP3, we will develop an injury pathway model to understand which elements in the pathway of injury response, care and treatment have the biggest impact on health and economic outcomes. In WP4, we will work with stakeholders to gain consensus on solutions to address identified issues; these solutions will be implemented and tested in future research. In WP5, in order to ascertain where learning is transferable across contexts, we will identify which outcomes are shared across countries. The study has received approval from ethical review boards (ERBs) of all partner countries in South Africa, Rwanda, Ghana, Pakistan and the University of Birmingham. Discussion This health system evaluation project aims to provide a deeper understanding of injury care and develop evidence-based interventions within and across partner countries in four diverse LMICs. Strong partnership with multiple stakeholders will facilitate utilisation of the results for the co-development of sustainable interventions.

Introduction: A good learning environment (LE) will affect the quality and standard of the learning process, student performance, and the outcome of the curriculum as well as predictor of the quality of health services. Our study aims to assess residents’ perception of the LE in Ophthalmology training programs for future improvement. Methods: Mixed method with an explanatory sequential design was implemented in this study using the Post-graduate Hospital Educational Environment Measure (PHEEM) as a quantitative approach and open-ended questions collaborated with focus group discussion (FGD) as a qualitative measurement. A comparison of the quantitative data was made using parametric and non-parametric analyses. Thematic analyses were performed for qualitative data. Integration of quantitative and qualitative data was done by connecting both data. Results: Fifty-three residents participated in this survey. The mean age was 30.96±2.18 years old, 64.15% were female and 77.36% are at the internship stage. The mean score of overall PHEEM was 123.40 ±12.35, indicated an excellent LE, while the mean score of perceptions of role autonomy, perceptions of teaching, and perceptions of social support were 42.57±4.62, 47.75±4.84 and 33.08±4.15, respectively. There is no significant difference between gender and study period with the perception of LE. Thematic analysis from qualitative data reveals six positive and five negative perception themes. All discovered themes confirmed concordance with the result of LE perception. Conclusion: Learning environment perception in the ophthalmology residency program was excellent and essential for the student's skills and performance quality. Some specific areas still need improvement strategies for institutional development.

Background: Intimate partner violence (IPV) is the most common form of violence against women. Postpartum IPV refers to any type of IPV that occurs up to one year after childbirth and has many adverse impacts on mothers and their children. Considering the lack of sufficient information on the prevalence and factors related to IPV after childbirth in Iran, this study aimed to evaluate the frequency and severity of IPV, its different forms, and psychosocial factors related to IPV, as well as to explore how IPV is perceived among mothers one year after childbirth. Methods: An explanatory sequential mixed-methods design was used to conduct this study in two phases. The first phase is a cross-sectional study that will be performed on postpartum mothers who have a one-year-old child referred to health care centers in the southern region of Tehran, Iran, with the aim of determining the prevalence of IPV and its related factors. The second phase is a qualitative conventional content analysis study with the purpose of exploring women's experiences and perceptions of IPV and its preventive or protective factors. Purposive sampling will be used. Based on the results of the quantitative phase, mothers who are at the two ends of the IPV spectrum (based on their total Conflict Tactics Scale (CTS-2) scores) will be selected, and in-depth and semistructured interviews will be conducted with them. Finally, the researchers will provide an interpretation of the quantitative results using qualitative data. Discussion: This is the first study that uses a mixed methods approach to explain different dimensions of IPV, its related factors, and mothers' perceptions of it. By providing a better understanding of this phenomenon, it is hoped that the results of this research will be used by policymakers and officials of educational and cultural systems to plan and provide effective interventions, enact laws, and present educational and cultural programs to prevent IPV after childbirth. Ethical code: IR.TUMS.FNM.REC1400.200. Plain English summary: Intimate partner violence is the most common form of violence against women, with a higher prevalence in Asian and Eastern Mediterranean countries, including Iran. The period after childbirth is a stressful and anxiety-provoking event due to the increased physical, psychological, social, and economic needs of parents, leading to intimate partner violence. Studies show that women who experience violence after childbirth face many physical, sexual, and emotional problems. Additionally, it will have a negative impact on their baby. Many factors can lead to intimate partner violence, among which psychological factors are among the most important. Therefore, we decided to perform a study in two phases with the aim of determining the prevalence and factors related to intimate partner violence. In the first phase, we will study Iranian women who have a one-year child living in southern Tehran city and ask them to complete questionnaires related to intimate partner violence. In the second phase, we will conduct an interview with women who have experienced violence after childbirth to obtain more information about the factors involved. [ABSTRACT FROM AUTHOR]

This study investigates how tourists' Green Environmental Knowledge, Green Hotel Knowledge, and environment concern impact pro-environmental (PE) attitudes. Using mixed methods, it examines how PE attitudes influence the intention to stay at eco-friendly hotels, based on the theory of planned behavior. The study further explores the moderating role of the "Greta Effect" in connecting PE attitudes and hotel choice. This study utilizes a mixed-methods approach to enhance the comprehension of quantitative findings, on exploring the moderating impact of the "Greta Effect". The findings highlight the important role of environmental activism in inspiring action for green hotel choice. [ABSTRACT FROM AUTHOR]

This mixed methods research study aimed to determine spiritual care competencies and death anxiety levels of nursing students practicing in intensive care. The quantitative part of this study included 33 students while the qualitative part included 17 students. Nursing students' spiritual care competence was detected to be above medium and their death anxiety was high. Two themes emerged from the qualitative data collected through in-depth interviews with 17 nursing students: (a) Views on spiritual care competencies and (b) Views on death. These findings are significant to reduce nursing students' death anxiety, increase spiritual care competencies and the quality of patients' end-of-life care. [ABSTRACT FROM AUTHOR]

Young men from disadvantaged contexts are the least likely to attend university in Australia; furthermore, when they do attend, they are likely to struggle. This article draws on empirical data documenting the aspirations and resilience of first-in-family young men in Australian higher education, with the aim of nuancing their classed experience of university. Drawing on an exploratory longitudinal study (n = 42) and adopting a mixed method approach, we use the 25-item Connor-Davidson Resilience Scale (CD-RISC) and semi-structured interviews over a three-year period to explore changes in resilience of first-in-family men from the age of 17 to 20. The mixed-method approach employed in this study allows us to draw connections between the participants' subjective experience of resilience and the more objective measures of resilience as captured by the Connor-Davidson Resilience Scale, a psychometrically sound and validated instrument. Quantitative analyses of data enable us to document the trends in resilience over time for different groups of first-in-family men, while qualitative data provide insights structured around three key themes: independence and isolation; managing and adjusting; and using support structures. The article draws on analysis across these data to consider the participants' perceptions of their resilience, and how these perceptions change in reference to their experience, in order to paint a more nuanced picture of first-in-family men's classed experience of higher education. [ABSTRACT FROM AUTHOR]

Context: Despite the Weekly Iron folic acid supplementation (WIFS) program, the prevalence of anaemia among adolescent girls remains high. Phase 1 Indian Council of Medical Research (ICMR) task force study conducted in 2016 in Kallur showed that the IFA provision rate for adolescent girls was 72% but the consumption rate was only 15% in the Kallur area. The present study was done to identify the gaps for the difference between provision and consumption rate of weekly IFA tablets among adolescent girls using the WHO conceptual framework in home‑based settings. Materials and Methods: This crosssectional study with a mixedmethod design was conducted from October 2020 to December 2021. Quantitative data were collected from 972 adolescent girls and their parents using a structured pretested questionnaire, whereas qualitative exploration was done by focus group discussions. Descriptive analysis and bivariate analysis were used to analyse the quantitative data. Qualitative data were analysed and integrated with quantitative results. Results: The overall number of girls who were aware of Iron Folic acid therapy (IFAT) was 704 (72%). However, only 132 (13%) adolescent girls were found to be adherent to IFA therapy. Multivariable regression analysis revealed that side effects encountered on intake of IFAT (Odds ratio (OR) =0.5, P = 0.009) were associated with higher rates of nonadherence, whereas regular supply (OR = 13.6, P = 0.000), health education to parents (OR = 2.76, P = 0.002), and experiencing benefits (OR = 1.72, P = 0.006) were associated with higher rates of adherence. These were substantiated by qualitative findings. Conclusions: Ignorance on the impact of anaemia on adolescent health, fear of side effects, unpleasant effects experienced on intake of Iron folic acid (IFA), and inadequate counselling determines the adherence to weekly IFA supplements among adolescent girls. [ABSTRACT FROM AUTHOR]

Copyright of Cumhuriyet International Journal of Education is the property of Cumhuriyet University, Faculty of Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We study the impact of providing consulting services and major capital infusions to small‐ and medium‐sized enterprises (SMEs) in the food sector in Kenya. We exploit a quasi‐experimental design that matches treated firms with comparable firms that applied for the same support but were just short of scoring sufficient points to receive this support. Using mixed methods, this quantitative analysis is supplemented by in‐depth qualitative interviews, which provide further insights into the workings of the program. The program helped SMEs launch new products and increased numbers of employees. Interviewees described higher sales resulting from the major capital infusions they received. [ABSTRACT FROM AUTHOR]

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

The aim of the study is to examine the role of childhood experiences and achievement motivation in high school students' hope levels. The quantitative (N = 686, 43.9% females and 56.1% males, aged between 13 and 19; Mage = 16.02, standard deviation = 1.23) and qualitative data of the study, in which enriched design was used, were collected from high school students studying in the Southeast of Turkey. Hierarchical regression was used in the quantitative part of the study and content analysis was carried out in the qualitative part. It is seen that the results in the qualitative analysis part largely coincide with the results in the quantitative part. The results denote that high school students have high hope levels. Also, according to the results, there is a negative, low‐level, and significant relationship between childhood experiences and hope, and a positive and moderately significant relationship between hope and achievement motivation. Although childhood experiences and achievement motivation significantly predict the level of hope, it is concluded that achievement motivation contributes more to the hope‐related variance which is explained. The findings reveal the value of achievement motivation and childhood experiences in understanding adolescents' hope multidimensionally. Practitioner Points: Childhood experiences and achievement motivation significantly predict adolescents' hope.It has been concluded that negative experiences do not affect the level of hope in adolescents who predominantly remember these experiences from childhood.Hope in adolescents is more related to achievement motivation, which is a goal‐oriented and individual trait, than to childhood experiences. [ABSTRACT FROM AUTHOR]