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Objectives: Very little is known about the role of self-compassion on performing artists' mental health. This project had two primary aims. First, was to examine the relationship between self-compassion and mental health among performing artists in dance, music, and acting. Second, was to test a brief compassion-based intervention to establish proof of concept for future work. Method: Two sequential studies recruiting Australian performing artists were conducted. In Study 1, a cross-sectional online survey of performing artists explored patterns of association between self-compassion and mental health. In Study 2, participants engaged with a brief compassion-based intervention including an online workshop and daily meditation over 3 weeks. Descriptive pre-post data combined with thematic analysis of semi-structured interview transcripts identified performer perspectives of the compassion-based intervention. Results: In Study 1, 211 participants were included in the final cross-sectional analysis, which showed that the intention to be self-compassionate was associated with lower symptoms of depression and anxiety, and higher wellbeing, even while controlling for several key demographic and risk factors (stress, alcohol use, and body appreciation). In Study 2, ten participants completed the intervention with medium-large improvements in self-compassion and small improvements in wellbeing and body appreciation. Qualitative data demonstrated that participants experienced self-compassion to be helpful, however fears of lowering standards existed. Participants feedback from this study can now directly inform future compassion-based interventions among performers. Conclusion: While acknowledging the small sample size, these findings suggest that self-compassion may help performing artists manage various forms of internal, interpersonal, and environmental distress. These findings warrant progression to controlled evaluation of compassion-based interventions within larger samples of performing artists. [ABSTRACT FROM AUTHOR]

Background: Ukrainians staying in Sweden under the EU mass refugee directive may face challenges due to traumas caused by the invasion that started on February 24, 2022. Part of an European Social Fund (ESF) project, our study showed that a brief trauma-focused group intervention onsite helped to increase health and mental-health literacy. The intervention has not yet been adapted online. Methods: This pilot study during six months aimed to investigate the feasibility, acceptability and outcome in perceived trust, anxiety/stress, and perceived health after this brief trauma-focused group intervention online. A second aim was to observe perceived acceptability of the group intervention with different ways of online intervention. Local coaches, interpreters, the authors, and local experts participated. A mixed-methods design with participatory methodology and evaluation were used. Data was collected with a short questionnaire in Ukrainian. Additionally, at the end of each set, we orally asked about perceived trust and integrity. There were six sets of five group sessions per set, a total of 30 sessions. Each group met online five times for 2 h, a total of 10 h excluding pre- and post-assessment. Breathing exercises sought to reduce stress among the participants. Results: The group intervention had both strengths and limitations. Baseline data were obtained from 136 participants, mostly females (75.7%). Answers to pre- and post-questionnaires showed that perceived anxiety/stress was significantly reduced (N = 91, chi-2 20.648, df = 6, p <.02). Perceived health significantly improved between pre- (mean 63.6) and post (77.2) (N = 77, t = −8.08, df = 66, p <.001). Older participants were vulnerable with higher stress and lower mean perceived health after the intervention. Four out of ten needed individual psychosocial support online.The participants' open questions were analyzed with qualitative content analysis, giving five general categories and 25 sub-categories and the theme "Strong efforts to cope with Swedish system". Conclusion: Trust and reduced anxiety level changed after the intervention and a combination online of small, closed group meetings with the possibility of personal acquaintance, trust and individual follow-up psychosocial support for those in need to be paid attention to for future refugee support services, particular an online format. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare professionals (HCPs) play a critical role in suicide prevention and clinical guidelines recommend inquiring about suicidality as part of medical history and diagnosis. Emerging evidence indicates a lack of implementation of such policies in clinical practice. However, to date, no comprehensive mixed-methods study has examined this issue in the field of oncology. Methods: A preregistered mixed-methods study was conducted with oncological HCPs (N = 20) from various professions, using semi-structured interviews and validated questionnaires. Employing an explorative theory-generating approach, qualitative content analysis was applied to the interviews. The different data sources are integrated and contrasted. Comparisons according to sociodemographic variables (profession, age, and gender) and frequency distributions were used to examine the questionnaire data. Results: Most HCPs reported direct or indirect experiences with suicidality in cancer patients. Nineteen HCPs did not routinely explore suicidality, of whom five reported not inquiring about it at all. Those who explored suicidality were more confident, less emotionally overwhelmed and reported higher subjective knowledge. HCPs also differed regarding their endorsement of suicide myths. Conclusion: The study highlights difficulties with active suicide exploration and differences among HCPs. Integrating these findings into education and training could improve HCPs’ skills and reduce disparities, supporting successful suicide prevention.Highlights: Mixed-Methods study on suicide prevention from oncology experts’ perspective. Experts experience different manifestations of suicidality in cancer patients. Recommendations to actively explore suicidality are not adequately followed. Differences in knowledge, confidence, and stigmatization. Common, but also diverging agreement with suicide myths. [ABSTRACT FROM AUTHOR]

Background: Physical activity is important for children's physical, mental and cognitive wellbeing, but many children are insufficiently active. Schools offer a promising setting in which to enable positive health behaviours and teachers can play an influential role in facilitating pupils' physical activity. The aim of this study was to use pupils' physical activity data from wearables to inform teacher-led strategies to improve pupils' physical activity outcomes. Methods: Participants included 11 teachers/classes, and 228 pupils aged 8–11 years from eight primary-schools in England. Baseline pupil physical activity was measured for 2 weeks using a commercially available accelerometer, before data visualisations were used to inform teacher-led strategies with the aim of improving pupils' physical activity. These strategies were then implemented, with physical activity being measured post-data-sharing discussions. Mixed-methods analysis explored the feasibility of using data visualisations to inform teachers' understanding of their pupils' physical activity and the development and implementation of teacher-led, school-specific strategies to increase pupils' physical activity. Results: Teachers understood and reflected on the data visualisations and used their knowledge of the school context to develop and implement bespoke school-specific strategies across the school day which successfully increased physical activity. Strategies included altering the physical or social environment, providing more opportunities and addressing physical activity inequalities. Teachers were encouraged when data showed increases in pupils' physical activity and many expressed the desire to continue addressing physical activity, with a particular focus on the least active pupils. Conclusion: These findings suggest that data-driven insights could be used effectively to inform school-based, teacher-led strategies to increase physical activity. [ABSTRACT FROM AUTHOR]

Because of their focus on the acquisition of new technologies, local energy communities are increasingly being recognised as major players in the current energy transition and revealing the valuable role of technological solutions in sustainable development. Nevertheless, the success of these communities is not limited to the acquisition of technologies. Instead, it is strongly dependent on citizen participation. Prior literature has focused much more on the institutional and policy factors than on the roles of citizens and their participation in such communities, and indirectly on sustainability. To address the lack, this study aims to explain the determinants of citizen participation in local energy communities by developing a research model grounded on the stimulus-organism-response (S-O-R) framework, and then through a mixed-methods design, study the impact of technological factors as a stimulus on more social outcomes, namely the organism and response behaviours. Our results highlight the strong impact of sustainable technologies and gamification in citizens' attitudes. Moreover, the research model reveals a strong influence of empowerment and pro-environmental behaviour in the citizen intention to participate in local energy communities. [ABSTRACT FROM AUTHOR]

Background: Professional standards and the Codes of Ethics from the International Council of Nurses and American Nurses Association are frameworks driving professional practice and are linked to positive patient and nursing outcomes. Objective: To describe qualitative themes extracted from narrative responses on how nurses' personal values influence nursing care and converge with quantitative results assessing personal values, professional values, and the practice environment, a key component of nurse satisfaction and subsequent care quality. Methods: A convenience sample of nurses across 19 sites within a large nonprofit healthcare system was surveyed. Quantitative measures included the Short Schwartz's Value Survey for personal values, the Nurses Professional Values Scale-3 for professional values, and the Practice Environment Scale of the Nursing Work Index, assessing practice settings. Concurrently, nurses were asked, "How do your values influence the care you provide?" Responses were examined using a descriptive qualitative method for thematic analysis. Results: The sample included qualitative (n = 408) and quantitative (n = 671) responses. Six qualitative themes emerged: patient-centered care, professionalism/integrity of practice, advocacy, dissonance, golden rule/ethics of reciprocity (religiosity), and perseverance. Themes converged with the mean personal values of achievement, self-direction, universalism, benevolence, tradition, and conformity, and diverged with hedonism, security, and stimulation. All professional values factor means and work environment subscale means converged. Conclusions: Findings highlight convergence and divergence between qualitative and quantitative responses from nurses, offering new insights into the themes of dissonance, perseverance, and religiosity. The findings present valuable opportunities to enhance recruitment and retention strategies. [ABSTRACT FROM AUTHOR]

Nutrition plays a crucial role in human and planetary health, as prevailing nutritional patterns significantly contribute to the global non-communicable disease pandemic. Moreover, the global food system is inextricably linked to planetary health deterioration. The relevance of nutrition for individual and planetary health is insufficiently addressed in German medical schools. Here, we present a two-week course for medical students in the 8th semester at Charité - Universitätsmedizin Berlin on nutrition and fasting in the context of human and planetary health. The course was developed iteratively along the Kern cycle for medical curricula and underwent evaluation through a mixed-methods design spanning across two consecutive semesters. Assessment involved quantitative questionnaires and qualitative interviews. The main exploratory outcome was the overall module rating. Further outcomes encompassed in-depth evaluations of specific aspects, including content, teaching methods, instructor performance, and subjective experiential aspects. The conceptualisation resulted in a highly participative two-week course of 37.5 h. The main learning objectives aimed at the acquisition of technical competences and personal competencies in four areas: (1) the role of nutrition in health and disease; (2) the exploration of global food systems; (3) communication on subjects of nutrition; (4) culinary medicine. Various interactive didactic methodologies were used. 77.8% (n = 27) of the participants rated the course as very good or good. The conviction that nutrition influences health and disease increased over the course (Wilcoxon signed rank test, z = -2.82, p = 0.005, r = 0.57). In the qualitative interviews (n = 8) the course content, its didactical diversity and the positive group experience were appreciated. Our results indicate that it could be worthwhile to further incorporate nutrition curricula in medical education. [ABSTRACT FROM AUTHOR]

Background: Autism Spectrum Disorder (ASD) presents early communication and social challenges, necessitating timely and accessible intervention. Pre-school Autism Communication Therapy (PACT), a parent-mediated intervention, empowers parents to facilitate their child's development. However, accessibility issues often hinder families from accessing evidence-based intervention. This pilot study assessed the feasibility of videoconferencing-based PACT as a precursor for a multicenter randomized controlled trial. Methodology: A mixed-methods approach integrated quantitative retrospective measures and semi-structured interviews. Participants included children diagnosed with ASD who received PACT, and PACT-trained professionals with videoconferencing experience. Feasibility was assessed through audio and video quality, internet stability, and session length. Professionals' experiences were analyzed using a qualitative thematic analysis. Autism severity, parent–child interaction, and therapeutic changes were also described. Results: Nine parent–child dyads and eight PACT therapists were included in the study. Videoconferencing-based PACT intervention proved feasible, with 95.1% of the 41 sessions rated as feasible on the scale. Technical challenges such as audio quality (7.3%) and screen sharing (19.1%) have emerged, which therapists circumvented to maintain intervention quality. Autism severity and parent–child interaction showed positive trends, supported by qualitative findings reporting increased parental confidence and enhanced synchrony. The core components of PACT were successfully adapted to the remote setting. Conclusion: This pilot study suggests that delivering PACT via videoconferencing is a feasible approach to enhance the accessibility of evidence-based interventions for ASD. Larger-scale research with rigorous controls is required to validate these promising findings. An ongoing multicenter randomized trial aims to address this gap. [ABSTRACT FROM AUTHOR]

Background: This study explores how personality traits and mindfulness facets interact to influence perceived stress, focusing on a Chinese adult sample. It aims to address gaps in understanding the combined effects of dispositional and mindfulness factors on stress. Methods: A sequential explanatory mixed-methods design was employed. In the quantitative phase, 637 Chinese adults completed surveys measuring personality traits, mindfulness (attention, acceptance), and perceived stress. Hierarchical multiple regression, moderation, and mediation analyses were conducted. In the qualitative phase, semi-structured interviews with selected participants provided deeper insights into the quantitative findings. Results: Neuroticism (β = 0.29, p < 0.001) and conscientiousness (β = 0.15, p < 0.01) were positively associated with perceived stress, while mindfulness-acceptance (β = −0.25, p < 0.001) was a significant negative predictor. Neuroticism and mindfulness-acceptance uniquely explained 8 and 6% of the variance in stress, respectively. Mindfulness-attention moderated the relationship between agreeableness and stress, amplifying agreeableness' stress-buffering effect in individuals with low mindfulness-attention. Mediation analysis revealed mindfulness-acceptance partially mediated the agreeableness-stress link. Qualitative interviews underscored the role of personality and mindfulness in shaping stress responses and coping mechanisms. Conclusion: The findings highlight mindfulness-acceptance as a critical factor in reducing stress, particularly in individuals with agreeable personalities. These results support the development of mindfulness-based interventions targeting acceptance to enhance stress resilience across diverse personality profiles. [ABSTRACT FROM AUTHOR]

Background: Supportive policy is an important component of a whole-systems approach to increasing physical activity and reducing inequalities. There is a growing body of literature surrounding the design and effectiveness of national policy approaches to physical activity, but evidence related to local-level approaches is lacking. The aim of this study was to examine 'what works', and identify factors underpinning change, focused on work to embed physical activity in local policy and practice in Bradford, UK. Methods: A mixed-methods case study approach involved collecting data from cross-sectoral stakeholders directly or indirectly engaged in the physical activity agenda in Bradford over a period of three years (2021–2024). Data collection included focus groups, semi-structured interviews, researcher observations of key workshops and meetings, and surveys at two time-points (December 2021 and January 2024). Qualitative data were analysed using reflexive thematic analysis. Quantitative data were analysed using descriptive and inferential statistics. Results: Four themes were identified which embody conditions that appear to be critical for working towards physical activity being embedded in local policy & practice within the Bradford District. These included: collaboration and sector integration, co-productive working, governance and leadership, and cultivating a learning culture. The process of co-producing a district-wide strategy for physical activity was key to facilitating shared ownership of the physical activity agenda across different levels of the system, and for supporting and maintaining cross-sectoral collaboration. On average, survey respondents connected with four more local organisations in relation to the physical activity agenda in January 2024 than in December 2021. Conclusion: Taking a partnership approach, and fostering a culture of evidence-informed decision making, is key to embedding physical activity into policy and practice at a local level. Investing time to understand the aims and values of each partner, and potential synergies and tensions between them, can support the development of a positive and productive collaboration and, subsequently, more effective whole-system delivery and population-level increases in physical activity. [ABSTRACT FROM AUTHOR]

Background: Newborn hearing screening (NHS) programs were established globally to reduce the negative consequences of hearing loss. Limited information is available about NHS programs in Riyadh and Saudi Arabia generally. This study explored how NHS programs are conducted in healthcare settings for quality assurance. Methods: The concurrent triangulation mixed methods design was used to gather data from the supervisors of NHS programs who were invited to answer a questionnaire and set for a structured interview. The questionnaire consisted of two categories: the facility and test personnel, and the test protocol. The structured interview included two questions about these programs' opportunities and challenges. Results: Data were collected from 24 participants who represented 11 public and 13 private healthcare facilities in Riyadh. The results showed that nurses were the most test personnel who were primarily trained by audiologists. Less than half of NHS programs were supervised by audiologists. The combination of otoacoustic emissions and automated auditory brainstem responses was the most used test protocol. More than half of newborns who failed the first NHS were referred to audiology clinics within a month of the first screening. Most test personnel were not trained on how to counsel parents. The interview resulted in one core category, three themes, and 15 subthemes. Low parental awareness about the NHS was identified, with suggestions to educate parents on the NHS before and after the screening. Not all insurance companies include NHS in all their insurance classes. Conclusions: Establishing a tracking system and standardizing test protocols with a surplus of test personnel and equipment were identified as areas for improvement. The Council of Health Insurance in Saudi Arabia is recommended to include NHS as a mandatory screening for all patients in the private sector, either covered by insurance or cash-pay patients. [ABSTRACT FROM AUTHOR]

This mixed-methods study examines the marketing of, and toxic ingredients found in, common personal care products (PCPs) such as shampoos or deodorants that are sold in the United States. Through qualitative analyses of the messaging presented by PCP packaging and quantitative analyses of the prevalence of toxic ingredients by product and target consumer, we reveal what we term "toxic personal care": the usage of products sold to consumers as minimally necessary, and perhaps even beneficial, to their personal well-being through gendered messaging, yet introduce consumers to chemical toxicity. Supporting research on postfeminist sensibilities, we find that products marketed to women are no more likely to contain toxic ingredients than those marketed to men, nor do lower-priced products contain more toxic ingredients. Instead, product descriptions perpetuate a "cult(ure) of confidence" that not only encourages the usage of PCPs equally across women and men through drawing from traditional gendered stereotypes, but also masks the similarities in ingredients and toxins. These findings have implications for understanding consumption, well-being practices, gendered marketing, and constructions of confidence in the United States, including monetary and possible health costs to consumers. [ABSTRACT FROM AUTHOR]

Drawing from theories of affect, role strain and stress processes, we studied the impact of raising grandchildren on older mothers' relationships with the adult offspring whose children they raised, with particular attention to how these patterns differ by race and ethnicity. We used mixed-methods data collected from 531 older mothers regarding their relationships with 1935 of their adult children as part of the Within-Family Differences Study. Multilevel regression analyses showed that raising grandchildren was associated with greater mother-adult child closeness in Black families; however, in White families, raising grandchildren was associated with greater mother-adult child conflict. Qualitative analyses revealed that these differences could be explained by the tendency of Black grandmothers to emphasize positive aspects of raising grandchildren, compared to White grandmothers, who viewed raising grandchildren as demanding and who described their exchanges with their adult children as unequal. Overall, our findings reflect racial and ethnic differences in intergenerational solidarity. [ABSTRACT FROM AUTHOR]

This study examines the relationships among Foreign Language Learning Enjoyment (FLLE), L2 grit, academic burnout, and motivated behavior in English as a Foreign Language (EFL) learners, using a mixed-methods approach. A total of 534 Chinese undergraduate EFL learners participated in the quantitative phase, which used a cross-sectional survey, followed by narrative inquiry with 15 participants in the qualitative phase. Structural Equation Modeling (SEM) analysis revealed that FLLE positively influenced motivated behavior while reducing academic burnout. L2 grit mediated the relationships between FLLE, burnout, and motivation, indicating that enjoyment promotes perseverance and resilience. Burnout was found to negatively impact motivation, underscoring the role of emotional well-being in maintaining engagement. The qualitative findings further supported these results, offering insights into learners' experiences of joy, perseverance, and recovery from burnout. Participants described how moments of enjoyment reignited their long-term motivation, while grit helped them persevere through challenges. Burnout was linked to emotional exhaustion, but positive experiences often helped restore motivation. These findings offer a deeper understanding of the emotional and psychological factors influencing language learning success. The study provides important implications for educators, highlighting the need to create positive learning environments, promote resilience, and address burnout to support students' sustained commitment to language learning. [ABSTRACT FROM AUTHOR]

Background: Low back pain is a common musculoskeletal condition which causes substantial disability globally. The biopsychosocial model of management has been recommended in national and international guidelines for the management of patients with chronic low back pain (CLBP). However, biopsychosocial approaches are predominantly delivered in high income countries (HICs), although the prevalence of LBP is substantially higher in low- and middle-income countries (LMICs) especially in Africa (39%; 95% CI 30–47). Understanding the effectiveness of BPS interventions in LMICs especially in Africa is underexplored, with substantial inequity between research from HICs and LMICs. Ghana is a LMIC where the effectiveness of biopsychosocial interventions has been underexplored. Therefore, the aim of this study was to explore the feasibility of delivering a physiotherapist-led BPS programme for the management of patients with CLBP in Ghana. Methods: This was a mixed-methods, sequential, pretest-posttest feasibility study. Participants involved thirty patients with CLBP. The biopsychosocial intervention involved an exercise and patient education programme based on principles of cognitive behavioural strategies with emphasis on self-management. The biopsychosocial intervention was delivered for six weeks for each participant. Feasibility outcomes regarding management and processes were captured pre-intervention, post-intervention, and three-months post intervention. Semi-structured interviews were conducted post-intervention to explore participants' experiences with the biopsychosocial intervention. Patients' demographics were collected at baseline. Patient reported outcome measures such as intensity of pain, disability, pain catastrophising, kinesiophobia, self-efficacy, and general quality of life, were collected pre-intervention, post-intervention and at three-months follow-up. Qualitative analysis explored participants' experiences regarding the acceptability of the biopsychosocial intervention. Results: The results of this feasibility study demonstrated that the training programme was acceptable to physiotherapists. Recruitment rate (5 patient participants per week − 100% recruitment met), retention rate post-intervention (90%), data completion rate post-intervention (99.8%) and intervention fidelity (83.1%), all met feasibility thresholds. There were no adverse events. Qualitative data also demonstrated that the biopsychosocial intervention was acceptable to participants. Conclusion: This study has established the potential to deliver a biopsychosocial intervention programme in a Ghanaian hospital setting. This biopsychosocial intervention therefore shows promise, and the result of the study provides a platform to develop future clinical studies. [ABSTRACT FROM AUTHOR]

Background: Tanzania, like most low- and middle-income countries, is facing an increasing prevalence of obesity in the general population, including among women of reproductive age. Excess weight pre-pregnancy is a risk factor for the onset of gestational diabetes mellitus (GDM), which is associated with several poor pregnancy outcomes. Screening for GDM, as a primary preventive measure, is not systematically done in Tanzania. This study aims to explore current practices of screening for GDM during routine antenatal care (ANC), estimate the prevalence of GDM among ANC users and compare the performance of two commonly used GDM screening algorithms. We will then explore the best ways for implementing a functional screening practice for GDM at primary level hospitals using perspectives of health care workers, health managers, and pregnant women. Methods: This will be an observational cross-sectional study design with sequential mixed-methods approach conducted in ANC clinics of two primary level hospitals: Kisarawe District Hospital in Coast region and Mbagala Rangi Tatu Hospital in Dar es Salaam region, Tanzania. Quantitative data will be collected to determine the current structural capacity and screening practices for GDM, the prevalence of GDM among ANC users, and the sensitivity and specificity of the two recommended screening algorithms. Qualitative data will be collected through key informant interviews with health managers and pregnant women and focus group discussions with healthcare workers to understand the rationale, challenges, possible solutions and benefits of the used screening algorithm. We will also explore the meaning of screening/diagnosis to pregnant women, and propose a functional GDM screening algorithm informed by users (i.e. pregnant women, health managers and care workers). Discussion: ANC is an entry point for pregnant women to access preventive services including screening for GDM. When done appropriately, GDM screening would reduce undesired outcomes attributed to GDM also beyond the pregnancy period. Through this study we will understand the bottlenecks and propose evidence to inform feasible ways to overcome them and establish a functional and standardized GDM screening service. [ABSTRACT FROM AUTHOR]

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Recent reports show that low-income students make up a significant share of those participating in higher education, and their well-being constitutes a key factor that influences their college success. This mixed-methods study examined first-year, low-income students' time use and its relationship to well-being framed by an equity-oriented lens that recognizes the time constraints low-income students navigate. Our mixed methods findings identified the link between time use and well-being and—critically—empirical explanations for these links. First, leveraging a unique experience sampling survey design and multilevel analyses, we found that attending class, studying or doing homework, and working for pay were consistently and adversely related to low-income students' well-being. Low-income students who were also first-generation in college fared worse than continuing-generation students when engaging in these experiences. On the other hand, socializing was positively related to low-income students' well-being. Second, an exploration of longitudinal data from hundreds of student interviews illuminated two primary factors that shaped the relationship between low-income students' time use and well-being: (a) structuring time and developing a routine, and (b) the power of reflection and meaning-making. These findings provide important novel insights about low-income students' college experiences and the relationship between their time use and well-being, and offer crucial guidance for educators on how to support low-income students' well-being as they navigate college. [ABSTRACT FROM AUTHOR]

Aim: To assess a commercially available electronic whiteboard's usability and acceptability in isolation rooms, focusing on improving nurse–patient communication and supporting data input. Design: A cross‐sectional study with quantitative and qualitative mixed methods. Methods: We evaluated the usability and acceptability of electronic whiteboards among nurses using scenarios in a virtual isolation room environment. Results: Nurses recognised the electronic whiteboard as a valuable tool for communication and error reductions in record‐keeping but noted a learning curve for less tech‐savvy users. Positive correlations were found between perceived usefulness, ease of use and adoption intent. Despite challenges, electronic whiteboards show promise for enhancing patient care, requiring comprehensive training and management systems. Time allocation in patient wards and nurse–patient interactions are crucial considerations. Conclusion: Electronic whiteboards have usability and acceptability as a tool to improve nurse–patient communication. However, considering technical issues and staff resistance, a management system and user training are necessary. Implications for the Profession and/or Patient Care: Nurses perceive electronic whiteboards as user‐friendly and as facilitating data input. Reporting Method: TREND (Nonrandomised evaluations of behavioural and public health interventions). Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities. Design: Mixed‐methods explanatory sequential. Methods: In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web‐based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper‐and‐pencil questionnaire. Twenty semi‐structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays. Results: Participants spent approximately one‐quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision‐making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care. Conclusion: Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions. Impact: This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills. Reporting Methods: MMR checklist. Patient/Public Contribution: None. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the feasibility of a workplace-delivered outpatient multidisciplinary service (ReCOV) for staff experiencing post COVID-19 condition ('Long COVID'). Methods: A mixed-methods study of staff at a large, tertiary hospital with Long COVID who attended the service was conducted. Participants completed questionnaires to determine baseline symptoms and were offered allied health appointments for up to 12 weeks each based on clinical indication. Acceptability, implementation, practicality and limited efficacy were evaluated via one-on-one semi-structured interviews and analysed using inductive thematic analysis. Limited efficacy was evaluated via pre- and post-questionnaires and demand via multidisciplinary utilisation. Results: Twenty-three (median age 37 [interquartile range 30–45] years, 52% female) participants were included. Participants had appointments with a median of 4 [3–5] different professions; most commonly exercise physiology (n = 19, 83%), occupational therapy (n = 17, 74%) and neuropsychology (n = 15, 65%). Median time spent on the ReCOV service was 15 [9–19] weeks. Thirteen semi-structured interviews were completed and analysed. Participants valued ReCOV for being a COVID-19 specific, convenient, flexible and multidisciplinary service at their workplace. Participants preferred the service to have been available for longer than 12 weeks to achieve further benefits as many participants perceived little change in physical health. Conclusions: Attending a multidisciplinary service located at their workplace was feasible for staff to manage post COVID-19 symptoms. Further research is required to confirm the efficacy on patient outcomes. What is known about the topic? Self-management strategies and multidisciplinary rehabilitation with self-monitoring are considered best practice for treatment of Long COVID. What does this paper add? A workplace delivered outpatient multidisciplinary service was feasible in terms of demand, acceptability and practicality and provided valued support for hospital staff experiencing Long COVID. What are the implications for practitioners? A flexible, workplace delivered multidisciplinary service was acceptable and convenient to hospital staff with Long COVID. Further research is required to confirm the effectiveness of such a service on patient outcomes. [ABSTRACT FROM AUTHOR]

The AI-enabled intelligent learning system (AEILS) is able to provide personalised and intelligent tutoring and is more capable of meeting individuals' need. Nevertheless, limited studies focused on the effect of AI-specific factors on user behaviour. To fill this research gap, we identified the AEILS-specific affordances (i.e. interactivity, personalisation, competition, convenience) and explored their effect on user engagement and foreign language speaking anxiety (FLSA). In this paper, we integrate quantitative and qualitative studies to explore user behaviour in AEILS. Survey data was collected from 457 respondents and analysed using structural equation modelling with the smart-PLS software. The results showed that AEILS-specific affordances significantly affect flow experience and self-expansion, thus facilitating user engagement and alleviating FLSA. Semi-structured interviews were conducted to corroborate the findings of the quantitative study. These findings highlighted the importance of technology affordance in AEILS. This study contributed to the literature on IS and education by incorporating context-specific factors into account. [ABSTRACT FROM AUTHOR]

The surge of emojis in computer-mediated communication (CMC) since 2011 presents a significant analytical challenge across various disciplines, such as linguistics, neurophysiology, psychology, computer science, and marketing. Departing from earlier works that exclusively utilized Natural Language Processing (NLP) techniques or engaged in the analysis of experimental or selectively curated social media texts, this study embraces a broader linguistic scope. By integrating NLP extraction and linguistic analysis of emojis within a specific language, in a one-to-one CMC corpus, this paper delivers an extensive examination of emoji usage in Mexican Spanish WhatsApp messages, uncovering underlying cultural nuances, gender differences, and a variety of pragmatic functions. The corpus contains 1,487,503 messages from a gender-balanced group of male and female participants finding that females used emojis in 17% of messages, whereas males used them in 11%. Comparing emoji usage trends revealed that while most commonly used emojis usually reflect global patterns, some culture-specific deviations exist. Out of 1049 distinct emojis, 34 were deemed significant in predicting gender-based usage, taking into account a minimum occurrence (0.8% of messages). Variables like message length, emoji positioning, and sentiment were also analyzed. This study also examines emoji Mexicanisms and employs a semiotic approach to emojis under the framework of Peirce's theory. Additionally, a structured codebook that categorizing emoji functions is provided. Employing a mixed-methods approach, this study elucidated gender-based variations in emoji usage patterns across various functions, including discourse management, substitution, and reiteration. [ABSTRACT FROM AUTHOR]

The unprecedented complexity of today's business and working environment increases the need for leaders and employees to learn new skills, be adaptable, and open to embracing change. New abilities and mindsets emerge, and their evaluation is challenging. This research utilized an exploratory sequential mixed methods design to develop and provide a preliminary validation of a scale measuring individual differences in learning agility (LA) at work. The measure has been tested in Central‐Eastern European countries, Italy, and Egypt. Results showed satisfactory reliability and nomological validity. The final scale of 11 items provides HRD researchers and practitioners with a reliable and concise tool suitable for investigating individual differences in LA across different job roles and positions. The scale has been tested in a cross‐cultural setting and is available in English, making it especially appropriate for multinational contexts. [ABSTRACT FROM AUTHOR]

Along with the global trend of developing students' 21st-century skills, teacher education must enable preservice teachers (PSTs) to improve students' learning outcomes with Information and Communications Technology (ICT), and school practicum plays an essential role in the process. This study investigated Hong Kong PSTs' ICT competency with or without teaching practicum completed and explored factors contributing to ICT competency in and beyond the practicum. This mixed-methods study began with a questionnaire to give a broad picture of the ICT competence of Hong Kong PSTs of English (N = 127), who were found to perceive themselves as competent with educational technology and their competencies of understanding ICT related policy and using ICT for professional development was enhanced after school practicum. A purposeful subset of the sample (N = 10) was interviewed based on their ICT competency scores, exploring the factors shaping interviewees' readiness and ICT use in their teaching practicum. It highlights that digital native students do not naturally transform into teachers with ICT competency to facilitate 21st-century learning, and the practicum could play a more critical role in enhancing their ICT competence to future-proof their skills. Promoting ICT-friendly school culture and designing better teaching practicum programmes are suggested. [ABSTRACT FROM AUTHOR]

Safety climate has been extensively studied using survey-based approaches, providing significant insights into safety perceptions and behaviors. However, understanding its dynamics in construction projects requires methods that address temporal and trade-specific variability. This study employs a longitudinal, mixed-methods design to explore safety climate dynamics. Quantitative data analyzed with ANOVA revealed stable overall safety climate scores across project phases, while Item Response Theory (IRT) identified survey items sensitive to safety climate changes. Positive perceptions were associated with management commitment and regular safety meetings, while negative perceptions highlighted challenges such as workplace congestion and impractical safety rules. Qualitative data from semi-structured interviews uncovered trade-specific and phase-specific safety challenges, including issues tied to site logistics and workforce dynamics. For instance, transitioning from structural to interior work introduced congestion-related risks and logistical complexities, underscoring the need for phase-adapted strategies. This combination of quantitative stability and qualitative variability provides empirical evidence of safety climate dynamics in construction. The findings emphasize the importance of tailoring safety interventions to address trade-specific and phase-specific risks. This study advances the understanding of the safety climate in dynamic work environments and offers actionable recommendations for improving construction safety management through targeted, proactive strategies. [ABSTRACT FROM AUTHOR]

This study investigates the degree to which pre-service interdisciplinary groups of undergraduate education candidates recognize co-teaching skills and behaviors in practice. With the increasing emphasis on collaborative teaching models in contemporary educational settings, understanding how future educators perceive and identify effective co-teaching practices is crucial for enhancing educational preparation programs (EPPs). Using a mixed-methods approach, this study analyzed consensus ratings from an interdisciplinary assignment that asked candidates to work collaboratively while identifying best practices in co-teaching across example and non-example videos. Both quantitative and qualitative data were collected using student ratings and videos of group discussion for consensus scoring. Quantitative data were collected using consensus ratings for each indicator on the observation checklist. Qualitative data derived from video transcripts of the consensus rating sessions illuminated the process each group used and reasons each group provided for consensus ratings. The findings reveal varying degrees of recognition and understanding of co-teaching skills, highlighting both strengths and areas for improvement in the candidates' ability to identify and apply these practices. This study provides valuable insights into the preparedness of pre-service educators for collaborative teaching environments and offers recommendations for integrating co-teaching competencies more effectively into EPPs. [ABSTRACT FROM AUTHOR]

"Ariadne's thread" is a psycho-educational intervention designed by the Breast Unit and the Clinical Psychology Unit of an Italian Comprehensive Cancer Center and aims to promote empowerment in patients with metastatic breast cancer. It consists of 8 online meetings led by a psycho-oncologist in which informative sessions by patients' referring physicians alternate with moments of stress management techniques. This study aims to investigate (1) the feasibility of the "Ariadne's thread" pilot intervention and (2) the satisfaction and perceived benefits of the pilot intervention. We used a mixed method approach in which (1) it was detected: the number of acceptance to the single session of the intervention by both patients and professionals, the number of help requests by patients, and the number of change of date requests by professionals; (2) semi-structured interviews were conducted with the professionals who participated in the intervention; (3) 2 focus groups were conducted with patients, and (4) a questionnaire was submitted to each of them. The intervention is sustainable from the perspective of the organization, professionals, and patients. In particular, the patients declared perceiving benefits in many aspects: improved relationships with doctors, acceptance of their illness, learning of a relaxation technique, possibility to look at the world with trust and hope, etc. The questionnaires show an improvement in empowerment and satisfaction as a result of the intervention. "Ariadne's thread" is a psycho-educational intervention that effectively addresses the needs of patients with MBC. It can be applied to other contexts (1) if it has been confirmed that similar needs exist or (2) if it can be modified to accommodate other needs. [ABSTRACT FROM AUTHOR]

BACKGROUND: To improve the sustainable employability (SE) of employees in low-skilled jobs, there is an urgent need to implement more effective approaches for this group. OBJECTIVE: This evaluation study aimed to get insight into the effect and implementation process of an organisational intervention called 'Healthy HR' (HHR), which promoted the job control and SE of employees in low-skilled jobs in two Dutch organisations. METHODS: An effect evaluation with a pretest-posttest design and a mixed-methods process evaluation were conducted. Quantitative data were collected at baseline (N = 120) and at 12 months' follow-up (N = 71). Paired t-tests and dose-response analyses were performed (N = 50). Mixed-methods process data were collected on the implementation process using questionnaires, individual interviews with employees and employer representatives (N = 26), focus groups (N = 4) and logbooks. RESULTS: A positive effect was found for job control at 12 months' follow-up. An effect on the distal outcome SE was not significant. The dose-response analysis showed that a higher dose of HHR resulted in better job control. This positive effect was supported by the qualitative process analysis. HHR had a positive impact on the awareness level about health and healthy workplaces among all stakeholders. CONCLUSIONS: This study showed a promising participatory approach to improve job control for employees in low-skilled jobs by actively involving them in a genuine dialogue and giving them an active voice. Effects on SE might require a longer follow-up. [ABSTRACT FROM AUTHOR]

The increase in greenhouse gas emissions prompts the transport sector towards new technological perspectives on personal mobility. Addressing sustainable mobility through electric micromobility requires interdisciplinary design research methods and approaches. In the context of the LEONARDO project, funded under the Horizon 2020 framework, this paper addresses a critical literature review on the design thinking, design research models, tools, and mixed methods to be undertaken for driving product mobility innovation in a cross-disciplinary context. Following the "research through design" research strategy, the authors applied the Double-Diamond design thinking model to frame the design research process in four phases, aligning with three overarching objectives, four specific research objectives, and 24 research tasks, supported by a total of 71 mixed methods and tools. As a result, the transdisciplinary process provides a co-designed energy-efficient stand-alone microvehicle and a scalable interdisciplinary design model for urban transport product innovation. In conclusion, this case study suggests the value of the Double-Diamond design thinking model as a design research instrument capable of addressing sustainable mobility and guiding interdisciplinary design research, design practice, and education in the industrial engineering and design disciplinary sectors. [ABSTRACT FROM AUTHOR]

Introduction: Invasive meningococcal disease (IMD) has a low incidence but is a life-threatening illness with a 10–15% mortality rate. Even with timely treatment, survivors may experience acute and long-term health complications. While meningococcal vaccines are recommended for adolescents and young adults in the USA, vaccination coverage remains uneven across serotypes. This study investigated the physical, social, psychological, and economic burden of IMD on survivors and their caregivers in the USA during the acute phase (Part 1, presented in this manuscript) and the long-term phase (Part 2, presented in a separate manuscript) of IMD. Methods: This study implemented a non-interventional, mixed-methods approach using a bespoke survey and qualitative interviews (designed on the basis of a preliminary conceptual model of IMD) with US survivors and their caregivers. Results: A total of 11 survivors (1 adolescent, 10 adults) and 3 caregivers participated in the study. Survivors contracted IMD during infancy (n = 2), childhood (n = 3), or adulthood (n = 6), and often described leading healthy lives pre-IMD. At IMD onset, interactions with the healthcare system impacted participants' experiences; confusion and care delays were common, and procedures were often invasive (e.g., amputations). Survivors commonly experienced symptoms including skin rash (7/11), fever (6/11), and unconsciousness (6/11), consistent with caregivers' reports. Survivors able to report on the short-term impacts of IMD (n = 9) described functional limitations (9/9), emotional impacts (6/9) such as fear and trauma, and school (6/9), work (4/9), and financial (5/9) challenges. Caregivers also experienced emotional impacts (3/3) and family (2/3), work (3/3), and financial (3/3) impacts during the acute phase. Conclusions: IMD places a significant humanistic burden on survivors and their caregivers during the acute phase. Results from Part 1 of this study indicate a need for increased disease awareness and healthcare provider education, expeditious diagnosis, and improved access to prevention methods such as available meningococcal vaccines. A video abstract is available with this article. 7CedpUhoy_P6EE5C2Mz6-e Video abstract (MP4 1,24,432 kb) Plain Language Summary: Invasive meningococcal disease (IMD) is an uncommon but serious infection. Even with treatment, IMD is deadly for up to 10–15% of people who get sick, and survivors may experience short-term and long-term health problems. While IMD can be prevented through vaccination, many people are not vaccinated. We asked 11 survivors and 3 of their caregivers in the USA about their experiences with IMD during the time of their infection and initial recovery (the "short term"). We were particularly interested in the symptoms that survivors experienced, their diagnosis and treatment experiences, and the impact on survivors' and caregivers' quality of life. Most survivors described leading healthy lives before getting sick. Severe skin rash, fever, and unconsciousness were common symptoms when survivors got the infection. Most participants were admitted to the hospital when symptoms started (many through the emergency room). However, not everyone was diagnosed quickly or accurately, and many experienced delays in receiving care. Treatments could be drastic, such as immediate surgery to remove arms or legs. Survivors and caregivers described feeling scared and traumatized, and many experienced challenges with day-to-day activities. Healthcare-related expenses and the inability to attend school or work led to financial challenges for some. The burden of IMD infection and initial recovery is significant. There is a need for increased public disease awareness, targeted education for healthcare providers, and improved access to prevention measures such as vaccination. The long-term effects of IMD infection were also explored in this study, and are presented in another paper [1]. [ABSTRACT FROM AUTHOR]

Introduction: Invasive meningococcal disease (IMD) has a low incidence but is a life-threatening illness that is preventable via vaccination. Even with treatment, up to 10–15% of cases are fatal, and many survivors may experience severe long-term sequelae. Building upon the acute-phase findings presented in the Part 1 manuscript for this study, we describe the long-term physical, social, psychological, and economic burden of IMD on US survivors and their caregivers in this Part 2 manuscript. Methods: This was a novel, non-interventional, mixed-methods study among US survivors and their caregivers using a bespoke survey and qualitative interviews. Results: Ten adult survivors, one adolescent survivor, and three caregivers participated in this study. Survivors described extensive physical, neurological, and systemic sequelae, including difficulty walking (11/11), repeat secondary infections (9/11), and numbness (6/11), among others, which were echoed by caregivers. Survivors shared that IMD had negatively impacted their long-term quality of life, citing long-term impacts including emotional impacts (11/11), social impacts (10/11), memory (7/11) and attention (5/11) problems, and difficulty with functional (10/11), self-care (7/11), and physical (6/11) activities. Caregivers were also impacted, describing emotional trauma (3/3), sleep problems (2/3), and day-to-day challenges (2/3). Long-term financial challenges related to healthcare resource utilization were substantial, with specialized care and rehabilitation therapy expenses (11/11), insurance challenges (8/11), and high out-of-pocket costs (6/11) for survivors. Productivity losses were also commonly described by survivors (9/11); sequelae hindered ability to attend school (9/11) or work full time (8/11). Caregivers (2/3) described taking leave from their employment, affecting family income. Conclusions: The humanistic burden of IMD on survivors and their caregivers is substantial and persistent. A comprehensive approach, including preventative measures (e.g., vaccination) and long-term medical, psychological, and financial support for those affected, is needed to mitigate the burden of IMD. A video abstract is available with this article. -99uXpJYNLEniKmRRZ2d4e Video abstract (MP4 1,17,430 kb) Plain Language Summary: Invasive meningococcal disease (IMD) is an uncommon but life-threatening disease that can lead to serious long-term health problems and impacts on quality of life. We conducted this study to understand the experiences of survivors of IMD and their caregivers in the USA. In a previous paper, we described the experiences of 11 survivors and 3 caregivers during the time of IMD infection and initial recovery (the "short-term") [1]. Here, we continue to follow the journeys of those survivors and caregivers, and explore the health complications and impacts of IMD that persist long after initial recovery. Survivors experienced long-term physical, neurological, and systemic health problems due to IMD, such as difficulty walking, repeat infections, and numbness. Many shared that their quality of life had been negatively affected by IMD, describing memory and attention problems, social challenges, emotional trauma, and difficulty with daily activities. Caregivers were also impacted, experiencing sleep problems, distress, and day-to-day challenges. Even with insurance, specialized medical care and therapies were expensive and led to long-term financial challenges. Many survivors also found it difficult to attend school or work full-time because of their health limitations. Caregivers' ability to work was also limited because of caregiving needs, affecting ability to earn income. IMD places a heavy, long-term burden on survivors and their caregivers, and understanding the lived experiences of those affected is crucial. In addition to prevention (such as through vaccination), comprehensive, long-term medical, psychological, and financial support is needed to reduce the burden of this disease. [ABSTRACT FROM AUTHOR]

Purpose: To quantitatively assess changes in recovery of people recovering from COVID-19 treated by a primary care allied health professional, and to qualitatively describe how they dealt with persistent complaints. Materials and methods: This mixed-methods study is part of a Dutch prospective cohort study, from which thirty participants were selected through purposive sampling. Quantitative data on recovery were collected at start of treatment and 6 months. Additionally, by use of semi-structured interviews participants were asked on how persistent complaints influenced their lives, and how they experienced received primary care allied health treatment. Results: Despite reported improvements, most participants still experienced limitations at 6 months. Hospital participants reported a higher severity of complaints, but home participants reported more diverse complaints and a longer recovery. Most participants were satisfied with the primary care allied healthcare. Tender loving care and a listening ear, learning to manage limits, and support and acceptance of building up in small steps were perceived as contributing most to participants' recovery. Conclusion: Although improvements were reported on almost all outcomes, most participants suffered from persistent complaints. Despite these persistent complaints, many participants reported being better able to cope with persistent complaints because they had decreased substantially in their intensity. Trial registration: Clinicaltrials.gov registry (NCT04735744). IMPLICATIONS FOR REHABILITATION: Participants recovering from COVID-19 receiving treatment from primary care allied health professionals reported improvements after 6 months, but still experienced persistent complaints. Home participants reported more persistent complaints and a longer recovery from COVID-19 than hospital participants. Personal attention for patients recovering from COVID-19 is necessary. Next to implementing a treatment plan (e.g. physical exercise), primary care allied health professionals should also pay attention to listening to the patient's story and offering support. Interprofessional collaboration between primary care allied health professionals, with a unified message to patients, is essential. [ABSTRACT FROM AUTHOR]

The worldwide population of migrant families is on the rise, and there is growing acknowledgement of the significance of supporting parental mental health within these families. However, understanding of the experiences of migrant fathers during the perinatal period remains incomplete. The objective of this review is to provide an overview of existing research on perinatal migrant fathers' experiences in different cultures. Multiple searches were conducted in April 2023 for quantitative, qualitative, and mixed-methods studies across six electronic databases: Medline, CINAHL, Embase, PsycINFO, Web of Science, and Scopus. Fourteen eligible articles were identified, including nine qualitative studies, five quantitative studies, and no mixed-methods studies. The Mixed-methods Appraisal Tool was used to assess the quality of these studies. The quantitative findings were transformed into narrative summaries to be analysed thematically along with the qualitative data. Three themes were identified: (1) Cultural competence (dealing with cultural differences, needs related to original country); (2) Parenthood in a new country (challenges and adaptation to fatherhood, challenging traditional gender norms, lack of extended family and building new support networks, being the main supporter for the family); (3) Needs of the fathers and their personal difficulties. The findings of this review suggest a direction for future research in perinatal psychology. The review also provides insights into the need for social and community support for migrant fathers and how healthcare services can support this group during the perinatal period. [ABSTRACT FROM AUTHOR]

Purpose: This research analyzes the effects of a Service-learning program on the development of civic attitudes and skills on preservice teachers (n = 98). They provided a direct service of motor sessions aimed at children with functional diversity. Method: The topic was approached using a mixed methodological approach. A pre- and posttest quantitative analysis was performed on the results obtained after applying the Civic Attitudes and Skills Questionnaire, and a qualitative analysis was performed on the content of follow-up journals. Results: The quantitative results indicated a significant positive posttest, and qualitative analysis explained the civic skills and attitudes that the preservice teachers acquired. Discussion/Conclusion: Service-learning is a useful method for promoting the civic attitudes and skills of preservice teachers. The acquired learning specifically affected the different dimensions involved in achieving meaningful learning, an improvement in the skills and attitudes that are essential characteristics of an inclusive teacher. [ABSTRACT FROM AUTHOR]

Purpose: Acupuncture for cancer care is safe and effective and can be provided in group or individual settings. Previously, group acupuncture (GA) has been compared with individual acupuncture (IA) for specific cancer-related symptoms or patient experience, but has not correlated symptoms with patient experience between GA and IA. This service evaluation, using a mixed-methods design, aimed to compare GA with IA for symptom-related outcomes, and patients experience and explore their inter-relationships, in order to inform future development of the service. Methods: Cancer patients referred to the acupuncture service in a UK NHS hospital received six treatments of GA or IA. Outcomes were gathered using Measure Yourself Concerns and Wellbeing (MYCaW) questionnaires pre- and post-treatment. Experience of acupuncture was gathered post-treatment using a questionnaire and analysed using reflexive thematic analysis. Results: Forty-eight participants’ data were analysed. There were statistically significant improvements in outcomes overall, with no difference between GA and IA. Most participants had a positive experience; IA participants focused more on the relationship with their acupuncturist, whilst GA participants focused more on environmental factors. For a few GA participants, the group experience was negative, but data synthesis revealed this did not impact symptom-related outcomes. Conclusion: In both GA and IA arms, symptom-related outcomes mostly improved alongside a positive experience. For those participants for whom GA was not an ideal setting, there was no effect on symptom-related outcomes. These results may be of relevance when establishing acupuncture services in supportive cancer care settings. [ABSTRACT FROM AUTHOR]

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Unequal representation can result from politicians' biased perception of public opinion. Existing research has focused on the numerical accuracy with which politicians estimate preferences distributions in surveys. This method ignores politicians' broader assumptions about public preferences; e.g. regarding their crystallization, salience, malleability, and measurability in surveys. We address these assumptions in a novel two-stage research design using redistributive tax policy in Germany as a case. Interviews with parliamentarians show that voters are perceived as uninformed, disinterested, and susceptible to anti-tax mobilization by business representatives. Support for taxing the rich in polls is dismissed as superficial and irrelevant for political behavior. In a second step, we verify these assumptions in twelve focus groups with high- or low-educated citizens. They largely confirm the assumed indifference and anti-tax attitudes. An education gap in tax preferences cannot be identified. Support expressed in previous surveys tends to disappear in conversations, which aligns with politicians' experiences. [ABSTRACT FROM AUTHOR]

Firms can leverage social media brand communities (SMBCs) to manage consumer relationships. This study investigated firm engagement tactics using a mixed-methods approach with qualitative (Study one) and quantitative (Study two) analyses. Building on uses and gratifications theory and the qualitative results, we identify brand-specific consumer education, reputation enhancement, incentives provision, interaction support, and entertainment support as firm engagement tactics. Next, we explore the moderating effect of firm engagement tactics on the SMBC identification/SMBC engagement and SMBC engagement/brand loyalty relationships using the partial least squares method. The results confirm that consumer engagement mediates the link between SMBC identification and brand loyalty. In addition, firm engagement tactics positively moderate the aforementioned relationships. The theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Background: In the UK, over 7,000 people are on the waiting list for an organ transplant and there are inequalities in need, access and waiting time for organs, with notable differences between minority ethnic groups. In May 2020, England changed the law and introduced a 'soft' opt-out system of consent to organ donation with a view to increase consent rates. We aimed to learn more about the impact of the law change on attitudes and views likely to be relevant to consent to deceased organ donation between different population subgroups. Methods: Mixed-methods design involving latent class analysis of data from twelve repeated cross-sectional surveys undertaken from 2015 to 2021 (n = 19,011); analysis of the law change survey dataset collected quarterly from 2018 to 2022 (n = 45,439); and interviews with purposively selected members of the public (n = 30) with a focus on minority perspectives. Results: Support for the principle of deceased organ donation remained high and stable in the general population (80%) but was 20% lower among ethnic minorities. From 2018 to 2022, an average of 58% of the general population was aware of the law change; this was lower among minority ethnic groups (31%). We identified four population subgroups (supportive donors (24% of the population); unengaged donors (22%); uncommitted donors (46%); and unsupportive donors (9%)). Interview themes included the challenges of discussing organ donation decisions, balancing autonomy with respecting family relationships, targeted misinformation, frustrations at the lack of consensus between community leaders, limited understanding of what happens during the end-of-life care leading to organ donation, and how this aligns with cultural values and preferences. Conclusion: Implementation of the law change has not been associated to date with any change in public attitudes and preferences likely to influence consent overall or in minority ethnic groups in England. Uncommitted donors may benefit from encouragement to express their organ donation decision, and unengaged donors from attempts to address mis/information, confusion, and uncertainty. Interventions to raise the consent rate need to take account of the significant role of the family as well as wider community influences on attitudes, preferences and decision-making, particularly among certain minority (ethnic) groups. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the influence of teacher job embeddedness, collective efficacy, and work meaningfulness on the psychological well-being of Chinese teachers. The focus is on understanding how these constructs contribute to teacher well-being through a mixed-methods approach. Methods: A two-stage structural equation modeling (SEM) analysis was conducted using quantitative data collected from 406 in-service Chinese teachers. The study also incorporated a qualitative phase involving digital ethnography within online teaching communities to provide deeper insights into teachers' experiences. Results: The quantitative analysis revealed significant positive direct effects of job embeddedness, collective efficacy, and work meaningfulness on psychological well-being, with work meaningfulness showing the strongest effect. The mediating role of work meaningfulness partially explained the relationships between job embeddedness, collective efficacy, and teacher well-being. The qualitative findings supported and expanded upon these results, emphasizing the role of a supportive school community and strong administrative leadership. Discussion: The results suggest that enhancing job embeddedness, collective efficacy, and work meaningfulness can significantly contribute to teachers' psychological well-being. These findings provide actionable insights for school leaders and policymakers in the Chinese educational system to foster environments that promote teacher well-being. [ABSTRACT FROM AUTHOR]

Background: Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study's goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. Methods: This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Results: Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients' mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient's death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, "It is not the fault of the health care team - it is the way the system works." Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, "It seems like everything is like an isolated incident... there's no overall, big picture viewpoint." (2) Administrative burdens, "In the end I gave up [scheduling care] because I was tired of calling." (3) Financial burdens, "This oncologist wanted to put him on a drug...but it was $4000 a month." Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. Conclusions: These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families. [ABSTRACT FROM AUTHOR]

Background: The efficacy of lung cancer screening (LCS) to reduce lung cancer specific mortality is heavily dependent on adherence to recommended screening guidelines, with real-world adherence rates reported to be drastically lower than rates described in clinical trials. There is a dearth in the literature on reminder processes and clinical workflows used to address adherence and robust data is needed to fully understand which clinical set-ups, processes, and context enhance and increase continued LCS participation. This paper describes a protocol for an environmental scan of adherence and reminder processes that are currently used in LCS programs across the United States. Methods: This study will triangulate data using a 3-step explanatory sequential mixed methods design to describe mechanisms of current adherence and reminder systems within academic and community LCS programs to pinpoint clinic or system barrier and facilitator combinations that contribute to increased adherence. In step 1, surveys from a nationally representative sample of LCS programs will yield quantitative data about program structure, volume, and tracking/reminder processes and messages. After completion of the survey, interested LCS program personnel will be invited to participate in an in-depth interview (step 2) to explore current processes and interventions used for adherence at the participant and program level. Finally, in step 3, triangulation of quantitative and qualitative data will be completed through qualitative comparative analysis to identify combinations of components that affect higher or lower adherence. Discussion: This research advances the state of the science by filling a gap in knowledge about LCS program characteristics and processes associated with better adherence which can inform the development and implementation of interventions that are scalable and sustainable across a wide variety of clinical practice settings. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to establish the feasibility of delivering a structured post‐diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings. Design: A two‐phase explanatory mixed‐method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five‐part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self‐efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility. Methods: Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post‐programme and 3‐month follow‐up. Post‐programme semi‐structured interviews were conducted with dyads and programme facilitators. Results: Twenty‐nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members. Conclusion: Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow‐up time to 6 months. Impact: This study established the feasibility of registered nurses delivering a post‐diagnosis information and support programme for people living with early‐stage dementia or mild cognitive impairment and their informal carers in primary care settings.The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time.Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance.Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting. Reporting Method: The authors have adhered to the EQUATOR STROBE Statement. Patient or Public Contribution: A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation. [ABSTRACT FROM AUTHOR]

Introduction: As research on cognitive training methods for older adults with mild cognitive impairment (MCI) progresses, fully immersive virtual reality cognitive training (fi-VRCT) has shown promise in enhancing cognitive function. However, its effectiveness in improving instrumental activities of daily living (IADL) and fostering independence is still unclear. This study aims to address these uncertainties by developing and validating a fi-VRCT program focused on IADL, with the goal of enhancing both cognitive function and IADL performance in older adults with MCI. Methods and Analysis: This mixed methods program evaluation study consists of three phases: feasibility, intervention, and extension. In the feasibility phase, we will implement fi-VRCT in real-world community settings and invite 20 older adults with MCI to participate in a single training session. Participants will provide feedback through questionnaires and individual interviews. The intervention phase will involve a double-blind, cluster-randomized controlled trial with 52 older adults with MCI, who will be randomly assigned to either the fi-VRCT or control groups. Both groups will complete 16 sessions over eight weeks, with cognitive and functional performance assessed at various intervals. During the extension phase, feedback will be gathered from 26 participants who underwent fi-VRCT through focus group interviews and ongoing questionnaires. Quantitative and qualitative findings will be synthesized to refine the fi-VRCT program and elucidate training outcomes. Ultimately, fi-VRCT has the potential to enhance cognitive and functional abilities in older adults with MCI in community settings. Ethics and Dissemination: Ethical approval has been obtained from the Research Ethics Committee at National Taiwan Normal University (202312EM009). The research findings will be disseminated through reputable, peer-reviewed journals and professional international conferences to engage and inform academic and clinical audiences. Trial Registration: NCT06392412. [ABSTRACT FROM AUTHOR]

This study explores the relationship between language competence and intercultural communicative competence (ICC) among English as a Foreign Language (EFL) learners through a mixed-methods approach. A sample of 196 Chinese EFL learners was divided into three proficiency groups (low, intermediate, and high), with data collected through Likert-scale questionnaires and semi-structured interviews involving 16 participants. Quantitative analysis revealed that higher language proficiency is linked to improved overall ICC scores and its specific dimensions. The Kruskal-Wallis H test confirmed significant differences in overall ICC, attitude, and skill across proficiency levels, with attitude showing the strongest effect. Spearman's correlation analysis demonstrated small but significant positive correlations between English proficiency and overall ICC, attitude, and skill. Qualitative findings further enriched the quantitative results, emphasizing the foundational and catalytic role of language competence in enhancing ICC and its dimensions. However, participants acknowledged that language competence alone is insufficient for fully successful intercultural interactions. This study expands Byram's model by offering detailed insights into the intricate relationship between language competence and various ICC dimensions. The study recommends that to fully cultivate ICC, it is essential to integrate the development of language competence into instructional practices. [ABSTRACT FROM AUTHOR]

Purpose: Adaptive sports participation has been shown to improve quality of life (QoL) in individual with disabilities. However, inconsistent results in various domains of QoL exist in the literature. The objective of this mixed-methods systematic review is to identify and synthesize evidence from quantitative and qualitative studies on the effect of adaptive sports on QoL in individuals with disabilities who use wheelchairs for mobility. Methods: A systematic literature review of quantitative, qualitative, and mixed-methods research on the effect of adaptive sports on QoL was conducted on five databases (Scopus, Web of Science, PsycINFO, Medline, and PubMed). Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Results: This review identified 4 key findings from 41 studies, including 31 quantitative and 10 qualitative studies. First, individuals with disabilities using wheelchairs for mobility who actively engaged in adaptive sports tend to report higher QoL scores compared with those who were inactive or did not participate. Second, the relationship between the duration of regular participation in adaptive sports and QoL scores exhibited inconsistent results. Third, a multi-component adaptive sports program demonstrates the potential to further improve QoL scores. Last, qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion. Conclusion: This review provides a comprehensive relationship between adaptive sports participation and QoL of wheelchair users. This study identifies the value of multi-component interventions and demonstrates the diverse positive influences of adaptive sports on well-being. IMPLICATIONS FOR REHABILITATION: Individuals with disabilities who actively engage in adaptive sports report higher quality of life (QoL) scores compared with those who were inactive or did not participate. The relationship between the duration of regular participation in adaptive sports and QoL scores exhibits inconsistent results. A multi-component adaptive sports program may further improve QoL scores. Qualitative investigations reveal that participation in adaptive sports positively influences various domains of well-being in wheelchair users, including encompassing physical and emotional well-being, interpersonal relationships, material well-being, personal development, self-determination, and social inclusion. [ABSTRACT FROM AUTHOR]