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BACKGROUND: Outcome measures are crucial to support a treat-to-target approach to rheumatoid arthritis (RA) care, yet their integration into clinical practice remains inconsistent. We developed an Electronic Heath Record-integrated, patient-facing side-car application to display RA outcomes (disease activity, functional status, pain scores), medications, and lab results during clinical visits (RA PRO Dashboard). The study aimed to evaluate patient perceptions and attitudes towards the implementation of a novel patient-facing dashboard during clinical visits using a mixed-methods approach. METHODS: RA patients whose clinicians used the dashboard at least once during their clinical visit were invited to complete a survey regarding its usefulness in care. We also conducted semi-structured interviews with a subset of patients to assess their perceptions of the dashboard. The interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. Emerging themes and subthemes were organized into four domains of the Ecological Model of Health. RESULTS: Out of 173 survey respondents, 79% were interested in seeing the dashboard again at a future visit, 71% felt it improved their understanding of their disease, and 65% believed it helped with decision-making about their RA care. Many patients reported that the dashboard helped them discuss their RA symptoms (76%) and medications (72%) with their clinician. Interviews with 29 RA patients revealed 10 key themes: the dashboard was perceived as a valuable visual tool that improved patients understanding of RA outcome measures, enhanced their involvement in care, and increased their trust in clinicians and the clinic. Common reported limitations included concerns about reliability of RA outcome questionnaires for some RA patients and inconsistent collection and explanation of these measures by clinicians. CONCLUSIONS: In both the quantitative and qualitative components of the study, patients reported that the dashboard improved their understanding of their RA, enhanced patient-clinician communication, supported shared decision-making, and increased patient engagement in care. These findings support the use of dashboards or similar data visualization tools in RA care and can be used in future interventions to address challenges in data collection and patient education.

BACKGROUND: Although women comprise the majority of medical students, gender disparities emerge early and remain at the highest levels of academia. Most leadership courses focus on faculty or students rather than women graduate medical education (GME) trainees. AIM: To promote the leadership development of women GME trainees through empowerment, community building, networking and mentorship, and concrete leadership skills development. SETTING: University of California, San Francisco. PARTICIPANTS: 359 women residents and fellows from 41 specialties. PROGRAM DESCRIPTION: A longitudinal curriculum of monthly workshops designed to support leadership development for women trainees. Sessions and learning objectives were designed via needs assessments and literature review. PROGRAM EVALUATION: A mixed-methods evaluation was performed for 3 years of WILD programming. Quantitative surveys assessed participant satisfaction and fulfillment of learning objectives. Structured interview questions were asked in focus groups and analyzed qualitatively. DISCUSSION: 23% of invited participants attended at least one session from 2018 to 2021, despite challenging trainee schedules. Surveys demonstrated acceptability and satisfaction of all sessions, and learning objectives were met at 100% of matched sessions. Focus groups highlighted positive impact in domains of community-building, leadership skills, mentorship, and empowerment. This program has demonstrated WILDs longitudinal sustainability and impact for women trainees.

BACKGROUND: Information on salt consumption patterns is needed to inform the need for and design of salt reduction strategies. OBJECTIVES: In northern Ghana, this study aimed to estimate household consumption of salt, including salt from bouillon, and compare (estimated) women and childrens salt intake to global recommendations; to estimate the proportion of salt consumed from bouillon; and to identify factors, including knowledge, attitudes, and practices, associated with household salt consumption. METHODS: Employing mixed-methods methodology, we conducted a pilot survey (n = 369 households enrolled) and focus group discussions (FGDs; n = 20) in Tolon and Kumbungu districts (14 urban, 14 rural clusters) (clinicaltrials.gov registry: NCT04632771). Households reported purchases of discretionary salt (DS, table salt) and bouillon cubes. DS and total salt (TS; DS+salt from bouillon) consumption for women (15-49 y) and children (2-5 y) were estimated using the Adult Male Equivalent method and compared with global recommendations (

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]

BackgroundDespite being disproportionately impacted by COVID-19 due to a lack of structural support, marginalized communities have been largely ignored in the politically polarized debate over school masking. In response to this, we sought to explore masking attitudes by centering the voices of parents and children at historically marginalized, predominantly Hispanic schools in southern California.MethodsWe conducted a mixed-methods study with parents and children attending 26 low-income predominantly Hispanic-serving elementary schools. A random sample of parents was asked to provide a freelist of words they associate with masking. A subset of parents with children aged 4-6 was recruited from these surveys to participate in parent-child interviews (PCI). We calculated Smith's salience index for all unique items, stratifying by language (English/Spanish). Item salience guided PCI thematic analysis for additional context and meaning.Results648 participants provided 1118 unique freelist items in English and Spanish. 19 parent-child pairs were interviewed, 11 in Spanish and 8 in English. The most salient words were "safety"(0.37), "protection"(0.12), "prevention"(0.05), "health"(0.04), "good"(0.03), "can't breathe"(0.03), "necessary"(0.02), "care"(0.02), "precaution"(0.02), and "unnecessary"(0.02). Spanish speakers had a more favorable view of masking than English speakers, particularly regarding "protection" (0.20 vs 0.08) and "prevention" (0.10 vs 0.02).DiscussionMasking is an affordable individual-level risk mitigation that protects the communities that have inequitably shouldered the burdens of the COVID-19 pandemic. We recommend that policymakers prioritize the views of those most impacted when deciding on risk mitigation policies like school masking.

BACKGROUND: Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize womens health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS: This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION: Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and womens outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.

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]

Street‐level bureaucrats rely on credibility judgments when navigating interactions with citizen‐clients who are mostly strangers. These credibility judgments are inherently susceptible to prejudice against marginalized social groups, especially among majority bureaucrats who do not represent the marginalized groups in question. This argument was examined through a sequential mixed‐methods design, focusing on the case of police investigations of women's sexual assault accusations. In a mock investigatory case presented through vignettes, results revealed that male investigators were less inclined than their female counterparts to find the accusations credible. Interviewed investigators admitted to often relying on stereotyping cues when assessing the accusations' credibility, and elaborated on how increasing female representation in the workforce could help mitigate this problem. Our study highlights that client credibility judgments act as an inequitable gatekeeper in street‐level implementation. The implications extend beyond policing to other policy domains where program integrity is a salient issue, such as welfare. [ABSTRACT FROM AUTHOR]

This research is designed to identify distinct profiles of well-being among hospitality employees and their relationships with motivation. Results from a latent profile analysis reveal four well-being profiles: lack of pursuit, task-focused, overall well-being, and flourishing groups. Then, these four well-being profiles were further supported and explained with the qualitative results through a content analysis. Lastly, results of multinomial logistic regression analysis suggest that integrated regulation and amotivation significantly predict hospitality employees’ well-being. This work contributes to well-being studies by extending the scope of well-being theory and self-determination theory. It offers practical insights for developing managerial strategies to improve hospitality employees’ well-being and increase their motivation. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion Our understanding of the impact of eating disorders (ED) treatment in Autistic people remains elusive. Research has begun to explore ED treatment outcomes and experiences in this population, however current understandings are poorly integrated. The current review therefore sought to explore the impact of ED treatment on Autistic people and those with higher Autistic traits.A convergent, segregated approach was used, independently evaluating quantitative then qualitative studies before integrating findings into a coherent narrative synthesis.Autistic people and people with higher Autistic traits report poorer experiences of treatment and may be at increased risk of inpatient admission and prolonged inpatient treatment, possibly explained by difficulties with treatment timeframes and a lack of autism‐informed support. Both groups reported similar improvements in ED symptoms and BMI. Higher rates of psychosocial difficulties pre‐and post‐treatment were reported in those with higher Autistic traits, and emotion‐focused interventions were felt to be particularly relevant to Autistic presentations of EDs. Concerns were reported as to how well aligned group‐based programs and cognitive‐based interventions are for Autistic individuals and those reporting higher Autistic traits.Future research in diagnosed autism samples is urgently needed to develop a more robust understanding of Autistic outcomes and experiences. Review findings demonstrate the need for increased understanding of ED presentations and the possible need for treatment adaptations, for Autistic people or those with higher Autistic traits. [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]

ABSTRACT Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10‐year period and understand their reasons by interviewing obstetricians and midwives.Mixed‐methods study.A tertiary university public maternity hospital, Paris, France.All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician‐gynaecologists and midwives.Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi‐structured interview with 20 obstetricians and midwives, with an interview guide.Obstetric anal sphincter injuries.The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10‐year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals. [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: 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]

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]

Clinical supervision plays a pivotal role in training the next generation of health service psychologists. Given the dyadic nature and multiple priorities of supervision, dilemmas are common; however, few data exist on the frequency and types of dilemmas, and more importantly, how they are navigated. Of the limited data that are available on this topic, few encompass the perspectives of both supervisors and supervisees. This study aims to address these gaps by surveying supervisor (N = 29) and supervisee (N = 65) responses to eight vignettes of supervision dilemmas. We use a mixed-methods approach to investigate quantitative ratings of perceived dilemma frequency and harmfulness, and content analysis to identify themes in qualitative responses assessing how participants navigate dilemmas. A supervisor failing to provide adequate critical feedback to a supervisee was perceived by participants as the most frequent and harmful dilemma. Strong consistency in frequency and harmfulness ratings of vignettes was found among supervisors and supervisees. Content analysis revealed four main themes among reported strategies: relational, reflective, direct, and indirect. The majority of strategies reported were direct, involving confrontation and problem solving. However, there were situational and temporal nuances in how participants described they would use strategies. Supervisees reported greater use of indirect strategies involving passivity and avoidance. Overall, our study underscores the potential for a decision-making framework that could help standardize supervision guidelines and recommends that such a framework incorporate an assessment of the severity, frequency, and temporal aspects of each dilemma. Public Significance Statement: Supervision is a core clinical competency, yet how supervision dilemmas are navigated is not well understood. This study suggests that supervisors and supervisees report that they would mainly use direct confrontative and problem-solving strategies to address dilemmas and occasionally use relational, reflective, and indirect strategies. Results could inform a framework that standardizes supervision guidelines surrounding common supervision dilemmas. [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]

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]

Context: Agriculture relies on irrigation in many parts of the world, and the need for irrigation is increasing due to rising demands for agricultural products and climate change-induced alterations in rainfall patterns. However, irrigated agriculture has been found to damage ecosystems and threaten landscape sustainability. Objectives: Against this background, there has been a recent development towards large-scale irrigation in Spain. The aim of this study is to understand this development at the landscape level and its impact in the context of landscape sustainability. Methods: We focused on two study sites in Castilla y León using a mixed-methods approach. We studied driving forces, landscape changes, and sustainability outcomes through document analysis, interviews, and aerial photograph analysis. Results: The development of a landscape-level underground pipe network took place at one study site and is planned for the second study site. Interviewees perceived institutional and social driving forces as particularly influential and technological driving forces as less influential. Political and economic driving forces were often interlinked. The irrigation development tied to land consolidation led to landscape changes, such as the removal of trees and increases in field size. Thus, in terms of environmental sustainability, trade-offs were found, while social sustainability outcomes were mainly positive. The impact on farmers’ economic security varied. Conclusions: For further landscape-level irrigation developments, we recommend integrating preserving seminatural habitats and the structural diversity of the agricultural landscape in planning processes. We also recommend a shift towards more water efficient crops, evapotranspiration management, and a new funding scheme for farmers to offset rising electricity costs. [ABSTRACT FROM AUTHOR]

Background and aims Design Setting Participants Measurements Findings Conclusions Involuntary civil commitment (ICC) is a legal process by which people are compulsorily admitted to substance use treatment. This study explored views about and promotion of ICC procedures for substance use disorders among public health‐public safety post‐overdose outreach programs and their outreach team members in Massachusetts, USA.In this mixed‐methods study, survey data were collected from post‐overdose outreach programs in 2019, and semi‐structured interviews were conducted with outreach team members in 2019 and 2020.Massachusetts, USA.We received 138 survey responses and conducted 38 interviews with post‐overdose outreach team members (law enforcement officers, recovery coaches, social workers and harm reductionists) who were majority male (57%) and white (66%).We used the survey instrument to categorize programs as more (discussed ICC at 50% or more of outreach encounters) or less ICC focused (discussed ICC at less than 50% of outreach encounters) and to identify program characteristics that corresponded with each categorization. Semi‐structured interviews explored staff perceptions of ICC effectiveness.Among 138 programs, 36% (n = 50) discussed ICC at 50% or more of outreach encounters. Discussing ICC at a majority of visits was positively associated with abstinence‐only program philosophies (36% v. 6%, P < 0.001) and collaborating with drug courts (60% v. 30%, P < 0.001), but negatively associated with naloxone distribution (48% v. 75%, P < 0.001) and referring to syringe service programs (26% v. 65%, P < 0.001). Qualitative interviews identified three themes: 1) some programs viewed ICC as a first line tool to engage overdose survivors in treatment; 2) other programs considered ICC a last resort, skeptical of its benefits and concerned about potential harms; 3) families commonly initiated discussions about ICC, reportedly out of desperation.Promotion of involuntary civil commitment (ICC) appears to vary widely across post‐overdose outreach programs in Massachusetts, USA, with approaches ranging from seeing it as a first step to treatment to being a tool of last resort. Demand for ICC among family members may relate to inadequate access to voluntary treatment. Family interest in ICC appears to be driven by inadequate availability of treatment and other services. ICC at post‐overdose outreach visits should be limited, if used at all. [ABSTRACT FROM AUTHOR]

Background: Learning assistants (LAs) are undergraduate students who serve as instructional assistants in STEM classrooms. In addition to engaging in active practice, they take a pedagogy seminar and regularly meet with a content instructor. While aspects of LAs' pedagogical beliefs and actions have been investigated, there remains a gap in understanding how LAs make sense of their new instructional roles and how they negotiate between their experiences as students and their responsibilities as instructors. This study uses a sequential, exploratory mixed-methods approach, which includes constant comparative open-coding, thematic analysis, and epistemic network analysis, to analyze 178 reflections written by 89 LAs across five terms at two institutions. Here, we identify each LA's expressed goals and intended actions at the start and the end of their first term as an LA. Using a community of practice framework, we seek to explicate the shifts in these LAs' values as they become more central members of the LA community. Results: LAs' expressed roles shift from being cognitive coaches, where they focus on student thinking, sense-making, and understanding of disciplinary concepts, to being social architects, where their focus shifts to attending to the aspects of the environment that can support productive interactions for learning. A social architect prioritizes goals related to mutual trust, respect, & approachability, understanding and learning about students, and creating a sense of belonging. Similarly, their intended actions emphasize compassion, understanding, and facilitating group discussion. While all LAs studied exhibited this shift, it manifested in different ways and to different extents, as illustrated in detail by four selected cases. These cases illustrate how the shifts coupled to a change in language around teaching, becoming more specific and contextual. Conclusions: LAs express a shift in their valued practices over their first term as LAs related to their instructional role. The goal of student-centered instructional practice is often framed as becoming a better cognitive coach; however, this orientation does not foreground ideas around teaching practice that aim to foster engagement, belonging, and student agency. Implications for both the LA model and, more generally, for postsecondary STEM instructors are discussed. [ABSTRACT FROM AUTHOR]

Background: Caring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding. Methods: A multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results. Results: The overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=–0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=–0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data. Conclusion: Discrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Method Results Conclusion Psychosis is associated with significant health and societal costs. Early intervention in psychosis services (EIP) are highly effective in promoting recovery, yet substantial proportions of young people disengage. The current study aimed to develop and evaluate a novel engagement intervention in EIP services.A qualitative investigation of facilitators and barriers to engagement in 68 first episode psychosis patients, family members and young people, and a Delphi consultation with 27 regional and national youth and psychosis service leads informed the development of the intervention.A mixed‐methods feasibility‐pilot study then compared engagement outcomes in 298 EIP service users in two cohorts: standard EIP versus standard EIP plus the novel early youth‐engagement (EYE) intervention. A qualitative study explored intervention experiences in 22 randomly selected service users, carers and clinicians. A process evaluation explored delivery.Disengagement was 24% in the standard EIP cohort compared to 14.5% in the standard EIP plus EYE intervention cohort. A 95% Bayesian credibility interval revealed a 95% probability that the true reduction in disengagement lay somewhere between 0% and 18%. The number needed to treat was 11, 95% CI [5, 242]. Use of the EYE resources was associated with engagement. Qualitiative feedback supported effects on communication, social network engagement, service user goals, mental health and well‐being outcomes.The EYE intervention was designed from a service user, young person and carer perspective. Both qualitative and quantitative data support impacts on engagement. We now need to evaluate effectiveness, cost‐effectiveness and implementation in a multi‐site randomised controlled trial. [ABSTRACT FROM AUTHOR]

Background: Research is needed to better understand the specific challenges for autistic learners in informal STEM learning settings. This study aimed to increase inclusion in STEM museums, with a larger goal of increasing the impact (i.e., learning and application of knowledge during and after visits) of informal STEM learning settings for autistic youth. We conducted an online parent attitudes survey with 93 parents of autistic adolescents and 53 parents of adolescents in the general population to better understand the experiences of autistic adolescents when visiting STEM-related museums. Parent responses informed professional development training for museum staff at four partner museums, which taught strategies to better support autistic learners. Then, autistic adolescents (n = 20) and their parents were randomly assigned to visit one partner and one control museum. They were asked to report their experiences through an online survey and semi-structured interviews. Results: Participants who completed the parent attitudes survey indicated significantly lower inclusion, engagement, and general impact of STEM museum visits among autistic adolescents compared to the general population comparison group. Parents of adolescents who visited partner and control museums reported higher STEM impact during visits to partner museums; however, parent-reported inclusion, engagement, and general impact did not differ significantly between partner and control museums. Qualitative analysis identified four themes (Spectrum of Museum Impact; Adolescent-Environment Fit; Barriers to Engagement, and Barrier Breakers), providing context for quantitative findings. Conclusions: Findings underscore the need for increased inclusion for autistic individuals in informal STEM learning environments like museums. This project demonstrated feasibility of professional development training of forward-facing staff and identified several themes that should inform future efforts to improve inclusion in informal STEM learning settings. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsMedical students seek early patient contact but their curriculum starts with scientific knowledge. We integrated the Healthcare Assistant (HCA) course into semester one for early patient-facing clinical contact. This study compares students’ aspirations for this learning with the realities of employed work as HCAs.This sequential mixed-methods study used pre-post-scored questionnaire data, followed by post-course focus groups, and interviews a year later. The quantitative data were analysed using SPSS and the qualitative data using thematic analysis.The learning was highly valued with early perceptions challenged. The learning both accelerated and advanced their medical skills. Their naivety of nurses’ work within team-based practice quickly eroded; they symbiotically linked their clinical and non-clinical learning; they acclimatised to the hospital environment while future gazing in preparation for clinical learning. Early anxieties for starting employment were overcome, building resilience.HCA training offers a practical patient-facing set of competencies on which to build medical capability. Student text-book scientific knowledge was validated through their experiences with recognition of the importance of empathetic patient-centred care. They quickly learnt and absorbed ward function; experienced good and poor teamworking; highly valued the nursing role; and experienced the every-day stresses of being a front-line practitioner. [ABSTRACT FROM AUTHOR]

Lifelong learning is emerging as a key priority for promoting equity and sustainability in societies. Self-regulated learning (SRL) is a fundamental requirement for achieving successful lifelong learning, and digitization is increasingly influential in this regard. This mixed-methods study explores the degree to which adaptive learning technology (ALT) can assist university students in their SRL with timely and personalized support. Additionally, the study examines how students perceive this feedback and incorporate it into their learning behavior. Using hierarchical linear modeling, we investigated the development of SRL over a 9-week period. Semi-structured interviews were conducted with purposively selected learners, based on stimulated recalls. The quantitative results demonstrate positive development in certain components of SRL. Furthermore, the results indicate that metacognitive activity can be partially predicted by motivational and emotional states. The qualitative findings reveal that learners have varying perceptions of feedback received from ALT and integrate it into their learning behaviors based on their individual benefits. The results support the assumption that feedback provided through educational technology must be precisely tailored to the needs of learners, taking into account the dynamics of their individual learning processes. The study contributes to the ongoing discussion on the design of educational technology. [ABSTRACT FROM AUTHOR]

AbstractThis study explored the types of constraints that inhibit women’s participation in community basketball. It investigated whether the perception of these constraints changes at different ages to understand how this impacts one’s intention to leave the sport of basketball. A mixed-methods approach was used. In phase 1, Concept Mapping examined the types of constraints faced by Australian women community basketball players. In phase 2, quantitative survey data were analyzed to understand how age and the constraints identified from phase 1 impacted on women’s intention to leave basketball. Results demonstrated that key types of constraints are a lack of playing opportunities and gender discrimination. Younger women were more likely to intend to leave basketball when they reported higher incidences of these constraints, indicating that they are more difficult to negotiate. Sport organizations must increase playing opportunities for young women and eradicate nuanced gender discrimination to improve the retention of younger women. [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]

Introduction: Treatment with chimeric antigen receptor T (CAR-T) cells involves a large number of interdisciplinary stakeholders and is associated with complex processes ranging from patient-specific production to follow-up care. Due to the complexity, maximum process optimization is required in order to avoid efficiency losses. This study aimed at systematically determining the preconditions for a frictionless flow of the CAR-T process by surveying the stakeholders involved. Methods: A Group Concept Mapping (GCM) analysis, a mixed-methods participatory research, was conducted. CAR-T experts from different professional backgrounds went through three steps: 1) Brainstorming relevant aspects (statements) for a frictionless process, 2) Sorting the collected statements based on their similarity, and 3) Rating the importance and feasibility of each statement. A cluster map reflecting the overarching topics was derived, and mean ratings per statement and cluster were calculated. Results: Overall, 20 CAR-T experts participated. A total of 80 statements were collected, resulting in a map of the following 10 clusters (mean importance/feasibility): Information for patients and physicians (4.16/3.77), Supportive network (4.03/3.53), Eligibility of patients (4.41/3.63), Evidence, transparency and communication (4.01/3.33), Paperwork (4.1/2.52), Interface with pharmaceutical manufacturer (4.03/2.85), Reimbursement (4.29/2.31), Quality Management (4.17/3.18), Infrastructure of CAR-T clinics (4.1/2.93), and Patientoriented processes (4.46/3.32). Discussion: The 80 statements underlined the complex and manifold nature of the CAR-T treatment process. Our results reflect the first step in overcoming hurdles: identifying potential hurdles and required preconditions. Decisionmakers and stakeholders can use the results to derive strategies and measures to further promote a frictionless process. [ABSTRACT FROM AUTHOR]

Background/Objective: The Alternative Model for Personality Disorders (AMPD) within the DSM‐5 includes separable components representing general personality dysfunction (Criterion A) and maladaptive personality traits (Criterion B). Some critique Criterion A for accounting for little incremental variance in PD beyond Criterion B. However, Morey et al. (2020) hypothesized that personality dysfunction is a key mechanism through which normal‐range traits account for the maladaptive component of personality traits, justifying its inclusion. We sought to replicate and extend this work in a psychiatric sample with mixed methods. Method: In total, 152 participants recruited from mental health clinics completed multiple measures of personality dysfunction and normal‐range and maladaptive traits. Results: Replication was only partially achieved. The degree of incremental prediction of maladaptive traits and the extent to which personality dysfunction explained the relations between normal‐range and maladaptive traits varied significantly across traits, and those effects that reached significance were small in magnitude. Removing variance due to personality dysfunction reduced intercorrelations among maladaptive traits by only a small amount. Conclusion: Counter to Morey et al. (2020), our results failed to support maladaptive traits as composites of normal‐range traits and personality dysfunction, suggesting that other methods of distinguishing personality pathology severity and style are needed. [ABSTRACT FROM AUTHOR]

Unlike in most Western countries where singleness has been relatively considered as an individual's choice, singleness is often regarded as a social problem in Indonesia. This causes challenges for never married individuals to meet their belonging needs and to maintain their well-being. The current study aimed to explore the roles of social support, religiosity, and religious coping in assisting never-married Indonesian adults to maintain their well-being, as indicated by their levels of life satisfaction and loneliness. An online survey administered to 350 never-married adults (Mage = 29.79; SD = 4.50), followed by in-depth interviews to 40 participants (Mage = 33.14; SD = 4.04) demonstrated that, unlike in many Western countries where the religion seems to be losing its role, In Indonesia, engaging in a nurturing spiritual relationship may assist unmarried individuals, especially those wishing to get married, to cope with societal and personal challenges of being single. [ABSTRACT FROM AUTHOR]

Purpose: This study examined the health-related quality of life (HRQoL) among ethnically diverse Black men (BM) with prostate cancer (CaP) in the United States. Methods: A convergent parallel mixed-methods design, employing both qualitative and quantitative research, involved recruiting Black CaP survivors through multiple channels. The target population was native-born BM (NBBM), African-born BM (ABBM), and Caribbean-born BM (CBBM). QoL for all men was assessed using The Functional Assessment Cancer Therapy-Prostate (FACT-P) measure, which includes five domains: physical- (PWB), emotional- (EWB), social-(SWB), and functional-wellbeing (FWB), and a CaP subscale (PCS). A subset of men completed qualitative interviews. Demographic and clinical characteristics were also collected. Results: Black CaP survivors aged 49–85 participated in the study (n = 108), with a subset (n = 31) completing a qualitative interview. Participants were mainly NBBM (72.2%) and treated with radiotherapy (51.9%). The FACT-P scale total mean score (± SD) was 114 ± 24.1 (theoretical range 0–156), with lower scores reported on the SWB, FWB, and EWB domains. The mixed-methods findings approach included meta-inferences derived from integrating the corresponding quantitative and qualitative data, covering all the domains within the FACT-P. Conclusion: Black CaP survivors experienced significant burdens that impacted their overall HRQoL. The analysis revealed impacts on physical, social, and emotional well-being, with variations among ethnic groups suggesting the need for culturally tailored interventions. EWB was also profoundly impacted by CaP treatment, with universal emotional burdens emphasized across all groups. Healthcare providers must recognize and address these multifaceted needs to promote better outcomes and HRQoL for Black CaP survivors. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the fourth most common cancer in women worldwide, and women with human immunodeficiency virus (HIV) are particularly at risk of developing it. Regular screening effectively prevents morbidity and mortality. This mixed-methods study quantitatively assessed cervical cancer screening uptake and qualitatively explored the process of undergoing cervical cancer screening to understand possible reasons for delayed screening among women with HIV in Lesotho. Methods: Between October 2020 and March 2022, the Viral load Triggered ART care in Lesotho (VITAL) trial enrolled women aged 18 years and older with HIV who were taking antiretroviral therapy (ART). Cervical cancer screening delay was defined as reporting a screening that occurred more than two years ago or never having been screened. Cervical cancer screening uptake and the association between screening delay and sociodemographic variables were assessed using a multivariable mixed-effects logistic regression model accounting for clustering at clinic level. In-depth interviews were conducted with 16 women to obtain information on awareness, perceptions, and barriers to cervical cancer screening and were analyzed using thematic analysis. Results: Quantitative data were available for 3790 women. Among them, cervical cancer screening was delayed in 1814 (47.9%), including 1533 (40.5%) who were never screened. Compared to women aged 25 to 39 years, women aged 18 to 24 years (adjusted odds ratio (aOR) 2.8; 95% confidence interval (CI) 2.1–3.7), women aged 40 to 59 years (aOR 1.3; CI 1.1–1.6), and women older than 60 years (aOR 3.9; CI 3.0-5.1) were at higher risk of screening delay. Furthermore, time on ART below 6 months (aOR 1.6; CI 1.1–2.3) compared to above 6 months was associated with screening delay. Qualitative data identified limited awareness of cervical cancer risks and screening guidelines, misconceptions and fears created by the influence of other women's narratives, and low internal motivation as the main barriers to screening uptake. Conclusions: Cervical cancer screening delay was common. Limited personal awareness and motivation as well as the negative influence of other women were the primary internal barriers to cervical cancer screening. Awareness and screening campaigns in Lesotho should consider these factors. Trial registration: clinicaltrials.gov, NCT04527874, August 27, 2020. [ABSTRACT FROM AUTHOR]

This study explores how media users define false information in the daily flow of their lives against a backdrop of sociopolitical contexts. We focus on the vernacular definitions of false information through the concept of folk theories, which are the intuitive explanatory tools users develop to make sense of and act in the world around them. Based on mixed-method research conducted in Turkey during the Covid-19 pandemic, we identify three prevailing folk theories of false information. First, users consider text-based characteristics, such as the presence of evidence as a flag of accuracy/inaccuracy. Second, users assume that people in their social networks distinguish between the accurate and the inaccurate, and thus the information coming from these circles is accurate. Finally, users imagine that people whose worldviews conflict with theirs spread inaccurate information. Despite users' overarching references to textual traits of news, it appears that the latter two folk theories drive users' information processing practices in daily life. [ABSTRACT FROM AUTHOR]

Building information modeling (BIM) and blockchain applications have introduced significant benefits to the architecture, engineering, construction, and operation (AECO) industry in recent years. Although publications on BIM and blockchain integration have been increasing, no systematic examination of the present status and managerial implications of integrated BIM and blockchain has been conducted. To bridge this gap, this paper conducts a state-of-the-art review of the development of integrated BIM and blockchain in a built environment. A combination of qualitative and quantitative methods was adopted to synthesize and analyze the research evidence. The results revealed five key managerial implications of BIM integration with blockchain at the project level: design and collaboration, financial management, construction management, information management, and integration management (with other cutting-edge technologies). Challenges and opportunities are outlined and articulated from both technological and managerial perspectives, such as stakeholder management, impact assessment, real-time project management, information redundancy, and incompatibility. [ABSTRACT FROM AUTHOR]

For emerging adults enrolled in higher education institutions, their sense of belonging to the university largely influences their development. However, not all students experience university belonging in the same way. There is a dearth of work identifying how students make meaning of their everyday experiences and how those experiences affect their daily university belonging. Our article draws on a mixed-methods study of students' sense of university belonging to investigate how daily experiences within university contexts shape and influence their university belonging. We found five categories of daily experiences (e.g., non-academic interpersonal interactions, community-building events, academics, campus resources, emotions and stress) which affected students' university belonging. The results suggest that signals of university belonging exist in all facets of university life, helping us further understand the reasons behind students' university belonging fluctuations. [ABSTRACT FROM AUTHOR]

Cultural identity has become increasingly important and complex within many contemporary globalized societies. Consequently, methodological development is needed to expand our conceptualization and measurement of (a) the formation and experiences of multiple nested cultural identities and (b) how such identities relate to psychosocial functioning. In the preregistered and experimental quantitative phase (Study 1), Danish participants (n = 308) were divided into three subsamples completely at random and exposed to various priming regarding global events (i.e., COVID-19, war in Ukraine, or a control prompt not related to current events). Danish, European, and global cultural identities were all highly endorsed across our sample, and global identity was enhanced by priming related to the war in Ukraine as compared with the other two priming conditions. Danish cultural identity was positively associated with well-being (self-esteem and life satisfaction) both directly and indirectly through self-concept clarity, whereas European identity was negatively associated with self-concept clarity, and global identity was positively associated with self-esteem. In the qualitative phase (Study 2), with a selected subsample of the Study 1 sample (n = 5), we conducted in-depth semistructured interviews to explore the experience of sociohistorically embedded cultural identities (i.e., shaped by a complex interplay of culture, language, and social practices) within the globalized context of Denmark. Results highlight ideographic understandings of cultural identities and how these identities are politically embedded and shaped through intercultural experiences and events. These results are discussed in terms of how multi-method approaches can enhance our understanding of contemporary complex cultural identities. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusions Impact Reporting Method Patient or Public Contribution Trial Registration To develop an evidence‐driven, behaviour change focused strategy to maximise implementation and uptake of HIRAID (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) in 30 Australian rural, regional and metropolitan emergency departments.An embedded, mixed‐methods study.This study is the first phase of a step‐wedge cluster randomised control trial of HIRAID involving over 1300 emergency nurses. Concurrent quantitative and qualitative data were collected via an electronic survey sent to all nurses to identify preliminary barriers and enablers to HIRAID implementation. The survey was informed by the Theoretical Domains Framework, which is a synthesis of behavioural change theories that applies the science of intervention implementation in health care to effect change. Quantitative data were analysed using descriptive statistics and qualitative data with inductive content analysis. Data were then integrated to generate barriers and enablers to HIRAID implementation which were mapped to the Theoretical Domains Framework. Corresponding intervention functions and Behaviour Change techniques were selected and an overarching implementation strategy was developed through stakeholder consultation and application of the APEASE criteria (Affordability, Practicability, Effectiveness and cost‐effectiveness, Acceptability, Side‐effects/safety and Equity).Six barriers to HIRAID implementation were identified by 670 respondents (response rate ~58%) representing all 30 sites: (i) lack of knowledge about HIRAID; (ii) high workload, (iii) lack of belief anything would change; (iv) not suitable for workplace; (v), uncertainty about what to do and (vi) lack of support or time for education. The three enablers were as follows: (i) willingness to learn and adopt something new; (ii) recognition of the need for something new and (iii) wanting to do what is best for patient care. The 10 corresponding domains were mapped to seven intervention functions, 21 behaviour change techniques and 45 mechanisms. The major components of the implementation strategy were a scaffolded education programme, clinical support and environmental modifications.A systematic process guided by the behaviour change wheel resulted in the generation of a multifaceted implementation strategy to implement HIRAID across rural, regional and metropolitan emergency departments. Implementation fidelity, reach and impact now require evaluation. HIRAID emergency nursing assessment framework reduced clinical deterioration relating to emergency care and improved self‐confidence and documentation in emergency departments in pilot studies. Successful implementation of any intervention in the emergency department is notoriously difficult due to workload unpredictability, the undifferentiated nature of patients and high staff turnover. Key barriers and enablers were identified, and a successful implementation strategy was developed. This study uses theoretical frameworks to identify barriers and enablers to develop a data‐driven, behavioural‐focused implementation strategy to optimise the uptake of HIRAID in geographically diverse emergency departments which can be used to inform future implementation efforts involving emergency nurses. The CROSS reporting method (Supporting Information S3) was used to adhere to EQUATOR guidelines.No Patient or Public Contribution.Australian New Zealand; Clinical Trials Registry (ANZCTR) number: ACTRN12621001456842, registered 25/10/2021 [ABSTRACT FROM AUTHOR]

This study examines how Americans' narratives of pain are connected to social inequalities using more than 1,500 in-depth interviews collected as part of the American Voices Project. Our novel mixed-method approach to these "big (qualitative) data" uses machine learning and qualitative analysis to demonstrate that discussions of physical pain are prevalent across groups, but narrative content varies by demographics including educational background and gender identity. Our findings demonstrate (1) that pain is commonly described as a challenge that shapes everyday life, (2) that pain narratives often invoke morality and distinction, and (3) that narratives diverge around discussions of unequal medical treatment, illness identities, vulnerability and suffering. We discuss the implications of our findings for scholarship on inequality and experience, social scientific methods, and health policy. [ABSTRACT FROM AUTHOR]

Background: Medical deserts pose significant challenges to healthcare systems worldwide, leading to unmet healthcare needs and exacerbated health issues, particularly in underserved regions. Methods: This study aims to characterise cancer care services in the North-West region of Romania through the lens of medical desertification, employing a mixed-methods approach. Quantitative analysis – descriptive statistics – of secondary data from the Activity of Healthcare Units reports from 2009 to 2022, along with qualitative data – thematic analysis – from interviews with cancer patients and healthcare professionals, were employed to uncover the current state of cancer care in Romania. Results: The qualitative analysis highlighted the prevalence of medical deserts in oncology, with inadequate human resources, facility deficiencies, prolonged waiting times, high costs, and socio-cultural barriers hindering access to cancer care. Opportunities for action include revising treatment protocols, enhancing palliative care, implementing prevention strategies, promoting collaboration among healthcare professionals, and digitalising the healthcare system. However, challenges persist, including a shortage of oncology specialists, geographical disparities in cancer prevalence, and limited access to advanced treatment modalities in rural areas. Conclusions: Addressing medical deserts in cancer care requires comprehensive approaches, including strategic resource allocation, workforce development, infrastructure investments, access to innovative treatments, and digital health technologies. Collaboration among policymakers, healthcare providers, and communities is crucial to mitigating medical deserts and improving cancer outcomes. Despite limitations, this study provides valuable insights into cancer care services and underscores the need for concerted efforts to overcome medical desertification and ensure equitable access to high-quality cancer care. Key points: • The study reveals medical deserts in Romania's North-West region, marked by limited access to oncology facilities and healthcare professionals due to various barriers such as inadequate resources, long waiting times, and high costs. • Addressing medical desertification requires revising treatment protocols, enhancing palliative care, implementing prevention strategies, and embracing digital health. Despite challenges like specialist shortages and geographic disparities, collaborative efforts can improve cancer care accessibility and quality. • Strategic resource allocation, workforce development, and digitalization are essential for successfully mitigating medical deserts in oncology and ensuring equitable access to high-quality cancer care across the region. [ABSTRACT FROM AUTHOR]

Introduction Method Results Conclusion Daily variations in frustration of basic psychological needs (autonomy, competence, and relatedness) have received limited attention. This mixed‐methods study examines such daily variations and their relations to recovery from work and employee well‐being.The study uses multilevel modeling of repeated measures through daily surveys from a period of 8 working days across 2 consecutive weeks, combined with in‐depth interviews. A sample of 54 Norwegian health‐care workers completed a total of 242 daily surveys, and follow‐up interviews were conducted with 10 participants.Quantitative results showed that need frustration at work fluctuates from day to day, with competence frustration notably impairing recovery (i.e., lower psychological detachment and relaxation) and increasing ill‐being (i.e., higher exhaustion and negative work affect). Autonomy frustration was related to increased exhaustion and sleep complaints, while relatedness frustration showed no significant relation to recovery, ill‐being, or sleep. Qualitative findings corroborated and expanded on these results, offering deepened insights into how competence and, sometimes, relatedness need frustration hampered the recovery process and sleep.The results of the current study add to the scarce body of literature on daily fluctuations in need frustration at work and its adverse consequences. [ABSTRACT FROM AUTHOR]

As governments and multilateral institutions launch projects and programs to support climate change mitigation and adaptation, the challenge lies in determining their effectiveness. The high complexity of climate-change programs often makes it difficult to determine their effectiveness through standard monitoring and evaluation procedures. 'complexity-aware monitoring' is a qualitative approach to monitoring, recently introduced by international development programs. This increasing awareness of complexity in the evaluation sector opens up a window of opportunity for complexity science to support climate change mitigation and adaptation programs. This paper's contribution is a hands-on methodology for live monitoring and evaluation of development programs. The methodology is rooted in existing literature on social–ecological systems, as pioneered by Ostrom, and in quantitative methods from complexity science. To illustrate the methodology, an existing climate mitigation project in Madagascar, funded, monitored and evaluated by the Green Climate Fund, is discussed. [ABSTRACT FROM AUTHOR]

In 2019, the United Methodist Church (UMC) voted to maintain their stance of prohibiting the ordination of gay clergy and the performance of same‐sex marriages within the church. As part of a multi‐method study, we hosted focus groups, interviews, and conducted surveys with 54 individuals from four UMC churches to assess attitudes about the outcome of the vote. Consistent with hypotheses, the majority expressed disappointment and evidence of having resolved cognitive dissonance that arose from continued church attendance. Both quantitative and qualitative measures indicated a tendency for participants to disidentify with the global church and denomination but to strengthen their commitment and ties to their more LGBTQ‐friendly local congregations. We identified themes of resilience, community, and increased activism. We discuss implications for other organizations grappling with the inclusion of sexual and gender minorities as well as implications for political polarization more broadly. [ABSTRACT FROM AUTHOR]

A convergent, mixed‐methods design was used to understand associations between partner behaviors and relationship quality among people in interracial and intraracial romantic relationships. Across two samples, 224 individuals (including 55 couples) who were in a relationship in which they and/or their partner identified as Black completed measures of perceived partner responsiveness, partner responses to stress, and relationship quality. Participants in the first sample also provided open‐ended responses about the role of race in their relationship. Participants who reported higher partner responsiveness, more supportive partner responses to their stress, better overall dyadic coping, and fewer unsupportive partner responses to their stress reported higher relationship quality. The strength of the associations for perceived partner responsiveness and partner responses to stress with relationship quality did not differ based on the racial composition of the relationship. Qualitative responses revealed additional support processes and barriers to support that may be unique to different relationship compositions. These findings expand understanding of the most effective support behaviors that Black individuals and their romantic partners use in their relationships and illuminate how support processes might differ depending on an individual's race and the race of their partner. [ABSTRACT FROM AUTHOR]

This study examined whether mentorship could promote young gay men's identities and well‐being, and whether a mentor's sexual orientation matters. A randomized control trial compared outcomes across three conditions: Arm A (a mentee matched with a sexual minority mentor), Arm B (a mentee matched with a heterosexual mentor), and a control arm receiving psychoeducation only. A community sample of 60 mentees aged 18–25 years was randomly allocated to the three arms and completed questionnaires at baseline, 3 months into the intervention, and at the end of the 6‐month program. Fifteen mentees recounted their mentoring experiences through in‐depth interviews. Linear mixed effects models showed that for both intervention and control conditions, internalized homonegativity declined while resilience, loneliness, and body acceptance improved over time. No time and group interactions were found. Meanwhile, a mentor's sexual orientation did not drive differential quality and outcomes of mentorship. Interviewees cited various benefits of mentorship, including providing companionship, enriching connection with lesbian, gay, bisexual (LGB) communities, and adding knowledge and perspectives of LGB lives and identities. Although quantitative data did not support any exclusive benefits of mentorship, most mentees recognized mentorship as a vital source of affirmation and companionship. Implications for research and mentoring programs are discussed. Highlights: Mentorship has been suggested as a community‐based program to improve LGB people's mental health.This study found equivocal quantitative evidence for short‐term effects of a mentorship.Qualitative interviews reveal potential benefits of mentorship for young gay mentees.Mentors' sexual orientations did not play a major part in the quality and outcomes of mentorship. [ABSTRACT FROM AUTHOR]

Gender sexuality alliances (GSAs) represent consciousness‐raisings that hold potential for critical consciousness development in youth. In this study, we focus on critical reflection—the understanding that oppression is structured and maintained by human action. We engage intersectionality as our analytical framework and analyze both student interview data (n = 38) and advisor closed‐ended and open‐ended survey data (n = 58) to examine: (1) the nature/content of critically reflective discussions in GSAs and (2) how advisors support critically reflective discussions in GSAs and their role in these discussions. Our findings suggest that (1) conversations centering race and its intersections with other socio‐structural axes occur, albeit infrequently; (2) youth recognize and understand the concept of intersectionality in nuanced ways, desire to have critical intersectional conversations, and experience fragmentation from conversations around race, sexuality, and gender if they are situated at privileged locations on those axes; and (3) students want advisors to engage in critically reflective discussions in GSAs. The findings suggest that interventions and programming are needed that could cultivate advisors' and youth leaders' skills in facilitating intersectional dialogues for critical reflection among members. [ABSTRACT FROM AUTHOR]