The “movement” of mixed methods research and the role of educators

The landscape of research is continually evolving, enabling researchers to study increasingly complex phenomena. Educational researchers have propelled much of this forward progress and have developed novel methodologies to provide increasingly sound and complete evidence. Mixed methods research has emerged alongside quantitative and qualitative approaches as an important tool for researchers. In this article our overall aim is to better acquaint educational scholars with the mixed methods field by articulating the development of the mixed methods field and by citing current trends and issues. The role of educational researchers in the evolution of mixed methods research is highlighted. The early and ongoing dialogue of mixed methods research is multidisciplinary in nature with current writings across fields. The current debate over key aspects of mixed methods research is now in progress and is ripe for future contributions. Even the very nature of what constitutes mixed methods research is being discussed among scholars. Understanding and advancing the mixed methods field is an important goal for methodologists and researchers. With the increased interest and enthusiasm for mixed methods research, it is likely that the dialogue surrounding mixed methods approaches will thrive, continuing the movement of the field. Keywords: educational research; mixed methods South African Journal of Education Vol. 28 (3) 2008: pp. 321-33

How do SYMPtoms and management tasks in chronic heart failure imPACT a person's life (SYMPACT)? Protocol for a mixed-methods study.

AIMS: Patients with chronic heart failure (CHF) struggle to follow self-care plans, which may lead to worsening illness and poor quality of life. Burden of treatment (BoT) describes this workload and its impact on patients' lives. Suggesting the balance between a patient's treatment workload and their capability to manage it is crucial. If BoT is reduced, self-care engagement and quality of life may improve. This article describes the SYMPACT study design and methods used to explore how symptoms and management tasks impact CHF patients' lives. METHODS AND RESULTS: We used a sequential exploratory mixed-methods design to investigate the interaction between symptoms and BoT in CHF patients. CONCLUSIONS: If symptoms and BoT are intrinsically linked, then the high level of symptoms experienced by CHF patients may lead to increased treatment burden, which likely decreases patients' engagement with self-care plans. SYMPACT may identify modifiable factors to improve CHF patients' experience

Use of clinical guidelines in cardiology practice in Sudan

Rationale, aims, and objective: The aim of this study was to explore the views of prescribers in cardiology in Sudan about the use of guidelines in clinical practice and the extent to which guidelines whether national or international can be adopted in clinical practice in Sudan. Methods: Interviews were conducted with the consultants in 2 of the main cardiac hospitals in Sudan. This was followed by a survey amongst the doctors in the hospitals to examine the views of a larger population of prescribers about the matter investigated. Results: Twelve consultants were interviewed, and 47 prescribers (60%) replied to the questionnaire that followed. Most doctors relied on foreign guidelines to prescribe for their patients. The doctors acknowledged the limitation of using foreign guidelines in Sudan. A number of doctors were not in favour of following any guidelines, as they perceived that the practice in Sudan does not allow implementation of guidelines. Conclusion: The prescribers in Sudan had to rely on guidelines made in foreign countries if they want to get the benefit of evidence‐based medicine to their patients, but they had to find a way to adapt these guidelines to their patients and to the health care system they are working within. However, it is not known if this adaptation of foreign guidelines is providing the benefits intended or is risking evidence‐based medicine

The influence of placements on adult nursing graduates’ choice of first post

Background: This article presents findings from a study that sought to explore the extent to which clinical placements have an impact on nursing students’ decisions regarding their first staff nurse post. Within the UK, nursing is facing a recruitment crisis with particular difficulty recruiting to areas such as primary and elderly care. Transitioning into a new role is challenging in any occupation, but it is a particular problem in nursing where the realities of professional practice often differ from students’ perception of the staff nurse role as shaped by their clinical placements. Aim: This pilot study aimed to explore the influence of practice placements on final year adult nursing students’ career decisions. Method: Qualitative and quantitative data were collected in a single phase using a questionnaire distributed to nursing students on the final day of their course. A total of 35 completed questionnaires were returned (response rate 57%). Results: Half of the participants entered the course with preconceived preferences for clinical specialisms. However, only five participants (14%) applied for first destination posts in that specialism. The overall importance of placements in career choice increased across the three years of the programme. Although placements in all three years are important, the experiences in year 3 are pivotal, with 74% rankingthese as ‘significantly influential’ in their decision-making process. Analysis of the data obtained from the free-text responses from the questionnaire suggested that working environment; the level of support provided by mentors and clinical staff; the opportunity to make a difference to patients’ lives and the variety of placements, were key influences on nursing students’ decision regarding their first staff nurse post. Conclusions: This study highlights the key role of practice placements in the career choices of student nurses, particularly during the final year of their programme. It shows that students are likely to apply for posts in the placement area they found to be most supportive and developmental

Comprehensive medication reviews by ward-based pharmacists in Swedish hospitals: what does the patient have to say?

Rationale, aims, and objectives: Inappropriate medication prescribing and use amongst older patients is a major patient safety and health care problem. To promote appropriate medication prescribing and use, comprehensive medication reviews (CMRs) by ward-based pharmacists, including follow-up telephone calls after hospital discharge, have been conducted in older patients in the context of a randomized controlled trial (RCT). One of the key actors in a CMR is the patient. To support the understanding of the effects of CMRs on patients' health outcomes and improve clinical practice, knowledge about the patient perspective is needed. We therefore aimed to explore older patients' experiences with, and views on, hospital-initiated CMRs and follow-up telephone calls by ward-based clinical pharmacists within an RCT. Methods: We conducted in-depth semi-structured interviews with 15 patients (66-94 years) and carers from four hospitals in Sweden. Discussion topics included communication, information, decision-making, and effects on the patient. Interviews took place after discharge, were audio-recorded, transcribed verbatim, and thematically analysed using a framework approach. Results: In general, patients' experiences and views were positive. Seven key themes were identified: (a) feeling of being taken care of and heterogenous health effects; (b) the pharmacist is competent; (c) despite the unclear role of pharmacists, their involvement is appreciated; (d) patients rely on health care professionals for decision-making; (e) importance of being informed, but receiving and retaining information is problematic; (f) time, location, and other factors influencing the effectiveness of CMRs; and (g) generic substitution is a problem. Conclusions: Older patients generally have positive experiences with and views on CMRs and follow-up telephone calls. However, some factors, like the unclear role of the ward-based pharmacist and problems with receiving and retaining information, may negatively impact the effectiveness of these interventions. Future initiatives on hospital-initiated CMRs by clinical pharmacists should address these negative factors and utilize the positive views

Exploring the acceptability and feasibility of a preconception and diabetes information app for women with pregestational diabetes: A mixed-methods study protocol

Background Women with diabetes are at increased risk of adverse maternal and fetal outcomes. Preconception care can improve pregnancy outcomes and is paramount to minimise complications, but, current provision is sub-optimal. Mobile technology, particularly smartphones and apps have the potential to improve preconception care provision but research is lacking in this area. The need to use modern technologies to improve preconception care knowledge and awareness led to the development of a Preconception and Diabetes Information app in stage A of this study. Objective The aim of this paper, stage B of the study, is to explore the feasibility and acceptability of the Preconception and Diabetes Information app to improve preconception care knowledge and attitudes in women with diabetes, and explore the potential for wider implementation. Methods A mixed methods study design adopting a quasi-experimental approach will assess women’s knowledge and attitudes related to preconception care, and level of patient activation (knowledge and confidence for self-management of health) before and after the 3 month intervention period. A log of activity will be used to determine engagement with the app and semi-structured interviews will explore women’s experiences. Conclusions This is the first study to explore the acceptability and feasibility of a Preconception and Diabetes Information app for women with diabetes. The app has potential to change the way preconception care is delivered, improve pregnancy outcomes and be widely implemented in both developed and developing countries. This is important given the considerable shortfalls in current preconception care services in the United Kingdom and around the world

Children's perceptions of playing on inclusive playgrounds : a qualitative study

Background: Inclusive playgrounds aim to enable all children to participate and be socially included on playgrounds through the way they are designed. However, knowledge is lacking about how children with and without disabilities perceive playing on inclusive playgrounds and whether these playgrounds lead to more social inclusion. Aims/Objectives: The study explores the experiences of children, with and without disabilities, of playing on inclusive playgrounds. Material and methods: Semi-structured interviews and observations were conducted on six inclusive playgrounds in Switzerland. Overall, 32 children aged 7–12 years participated; 14 children had a disability while 18 children did not. A qualitative content analysis was used for data analysis. Results: The children’s experiences of playing on an inclusive playground resulted in the creation of three categories describing: how children with and without disabilities experience play activities on inclusive playgrounds; invisible barriers on inclusive playgrounds; and the fact that children with disabilities have recommendations for the design of inclusive playgrounds. Conclusions and significance: The results showed that achieving inclusion on a playground is complex and must be considered as a transaction among different environments. For occupational therapists, this could mean that, to support play as an activity on inclusive playgrounds, intervention is necessary at the community and political levels

Facilitating integrated delivery of services across organisational boundaries: Essential enablers to integration

Introduction: Integrating services is a key tenet to developing services across the United Kingdom. While many aspects ofintegration have been explored, how to facilitate integration of services remains unclear.Method: An exploratory qualitative study was undertaken in 2015 to explore occupational therapists’ perceptions on integratingservice provision across health and social care organisational boundaries. The views of practitioners who had experiencedintegration were sought on a range of aspects of integrating services. This paper focuses on the facilitators for deliveringintegration and the essential enablers are identified.Findings: Numerous factors were noted to facilitate integration and three essential enablers were highlighted. Leadership,communication and joint education were recognised as playing a central role in integrating services across organisationalboundaries; without these three essential enablers, integration is liable to fail.Conclusion: Integration is a process rather than an event; continued emphasis will be required on leadership, communication andjoint education to progress integration achievements made to date

A mixed methods evaluation of medical tattooing for people who have experienced a burn injury

Introduction: There are no existing studies examining the psychological merits of using facial medical tattooing (MT) following burn injury. This study evaluated an MT service supported by The Katie Piper Foundation. It examined accessibility, satisfaction and whether there were improvements in quality of life (QoL). Methods: Thirty-five service-users were invited to participate in a cross-sectional online survey. Twenty-five (71%) responded (24 women; age range = 21–64 years), and of these five (4 women; age range = 26–59 years) also participated in telephone interviews, which were analysed using descriptive thematic analysis. Findings: The service was largely considered easy to access (22/25) and convenient (25/25). Most service-users (22/25) were satisfied with the results of MT. Some areas of dissatisfaction were described, by a minority of service-users, including: the procedure being painful (1/25); the tattoo being below expectation or fading over time (3/25). The majority reported that MT had improved confidence (22/25); mood (19/25); and ability to socialise (19/25). The procedure improved some service-users’ ability to carry out essential activities (14/25) and enjoyable activities (16/25). The qualitative responses provided during interview, indicated that all respondents found the procedure useful to their adjustment, although a minority (3/5) found it painful and also commented on fading (1/5). All described MT as contributing to a sense of increased normality. Conclusions: MT had the largest impact on emotional wellbeing and interpersonal domains of QoL. MT services should now improve awareness of the procedure, lobby for further support to provide wider access to the procedure, and routinely use measures assessing psychosocial outcomes