Achieving Integration in Mixed Methods Designs—Principles and Practices

Mixed methods research offers powerful tools for investigating complex processes and systems in health and health care. This article describes integration principles and practices at three levels in mixed methods research and provides illustrative examples. Integration at the study design level occurs through three basic mixed method designs—exploratory sequential, explanatory sequential, and convergent—and through four advanced frameworks—multistage, intervention, case study, and participatory. Integration at the methods level occurs through four approaches. In connecting, one database links to the other through sampling. With building, one database informs the data collection approach of the other. When merging, the two databases are brought together for analysis. With embedding, data collection and analysis link at multiple points. Integration at the interpretation and reporting level occurs through narrative, data transformation, and joint display. The fit of integration describes the extent the qualitative and quantitative findings cohere. Understanding these principles and practices of integration can help health services researchers leverage the strengths of mixed methods.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101791/1/hesr12117.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/101791/2/hesr12117-sup-0001-AuthorMatrix.pd

Produce Sections, Town Squares, and Farm Stands: Comparing Local Food Systems in Community Context

A growing literature has grappled with the emergence of local food systems as an alternative to the conventional agricultural model and assumes that the development of local food system venues, such as farmers’ markets, are positive community-building initiatives. Too often left out of this discourse are empirical assessments of the community characteristics that lend themselves to the success of farmers’ markets or similar initiatives. Further, when farmers’ markets are not significantly patronized by community members, does this necessarily mean that people do not value local produce? This article uses the results from surveys of farmers’ market consumers and case studies of local foods initiatives in parts of Illinois to answer these questions and applies the community capitals framework and convention theory to help categorize communities according to their acceptance of farmers’ markets. Our findings demonstrate that consumers value locally-grown food despite location, but seek it out through different channels. The implications are that building successful local food systems is not simply about changing consumer opinion or applying a one-size-fits-all approach to local markets, but will require creativity in developing local markets that build on the current shopping behaviors of consumers

Managing health worker migration: A qualitative study of the Philippine response to nurse brain drain

Background: The emigration of skilled nurses from the Philippines is an ongoing phenomenon that has impacted the quality and quantity of the nursing workforce, while strengthening the domestic economy through remittances. This study examines how the development of brain drain-responsive policies is driven by the effects of nurse migration and how such efforts aim to achieve mind-shifts among nurses, governing and regulatory bodies, and public and private institutions in the Philippines and worldwide. Methods:Interviews and focus group discussions were conducted to elicit exploratory perspectives on the policy response to nurse brain drain. Interviews with key informants from the nursing, labour and immigration sectors explored key themes behind the development of policies and programmes that respond to nurse migration. Focus group discussions were held with practising nurses to understand policy recipients’ perspectives on nurse migration and policy. Results: Using the qualitative data, a thematic framework was created to conceptualize participants’ perceptions of how nurse migration has driven the policy development process. The framework demonstrates that policymakers have recognised the complexity of the brain drain phenomenon and are crafting dynamic policies and programmes that work to shift domestic and global mindsets on nurse training, employment and recruitment. Conclusions: Development of responsive policy to Filipino nurse brain drain offers a glimpse into a domestic response to an increasingly prominent global issue. As a major source of professionals migrating abroad for employment, the Philippines has formalised efforts to manage nurse migration. Accordingly, the Philippine paradigm, summarised by the thematic framework presented in this paper, may act as an example for other countries that are experiencing similar shifts in healthcare worker employment due to migration

Effect of Water Depth on Heart Rate and Core Temperature During Underwater Treadmill Walking

Exercising using an underwater treadmill (UTM) has become a popular modality; however, few studies have focused on the physiological demands of UTM walking at varying water depths. Thus, the objective of this study was to investigate changes in heart rate (HR) and core temperature (CT) values in college-aged males and females while exercising at different water immersion depths using an UTM. Twenty participants (age = 21.50 ± 2.19 years; height = 169.04 ± 10.85cm; weight = 75.56 ± 22.28kg) walked at water depths of 10cm below the xiphoid process and at the level of the superior iliac crest (I.C.). Each UTM session lasted 15 minutes, consisting of 5-minute bouts at 1, 2, and 3 mph. Polar HR monitors and ingestible thermoregulatory pills were used to measure HR and CT. Results indicated that HR at 1 (p = .305) and 2 mph (p = .864) were not significantly different between water depths. Heart rate was significantly higher at 3 mph (p = .003) at the I.C. water level. No significant differences were found in CT at 1 (p = .919), 2 (p = .392), or 3 mph (p = .310) during either immersion depth. As a result, higher immersion depths resulted in a lower average HR during higher intensity exercise due to the increased buoyancy effects and the reduced gravity environment of the water. Thus, exercising in higher immersion depths allows participants to exercise at a higher intensity with less overall stress placed on the lower extremities

A Systems Approach to Improving Rural Care in Ethiopia

Background: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. Methodology/Principal Findings: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, an

Prehospital Electronic Patient Care Report Systems: Early Experiences from Emergency Medical Services Agency Leaders

Background: As the United States embraces electronic health records (EHRs), improved emergency medical services (EMS) information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR) systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. Methods: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP) members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. Results: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1) identify creative funding sources; 2) leverage regional health information organizations; and 3) build internal information technology capacity. Conclusion: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and implementation of e-PCR systems has been challenging for many. Emerging strategies from EMS agencies and others that have successfully implemented EHRs may be useful in expanding e-PCR system use and facilitating this transition for other EMS agencies

Spatial theory and human behavior

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45971/1/10110_2005_Article_BF01952731.pd