Mixed methods study of clinicians' perspectives on barriers to implementation of treat to target in psoriatic arthritis

Objectives: In treat to target (T2T), the patient is treated to reach and maintain specified and sequentially measured goals, such as remission or low disease activity. T2T in psoriatic arthritis (PsA) has demonstrated improved clinical and patient-reported outcomes and is recommended in European guidelines. However, most clinicians do not use T2T in PsA. This study examined the barriers and enablers to implementation in practice. Methods: Sequential mixed methods comprising a qualitative design (interviews and focus group) to inform a quantitative design (survey). Qualitative data were analysed thematically, and quantitative statistics were analysed descriptively. Results: Nineteen rheumatology clinicians participated in telephone interviews or a face-to-face focus group. An overarching theme 'Complexity' (including 'PsA vs Rheumatoid Arthritis', 'Measurement' and 'Resources') and an underpinning theme 'Changes to current practice' (including 'Reluctance due to organisational factors' and 'Individual determination to make changes') were identified. 153 rheumatology clinicians responded to an online survey. Barriers included limited clinical appointment time to collect outcome data (54.5%) and lack of training in assessing skin disease (35%). Enablers included provision of a protocol (86.4%), a local implementation lead (80.9%), support in clinic to measure outcomes (83.3%) and training in T2T (69.8%). The importance of regular audit with feedback, specialist PsA clinics and a web-based electronic database linked to hospital/national information technology (IT) systems were also identified as enablers. Conclusions: Implementation of T2T in PsA requires an integrated approach to address the support, training and resource needs of individual clinicians, rheumatology teams, local IT systems and service providers to maximise success

Investigating information systems with mixed-methods research

Mixed-methods research, which comprises both quantitative and qualitative components, is widely perceived as a means to resolve the inherent limitations of traditional single method designs and is thus expected to yield richer and more holistic findings. Despite such distinctive benefits and continuous advocacy from Information Systems (IS) researchers, the use of mixed-methods approach in the IS field has not been high. This paper discusses some of the key reasons that led to this low application rate of mixed-methods design in the IS field, ranging from misunderstanding the term with multiple-methods research to practical difficulties for design and implementation. Two previous IS studies are used as examples to illustrate the discussion. The paper concludes by recommending that in order to apply mixed-methods design successfully, IS researchers need to plan and consider thoroughly how the quantitative and qualitative components (i.e. from data collection to data analysis to reporting of findings) can be genuinely integrated together and supplement one another, in relation to the predefined research questions and the specific research contexts

Advocating mixed-methods approaches in health research

This methods paper provides researchers in Nepal with a broad overview of the practical and philosophical aspects of mixed-methods research. The three authors have a wide-ranging expertise in planning and conducting mixed-methods studies. The paper outlines the different paradigms or philosophies underlying quantitative and qualitative methods and some of the on-going debates about mixed-methods. The paper further highlights a number of practical issues, such as (a) the particular mix and order of quantitative and qualitative methods; (b) the way of integrating methods from different philosophical stance; and (c) how to synthesise mixed-methods findings

A mixed methods study of factors influencing health managers acceptance of eHealth services in the Kingdom of Saudi Arabia.

The Kingdom of Saudi Arabia (KSA) is a country with one of the largest land masses and most difficult geographical terrain in the Middle East. The accessibility of advanced health services, especially for people in rural areas, has been considered one of the main health challenges. Health services across the country are accessible through three categories of providers. The Ministry of Health (MOH), which is the dominant health provider, is responsible for 60% of all health services and facilities. The private health sector and other government-run health authorities are the providers for the remaining 40%. Many initiatives to embrace technology in healthcare were launched by the MOH to advance the level of acceptance. One of the initiatives was the ambitious National eHealth Strategy, which was launched in 2011 to govern eHealth projects across the country, and to set consistent standards, policies, and procedures for the practice activities. This study was sponsored by the MOH as part of a bigger plan to involve stakeholders in the digital transformation. The overall aim of this doctoral research was to explore the factors that influence health managers' acceptance of eHealth services in KSA. The 1st phase was a systematic review (SR): based on a PRISMA-P guided protocol published with CRD Prospero, five databases were searched for studies published between 1993 and 2017. One reviewer performed the search; two reviewers screened the titles and abstracts. Exclusions were recorded with reasons. Tools appropriate to study design were applied independently by two reviewers to assess the quality of included studies. After duplicates were removed, 110 papers were screened and 15 studies met the inclusion criteria. From these 15 papers, 39 factors were identified as influencing varying levels of eHealth adoption and acceptance in KSA. Lack of studies on the views of health managers and limited studies from only a few geographical settings were also identified as knowledge gaps. The 2nd phase was a survey: an online questionnaire in both Arabic and English language was designed around the Unified Theory of Acceptance and Use of Technology (UTAUT) model determinants. Professionals with a health managerial role from multiple disciplines - such as health professions, administration, and health IT - were invited to take part in the study. Ethical approval had been gained. Participation links were distributed across a range of social media platforms. SPSS v25 was used for data analysis. Findings from the 2nd phase survey showed the significance (p < 0.05) of Performance Expectancy and Social Influence moderated by age to the Behavioural Intention of health managers as well as the Performance Expectancy and Facilitating Conditions to the actual Use Behaviour. Some ambiguous results need further investigations. The 3rd phase consisted of a mixture of face-to-face and telephone in-depth interviews with 21 health managers from Aseer province, KSA. Four umbrella domains were derived from the UTAUT model. The pre-defined themes from phases 1 and 2 were explored and mapped against the domains. Ethical approval had been gained. Microsoft Excel and NVivo were used for the data analysis. Through the interviews, ambiguity in the previous phase was clarified and the most influential factors based on the views of health managers in Aseer province, KSA, were identified. Three domains out of four showed significance: Performance Expectancy, Social Influence, and Facilitating Conditions. This mixed methods research design presented across three phases was adopted with the findings from each phase informing the next. Overall, the research confirmed the influence of the same factors on health managers' acceptance of eHealth services in KSA and generated original findings. First, by providing evidence that this area has not been previously studied through registering a protocol and publishing a systematic review. Second, by using social media platforms to support a novel recruitment approach for the study. Third, by employing UTAUT as a theoretical framework in both quantitative and qualitative phases. Finally, exploring eHealth practice in Aseer province, a part of KSA that has not previously been explored in the published literature. These original findings draw a clearer picture of the potential challenges faced by health managers in KSA in accepting and using eHealth services. The findings may also work as a foundational basis from which to better prepare other stakeholder groups for accepting eHealth services. By doing so, staff can more effectively utilise health technology interventions as key concepts in making successful and positive transformational and sustainable change to the delivery of healthcare

Mixed-methods approaches in health research in Nepal

Combining and integrating a mixture of qualitative and quantitative methods in one single study is widely used in health and social care research in high-income countries. This editorial adds a few words of advice to the novice mixed-methods researcher in Nepal