Nataliya Ivankova

Using Mixed-Methods Sequential Explanatory Design: From Theory to Practice

This article discusses some procedural issues related to the mixed-methods sequential explanatory design, which implies collecting and analyzing quantitative and then qualitative data in two consecutive phases within one study. Such issues include deciding on the priority or weight given to the quantitative and qualitative data collection and analysis in the study, the sequence of the data collection and analysis, and the stage/stages in the research process at which the quantitative and qualitative data are connected and the results are integrated. The article provides a methodological overview of priority, implementation, and mixing in the sequential explanatory design and offers some practical guidance in addressing those issues. It also outlines the steps for graphically representing the procedures in a mixed-methods study. A mixed-methods sequential explanatory study of doctoral students’ persistence in a distance-learning program in educational leadership is used to illustrate the methodological discussion.

An analysis of methodologies that can be used to validate if a perioperative surgical home improves the patient-centeredness, evidence-based practice, quality, safety, and value of patient care.

Approximately 80 million inpatient and outpatient surgeries are performed annually in the United States. Widely variable and fragmented perioperative care exposes these surgical patients to lapses in expected standard of care, increases the chance for operational mistakes and accidents, results in unnecessary and potentially detrimental care, needlessly drives up costs, and adversely affects the patient healthcare experience. The American Society of Anesthesiologists and other stakeholders have proposed a more comprehensive model of perioperative care, the Perioperative Surgical Home (PSH), to improve current care of surgical patients and to meet the future demands of increased volume, quality standards, and patient-centered care. To justify implementation of this new healthcare delivery model to surgical colleagues, administrators, and patients and maintain the integrity of evidenced-based practice, the nascent PSH model must be rigorously evaluated. This special article proposes comparative effectiveness research aims or objectives and an optimal study design for the novel PSH model.

Implementing Quality Criteria in Designing and Conducting a Sequential QUAN → QUAL Mixed Methods Study of Student Engagement With Learning Applied Research Methods Online

In spite of recent methodological developments related to quality assurance in mixed methods research, practical examples of how to implement quality criteria in designing and conducting sequential QUAN → QUAL mixed methods studies to ensure the process is systematic and rigorous remain scarce. This article discusses a three-step procedure for securing the quality of the meta-inferences generated from sequential employment of quantitative and qualitative methods and offers several validation strategies specific to a sequential QUAN → QUAL mixed methods design: applying a systematic process for selecting participants for qualitative follow-up, elaborating on unexpected quantitative results, and observing interaction between qualitative and quantitative study strands. The discussed procedures are illustrated using a mixed methods study of graduate student engagement in learning applied research methods online.

Experience of sexual violence among women in HIV discordant unions after voluntary HIV counselling and testing: a qualitative critical incident study in Uganda.

Abstract HIV-serodiscordant relationships are those in which one partner is infected with HIV while the other is not. We investigated experiences of sexual violence among women in HIV discordant unions attending HIV post-test club services in Uganda. A volunteer sample of 26 women from three AIDS Information Centres in Uganda who reported having experienced sexual violence in a larger epidemiological study were interviewed, using the qualitative critical incident technique. Data were analysed using TEXTPACK, a software application for computer-assisted content analysis. Incidents of sexual violence narrated by the women included use of physical force and verbal threats. Overall, four themes that characterise the womens experience of sexual violence emerged from the analysis: knowledge of HIV test results, prevalence of sexual violence, vulnerability and proprietary views and reactions to sexual violence. Alcohol abuse by the male partners was an important factor in the experience of sexual violence among the women. Their experiences evoked different reactions and feelings, including concern over the need to have children, fear of infection, desire to separate from their spouses/partners, helplessness, anger and suicidal tendencies. HIV counselling and testing centres should be supported with the capacity to address issues related to sexual violence for couples who are HIV discordant.

Patient satisfaction with anesthesia: Beauty is in the eye of the consumer

245 August 2013 V in health care— broadly defined as the patient health outcomes achieved per dollar spent—has received increasing attention, including with anesthesia services.1,2 To deliver value, clinicians and other stakeholders must integrate the often disparate and conflicting healthcare delivery goals of quality, safety, effectiveness, efficiency, timeliness, patientcenteredness, equitable access, convenience, cost containment, and profitability.2 Patient satisfaction has also become a standard indicator of the value of delivered health care, including with anesthesia-related care.3 Patient satisfaction has been defined as the degree of congruence between patient expectation and provider accomplishment.4 However, the complexity of the construct of human satisfaction and its multidimensional nature have often impaired the development of psychometrically valid evaluation tools, including those used in the perioperative setting.5 Nevertheless, central elements of current and likely future health care reform in the united States will link payment to “pay-for-performance” and “value-based purchasing” models,6 including mandatory reporting of patient-reported scores (e.g., Hospital Consumer assessment of Healthcare Providers and Systems Survey).7 In this issue of aNeSTHeSIology , Barnett et al.8 present their qualitative systematic review of the literature regarding measures of patient satisfaction in anesthesia. Their findings and recommendations are timely and relevant to researchers, practitioners, and policymakers alike. The medical profession has most recently been principally challenged and transformed by the factors such as (1) the increase in patient consumerism, (2) the advent of evidence-based medicine, and (3) the increasing power of the pharmaceutical industry.9 This increasing consumer orientation of health care is typified by an emphasis on patient satisfaction and has important differences from the more classical, professionally dominated definitions of quality and value.10 Patient satisfaction is fundamentally based on patientcentered care and shared decision making—two new and often foreign concepts to many clinicians— including anesthesiologists. Berwick has defined patientcentered care as “the experience (to the extent in which the informed individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care...to include the experience of family and loved ones of their choosing.”10 Such patient-centeredness is reflected in the heightened awareness that the quality and value of healthcare services are most appropriately determined from the perspective of the individual patient.1,2 It is likewise manifested in the greater emphasis on patient-reported outcomes, including assessments of the experience of health care, as the basis for comparing the effectiveness of services delivered by physicians, health plans, and hospital systems.1,11 The medical community and the public are also increasingly embracing shared decision making, a process by which health care choices are made jointly by the practitioner and the patient.12 akin to the Medical Home model which has been piloted in the primary care outpatient setting,13 the Surgical Home has thus been proposed by the american Society of anesthesiologists and other stakeholders as an innovative, patient-centered, surgical continuity of care model that incorporates shared decision making.14,15 Shared Patient Satisfaction with Anesthesia

Teaching and Learning Mixed Methods Research in Computer-mediated Environment: Educational Gains and Challenges

ABSTRACT The purpose of this article is to describe the unique experiences of teaching and learning applied mixed methods research course in the computer-mediated environment and the associated educational gains and challenges, drawing on both instructor and students’ experiences. Students’ perspective is based on the formative feedback received during the course, end-of-course evaluations, and students’ emails to the instructor collected during five semesters of the course offering. Educational gains that the online format offered were evident in the increased access to the course, more enriched and engaged learning, availability of prompt formative feedback, and exposure to multiple mixed methods research situations. For students, learning challenges fell into four categories: content, cognitive, technological, and those related to the online asynchronous learning environment. Pedagogical challenges related to the course design and student involvement with the course, while methodological challenges were caused by the specifics of the course content and availability of teaching resources.

Exploring factors facilitating adults with spinal cord injury rejoining the workforce: a pilot study

Abstract Background: Return-to-work (RTW) rates after spinal cord injury (SCI) in the USA are very low and are continuing to decline. Previous research has attempted to identify factors facilitating RTW; however, the phenomenon of RTW involves many personal factors and predicting RTW success remains difficult. Purpose: The purpose of this pilot study was to explore the factors facilitating adults with SCI rejoining the workforce in an urban area in order to identify items that may be emphasized in the rehabilitation process. Methods: The study was completed using qualitative methods. Four adults who had acquired a traumatic SCI in adulthood and were currently employed participated. Their experiences in RTW after injury were collected via semi-structured interviews and photography of assistive devices. Results: The most common facilitating factor was motivation, with family and rehabilitation professionals serving as extrinsic motivators. Other facilitators were resources and perceived benefits. Conclusions: Motivation and resources were important facilitators, including rehabilitation professional’s personal influence and therapies, and resource assistance from state agencies. The results indicate that practitioners can play an important role in influencing RTW, and resources from state agencies are helpful when individuals know how to access and utilize them. Implications for Rehabilitation Assistive technology supports successful return to work after SCI. Motivation strongly influences return to work after SCI and can be influenced by rehabilitation professionals, family and community members. Patients should be well informed about how to access assistance programs such as vocational rehabilitation.

Caregiver perceptions of the food marketing environment of African-American 3-11-year-olds: a qualitative study.

OBJECTIVE To assess caregivers’ perceptions of the extent to which the food marketing environment influences food consumption among African-American children (aged 3–11 years) in order to generate potential strategies to make the marketing environment more favourable to healthier eating. DESIGN Individual semi-structured interviews with caregivers were conducted by trained community leaders to ascertain their awareness of and perceptions about food marketing environments contributing to African-American childrens food consumption. SETTING Six predominantly African-American communities in metro Birmingham, Alabama, USA with high proportions of school-age children and lower-income residents. SUBJECTS Caregivers (n 25) were predominantly female (93 %) and either parents/guardians (64 %) or grandparents (28 %) of African-American children aged 3–11 years. Caregiver mean age was 43 years and 46 % had lived in their current residence for over 10 years. RESULTS Caregivers reported all aspects of the food marketing matrix as supporting unhealthy eating among African-American youth. Child preference for foods higher in fat and sugar, lower pricing of less healthy foods, limited access to healthier food retailers and targeted advertisements were particularly influential on the food selection, acquisition and consumption of children. Company loyalty, corporate sponsorship of local events and conflicts over parental v. food company responsibility contributed to less consensus about the overall impact (positive or negative) of food companies in African-American communities. CONCLUSIONS While caregivers perceived aspects of their food marketing environments as primarily contributing to unhealthy eating among African-American children, framing the demand for changes in the food marketing environments of African-American youth may be particularly challenging.

Utilizing Mixed Methods to Assess Parasocial Interaction of an Entertainment-education Program Audience

Abstract The purpose of this study was to develop a model to interpret the degree that parasocial interaction affects entertainment-education radio drama listeners’ levels of self-efficacy and practices pertaining to physical exercise. The study utilized a concurrent triangulation mixed methods design. The quantitative strand tested the hypothesized model via path analysis on survey data collected from 105 participants. The qualitative strand developed a grounded theory based on interviews of 18 individuals. The final composite model was developed utilizing triangulation and complementarity in the integration process. Empirical evidence and theoretical discussion supported the processes of integration. Limitations and implications are also addressed.

Gout Self-Management in African American Veterans: A Qualitative Exploration of Challenges and Solutions From Patients' Perspectives

To explore gout self‐management and associated challenges and solutions in African Americans.