Using Mixed Methods to Assess Trade-Offs Between Agricultural Decisions and Deforestation

Background: The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children’s health in low-and-lower-middle-income countries. Methods: A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between November 1st-10th 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on low-and-lower-middle-income countries, addressed impacts on women and child’s health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute’s critical appraisal tools were used to assess the quality of the studies, and the PRISMA guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative data-based convergent synthesis design. Results: The review process identified 46 papers meeting the inclusion criteria from 17 countries whichall focussed on the COVID-19 and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women is well-established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods are disrupted, and poverty levels increase. Conclusion: Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the trade-offs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

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Developing patient-centred, feasible alternative care for adult emergency department users with epilepsy: protocol for the mixed-methods observational ‘Collaborate’ project

BMJ Open ◽

10.1136/bmjopen-2019-031696 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031696 ◽

Cited By ~ 2

Author(s):

Adam J Noble ◽

Amy Mathieson ◽

Leone Ridsdale ◽

EA Holmes ◽

Myfanwy Morgan ◽

...

Keyword(s):

Emergency Department ◽

Mixed Methods ◽

Care Pathway ◽

Knowledge Exchange ◽

Discrete Choice Experiments ◽

Nominal Group ◽

Structured Interviews ◽

Dissemination Strategy ◽

Alternative Care ◽

Trade Offs

IntroductionEmergency department (ED) visits for epilepsy are common, costly, often clinically unnecessary and typically lead to little benefit for epilepsy management. An ‘Alternative Care Pathway’ (ACP) for epilepsy, which diverts people with epilepsy (PWE) away from ED when ‘999’ is called and leads to care elsewhere, might generate savings and facilitate improved ambulatory care. It is unknown though what features it should incorporate to make it acceptable to persons from this particularly vulnerable target population. It also needs to be National Health Service (NHS) feasible. This project seeks to identify the optimal ACP configuration.Methods and analysisMixed-methods project comprising three-linked stages. In Stage 1, NHS bodies will be surveyed on ACPs they are considering and semi-structured interviews with PWE and their carers will explore attributes of care important to them and their concerns and expectations regarding ACPs. In Stage 2, Discrete Choice Experiments (DCE) will be completed with PWE and carers to identify the relative importance placed on different care attributes under common seizure scenarios and the trade-offs people are willing to make. The uptake of different ACP configurations will be estimated. In Stage 3, two Knowledge Exchange workshops using a nominal group technique will be run. NHS managers, health professionals, commissioners and patient and carer representatives will discuss DCE results and form a consensus on which ACP configuration best meets users’ needs and is NHS feasible.Ethics and disseminationEthical approval: NRES Committee (19/WM/0012) and King’s College London ethics Committee (LRS-18/19-10353). Primary output will be identification of optimal ACP configuration which should be prioritised for implementation and evaluation. A pro-active dissemination strategy will make those considering developing or supporting an epilepsy ACP aware of the project and opportunities to take part in it. It will also ensure they are informed of its findings.Project registration numberResearchregistry4723.

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The Opportunity Cost of Changing Clinical Practice in Anticipation of a Surge of Covid-19 patients – A Convergent Mixed Methods Study Protocol

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v8i3.1793 ◽

2020 ◽

Vol 8 (3) ◽

pp. 301

Author(s):

Veena Manja ◽

James Wiedeman ◽

Jeffrey S Hoch ◽

Diana Lee Farmer

Keyword(s):

Mixed Methods ◽

Teaching And Learning ◽

Mixed Methods Study ◽

Case Mix ◽

Negative Consequences ◽

Structured Interviews ◽

Case Volume ◽

Quantitative Phase ◽

Trade Offs ◽

The Impact

Background: The rapid rise of COVID-19 infections has strained the capacity of healthcare systems worldwide. Many organizations are changing practice to make room for a surge in patients with COVID-19 infections. Cancelling and rescheduling elective procedures is one strategy advocated and used by many. This process may result in negative consequences for the patients who need procedures and have negative teaching and economic implications.Rationale and Study Design: This convergent mixed-methods study includes analysis of surgical databases to evaluate differences in case-volume and case-mix before and after the emergence of COVID-19 pandemic (quantitative phase), prospective observational study of patients impacted by the delayed scheduling of surgical procedures (quantitative phase) and 1:1 semi-structured interviews with patients, physicians and administrators to understand the impact of operational changes as a result on COVID-19 infection on patient care, teaching and learning and fiscal outcomes.Methods: The quantitative phase will consist of a review of the surgical database to quantify the differences in case-volume and case-mix during 2019 and 2020. In addition a prospective cohort of patients impacted by the delay in these procedures will be followed for 6 months to assess changes in patient important outcomes due to changes in scheduling procedures. The qualitative phase will consist of 1:1 semi-structured interviews to gain a depth of understanding of the trade-offs due to a change in practice related to COVID-19. The interviews will be analyzed using qualitative description.Discussion: The COVID-19 pandemic has caused worldwide disruption in the practice of healthcare, current focus on increasing capacity in preparation for a COVID-19 surge may have unforeseen consequences for patients who need non-COVID-19 related care. Studying the impact prospectively will provide information on the trade-offs associated with change in healthcare priorities. These results may be helpful in informing optimal healthcare practices and resource allocation in the future.

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Treatment preferences for preventive interventions for rheumatoid arthritis: protocol of a mixed methods case study for the Innovative Medicines Initiative PREFER project

BMJ Open ◽

10.1136/bmjopen-2020-045851 ◽

2021 ◽

Vol 11 (4) ◽

pp. e045851

Author(s):

Marie Falahee ◽

Gwenda Simons ◽

Rachael L DiSantostefano ◽

Larissa Valor Méndez ◽

Christine Radawski ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Life Cycle ◽

Mixed Methods ◽

Patient Preferences ◽

Ethics Committee ◽

Nominal Group ◽

Preventive Interventions ◽

The Public ◽

Trade Offs

IntroductionAmidst growing consensus that stakeholder decision-making during drug development should be informed by an understanding of patient preferences, the Innovative Medicines Initiative project ‘Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle’ (PREFER) is developing evidence-based recommendations about how and when patient preferences should be integrated into the drug life cycle. This protocol describes a PREFER clinical case study which compares two preference elicitation methodologies across several populations and provides information about benefit–risk trade-offs by those at risk of rheumatoid arthritis (RA) for preventive interventions.Methods and analysisThis mixed methods study will be conducted in three countries (UK, Germany, Romania) to assess preferences of (1) first-degree relatives (FDRs) of patients with RA and (2) members of the public. Focus groups using nominal group techniques (UK) and ranking surveys (Germany and Romania) will identify and rank key treatment attributes. Focus group transcripts will be analysed thematically using the framework method and average rank orders calculated. These results will inform the treatment attributes to be assessed in a survey including a discrete choice experiment (DCE) and a probabilistic threshold technique (PTT). The survey will also include measures of sociodemographic variables, health literacy, numeracy, illness perceptions and beliefs about medicines. The survey will be administered to (1) 400 FDRs of patients with RA (UK); (2) 100 FDRs of patients with RA (Germany); and (3) 1000 members of the public in each of UK, Germany and Romania. Logit-based approaches will be used to analyse the DCE and imputation and interval regression for the PTT.Ethics and disseminationThis study has been approved by the London-Hampstead Research Ethics Committee (19/LO/0407) and the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg (92_17 B). The protocol has been approved by the PREFER expert review board. The results will be disseminated widely and will inform the PREFER recommendations.

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Safety Trade-Offs in Home Care During COVID-19: A Mixed Methods Study Capturing the Perspective of Frontline Workers

Patient Safety ◽

10.33940/infection/2021.9.1 ◽

2021 ◽

pp. 6-17

Author(s):

Godwin Osei-Poku ◽

Ola Szczerepa ◽

Alicia Potter ◽

M.E. Malone ◽

Barbara Fain ◽

...

Keyword(s):

Mixed Methods ◽

Home Care ◽

Mixed Methods Study ◽

Older Individuals ◽

Survey Question ◽

Trade Offs ◽

Care Workers ◽

Virtual Focus Groups ◽

Exposure Risks ◽

Home Care Workers

Background: Home care workers help older individuals and those with disabilities with a variety of functional tasks. Despite their core role providing essential care to vulnerable populations, home care workers are often an invisible sector of the healthcare workforce. The transmission of COVID-19 and the nature of home care work raise several questions about the overall safety of these workers during the pandemic. Objective: To examine the experiences of home care workers during COVID-19, particularly their access to information about infection status, to testing, and to personal protective equipment (PPE); their understanding of guidelines; and trade-offs associated with protecting workers’ safety. Methods: A mixed methods study including qualitative analysis of guided discussion questions and quantitative analysis of multiple-choice survey questions was conducted. Eleven virtual focus groups in October and November 2020 involved 83 home care workers who care for clients/consumers in Massachusetts. Thirty-nine participants worked as personal care attendants (PCAs) employed directly by a consumer and 44 participants worked for an agency. Ninety percent self-identified as female and 54% had worked in home care for more than five years. Qualitative data was analyzed using thematic analysis, with identification of major and minor themes. Likert scale survey question data on perceptions of COVID-19 exposure, access to resources to prevent transmission, and perceptions of safety at work were dichotomized into agree or disagree. Results: PCAs and agency-employed home care workers were regularly faced with trade-offs between meeting client/consumer needs and protecting themselves from COVID-19 exposure. Twenty-five percent of participants reported serving a client/consumer who had COVID-19, 75% reported worrying about getting COVID-19 at work, and 29% reported thinking about stopping their work in home care. Despite a low pay structure, participants reported opting to risk exposure rather than to leave their clients/consumers without essential care. However, workers often lacked the resources (e.g., PPE, testing) to feel truly protected. This scarcity of resources combined with insufficient guidance and policies specific to home care settings led many workers to informally collaborate with clients/consumers to assess exposure risks and agree upon safety protocols. Focus group participants expressed uncertainty as to whether workers were truly empowered to ask for changes if conditions seemed unsafe. The burden of determining safety protocols was felt more strongly by PCAs who operate more independently than agency-employed workers who have supervisors to consult. Conclusions: Home care workers expressed deep commitment to continuing to care for their clients/consumers during COVID-19, but often had to operate with insufficient resources and under conditions that made their work environments feel unsafe. Their ability to identify exposure risks and make decisions on how to protect themselves often hinged on a transparent and trusting relationship with their clients/consumers. These relationships were particularly important for PCAs who did not have access to safety guidance from a home care agency.

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Models of intrapartum care and women’s trade-offs in remote and rural Scotland: a mixed-methods study

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.2007.01516.x ◽

2007 ◽

Vol 115 (5) ◽

pp. 560-569 ◽

Cited By ~ 42

Author(s):

E Pitchforth ◽

V Watson ◽

J Tucker ◽

M Ryan ◽

E Van Teijlingen ◽

...

Keyword(s):

Mixed Methods ◽

Mixed Methods Study ◽

Intrapartum Care ◽

Trade Offs

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The Mixed Methods Practical Sustainability Research Framework: An Illustration From Research on the Creeping Problem of Coastal Complexity and Mangrove Management

Journal of Mixed Methods Research ◽

10.1177/15586898211014422 ◽

2021 ◽

pp. 155868982110144

Author(s):

A. M. Dencer-Brown ◽

R. M. Jarvis ◽

A. C. Alfaro ◽

S. Milne

Keyword(s):

Mixed Methods ◽

Knowledge Exchange ◽

Ecosystem Change ◽

World Population ◽

Research Framework ◽

Social Ecological ◽

Trade Offs ◽

Sustainability Research ◽

The Social

With a rising world population and pressure on ecosystems due to development, researchers need sophisticated and integrated approaches for conducting sustainability research. We outline a mixed methods practical sustainability research framework, defined as an equal-priority social–ecological methodology, whereby both community engagement and integrated biodiversity assessments are constructed to identify sustainability trade-offs. We illustrate the framework’s use for investigating the social–ecological trade-offs between preserving and removing temperate mangroves in New Zealand. We used a multistage mixed methods design with three stages to generate knowledge and identify social–ecological trade-offs. Our case study illustrates an operational approach for local mangrove management and regional coastal sustainability. Working with communities affected by ecosystem change through participatory research proved key to knowledge exchange and colearning.

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Mixed-Methods Research in a Complex Multisite VA Health Services Study: Variations in the Implementation and Characteristics of Chiropractic Services in VA

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/701280 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Raheleh Khorsan ◽

Angela B. Cohen ◽

Anthony J. Lisi ◽

Monica M. Smith ◽

Deborah Delevan ◽

...

Keyword(s):

Mixed Methods ◽

Data Collection ◽

Mixed Methods Research ◽

Implementation Process ◽

Lessons Learned ◽

Data Sources ◽

Department Of Veterans Affairs ◽

Policy And Practice ◽

Trade Offs ◽

The Us

Maximizing the quality and benefits of newly established chiropractic services represents an important policy and practice goal for the US Department of Veterans Affairs’ healthcare system. Understanding the implementation process and characteristics of new chiropractic clinics and the determinants and consequences of these processes and characteristics is a critical first step in guiding quality improvement. This paper reports insights and lessons learned regarding the successful application of mixed methods research approaches—insights derived from a study of chiropractic clinic implementation and characteristics, Variations in the Implementation and Characteristics of Chiropractic Services in VA (VICCS). Challenges and solutions are presented in areas ranging from selection and recruitment of sites and participants to the collection and analysis of varied data sources. The VICCS study illustrates the importance of several factors in successful mixed-methods approaches, including (1) the importance of a formal, fully developed logic model to identify and link data sources, variables, and outcomes of interest to the study’s analysis plan and its data collection instruments and codebook and (2) ensuring that data collection methods, including mixed-methods, match study aims. Overall, successful application of a mixed-methods approach requires careful planning, frequent trade-offs, and complex coding and analysis.

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Developing policy packages for low-carbon passenger transport: A mixed methods analysis of trade-offs and synergies

Ecological Economics ◽

10.1016/j.ecolecon.2021.107304 ◽

2022 ◽

Vol 193 ◽

pp. 107304

Author(s):

Anna Dugan ◽

Jakob Mayer ◽

Annina Thaller ◽

Gabriel Bachner ◽

Karl W. Steininger

Keyword(s):

Mixed Methods ◽

Low Carbon ◽

Passenger Transport ◽

Trade Offs

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Novel players fine-tune plant trade-offs

Essays in Biochemistry ◽

10.1042/bse0580083 ◽

2015 ◽

Vol 58 ◽

pp. 83-100 ◽

Cited By ~ 25

Author(s):

Selena Gimenez-Ibanez ◽

Marta Boter ◽

Roberto Solano

Keyword(s):

Ubiquitin Ligase ◽

Feedback Loop ◽

Molecular Level ◽

26S Proteasome ◽

Signalling Molecules ◽

Transcriptional Reprogramming ◽

Trade Offs ◽

Jaz Proteins ◽

Regulatory Feedback Loop ◽

Fine Tune

Jasmonates (JAs) are essential signalling molecules that co-ordinate the plant response to biotic and abiotic challenges, as well as co-ordinating several developmental processes. Huge progress has been made over the last decade in understanding the components and mechanisms that govern JA perception and signalling. The bioactive form of the hormone, (+)-7-iso-jasmonyl-l-isoleucine (JA-Ile), is perceived by the COI1–JAZ co-receptor complex. JASMONATE ZIM DOMAIN (JAZ) proteins also act as direct repressors of transcriptional activators such as MYC2. In the emerging picture of JA-Ile perception and signalling, COI1 operates as an E3 ubiquitin ligase that upon binding of JA-Ile targets JAZ repressors for degradation by the 26S proteasome, thereby derepressing transcription factors such as MYC2, which in turn activate JA-Ile-dependent transcriptional reprogramming. It is noteworthy that MYCs and different spliced variants of the JAZ proteins are involved in a negative regulatory feedback loop, which suggests a model that rapidly turns the transcriptional JA-Ile responses on and off and thereby avoids a detrimental overactivation of the pathway. This chapter highlights the most recent advances in our understanding of JA-Ile signalling, focusing on the latest repertoire of new targets of JAZ proteins to control different sets of JA-Ile-mediated responses, novel mechanisms of negative regulation of JA-Ile signalling, and hormonal cross-talk at the molecular level that ultimately determines plant adaptability and survival.

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