Teacher Exit Survey Development Through a Researcher–Practitioner Partnership: A Collaborative Approach

This article details the community-engaged research process employed by a researcher–practitioner partnership (RPP) to develop and pilot a common exit survey of teachers from participating school districts at the end of the 2018–2019 school year. This development occurred with input from school district representatives serving on a study team as well as through ongoing conversations with district human resource directors. There were three goals for this process: (1) to develop a common exit survey relevant to local needs with a strong conceptual framework, (2) to increase response rates and establish consistent administration practices in the region, and (3) to inform future data collection and analysis related to the broader RPP study on teacher retention. The resultant instrument articulated nine common categories of reasons for leaving based on analysis and adaptation of regional exit surveys: retirement, personal reasons, teacher preparation, compensation and benefits, career advancement/switch or higher education, community context, district context, school context, and testing and accountability context. Exit survey items are provided with reliability and validity information, and theoretical and practical implications are discussed.

Characterizing Nonreturning College Students and Their Departure Intentions

Success for 4-year universities is often measured by graduation and retention rates; however, gaps exist in understanding nonreturning students at private institutions. Recent research is helping to build the lexicon of drop-outs, stop-outs, opt-outs, and transfer-outs to inform strategic retention initiatives. Using an action research method, we characterized 1,091 students into designated subclasses and utilized exit interviews, advising notes, and university surveys to theme their departure intentions. Findings reveal transfer-outs to be the largest subclass, with departure reasons being summarized within themes of university experience and fit, health, academic, and financial. Recommendations are made for university administrators and retention offices related to exit survey questions, broadening success metrics, and to focus on specific student characteristic groups.

Evaluation of the Diet Tracking Smartphone Application Keenoa™: A Qualitative Analysis

Keenoa™ is a novel Canadian diet application (app) currently used by Canadian dietitians to collect diet-related data from clients. The goal of this study was to evaluate Keenoa™ based on user feedback and compare it to a conventional pen and paper method. One hundred and two participants were recruited and randomly assigned to record their diets using this application for 3 nonconsecutive days. Following this, participants were invited to complete an online “exit” survey. Seventy-two subjects responded, with 50 completing an open-ended question asking for general feedback about the app. Data were reviewed and 3 main themes emerged: strengths, challenges, and future recommendations. Strengths associated with the app consisted of picture recognition software, the additional commentary feature, and the overall pleasant data collection process. Challenges that were identified included inconsistencies with the barcode scanning features, the limited food database, time to enter food details, and software issues. Future recommendations included using a larger food database, pairing dietary intake with physical activity monitoring, and having accessible nutritional data. Despite these limitations, participants preferred using mobile apps to record diet compared with traditional written food diaries.

Black students applying and admitted to medicine in the province of Quebec, Canada: what do we know so far?

To address the underrepresentation of Black students in medical schools in Canada and identify barriers in selection processes, we compare data from the latest Canadian census to that of an exit-survey conducted after a situational judgment test (Casper) among medical school applicants and from questionnaires done after selection interviews in Quebec, Canada. The proportion of Black people aged 15-34 years old in Quebec in 2016 was 5.3% province-wide and 8.2% in the Montreal metropolitan area. The proportion in the applicant pool for 2020 in Quebec was estimated to be 4.5% based on Casper exit-survey data. Comparatively, it is estimated that Black people represented 1.8% of applicants invited to admission interviews and 1.2% of admitted students in Quebec in 2019. Although data from different cohorts and data sources do not allow for direct comparisons, these numbers suggest that Black students applying to medical school are disproportionately rejected at the first step compared to non-Black students. Longitudinal data collection among medical school applicants will be necessary to monitor the situation. Further studies are required to pinpoint the factors contributing to this underrepresentation, to keep improving the equity of our selection processes.

Linking Individual-level Facebook Posts with Psychological and Health Data in an Epidemiologic Cohort: A Feasibility Study (Preprint)

BACKGROUND Psychological factors (e.g., depression, optimism) and related biological and behavioral responses are associated with numerous physical health outcomes. The majority of research in this area relies on self-reported assessments of psychological factors, which are difficult to scale because they may be expensive to administer and time-consuming to complete. Investigators are increasingly interested in using social media as a novel and convenient platform for obtaining information rapidly in large populations. OBJECTIVE We evaluated the feasibility of obtaining Facebook data from a large ongoing cohort of midlife and older women which may be used to assess psychological functioning efficiently with low cost. METHODS This protocol was conducted with participants in the Nurses’ Health Study II (NHSII) which was started in 1989 with biennial follow-ups. Facebook does not share data readily; therefore, we developed procedures to enable women to download and transfer their Facebook data to the cohort servers (for linkage with other study data they have provided). Since privacy is a critical concern when collecting individual-level data, we partnered with a third-party software developer, Digi.me, to enable participants to obtain their own Facebook data and to send it securely to our research team. In 2020, we invited a subset of the 18,519 NHSII participants (aged 56-73 years) via email to participate. Women were selected if they reported on the 2017-2018 questionnaire that they regularly posted to Facebook and were still active cohort participants. We included an exit survey for those who chose not to participate to gauge reasons for non-participation. RESULTS We invited 309 women to participate. Few women signed the consent form (N=52) and only three used the Digi.me app to download and transfer their Facebook data. These low participation rates were observed despite modifying our protocol between waves of recruitment, including by 1) excluding active healthcare workers, who might be less available to participate due to the pandemic; 2) developing a Frequently Asked Questions factsheet to provide more information regarding the protocol; and 3) simplifying the instructions for using the Digi.me app. On our exit survey, reasons most commonly reported for not participating were concerns regarding data privacy and hesitation sharing personal Facebook posts. The low participation rates suggest that obtaining individual-level Facebook data in a cohort of middle-aged and older women may be challenging. CONCLUSIONS In this cohort of midlife and older women who were actively participating for over three decades, we were largely unable to obtain permission to access to individual-level data from participants’ Facebook accounts. Despite working with a third-party to customize an app to implement safeguards for privacy, data privacy remained a key concern in these women. Future studies aiming to leverage individual-level social media should explore alternate populations or means of sharing social media data.

Packaging the Promise: Money, Messaging, and Misalignment

Background Promise programs are a quickly spreading policy tool in the free college movement. Despite their rapid spread, promise programs remain generally untested and there is even less information about how they are implemented. Research Questions (1) In what ways were The Degree Project's (TDP) theory of change and intents represented in messaging materials to students and to school staff? 1(a) In what ways did these messages shape conditions (or not) for sensemaking? (2) In what ways did these messages support (or not) students and school staff in changing their practice? (2a) What changes in practice did we see (or not) for students and school staff? Intervention TDP, which was implemented in Milwaukee Public Schools between 2011–15, is the nation's first randomized control trial of a promise program. Freshmen in the treatment group were offered $12,000 for college if they met particular requirements (e.g., average 2.5 GPA, 90% attendance). TDP leaned heavily on marketing materials and personalized letters to students, families, and school staff to communicate its requirements and to provide college access tips. Research Design We analyze messaging materials, climate and exit survey data, and student and school staff interviews to understand how TDP's theory of change and intents were packaged into messaging materials and ultimately enacted among target students and staff. Findings TDP implementation was successful to a point. School staff handed out messaging materials; students understood the requirements and demonstrated an increase in motivation and desire to go to college. However, TDP failed to meet its goal of sending more students to college. Expectations for school staff (hand out flyers and speak to students) versus students were misaligned, contributing to a lack of substantive conversation and structures for students to convert their increased motivation to go to college into actionable practices over time. School staff were already stretched thin and, with no added structural support, were unable to interact more meaningfully with students. Conclusion TDP failed to send more students to college because it targeted change at the individual rather than organizational level. Students exhibited change in their motivation to attend college, but this was not met with the support needed to convert this motivation to meaningful action. To achieve their full potential, such programs will have to not only address financial barriers, but also leverage broader structural supports in schools to help channel increased student motivation in more productive directions.

Customers’ Perspectives of Service Quality in Community Pharmacies in Nigeria: A Cross-Sectional Survey

Background: There is a growing need to understand the determinants of service quality in community pharmacy from the viewpoint of customers. Objectives: The study explored customer perspectives of pharmacy services using quality indicators and proposed a path for quality improvement. Methods: A questionnaire-based cross-sectional survey was conducted on 704 conveniently selected customers of community pharmacies between August and October, 2019. The exit survey examined customer expectations compared to actual services received. Questionnaire items were drawn from service quality domains of reliability, assurance, tangibles, equity, and responsiveness. Descriptive statistics was used to summarize demographic characteristics of respondents. To explore gaps between expected and perceived service quality, each domain was subjected to a pairwise t-test. Results: Customers’ response rate was 91.2% (n = 642) while their mean age was 52.1±3.55 years. Majority 60% (n = 259) were females, 62.5% (n = 401) had spent five years or less as customers of individual pharmacies. There was significant gap between expected and perceived service quality (t =13.55, p = 0.047). Domains of responsiveness (t = 162.67, p = 0.004) and reliability (t = 27.96, p = 0.023) contributed significantly to this gap with responsiveness being disproportionately impactful. Conclusion: There was significant gap between customer expectations of responsiveness and reliability of pharmacy teams and service fulfilment. This demands improved willingness to prioritize customer needs, serving them promptly, accurately, and as promised.

Chlorhexidine for facility-based umbilical cord care: EN-BIRTH multi-country validation study

Background Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts. In Bangladesh and Nepal, national policies recommend CHX use for all facility births. Population-based household surveys include optional questions on CHX use, but indicator validation studies are lacking. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) was an observational study assessing measurement validity for maternal and newborn indicators. This paper reports results regarding CHX. Methods The EN-BIRTH study (July 2017–July 2018) included three public hospitals in Bangladesh and Nepal where CHX cord application is routine. Clinical-observers collected tablet-based, time-stamped data regarding cord care during admission to labour and delivery wards as the gold standard to assess accuracy of women’s report at exit survey, and of routine-register data. We calculated validity ratios and individual-level validation metrics; analysed coverage, quality and measurement gaps. We conducted qualitative interviews to assess barriers and enablers to routine register-recording. Results Umbilical cord care was observed for 12,379 live births. Observer-assessed CHX coverage was very high at 89.3–99.4% in all 3 hospitals, although slightly lower after caesarean births in Azimpur (86.8%), Bangladesh. Exit survey-reported coverage (0.4–45.9%) underestimated the observed coverage with substantial “don’t know” responses (55.5–79.4%). Survey-reported validity ratios were all poor (0.01 to 0.38). Register-recorded coverage in the specific column in Bangladesh was underestimated by 0.2% in Kushtia but overestimated by 9.0% in Azimpur. Register-recorded validity ratios were good (0.9 to 1.1) in Bangladesh, and poor (0.8) in Nepal. The non-specific register column in Pokhara, Nepal substantially underestimated coverage (20.7%). Conclusions Exit survey-report highly underestimated observed CHX coverage in all three hospitals. Routine register-recorded coverage was closer to observer-assessed coverage than survey reports in all hospitals, including for caesarean births, and was more accurately captured in hospitals with a specific register column. Inclusion of CHX cord care into registers, and tallied into health management information system platforms, is justified in countries with national policies for facility-based use, but requires implementation research to assess register design and data flow within health information systems.