Browsing by Subject "Mixed-methods"

Now showing 1 - 6 of 6
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    An evaluation of practices and policies used in genetics clinics across the United States to manage referrals for Ehlers-Danlos and hypermobility syndromes
    (Elsevier, 2025-01-07) Boucher, Lauren; Nestler, Berkley; Groepper, Daniel; Quillin, John; Deyle, David; Halverson, Colin M. E.; Medicine, School of Medicine
    Purpose: Hypermobile Ehlers-Danlos syndrome (hEDS) and joint hypermobility syndrome (JHS), among other conditions, comprise a collection of heritable disorders of connective tissue. There are recognized challenges in diagnosing JHS/hEDS. Despite a lack of identifiable molecular etiology for these conditions, referrals to medical geneticists for evaluation are commonplace, and they continue to rise. Because of an absence of nationally recognized referral guidelines for JHS/hEDS, health care institutions are left to develop their own policies. The purpose of our study was to characterize these ad hoc policies systematically and at a nationwide level. Methods: We conducted a mixed-methods study of 71 board-eligible or board-certified genetic counselors, including 15 qualitative interviews. Results: Cross-case analysis revealed multiple motivations for creating these policies, methods to more effectively manage referrals for hypermobility and concern for EDS, and participants' evaluations of the successes and shortcomings of these policies at their institutions. We found diverse and unstandardized policies that were meant to address numerous perceived challenges. This lack of standardization is a concern because it may result in inconsistent access to care for patients with JHS/hEDS and create barriers to diagnosis and treatment. Conclusion: Our findings demonstrate that policies vary widely, and genetic counselors are concerned about the potential impact of this variability on the quality of care for patients with JHS/hEDS.
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    Black Americans' perceptions of Alzheimer's disease, a healthy brain, and strategies for brain health promotion
    (Elsevier, 2024-04-19) Eliacin, Johanne; Polsinelli, Angelina; Cameron, Kenzie A.; Saykin, Andrew J.; Wang, Sophia; Medicine, School of Medicine
    Objectives: Lack of awareness of Alzheimer's disease (AD) among Black Americans may undermine their ability to identify potential AD risk. We examined Black Americans' perceptions and knowledge of AD, and views of a healthy brain, which may contribute to the development of effective and culturally sensitive strategies to address racial disparities in AD. Methods: We conducted a mixed-methods study, integrating a cross-sectional survey of 258 older (>55 years) Black participants and qualitative interviews with a sub-sample of N = 29. Both data sets were integrated to inform the results. Results: Participants endorsed having little knowledge of AD. While most participants reported practicing a healthy lifestyle to promote a healthy brain, the range of activities listed were limited. Participants made several suggestions to increase AD awareness, which includes using AD educational materials containing information that would benefit the whole family, not only older adults. Outreach approaches that address both individual behaviors and structural factors were also encouraged. Conclusion: Our findings identify ongoing needs to improve AD awareness among traditionally under-represented groups. Innovation: The study utilized novel approaches to examine participants' perspectives of AD that included a diverse sample of research naïve participants, and integrated exploration of participants' views of AD and brain health.
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    Characterizing caregivers of youth at risk for substance use and caregiver engagement in the youth legal system: a mixed methods approach
    (Frontiers Media, 2025-04-08) Turner, Annie; Pederson, Casey A.; Salgado, Eduardo; Dir, Allyson; Adams, Zachary; Zapolski, Tamika; Hulvershorn, Leslie; Aalsma, Matthew C.; Psychiatry, School of Medicine
    Background: Increasing caregiver and family participation is a key feature underlying many strategies to improve success among youth on community supervision. However, engaging caregivers in probation services remains a challenge for juvenile probation officers (JPOs), especially in families with significant needs. The goal of this study was to gain a better understanding of caregivers of legally involved youth at risk for substance use and their engagement with the youth legal system from a legal staff perspective. Methods: In this mixed-methods study, qualitative interviews were conducted with n = 15 youth legal staff from two midwestern counties. In addition, surveys were analyzed from n = 72 caregivers of youth with recent legal involvement who were also at risk for substance use in the two counties to characterize caregivers and provide context to the staff interviews. Results: Qualitative themes identified from the staff interviews included defining caregiver engagement, barriers to caregiver engagement (e.g., financial barriers, transportation barriers, caregiver substance use, and lack of parenting skills), and strategies to increase caregiver engagement. Quantitative data from the caregiver surveys focused on demographics and life circumstances of caregivers in the counties studied. Conclusions: Results highlight a wide variability in degree of caregiver participation with the youth legal system and legal staff's approaches to caregivers as well as significant barriers that caregivers face in their attempt to be involved in their youth's lives and legal cases. Additional work is needed to explore the caregiver perspective and identify the impact of specific caregiver characteristics on their youth and their youth's legal outcomes.
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    Determinants of inter-organizational implementation success: A mixed-methods evaluation of Veteran Directed Care
    (Elsevier, 2022) Sperber, Nina R.; Miech, Edward J.; Clary, Alecia Slade; Perry, Kathleen; Edwards-Orr, Merle; Rudolph, James L.; Van Houtven, Courtney Harold; Thomas, Kali S.; Emergency Medicine, School of Medicine
    Background: Veteran Directed Care (VDC) aims to keep Veterans at risk for nursing home placement in their communities. VA medical centers (VAMCs) purchase VDC from third-party organizational providers who then partner with them during implementation. Experiences with VDC implementation have varied. Objectives: We sought to identify conditions differentiating partnerships with higher enrollment (implementation success). Methods: We conducted a case-based study with: qualitative data on implementation determinants two and eight months after program start, directed content analysis to assign numerical scores (-2 strong barrier to +2 strong facilitator), and mathematical modeling using Coincidence Analysis (CNA) to identify key determinants of implementation success. Cases consisted of VAMCs and partnering non-VAMC organizations who started VDC during 2017 or 2018. The Consolidated Framework for Implementation Research (CFIR) guided analysis. Results: Eleven individual organizations within five partnerships constituted our sample. Two CFIR determinants- Networks & Communication and External Change Agent-uniquely and consistently identified implementation success. At an inter-organizational partnership level, Networks & Communications and External Change Agent +2 (i.e., present as strong facilitators) were both necessary and sufficient. At a within-organization level, Networks & Communication +2 was necessary but not sufficient for the non-VAMC providers, whereas External Change Agent +2 was necessary and sufficient for VAMCs. Conclusion: Networks & Communication and External Change Agent played difference-making roles in inter-organizational implementation success, which differ by type of organization and level of analysis. Implications: This multi-level approach identified crucial difference-making conditions for inter-organizational implementation success when putting a program into practice requires partnerships across multiple organizations.
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    Positive Deviants for Medication Therapy Management: A Mixed-Methods Comparative Case Study of Community Pharmacy Practices
    (Elsevier, 2021) Adeoye-Olatunde, Omolola A.; Lake, Leslie M.; Strohmier, Celena A.; Gourley, Amanda K.; Ray, Ashli R.; Zillich, Alan J.; Snyder, Margie E.; Medicine, School of Medicine
    Background: To optimize medication use in older adults, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Part D policy; however, strategies for achieving high quality MTM outcomes are not well understood. Objective: The objective of this study was to generate hypotheses for strategies contributing to community pharmacies' high performance on policy-relevant MTM quality measures. Methods: This mixed-methods comparative case study was guided by the Positive Deviance approach and Chronic Care Model. The study population consisted of pharmacy staff employed by a Midwestern division of a national supermarket-community pharmacy chain. Data consisted of demographics and qualitative data from semi-structured interviews. Qualitative and quantitative data were analyzed deductively and inductively or using descriptive statistics, respectively. MTM quality measures used to evaluate participant pharmacies' MTM performance mirrored select 2017 Medicare Part D Plans' Star Rating measures. Results: Thirteen of 18 selected case pharmacies (72.2%) participated in this study, of which 5 were categorized as high performers, 4 moderate performers, and 4 low performers. Eleven pharmacists, 11 technicians, and 3 student interns participated in interviews. Eight strategies were hypothesized as contributing to MTM performance: Strong pharmacy staff-provider relationships and trust, Inability to address patients' social determinants of health (negatively contributing), Technician involvement in MTM, Providing comprehensive medication reviews in person vs. phone alone, Placing high priority on MTM, Using available clinical information systems to identify eligible patients, Technicians using clinical information systems to collect/document information for pharmacists, Faxing prescribers adherence medication therapy problems (MTPs) and calling on indication MTPs. Conclusions: Eight strategies were hypothesized as contributing to community pharmacies' performance on MTM quality measures. Findings from this work can inform MTM practice and Medicare Part D MTM policy changes to positively influence patient outcomes. Future research should test hypotheses in a larger representative sample of pharmacies.
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    Travel despite the COVID-19 pandemic: Implications for tourism recovery
    (Frontiers Media, 2022-10-05) Liu, Hongbo; Liu-Lastres, Bingjie; Zeng, Li; Donohoe, Holly; Tourism, Event, & Sport Management, School of Health and Human Sciences
    The COVID-19 pandemic has devastated the global tourism industry. This study explores why some Chinese residents travel during the pandemic. A mixed-methods research design was adopted, guided by the health belief model and relevant literature. Through 21 interviews with Chinese tourists who took an overnight leisure trip in May 2020, and a national survey among Chinese residents, this study explored factors influencing Chinese residents' travel-related decisions and behaviors during the pandemic. Results outline the influences of health beliefs, government trust, past travel experience, and psychological capital on tourists' risk-reduction behaviors. Theoretical and practical implications are provided regarding tourism recovery during pandemics.