Using qualitative mixed methods to study small health care organizations while maximising trustworthiness and authenticity

Background The primary health care sector delivers the majority of health care in western countries through small, community-based organizations. However, research into these healthcare organizations is limited by the time constraints and pressure facing them, and the concern by staff that research is peripheral to their work. We developed Q-RARA—Qualitative Rapid Appraisal, Rigorous Analysis—to study small, primary health care organizations in a way that is efficient, acceptable to participants and methodologically rigorous. Methods Q-RARA comprises a site visit, semi-structured interviews, structured and unstructured observations, photographs, floor plans, and social scanning data. Data were collected over the course of one day per site and the qualitative analysis was integrated and iterative. Results We found Q-RARA to be acceptable to participants and effective in collecting data on organizational function in multiple sites without disrupting the practice, while maintaining a balance between speed and trustworthiness. Conclusions The Q-RARA approach is capable of providing a richly textured, rigorous understanding of the processes of the primary care practice while also allowing researchers to develop an organizational perspective. For these reasons the approach is recommended for use in small-scale organizations both within and outside the primary health care sector.

The impact of socialisation on graduates’ public service motivation : a mixed method study

The need to attract and retain a high calibre cadre of public servants today has resulted in a renaissance of interest in public service motivation (PSM) within public management literature. This article outlines a study of PSM with graduate employees within an Australian public sector. The study extends our understanding of PSM by adopting a longitudinal, mixed method design, including surveys and individual interviews, to consider the effects of socialisation on levels of PSM. Results show an organisation's mission and values do not affect individual PSM while work type and communication style is vital and organisational socialisation can provide a negative influence.

Uptake of influenza vaccination in pregnancy amongst Australian Aboriginal and Torres Strait Islander women: A mixed-methods pilot study

Background Influenza infection during pregnancy is associated with significant morbidity and mortality. Immunisation against influenza is recommended during pregnancy in several countries but uptake of vaccine is poor. There are limited data on vaccine uptake, and the determinants of vaccination, in Australian Aboriginal and/or Torres Islander women during pregnancy. This study aimed to establish an appropriate methodology and collect pilot data on vaccine uptake and attitudes towards, and perceptions of, maternal influenza vaccination in that population in order to inform the development of larger studies. Methods A mixed-methods study comprised of a cross-sectional survey and yarning circles (focus groups) amongst Aboriginal and Torres Strait Islander women attending two primary health care services. The women were between 28 weeks gestation and less than 16 weeks post-birth. These data were supplemented by data collected in an ongoing national Australian study of maternal influenza vaccination. Aboriginal research officers collected community data and data from the yarning circles which were based on a narrative enquiry framework. Descriptive statistics were used to analyse quantitative data and thematic analyses were applied to qualitative data. Results Quantitative data were available for 53 women and seven of these women participated in the yarning circles. The proportion of women who reported receipt of an influenza vaccine during their pregnancy was 9/53. Less than half of the participants (21/53) reported they had been offered the vaccine in pregnancy. Forty-three percent reported they would get a vaccine if they became pregnant again. Qualitative data suggested perceived benefits to themselves and their infants were important factors in the decision to be vaccinated but there was insufficient information available to women to make that choice. Conclusions The rates of influenza immunisation may continue to remain low for Aboriginal and/or Torres Strait Islander women during pregnancy. Access to services and recommendations by a health care worker may be factors in the lower rates. Our findings support the need for larger studies directed at monitoring and understanding the determinants of maternal influenza vaccine uptake during pregnancy in Australian Aboriginal and Torres Strait Islander women. This research will best be achieved using methods that account for the social and cultural contexts of Aboriginal and Torres Strait Islander communities in Australia.

Haemodialysis work environment contributors to job satisfaction and stress: A sequential mixed methods study

Background: Haemodialysis nurses form long term relationships with patients in a technologically complex work environment. Previous studies have highlighted that haemodialysis nurses face stressors related to the nature of their work and also their work environments leading to reported high levels of burnout. Using Kanters (1997) Structural Empowerment Theory as a guiding framework, the aim of this study was to explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses. Methods: Using a sequential mixed-methods design, the first phase involved an on-line survey comprising demographic and work characteristics, Brisbane Practice Environment Measure (B-PEM), Index of Work Satisfaction(IWS), Nursing Stress Scale (NSS) and the Maslach Burnout Inventory (MBI). The second phase involved conducting eight semi-structured interviews with data thematically analyzed. Results: From the 417 nurses surveyed the majority were female (90.9 %), aged over 41 years of age (74.3 %), and 47.4 % had worked in haemodialysis for more than 10 years. Overall the work environment was perceived positively and there was a moderate level of job satisfaction. However levels of stress and emotional exhaustion (burnout) were high. Two themes, ability to care and feeling successful as a nurse, provided clarity to the level of job satisfaction found in phase 1. While two further themes, patients as quasi-family and intense working teams, explained why working as a haemodialysis nurse was both satisfying and stressful. Conclusions: Nurse managers can use these results to identify issues being experienced by haemodialysis nurses working in the unit they are supervising.

Motivation or demotivation of health workers providing maternal health services in rural areas in Vietnam: findings from a mixed-methods study

Background Motivation is an important driver for health professionals to maintain professional competencies, continue in a workforce and contribute to work tasks. While there is some research about motivation in health workers in low to middle income countries, maternal morbidity and mortality remains high in many low and middle income countries and this can be improved by improving the quality of maternal services and the training and skills maintenance of maternal health workers. This study examines the impact of motivation on maintenance of professional competence among maternal health workers in Vietnam using mixed methods. Methods The study consisted of a survey using a self-administered questionnaire of 240 health workers in 5 districts across two Vietnamese provinces and in-depth interviews with 43 health workers and health managers at the commune, district and provincial level to explore external factors that influenced motivation. The questionnaire includes a 23 item motivation instrument based on Kenyan health context, modified for Vietnamese language and culture. Results The 240 responses represented an estimated 95% of the target sample. Multivariate analysis showed that three factors contributed to the motivation of health workers: access to training (β = -0.14, p=0.03), ability to perform key tasks (β = 0.22, p=0.001), and shift schedule (β = -0.13, p=0.05). Motivation was higher in health workers self-identifying as competent or enabled to provide more care activities. Motivation was lower in those who worked more frequent night shifts and those who had received training in the last 12 months. The interviews identified that the latter was because they felt the training was irrelevant to them, and in some cases, they do not have opportunity to practice their learnt skills. The qualitative data also showed other factors relating to service context and organisational management practices contributed to motivation. Conclusions The study demonstrates the importance of understanding the motivations of health workers and the factors that contribute to this and may contribute to more effective management of the health workforce in low and middle income countries.

Evaluation of an intervention for patients with alcohol-related injuries: results of a mixed methods study

Objective: To explore the effect of education and training on the delivery of alcohol screening and brief intervention and referral to high-risk patients in a hospital setting. Main outcome measures included; delivery of training; practice change in relation to staff performing alcohol screening, brief intervention and referrals. Methods: Observational study design using mixed methods set in a tertiary referral hospital. Pre-post assessment of medical records and semi-structured interviews with key informants. Results: Routine screening for substance misuse (9% pre / 71.4% post) and wellbeing concerns (6.6% pre / 15 % post) was more frequent following the introduction of resources and staff participation in educational workshops. There was no evidence of a concomitant increase in delivery of brief intervention or referrals to services. Implementation challenges, including time constraints and staff attitudes, and enablers such as collaboration and visible pathways, were identified. Conclusion: Rates of patient screening increased, however barriers to delivery of brief intervention and referrals remained. Implementation strategies targeting specific barriers and enablers to introducing interventions are both required to improve the application of secondary prevention for patients in acute settings. Implications: Educational training, formalised liaison between services, systematised early intervention protocols, and continuous quality improvement processes will progress service delivery in this area.

The effect of gender context on children's social behaviour in a limited resources situation : an observational study

Knowing when to compete and when to cooperate to maximize opportunities for equal access to activities and materials in groups is critical to children's social and cognitive development. The present study examined the individual (gender, social competence) and contextual factors (gender context) that may determine why some children are more successful than others. One hundred and fifty-six children (M age=6.5 years) were divided into 39 groups of four and videotaped while engaged in a task that required them to cooperate in order to view cartoons. Children within all groups were unfamiliar to one another. Groups varied in gender composition (all girls, all boys, or mixed-sex) and social competence (high vs. low). Group composition by gender interaction effects were found. Girls were most successful at gaining viewing time in same-sex groups, and least successful in mixed-sex groups. Conversely, boys were least successful in same-sex groups and most successful in mixed-sex groups. Similar results were also found at the group level of analysis; however, the way in which the resources were distributed differed as a function of group type. Same-sex girl groups were inequitable but efficient whereas same-sex boy groups were more equitable than mixed groups but inefficient compared to same-sex girl groups. Social competence did not influence children's behavior. The findings from the present study highlight the effect of gender context on cooperation and competition and the relevance of adopting an unfamiliar peer paradigm when investigating children's social behavior.

Study on microwave dielectric properties of epoxy resin mixtures used for rapid product development

This paper presents a preliminary study on the dielectric properties and curing of three different types of epoxy resins mixed at various stichiometric mixture of hardener, flydust and aluminium powder under microwave energy. In this work, the curing process of thin layers of epoxy resins using microwave radiation was investigated as an alternative technique that can be implemented to develop a new rapid product development technique. In this study it was observed that the curing time and temperature were a function of the percentage of hardener and fillers presence in the epoxy resins. Initially dielectric properties of epoxy resins with hardener were measured which was directly correlated to the curing process in order to understand the properties of cured specimen. Tensile tests were conducted on the three different types of epoxy resins with hardener and fillers. Modifying dielectric properties of the mixtures a significant decrease in curing time was observed. In order to study the microstructural changes of cured specimen the morphology of the fracture surface was carried out by using scanning electron microscopy.

Vitamin D and sun protection : the impact of mixed public health messages in Australia

Exposure of the skin to sunlight can cause skin cancer and is also necessary for cutaneous vitamin D production. Media reports have highlighted the purported health benefits of vitamin D. Our aim was to examine attitudes and behaviours related to sun protection and vitamin D. A cross-sectional study of 2,001 residents in Queensland, Australia aged 20-70 years was undertaken. Information collected included: skin cancer risk factors; perceptions about levels of sun exposure required to maintain vitamin D; belief that sun protection increases risk of vitamin D deficiency; intention, and actual change in sun protection practices for adults and children. Multivariate models examined predictors of attitudinal and behavioural change. One-third (32%) believed a fair-skinned adult, and 31% thought a child required at least 30 minutes per day in summer sun to maintain vitamin D levels. Reductions in sun protection were reported by 21% of adults and 14% of children. Factors associated with belief that sun protection may result in not obtaining enough vitamin D included aged ≥ 60 years (OR=1.35, 95% CI 1.09-1.66) and having skin that tanned easily (OR=1.96, 95% CI 1.38-2.78). Participants from low income households, and those who frequently used sun protective clothing were more likely to have reduced sun protection practices (OR=1.33, 95% CI 1.10-1.73 and OR=1.73, 95% CI 1.36-2.20, respectively). This study provides evidence of reductions in sun protection practices in a population living in a high UV environment. There is an urgent need to re-focus messages regarding sun exposure and for continued sun protection practices.

A model of teacher professional development based on the principles of lesson study

The researcher’s professional role as an Education Officer was the impetus for this study. Designing and implementing professional development activities is a significant component of the researcher’s position description and as a result of reflection and feedback from participants and colleagues, the creation of a more effective model of professional development became the focus for this study. Few studies have examined all three links between the purposes of professional development that is, increasing teacher knowledge, improving teacher practice, and improving student outcomes. This study is significant in that it investigates the nature of the growth of teachers who participated in a model of professional development which was based upon the principles of Lesson Study. The research provides qualitative and empirical data to establish some links between teacher knowledge, teacher practice, and student learning outcomes. Teacher knowledge in this study refers to mathematics content knowledge as well as pedagogical-content knowledge. The outcomes for students include achievement outcomes, attitudinal outcomes, and behavioural outcomes. As the study was conducted at one school-site, existence proof research was the focus of the methodology and data collection. Developing over the 2007 school year, with five teacher-participants and approximately 160 students from Year Levels 6 to 9, the Lesson Study-principled model of professional development provided the teacher-participants with on-site, on-going, and reflective learning based on their classroom environment. The focus area for the professional development was strategising the engagement with and solution of worded mathematics problems. A design experiment was used to develop the professional development as an intervention of prevailing teacher practice for which data were collected prior to and after the period of intervention. A model of teacher change was developed as an underpinning framework for the development of the study, and was useful in making decisions about data collection and analyses. Data sources consisted of questionnaires, pre-tests and post-tests, interviews, and researcher observations and field notes. The data clearly showed that: content knowledge and pedagogical-content knowledge were increased among the teacher-participants; teacher practice changed in a positive manner; and that a majority of students demonstrated improved learning outcomes. The positive changes to teacher practice are described in this study as the demonstrated use of mixed pedagogical practices rather than a polarisation to either traditional pedagogical practices or contemporary pedagogical practices. The improvement in student learning outcomes was most significant as improved achievement outcomes as indicated by the comparison of pre-test and post-test scores. The effectiveness of the Lesson Study-principled model of professional development used in this study was evaluated using Guskey’s (2005) Five Levels of Professional Development Evaluation.

Translation and news making : a study of contemporary arabic television

Arabic satellite television has recently attracted tremendous attention in both the academic and professional worlds, with a special interest in Aljazeera as a curious phenomenon in the Arab region. Having made a household name for itself worldwide with the airing of the Bin Laden tapes, Aljazeera has set out to deliberately change the culture of Arabic journalism, as it has been repeatedly stated by its current General Manager Waddah Khanfar, and to shake up the Arab society by raising awareness to issues never discussed on television before and challenging long-established social and cultural values and norms while promoting, as it claims, Arab issues from a presumably Arab perspective. Working within the meta-frame of democracy, this Qatari-based network station has been received with mixed reactions ranging from complete support to utter rejection in both the west and the Arab world. This research examines the social semiotics of Arabic television and the socio-cultural impact of translation-mediated news in Arabic satellite television, with the aim to carry out a qualitative content analysis, informed by framing theory, critical linguistic analysis, social semiotics and translation theory, within a re-mediation framework which rests on the assumption that a medium “appropriates the techniques, forms and social significance of other media and attempts to rival or refashion them in the name of the real" (Bolter and Grusin, 2000: 66). This is a multilayered research into how translation operates at two different yet interwoven levels: translation proper, that is the rendition of discourse from one language into another at the text level, and translation as a broader process of interpretation of social behaviour that is driven by linguistic and cultural forms of another medium resulting in new social signs generated from source meaning reproduced as target meaning that is bound to be different in many respects. The research primarily focuses on the news media, news making and reporting at Arabic satellite television and looks at translation as a reframing process of news stories in terms of content and cultural values. This notion is based on the premise that by its very nature, news reporting is a framing process, which involves a reconstruction of reality into actualities in presenting the news and providing the context for it. In other words, the mediation of perceived reality through a media form, such as television, actually modifies the mind’s ordering and internal representation of the reality that is presented. The research examines the process of reframing through translation news already framed or actualized in another language and argues that in submitting framed news reports to the translation process several alterations take place, driven by the linguistic and cultural constraints and shaped by the context in which the content is presented. These alterations, which involve recontextualizations, may be intentional or unintentional, motivated or unmotivated. Generally, they are the product of lack of awareness of the dynamics and intricacies of turning a message from one language form into another. More specifically, they are the result of a synthesis process that consciously or subconsciously conforms to editorial policy and cultural interpretive frameworks. In either case, the original message is reproduced and the news is reframed. For the case study, this research examines news broadcasts by the now world-renowned Arabic satellite television station Aljazeera, and to a lesser extent the Lebanese Broadcasting Corporation (LBC) and Al- Arabiya where access is feasible, for comparison and crosschecking purposes. As a new phenomenon in the Arab world, Arabic satellite television, especially 24-hour news and current affairs, provides an interesting area worthy of study, not only for its immediate socio-cultural and professional and ethical implications for the Arabic media in particular, but also for news and current affairs production in the western media that rely on foreign language sources and translation mediation for international stories.

Characterisation of soils with the use of instrumental techniques : a multivariate forensic study

The value of soil evidence in the forensic discipline is well known. However, it would be advantageous if an in-situ method was available that could record responses from tyre or shoe impressions in ground soil at the crime scene. The development of optical fibres and emerging portable NIR instruments has unveiled a potential methodology which could permit such a proposal. The NIR spectral region contains rich chemical information in the form of overtone and combination bands of the fundamental infrared absorptions and low-energy electronic transitions. This region has in the past, been perceived as being too complex for interpretation and consequently was scarcely utilized. The application of NIR in the forensic discipline is virtually non-existent creating a vacancy for research in this area. NIR spectroscopy has great potential in the forensic discipline as it is simple, nondestructive and capable of rapidly providing information relating to chemical composition. The objective of this study is to investigate the ability of NIR spectroscopy combined with Chemometrics to discriminate between individual soils. A further objective is to apply the NIR process to a simulated forensic scenario where soil transfer occurs. NIR spectra were recorded from twenty-seven soils sampled from the Logan region in South-East Queensland, Australia. A series of three high quartz soils were mixed with three different kaolinites in varying ratios and NIR spectra collected. Spectra were also collected from six soils as the temperature of the soils was ramped from room temperature up to 6000C. Finally, a forensic scenario was simulated where the transferral of ground soil to shoe soles was investigated. Chemometrics methods such as the commonly known Principal Component Analysis (PCA), the less well known fuzzy clustering (FC) and ranking by means of multicriteria decision making (MCDM) methodology were employed to interpret the spectral results. All soils were characterised using Inductively Coupled Plasma Optical Emission Spectroscopy and X-Ray Diffractometry. Results were promising revealing NIR combined with Chemometrics is capable of discriminating between the various soils. Peak assignments were established by comparing the spectra of known minerals with the spectra collected from the soil samples. The temperature dependent NIR analysis confirmed the assignments of the absorptions due to adsorbed and molecular bound water. The relative intensities of the identified NIR absorptions reflected the quantitative XRD and ICP characterisation results. PCA and FC analysis of the raw soils in the initial NIR investigation revealed that the soils were primarily distinguished on the basis of their relative quartz and kaolinte contents, and to a lesser extent on the horizon from which they originated. Furthermore, PCA could distinguish between the three kaolinites used in the study, suggesting that the NIR spectral region was sensitive enough to contain information describing variation within kaolinite itself. The forensic scenario simulation PCA successfully discriminated between the ‘Backyard Soil’ and ‘Melcann® Sand’, as well as the two sampling methods employed. Further PCA exploration revealed that it was possible to distinguish between the various shoes used in the simulation. In addition, it was possible to establish association between specific sampling sites on the shoe with the corresponding site remaining in the impression. The forensic application revealed some limitations of the process relating to moisture content and homogeneity of the soil. These limitations can both be overcome by simple sampling practices and maintaining the original integrity of the soil. The results from the forensic scenario simulation proved that the concept shows great promise in the forensic discipline.

Raman spectroscopic study of the multi-anion mineral dixenite CuMn2+14Fe3+(AsO3)5(SiO4)2(AsO4)(OH)6

The mixed anion mineral dixenite has been studied by Raman spectroscopy, complimented with infrared spectroscopy. The Raman spectrum of dixenite shows bands at 839 and 813 cm-1 assigned to the (AsO3)3- symmetric and antisymmetric stretching modes. The most intense Raman band of dixenite is the band at 526 cm-1 and is assigned to the ν2 AsO33- bending mode. DFT calculations enabled the position of AsO22- symmetric stretching mode at 839 cm-1, the antisymmetric stretching mode at 813 cm-1, and the deformation mode at 449 cm-1 to be calculated. Raman bands at 1026 and 1057 cm-1 are assigned to the SiO42- symmetric stretching vibrations and at 1349 and 1386 cm-1 to the SiO42- antisymmetric stretching vibrations. Both Raman and infrared spectra indicate the presence of water in the structure of dixenite. This brings into question the commonly accepted formula of dixenite as CuMn2+14Fe3+(AsO3)5(SiO4)2(AsO4)(OH)6. The formula may be better written as CuMn2+14Fe3+(AsO3)5(SiO4)2(AsO4)(OH)6•xH2O.

The mobile Internet and small business : an exploratory study of needs, uses and adoption with full-adopters of technology

The technological environment in which contemporary small and medium-sized enterprises (SMEs) operate can only be described as dynamic. The exponential rate of technological change, characterised by perceived increases in the benefits associated with various technologies, shortening product life cycles and changing standards, provides for the SME a complex and challenging operational context. The primary aim of this research was to concentrate on those SMEs that had already adopted technology in order to identify their needs for the new mobile data technologies (MDT), the mobile Internet. The research design utilised a mixed approach whereby both qualitative and quantitative data was collected to address the question. Overall, the needs of these SMEs for MDT can be conceptualised into three areas where the technology will assist business practices; communication, eCommerce and security.

Case study 3. A subtropical urban community. Medium to high density residential typologies

Subtropical Urban Communities Project Urban design and residential buildings The Centre for Subtropical Design has researched design concepts for livable subtropical neighbourhoods characterised by higher-density, mixed-use, family oriented housing by conducting a design charrette and analysing the proposed designs to evaluate how well these typologies might support economic, environmental and social sustainability. http://www.subtropicaldesign.org.au/index.php?option=com_content&task=view&id=125&Itemid=163 The QUT Team produced designs (Case Study 3) within the research framework of the design charrette.