BACKGROUND: Experiential education, particularly through game-based approaches, has gained recognition for effectively addressing the myriad challenges faced by expectant parents.
OBJECTIVE: To consolidate and synthesize the available evidence regarding expectant parents\' experiences of game-based perinatal education.
METHODS: A mixed studies review.
METHODS: Six electronic databases were searched from their inception until March 2024: PubMed, Embase, CINAHL, Web of Science, Scopus, ProQuest Dissertations and Theses Global.
METHODS: This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was guided by Pluye and Hong\'s (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies review was adopted to analyse all findings and thematic analysis was conducted.
RESULTS: Three themes and 10 subthemes were generated from the eight included studies. The main themes were: (1) Exploring novel frontiers to deliver perinatal education, (2) Empowerment through play: Unveiling key insights and (3) Insights and recommendations.
CONCLUSIONS: The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills in an engaging and immersive manner to navigate the challenging perinatal period.
UNASSIGNED: The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills to navigate the challenging perinatal period. Nurses should consider incorporating or developing a game-based curriculum to supplement current educational classes to encourage parental participation and enhance learning for perinatal education.
UNASSIGNED: This study adhered to the PRISMA reporting guidelines.
UNASSIGNED: No Patient or Public Contribution.
UNASSIGNED: A protocol was submitted to PROSPERO (CRD42023447527).

OBJECTIVE: Research has associated lack of parental care, physical abuse, and parental substance abuse to homelessness, with the presence of two or more such factors dramatically increasing one\'s chances of becoming homeless as an adult. Less clear is which (cumulation of) factors may mediate the difference between transitional and recurrent homelessness.
METHODS: Quantitative analysis of four risk factors-addiction, weak social network, criminal activity, psychopathology-among 69 transitionally and recurrently homeless (RH) adults, followed by in-depth qualitative analysis of adverse childhood experiences (ACEs) among 30 selected participants.
RESULTS: RH participants had higher cumulative risk and a higher prevalence and broader range of ACEs than transitionally homeless participants, with the prevalence of childhood physical abuse marking the greatest difference between the two groups. Recurrent homelessness was also correlated with addiction to hard drugs, criminal activity, and weak social networks.
CONCLUSIONS: Longitudinal and intervention studies in larger groups are needed to assess causality.

Personalized social media advertisements (PSMAs) are developed by using consumers\' personal information like names, demographic details, location, past buying history, and lifestyle interests to quickly grab consumers\' attention within the cluttered space of digital advertisements. Generation Z consumers are highly connected to social media. Hence, this study attempts to understand how Generation Z consumers with different personality traits perceive personalized advertisements (PAs) on Facebook, and subsequently, how their perceived personalization influences their intention to click on PAs based on perceived usefulness and privacy concerns associated with those advertisements. The theoretical underpinning of this research is based on the self-congruency theory and privacy-calculus theory. An explanatory sequential mixed-methods design has been adopted, where a quantitative analysis (Study 1) is followed by a qualitative approach (Study 2). For Study 1, responses were collected from 324 Generation Z consumers through a structured questionnaire and the data was analyzed using the structural equation modeling technique to measure relationships among the constructs. Further, in Study 2, in-depth interviews were conducted with 15 Generation Z consumers, a purposively selected subset of informants from Study 1, to explore the potential causes of those relationships observed in Study 1. It has been found from the study that consumers\' perception of PSMAs varies based on their personality traits. Consumers with dominant extraversion, conscientiousness, and neurotic personality traits perceive PSMAs positively whereas the openness to experience and agreeableness dominant consumers perceive those negatively. Positive perception of PSMAs among consumers increases the perceived usefulness of communications and subsequently improves the click-through intentions of the consumers. Generation Z Consumers\' perception of PSMAs does not have any influence on their privacy concerns. Consumers\' high privacy concerns reduce the click-through intention rate toward PSMAs. The study will help digital marketing managers to strategically deliver PSMAs, thereby enhancing the efficiency of their advertisements.

BACKGROUND: Hope is an important resource that helps patients and families thrive during difficult times. Although several studies have highlighted the importance of hope in different contexts, its specific manifestations in the realm of advanced chronic illness need further exploration. In this study, we sought to elucidate the intricate interplay between the construct of hope and the lived experience of advanced chronic illness within patient-caregiver dyads. Our objectives were (a) to explore the dyadic experience of hope as a changing dynamic over time for patients living with advanced chronic illness and their informal caregivers and (b) to evaluate variations of hope and symptom burden across time.
METHODS: We conducted a longitudinal mixed-methods study with a convergent design between December 2020 and April 2021. Patients living with advanced chronic illness and informal caregivers participated as a dyad (n = 8). The Herth Hope Index scale was used to measure dyads\' level of hope and the Edmonton Symptom Assessment System was used to measure patients\' symptom burden. Descriptive statistics were undertaken. A thematic analysis as described by Braun and Clarke was conducted to analyze dyadic interview data. Dyads\' experience of hope was described by using the six dimensions of hope in the Model of Hope of Dufault and Martocchio.
RESULTS: Dyadic scores of hope and patients\' symptom burden were stable over time. The constructs of hope in dyads included \"Living one day at the time,\" \"Having inner force/strength,\" and \"Maintaining good health.\" Changes in patterns of hope were captured for each dyad in their transition over time. Data converged for all dyads except one.
CONCLUSIONS: The findings of our study show a constant presence of hope even in the face of adversity. Healthcare professionals must find ways to promote hope in dyads of patients living with advanced chronic diseases. Nurses play a pivotal role; dyadic interviews should be promoted to create a safe space for both patients and informal caregivers in order to share experiences. More research is needed to address patients\' and informal caregivers\' hope in chronic illness because current hope-based interventions primarily target cancer diagnoses.

OBJECTIVE: Use qualitative and quantitative methods to explore factors influencing the adoption of guideline-based physical activity (PA) and dietary recommendations among participants enrolled in a lifestyle intervention during and after chemotherapy for breast cancer.
METHODS: Among women with stage I-III breast cancer who participated in the intervention arm of the Lifestyle, Exercise, and Nutrition early after diagnosis (LEANer) trial, we used stratified, purposeful sampling to interview women who met both, one, or neither intervention goal after the 1-year intervention: (1) 150 min/week moderate-to-vigorous intensity exercise via a self-reported PA questionnaire and (2) improved self-reported diet quality measured by the Healthy Eating Index-2015. Semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis.
RESULTS: The 29 women interviewed were 52 ± 11 years old on average, with a mean body mass index of 29.6 ± 7.7 kg/m2. Three themes emerged regarding aspects of the LEANer intervention that facilitated behavior change: (1) providing a conduit of trustworthy, timely, and personalized support and education; (2) shifting mindsets and enhanced understanding of the benefits of PA and nutrition during chemotherapy; and (3) fostering a sense of control and alternative focus. Factors described as hindering adoption of goals included: (1) adverse effects of chemotherapy and (2) competing priorities.
CONCLUSIONS: Women reported the external support, tailored education, and experiencing the physical and mental benefits of the LEANer intervention facilitated the adoption of the interventions\' behavioral goals. Addressing chemotherapy-related symptoms and competing priorities may facilitate adherence to lifestyle interventions during chemotherapy for breast cancer.

OBJECTIVE: This study aims to test the feasibility and acceptability of a group-based pelvic floor muscle training for pregnant women in China and facilitate women\'s adherence to the pelvic floor muscle training programme.
BACKGROUND: Urinary incontinence is a prevalent health problem in women worldwide, especially in pregnant women. Supervised pelvic floor muscle training is recommended as the first-line conservative treatment for urinary incontinence. However, the implementation and effectiveness of pelvic floor muscle training are limited by insufficient human resources and low adherence. Group-based interventions may improve people\'s adherence to interventions by facilitating peer support. However, it has been investigated in a limited number of maternity studies.
METHODS: Feasibility testing randomized controlled trial, accompanied by a mixed methods process evaluation.
METHODS: This study was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel guide to developing interventions. A three-phase, mixed-methods design was used in this study. This study reported the feasibility of the group-based pelvic floor muscle training programme. Semi-structured reviews were conducted following the intervention to explore the acceptability of the programme.
RESULTS: The study included 48 pregnant women with a recruitment rate of 52.17%. The adherence rate to the training programme was 66.67%. The intervention was positively valued, in particular the support promoting participants\' adherence, but additional changes need to be made to the programme for a future trial.
CONCLUSIONS: Group-based pelvic floor muscle training programme provides a possible way of delivering pelvic floor muscle training with limited health professionals in China. The study showed promising results concerning the acceptability and feasibility of the intervention, which were well perceived by both pregnant women and the midwife.
CONCLUSIONS: Group-based pelvic floor muscle training may have the potential of reducing the prevalence of urinary incontinence in pregnant women with insufficient healthcare professionals.
CONCLUSIONS: This study assessed the feasibility of delivering group-based pelvic floor muscle training in pregnant women in China. The group-based pelvic floor muscle training is acceptable to both pregnant women and the midwife, but integrating online and face-to-face sessions need to be considered. The findings of this study provided evidence for delivering group-based pelvic floor muscle training to pregnant women in China.
UNASSIGNED: The study has adhered to CONSORT guidelines (Table S1) and TIDier checklist (Table S2).
UNASSIGNED: The patient and public have been invited as stakeholders during the development of the intervention. They worked with healthcare professionals to co-design the group-based pelvic floor muscle training programme.
BACKGROUND: The trial was registered on ClinicalTrials.gov (NCT05242809) under the title \'Development and Feasibility Testing of a Group-based PFMT Programme for Antenatal Women in Nanjing City in China\'.

Employing a mixed methods approach, this study examined the knowledge and information Ontario physicians have concerning Autism Spectrum Disorder (ASD). Physicians are at the front line when it comes to identifying ASD. The Healthcare Professional Questionnaire was filled out by 46 physicians and 16 filled out the Knowledge about Childhood Autism among Health Workers Questionnaire (KCAHW) before being asked to participate in a semi-structured interview in which 7 participated. Paediatricians and psychiatrist reported having the highest levels of knowledge. Findings revealed that physicians are lacking in information regarding some early signs (i.e. social smiling = 50%), added diagnostic criteria (i.e. hypo-reactivity to sensory information = 56%), and the prevalence rate of ASD (average estimate of 1 in 1109). Additionally, exposure to individuals with ASD was found to be a facilitator to knowledge acquisition regarding ASD. The physicians recommended a road map method to disseminate information and increase knowledge and awareness. Implications of the findings include what areas of knowledge and information need to be increased, and how knowledge and competency can be increased, to better care for this population.

While grit is considered essential to EFL learners as they navigate the challenges and setbacks of foreign language learning, it has been largely overlooked by EFL researchers. In this sequential mixed methods study with qualitative data and structural equation modeling (SEM), we examined the role of teacher confirmation and emotional support in predicting L2 grit among 309 low-proficiency Chinese EFL learners who were majoring in music, fine arts, and physical education at Chinese universities. Our results revealed positive correlations between teacher confirmation, emotional support, and L2 grit, with both teacher confirmation and emotional support significantly predicting L2 grit in our presumptive model. Qualitatively, we analyzed 22 participants\' responses to three open-ended questions from a semi-structured interview. Interviewees named a spectrum of interpersonal, learner, context, teacher, and task related factors they believed to be affecting their L2 grit. Among the interpersonal factors, teacher-student communication variables were most frequently named, echoing our quantitative findings. We discussed the limitations, pedagogical implications, and recommended future directions of this research.

BACKGROUND: Older adults with acute functional decline may visit emergency departments (EDs) for medical support despite a lack of strict medical urgency. The introduction of transitional care teams (TCT) at the ED has shown promise in reducing avoidable admittances. However, the optimal composition and implementation of TCTs are still poorly defined. We evaluated the effect of TCTs consisting of an elderly care physician (ECP) and transfer nurse versus a transfer nurse only on reducing hospital admissions, as well as the experience of patients and caregivers regarding quality of care.
METHODS: We assessed older adults (≥ 65 years) at the ED with acute functional decline but no medical indication for admission. Data were collected on type and post-ED care, and re-visits were evaluated over a 30-day follow-up period. Semi-structured interviews with stakeholders were based on the Consolidated-Framework-for-Implementation-Research, while patient and caregiver experiences were collected through open-ended interviews.
RESULTS: Among older adults (N = 821) evaluated by the TCT, ECP and transfer nurse prevented unnecessary hospitalization at the same rate (81.2%) versus a transfer nurse alone (79.5%). ED re-visits were 15.6% (ECP and transfer nurse) versus 13.5%. The interviews highlighted the added value of an ECP, which consisted of better staff awareness, knowledge transfer and networking with external organizations. The TCT intervention in general was broadly supported, but adaptability was regarded as an important prerequisite.
CONCLUSIONS: Regardless of composition, a TCT can prevent unnecessary hospitalization of older adults without increasing ED re-visiting rates, while the addition of an ECP has a favourable impact on patient and professional experiences.

Research capacity is increasing in low- and middle-income countries (LMICs), with progressive development in the range and complexity of studies being undertaken, often in collaboration with high-income country partners. Although senior local stakeholders are typically involved in ensuring that research is conducted according to accepted standards for ethical and scientific quality, to date there has been little exploration of the views of younger generations around the ethics of research involving human subjects. We present our protocol to establish a longitudinal mixed-methods student cohort at the University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam, that is investigating students\' views around the ethics of clinical and public-health oriented research. We use a synergistic approach involving initial deliberative engagement activities ( e.g. science cafes, debates) to inform participants about complex concepts, prior to formal quantitative and qualitative methods (surveys, focus group discussions and in-depth interviews) that are designed to explore the students\' views in detail. We focus in particular on dengue research, i.e. research that addresses a locally relevant disease with which the students are likely familiar, and probe their thoughts on such themes as appropriate remuneration for research participants, involvement of vulnerable groups, use of human challenge trials in LMICs etc. A snapshot of the cohort and its activities after one year is also presented; among 429 active students, primarily from the Faculty of Medicine, the proportions of male and female students were similar, the majority were from southern or central Vietnam where dengue is endemic, and available data indicates the cohort to be representative of the expected spectrum of socioeconomic groups. The cohort provides a unique resource to investigate the views of young people on medical ethics, an important but hitherto underrepresented group in such discussions. Feedback indicates a clear interest in contributing thoughts and ideas to the development of clinical research in Vietnam.