HS895 Unit 8 Mixed Methods Manuscript Draft Example

Six GRAMMS Items Mapped to Pages: A Unit 8 Manuscript Draft on Persistent Gonadal Shielding for Radiologic Technology

[Student Name]

Purdue University Global

HS895: Doctoral Project IV: Communication and Dissemination

Unit 8 Manuscript Draft

[Instructor Name]

[Date]

The study and its results are composite and shown as placeholders; the target journal, reporting guideline and sources cited are real.

Title Page

Title: Habit, Expectation and the Room: A Mixed Methods Study of Why Radiographers Continue Gonadal Shielding. Target journal: Radiologic Technology. Article type: peer-reviewed research. Word count, excluding abstract, tables and references: [3,980]. Tables: 3. Figures: 1. The journal's author guidelines set the word limit, the unstructured abstract of no more than [150] words and AMA reference style; references in this course draft appear in APA to match program requirements and will be converted before submission.

Abstract

Professional guidance no longer supports routine gonadal shielding, yet the practice continues. This study surveyed radiographers across a fourteen-site imaging network and interviewed a subset to identify what sustains it. One in three respondents reported shielding children routinely during pelvic radiography. Shielders and nonshielders knew the guidance equally well. Shielders scored higher on four domains covering automatic choices, pressure from others, room cues and identity, and interviews described these influences acting together during examinations. Retiring the practice will likely require changes to room setup and preparation for conversations with parents rather than further education.

Introduction

For decades, radiographers were taught to place a lead shield over a child's reproductive organs during pelvic and abdominal imaging. The rationale has since weakened. The gonads are now considered less sensitive to radiation than earlier models assumed, digital equipment delivers low doses, and a shield in the beam can increase exposure through automatic exposure control or hide anatomy and prompt a repeat (Marsh & Silosky, 2019). In young girls, the ovaries frequently lie where a standard shield does not reach (Fawcett et al., 2012). Medical physics and radiation protection bodies have recommended ending routine use. Nevertheless, surveys suggest many radiographers still shield. This study asked why, using the Theoretical Domains Framework to examine determinants beyond knowledge (Cane et al., 2012).

Methods

GRAMMS item 1, justification for mixed methods: a survey could show which determinants distinguish shielders, and interviews could show how those determinants operate during an examination; neither alone could do both.

GRAMMS item 2, design: convergent, with both strands collected in the same period, analyzed separately and integrated by domain.

Setting and participants. An imaging network with fourteen radiography sites in the United States. Every registered radiographer performing projection radiography were invited to an anonymous survey; volunteers from the survey were purposively selected for interviews across shielding practice, site type and experience.

Survey. Shielding frequency for pediatric AP pelvis radiography on a five-point scale, dichotomized as routine (often or always) or not; 14 framework domains measured with adapted agreement items; demographics.

Interviews. Semi-structured, with prompts for each domain beginning from a recent examination; recorded, transcribed and deidentified.

GRAMMS item 3, methods for each strand: domain scores compared with Mann-Whitney tests and false discovery rate control, followed by logistic regression adjusted for site type and experience; transcripts analyzed by directed content analysis with the domains as initial codes and a second coder.

GRAMMS item 4, integration: a joint display listing each domain's survey result beside its interview belief statements, labeled convergent, complementary or discordant (Fetters et al., 2013).

Ethics. Approved by the university review board; survey responses anonymous; interview participants consented in writing.

Results

Of [286] invited radiographers, [121] responded ([42] percent) after a recruitment amendment; [17] were interviewed. Routine shielding was reported by [33] percent, ranging from [16] percent in hospital departments to [48] percent in outpatient centers. Two domains with low reliability were excluded from testing.

Knowledge did not differ between groups. Four domains did: habitual decision-making, the influence of other people, the room environment and professional role. In the adjusted model, automatic decision processes (odds ratio [2.3]) and social influences ([1.9]) remained associated with routine shielding, as did working in an outpatient center ([2.8]).

Interviews converged with the survey on three domains. Radiographers described reaching for a shield "before I think," anticipating parents who "ask where the apron is" and shields that "hang right where my hand goes." Professional identity was complementary, explained by statements linking shielding to care for children. Beliefs about consequences was discordant: interviewees often feared complaints, but the adjusted survey comparison showed no difference.

The study's central result is a gap that runs the wrong way for education: knowledge was nearly universal, and practice still split the workforce in thirds.

Discussion

Persistent shielding appears to be maintained by the same forces that sustain other low-value practices: routine, social expectation and an environment that cues the old behavior (Norton & Chambers, 2020). Because knowledge did not distinguish shielders, departments that rely on memos and in-service sessions are likely to see little change. The findings point to two practical moves: removing shields from default positions in rooms and preparing radiographers with language for parents. These map onto intervention types for habitual behavior that alter the environment and provide social support (Michie et al., 2011). The higher shielding rate in outpatient centers deserves attention; smaller sites with fewer colleagues may be slower to change shared routines.

Limitations. Shielding was self-reported and may be understated. Response was moderate and late respondents differed from early ones. Two domains had low reliability. The study took place in one network.

GRAMMS item 5, limitations of one method compensated by the other: interviews explained mechanisms that the cross-sectional survey could not; the survey showed how widespread the patterns were, which a small interview sample could not.

GRAMMS item 6, insights from integration: the discordant result for beliefs about consequences, prominent in interviews but not in the survey, suggests that fear of complaints is widely shared by shielders and nonshielders alike and may not explain the difference between them.

Implications for education. Radiography programs that still teach shielding as routine will keep supplying the habit the study describes. Program directors can revise competency checklists and, perhaps more importantly, choose clinical placements where students see the current practice modeled.

Conclusion

Shielding radiographers are not short of information. Retiring the practice will depend on changing what is in the room and preparing staff for what parents ask.

GRAMMS Checklist

Item 1, justification: Methods, page [6]. Item 2, design: Methods, page [6]. Item 3, each method's sampling, collection and analysis: Methods, pages [6] to [8]. Item 4, integration: Methods, page [8]; Figure 1. Item 5, limitations of one method offset by the other: Discussion, page [13]. Item 6, insights from integration: Discussion, page [13] (O'Cathain et al., 2008).

References

Cane, J., O'Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7, 37. https://doi.org/10.1186/1748-5908-7-37

Fawcett, S. L., Gomez, A. C., Barter, S. J., Ditchfield, M., & Set, P. (2012). More harm than good? The anatomy of misguided shielding of the ovaries. The British Journal of Radiology, 85(1016), e442-e447. https://doi.org/10.1259/bjr/25742247

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs: Principles and practices. Health Services Research, 48(6 Pt 2), 2134-2156. https://doi.org/10.1111/1475-6773.12117

Marsh, R. M., & Silosky, M. (2019). Patient shielding in diagnostic imaging: Discontinuing a legacy practice. American Journal of Roentgenology, 212(4), 755-757. https://doi.org/10.2214/AJR.18.20508

Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42. https://doi.org/10.1186/1748-5908-6-42

Norton, W. E., & Chambers, D. A. (2020). Unpacking the complexities of de-implementing inappropriate health interventions. Implementation Science, 15, 2. https://doi.org/10.1186/s13012-019-0960-9

O'Cathain, A., Murphy, E., & Nicholl, J. (2008). The quality of mixed methods studies in health services research. Journal of Health Services Research & Policy, 13(2), 92-98. https://doi.org/10.1258/jhsrp.2007.007074