Digital Commons Network^™

English As A Second Language Students’ Perceptions On Their Reasons To Persist In An Adult Learning Program In Connecticut, Laurie Anne Winek

Walden Dissertations and Doctoral Studies

The problem that was addressed through this study is that 30% of the English as a second language (ESL) students drop out of classes after the first 2 weeks in an adult education program in Connecticut. Grounded in Tinto’s model of student departure, the purpose of this study was to explore ESL students’ perceptions on reasons they persisted in an adult education program in Connecticut. For this basic qualitative design, semistructured interviews were conducted with five students. The data analysis procedures used open coding and categories, with eight themes emerging: ESL students persisted when their instructors cultivated lifelong learning; included …

Staff Education To Increase Knowledge Of Universal Protocol And Surgical Readiness Documentation Among Ambulatory Surgery Staff, Miranda Gould

Walden Dissertations and Doctoral Studies

This Doctor of Nursing Practice (DNP) project evaluated the impact of a structured staff educational intervention on ambulatory surgery center (ASC) staff knowledge of Universal Protocol and SOAP (Surgeon, Operating Room, Anesthesia, and Preprocedure Ready) documentation. A practice gap was identified in staff knowledge of perioperative safety processes that are essential for preventing surgical safety events. The purpose of this doctoral project was to improve ASC staff knowledge of Universal Protocol and SOAP readiness documentation through an evidence-based educational intervention designed to strengthen perioperative safety practices. The practice-focused question was: According to the evidence, in multi-specialty ASC staff, what is …

Adults’ Lived Experiences With Placement In Child Protective Services During Adolescence, Michaela First Haynes

Walden Dissertations and Doctoral Studies

Perceptions of safety and emotional support during involvement with child protective services (CPS) during adolescence may play a significant role in shaping attachment experiences and relationships in adulthood. Although researchers have examined the effects of child maltreatment and foster care involvement, limited research has explored how adolescents perceive emotional support and safety during CPS involvement and how those experiences influence attachment in adulthood. The purpose of this qualitative study was to explore the lived experiences of adults who experienced CPS involvement during adolescence and to understand how perceptions of safety and emotional support are reflected in their adult attachment relationships. …

Training Strategies For Employees To Use Electronic Human Resource Management Systems, Anita Wright

Walden Dissertations and Doctoral Studies

Ineffective electronic human resource management (e-HRM) training can weaken HR employees’ ability to use digital human resource (HR) systems that support HR operations, employee services, and workplace efficiency. HR managers in small to medium-sized enterprises (SMEs) recognize that poor e-HRM training undermines employees’ confidence, consistency, and accuracy in HR tasks. Grounded in the technology acceptance model (TAM), the purpose of this qualitative pragmatic inquiry project was to identify and explore the effective strategies some SME HR managers use to train HR employees to use e-HRM systems. The participants were eight SME HR managers in the southeastern United States with experience …

Reducing Urinary Tract Infections In Long-Term Care Residents, Felicity Antwi

Walden Dissertations and Doctoral Studies

This quality improvement (QI) project addressed delays in diagnosing urinary tract infections (UTIs) at a skilled nursing facility (SNF), where reliance on urine culture testing and patient monitoring resulted in an average diagnostic period of 72 hours. A high UTI incidence and UTI-involved hospitalization rate are both nurse-sensitive indicators that are important to address in the nursing practice context because they portend negatively for nursing quality and safety. This quality improvement (QI) project addressed the practice-focused question: among long term care (LTC) residents with suspected UTIs in a nursing home (NH), how does reducing the diagnostic period from 72 hours …

Postmodern Fantasy & Its Twin Traditions, Skyler J. Alexander

Honors Thesis

Fantasy literature is diverse and difficult to categorize; nevertheless, throughout the twentieth century two main subgenres emerged: sword-and-sorcery and high fantasy. This thesis examines the differences and similarities between these two traditions, how contemporary examples of the genre fit into or diverge away from the traditions that influenced them, and proves in the negative what and how much of contemporary fantasy fiction is original to itself, with no prominent antecedent. The analysis was performed by comparatively reading two contemporary fantasy novels, The Eye of the World by Robert Jordan and A Game of Thrones by George R. R. Martin, with …

Multimodal Digital Libraries: A Response To Culturally And Linguistically Sustaining Classrooms, Abigail Lopez

Masters Projects

Poorly represented minority groups fail to connect reader identity backgrounds

with the characters in texts due to curriculum traditionally relying on English dominant

translations. This system challenge deficit fails students by placing limitations on the

exposure of rich vocabulary, cultural awareness and sets up lack of engagement. This

project is grounded in Culturally and Linguistically Sustaining Pedagogy, Sociocultural

Theory, Constructing Reader Identities and Engagement theories that transforms

student diversity into an instructional practice that empowers multilingual learners.

To empower students, this digital culturally relevant library optimizes educator

planning time. This digital library provides immediate access to multicultural books

alongside a …

Mitigation Of The Seductive Details Effect In Children, Allison S. Dobuler

Electronic Theses and Dissertations 2020 - Present

The present thesis examines if interspersing guiding questions between sections of an expository text can mitigate the seductive details effect, in which the addition of interesting but tangentially related information to the base text may hinder the ability to learn the essential material, for typically developing children. Participants were given two passages to read, one with seductive details and one without. They either had no guiding questions for both passages or guiding questions interspersed between the text of both passages. They were given retention and comprehension assessments for both passages. While the guiding questions did not mitigate the seductive details …

A Comprehensive In-Silico Pipeline For The Discovery Of Non-Toxic, Stable Antimicrobial Peptides From Databases For Targeting Multi-Drug Resistant K. Pneumoniae, Pranab D. Sharma, Abdullah A. Noman, Al Hafiz

Faculty Articles

The rapid emergence of multidrug-resistant Klebsiella pneumoniae has significantly reduced the effectiveness of conventional antibiotics, highlighting the need for alternative therapeutic strategies. This study employed a comprehensive in silico pipeline to identify antimicrobial peptides (AMPs) targeting the essential DNA replication initiator protein DnaA. A total of 28,361 peptide sequences were collected from publicly available AMP databases and sequentially filtered based on peptide length, net charge, GRAVY score, instability index, antimicrobial activity, toxicity, hemolytic potential, aggregation propensity, sequence similarity and favorable amphipathic properties. Four peptides satisfied all selection criteria and were subjected to structural prediction, membrane-binding analysis, protein–DNA docking, protein–peptide docking, …

Experiences Of Novice Assistant Principals: Perceptual Evidence From Texas, Gregory Vidal

Electronic Theses and Dissertations

Assistant principals play essential roles in supporting instructional leadership and campus operations. However, limited research has examined how novice assistant principals experience their transition into administration and interpret their preparation and support. This study addressed the gap in understanding how novice assistant principals in a suburban Texas public school district made sense of their preservice preparation and early leadership practice, and how these experiences shaped their perceptions of training and organizational supports. The purpose of this qualitative, experiential, phenomenological study was to explore the lived experiences of novice assistant principals during their first three years in the role. The study …

Creating Sustainable School And Home Gardens: Creating An Outreach Booth, Aurora Hughes Villa, Tyelar Haines, Rita Hagevik, Kathy Cabe Trundle, Michelle Parslow

All Current Publications

An outreach booth is a physical presentation that allows your audience to learn more about a subject and how they can participate. It provides information on a topic (e.g., an environmental issue or a community project) through direct interaction with experts in the field. Through this approach, people become engaged, and discussions emerge that foster a sense of community around the topic. Interested in creating one for yourself? Follow the steps outlined in this fact sheet.

Perilaku Merokok Dan Paparan Informasi Bahaya Merokok Di Media Pada Penduduk ≥15 Tahun: Analisis Potong Lintang Gats Indonesia 2021, Hana Aulia Putri, Izza Nayla Paramitha, Nuha Nazeeha, Rahma Amalia

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Smoking remains a significant health problem in Indonesia. Although anti-smoking information is disseminated through various media, exposure levels and effectiveness among adults are not clearly documented.

Objective. To describe the proportion of anti-smoking information exposure among Indonesian adults by media type (television, radio, billboards, newspaper/magazines, internet, and others) and compare exposure between smokers and non-smokers using GATS 2021 data.

Methods. Cross-sectional study using Global Adult Tobacco Survey (GATS) Indonesia 2021 data. A total of 9,156 respondents aged ≥15 years were analyzed descriptively to determine exposure proportions by smoking status across multiple media channels.

Results. Television showed the highest exposure …

The Effectiveness Of "Little Doctor" Training On Health Knowledge And Behavior Of Karawang Primary Students (2025), Aurelia A. Erawan, Shahnaz F. Azzahra, Rubee P. Risdiyanto, Patricia Andini, Muhammad K. Ramadhan, Ailsa T. Kirana, Istingadah Desiana Md, Raden M. Rifada Md

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background. Acute respiratory infection (ARI) remains a major public health problem in Indonesia, with West Java reporting the highest incidence. Poor Health-Related Behavior (HRB) practices are associated with increased ARI risk. The "Little Doctor" program is a government initiative that focuses on school health and aims to promote HRB among students. Along with this goal, this study aimed to determine the effectiveness of the program in improving knowledge of HRB and ARI among elementary school students in Pancawati Village, Karawang Regency.

Methods. This study employs a quasi-experimental one-group pretest-posttest design. Participants were selected based on inclusion criteria referring to the …

Hubungan Paparan Informasi Anemia Dan Tablet Tambah Darah (Ttd) Melalui Media Digital Dengan Kebiasaan Konsumsi Makanan Ibu Hamil Berdasarkan Food Frequency Questionnaire (Ffq), Muthiah Salsabilah, Bernadette Oktavia Jelita, Thariq Zafar Surapati, Alya Khairunnissa, Primasti Nuryandari Putri, Ratu Ayu Dewi Sartika

Perilaku dan Promosi Kesehatan: Indonesian Journal of Health Promotion and Behavior

Background: Proper nutrition is important for the mother and baby. The media is an important source of information for every pregnant woman, but the information might be inaccurate.

Aim: This study aims to examine the association between exposure to digital media information on anemia and iron-folic acid (IFA) supplementation and the food consumption habits of pregnant women as measured by the Food Frequency Questionnaire (FFQ) at Puskesmas Kecamatan Beji, Depok City in 2024.

Method: This study utilized a cross-sectional design involving secondary data analysis of the 2024 antenatal care (ANC) survey conducted at Beji Primary Health Center, Depok City. Purposive …

Lessons Learned For The Independent Panel For Evidence For Action Against Amr From Previous International Science Panels: Stakeholder Views From The 2025 Lagos Workshop, Iruka N. Okeke, Anthony Mcdonnell, Ayodele A. Akinyele, Javier Guzman, Kevin Outterson

Faculty Scholarship

In September, 2024, the UN General Assembly assigned the Quadripartite Joint Secretariat on Antimicrobial Resistance (AMR) the task of establishing an Independent Panel for Evidence for Action against AMR (IPEA). To promote stakeholder views and input around the constitution and functioning of this Panel, which could feed into the Quadripartite Joint Secretariat’s consultation process, we independently commissioned seven papers to examine the lessons that could be learned from other high-level scientific panels. We then convened 85 stakeholders, primed with the background papers. The Workshop, held in Lagos, Nigeria in April, 2025, drew representation from around the world, particularly low-income or …

Relationship Of Covid-19-Related Racial Discrimination And Oppressed Identities On Chinese American Mental Health, Allison A. Fong

Doctoral Dissertations

Although anti-Asian hate has been present throughout history, the country witnessed an uptick in race-based violence and discrimination against Asian Americans during the COVID-19 pandemic. Utilizing the framework of intersectionality, this quantitative cross-sectional study aimed to capture the additive impact of various forms of oppression, including COVID-19-related racial discrimination, on levels of depression, anxiety, and life satisfaction in Chinese American college students (n = 35) in the Greater San Francisco Bay Area. Within this relationship, bicultural identity integration was also explored as a possible moderator. Although regression analysis did not show significant relationships between COVID-19-related racial discrimination and intersectional discrimination …

Metal-Assisted Chemical Etching For Heterogeneous Integration And Advanced Processing, Sami Znati

Theses

Emerging and existing technologies will require novel approaches to continue advances in development. Heterogeneous integration of next generation materials, such as 2-D materials and III-V semiconductors, onto existing platforms is a critical step to enabling new, better performing devices. Microtransfer printing (µTP) is a promising technique for integrating device coupons onto supportive platforms. InP coupons are integrated into mixed-dimensional structures by printing onto 2-D materials as part of an electronic device. Etching of next generation materials to define device structures is an integral part of any process. Catalytic wet etching is an alternative to dry etching that may offer improvements …

Decreased Frequency Of Splenectomy For High-Grade Splenic Injuries Following The Implementation Of An Interventional Radiology Alert Protocol., Maura Kopchak, John Bach, William B Devoe, Brian Dusseau, Katherine A Graham, John Dillis, Thomas Glusich, Jeff Hubartt

OhioHealth Research Institute Articles

Background A vascular interventional radiology (VIR) protocol was initiated at a mature level 2 trauma center on 3/1/2023 to reduce time to vessel puncture to < 60 minutes as per American College of Surgeons (ACS) guidelines. The average time to vessel puncture in the two years prior to protocol initiation was 102 minutes. Following initiation, time to vessel puncture was reduced to 48.2 minutes (p < 0.001). A statistically significant increase in the number of splenic embolizations was noted in the post-protocol group. The primary outcome of the current study was to evaluate if the initiation of a VIR protocol correlated with a statistically significant decrease in splenectomies for high-grade splenic injuries (American Association for the Surgery of Trauma (AAST) grade 3 or higher) in favor of splenic embolization. The secondary outcomes of the study were to assess whether the initiation of the VIR alert protocol improved our rate of splenic salvage, defined as preserved splenic immune function, and if there was a decreased rate of splenectomies across all injury grades. Methods The trauma registry database was queried for all splenic injuries from 1/1/2021 to 9/1/2024. Admission CT scans were used to grade injuries using the AAST Organ Injury Scale. Demographic and clinical characteristics, including severity of illness (ISS), admission INR, age, blood product required pre- and post-intervention, mortality, sex, length of stay, anticoagulant (AC)/antiplatelet (AP) use, mechanism of injury, and need for REBOA (resuscitative endovascular balloon occlusion of the aorta) placement, were collected for all patients. Patients were further broken down into those requiring splenectomy, embolization, or no intervention. Data were analyzed using chi-square and Mann-Whitney U with Jamovi Version 2.3.26.0 (The Jamovi Project, 2023). Results No statistically significant difference was found for clinical or demographic characteristics between groups. Fewer splenectomies and more splenic embolizations were performed in the post-protocol group for high-grade splenic injuries (grade 3), which was statistically significant (p< 0.001). This was also true when all grade splenic injuries were compared (p< 0.001). Conclusion Following the establishment of an institutional VIR alert protocol for active hemorrhage control in trauma patients, more frequent utilization of angioembolization for high-grade splenic injuries was found with a subsequent decrease in splenectomy rate. Implementation of the VIR alert protocol directly correlated with a shift in practice pattern reflecting attempts at splenic salvage for all injury grades.

Kembang Setaman Dalam Budaya Jawa Sebagai Ide Penciptaan Seni Lukis Kontemporer, Lintang Putri Kinasih, Ponimin Ponimin

Journal of Language, Literature, and Arts

Kembang setaman is a traditional floral arrangement used in various Javanese cultural practices and carries symbolic meanings associated with human life. This research and artistic creation aims to reinterpret the symbolism of kembang setaman through contemporary painting and explore its potential as a source of visual ideas for representing the human life journey. The creative process adapted Alma M. Hawkins’ method, comprising exploration, improvisation, and realization. Exploration involved literature and visual studies as well as reflection on personal experience; improvisation involved sketch development and artistic experimentation; and realization employed acrylic paint on canvas. The process resulted in six paintings representing …

``But What About Me?'': A Structural Redesign For Cascading Trust Into An Integrated Culture Of Care, Hazelin Hei Laam Ngan

Patient Experience Journal

In healthcare, patient experience (PX) and employee experience (EX) are often managed as separate priorities despite their interdependence. This article presents a case study from NYC Health + Hospitals/Community Care, a 250-person safety-net division providing home-based services across New York City. In response to frontline staff repeatedly asking, ``But what about me?'' when offered PX best practice suggestions, the organization integrated patient experience, staff engagement, and wellness into a unified Care Experience portfolio led by the Chief Experience Officer. From this structural redesign emerged a practical framework for trust-building organized around three pillars: Purpose, Presence, and Partnership. Purpose aligns staff …

Building A Culture Of Trust: Engaging Teams With Targeted Tactics For Meaningful Improvement In Patient Experience, Anna Buckner, Kimberly Lewis

Patient Experience Journal

Rising financial pressures and the need to revitalize culture prompted a renewed emphasis on patient experience at Billings Clinic. This case study describes the impact of redefining patient experience as a measure of trust and a set of care processes. It presents an alternative to the more traditional view of patient experience as an outcome metric based on meeting patient expectations. Billings Clinic chose the patient survey question likelihood of recommending as an organizational goal or key performance indicator (KPI). Under the direction of executive leadership, the patient experience team developed a new strategic framework aimed at driving improvement for …

Plan Of Day | Plan Of Stay: How Inter-Disciplinary Communication Improved Patient Experience And Hospital Throughput, Theresa Jean Dionne, Felicia Hurst, Danna Qunibi, Lauren Lazar, Sydney Mccurdy, Ashlyn Coenraad, Brittney Ward, Whitney Black, Ashley Nelson, Judd Salem, Luisa Restrepo

Patient Experience Journal

Background: Effective communication among healthcare team members is critical for delivering high-quality, patient- and family-centered care while optimizing hospital operations. This case study examines the implementation of a structured ``Plan of Day | Plan of Stay'' model, leveraging bedside whiteboards to enhance inter-disciplinary communication in a pediatric hospital setting. By providing a clear, visual summary of daily care plans, care team members, and discharge goals, whiteboards foster transparency, empower patients and families, and facilitate coordinated clinical decision-making. Purpose: This quality improvement initiative evaluated the implementation of a standardized Plan of Day | Plan of Stay communication model on a pediatric …

Patient Psychological Safety: A Qualitative Study Of Patient Experiences, Derick R. Simmons, Cheryl Rathert, Ryan Valayil, Maria Joseph, Ibraheem Jawadi

Patient Experience Journal

There is growing interest in understanding patients' experiences with psychological safety during healthcare encounters. Recent studies reveal that patients describe needing patient psychological safety (PPS) to form connections with their care providers, which are associated with better health outcomes. Therefore, it is critical to examine indicators of PPS. Using a phenomenological interpretive approach, this study utilized a patient narrative survey methodology to qualitatively explore how and why patients experience a lack of PPS during their healthcare encounters. We surveyed patients from across the U.S. and analyzed responses among a sub-sample of respondents to an open-ended question whose responses indicated they …

Patient-Centred Care: An Integrated Bibliometric And Structural Equation Modelling Approach, Japheth Nuhu Ahmed

Patient Experience Journal

This study investigates how communication and service quality in Patient Relationship Management impact patient satisfaction through trust. The literature in this field is predominantly in developed countries, whereas it is scarce in sub-Saharan Africa. Combining bibliometric analysis and structural equation modelling, the study highlights emerging research trends and provides empirical evidence to guide healthcare practitioners, policymakers, and researchers in improving patient care. To strengthen its theoretical foundation, the study integrates the Social Exchange Theory and Expectancy–Disconfirmation Theory to explain the model. The study retrieved quantitative data from the Scopus database for bibliometric analysis. A questionnaire was used to collect data …

From Anticipation To Relief: Anxiety Reduction And Patient Experience As Indicators Of Trust During Dental Extractions In Orthodontic Treatment, Kanza Tahir, Mubassar Fida, Rashna Hoshang Sukhia

Patient Experience Journal

Trust is central to healthcare encounters involving fear and uncertainty. This quasi-experimental study evaluated changes in anxiety before and after dental extractions performed during orthodontic treatment planning and examined whether patient experience factors were associated with post-extraction anxiety. Fifty patients aged 11–40 years undergoing fixed orthodontic treatment requiring extraction were recruited consecutively at a tertiary care hospital from October 2023 to June 2024. Anxiety was measured immediately before and after extraction using the Beck Anxiety Inventory. Post-procedure patient experience was assessed with a structured questionnaire addressing reassurance, communication, privacy, shared decision-making, perceived understanding, and overall experience. Paired t-tests and simple …

Self-Medication Experience And Healthcare Trust Among Youth: A Regionally Concentrated Digital Survey In Indonesia, Wahyudi Wahyudi, Azra Muzaiyana Nasution, Arini Dwi Rahmadani, Alysa Rahmadani Hasibuan

Patient Experience Journal

Self-medication has become a central experience for youth transitioning toward independent medical decision-making. In the digital era, young people must navigate a complex landscape of health information while seeking independent health solutions. This study investigates self-medication experiences and healthcare trust among youth, utilizing a regionally concentrated digital survey approach in Indonesia. Data were collected via a cross-sectional approach using digital platforms (Instagram, TikTok, and Twitter/X), facilitated by 76 trained enumerators. While respondents from all 38 provinces participated, the sample (N = 2,790) exhibits a major geographical concentration in the Sumatra region. The study employed a validated 16-item instrument to evaluate …

Trust Earned Through Relational Care: How Adverse Childhood Experiences Shape Patient Trust In Their Inpatient Physicians—A Convergent Mixed-Methods Study, Marlise Jeanne Pierre-Wright, Ibrahim Badreldin Mokhtar, Uma Thachapuzha, Yashoswini Chakraborty, Revika Singh, Rachel O'Conor, Jing Song, Julia Lee, Maria E. Theodorou, Christine Schaeffer, Kimberly Collins, Muriel Jean-Jacques

Patient Experience Journal

Background: Adverse childhood experiences (ACEs) are common, with approximately 60% of the population reporting at least one exposure. Despite well-established links between ACEs and adverse health outcomes, little is known about how ACE exposure shapes hospitalized patients' trust in inpatient physicians. Objective: To examine the association between ACEs and hospitalized patients' trust in inpatient physicians and to explore how trust is formed among patients with high ACE exposure. Methods: In this convergent mixed-methods study, 86 patients admitted to a general internal medicine teaching service at a large urban academic medical center were surveyed across six data-collection sessions (January–July 2024). Participants …

Navigating Uncertainty: Patient Experiences Of Birads 0 Mammogram Results, Petranea Smith, Jasmine Warren, Marina Demas, Roberta Goldman, Joanne E. Wilkinson

Patient Experience Journal

Objective: Describe experiences of patients receiving BIRADS 0 (inconclusive) mammogram results in electronic health portals. Methods: Recruited eighteen patients who had received BIRADS 0 results via the portal in the last 5 years.Semi-structured interviews yielded qualitative data, analyzed sequentially using the immersion crystallization method to identify content and then iterative coding both individually and in groups. A team of 4 researchers coded and analyzed the transcripts, using repeated meetings and a shared spreadsheet to organize codes and develop thematic elements via visual organization. Results: Themes included baseline comfort/trust with healthcare and how it interacted with anxiety about the uncertainty of …

From Hospital To Home After Lower-Extremity Open Reduction And Internal Fixation: Patients' Experiences Of Pain Self-Management And Trust-Building Discharge And Follow-Up Support, Sahrudi Sahrudi, Achmad Fauzi Kamal, Masfuri Masfuri, Kasiyah Junus

Patient Experience Journal

After lower-extremity open reduction and internal fixation (ORIF), patients often return home while pain, wound care, mobility restrictions, medication routines, and follow-up needs are still evolving. During this transition, trust in discharge information may shape how patients interpret symptoms, use analgesics, mobilise, involve family members, and decide when to seek help. This qualitative descriptive study explored patients' experiences of pain self-management after lower-extremity ORIF in an Indonesian public hospital context, with attention to trust-building needs across discharge and early follow-up. Eighteen adults participated in individual face-to-face semi-structured interviews at an orthopaedic outpatient clinic. Interviews were audio-recorded, transcribed verbatim, and analysed …

Nurses' Perceptions Of Medical Services In Acute Care Hospitals In The Post-Covid-19 Era, Yoko Nakano, Tomoya Yokotani, Rika Nakajima, Hidemi Yoshii

Patient Experience Journal

Purpose: This study aimed to clarify nurses' perceptions of healthcare services in acute care hospitals. Methods: A cross-sectional, anonymous, web-based questionnaire was conducted using SurveyMonkey. Participants were selected using convenience sampling. The survey included questions about the participants' basic attributes and the 22-item M-SERVQUAL scale (a modified multiple-item scale for measuring consumer perceptions of medical service quality). Data analysis involved age-based comparisons using the Kruskal–Wallis test, followed by multiple comparisons using the Bonferroni method. The significance level was set at p < 0.01. Results: The survey was distributed to 1,542 participants, yielding 566 valid responses, with an effective response rate of 36.7%. …