This invited editorial article is based on my experience shared at the 2021 MMIRA Asia Regional / 7th JSMMR Annual Conference. The inaugural Asia Open Forum (AOF) was initiated by the Japan Society for Mixed Methods Research (JSMMR) and the Mixed Methods International Research Association (MMIRA) in 2019 at Hamamatsu, Shizuoka, Japan. The 2021 AOF was the 3rd panel which I have been honored and privileged to be a part of since it was established. The focus of the 2021 AOF was on “Mixed Methods Research Knowledge and Skills Acquired While Abroad.” The purpose was to capture the journey of panel speakers’ mixed methods learning outside of Asia and discuss the impact on their research career of their scholarly activities while abroad. I shared my mixed method research (MMR) learning in the U.S. and how I brought and shared what I leaned back to Taiwan. This article briefly discussed the following areas: (1) my background and my MMR dissertation, (2) my career path and the innovative Taiwan study abroad program, (3) my academic training abroad and continued professional development in mixed methods research, (4) my teaching of mixed methods research doctoral course, (5) my MMIRA and JSMMR encounters, and (6) my promotion of MMR in Taiwan, Asia, and abroad.

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Positive Deviance (PD) is defined as "an approach to social and organizational change that enables communities to discover and act upon the wisdom they already possess." Since the concept was established in Vietnam in the 1990s to address the issue of child malnutrition, it has been used to solve complex social problems. When PD is actually utilized as an approach to solving problems, it is necessary to proceed using quantitative and qualitative research methods, and thus has high compatibility with the mixed research method (MMR). By promoting mutual understanding, not only will this bring social issue practice and research closer together and promote the creation of findings that are highly applicable and practical in the real world, but it is also expected to produce highly novel academic results due to the shift in thinking required by the use of PD. This paper is presented at the pre-conference workshop of the Mixed Asia Regional Conference of the International Society for Mixed Research Methods held in October 2021, where the author introduced PD in relation to MMR with the aim of encouraging many MMR researchers to incorporate PD into their own research activities and to incorporate it into their research practice This paper summarizes the contents of the workshop in an organized manner.

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Positive Deviance (PD) is defined as "an approach to social and organizational change that enables communities to discover and act upon the wisdom they already possess." Since the concept was established in Vietnam in the 1990s to address the issue of child malnutrition, it has been used to solve complex social problems. When PD is actually utilized as an approach to solving problems, it is necessary to proceed using quantitative and qualitative research methods, and thus has high compatibility with the mixed research method (MMR). By promoting mutual understanding, not only will this bring social issue practice and research closer together and promote the creation of findings that are highly applicable and practical in the real world, but it is also expected to produce highly novel academic results due to the shift in thinking required by the use of PD. This paper is presented at the pre-conference workshop of the Mixed Asia Regional Conference of the International Society for Mixed Research Methods held in October 2021, where the author introduced PD in relation to MMR with the aim of encouraging many MMR researchers to incorporate PD into their own research activities and to incorporate it into their research practice This paper summarizes the contents of the workshop in an organized manner.

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Despite growing popularity in mixed methods research, many who are new to the field are unfamiliar with fundamental concepts and particularly about key aspects relative to integration in the paradigm and methodological dimensions. The mixed methods research integration trilogy was advanced as an approach for considering integration of the philosophical or paradigm, methodological, and methods dimensions of mixed methods research projects. In the mixed methods context, the paradigm dimension refers to a worldview held by scholars that comprises distinct assumptions and beliefs about matters such as what is considered reality (ontology), the basis of knowledge (epistemology), and research values (axiology). Methodology refers to the logic of inquiry grounded in its history of use. The methods dimension reflects the specific strategies, techniques, and procedures researchers use to conduct the study. An example illustrates how these different but interrelated dimensions are integrated in rigorous mixed methods studies. A template can be utilized to facilitate thinking and planning about these dimensions, and for representing to others these critical elements in projects. The integration trilogy provides a conceptual structure for considering the interconnectivity of the paradigm, methodological, and methods levels and can be used by mixed methods researchers in their own projects, and by teacher of mixed methods researchers with their learners. Greater attention to these levels of mixed methods research should enhance the rigor and transparency of the integrity of mixed methods studies.

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Objective: While improving health literacy can enhance health among older adults, surmountable barriers preclude full utilization. The purpose of this study was to prospectively measure health literacy changes in older adults with chronic conditions exposed to home monitoring-based telenursing (HMBTN) by examining its link with their experiences of HMBTN, self-care, symptoms, and health status.

Methods: In this study, a prospective fully longitudinal mixed methods design was employed. Eighteen older adults with chronic conditions, such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, amyotrophic lateral sclerosis, and non-small cell lung cancer were included in a 12-week HMBTN intervention. Health literacy, self-care, and symptoms were assessed quantitatively, interviews were conducted to understand experiences with HMBTN, and healthcare/telenursing care records were reviewed to collect health status at baseline, mid-term, and after HMBTN. The findings were converged twice to facilitate the drawing of interpretations and super-meta-inferences throughout the study.

Results: Sixteen participants completed the 12-week HMBTN intervention program. Their scores for applying (p = .031) and understanding health literacy (p =.039), and self-care activities (p =.002) significantly improved. Qualitatively, their ambivalent feelings about and expectations for HMBTN at baseline changed as they made positive lifestyle adjustments through usage. Increased motivation, sense of confidence, and better understanding of symptoms involving self-management were linked to improvements in health literacy.

Conclusions: Improvements in the applying and understanding domains of health literacy among older adults with chronic conditions were linked to their proficiency in utilizing new technologies to make appropriate lifestyle changes. Furthermore, they developed a sense of confidence through their daily HMBTN.

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Objective: This study aimed to develop a concept that satisfies the element of “principles that are true to the clinical situation, up-to-date, and with a simple structure” in genetic and genomic nursing competencies.

Methods: Phase 1 involved a literature review and qualitative interviews with a focus group of nurses practicing genetic nursing. In Phase 2, nurses from randomly selected facilities in Japan answered a questionnaire based on the Phase 1 results. The integration of the results involved comparing the structure and content, and restructuring the concept.

Results: Nursing practices, consisting of seven structures, were extracted from 41 documents and interviews with 21 nurses. Ultimately, 88 items were used to develop the questionnaire. A survey of 137 participants revealed that 54 items had a practice rate of < 80%. Fourteen cluster structures were identified through factor analysis. Using meta-inference, the structural incongruity obtained from these qualitative and quantitative data may be due to a mixture of noise attributes resulting from infrequent practice. In total, 54 items with <80% clinical practice and 22 items whose similarity was confirmed by IT correlation were deleted. The remaining 12 items had a one-factor structure (Cronbach’s α = 0.903), and seven structures in Phase 1 were covered. Finally, factor loadings of 0.47–0.79 were determined as attribute weights, specified as an attribute of the concept, in line with clinical practice.

Conclusion: Mixed methods have helped in developing the concept of “clinical competency in oncological genetics and genomics nursing,” which combines the characteristics of intensity.

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