Mixed-Methods Study Design

The mixed-methods design is intended to compensate for limitations in administrative and qualitative data sources. A strength of the design is that it combines quantitative breadth with qualitative depth. The trial will recruit 128 cervical cancer patients from Nelson Mandela Academic Hospital and St Elizabeth Hospital. The study sample size provides 80% power to detect a moderate effect size of 0.5 at the Bonferroni-adjusted significance threshold. No formal power calculation is used because the study is exploratory and mixed-methods in design. Forty informants from nine European countries participated in the five focus groups, spanning clinical, organisational, and policy roles. The survey achieved a response rate of only 3.8%, with substantial overrepresentation of Italian and Spanish cardiologists, which limits generalisability across national contexts. Case-study themes will be compared with mapped service variation and workforce data patterns to triangulate workforce challenge and sustainability indicators. Outcome questionnaires will be administered at three time points: one week, one month, and three months after the first medical consultation. The protocol uses a multipha…