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Lim M, Bohorquez NG, Mitchell R, Cramb S, Bradford N, Naicker S, Kularatna S, Senanayake S. Financial Aid in Children, Adolescents and Young Adult's Cancer Care: A Scoping Review. J Adolesc Young Adult Oncol 2024. [PMID: 38451723 DOI: 10.1089/jayao.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.
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Affiliation(s)
- Megumi Lim
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalia Gonzalez Bohorquez
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at the Centre for Children's Health Research, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
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Woodland R, Morgan P, MacLean S, Downey H. The experiences of a regional Aboriginal community accessing primary health care during times of crisis. Aust J Rural Health 2024; 32:80-89. [PMID: 37985472 DOI: 10.1111/ajr.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION The importance of primary health care (PHC) to Aboriginal Australians is widely acknowledged, as is the underservicing of the Aboriginal Australian population. Aboriginal People continue to face significant obstacles when accessing and using health care services. OBJECTIVE This study identifies environmental factors (beyond personal and service delivery) that functioned as barriers and enablers to Aboriginal Australians' experiences accessing PHC during crises and recommends approaches during future events. DESIGN This research utilised a case study approach. Data were collected through in-depth interviews and analysed using thematic analysis. The study was set in Lakes Entrance, a regional Victorian locality with a sizable Aboriginal community, which was affected by bushfires during 2019/2020 and COVID-19 restrictions during 2020-2021. Participants were 18 Aboriginal People over the age of 18 living in the locality during either bushfires or COVID-19. FINDINGS The barriers identified included the impact on PHC access of priorities other than health, including housing; financial constraints; difficulties with transport; medical bureaucracy and the physical environment of the health care setting, including appointment-making processes; interactions with medical reception staff; and waiting room environments. Enablers identified included the supportive role of the local Aboriginal Community Controlled Health Organisations (ACCHO) and their staff, which was highlighted in participant responses. DISCUSSION The preference of many Aboriginal people to access PHC via their local ACCHO, rather than mainstream health care services, appears even more salient during crises than in normal times. This research identified that ACCHOs are ideally placed to promote and protect the health of Aboriginal communities during crises. CONCLUSION Results may help direct interventions to improve PHC access and experiences for regional Aboriginal communities both during and outside periods of crisis.
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Affiliation(s)
- Rebecca Woodland
- Gippsland Lakes Complete Health, Lakes Entrance, Victoria, Australia
| | - Paula Morgan
- Lakes Entrance Aboriginal Health Association, Lakes Entrance, Victoria, Australia
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Friedrich B, Vindrola-Padros C, Lucassen AM, Patch C, Clarke A, Lakhanpaul M, Lewis C. "A very big challenge": a qualitative study to explore the early barriers and enablers to implementing a national genomic medicine service in England. Front Genet 2024; 14:1282034. [PMID: 38239852 PMCID: PMC10794539 DOI: 10.3389/fgene.2023.1282034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Background: The Genomic Medicine Service (GMS) was launched in 2018 in England to create a step-change in the use of genomics in the NHS, including offering whole genome sequencing (WGS) as part of routine care. In this qualitative study on pediatric rare disease diagnosis, we used an implementation science framework to identify enablers and barriers which have influenced rollout. Methods: Semi-structured interviews were conducted with seven participants tasked with designing the GMS and 14 tasked with leading the implementation across the seven Genomic Medicine Service Alliances (GMSAs) and/or Genomic Laboratory Hubs (GLHs) between October 2021 and February 2022. Results: Overall, those involved in delivering the service strongly support its aims and ambitions. Challenges include: 1) concerns around the lack of trained and available workforce (clinicians and scientists) to seek consent from patients, interpret findings and communicate results; 2) the lack of a digital, coordinated infrastructure in place to support and standardize delivery with knock-on effects including onerous administrative aspects required to consent patients and order WGS tests; 3) that the "mainstreaming agenda", whilst considered important, encountered reluctance to become engaged from those who did not see it as a priority or viewed it as being politically rather than clinically driven; 4) the timelines and targets set for the GMS were perceived by some as too ambitious. Interviewees discussed local adaptations and strategies employed to address the various challenges they had encountered, including 1) capacity-building, 2) employing genomic associates and other support staff to support the consent and test ordering process, 3) having "genomic champions" embedded in mainstream services to impart knowledge and best practice, 4) enhancing collaboration between genetic and mainstream specialties, 5) building evaluation into the service and 6) co-creating services with patients and the public. Conclusion: Our findings highlight the challenges of implementing system-wide change within a complex healthcare system. Local as well as national solutions can undoubtedly address many of these barriers over time.
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Affiliation(s)
- Bettina Friedrich
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention and Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, United Kingdom
| | - Anneke M. Lucassen
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Centre for Personalised Medicine, The Wellcome Centre for Human Genetics, Oxford, United Kingdom
| | - Chris Patch
- Engagement and Society, Wellcome Connecting Science Wellcome Genome Campus, Hinxton, United Kingdom
| | - Angus Clarke
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Celine Lewis
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- London North Genomic Laboratory Hub, London, United Kingdom
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Mohamed S, Abbashar A, Abushama H. Women's career motivation: social barriers and enablers in Sudan. Front Psychol 2023; 14:1153613. [PMID: 37720639 PMCID: PMC10501794 DOI: 10.3389/fpsyg.2023.1153613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/02/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction This study presents an original contribution by examining an often-neglected country in the Middle East and Northeast Africa (MENA), with a specific focus on women's career research. It identifies challenges that have created barriers for Sudanese women's career progression, consequently limiting their opportunities for career and leadership growth. To conceptualize understand women's career motivations on a global and regional scale, the study conducted an in-depth review and analysis of literature, benchmarked similar countries, and incorporated psychological and organizational behavior theories, alongside examples of women's empowerment cases from the MENA region. Methods The study employs a multifaceted approach that involves exploring psychological and organizational theories, drawing insights from self-efficacy, stereotype, and implicit bias theories, as well as MENA empowerment cases. Additionally, an empirical investigation is conducted through an extensive three-round Delphi study involving 75 Sudanese women leaders from diverse sectors. The empirical findings are crucial for understanding obstacles faced by women and the impact of Sudan's unique social context on their career paths. Results The research findings shed light on the complex interplay of factors creating roadblocks for Sudanese women's career advancement. Sudan's distinctive social context significantly shapes and influences women's career motivations in diverse and interconnected ways. Empirical evidence from the Delphi study underscores the broad impact of these roadblocks, highlighting the multiplicity of challenges faced by women in Sudan. This comprehensive analysis not only aids in comprehending workplace obstacles but also provides valuable insights into the diverse experiences and needs of female employees. The findings emphasize the broad impact of these barriers on women, underscoring their varied challenges. Discussion The research holds far-reaching implications. By contextually identifying barriers that impede Sudanese women's career motivations, the study lays a foundation for targeted solutions. This understanding is grounded in historical, theoretical, and policy-making perspectives, enabling informed strategies to support women's advancement. The study also offers actionable policy recommendations for governments, workplaces, and stakeholders, facilitating women's career growth through policy reforms and capacity-building initiatives. Furthermore, its significance extends beyond Sudan, acting as a catalyst for developing gender-responsive policies in similar MENA countries and beyond.
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Affiliation(s)
- Souad Mohamed
- Middle East Centre, London School of Economics and Political Science, London, United Kingdom
| | - Aida Abbashar
- Middle East Centre, London School of Economics and Political Science, London, United Kingdom
| | - Hala Abushama
- The Gender Studies Institute, University of Khartoum, Khartoum, Sudan
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Cianciara D, Lewtak K, Poznańska A, Piotrowicz M, Gajewska M, Urban E, Sugay L, Rutyna A. Participation in Population Health Interventions by Older Adults in Poland: Barriers and Enablers. Int J Environ Res Public Health 2023; 20:2284. [PMID: 36767650 PMCID: PMC9915132 DOI: 10.3390/ijerph20032284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The participation of older adults in population health interventions constitutes a key factor in their physical, mental and social health. The aim of this study was to determine variables considered as enablers and barriers to participation in health programmes. METHODS The conceptual framework of the study was developed and population health interventions were operationalised as health programmes. A total of 805 older adults participated in a questionnaire survey. The questionnaire included questions about socio-demographic, health and social connectedness-related factors as well as participation in population health interventions/programmes. Multiple logistic regression was used to examine the relationship between respondents' characteristics and participation in the intervention. RESULTS Participation in health programmes was declared by 316 respondents. The enablers of participation were general practitioner's affability (OR = 2.638 [1.453-4.791], p = 0.001), three or more social activities (OR = 3.415 [1.477-7.894], p = 0.004), taking part in support groups (OR = 4.743 [1.255-17.929], p = 0.022) and involvement in Universities of the Third Age (OR = 2.829 [1.093-7.327], p = 0.032). The barriers were primary education (OR = 0.385 [0.215-0.690], p = 0.001), infrequent general practitioner's appointments (OR = 0.500 [0.281-0.888], p = 0.018) and lack of social activity (OR = 0.455 [0.299-0.632], p < 0.001). CONCLUSION The enablers of participation appeared to solely include variables regarding health service utilisation, patient experience and social activity, i.e., interpersonal and community relationships, not intrapersonal factors.
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Affiliation(s)
- Dorota Cianciara
- Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - Katarzyna Lewtak
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland
| | - Anna Poznańska
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
| | - Maria Piotrowicz
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
| | - Małgorzata Gajewska
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
| | - Ewa Urban
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
| | - Larysa Sugay
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
| | - Anna Rutyna
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland
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Guccione L, Fullerton S, Gough K, Hyatt A, Tew M, Aranda S, Francis J. Why is advance care planning underused in oncology settings? A systematic overview of reviews to identify the benefits, barriers, enablers, and interventions to improve uptake. Front Oncol 2023; 13:1040589. [PMID: 37188202 PMCID: PMC10175822 DOI: 10.3389/fonc.2023.1040589] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Background Advance care planning (ACP) centres on supporting people to define and discuss their individual goals and preferences for future medical care, and to record and review these as appropriate. Despite recommendations from guidelines, rates of documentation for people with cancer are considerably low. Aim To systematically clarify and consolidate the evidence base of ACP in cancer care by exploring how it is defined; identifying benefits, and known barriers and enablers across patient, clinical and healthcare services levels; as well as interventions that improve advance care planning and are their effectiveness. Methods A systematic overview of reviews was conducted and was prospectively registered on PROSPERO. PubMed, Medline, PsycInfo, CINAHL, and EMBASE were searched for review related to ACP in cancer. Content analysis and narrative synthesis were used for data analysis. The Theoretical Domains Framework (TDF) was used to code barriers and enablers of ACP as well as the implied barriers targeted by each of the interventions. Results Eighteen reviews met the inclusion criteria. Definitions were inconsistent across reviews that defined ACP (n=16). Proposed benefits identified in 15/18 reviews were rarely empirically supported. Interventions reported in seven reviews tended to target the patient, even though more barriers were associated with healthcare providers (n=40 versus n=60, respectively). Conclusion To improve ACP uptake in oncology settings; the definition should include key categories that clarify the utility and benefits. Interventions need to target healthcare providers and empirically identified barriers to be most effective in improving uptake. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42021288825.
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Affiliation(s)
- Lisa Guccione
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Lisa Guccione,
| | - Sonia Fullerton
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Department of Oncology, Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Amelia Hyatt
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Tew
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sanchia Aranda
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jill Francis
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Ottawa Hospital research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
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Armstrong E, Yin X, Razee H, Pham CV, Sa-Ngasoongsong P, Tabu I, Jagnoor J, Cameron ID, Yang M, Sharma V, Zhang J, Close JCT, Harris IA, Tian M, Ivers R. Exploring Barriers to, and Enablers of, Evidence-Informed Hip Fracture Care in Five Low- Middle-Income Countries: China, India, Thailand, the Philippines and Vietnam. Health Policy Plan 2022; 37:1000-1011. [PMID: 35678318 DOI: 10.1093/heapol/czac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle‑Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence informed care of patients with fragility fractures, are applicable to these settings. This study utilised semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from eleven hospitals in five countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility, and utilisation of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care.
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Affiliation(s)
| | - Xuejun Yin
- The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Husna Razee
- School of Population Health, UNSW Sydney, Australia
| | - Cuong Viet Pham
- Centre for Injury Policy and Prevention Research, Hanoi University of Public Health, Hanoi, Vietnam
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Irewin Tabu
- Orthopedic Trauma Division and Arthroplasty Service, University of the Philippines Manila -Philippine General Hospital, The Philippines
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, New Delhi, India.,UNSW Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Vijay Sharma
- Department of Orthopaedics, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Jing Zhang
- School of Population Health, UNSW Sydney, Australia
| | - Jacqueline C T Close
- Falls Balance Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, UNSW Sydney, Australia
| | - Ian A Harris
- South Western Sydney Clinical School, UNSW Sydney, Liverpool, Australia; Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Healt, UNSW Sydneyh, Australia.,School of Public Health, Harbin Medical University, Harbin, China
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Prothero L, Lawrenson JG, Cartwright M, Crosby‐Nwaobi R, Burr JM, Gardner P, Anderson J, Presseau J, Ivers N, Grimshaw JM, Lorencatto F. Barriers and enablers to diabetic eye screening attendance: An interview study with young adults with type 1 diabetes. Diabet Med 2022; 39:e14751. [PMID: 34837256 PMCID: PMC9304253 DOI: 10.1111/dme.14751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/09/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to identify barriers and enablers of diabetic eye screening (DES) attendance amongst young adults with diabetes living in the United Kingdom. METHODS Semistructured qualitative interviews with adults aged 18-34 years with diabetes. Participants were purposively sampled to aim for representation across gender, geographical locations, diabetes type, years since diabetes diagnosis and patterns of attendance (i.e. regular attenders, occasional non-attenders, regular non-attenders). Data were collected and analysed using the Theoretical Domains Framework (TDF) to explore potential individual, sociocultural and environmental influences on attendance. Data were analysed using a combined deductive and inductive thematic analysis approach. Barriers/enablers were mapped to behaviour change techniques (BCTs) to identify potential strategies to increase attendance. RESULTS Key barriers to attendance reported by the sample of 29 study participants with type 1 diabetes, fell within the TDF domains: [Knowledge] (e.g. not understanding reasons for attending DES or treatments available if diabetic retinopathy is detected), [Social Influences] (e.g. lack of support following DES results), [Social role and Identity] (e.g. not knowing other people their age with diabetes, feeling 'isolated' and being reluctant to disclose their diabetes) and [Environmental Context and Resources] (e.g. lack of appointment flexibility and options for rescheduling). Enablers included: [Social Influences] (e.g. support of family/diabetes team), [Goals] (e.g. DES regarded as 'high priority'). Many of the reported barriers/enablers were consistent across groups. Potential BCTs to support attendance include Instructions on how to perform the behaviour; Information about health consequences; Social support (practical) and Social comparison. CONCLUSIONS Attendance to diabetic eye screening in young adults is influenced by a complex set of interacting factors. Identification of potentially modifiable target behaviours provides a basis for designing more effective, tailored interventions to help young adults regularly attend eye screening and prevent avoidable vision loss.
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Affiliation(s)
| | | | | | | | | | - Philip Gardner
- Office for Health Improvement and DisparitiesDepartment of Health and Social CareLondonUK
| | - John Anderson
- Homerton University Hospital NHS Foundation TrustLondonUK
| | | | - Noah Ivers
- Women’s College Research InstituteTorontoOntarioCanada
| | - Jeremy M. Grimshaw
- Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
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Levy DC, Naehrig D, Sullivan L, Chin YS. Communication and collaboration skills training in Radiation Oncology in Australia and New Zealand: A qualitative study. Asia Pac J Clin Oncol 2022; 18:e356-e362. [PMID: 35043566 DOI: 10.1111/ajco.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Effective communication and collaboration with patients, carers and between healthcare professionals improves patient management. This study aimed to explore essential communication and collaboration skills training (CCST) for a radiation oncologist (RO) to inform competencies, learning outcomes and enhance curriculum training methods. MATERIALS AND METHODS Eight focus group discussions with 10 fellows and 14 trainees of the Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists (FRO RANZCR) were conducted face to face between October 2018 and March 2019. Participants included doctors from culturally and linguistically diverse backgrounds, working in public and private, metropolitan, and rural sectors. Data were recorded, transcribed verbatim, managed in Excel, and coded using a qualitative content analysis framework. The study was approved by South Eastern Sydney Local Health District HREC (18/186). Participants provided informed written consent. RESULTS After achieving thematic saturation, four predominant themes emerged. These were as follows: (1) Enablers and barriers to effective communication and collaboration; (2) written communication; (3) communicating bad news; and (4) multidisciplinary team meeting collaboration. Managing uncertainty and workplace culture emerged as interconnected sub-themes. CONCLUSIONS There is a current lack of CCST in radiation oncology in Australia and New Zealand. The most common theme that emerged to improve CCST focused on increasing the exposure to a variety of communication and collaboration clinical scenarios, which are observed and upon which immediate structured feedback is given. Consultants and trainees offered tangible suggestions on how to improve the curriculum. These findings underscore the importance of using a combination of structured teaching methods and work-based assessments. CCST templates are recommended.
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Affiliation(s)
- David C Levy
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Diana Naehrig
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Diana Naehrig Coaching & Communication, Sydney, Australia
| | - Lisa Sullivan
- The Canberra Hospital, Garran, Australian Capital Territory, Australia.,Icon Cancer Centre, Bruce, Australian Capital Territory, Australia.,School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Yaw S Chin
- Department of Radiation Oncology, St. George Hospital, Kogarah, New South Wales, Australia.,St. George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia
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Bianchi CM, Mariotti F, Reulet E, Le Goff G, Lluch A, Verger EO, Huneau JF, Gurviez P. Perceptions of Tailored Dietary Advice to Improve the Nutrient Adequacy of the Diet in French Pregnant Women. Nutrients 2021; 14:nu14010085. [PMID: 35010960 PMCID: PMC8747067 DOI: 10.3390/nu14010085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
Tailored dietary counseling could be specifically efficient during pregnancy, a period accompanied by a rise in nutrition awareness, but little is known about the expectations of pregnant women in this regard. We studied these expectations regarding tailored dietary advice in French women during their pregnancy, as well as their motivations and the perceived barriers and enablers. In French pregnant women, we evaluated the perceptions of tailored dietary advice provided by stepwise dietary counseling based on three types of dietary changes, consisting of: (1) a modification of the amounts consumed, (2) substitutions within the food subgroups, and (3) substitutions between food subgroups. A sequential explanatory mixed-method approach was designed. Using qualitative data from a focus group study (n = 40), we intended to explore in depth the women’s expectations regarding dietary advice and adherence to a tailored approach. These were combined with quantitative and qualitative data from a 6-week online longitudinal study (n = 115), using questionnaires designed to assess the modifications of dietary habits during pregnancy and to evaluate each type of dietary change. Both studies confirmed that most women in our samples did indeed intend to institute changes regarding healthier dietary practices during pregnancy. The principal motivation behind changes to their habits was to ensure the health and well-being of both their babies and themselves. The proposal of dietary advice that is tailored to both the current diet and the specific needs of pregnant women, but that is also positive and credible, was perceived as enabling implementing healthier dietary practices during pregnancy. Regarding the implementation of the dietary changes proposed, the enablers and barriers identified differed between modifications of the amounts consumed and substitutions. The women displayed interest in all types of dietary changes. This gave relevance to combining different types of changes in order to propose dietary counseling during pregnancy. Tailored dietary counseling was identified by French pregnant women in our samples as enabling them to adopt a healthier diet. However, perceived barriers might limit the implementation of dietary changes, especially when they involved marked modifications to their usual diet.
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Affiliation(s)
- Clélia M. Bianchi
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - François Mariotti
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
- Correspondence:
| | - Elodie Reulet
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - Gaëlle Le Goff
- AgroParisTech, INRAE, UMR SayFood, Université Paris-Saclay, 91700 Massy, France; (G.L.G.); (P.G.)
| | - Anne Lluch
- Alimentation Science Department, Danone Nutricia Research, Centre Daniel Carasso, RD 128, 91737 Palaiseau, France;
| | - Eric O. Verger
- MoISA, University Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, 34394 Montpellier, France;
| | - Jean-François Huneau
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - Patricia Gurviez
- AgroParisTech, INRAE, UMR SayFood, Université Paris-Saclay, 91700 Massy, France; (G.L.G.); (P.G.)
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11
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Morrison L, Johnston B, Cooper M. Mixed methods systematic review: Factors influencing research activity among nurses in clinical practice. J Clin Nurs 2021; 31:2450-2464. [PMID: 34820932 DOI: 10.1111/jocn.16133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to identify, evaluate and summarise current evidence in relation to the factors that influence the conducting of research by nurses in clinical practice. DESIGN This study used mixed methods systematic review. DATA SOURCES CINAHL, EMBASE, MEDLINE, Scopus and ASSIA, with dates limited from 2015 to 2020, were used to conduct a systematic search of the literature. REVIEW METHODS The Joanna Briggs Institute approach was followed, with results reported according to the Preferred Reporting System for Systematic Reviews and Meta-Analyses. The associated checklist for systematic reviews was also used. A standardised data extraction tool was then used, with quality appraisal guided by the Mixed Methods Appraisal Tool, with a subsequent convergent qualitative synthesis. RESULTS Sixteen papers were identified for inclusion, nine quantitative, six qualitative and one mixed methods. Four themes were identified: research competence and culture, proactive research mentorship, research resources and making a difference. These were critically discussed in relation to barriers and enablers to the conduct of research by nurses in clinical practice. Commonly cited barriers included a lack of research knowledge, confidence and access to resources, particularly protected time, while enablers such as educational partnerships, identifying research-motivated clinical nurses and access to research role models were also apparent in the literature. CONCLUSIONS Globally, nurses in clinical practice are clearly motivated to engage in the research process despite apparent barriers that have a significant impact on productivity. Nevertheless, there are also enablers to building research capacity apparent that offer methodological and structural approaches to empower this group to conduct research.
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Affiliation(s)
- Lindy Morrison
- University of Glasgow/NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Mark Cooper
- University of Glasgow, Nursing and Health Care School, Glasgow, UK
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12
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Bester P, Smit K, De Beer M, Myburgh PH. When online learning becomes compulsory: Student nurses' adoption of information communication technology in a private nursing education institution. Curationis 2021; 44:e1-e9. [PMID: 34797105 PMCID: PMC8603156 DOI: 10.1590/0034-7167-2020-0422 10.4102/curationis.v44i1.2152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Integrating the use of information communication technology (ICT) in nursing curricula when preparing student nurses for the digital health future such as the sudden online learning as a result of the coronavirus disease 2019 (COVID-19) pandemic is vital. However, when student nurses in a South African private nursing education institution, struggled to complete obligatory online learning courses, nurse educators had to search for solutions. OBJECTIVES To explore the barriers and enablers for ICT adoption by a diverse group of student nurses in a private nursing education institution in the Free State Province. METHOD Following a qualitative, explorative, interpretive-descriptive design, student nurses were invited to participate. Based on all-inclusive, purposive sampling with inclusion criteria enabled selecting, a total of 17 participants who took part in three focus groups and written narratives. Transcribed interviews underwent thematic analysis with co-coder consensus. The study adhered to strategies to enhance trustworthiness. RESULTS Students shared their views related to ICT and online learning within their theory and practice training. Student nurses held positive, negative and contrasting views of ICT adoption and online learning. Actions to master ICT adoption and online learning are highlighted. Information communication technology brings a challenging interdependence between nurses and technology. CONCLUSION Integration of ICT into nursing programmes is important. The enablers and barriers to ICT are described. Expose students to different technologies, especially using smart phones to search for (academic/non-academic) information. The adoption of ICT should enhance the learning process and facilitate deep learning. Students preferred online learning for self-assessment and described how they tried to master ICT and online learning. Information communication technologies in the clinical setting highlight the challenged interdependence between nurses and technology. Context-specific recommendations are proposed.
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Affiliation(s)
- Petra Bester
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom.
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13
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Bester P, Smit K, De Beer M, Myburgh PH. When online learning becomes compulsory: Student nurses' adoption of information communication technology in a private nursing education institution. Curationis 2021; 44:e1-e9. [PMID: 34797105 PMCID: PMC8603156 DOI: 10.4102/curationis.v44i1.2152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background Integrating the use of information communication technology (ICT) in nursing curricula when preparing student nurses for the digital health future such as the sudden online learning as a result of the coronavirus disease 2019 (COVID-19) pandemic is vital. However, when student nurses in a South African private nursing education institution, struggled to complete obligatory online learning courses, nurse educators had to search for solutions. Objectives To explore the barriers and enablers for ICT adoption by a diverse group of student nurses in a private nursing education institution in the Free State Province. Method Following a qualitative, explorative, interpretive-descriptive design, student nurses were invited to participate. Based on all-inclusive, purposive sampling with inclusion criteria enabled selecting, a total of 17 participants who took part in three focus groups and written narratives. Transcribed interviews underwent thematic analysis with co-coder consensus. The study adhered to strategies to enhance trustworthiness. Results Students shared their views related to ICT and online learning within their theory and practice training. Student nurses held positive, negative and contrasting views of ICT adoption and online learning. Actions to master ICT adoption and online learning are highlighted. Information communication technology brings a challenging interdependence between nurses and technology. Conclusion Integration of ICT into nursing programmes is important. The enablers and barriers to ICT are described. Expose students to different technologies, especially using smart phones to search for (academic/non-academic) information. The adoption of ICT should enhance the learning process and facilitate deep learning. Students preferred online learning for self-assessment and described how they tried to master ICT and online learning. Information communication technologies in the clinical setting highlight the challenged interdependence between nurses and technology. Context-specific recommendations are proposed.
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Affiliation(s)
- Petra Bester
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom.
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14
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Tremblay MC, Bradette-Laplante M, Witteman HO, Dogba MJ, Breault P, Paquette JS, Careau E, Echaquan S. Providing culturally safe care to Indigenous people living with diabetes: Identifying barriers and enablers from different perspectives. Health Expect 2020; 24:296-306. [PMID: 33350572 PMCID: PMC8077144 DOI: 10.1111/hex.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/08/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
In recent years, cultural safety has been proposed as a transformative approach to health care allowing improved consideration of Indigenous patient needs, expectations, rights and identities. This community‐based participatory study aimed to identify potential barriers and enablers to cultural safety in health care provided to Atikamekw living with diabetes in Québec, Canada. Based on a qualitative descriptive design, the study uses talking circles as a data collection strategy. Three talking circles were conducted with Atikamekw living with diabetes and caregivers, as well as with health professionals of the family medicine teaching clinic providing services to the community. Two team members performed deductive thematic analysis based on key dimensions of cultural safety. Results highlight four categories of barriers and enablers to cultural safety for Atikamekw living with diabetes, related to social determinants of health (including colonialism), health services organization, language and communication, as well as Atikamekw traditional practices and cultural perspectives of health. This study is one of the few that provides concrete suggestions to address key aspects of diabetes care in a culturally respectful way. Our findings indicate that potential enablers of cultural safety reside at different (from individual to structural) levels of change. Solutions in this matter will require strong political will and policy support to ensure intervention sustainability. Patient or public contribution Partners and patients have been involved in identifying the need for this study, framing the research question, developing the data collection tools, recruiting participants and interpreting results.
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Affiliation(s)
- Marie-Claude Tremblay
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Maude Bradette-Laplante
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Maman Joyce Dogba
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Pascale Breault
- Groupe de Médecine de famille universitaire du Nord de Lanaudière, Joliette, QC, Canada
| | - Jean-Sébastien Paquette
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada.,Groupe de Médecine de famille universitaire du Nord de Lanaudière, Joliette, QC, Canada
| | - Emmanuelle Careau
- Vice-décanat à la responsabilité sociale, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Sandro Echaquan
- Centre Mihawoso, Centre de pédiatrie sociale, Manawan, QC, USA
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15
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Scannell N, Villani A, Mantzioris E, Swanepoel L. Understanding the Self-Perceived Barriers and Enablers toward Adopting a Mediterranean Diet in Australia: An Application of the Theory of Planned Behaviour Framework. Int J Environ Res Public Health 2020; 17:E9321. [PMID: 33322111 DOI: 10.3390/ijerph17249321] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023]
Abstract
The transferability of a Mediterranean diet (MedDiet) in non-Mediterranean populations is appealing. However, little is known about the perceived enablers or barriers toward adherence, particularly in Australia. This study aimed to investigate the perceived beliefs, barriers, and enablers toward adherence to a MedDiet in Australian adults. Barriers and enablers were assessed using a self-administered online questionnaire, which included questions aligned with the Theory of Planned Behaviour (TPB). The survey was completed by n = 606 participants. Barriers and enablers toward adherence to MedDiet were grouped under the three core constructs of the TPB: attitudes (suitability, taste, restrictive, food waste); social norms (food culture); and perceived behavioural control (PBC) (motivation, affordability, time/effort, food access, knowledge, food outlets, natural conditions, cooking skills). PBC emerged as the most prominent construct influencing intention to follow a MedDiet. Perceived health benefits (n = 445; 76.5%) and improved diet quality (n = 224; 38.5%) were identified as major advantages. In contrast, dietary adherence (n = 147; 39.7%) was perceived as an important disadvantage. Future MedDiet interventions, in both research and clinical settings, should consider adopting strategies aimed at improving self-efficacy to reduce self-perceived barriers and facilitate dietary adherence.
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16
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Johnston K, Guingona M, Elsanousi S, Mbokazi J, Labarda C, Cristobal FL, Upadhyay S, Othman AB, Woolley T, Acharya B, Hogenbirk JC, Ketheesan S, Craig JC, Neusy AJ, Larkins S. Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries? Front Public Health 2020; 8:582464. [PMID: 33194989 PMCID: PMC7604342 DOI: 10.3389/fpubh.2020.582464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.
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Affiliation(s)
- Karen Johnston
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Monsie Guingona
- Ateneo de Zamboanga University School of Medicine, Zamboanga City, Philippines
| | | | - Jabu Mbokazi
- School of Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Charlie Labarda
- School of Health Sciences, University of the Philippines, Manila, Philippines
| | | | | | | | - Torres Woolley
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | | | - John C Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | - Sarangan Ketheesan
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Sarah Larkins
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
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17
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Maki G, Smith I, Paulin S, Kaljee L, Kasambara W, Mlotha J, Chuki P, Rupali P, Singh DR, Bajracharya DC, Barrow L, Johnson E, Prentiss T, Zervos M. Feasibility Study of the World Health Organization Health Care Facility-Based Antimicrobial Stewardship Toolkit for Low- and Middle-Income Countries. Antibiotics (Basel) 2020; 9:E556. [PMID: 32872440 PMCID: PMC7558985 DOI: 10.3390/antibiotics9090556] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial stewardship (AMS) has emerged as a systematic approach to optimize antimicrobial use and reduce antimicrobial resistance. To support the implementation of AMS programs, the World Health Organization developed a draft toolkit for health care facility AMS programs in low- and middle-income countries. A feasibility study was conducted in Bhutan, the Federated States of Micronesia, Malawi, and Nepal to obtain local input on toolkit content and implementation of AMS programs. This descriptive qualitative study included semi-structured interviews with national- and facility-level stakeholders. Respondents identified AMS as a priority and perceived the draft toolkit as a much-needed document to further AMS program implementation. Facilitators for implementing AMS included strong national and facility leadership and clinical staff engagement. Barriers included lack of human and financial resources, inadequate regulations for prescription antibiotic sales, and insufficient AMS training. Action items for AMS implementation included improved laboratory surveillance, establishment of a stepwise approach for implementation, and mechanisms for reporting and feedback. Recommendations to improve the AMS toolkit's content included additional guidance on defining the responsibilities of the committees and how to prioritize AMS programming based on local context. The AMS toolkit was perceived to be an important asset as countries and health care facilities move forward to implement AMS programs.
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Affiliation(s)
- Gina Maki
- Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USA;
| | - Ingrid Smith
- World Health Organization, 1202 Geneva, Switzerland; (I.S.); (S.P.)
| | - Sarah Paulin
- World Health Organization, 1202 Geneva, Switzerland; (I.S.); (S.P.)
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health System, Detroit, MI 48202, USA; (L.K.); (T.P.)
| | | | - Jessie Mlotha
- Ministry of Health, 207218 Lilongwe, Malawi; (W.K.); (J.M.)
| | - Pem Chuki
- Jigme Dorji Wangchuck National Referral Hospital, 11001 Thimpu, Bhutan;
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore 632004, India;
| | | | | | - Lisa Barrow
- Department of Health & Social Affairs, 96941 Pohnpei, Federated States of Micronesia; (L.B.); (E.J.)
| | - Eliaser Johnson
- Department of Health & Social Affairs, 96941 Pohnpei, Federated States of Micronesia; (L.B.); (E.J.)
| | - Tyler Prentiss
- Global Health Initiative, Henry Ford Health System, Detroit, MI 48202, USA; (L.K.); (T.P.)
| | - Marcus Zervos
- Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USA;
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
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18
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Cullinan L, McLean S, Dunn L. Preventing and controlling Cryptosporidium spp. in aquatic facilities: environmental health practitioners' experiences in Victoria, Australia. Aust N Z J Public Health 2020; 44:233-239. [PMID: 32459385 DOI: 10.1111/1753-6405.12984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To identify barriers and enablers to preventing and controlling Cryptosporidium spp. in aquatic facilities as perceived by environmental health practitioners (EHPs). METHODS A qualitative, constructivist study with a purposive sample of seven EHPs from Victoria, Australia, was conducted. A focus group discussion was guided by a semi-structured interview schedule using open-ended questions. The audio-recorded focus group was transcribed verbatim and analysed using thematic analysis. RESULTS Five themes represented the perceived barriers and enablers: i) pool water testing methods; ii) resources and training for EHPs; iii) knowledge and behaviour of aquatic facility operators and swimming pool users; iv) regulation; and v) aquatic facility and swimming pool design. Two key barriers within these themes included aquatic facility regulation and unhealthy swimming behaviours. CONCLUSIONS Several barriers and enablers to preventing and controlling Cryptosporidium spp. in aquatic facilities were perceived by EHPs. Suggestions to overcome perceived barriers were also identified. Further research is required to determine the impact of these findings on the incidence of cryptosporidiosis associated with aquatic facilities. Implications for public health: The findings contribute to a greater understanding of the barriers and enablers to Cryptosporidium spp. prevention and control in aquatic facilities, which may improve the effectiveness of current prevention and control strategies.
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Affiliation(s)
- Lauren Cullinan
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Victoria
| | - Sarah McLean
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Victoria
| | - Louise Dunn
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Victoria
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19
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Ho P, Bulsara C, Patman S, Downs J, Hill AM. Exploring enablers and barriers to accessing health services after a fall among people with intellectual disability. J Appl Res Intellect Disabil 2020; 33:604-617. [PMID: 32039539 DOI: 10.1111/jar.12704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adults with intellectual disability experience high rates of falls making falls prevention an important health need. The purpose of the study was to seek perspectives of older adults with intellectual disability and their caregivers to (a) explore the experiences of older adults with intellectual disability when seeking healthcare services after a fall and (b) identify enablers and barriers when taking up evidence-based falls recommendations. METHOD A qualitative exploratory study was undertaken as part of a prospective observational cohort study. Semi-structured interviews were conducted with a purposeful sample. Data were analysed thematically using Colaizzi's method. RESULTS Seventeen interviews were conducted (n = 21). Emergent themes demonstrated that participants had limited knowledge about falls prevention. Enablers included individualizing falls prevention strategies. Barriers included not being offered access to established falls prevention pathways. CONCLUSION There is an urgent need to develop high-quality falls prevention services for older adults with intellectual disability.
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Affiliation(s)
- Portia Ho
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Caroline Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Jenny Downs
- Telethon Kids Institute, Perth Children's Hospital, West Perth, WA, Australia.,Curtin University, Perth, WA, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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20
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Cross AJ, Buchbinder R, Bourne A, Maher C, Mathieson S, Lin CWC, O'Connor DA. Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: protocol for a qualitative evidence synthesis using the Theoretical Domains Framework. BMJ Open 2019; 9:e034039. [PMID: 31722956 PMCID: PMC6858188 DOI: 10.1136/bmjopen-2019-034039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION The over-prescription and overuse of opioid analgesics for chronic non-cancer pain (CNCP) is a growing issue. Synthesis of evidence about the barriers and enablers to reducing long-term opioid prescribing and use will enable the development of tailored interventions to address both problems. OBJECTIVE To synthesise the barriers and enablers to monitoring the ongoing appropriateness of opioid treatment and deprescribing opioids for CNCP from the clinician, patient and general public point of view, and to map the findings to the Theoretical Domains Framework (TDF). METHODS AND ANALYSIS We will perform a qualitative evidence synthesis using the TDF. We will include qualitative research that has explored clinician, patient and the general public's perceptions regarding barriers and enablers to monitoring and deprescribing opioids for CNCP. Studies will be identified via searches in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Databases will be searched from inception to July 2019, and the studies must be published in English. Article selection and data extraction will be completed independently by two review authors. Methodological quality of included studies will be independently assessed by two review authors using the Critical Appraisal Skills Programme quality assessment tool. We will conduct thematic synthesis and then map identified themes and sub-themes to TDF domains. Confidence in synthesis findings will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research tool. ETHICS AND DISSEMINATION Ethical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019140784.
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Affiliation(s)
- Amanda J Cross
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Allison Bourne
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Christopher Maher
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Chung-Wei C Lin
- Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
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Waterworth P, Pescud M, Chappell S, Davies C, Roche D, Shilton T, Ledger M, Slevin T, Rosenberg M. Culture, management and finances as key aspects for healthy workplace initiatives. Health Promot Int 2018; 33:162-172. [PMID: 27543456 DOI: 10.1093/heapro/daw068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to qualitatively explore the barriers and enablers to implementing healthy workplace initiatives in a sample of workplaces based in Perth, Western Australia. In-depth interviews were conducted with representatives from 31 organizations representing small, medium and large businesses in the Perth metropolitan area which reported having healthy workplace initiatives. In total, 43 factors were mentioned as influencing the implementation of healthy workplace initiatives. Factors appearing to exert the most influence on the implementation of health promoting initiatives in this sample were culture; support from managers and staff; collaboration with industry providers; financial resources circumstances and the physical environment. These factors appeared to be mutually reinforcing and interconnected. Findings suggest there may be merit in applying an organizational development lens to the implementation of workplace health promotion initiatives as this could assist in leveraging enablers and minimizing barriers.
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Affiliation(s)
- Pippa Waterworth
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Melanie Pescud
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.,School of Regulation and Global Governance (RegNet), ANU College of Asia & The Pacific, The Australian National University, Fellows Road, Canberra, ACT 2601, Australia.,The Australian Prevention Partnership Centre, Sax Institute, Ultimo, NSW 2007, Australia
| | - Stacie Chappell
- College of Business, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, USA
| | | | - Dee Roche
- UWA Business School, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Trevor Shilton
- National Heart Foundation (WA Branch), 334 Rokeby Road, Subiaco, WA 6008, Australia
| | - Melissa Ledger
- Cancer Council WA, 420 Bagot Road, Subiaco, WA 6008, Australia
| | - Terry Slevin
- Cancer Council WA, 420 Bagot Road, Subiaco, WA 6008, Australia
| | - Michael Rosenberg
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.,Health Promotion Evaluation Unit, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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Phillips CJ, Marshall AP, Chaves NJ, Jankelowitz SK, Lin IB, Loy CT, Rees G, Sakzewski L, Thomas S, To TP, Wilkinson SA, Michie S. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study. J Multidiscip Healthc 2015; 8:139-46. [PMID: 25834455 PMCID: PMC4370908 DOI: 10.2147/jmdh.s78458] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.
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Affiliation(s)
- Cameron J Phillips
- Division of Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia ; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Andrea P Marshall
- Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Southport, QLD, Australia ; Gold Coast University Hospital, Southport, QLD, Australia
| | - Nadia J Chaves
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Stacey K Jankelowitz
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Institute of Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ivan B Lin
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Clement T Loy
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Huntington Diseases Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Gwyneth Rees
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Susie Thomas
- Physiotherapy Department, Flinders Medical Centre, Bedford Park, SA, Australia ; International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - The-Phung To
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Shelley A Wilkinson
- Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia ; Department of Nutrition and Dietetics, Mater Health Services, South Brisbane, QLD, Australia
| | - Susan Michie
- University College London Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College, London, UK
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Mosquera PA, Hernández J, Vega R, Labonte R, Sanders D, Dahlblom K, San Sebastián M. Challenges of implementing a primary health care strategy in a context of a market-oriented health care system: the experience of Bogota, Colombia. Int J Health Plann Manage 2013; 29:e347-67. [PMID: 24254649 DOI: 10.1002/hpm.2228] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/07/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although Colombia has a health system based on market and neoliberal principles, in 2004, the government of the capital-Bogota-took the decision to formulate a health policy that included the implementation of a comprehensive primary health care (PHC) strategy. This study aims to identify the enablers and barriers to the PHC implementation in Bogota. METHODS The study used a qualitative multiple case study methodology. Seven Bogota's localities were included. Eighteen semi-structured interviews with key informants (decision-makers at each locality and members of the District Health Secretariat) and fourteen FGDs (one focus group with staff members and one with community members) were carried out. Data were analysed using a thematic analysis approach. RESULTS The main enablers found across the district and local levels showed a similar pattern, all were related to the good will and commitment of actors at different levels. Barriers included the approach of the national policies and a health system based on neoliberal principles, the lack of a stable funding source, the confusing and rigid guidelines, the high turnover of human resources, the lack of competencies among health workers regarding family focus and community orientation, and the limited involvement of institutions outside the health sector in generating intersectoral responses and promoting community participation. CONCLUSION Significant efforts are required to overcome the market approach of the national health system. Interventions must be designed to include well-trained and motivated human resources, as well as to establish available and stable financial resources for the PHC strategy.
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Affiliation(s)
- Paola A Mosquera
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden; Postgraduate programs in Health Administration and Public Health, Pontificia Universidad Javeriana, Bogota, Colombia
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