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Thompson S, Shukralla H, Fyfe K, Newman E, Fitzgerald K. Barriers and enablers of dementia training in healthcare workers in rural and remote Australia: A scoping review to inform future approaches to training. Aust J Rural Health 2024; 32:236-248. [PMID: 38409904 DOI: 10.1111/ajr.13090] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION Dementia is now responsible for the greatest burden of disease of any chronic illness in older Australians. Rural and remote communities bear the impacts of this disproportionately. Additional training and education for healthcare staff to support people living with dementia is needed. OBJECTIVE The objective of this scoping review was to map and synthesise the evidence related to barriers and enablers of accessing dementia training for Australian healthcare workers located in rural and remote areas. DESIGN This scoping review systematically searched multiple databases in January 2023 for peer-reviewed literature on the topic. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles. FINDINGS From 187 articles screened, seven peer-reviewed journal articles were included in the final data analysis; all were from Australia or Canada. The most common barrier described was low staffing, precluding release of staff for dementia training. Enablers to participation in dementia training were availability of online training programs, as well as training providers collaborating with end users to ensure the training met their learning needs. DISCUSSION This review provides evidence of barriers and enablers specific to rural and remote healthcare workers accessing dementia training. It also explores other approaches to training that have been trialled successfully in different settings. CONCLUSION Addressing the identified barriers and enablers may assist in developing training approaches appropriate for existing staff, and in meeting training needs for the future workforce.
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Affiliation(s)
- Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Heidi Shukralla
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Katrina Fyfe
- Dementia Training Australia, University of Western Australia, Perth, Western Australia, Australia
| | - Ellie Newman
- Dementia Training Australia, University of Western Australia, Perth, Western Australia, Australia
| | - Kathryn Fitzgerald
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
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Rosin M, Mackay S, Gerritsen S, Te Morenga L, Terry G, Ni Mhurchu C. Barriers and facilitators to implementation of healthy food and drink policies in public sector workplaces: a systematic literature review. Nutr Rev 2024; 82:503-535. [PMID: 37335857 PMCID: PMC10925903 DOI: 10.1093/nutrit/nuad062] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
CONTEXT Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. OBJECTIVE The objective of this review was to systematically synthesize evidence on barriers and facilitators to implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces. DATA SOURCES Nine scientific databases, 9 grey literature sources, and government websites in key English-speaking countries along with reference lists. DATA EXTRACTION All identified records (N = 8559) were assessed for eligibility. Studies reporting on barriers and facilitators were included irrespective of study design and methods used but were excluded if they were published before 2000 or in a non-English language. DATA ANALYSIS Forty-one studies were eligible for inclusion, mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centers, and government agencies. Interviews and surveys were the predominant methods of data collection. Methodological aspects were assessed with the Critical Appraisal Skills Program Qualitative Studies Checklist. Generally, there was poor reporting of data collection and analysis methods. Thematic synthesis identified 4 themes: (1) a ratified policy as the foundation of a successful implementation plan; (2) food providers' acceptance of implementation is rooted in positive stakeholder relationships, recognizing opportunities, and taking ownership; (3) creating customer demand for healthier options may relieve tension between policy objectives and business goals; and (4) food supply may limit the ability of food providers to implement the policy. CONCLUSIONS Findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested or engaging in healthy food and drink policy development and implementation. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021246340.
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Affiliation(s)
- Magda Rosin
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sarah Gerritsen
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Lisa Te Morenga
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Gareth Terry
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
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Soeker MS, Allie M, Arend R, Bell C, Benjamin A, Cassiem T. A human resource professional perspective of strategies to accommodate employees with mental health conditions in the workplace in South Africa. Work 2024:WOR220688. [PMID: 38251082 DOI: 10.3233/wor-220688] [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: 01/23/2024] Open
Abstract
BACKGROUND The South African Labour Relations Act, specifically the Code of Good Practice (CGP) advocates against the discrimination and unfair dismissal of individuals with mental health conditions in the workplace. However, little is known about the implementation of these national policies within the workplace, especially from the perspective of the employer rather than the employee. OBJECTIVE The aim of this study was to explore the experiences and perceptions of how human resource practitioners accommodate and support individuals with mental health conditions in the workplace. METHOD Eleven participants (Human Resource Professionals) participated in the study. The researchers utilized semi-structured interviews where the data was analysed by means of thematic analysis to formulate themes. RESULTS Three themes emerged depicting the participants' experiences and perceptions of barriers and facilitators which influenced their return to work: The themes that emerged through thematic analysis consisted of 1) Challenges perceived by Human Resource personnel that influences work participation; 2) The influence that workplace accommodations and support structures have on the work participation; 3) The prevalence of policies and laws that are available in theworkplace. CONCLUSION The study highlighted that Human Resource Professionals struggle to interpret and implement labor related polices that aid in employing individuals with mental health conditions in the workplace. It is important to implement strategies that will assist Human Resource practitioners in understanding how to implement such policies to successfully accommodate individuals with mental health conditions in the workplace.
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Affiliation(s)
| | - Mishkah Allie
- Department of Occupational Therapy, University of the Western Cape, Cape Town, South Africa
| | - Raeesa Arend
- Department of Occupational Therapy, University of the Western Cape, Cape Town, South Africa
| | - Chelsea Bell
- Department of Occupational Therapy, University of the Western Cape, Cape Town, South Africa
| | - Aqeeda Benjamin
- Department of Occupational Therapy, University of the Western Cape, Cape Town, South Africa
| | - Tasneem Cassiem
- Department of Occupational Therapy, University of the Western Cape, Cape Town, South Africa
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Melman A, Vella SP, Dodd RH, Coombs DM, Richards B, Rogan E, Teng MJ, Maher CG, Ghinea N, Machado GC. Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study. JMIR Rehabil Assist Technol 2023; 10:e47227. [PMID: 37988140 DOI: 10.2196/47227] [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: 03/13/2023] [Revised: 09/02/2023] [Accepted: 09/27/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Alternate "hospital avoidance" models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called "Back@Home" and use qualitative interviews with stakeholders to develop and refine the model. OBJECTIVE We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. METHODS We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. RESULTS A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. CONCLUSIONS The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.
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Affiliation(s)
- Alla Melman
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Simon P Vella
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Rachael H Dodd
- The Daffodil Centre, Faculty of Medicine and Health, a joint venture between The University of Sydney and Cancer Council New South Wales, Sydney, Australia
| | - Danielle M Coombs
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bethan Richards
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- Rheumatology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Min Jiat Teng
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- RPA Virtual Hospital, Sydney, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Narcyz Ghinea
- Department of Philosophy, Macquarie University, Sydney, Australia
| | - Gustavo C Machado
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
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Kengne Talla P, Inquimbert C, Dawson A, Zidarov D, Bergeron F, Chandad F. Barriers and Enablers to Implementing Teledentistry From the Perspective of Dental Health Care Professionals: Protocol for a Systematic Quantitative, Qualitative, and Mixed Studies Review. JMIR Res Protoc 2023; 12:e44218. [PMID: 37494093 PMCID: PMC10413248 DOI: 10.2196/44218] [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: 11/11/2022] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND There is growing literature on the potential of digital technologies for improving access to, ensuring continuity and quality of health care, and to strengthen health systems. Some studies have reported the cost-effectiveness of teledentistry, its reliability for remote dental screening, diagnosis, consultation, and treatment planning. Nonetheless, current evidence suggests that teledentistry implementation faces many challenges and is not yet adopted by dental health care providers (DHCPs). Developing strategies to improve teledentistry adoption requires an understanding of the factors that promote or hinder its successful implementation. OBJECTIVE This systematic review aims to identify and synthetize barriers and enablers to implementing teledentistry as perceived by DHCPs in their clinical practices, using the Theoretical Domains Framework (TDF) and the Capacity, Opportunity, and Motivation Behavior (COM-B) model. METHODS This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols) checklist. Literature will be searched in the following databases: PubMed, Cochrane Library, Web of Science, CINAHL, Embase, and PsycINFO. We will perform additional searches on Google, Google Scholar, and ProQuest Dissertations & Theses Global, screen the references of the included studies to capture additional relevant studies, and contact the authors of studies if we need more details. We will consider studies using qualitative, quantitative, and mixed methods. There will be no restrictions on the publication date and dental setting. We will include studies published in French, English, and Portuguese. Two independent reviewers will select the study, extract data, and assess methodological quality using the Mixed Methods Appraisal Tool's checklist. Data analysis will include a descriptive and a thematic content analysis. We will synthetize and categorize the barriers and enablers using the TDF and COM-B model and present a narrative synthesis of our results using tables, figures, and quotes. RESULTS By March 2023, the literature search has retrieved 7355 publications. We will identify the range of barriers and enablers to implementing teledentistry through DHCPs' perspectives. Considering the critical need for theory-based implementation interventions to improve the use of evidence-informed practices, we will synthesize the factors influencing the adoption of teledentistry based on the TDF domains and the 3 essential conditions predicting behavior change in accordance with the COM-B model. As needed, we will include additional determinants if not included in the TDF. We will conduct some subgroups analyses if studies are sufficient. We expect to complete the review by July 2024. CONCLUSIONS This review will provide some insights on the determinants of teledentistry implementation as perceived by DHCPs in dental settings. These findings will cater to patients, families, DHCPs, researchers, academic and professional decision-makers, and policy makers. The results of the systematic review could be used to develop theory-led interventions in improving teledentistry implementation. TRIAL REGISTRATION PROSPERO CRD42021293376; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=293376. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44218.
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Affiliation(s)
- Pascaline Kengne Talla
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Camille Inquimbert
- Faculty of Dental Medicine, University of Montpellier, Montpellier, France
| | - Aimée Dawson
- Faculty of Dental Medicine, Laval University, Quebec City, QC, Canada
| | - Diana Zidarov
- School of Rehabilitation, University of Montreal, Centre Intégré Universitaire de la Santé et des Services sociaux du Centre Sud-de-l'île-de Montréal, Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montreal, QC, Canada
| | - Frédéric Bergeron
- Faculty of Dental Medicine, Laval University, Quebec City, QC, Canada
| | - Fatiha Chandad
- Faculty of Dental Medicine, Laval University, Quebec City, QC, Canada
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Bennett S, Travers C, Liddle J, O'Connor C, Low L, Laver K, Clemson L, O'Reilly M, Beattie E, Smith S, Gitlin L. Barriers and enablers to the delivery and implementation of the tailored activity programme in Australia: Perspectives of occupational therapists and their managers. Aust Occup Ther J 2023; 70:218-232. [PMID: 36397718 PMCID: PMC10952758 DOI: 10.1111/1440-1630.12850] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/17/2022] [Accepted: 10/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prior to implementing new programmes or practices, it is essential to understand the context, barriers and enablers to support successful use. The tailored activity programme (TAP) is an evidence-based intervention provided by occupational therapists to support community-dwelling people living with dementia and their carers. The programme was developed in the United States, and although it is not currently available for routine use in Australia, its implementation would address the needs of many Australians with dementia and their carers. AIM The aim of the study is to understand the perspectives of occupational therapists and their managers regarding barriers and enablers to the delivery and implementation of the TAP in Queensland, Australia. METHODS A qualitative descriptive methodology was employed. Semistructured interviews were undertaken with occupational therapists (n = 18) who work with community-dwelling people with dementia and their carers, and their managers (n = 10). Participants were recruited from a range of organisations across Queensland, and they were asked about potential barriers and enablers to implementing TAP. Interviews were recorded and transcribed verbatim. Data were mapped using framework analysis whilst remaining open to other themes. FINDINGS Themes were identified, and facilitating factors included the close alignment of TAP with occupational therapists' scope of practice; their acceptance of, and optimism about the programme and its perceived benefits including improved client outcomes; and an opportunity for occupational therapists to further develop their skills. Managerial support and carers' readiness and willingness to participate were also identified as important factors for success, whereas barriers were cost to clients and the capacity of the occupational therapy workforce to provide TAP. CONCLUSION Occupational therapists and their managers expressed enthusiasm for TAP and awareness of its likely benefits, while also identifying barriers that will need to be addressed if implementation of the programme is to be successful in Australia.
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Affiliation(s)
- Sally Bennett
- School of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaQueenslandAustralia
| | - Catherine Travers
- School of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaQueenslandAustralia
| | - Jacki Liddle
- School of Information Technology and Electrical EngineeringThe University of QueenslandSt LuciaQueenslandAustralia
| | - Claire O'Connor
- HammondCare Centre for Positive AgeingHammondvilleNew South WalesAustralia
- School of Population HealthThe University of New South WalesKensingtonNew South WalesAustralia
| | - Lee‐Fay Low
- School of Health Sciences, Faculty of MedicineThe University of SydneySydneyNew South WalesAustralia
| | - Kate Laver
- Department of Rehabilitation Aged & Extended CareFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Lindy Clemson
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Maria O'Reilly
- School of Health, Medical and Applied SciencesCentral Queensland UniversityBundabergQueenslandAustralia
| | - Elizabeth Beattie
- School of NursingQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Sandra Smith
- School of Health and Rehabilitation SciencesThe University of QueenslandSt LuciaQueenslandAustralia
| | - Laura Gitlin
- College of Nursing and Health ProfessionsDrexel UniversityPhiladelphiaPennsylvaniaUSA
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Garcia Reyes EP, Kelly R, Buchanan G, Waycott J. Understanding Older Adults' Experiences With Technologies for Health Self-management: Interview Study. JMIR Aging 2023; 6:e43197. [PMID: 36943333 PMCID: PMC10131633 DOI: 10.2196/43197] [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: 10/03/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments. OBJECTIVE This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies. METHODS A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis. RESULTS The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar. CONCLUSIONS This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them.
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Affiliation(s)
- Elsy Paola Garcia Reyes
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
| | - Ryan Kelly
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
| | - George Buchanan
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
| | - Jenny Waycott
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Australia
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Paneru DP, Adhikari C, Poudel S, Adhikari LM, Neupane D, Bajracharya J, Jnawali K, Chapain KP, Paudel N, Baidhya N, Rawal A. Adopting social health insurance in Nepal: A mixed study. Front Public Health 2022; 10:978732. [PMID: 36589957 PMCID: PMC9798538 DOI: 10.3389/fpubh.2022.978732] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
Objective The Social Health Insurance Program (SHIP) shares a major portion of social security, and is also key to Universal Health Coverage (UHC) and health equity. The Government of Nepal launched SHIP in the Fiscal Year 2015/16 for the first phase in three districts, on the principle of financial risk protection through prepayment and risk pooling in health care. Furthermore, the adoption of the program depends on the stakeholders' behaviors, mainly, the beneficiaries and the providers. Therefore, we aimed to explore and assess their perception and experiences regarding various factors acting on SHIP enrollment and adherence. Methods A cross-sectional, facility-based, concurrent mixed-methods study was carried out in seven health facilities in the Kailali, Baglung, and Ilam districts of Nepal. A total of 822 beneficiaries, sampled using probability proportional to size (PPS), attending health care institutions, were interviewed using a structured questionnaire for quantitative data. A total of seven focus group discussions (FGDs) and 12 in-depth interviews (IDIs), taken purposefully, were conducted with beneficiaries and service providers, using guidelines, respectively. Quantitative data were entered into Epi-data and analyzed with SPSS, MS-Excel, and Epitools, an online statistical calculator. Manual thematic analysis with predefined themes was carried out for qualitative data. Percentage, frequency, mean, and median were used to describe the variables, and the Chi-square test and binary logistic regression were used to infer the findings. We then combined the qualitative data from beneficiaries' and providers' perceptions, and experiences to explore different aspects of health insurance programs as well as to justify the quantitative findings. Results and prospects Of a total of 822 respondents (insured-404, uninsured-418), 370 (45%) were men. Families' median income was USD $65.96 (8.30-290.43). The perception of insurance premiums did not differ between the insured and uninsured groups (p = 0.53). Similarly, service utilization (OR = 220.4; 95% CI, 123.3-393.9) and accessibility (OR = 74.4; 95% CI, 42.5-130.6) were found to have high odds among the insured as compared to the uninsured respondents. Qualitative findings showed that the coverage and service quality were poor. Enrollment was gaining momentum despite nearly a one-tenth (9.1%) dropout rate. Moreover, different aspects, including provider-beneficiary communication, benefit packages, barriers, and ways to go, are discussed. Additionally, we also argue for some alternative health insurance schemes and strategies that may have possible implications in our contexts. Conclusion Although enrollment is encouraging, adherence is weak, with a considerable dropout rate and poor renewal. Patient management strategies and insurance education are recommended urgently. Furthermore, some alternate schemes and strategies may be considered.
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Affiliation(s)
| | - Chiranjivi Adhikari
- School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
- Department of Public Health, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, India
| | - Sujan Poudel
- Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal
| | | | | | - Juli Bajracharya
- School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
| | - Kalpana Jnawali
- Department of Public Health, LA Grandee College, Pokhara University, Pokhara, Nepal
| | | | - Nabaraj Paudel
- Province Health Logistics Management Center, Gandaki Province, Pokhara, Nepal
| | - Nirdesh Baidhya
- Department of Public Health, Shaheed Krishna Sen Ichhuk Bahuprabidhik Institute, Dang, Nepal
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Davidson SR, Bolsewicz K, Kamper SJ, Haskins R, Petkovic D, Feenan N, Smith D, O'Flynn M, Pallas J, Williams CM. Perspectives of emergency department clinicians on the challenges of addressing low back pain in the emergency setting: A qualitative study. Emerg Med Australas 2021; 34:199-208. [PMID: 34549519 DOI: 10.1111/1742-6723.13854] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify and explore ED clinician perspectives on: (i) why patients with low back pain (LBP) present to the ED and are admitted into hospital from ED; (ii) barriers and enablers they face when providing care to patients with LBP; and (iii) strategies to improve the care of patients with LBP, and associated care processes, in the ED. METHODS We undertook a qualitative exploratory study with ED clinicians (medical officers, nurses and physiotherapists) at a tertiary-level public hospital in New South Wales, Australia, using focus groups and individual interviews. We used thematic analysis to synthesise participant responses to answer the predefined research questions. RESULTS Twenty-one clinicians participated (two individual interviews, 19 focus groups). Perceptions about better access to the ED and advanced care within ED were thought to drive presentations to the ED for LBP. Barriers and enablers to optimal patient care included patient-, clinician- and service-level factors. The main strategies to improve care included a department LBP pathway, modernised patient and clinician resources, better follow-up options post-discharge and improved communication between ED and primary care. CONCLUSION We identified a range of targets to improve LBP management in ED. Clinicians perceived internal and external factors to the ED as influences of ED presentation and hospital admission. Clinicians also reported that patient-, clinician- and service-level barriers and enablers influenced patient management in ED. Strategies suggested by clinicians included improved follow-up options, access to resources and an 'LBP pathway' to support decision making.
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Affiliation(s)
- Simon Re Davidson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Katarzyna Bolsewicz
- Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, New South Wales, Australia
| | - Steven J Kamper
- School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Allied Health Department, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia
| | - Robin Haskins
- Outpatient Services, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Dragan Petkovic
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Nicole Feenan
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Damien Smith
- Physiotherapy Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Michael O'Flynn
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Jeremy Pallas
- Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
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Nevers W, Ratcheva A, Boutin K, Gorman SK, Slavik R, Lesko N. Barriers to and Enablers of Implementation of High-Value Interventions by Renal Pharmacists: A Qualitative Study Informed by the Theoretical Domains Framework. Can J Hosp Pharm 2020; 73:177-185. [PMID: 32616943 PMCID: PMC7308154] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous studies have shown that patients with chronic kidney disease who are followed by a renal clinical pharmacist have improved clinical outcomes. In 2016, a consensus list of quality indicator drug therapy problems (QI-DTPs) was developed by renal clinical pharmacists to help prioritize which renal patients should receive interventions. Before QI-DTP interventions can be implemented in clinical practice, barriers to and enablers of their use need to be identified, to allow development of strategies to overcome the barriers and apply the enablers. OBJECTIVE To identify modifiable barriers to and enablers of implementation of renal QI-DTP interventions by renal clinical pharmacists. METHODS In this exploratory qualitative descriptive study, one-on-one, semistructured, audio-recorded telephone interviews were conducted with renal clinical pharmacists to identify the barriers to and enablers of implementation of renal QI-DTP interventions. The interviews consisted of questions developed according to the Theoretical Domains Framework. RESULTS Interviews were conducted with 13 renal pharmacists from across Canada. The main barriers to implementation of renal QI-DTP interventions that participants identified were knowledge gaps, prioritization, and nephrologist acceptance. The main enablers identified were training, colleague support, and better patient care. CONCLUSION Three barriers to and three enablers of implementation of renal QI-DTP interventions were identified. These barriers and enablers can be used to help with pharmacist education and to optimize the care that pharmacists provide to renal patients.
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Affiliation(s)
- William Nevers
- , BSc(Pharm), ACPR, PharmD, is a Clinical Pharmacy Specialist - Critical Care and Emergency Medicine, Kelowna General Hospital, Kelowna, British Columbia
| | - Alice Ratcheva
- , BSc(Pharm), is a Pharmacy Practice Resident, Interior Health Pharmacy Practice Residency Program, Kelowna General Hospital, Kelowna, British Columbia
| | - Kate Boutin
- , BSc, BSc(Pharm), ACPR, is a Clinical Pharmacist, Pharmacy Services, Kelowna General Hospital, Kelowna, British Columbia
| | - Sean K Gorman
- , BSc(Pharm), ACPR, PharmD, is Regional Coordinator - Clinical Quality and Research and Pharmacotherapeutic Specialist - Critical Care, Kelowna General Hospital, Kelowna, British Columbia; and is also a Clinical Associate Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Richard Slavik
- , BSc(Pharm), ACPR, PharmD, FCSHP, is Regional Manager, Pharmacy Professional Practice, and Pharmacotherapeutic Specialist - Critical Care, Kelowna General Hospital, Kelowna, British Columbia; and is also a Clinical Professor, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Natalie Lesko
- , BSc(Pharm), ACPR, PharmD, is a Clinical Pharmacy Specialist - Nephrology, Kelowna General Hospital, Kelowna, British Columbia
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Munt AE, Partridge SR, Allman-Farinelli M. The barriers and enablers of healthy eating among young adults: a missing piece of the obesity puzzle: A scoping review. Obes Rev 2017; 18:1-17. [PMID: 27764897 DOI: 10.1111/obr.12472] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/18/2016] [Accepted: 09/02/2016] [Indexed: 11/29/2022]
Abstract
Young adults in Western countries are gaining weight faster than their parents and are more likely to gain weight than any other age cohort. Despite this, investigation into the complex young adults' food choice motives, which enable and prevent healthy eating, has not been widely investigated. A scoping review was conducted involving an extensive literature search of four major electronic databases: Medline, Embase, PsychInfo and CINAHL. Data were collected from 34 articles: study descriptions numerically analysed and key findings thematically analysed. The key barriers found included: male apathy towards diet; unhealthy diet of friends and family; expected consumption of unhealthy foods in certain situations; relative low cost of unhealthy foods; lack of time to plan, shop, prepare and cook healthy foods; lack of facilities to prepare, cook and store healthy foods; widespread presence of unhealthy foods; lack of knowledge and skills to plan, shop, prepare and cook healthy foods; lack of motivation to eat healthily (including risk-taking behaviour). The key enablers found included: female interest in a healthy diet; healthy diet of friends and family; support/encouragement of friends and family to eat healthy; desire for improved health; desire for weight management; desire for improved self-esteem; desire for attractiveness to potential partners and others; possessing autonomous motivation to eat healthy and existence and use of self-regulatory skills. This research provides evidence that can be used to tailor interventions for healthy eating and overweight and obesity in this population. However, government intervention in addressing food access, affordability, marketing and taxation remains essential to any significant change.
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Affiliation(s)
- A E Munt
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - S R Partridge
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - M Allman-Farinelli
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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