An Exploratory Study of Issues in Training Facilitators for Online Training in Advance Care Planning: Mixed Methods Research

Advance care planning (ACP) has attracted increasing research attention in recent years. In Japan, extensive training has been conducted to improve communication through workshops, such as role-playing. In training, including trainee-centered work, the facilitator who assists trainee learning plays an important role. However, only a few studies have focused on the training of facilitators. Therefore, we exploratorily analyzed by the mixed method the differences in the approaches of experienced and inexperienced facilitators during workshops and conducted a study that could contribute to facilitator training in the future. We recorded the comments and attitudes of 12 facilitators who participated in ACP training conducted in 2022. Based on analysis of the obtained data, a distinct difference was confirmed in the progression of trainee-based learning, encouragement to deepen learning among trainees, and trainees' responses to questions. Thus, this study indicated the importance of having the opportunity for fellow facilitators to learn through facilitation with experienced facilitators and involvement in issue awareness.

Barriers and facilitators to implementation of healthy food and drink policies in public sector workplaces: a systematic literature review

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.

Barriers and facilitators associated with the implementation of surgical safety checklists: A qualitative systematic review

AIM

Despite the documented benefits of the World Health Organisation Patient Safety Checklist compliance rates with implementation continue to cause risk to patient safety. This qualitative systematic review aimed to explore the reported factors that impact compliance and implementation processes related to surgical safety checklists in perioperative settings.

DESIGN

A qualitative systematic review.

METHODS

A systematic review using the Joanna Briggs Institute (JBI) approach to synthesize qualitative studies was conducted and reported according to PRISMA guidelines. Electronic databases were expansively searched using keywords and subject headings. Articles were assessed using a pre-selected eligibility criterion. Data extraction and quality appraisal was undertaken for all included studies and a meta-aggregation performed.

DATA SOURCES

The CINAHL, Medline and Scopus databases were searched in August 2022 and the search was repeated in June 2023.

RESULTS

34 studies were included. Following the synthesis of the findings there were multiple interrelating barriers to checklist compliance that impacted implementation. There were more barriers than enablers reported in existing studies. Enablers included effective leadership, education and training, timely use of audit and feedback, local champions, and the option for local modifications to the surgical checklist. Further research should focus on targeted interventions that improve observed compliance rates to optimize patient safety.

CONCLUSION

This qualitative systematic review identified multiple key factors that influenced the uptake of the Surgical Safety Checklist in operating theatres.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Surgeon participation, hierarchical culture, complacency, and duplication of existing safety processes were identified which impacted the use and completion of the checklist.

Facilitators and barriers in the rehabilitation process described by persons with spinal cord injury: a deductive-inductive analysis from the Finnish spinal cord injury study

BACKGROUND

This study aimed to determine the factors that promote and facilitate rehabilitation as well as challenges and possible barriers perceived by people with spinal cord injury (SCI).

MATERIALS AND METHODS

This study was part of a larger, mixed-method Finnish Spinal Cord Injury (FinSCI) study. We interviewed 45 persons with SCI representing participants from the FinSCI study and used a qualitative approach and a deductive-inductive content analysis to analyse the data.

RESULTS

We identified 28 facilitators and 19 barriers in the rehabilitation process. The majority of the facilitators and barriers were related to the rehabilitation planning phase. There were more barriers than facilitators in applying for and accessing treatment or rehabilitation and during the implementation of rehabilitation. Facilitators consisted of successful, realized, or planned treatments or rehabilitation events; clear goals; multidisciplinary teamwork; support and monitoring in various changing situations; and the rehabilitees' own capabilities and activities, among other things. The barriers included delays, challenges and deficiencies in the planning and implementation of treatment or rehabilitation; the lack of different skills; and resources of rehabilitation professionals; and different personal factors, which made the rehabilitation process cumbersome.

CONCLUSIONS

Good communication and interaction between stakeholders are crucial for the progress of rehabilitation.

Problem Based Learning in Medical Education: Handling Objections and Sustainable Implementation

The introduction of problem-based learning (PBL) in 1969 is considered the greatest innovation in medical education of the past 50 years. Since then, PBL has been implemented in different educational settings across virtually all health professions. However, some PBL schools gradually faced resistance from academic staff who were more familiar with traditional teacher-centred curricula. At times this has resulted in reversion to tradition or compromise whereby PBL is implemented within a lecture-based curriculum. Resistance can also emerge in a traditional school when a PBL curriculum is being considered for implementation. One of the first signs of this erosion is doubts about PBL raised in the form of objections or criticisms. This perspective review describes eight objections raised to assert why PBL is inferior or untenable. The background to each objection is provided together with evidence-informed rebuttals derived from professional practice and the published literature. Best practices are discussed for sustainable management of a PBL-based curriculum. A well-implemented PBL curriculum with appropriate and cost-effective infrastructure, training, teaching-learning activities, and assessment will position schools to harness the full benefit of PBL in training medical and health professionals.

[Implantation de l'Accompagnement-citoyen personnalisé d'intégration communautaire (APIC) : vers l'optimisation de la mise en œuvre de cette approche novatrice visant la participation sociale des aînés]

La présente étude visait à documenter l'implantation de l'Accompagnement-citoyen personnalisé d'intégration communautaire (APIC), lors duquel des bénévoles soutiennent la participation sociale d'aînés, dans des organismes communautaires en identifiant les facteurs favorables et défavorables ainsi que ses conditions essentielles. Soutenu par un devis qualitatif descriptif de type recherche clinique, une rencontre et six entretiens semi-dirigés ont été réalisés afin de documenter cette implantation dans six organismes communautaires œuvrant en milieu urbain au Québec (Canada). Selon les six coordonnatrices de l'APIC, les cinq directeurs généraux et l'agente de recherche, le principal facteur favorable est la conviction des responsables de l'implantation en la valeur ajoutée de l'intervention, incluant sa concordance avec la mission et les valeurs des organismes et les besoins de la population qu'ils desservent. Les facteurs défavorables sont principalement la répartition aléatoire et le temps accordé pour l'implantation. Ces résultats permettront de mieux guider l'implantation de l'APIC à plus grande échelle.

Facilitators and Barriers of Integrated Care for Older Adults with Multimorbidity: A Descriptive Qualitative Study

Purpose

A lack of coordinated care leads to multiple adverse effects for older adults with multimorbidity, including high treatment burdens, adverse health outcomes, reduplicated healthcare service utilization, and catastrophic healthcare expenditure. To foster healthy aging, person-centered integrated care that is responsive to older adults has been proposed by the World Health Organization. The objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China.

Patients and Methods

From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings.

Results

Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission.

Conclusion

Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers.

Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study

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.

Factors Affecting Physical Activity in People with Dementia: A Systematic Review and Narrative Synthesis

Physical activity (PA) has positive effects on the physical and cognitive functioning of people with dementia. Knowledge about what limits and stimulates people with dementia to participate in PA is essential to promote effective PA implementation and enhance PA levels. Previous reviews primarily included opinion-based studies, using data from interviews, focus groups or dyads. By including implementation studies, we aimed to elaborate on previous reviews by identifying new barriers to PA and new facilitators and motivators for PA. We conducted systematic searches in Pubmed, PsychInfo and Web of Science for studies published up to the 21st of September 2021. Search terms were related to the population of people with dementia, PA interventions and implementation outcomes. Studies were included if PA participation was investigated during actual PA implementation. No restrictions were made regarding study design, date of publication, PA type or outcome measures. Studies not implementing PA or not evaluating the implementation were excluded. Based on 13 empirical studies, we identified 35 barriers, 19 facilitators and 12 motivators. Of these, 21 barriers, 11 facilitators and 4 motivators were not identified by previous reviews. New factors are related to the support for people with dementia from informal and formal caregivers, e.g., revealing the importance of a trusting relationship. Furthermore, support for staff from the institution or an external party is needed to overcome doubts about PA, for example, related to safety and effects. New factors also suggested specific recommendations for the content and organization of the PA intervention, for instance, related to how to give instructions. Overall, factors affecting PA identified with opinion-based or implementation studies are complementary. Our extended overview shows the complexity of PA implementation and may help to personalize PA, develop implementation strategies, facilitate actual PA implementation and free up resources needed for effective implementation.

Exploring the role of a facilitator in supporting family carers when embedding the iSupport for Dementia programme in care services: A qualitative study

AIMS

To explore stakeholders' perceptions of a facilitator's role in supporting carers when embedding iSupport for Dementia psychoeducation program, in care services.

METHODS

A qualitative descriptive study design was applied. Data were collected from workshops and interviews with carers of people living with dementia (PLWD)and with health and social care professionals from two tertiary hospitals and two community aged care organisations across three Australian states between October 2021 and March 2022. A thematic analysis was used to analyse data. The COREQ guideline was followed to report our findings.

RESULTS

A total of 30 family carers and 45 health and social care professionals participated in the study. Three main themes and seven subthemes were identified from the data. We described the main themes as (1) the facilitator's role at the time of dementia diagnosis, (2) the facilitator's role throughout the everyday dementia care journey and (3) the facilitator's role during transition moments.

CONCLUSIONS

Caring for family members with dementia is demanding and stressful for carers. Embedding a facilitator-enabled iSupport for Dementia program in hospital and community aged care settings has the potential to mitigate sources of stress associated with care recipient factors, carer factors and care service factors, and improve the health and well-being of carers and those for whom they care.

RELEVANCE TO CLINICAL PRACTICE

Our findings will inform the establishment of iSupport facilitators appointed by dementia care providers in hospital and community care settings and help determine their roles and responsibilities in delivering the iSupport program. Our findings relate to nurse-led and coordinated dementia care in hospital and community aged care settings.

PATIENT OR PUBLIC CONTRIBUTION

This study was co-designed with stakeholders from two aged care organisations and two tertiary hospitals. The study participants were staff employed by these organisations and carers of PLWD who were service users.

Need Assessment of Existing Mentorship Program Among Undergraduate Medical Students: Experience From a Medical College in Chhattisgarh, India

Introduction While mentoring students during regular medical education has a long-standing tradition in many developed countries' medical schools, it has yet to become a standard practice in the majority of medical institutions, especially in the developing world, such as India. In institutions where mentoring programs are sparsely implemented, there is a lack of data regarding their assessment. Methodology This qualitative study involved two groups of students - nine undergraduate medical students (five male and four female) and 10 undergraduate medical students (six male and four female) who had at least three years of experience in the existing mentorship program at a tertiary care teaching hospital. We conducted two focused group discussions (FGDs) with these two groups of students using a guide, with FGDs lasting 45 and 50 minutes, respectively. We recorded the audio and it was transcripted to text. Thematic analysis of the transcripts from the 2 FGDs was conducted using Atlasti (Version 7.1.8) software to assess perceptions of the mentorship program. Results The content analysis of the discussions revealed two broad themes, namely "Current Functioning of the Programme" and "Suggestions for Improvement." These themes were further divided into multiple domains and subdomains, providing a comprehensive overview of the study's findings. Although there is a consensus among students that the mentorship program is essential, the current operational framework still has limited confidence due to biases, fears, and misinformation among the students. Conclusion The ongoing medical curriculum imparts a vast amount of scientific knowledge within a limited timeframe, with practical application occurring primarily in the last three years of the academic curriculum and minimal emphasis on ethical practice, professionalism, effective communication, handling urgent health situations, and interacting with family members, underscores the genuine need for a structured mentorship curriculum for undergraduate medical students. To enhance the program's effectiveness, the active involvement of undergraduate students must address their specific needs.

An umbrella review of the acceptability of fiscal and pricing policies to reduce diet-related noncommunicable disease

CONTEXT

Poor diet has been implicated in a range of noncommunicable diseases. Fiscal and pricing policies (FPs) may offer a means by which consumption of food and non-alcoholic beverages with links to such diseases can be influenced to improve public health.

OBJECTIVE

To examine the acceptability of FPs to reduce diet-related noncommunicable disease, based on systematic review evidence.

DATA SOURCES

MEDLINE, EMBASE, PsychInfo, SCI, SSCI, Web of Science, Scopus, EconLit, the Cochrane Library, Epistemonikos, and the Campbell Collaboration Library were searched for relevant studies published between January 1, 1990 and June 2021.

DATA EXTRACTION

The studies included systematic reviews of diet-related FPs and: used real-world evidence; examined real or perceived barriers/facilitators; targeted the price of food or non-alcoholic beverages; and applied to entire populations within a jurisdiction. A total of 9996 unique relevant records were identified, which were augmented by a search of bibliographies and recommendations from an external expert advisory panel. Following screening, 4 systematic reviews remained.

DATA ANALYSIS

Quality appraisal was conducted using the AMSTAR 2 tool. A narrative synthesis was undertaken, with outcomes grouped according to the WHO-INTEGRATE criteria. The findings indicated a paucity of high-quality systematic review evidence and limited public support for the use of FPs to change dietary habits. This lack of support was related to a number of factors that included: their perceived potential to be regressive; a lack of transparency, ie, there was mistrust around the use of revenues raised; a paucity of evidence around health benefits; the deliberate choice of rates that were lower than those considered necessary to affect diet; and concerns about the potential of such FPs to harm economic outcomes such as employment.

CONCLUSION

The findings underscore the need for high-quality systematic review evidence on this topic, and the importance of responding to public concerns and putting in place mechanisms to address these when implementing FPs. This study was funded by Safefood [02A-2020].

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021274454.

Barriers and facilitators for healthcare providers to implement family-centered care in Parkinson's disease: a scoping review

Aims

This study aimed to identify and synthesize the barriers and facilitators to the implementation of family-centered care in Parkinson's disease (PD) and to provide a reference for evidence-based Parkinson's disease nursing practice.

Methods

This scoping review follows the methodology framework proposed by Arksey and O'Malley. Four databases including PubMed, Web of Science, Embase, and Cochrane Library were searched. Barriers and facilitators were summarized based on the ecological family-centered model.

Results

Through a comprehensive literature search, 35 studies were found for this scoping review. Barriers and facilitators to implementing family-centered care in PD included physiological factors, environmental factors, culturally based conflicts, living arrangements, education or skills training, group experiences, and individual and family consultations.

Conclusion

Implementing family-centered care in Parkinson's disease is essential to providing comprehensive care that improves outcomes for both PD patients and their family members.

Patients' Experiences Using a Mobile Health App for Self-Care of Heart Failure in a Real-World Setting: Qualitative Analysis

BACKGROUND

Publicly available patient-focused mobile health (mHealth) apps are being increasingly integrated into routine heart failure (HF)-related self-care. However, there is a dearth of research on patients' experiences using mHealth apps for self-care in real-world settings.

OBJECTIVE

The purpose of this study was to explore patients' experiences using a commercially available mHealth app, OnTrack to Health, for HF self-care in a real-world setting.

METHODS

Patient satisfaction, measured with a 5-point Likert scale, and an open-ended survey were used to gather data from 23 patients with HF who were provided the OnTrack to Health app as a part of routine HF management. A content analysis of patients' responses was conducted with the qualitative software Atlas.ti (version 8; ATLAS.ti Scientific Software Development GmbH).

RESULTS

Patients (median age 64, IQR 57-71 years; 17/23, 74% male) used OnTrack to Health for a median 164 (IQR 51-640) days before the survey. All patients reported excellent experiences related to app use and would recommend the app to other patients with HF. Five themes emerged from the responses to the open-ended questions: (1) features that enhanced self-care of HF (medication tracker, graphic performance feedback and automated alerts, secured messaging features, and HF self-care education); (2) perceived benefits (provided assurance of safety, improved HF self-care, and decreased hospitalization rates); (3) challenges with using apps for self-care (giving up previous self-care strategies); (4) facilitators (perceived ease of use and availability of technical support); and (5) suggested improvements (streamlining data entry, integration of apps with an electronic medical record, and personalization of app features).

CONCLUSIONS

Patients were satisfied with using OnTrack to Health for self-care. They perceived the features of the app as valuable tools for improving self-care ability and decreasing hospitalization rates. The development of apps in collaboration with end users is essential to ensure high-quality patient experiences related to app use for self-care.

Barriers and Enablers to Implementing Teledentistry From the Perspective of Dental Health Care Professionals: Protocol for a Systematic Quantitative, Qualitative, and Mixed Studies Review

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.

Assessment and Documentation of Social Determinants of Health Among Health Care Providers: Qualitative Study

BACKGROUND

Research clearly demonstrates social determinants of health (SDOH) impact health outcomes. Provider consideration of patient SDOH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDOH and improved population health, research demonstrates few providers document patient SDOH.

OBJECTIVE

This qualitative study aimed to better understand the barriers and facilitators of SDOH assessment, documentation, and referral in different health care settings and roles.

METHODS

Individual semistructured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022, and September 2, 2022. Participants were recruited via community partners' web-based newsletters or listservs using a purposive sampling design. An interview guide with 19 questions was used to explore the following research question: How do SDOH impact patient health and what are the facilitators and barriers experienced by multidisciplinary health care providers assessing and documenting patient SDOH?

RESULTS

Participants (N=5) included a neonatal intensive care unit registered nurse, a nurse practitioner, a certified nurse midwife, a family and preventive medicine physician, and a counselor (licensed clinical social worker) with careers spanning 12 to 32 years. Participant responses are presented according to the following 5 themes: participants' understanding of SDOH for the patient population, assessment and documentation practices, referrals to other providers and community-based resources, barriers and facilitators of SDOH assessment and documentation, and SDOH assessment and documentation training preferences. Overall, participants were aware of the importance of including patient SDOH in assessment and intervention but noted a variety of institutional and interpersonal barriers to assessment and documentation, including time constraints, perceptions of stigma around discussion of SDOH, and limited referral protocols.

CONCLUSIONS

Incentivizing inclusion of patient SDOH in health care must be facilitated from the top down, so assessment and documentation can be universally implemented in a pragmatic way that works for providers in a variety of roles and settings for the betterment of health care quality, health equity, and improved population health outcomes. Partnering with community organizations can serve to augment health care organizations' resource and referral availability for addressing patients' social needs.

Perceptions of medical students and their facilitators on clinical communication skills teaching, learning, and assessment

Introduction

Despite various efforts to develop communication skills (CS) in the classroom, the transfer of these skills into clinical practice is not guaranteed. This study aimed to identify barriers and facilitators of transferring CS from the classroom to clinical environments.

Methods

A qualitative study was conducted at one Australian medical school to explore the experiences and perceptions of facilitators and students in relation to teaching and learning clinical CS. Thematic analysis was used to analyze data.

Results

Twelve facilitators and sixteen medical students participated in semi-structured interviews and focus-group discussions, respectively. Primary themes included the value of teaching and learning, alignment between approaches to teaching and actual clinical practices and students' perceptions of practice, and challenges in different learning environments.

Discussion

This study reinforces the value of teaching and learning CS by facilitators and students. Classroom learning provides students with a structure to use in communicating with real patients, which can be modified to suit various situations. Students have limited opportunities, however, to be observed and receive feedback on their real-patient encounters. Classroom session that discussed CS experiences during clinical rotation is recommended to strengthen learning both the content and process of CS as well as transitioning to the clinical environment.

Determining acceptance and perceptions of chemotherapy dose banding in an ambulatory cancer centre

INTRODUCTION

Despite the advantages of dose banding (DB) and numerous plans to adopt this practice, uptake of DB is still poor. As opinions of healthcare professionals were deemed essential in DB's acceptance, this study surveyed key stakeholders to determine the acceptance, facilitators, and barriers of DB in chemotherapy to improve its implementation.

METHODS

A cross-sectional study at the National Cancer Centre Singapore, involving physicians, nurses, and pharmacy staff, was conducted in February 2022. The Theory of Planned Behaviour was adapted to design a survey questionnaire to obtain the acceptance, facilitators, and barriers of DB. Additional questions on maximum acceptable dose variance and essential criteria for selecting drugs for DB were included.

RESULTS

A total of 93 participants responded, with a mean 9.75  ±  7.37 years of clinical experience. Less than half have heard of DB while few had prior experience. Drug cost was the top selection criteria for DB, followed by toxicity, therapeutic index, frequency of use and drug wastage. Acceptance rate of DB was 41.9%, with majority agreeing to use DB in various drugs but to determine patient suitability before usage. Being greatly affected by subjective norms, having a positive outlook for DB's impacts, and no effect on toxicity significantly influenced acceptance.

CONCLUSION

Prior to implementing DB at the institutional level, educational training addressing concerns over toxicity, and providing technological support can help improve acceptance. Future studies can involve patients' perspectives and more institutions for greater diversity in opinions.

Consumers' Needs for Laboratory Results Portals: Questionnaire Study

BACKGROUND

Over the last decade, there has been an increase in the number of health care consumers (ie, patients, citizens, and laypeople) with access to their laboratory results through portals. However, many portals are not designed with the consumer in mind, which can limit communication effectiveness and consumer empowerment.

OBJECTIVE

We aimed to study design facilitators and barriers affecting consumer use of a laboratory results portal. We sought to identify modifiable design attributes to inform future interface specifications and improve patient safety.

METHODS

A web-based questionnaire with open- and closed-ended items was distributed to consumers in British Columbia, Canada. Open-ended items with affinity diagramming and closed-ended questions with descriptive statistics were analyzed.

RESULTS

Participants (N=30) preferred reviewing their laboratory results through portals rather than waiting to see their provider. However, respondents were critical of the interface design (ie, interface usability, information completeness, and display clarity). Scores suggest there are display issues impacting communication that require urgent attention.

CONCLUSIONS

There are modifiable usability, content, and display issues associated with laboratory results portals that, if addressed, could arguably improve communication effectiveness, patient empowerment, and health care safety.

The Attitude of Medical Students Toward Voluntary Body Donation: A Single Institute Survey and Narrative Review of Global Trends

INTRODUCTION

Voluntary body donation (VBD) programs form the backbone of cadaveric teaching and learning in medical schools. It benefits the medical fraternity the most. Yet, there is a dearth of VBD practice among medical students. We aimed to understand the knowledge and attitude of first-year medical students in a tertiary institute with a systematic review of willingness toward VBD among undergraduate students worldwide.

METHODS

 The first-year medical undergraduates were given a 12-item questionnaire to assess their knowledge and attitude toward VBD. Statistical tests were applied to analyze the difference between the variables. We systematically searched Google Scholar, PubMed, and SCOPUS databases until October 15, 2022. Data concerning knowledge, awareness, and attitude toward VBD among undergraduates of medical backgrounds were extracted and analyzed qualitatively.

RESULTS

A total of 82.5% of students returned the completed responses. A significant association was seen between their attitudes toward whole body donation by strangers (p=0.043) and family members (p=0.035). The religion of the participants significantly affected their opinions on VBD and their willingness to pledge themselves (p=0.034). For the review, 20 studies were selected to be analyzed qualitatively. These studies included 4232 undergraduate students globally who were assessed for knowledge, awareness, and attitude toward VBD. Around 50% of the studies were published in India. The first study included was published in 2008. Seven studies were exclusively conducted on medical undergraduates, while the rest consisted of a mixed cohort. The attitude and knowledge of medical undergraduates on VBD were assessed via questionnaires containing both open-ended and closed-ended questions.

CONCLUSION

Based on observations from our survey and review, we concluded that while undergraduate students have a highly positive attitude toward VBD, their rate of pledging is low. The most prominent barrier to this attitude is their experience with cadavers in the dissection hall. Hence, we recommend a revisit of cadaver handling practices and the establishment of appropriate protocols for safe and deferential cadaver handling.

Facilitators of Sexual Assault Disclosure: A Dyadic Study of Female Survivors and Their Informal Supports

Two-thirds of survivors typically disclose their experience to others at some point following sexual assault, but little in-depth research has addressed factors facilitating disclosure. In the current study, a diverse sample of 45 female sexual assault survivors (75% racial/ethnic minorities) and their 45 informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following assault. Disclosure facilitation was expressed by 40 survivors and 31 SPs, of which 28 were matched S/SP dyadic pairs. Narrative data on the overarching thematic category of sexual assault disclosure facilitation was analyzed using descriptive thematic analysis methods. Several themes emerged from the analysis of quotes specific to the facilitation of disclosure, including: individual (e.g., survivor psychological, behavioral, and disclosure recipient factors), interpersonal (e.g., SP-solicited disclosures, helping others, mutual disclosures), and societal (e.g., lack of barriers, formal supports, media). Implications are drawn for future research on facilitators of sexual assault disclosure. Clinical practice implications are provided for professionals supporting survivors and their informal support networks.

Differences in Factors Influencing Deprescribing between Primary Care Providers: Cross-Sectional Study

Deprescribing is a notable approach to improve medication management, but few healthcare systems recognize it. To introduce a new practice, it is important to examine the factors influencing the provision of a new or elaborate cognitive service within the desired setting. This study explores the perceived barriers and facilitators of deprescribing by primary healthcare providers, and identifies the factors associated with a willingness to suggest deprescribing. A cross-sectional survey was conducted (in Croatia, between October 2021 and January 2022) using a validated comprehensive healthcare providers' opinions, preferences, and attitudes towards deprescribing (CHOPPED) questionnaire. A total of 419 pharmacists and 124 physicians participated. Participants showed a high willingness to deprescribe, with significantly higher scores in physicians than in pharmacists (5.00 (interquartile range-IQR 5-5) vs. 4.00 (IQR 4-5), p < 0.001). Pharmacists had significantly higher scores in seven out of ten factors (knowledge, awareness, collaboration facilitators, competencies facilitators, healthcare system facilitators, collaboration barriers, competencies barriers) while in the remaining three factors (patient facilitators, patient and healthcare system barriers) there was no difference in scores. The strongest positive correlation with willingness to suggest deprescribing was found with the collaboration and healthcare system facilitators factors for pharmacists (G = 0.331, p < 0.001, and G = 0.309, p < 0.001, respectively), and with knowledge, awareness, and patient facilitators factors for physicians (G = 0.446, p = 0.001; G = 0.771, p < 0.001; and G = 0.259, p = 0.043, respectively). Primary healthcare providers are willing to suggest deprescribing but face different barriers and facilitators. For pharmacists, the most important facilitators were extrinsic, while for physicians they were more intrinsic and patient related. The stated results provide target areas which one could focus upon to help to engage healthcare providers in deprescribing.

Organizational facilitators and barriers for participation in workplace health promotion in healthcare: A qualitative interview study among nurses

Background

There is evidence for the positive effects of workplace health promotion (WHP) for nurses. Although this highly stressed target group also actively desires WHP, the number of participants is low. Individual reasons play a role in the decision to engage in WHP activities, yet it is interesting to consider which organizational factors a company could address to improve participation. In this regard, the question arises of what organizational factors facilitate participation in WHP activities from the perspective of nurses in inpatient care facility (ICF), outpatient care service (OCS), and acute care hospitals (ACH).

Method

Sixteen semi-structured interviews were conducted in different care settings between May and September 2021. Questions about everyday working life, WHP activities, and organizational framework conditions were asked.

Result

The results show that there is a wide range of influencing factors at the organizational level, some overall settings, and others setting-specific. High workload and the fit of WHP activities with shift times were particularly inhibiting overall settings. A negative association with the employer worked as a barrier in ICF and ACH.

Conclusion

When implementing WHP activities, it can be useful to consider organizational facilitators and barriers to promote sustainable and attractive WHP activities and higher participation rates in the different settings of nursing.

Barriers and facilitators to participation in everyday activities for children with intellectual disabilities in China

BACKGROUND

Children with intellectual disabilities (IDs) are vulnerable and participate less in everyday activities compared to their peers with typical development. This study aimed to identify barriers and facilitators related to the participation in everyday activities of children with IDs in China.

METHODS

Twenty semi-structured interviews were conducted with primary caregivers of children with IDs from special schools in Tianjin, China. The data were transcribed and analysed using inductive qualitative content analysis.

RESULTS

Four categories of barriers to participation in everyday activities for children with IDs were identified: insufficient knowledge, attitudes and skills in primary caregivers; ID-related characteristics of children; stigma and Chinese culture; and lack of support from society. Four categories describing facilitators of participation in everyday activities for children with IDs were also identified: the optimistic attitude of the primary caregiver; adequate family support; active environment in school and policy; and attractive characteristics of children with IDs.

CONCLUSIONS

The findings in this study add knowledge on important barriers and facilitators affecting the participation of children with IDs in everyday activities in China. The primary caregivers' voices need to be heard by government and society. Appropriate and effective changes in family-oriented services and the legal, social, political and economic context of the child welfare management system for the scale-up of improving participation should be implemented for children with IDs.

Facilitators and Barriers to Using Selective Laser Trabeculoplasty (SLT) as First-Line Treatment for Glaucoma: Physician and Patient Views Gathered during an Exploratory Descriptive Qualitative Study

PURPOSE

To explore the perception of selective laser trabeculoplasty (SLT) among physicians and patients and the acceptance of using SLT as first-line treatment for glaucoma.

METHODS

Exploratory descriptive qualitative study based on semi-structured interviews with glaucoma specialists and patients in two eye hospital of Zhejiang and Guangdong Provinces, China. Data were analyzed using the thematic analysis framework approach.

RESULTS

11 glaucoma specialists and 12 glaucoma patients were interviewed. Four themes were identified in the data: Physicians' preferences for treatment types, patient views on treatment types, decision-making during the physician-patient encounter and feasibility of SLT as a first-line therapy. Advantages of SLT include safety and repeatability with limited side effects. However, concerns about the durability of the effect of the treatment were often mentioned by both physicians and patients. Some factors such as practice preference, personal motivation and patient characteristics may influence treatment choice. Most patients lack knowledge about SLT and hold high expectations of their treatments. Physicians report insufficient evidence supporting the use of SLT as first line therapy. Physicians report the need for locally relevant, evidence-based guidelines regarding the use of SLT in the treatment of glaucoma.

CONCLUSIONS

SLT was suggested as the first-line treatment of glaucoma due to its reliable efficacy and potential advantage. Results from our study offer important insight into barriers of increasing the uptake of SLT, which also provides some guidance for the use of SLT in the future.

Finding New Meaning in the Practice of Medicine: A Quality Improvement Project Evaluating the Remote Communication Liaison Program during the Initial COVID Pandemic Surge

Background: In spring 2020, the COVID-19 pandemic overwhelmed intensive care teams with severely ill patients. Even at the end of life, families were barred from hospitals, relying solely on remote communication. A Remote Communication Liaison Program (RCLP) was established to ensure daily communication for families, while supporting overstretched intensivists. Objectives: To evaluate the effectiveness and impact of the RCLP on participating liaisons and intensivists. Design: Two quality improvement surveys were developed and administered electronically. Setting/Subjects: Based in the United States, all liaisons and intensivists who participated in this program were invited to take the surveys. Measurements: Descriptive statistics were used to analyze the quantitative Likert-scale data, and qualitative analysis was used to assess themes. Results: Among respondents, all (100%) liaisons and more than 90% of intensivists agreed or strongly agreed that the RCLP provided a valuable service to families. More than 70% of intensivists agreed or strongly agreed that the program lessened their workload. More than 90% of liaisons agreed or strongly agreed that participation in the program improved their confidence and skills in end-of-life decision making, difficult conversations, and comprehension of critical care charts. Themes elicited from the liaisons revealed that participation fostered a renewed sense of purpose as physicians, meaningful connection, and opportunities for growth. Conclusions: RCLP successfully trained and deployed liaisons to rapidly develop skills in communication with beleaguered families during COVID-19 surge. Participation in the program had a profound effect on liaisons, who experienced a renewed sense of meaning and connection to the practice of medicine.

Barriers to and facilitators of online health information-seeking behaviours among cancer patients: A systematic review

Objective: Disparities in cancer care contribute to higher rates of cancer mortality. Online health information would be a resource for cancer patients to obtain knowledge and make health decisions. However, factors that hinder or facilitate online searching behaviours among patients remain unexplored. The current systematic review aims to identify and synthesise evidence of cancer patients' barriers to and facilitators of online health information-seeking behaviours. Methods: Electronic databases (PubMed, EMBASE, Scopus) were systematically searched, and a total of 123 full-text studies were reviewed of which 24 met the inclusion criteria. Results: Thematic analysis was performed to identify barriers and facilitators of online health information-seeking behaviours. Seven key themes were identified: (1) socio-demographic characteristics (age, gender, education, income, ethnicity and language), (2) psychosocial aspects (psychological wellbeing, need for a face to face contact, motivation, support), (3) accessibility (Internet access, residence), (4) quality and quantity of information (amount, reliability), (5) cancer stage and symptoms (time since diagnosis, experiencing symptoms), (6) aspects related to healthcare professionals (relationship with the patients and opinions on online health information) and (7) digital literacy (computer skills and literacy). Conclusions: Findings underscore the significance of recognising the multifaceted nature of barriers and facilitators affecting cancer patients' online health information-seeking behaviours. A strong link between these factors and cancer patients' ability to make informed decisions and cope effectively with their diagnosis emerged. Consequently, addressing these barriers and leveraging the identified facilitators could lead to improvements in patient-centred care, ultimately contributing to better healthcare services and informed decision-making for cancer patients. Future research should prioritise exploring strategies for enhancing cancer care accessibility across all stakeholders involved.

Registration

CRD42023408091.

Exploration of Malaysian Stakeholders View on Barriers to and Facilitators of Colorectal Cancer Screening Among Older Population

According to the Malaysian National Cancer Registry (MNCR), more than 70% of colorectal cancer (CRC) cases in Malaysia are presented in the advanced stages of the disease, leading to poor survival rates while taxing the health care system. This study aims to explore the barriers to and facilitators of CRC screening uptake in the perspectives of the general population, health care providers, and policymakers. In-depth, semi-structured interviews were conducted with 25 purposively sampled respondents comprising general population above the age of 40, health care providers, and policymakers. Commonly reported barriers to CRC screening included psychological, poor knowledge and awareness, lack of physicians' recommendation, and inadequate implementation of CRC-related campaigns at systemic level. Facilitating factors for CRC screening included family support and family history of CRC. A comprehensive understanding of barriers and facilitators is relevant for designing an effective intervention and policy to increase CRC screening rates in Malaysia.

Factors That "Nudge People towards the Healthier" Snacks-A Qualitative Study with Student, Faculty, and Staff Leaders and Decision Makers

(1) College campuses pose numerous public health challenges for students, faculty and staff. The healthfulness of the snacks available on campuses is lacking, and there is a desire for change among the students and staff. The objective of this study is to understand the perspectives of the students, staff, and decision makers regarding the college campus food environment and the perceived facilitators and barriers to improving it. (2) In-depth interviews were conducted (n = 15) with decision makers in food, policy development, wellness, and nutrition at a large Hispanic-Serving University in South Florida. (3) The key stakeholders shared that educational campaigns, student buy-in, raising awareness around obesity and chronic disease, and the university's position within the community would all help to facilitate improvements to the snack food environment. However, the participants noted that the complex nature of what is considered to be healthy and what divergent consumers want are significant barriers to improving the snack food environment along with concerns over lost revenue and the corporate structure. (4) These results inform potential focal points for multi-level interventions and inform policy discussions focused on improving the snack food environment at minority-serving universities. Taking strategic actions to improve the snack food environment may aid the students and staff of the university to enhance their diet quality.

Stroke thrombolysis in a middle-income country: A case study exploring the determinants of its implementation

Introduction

Translation of evidence into clinical practice for use of intravenous thrombolysis in acute stroke care has been slow, especially across low- and middle-income countries. In Malaysia where the average national uptake was poor among the public hospitals in 2018, one hospital intriguingly showed comparable thrombolysis rates to high-income countries. This study aimed to explore and provide in-depth understanding of factors and explanations for the high rates of intravenous stroke thrombolysis in this hospital.

Methods

This single case study sourced data using a multimethod approach: (1) semi-structured in-depth interviews and focus group discussions, (2) surveys, and (3) review of medical records. The Tailored Implementation of Chronic Diseases (TICD) framework was used as a guide to understand the determinants of implementation. Twenty-nine participants comprising the Hospital Director, neurologists, emergency physicians, radiologists, pharmacists, nurses and medical assistants (MAs) were included. Thematic analyses were conducted inductively before triangulated with quantitative analyses and document reviews.

Results

Favorable factors contributing to the uptake included: (1) cohesiveness of team members which comprised of positive interprofessional team dynamics, shared personal beliefs and values, and passionate leadership, and (2) facilitative work process through simplification of workflow and understanding the rationale of the sense of urgency. Patient factors was a limiting factor. Almost two third of ischemic stroke patients arrived at the hospital outside the therapeutic window time, attributing patients' delayed presentation as a main barrier to the uptake of intravenous stroke thrombolysis. One other barrier was the availability of resources, although this was innovatively optimized to minimize its impact on the uptake of the therapy. As such, potential in-hospital delays accounted for only 3.8% of patients who missed the opportunity to receive thrombolysis.

Conclusions

Despite the ongoing challenges, the success in implementing intravenous stroke thrombolysis as standard of care was attributed to the cohesiveness of team members and having facilitative work processes. For countries of similar settings, plans to improve the uptake of intravenous stroke thrombolysis should consider the inclusion of interventions targeting on these modifiable factors.

Breast Cancer Treatment in Integrated Care Process in Andalusia: The Challenge of Multidisciplinarity

Despite the increasing trend in the incidence of breast cancer in recent decades, mortality has decreased in developed countries. The general objective of the study is to analyse the functioning and organisation of the care process for breast cancer treatment in Andalusia (Spain) in order to identify possible barriers and facilitators that may be affecting its effectiveness and, therefore, the survival of the disease. A qualitative method was adopted based on 19 semi-structured interviews with health professionals from different specialities in two Andalusian provinces: Huelva (mortality rate higher than the national average) and Granada (mortality rate similar to the national average). Results show the existence of barriers (seasonal delays, low frequency of multidisciplinary meetings, lack of human and technical resources, difficulties in accessing treatment in certain populations, etc.) and facilitators (creation of multidisciplinary units and committees for breast pathology, standardisation of treatments, assignment of professionals with preferential attention to breast pathology, etc.) in the care process of breast cancer treatment. The combination of these barriers can have an impact on the accessibility, quality, and efficacy of the treatment, and in the long term, on survival from the disease.

Facilitators and barriers influencing the post-crash emergency care of road traffic injuries in district Aligarh of Uttar Pradesh

Context

Road traffic injuries (RTIs) will become the fifth leading cause of death by 2030. It is often possible to mitigate the consequences of serious injury if victims have access to prompt, effective pre-hospital care within minutes following the crash.

Aims

To find out the facilitators and barriers for providing post-crash emergency care in Road traffic injuries in district Aligarh.

Settings and Design

The present study was undertaken on both the National highways (NH-91 and NH-93) and the bypass roads passing through district Aligarh of Uttar Pradesh.

Subjects and Methods

All the individuals who met road traffic accidents (RTA) between the earmarked areas from 1^st October 2018 to 30^th November 2020 and reported for treatment to the selected hospitals were included in the study.

Statistical Analysis Used

Data is presented in the form of frequency tables and percentages.

Results

A total of 1126 patients were interviewed during the study period. Out of 1126, 937 (83.2%) were males, and 189 (16.8%) were females, with M:F ratio being 4.96:1. Six hundred sixty-two (58.8%) of the respondents identified the layperson or common man as the first person to respond at the time of the crash. 1110 (98.58%) respondents identified the layperson as the facilitator in providing post-crash emergency care, followed by police and roadside shopkeepers/dhabawalas. The role of the layperson in calling for help by utilizing the helpline numbers, suggesting a nearby health facility together with facilitating for transportation of the victim to the nearby health facility was appreciated by the majority of the respondents. An ambulance was the best available mode of transportation. Seven hundred thirty-three (65.10%) of the total respondents were aware of the toll-free number to be dialled in case of RTA. However, only 320 (43.70%) among them used this toll-free facility after meeting the crash.

Conclusion

A layperson is the single most important facilitator for providing post-crash emergency care.

The Barriers to and Facilitators of Physical Activity and Sport for Oceania with Non-European, Non-Asian (ONENA) Ancestry Children and Adolescents: A Mixed Studies Systematic Review

BACKGROUND

Participation in sport and physical activity (PA) leads to better overall health, increased life expectancy, and decreased mortality rates across the lifespan; however, there may be a range of individual, family, and community factors that influence PA participation among ONENA children and adolescents residing in the 22 Pacific Island Countries and Territories (PICT) and Australia. This review aimed to synthesise existing quantitative and qualitative literature regarding barriers to and facilitators of PA and sport among ONENA youth.

METHODS

The literature was systematically searched to include studies reporting barriers to and facilitators of PA and sports participation among ONENA children and adolescents aged 0-18 years residing in the 22 PICT and Australia. Using a pre-established taxonomy based on the social-ecological model, a deductive analysis was performed. Quality appraisal was performed using the mixed methods appraisal tool.

RESULTS

Of 1388 articles, 14 studies were included, with 128 ONENA children and adolescent participants across the four qualitative studies; 156,581 ONENA children and adolescents across the seven quantitative studies; 801 parents, children, and adolescents in one quantitative study; and 642 parents in two quantitative studies. Of the 14 included studies, none were based in Australia and only 10 of the 22 PICT were reported as the participants' residence: Palau, New Zealand, Tonga, Cook Islands, Kiribati, Samoa, Solomon Islands, Tuvalu, Vanuatu, and Fiji. Four studies reported barriers, and another four studies reported facilitators of PA and sport, with the remaining studies reporting both barriers and facilitators. Overall, there were more barriers reported (30 in total) than facilitators (27 in total).

CONCLUSIONS

Research in this area is lacking, with ONENA youth living in Australia and 12 PICT not represented. Overall, there were a larger number of facilitators experienced at individual and interpersonal levels, while barriers were highest at the community level, with the policy level having facilitators and barriers equally represented. Programs that offer PA and sport participation options with embedded SDT-informed strategies for all family members; that are accessible through existing transport and related social, cultural, and physical infrastructure; and that are committed to communities through formal co-design partnerships are needed, to enhance the PA and sport participation of ONENA youth residing in PICT.

Why Should Pistachio Be a Regular Food in Our Diet?

The pistachio is regarded as a relevant source of biologically active components that, compared to other nuts, possess a healthier nutritional profile with low-fat content composed mainly of monounsaturated fatty acids, a high source of vegetable protein and dietary fibre, remarkable content of minerals, especially potassium, and an excellent source of vitamins, such as vitamins C and E. A rich composition in terms of phytochemicals, such as tocopherols, carotenoids, and, importantly, phenolic compounds, makes pistachio a powerful food to explore its involvement in the prevention of prevalent pathologies. Although pistachio has been less explored than other nuts (walnut, almonds, hazelnut, etc.), many studies provide evidence of its beneficial effects on CVD risk factors beyond the lipid-lowering effect. The present review gathers recent data regarding the most beneficial effects of pistachio on lipid and glucose homeostasis, endothelial function, oxidative stress, and inflammation that essentially convey a protective/preventive effect on the onset of pathological conditions, such as obesity, type 2 diabetes, CVD, and cancer. Likewise, the influence of pistachio consumption on gut microbiota is reviewed with promising results. However, population nut consumption does not meet current intake recommendations due to the extended belief that they are fattening products, their high cost, or teething problems, among the most critical barriers, which would be solved with more research and information.

Teaching staff in interprofessional education: A proposed terminology

Different terms (e.g., interprofessional, multiprofessional, interdisciplinary) are used in interprofessional education and collaboration without sufficient differentiation or precision in regard to meaning. In recent years academic publications in English and German have contributed to clarifying this issue. However, there are no definitions internationally or in the German-speaking countries (Germany, Austria, Switzerland) specifically referring to the people engaged in teaching interprofessional education. Teaching in interprofessional education has evolved from the traditional role of expert to one of mentor or facilitator. It is also evident that those who teach play a central role in the success of interprofessional courses. While many different designations are used to refer to interprofessional teachers in the relevant literature and in the language of daily use, a uniform and adequate terminology should be used to refer to such teaching staff. Based on literature reviews, this commentary seeks to propose terms for teaching staff active in the area of interprofessional education and thus provide a basis for discussion in the German-speaking countries. Taking the results of the literature analysis and the roles of teachers in interprofessional settings into consideration, we propose that the English term "IP facilitator" (IP for interprofessional) should also be used in the German-speaking world and "facilitateur IP" in the French-speaking world. A French translation is included in attachment 1 to enable broader discussion in Switzerland.

Understanding Patients' Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study

Background

After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients.

Objective

This study aimed to assess ACS patients’ intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use.

Methods

Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as “If this app were available to me, I would use it.” Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis.

Results

Among 100 respondents (response rate 8.1%), 45 (45%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90% (90/100) White, 39% (39/100) women, and 88% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65%) agreed or strongly agreed that they would use the app, among which 53 (82%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75% among those aged 65-74 years and dropped to 44% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care.

Conclusions

There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality.

Facilitators for use of oral healthcare services among people with substance use disorders: a qualitative study in Norway

OBJECTIVE

Opioid maintenance treatment (OMT) patients in Norway are eligible for free oral healthcare services; however, oral health morbidity remains high and the uptake of services among this patient group is low. As knowledge of the reasons for the low uptake of services among OMT patients is insufficient, this study adopted a qualitative approach to explore this from the perspectives of patients and dental healthcare workers (DHWs).

MATERIAL AND METHODS

Through focus group and individual interviews, data were collected from 63 participants: 30 patients receiving OMT and 33 DHWs. Key themes were identified through a thematic analysis.

RESULTS

Teeth were a significant factor in OMT patients' quality of life and recovery. Accompaniment to scheduled dentist appointments was identified as a facilitator by both the patients and the DHWs. The dentist-patient relationship was also seen as an important facilitator of dental treatment; DHWs with previous experience of treating OMT patients were valued by patients because of their high verbal and non-verbal communication.

CONCLUSIONS

Helping OMT patients attend dental appointments, improving the dentist-patient relationship, and expanding stakeholders' knowledge of OMT patients' right to oral healthcare services may increase the uptake and benefits of dental healthcare services among OMT patients. The current support framework within the OMT system has the potential to increase the communication and efficiency of dental healthcare services available to patients undergoing OMT.

Barriers and facilitators for the implementation of health condition and outcome registry systems: a systematic literature review

OBJECTIVE

Health condition and outcome registry systems (registries) are used to collect data related to diseases and other health-related outcomes in specific populations. The implementation of these programs encounters various barriers and facilitators. Therefore, the present review aimed to identify and classify these barriers and facilitators.

MATERIALS AND METHODS

Some databases, including PubMed, Embase, ISI Web of Sciences, Cochrane Library, Scopus, Ovid, ProQuest, and Google Scholar, were searched using related keywords. Thereafter, based on the inclusion and exclusion criteria, the required data were collected using a data extraction form and then analyzed by the content analysis method. The obtained data were analyzed separately for research and review studies, and the developed and developing countries were compared.

RESULTS

Forty-five studies were reviewed and 175 unique codes were identified, among which 93 barriers and 82 facilitators were identified. Afterward, these factors were classified into the following 7 categories: barriers/facilitators to management and data management, poor/improved collaborations, technological constraints/appropriateness, barriers/facilitators to legal and regulatory factors, considerations/facilitators related to diseases, and poor/improved patients' participation. Although many of these factors have been more cited in the literature related to the developing countries, they were found to be common in both developed and developing countries.

CONCLUSION

Lack of budget, poor performance of managers, low data quality, and low stakeholders' interest/motivation on one hand, and financing, providing adequate training, ensuring data quality, and appropriate data collection on the other hand were found as the most common barriers or facilitators for the success of the registry implementation.

Investigation of Barriers and Facilitators to Medication Adherence in Patients With Type 2 Diabetes Across Different Health Literacy Levels: An Explanatory Sequential Mixed Methods Study

Type 2 diabetes (T2D) incurs tremendous healthcare costs associated with various complications due to poor blood sugar control. Medication adherence, which is correlated with patients’ health literacy, should be consistently practiced to achieve optimal control of blood sugar. A comprehensive understanding of specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. To understand barriers and facilitators to medication adherence in people with T2D across different health literacy levels, the Health Literacy Pathway Model was used to identify the psychosocial and communication factors that may influence medication adherence. This mixed methods study used an explanatory sequential design, including a quantitative survey followed by qualitative semi-structured interviews. Two hundred and five participants completed the survey questionnaire, and 23 participants completed semi-structured interviews. Confirmed by quantitative and qualitative data, having stronger self-efficacy and fewer concerns about medications, as well as experiencing fewer perceived barriers to medication-taking, are necessary for better medication adherence among those with low adherence. Our findings will be useful to tailor interventions for diabetes care through addressing concerns among low-adherent patients with low health literacy and emphasizing self-efficacy and perceived barriers to medication adherence among all low-adherent patients with T2D.

Perception and Experience of Health Extension Workers on Facilitators and Barriers to Maternal and Newborn Health Service Utilization in Ethiopia: A Qualitative Study

Background: Health extension workers (HEWs) have substantial inputs to reduce maternal and newborn morbidity and mortality in Ethiopia. However, their perceptions and experiences were not well understood. Therefore, this study aimed to explore their perceptions and experiences on facilitators and barriers to maternal and newborn health services in Ethiopia. Methods: A descriptive qualitative study was conducted from 8–28 April 2021 in Oromia, Amhara and Southern Nation, Nationality, and People’s Regional State of Ethiopia. Focused group discussions were made with purposively selected 60 HEWs. The data were transcribed verbatim and translated into English. An inductive thematic analysis was carried out using Atlas ti.7.1. The findings were presented in major themes, categories, and sub-categories with supporting quote(s). Results: The findings were categorized into two major themes (i.e., facilitators and barriers) and seven sub-themes. Community-related facilitators encompass awareness and behavior at the individual, family, and community. Significant others such as traditional birth attendants, religious leaders, women developmental armies, and kebele chairman substantially contributed to service utilization. Availability/access to infrastructures such as telephone, transportation services, and solar energy systems facilitated the service utilization. Furthermore, health facility-related facilitators include the availability of HEWs; free services; supervision and monitoring; maternity waiting rooms; and access to ambulance services. Maternal and newborn health services were affected by community-related barriers (i.e., distance, topography, religious and socio-cultural beliefs/practices, unpleasant rumors, etc.,), health facility-related barriers (i.e., health worker’s behaviors; lack of logistics; lack of adequate ambulance service, and placement and quality of health post), and infrastructure (i.e., lack or poor quality of road and lack of water). Conclusions: The HEWs perceived and experienced a wide range of facilitators and barriers that affected maternal and newborn health services. The study findings warrant that there was a disparity in behavioral factors (awareness, beliefs, and behaviors) among community members, including pregnant women. This underscores the need to design health education programs and conduct social and behavioral change communication interventions to address individuals, families, and the broader community to enhance maternal and newborn health service utilization. On the other hand, the health sector should put into practice the available strategies, and health workers provide services with empathy, compassion, and respect.

A Rapid Systematic Review of Factors Influencing COVID-19 Vaccination Uptake in Minority Ethnic Groups in the UK

COVID-19 has disproportionately affected minority ethnic groups in the United Kingdom. To maximise the effectiveness of the vaccination programme, it is important to understand and address disparities in vaccine uptake. The aim of this review was to identify factors influencing COVID-19 vaccination uptake between minority ethnic groups in the UK. A search was undertaken in peer-reviewed databases, polling websites and grey literature from January 2020-May 2021. Studies were included if they reported data on vaccine uptake or the reasons for or against accepting the COVID-19 vaccination for minority ethnic groups in the UK. Twenty-one papers met the inclusion criteria, all of which were rated as either good or moderate quality. Ethnic minority status was associated with higher vaccine hesitancy and lower vaccine uptake compared with White British groups. Barriers included pre-existing mistrust of formal services, lack of information about the vaccine's safety, misinformation, inaccessible communications, and logistical issues. Facilitators included inclusive communications which address vaccine concerns via trusted communicators and increased visibility of minority ethnic groups in the media. Community engagement to address the concerns and informational needs of minority ethnic groups using trusted and collaborative community and healthcare networks is likely to increase vaccine equity and uptake.

Detailed characterization of the UMAMIT proteins provides insight into their evolution, amino acid transport properties, and role in the plant

Amino acid transporters play a critical role in distributing amino acids within the cell compartments and between plant organs. Despite this importance, relatively few amino acid transporter genes have been characterized and their role elucidated with certainty. Two main families of proteins encode amino acid transporters in plants: the amino acid-polyamine-organocation superfamily, containing mostly importers, and the UMAMIT (usually multiple acids move in and out transporter) family, apparently encoding exporters, totaling 63 and 44 genes in Arabidopsis, respectively. Knowledge of UMAMITs is scarce, based on six Arabidopsis genes and a handful of genes from other species. To gain insight into the role of the members of this family and provide data to be used for future characterization, we studied the evolution of the UMAMITs in plants, and determined the functional properties, the structure, and localization of the 47 Arabidopsis UMAMITs. Our analysis showed that the AtUMAMITs are essentially localized at the tonoplast or the plasma membrane, and that most of them are able to export amino acids from the cytosol, confirming a role in intra- and intercellular amino acid transport. As an example, this set of data was used to hypothesize the role of a few AtUMAMITs in the plant and the cell.

Policy Inertia on Regulating Food Marketing to Children: A Case Study of Malaysia

Unhealthy food marketing shapes children’s preference towards obesogenic foods. In Malaysia, policies regulating this food marketing were rated as poor compared to global standards, justifying the need to explore barriers and facilitators during policy development and implementation processes. The case study incorporated qualitative methods, including historical mapping, semi-structured interviews with key informants and a search of cited documents. Nine participants were interviewed, representing the Federal government (n = 5), food industry (n = 2) and civil society (n = 2). Even though the mandatory approach to government-led regulation of food marketing to children was the benchmark, more barriers than facilitators in the policy process led to industry self-regulations in Malaysia. Cited barriers were the lack of political will, industry resistance, complexity of legislation, technical challenges, and lack of resources, particularly professional skills. The adoption of industry self-regulation created further barriers to subsequent policy advancement. These included implementer indifference (industry), lack of monitoring, poor stakeholder relations, and policy characteristics linked to weak criteria and voluntary uptake. These underlying barriers, together with a lack of sustained public health advocacy, exacerbated policy inertia. Key recommendations include strengthening pro-public health stakeholder partnerships, applying sustained efforts in policy advocacy to overcome policy inertia, and conducting monitoring for policy compliance and accountability. These form the key lessons for advocating policy reforms.

Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study

Background

Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation.

Objective

The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high).

Methods

This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018.

Results

A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students’ mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents.

Conclusions

The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types.

Barriers and facilitators to implementing and sustaining peer support in kidney care

Introduction

Peer support offers informational, appraisal and emotional support for people with kidney disease, is recommended in national policy, yet has low engagement levels. This paper reports results of a national survey and qualitative interviews in the UK with the aim of increasing understanding of peer support availability and its barriers and facilitators.

Literature Review

A recent narrative review highlighted the barriers and facilitators to peer support uptake among people with kidney disease however called on further studies to be conducted.

Material and Methods

The survey, adapted from a 2012 version, was sent to all 83 UK kidney units. Semistructured interviews were conducted with staff, recipients and supporters from two units.

Results

Forty‐four units completed the survey, and 10 staff, 7 patients and 2 peer supporters were interviewed. The most common facilitators were promotion with staff and having peer support champions. Barriers included lack of staff time, guidance/information, other projects taking priority and too few supporters.

Discussion

Little progress has been made since 2012; a proportion of units without peer support remains significant, with similar barriers identified in 2020. Services could be designed to limit the time needed for their creation and maintenance through having simpler referrals and designating staff liaisons.

Implications for Clinical Practice

Peer support programmes should have passionate staff and volunteers, involve recipients in the design, recruit an array of supporters and establish evaluations to determine the progress/outcomes. A resource toolkit was developed in response to this project.

Conclusion

Findings from the national survey and qualitative interviews showed that more peer support optimisation and prioritisation is needed to ensure benefits are maximised.

Barriers and Facilitators of Nurses' and Physicians' Willingness to Work during a Respiratory Disease Outbreak: A Mixed-Methods Systematic Review

This review was undertaken to identify the perceived barriers and facilitators of nurses’ and physicians’ willingness to work during a respiratory disease outbreak. This mixed-methods systematic review involved the extraction of data from the electronic databases PubMed, Web of Science, CINAHL, and PsycINFO and from a manual search of articles published between 2003 and April 2021. The quality of the included studies was assessed using a mixed-method appraisal tool. A total of 29 studies were eligible for inclusion: 21 quantitative and 8 qualitative. Using the Integrated Behavioral Model, perceived barriers and facilitators were identified under seven categories: demographics, attitude, perceived norm, personal agency, knowledge and skills to perform the behavior, environmental constraints, and habit. The results of this study broaden the understanding of various factors that affect nurses’ and physicians’ willingness to work during a respiratory disease outbreak. These findings will facilitate the modification of current pandemic workplace staffing strategies and practices and will inform preparedness planning for similar situations in the future.

Worker roles in the open labor market: The challenges faced by people with intellectual disabilities in the Western Cape, South Africa

BACKGROUND

Work holds great meaning and benefits beyond just monetary gain for people with intellectual disabilities. It gives these individuals the opportunity to engage in meaningful occupation.

OBJECTIVE

The purpose of the study was to explore challenges that people with intellectual disabilities (PWID) experience when adapting to their worker roles in the open labor market.

METHODS

The study used grounded theory as the research design. Five male participants and two key informants participated in the study. Two semi structured interviews were conducted with each one of the seven participants (five PWID and two key informants).

RESULTS

Three core concepts emerged: 1) Unforeseen challenges of change; 2) A well-planned work preparation program enables success and 3) Crossing the bridge into the workplace: "Do I belong here?"

CONCLUSIONS

This indicated that with sufficient external support, PWID are able to gain a sense of social belonging and develop the necessary skills to cope with challenges that arise in the workplace when PWID transition from protective/sheltered workshops to the open labor market. The findings of the study also indicated that work preparation programs and supportive employment approaches helped PWID transition to the open labor market.

Brainstorming With a Social Robot Facilitator: Better Than Human Facilitation Due to Reduced Evaluation Apprehension?

Brainstorming is a creative technique used to support productivity and creativity during the idea generation phase of an innovation process. In professional practice, a facilitator structures, regulates, and motivates those behaviors of participants that help maintain productivity and creativity during a brainstorm. Emerging technologies, such as social robots, are being developed to support or even automate the facilitator’s role. However, little is known about whether and how brainstorming with a social robot influences productivity. To take a first look, we conducted a between-subjects experiment (N = 54) that explored 1) whether brainstorming with a Wizard-of-Oz operated robot facilitator, compared to with a human facilitator, influences productivity; and 2) whether any effects on productivity might be explained by the robot’s negative effects on social anxiety and evaluation apprehension. The results showed no evidence for an effect of brainstorming with a teleoperated robot facilitator, compared to brainstorming directly with a human facilitator, on productivity. Although the results did suggest that overall, social anxiety caused evaluation apprehension, and evaluation apprehension negatively affected productivity, there was no effect of brainstorming with a robot facilitator on this relationship. Herewith, the present study contributes to an emerging body of work on the efficacy and mechanisms of the facilitation of creative work by social robots.

The effectiveness of faculty development activities for interprofessional education : A systematic review protocol

Despite increasing international demand for interprofessional education (IPE) in health care, there remains limited understanding of the kind of faculty development (FD) activities needed. This paper reports on a protocol for a systematic review to answer the question: What are the available FD activities for IPE facilitators, and which are more effective? The review aims to identify principles and methods to develop competent facilitators in IPE and to identify the implications and effects of FD for IPE concerning individuals, organizations, education, and health practice. Literature was identified through systematic searches in the electronic databases: MEDLINE (Ovid), Embase (Ovid), Eric (EBSCO), CINAHL (EBSCO), Scopus, and Web of Science. There will be no restrictions on language or publication period. Screening of potential studies will be completed independently by at least two reviewers. The research quality of studies will be assessed for methodological rigor using established instruments based on the Critical Appraisal Skills Programme. Search results will be summarized using the PRISMA flow diagram. The proposed review seeks to provide clarity on the evidence base of FD for IPE facilitators, to strengthen future design and delivery of FD activities, and to enable ongoing success of this educational model.

Q-methodology identifies distinctive viewpoints of the facilitators and barriers to six-month exclusive breastfeeding in Northeast Thailand

BACKGROUND

The six-month exclusive breastfeeding (EBF) rate almost halved between 2009 and 2013 in Northeast Thailand for no clear reason. Specific facilitators and barriers to six-month EBF have been identified for Thailand, but mothers' views on these factors to continuing EBF breastfeeding until six months have not been explored in this region.

AIM

This study aimed to prioritize mothers' views on the identified facilitators and barriers of continuing six-month exclusive breastfeeding. Methods: Q-methodology was applied. This research was conducted at Well Baby Out-Patient Department of Khonkaen Hospital, Numphong Hospital and a private hospital. Thirty-four mothers, who had recently delivered infants aged between four and six months, were breastfeeding/had breastfed, were 20 to 40 years old, participated. Demographic data were analysed descriptively, and Q-method analysis was conducted using the PQ Method software 2.35.

RESULTS

There was consensus that having knowledge about the advantages of EBF was the most important facilitator of six-month EBF, and 'not having any other responsibilities besides caring for her infant' was the least important facilitator of six-month EBF. Three viewpoints emerged identifying different groups/clusters of mothers, namely, (1) caring for self, (2) requiring support and (3) breastfeeding knowledge. Conclusions: Despite some consensus among participants, three distinct viewpoints emerged regarding which facilitators and barriers were important to mothers. It is clear that a programme to improve the six-month EBF rate in Northeast Thailand would need to incorporate interventions or activities that address the different viewpoints identified.