Considerations, barriers and enablers of deprescribing among healthcare professionals in Ogun State, Southwest, Nigeria: a cross-sectional survey

BACKGROUND

Deprescribing is a clinical intervention aimed at managing polypharmacy and improving older adults' health outcomes. However, evidence suggests that healthcare professionals (HCPs) may face challenges in implementing the intervention. This study aimed to explore the considerations, barriers and enablers of deprescribing among HCPs in Southwest Nigeria.

METHODS

A quantitative cross-sectional survey was carried out among consecutively sampled HCPs including physicians, pharmacists and nurses in two public tertiary healthcare hospitals in Ogun State, Southwest, Nigeria. A structured 43-item self-administered questionnaire was used to explore the participants' sociodemographics, HCPs' experience, considerations, barriers and enablers of deprescribing in older adults. The data were summarised using descriptive statistics including frequency and percentage. The Kruskal-Wallis test was used to determine differences in perceptions among the groups on a Likert scale. A p-value < 0.05 was considered significant.

RESULTS

Overall, 453 copies of the questionnaire were analysed. Of the participants 204 (45.0%) were within the age group of 20-30 years; 173 (38.2%) claimed that older adults occasionally requested deprescribing of their medications. The majority (417; 92.1%) considered patients' quality of life to be very important in deprescribing; 423 (93.4%) opined that having a care goal known to members of the HCP team is an enabler for deprescribing while 308 (68.0%) disagreed or strongly disagreed that lack of incentives and remuneration for HCPs that de-prescribe is a barrier to deprescribing. There is a significant difference among the participants across professional groups on the assertion that pressure from pharmaceutical companies is a barrier to deprescribing in older adults (p = 0.037).

CONCLUSIONS

The participants in this study had various considerations for deprescribing medication in older adults including patients' quality of life. Having a care goal known to every HCP involved in managing a patient is an enabler for deprescribing while the lack of incentives and remuneration for HCPs that de-prescribe may not necessarily be a barrier to deprescribing. There is a need for regulations and policies to support the identified enablers among HCPs and reduce the barriers to effective deprescribing process.

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria

BACKGROUND

School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents.

METHODS

The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes.

RESULTS

The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level.

CONCLUSIONS

The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Barriers and enablers of post-COVID-19 acute care follow-up in Nigeria from service providers' perspective: a nominal group technique

BACKGROUND

Despite modest efforts to study and document the complications that arise after acute treatment of patients with coronavirus disease, its ramifications and regional variations are yet to be clearly understood. Progress in sub-Saharan Africa, notably Nigeria, has been impeded by patient disengagement from care and insufficient or non-existent follow-up arrangements. The aim of this study was to describe the barriers and enablers for follow-up services after discharge from COVID-19 care pathway in Nigeria.

METHODS

Seventeen experts involved directly in the care of patients with COVID-19 participated in brainstorming using the nominal group technique during a national workshop to review the new guidelines for COVID-19 case management in Nigeria. Participants discussed the barriers and facilitators of post-acute care follow-up of patients discharged from COVID-19 pathway and ranked their recommendations to arrive at three major factors per question.

RESULTS

Participants were mostly middle aged and predominantly clinicians. The top three barriers were patients' perception of their symptom severity, lack of organizational clarity/structure/policies on follow-up care after discharge, and financial constraints. Similarly, participants identified providers' initiated education on the reasons for follow-up at discharge, written organizational policies/structure and clarity and free follow-up services as the top three facilitators.

CONCLUSION

This study has enumerated barriers to follow-up care after discharge patients with coronavirus disease and highlighted providers, institutional and governmental responses that will facilitator follow-up care after discharge of patients with COVID-19. The implication is that, there is need for clear institutional guidelines for tracking and documenting post-COVID condition. In the future, it would be necessary to assess the achievements and shortcomings of post-COVID condition tracking in Nigeria through the use of implementation science outcomes.

Men's involvement in maternal health in sub-Saharan Africa: A scoping review of enablers and barriers

BACKGROUND

Globally, there are about 800 maternal deaths every day, with low-to-middle-income countries accounting for most of these deaths. A lack of access to maternal healthcare services is one of the main causes of these deaths. In sub-Saharan Africa (SSA), one of the barriers to accessing maternal healthcare services by women is a lack of their male partners' involvement. This scoping review aimed to assess the enablers and barriers to men's involvement in maternal healthcare services.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist was used as a guide for this review. We searched for peer-reviewed articles published between 2013 and 2023 in the English language from SCOPUS, ScienceDirect, PubMed, Africa Journals Online (AJOL), and Google Scholar databases. Two reviewers independently conducted the data extraction and article selection. All of the authors discussed and decided on the codes and categories for enablers and barriers after using NVivo to generate them.

RESULTS

Twenty-seven articles were used in this review. Of these, seventeen were qualitative studies, six were quantitative studies, and four were mixed-methods studies. The enablers of men's involvement in maternal healthcare were grouped into sociodemographic factors, health system factors, and policy factors, while barriers were grouped into sociodemographic, cultural, economic, and health system barriers. The lack of maternal health knowledge, insufficient economic resources, and unfriendly staff at healthcare facilities all contributed to a lack of involvement by men.

CONCLUSION

To improve men's involvement in maternal healthcare in SSA, there should be economic empowerment of both men and women, health education, and the provision of adequate infrastructure in healthcare facilities to accommodate men.

Developing effective In-Service Education for intensive care nurses: Exploring the views of clinical stakeholders in the Kingdom of Saudi Arabia

BACKGROUND

Evidence-based in-service education (ISE) in the intensive care unit (ICU) is essential to maintaining nurse skill and competence in this complex clinical area. However, there has been limited research that has focused on developing and optimising the specialised training required by ICU nurses working in trauma care.

OBJECTIVES

To explore the perspectives of ICU clinical stakeholders regarding their needs and preferences for ISE to inform the future development and implementation of effective educational interventions.

DESIGN

A qualitative, multiple-case study supported by the "Empowering Education" theoretical framework, which emphasises the importance of stakeholder involvement in education development.

SETTINGS

Adult ICUs in three major hospitals located in two geographical areas in Saudi Arabia.

PARTICIPANTS

Forty clinical nurses, twelve nurse managers, nine nurse leaders and seven clinical educators participated.

METHODS

Data were collected through semi-structured interviews followed by focus groups. Framework analysis was used for data analysis.

FINDINGS

Stakeholders wanted ISE and training by subject experts characterised by: (i): relevant educational content; (ii): a range of educational techniques and (iii) flexible delivery and format. Nurses also identified factors that encouraged them to participate in ISE including adequate resources and a supportive work environment, whilst heavy workloads, cost and scheduling issues hindered engagement.

CONCLUSION

This paper highlights the importance of considering staff needs and local context when developing in-service ICU education to support nurses' competence. Further recommendations and a proposed framework to develop future ISE in the ICU are provided.

TWEETABLE ABSTRACT

The key to effective in-service education for ICU nurses is understanding stakeholders' needs and motivational drivers, whilst addressing barriers to successful implementation.

"Are we there yet?" expectations and experiences with lower limb robotic exoskeletons: a qualitative evaluation of the therapist perspective

PURPOSE

Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation.

METHODS

Australian and New Zealand-based therapists with lower limb exoskeleton experience were recruited to complete an online survey and semi-structured interview. Survey data were transposed into tables and interviews transcribed verbatim. Qualitative data collection and analysis were guided by qualitative content analysis and interview data were thematically analysed.

RESULTS

Five participants revealed that the use of exoskeletons to deliver therapy involves the interplay of human elements - experiences and perspectives of use, and mechanical elements - the device itself. Two overarching themes emerged: the "journey", with subthemes of clinical reasoning and user experience; and the "vehicle" with design features and cost as subthemes, to explore the question "Are we there yet?"

CONCLUSION

Therapists expressed positive and negative perspectives from their experiences with exoskeletons, giving suggestions for design features, marketing input, and cost to enhance future use. Therapists are optimistic that this journey will see lower limb exoskeletons integral to rehabilitation service delivery.

Electric vehicles' choice behaviour: An emerging market scenario

Worldwide, the adoption of electric automobiles is gaining momentum, owing to a steady rise in customers' sustainability consciousness. So far, electric vehicle-related studies have investigated consumer motives, attitudes, and intentions toward adoption. However, empirical research on enablers and inhibitors of electric vehicle choice behaviour has not been fully explored, particularly in an emerging market context, (e.g., India). The present study employed a judicious mix of three notable theoretical lenses of dual-factor theory, innovation resistance theory, and the stimulus-organism-response model to empirically scrutinize electric vehicle adoption enablers and inhibitors by analysing data collected from 391 young Indian sustainability-oriented electric vehicle users. The sample was gathered via the purposive sampling method, and the data was analysed employing structural equation and PROCESS macro modelling. The research posits that consumer sustainability consciousness (CSC) is a stimulus with a positive influence on enablers (e.g., personal motives, social motives, and incentive policy) as well as inhibitors (e.g., usage, value, and risk barriers). Additionally, product involvement and perceived marketplace influence significantly moderate the relationship between choice behaviour and facilitators and inhibitors. The research offers a few useful strategic decision-making insights for electric vehicle manufacturers, green marketers, and policymakers from emerging markets.

Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies

BACKGROUND

Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and  management of cervical cancer in sub-Saharan Africa.

METHODS

We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels).

RESULTS

We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women's relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers' networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers' profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social-cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure.

CONCLUSIONS

There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented  across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.

Barriers and Enablers of Diabetes Self-Management Strategies Among Arabic-Speaking Immigrants Living with Type 2 Diabetes in High-Income Western countries- A Systematic Review

The aim of this review is to investigate barriers and enablers of diabetes self-management strategies among migrant Arabic-speaking background [ASB] individuals living with type 2 diabetes in high-income Western countries. Despite living in high-income Western countries, individuals from ASB are perceived to have difficulties adopting self-management strategies and this necessitates gaining an understanding of factors that may impact the uptake of these strategies. Ten studies are included in this review: five quantitative and five qualitative. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal and Hawker tools. The findings of the quantitative studies were descriptively analysed, while thematic analysis was performed for the qualitative studies. The results indicate that individuals from ASB are perceived to have low levels of adherence to diabetes self-management. It is also suggested that participants who did not complete high school have poorer glycaemic control compared to those with a high school qualification (30 vs. 16%). Regular exercise was reported to be less likely to be adopted by ASBs homemakers, and those who were unemployed, by 82% and 70%, respectively, compared to those employed (homemakers: OR = 0.187, P = 0.006; 95% CI = 056-0.620), (unemployed OR = 0.30, P = 0.046; 95% CI = 0.093-0.980). Cultural, social, religious beliefs, lack of knowledge and language barriers are some of the factors identified that impact self-management among ASB individuals. It is suggested that diabetes self-management education program (DSME) tailored to ASB immigrants culture may be an effective way to encourage them to uptake self-management strategies.

Patients' experience of accessing hepatitis C treatment through the Myanmar national hepatitis C treatment program: a qualitative evaluation

BACKGROUND

Globally, 56.8 million people are living with hepatitis C and over three-quarters of those reside in low and middle-income countries (LMICs). Barriers and enablers to hepatitis C care among people who inject drugs in high-income countries are well documented. However, there is scant literature describing the patient experience in LMICs. Understanding the barriers and enablers to care from the patient perspective is important to inform service refinements to improve accessibility and acceptability of hepatitis C care.

METHODS

We conducted a qualitative evaluation of the patient experience of accessing the national hepatitis C program at eight hospital sites in Myanmar. Semi-structured interviews were conducted with four to five participants per site. Interview data were analysed thematically, with deductive codes from Levesque et al.'s (2013) Framework on patient-centred access to healthcare.

RESULTS

Across the eight sites, 38 participants who had completed treatment were interviewed. Barriers to accessing care were mostly related to attending for care and included travel time and costs, multiple appointments, and wait times. Some participants described how they did not receive adequate information on hepatitis C, particularly its transmission routes, and on the level of cirrhosis of their liver and what they were required to do after treatment (i.e. reduce alcohol consumption, liver cirrhosis monitoring). Many participants commented that they had few or no opportunities to ask questions. Provision of treatment at no cost was essential to accessibility, and gratitude for free treatment led to high acceptability of care, even when accessing care was inconvenient.

CONCLUSIONS

These findings highlight the importance of streamlining and decentralising health services, adequate human resourcing and training, and affordable treatment in maximising the accessibility and acceptability of hepatitis C care in LMICs. Findings from this work will inform future service delivery refinements for national program and other decentralised programs to improve accessibility and acceptability of hepatitis C care in Myanmar.

Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in Malaysia (MySaltOH) from the perspective of street food vendors, caterers and consumers

OBJECTIVE

To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.

DESIGN

A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.

SETTING

Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.

PARTICIPANTS

Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.

RESULTS

Consumers and food operators perceived a high-salt intake within Malaysia's out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.

CONCLUSIONS

These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia's out-of-home sectors.

Barriers and enablers to the family meal across time; a grounded theory study comparing South Australian parents' perspectives

Family meals are positively associated with numerous beneficial health and social outcomes. Current discourse however claims that parents are faced with numerous barriers when trying to bring the family together to share a meal. Solutions for overcoming barriers to a positive shared family meal are often individualistic and do not address the systemic pressures and burdens families have faced for decades. The aim of this study was to explore the systemic and novel barriers and enablers to shared family meals as experienced by families across time. To achieve this, a qualitative study informed by grounded theory was conducted. Parents of South Australian families were recruited and interviewed in the 1990s, and a new sample of parents were recruited and interviewed in 2020. Transcripts were analysed using grounded theory and comparative analysis methods. Thirty-two parents from 16 families were interviewed in the 1990s, and 22 parents from 10 families in 2020. Ten factors were identified presenting as either enablers or barriers to the family meal, depending on the context they were experienced. Barriers and enablers were largely consistent across time. Scheduling and flexibility, children's disruptions and children's independence, privileges required to have family meals and motivation and commitment to the family meal were identified as persistent enablers and barriers across time. These findings indicate that parents are faced with similar challenges they have been facing for decades and are still not being adequately supported to execute family meals regularly. Recognising that factors present as either barriers or enablers to the family meal provides us with opportunities to transform barriers to enablers and support families to have regular, meaningful family meals.

BARRIERS AND ENABLERS OF INTERPROFESSIONAL COLLABORATION (IPC) AMONG HEALTH WORKERS IN A NIGERIAN TEACHING HOSPITAL

Introduction

Interprofessional collaboration is crucial to the optimal functioning of every health system because the complex nature of healthcare requires that health workers from different allied professions work as a team to deliver quality health to the patients. Identifying the enhancing factors and barriers to this synergy is essential to safe and efficient healthcare delivery. This study addresses this issue in Nigeria, where inter-professional rivalry is rife.

Objective

To determine the enablers of, and barriers to, interprofessional collaboration in Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.

Methodology

The study adopted the proportionate stratified random sampling technique to recruit 266 staff of the hospital across the different health professions. Data was collected using an adapted version of the Assessment of Interprofessional Team Collaboration Scale (AITCS) and data analysis was done using the Statistical Package for Social Sciences version 23.0. The ideal scores pre-set were 4.0 for the enablers and 2.0 for the barriers. Ethical review for the study was obtained from the Ethics Review Committee of the hospital.

Results

The mean score for the enablers was 4.28, and the strongest enabler of IPC identified was a climate of mutual respect, dignity, and trust among team members (4.36). On the other hand, the mean score for the barriers was 3.80, and the strongest barrier to IPC was the lack of role clarification (3.84).

Conclusion

The study revealed a strong level of enablers to IPC in ATBUTH. However, the barriers were above the set threshold, suggesting a significant impediment to IPC. The hospital should strengthen the identified enablers while making efforts to reduce the barriers. This type of study is also recommended for other hospitals in the country.

Barriers to and Facilitators of Implementing Guidelines for Detecting Familial Hypercholesterolaemia in Australia

BACKGROUND

Familial hypercholesterolaemia (FH) is a genetic condition that is a preventable cause of premature cardiovascular morbidity and mortality. High-level evidence and clinical practice guidelines support preventative care for people with FH. However, it is estimated that less than 10% of people at risk of FH have been detected using any approach across Australian health settings. The aim of this study was to identify the implementation barriers to and facilitators of the detection of FH in Australia.

METHODS

Four, 2-hour virtual focus groups were facilitated by implementation scientists and a clinicians as part of the 2021 Australasian FH Summit. Template analysis was used to identify themes.

RESULTS

There were 28 workshop attendees across four groups (n=6-8 each), yielding 13 barriers and 10 facilitators across three themes: (1) patient related, (2) provider related, and (3) system related. A "lack of care pathways" and "upskilling clinicians in identifying and diagnosing FH" were the most interconnected barriers and facilitators for the detection of FH.

CONCLUSIONS

The relationships between barriers and facilitators across the patient, provider, and system themes indicates that a comprehensive implementation strategy is needed to address these different levels. Future research is underway to develop a model for implementing the Australian FH guidelines into practice.

Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist

BACKGROUND

Computerized clinical decision support systems (CDSSs) can improve care by bridging knowledge to practice gaps. However, the real-world uptake of such systems in health care settings has been suboptimal. We sought to: (1) use the Theoretical Domains Framework (TDF) to identify determinants (barriers/enablers) of uptake of the Electronic Asthma Management System (eAMS) CDSS; (2) match identified TDF belief statements to elements in the Guideline Implementation with Decision Support (GUIDES) Checklist; and (3) explore the relationship between the TDF and GUIDES frameworks and the usefulness of this sequential approach for identifying opportunities to improve CDSS uptake.

METHODS

In Phase 1, we conducted semistructured interviews with primary care physicians in Toronto, Canada regarding the uptake of the eAMS CDSS. Using content analysis, two coders independently analyzed interview transcripts guided by the TDF to generate themes representing barriers and enablers to CDSS uptake. In Phase 2, the same reviewers independently mapped each belief statement to a GUIDES domain and factor. We calculated the proportion of TDF belief statements that linked to each GUIDES domain and the proportion of TDF domains that linked to GUIDES factors (and vice-versa) and domains.

RESULTS

We interviewed 10 participants before data saturation. In Phase 1, we identified 53 belief statements covering 12 TDF domains; 18 (34.0%) were barriers, and 35 (66.0%) were enablers. In Phase 2, 41 statements (77.4%) linked to at least one GUIDES factor, while 12 (22.6%) did not link to any specific factor. The GUIDES Context Domain was linked to the largest number of belief statements (19/53; 35.8%). Each TDF domain linked to one or more GUIDES factor, with 6 TDF domains linking to more than 1 factor and 8 TDF domains linking to more than 1 GUIDES domain.

CONCLUSIONS

The TDF provides unique insights into barriers and enablers to CDSS uptake, which can then be mapped to GUIDES domains and factors to identify required changes to CDSS context, content, and system. This can be followed by conventional mapping of TDF domains to behaviour change techniques to optimize CDSS implementation. This novel step-wise approach combines two established frameworks to optimize CDSS interventions, and requires prospective validation.

Barriers and enablers of breast cancer screening among women in East Africa: a systematic review

BACKGROUND

Breast cancer is among the most common cancers globally with a projected increase in incidence and mortality in low- and middle-income countries. The majority of the patients in East Africa present with advanced disease contributing to poor disease outcomes. Breast cancer screening enables earlier detection of the disease and therefore reduces the poor outcomes associated with the disease. This study aims to identify and synthesize the reported barriers and enablers of breast cancer screening among East African women.

METHODS

Medline, Embase, SCOPUS, and Cochrane library were searched for articles published on the subject from start to March 2022 using PRISMA guidelines. Also, forward citation, manual search of references and searching of relevant journals were done. A thematic synthesis was carried out on the "results/findings" sections of the identified qualitative papers followed by a multi-source synthesis with quantitative findings.

RESULTS

Of 4560 records identified, 51 were included in the review (5 qualitative and 46 quantitative), representing 33,523 women. Thematic synthesis identified two major themes - "Should I participate in breast cancer screening?" and "Is breast cancer screening worth it?". Knowledge of breast cancer and breast cancer screening among women was identified as the most influencing factor.

CONCLUSION

This review provides a rich description of factors influencing uptake of breast cancer screening among East African women. Findings from this review suggest that improving knowledge and awareness among both the public and providers may be the most effective strategy to improve breast cancer screening in Eastern Africa.

Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families' use of evidence-based vegetable feeding practices

Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: 'Child factors', 'Eating beliefs', 'Effectiveness beliefs', 'Past experience', 'Current family behaviours', 'Harms', 'Knowledge', 'Need for change', 'Parent effort', 'Parent values' and 'Practical issues'. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a "protective mindset" that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake.

Enhancing linkage to HIV care in the "Universal Test and Treat" era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa

Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the 'Universal Test and Treat' (UTT) strategy - initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients' perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support.

Indonesian agroindustry business agility: Enablers and challenges in the poultry industry based on ISM model

The Indonesian agroindustry is a crucial sector for food security, comprising several platforms such as the poultry industry that play a role in providing animal protein. Despite the advantages portrayed by the poultry sector in the country, stiff competition is still encountered with business transformation situation. The rigid and static structures of the Indonesian poultry industry are also reflected in bureaucracy, fear-based cultures, the inefficiency of functional silos, and aversion to change, leading to the need for appropriate agility incorporation. Therefore, this study aims to identify and analyze the key challenges and enablers influencing the achievement of business agility, as well as construct a structural interpretation model for the process through ISM (Interpretative Structural Modeling). The results showed that the hierarchical structure establishment of the influential factors emphasized a logical linkage through ISM implementation. This structural level also identified the major challenges to attaining business agility, indicating the difficulties encountered in work culture transformation and mindset adjustment toward an agile orientation. Meanwhile, management response and knowledge deftness are key enablers in achieving business agility. These results are expected to help business professionals in implementing sustainable organizational model, due to the existence of business agility.

Modeling key enablers influencing FinTechs offering SME credit services: A multi-stakeholder perspective

The study models inter-relationship among key enablers that influence the growth of FinTechs that offer credit services to small and medium enterprises (SMEs). It focuses on emerging market of India, which is the world's third-largest FinTech centre. It employs Grey DEMATEL method to measure the cause-effect relationship based on the assessment given by FinTech practitioners, experts, policymakers, and investors. The results show that credit demand by SME borrowers, availability of alternate data sources, and Covid-19 are the critical enablers that exercise strong impact on FinTech system. Collaboration between FinTechs and traditional financial institutions, end-to-end financial solutions, and scalability of business operations are recognized as critical dependents that are hugely affected by others. The study recommends policymakers to foster collaborative environment, strengthen digital data landscape, and improve financial literacy to develop FinTech sector. It recommends practitioners to focus on data security and to offer end-to-end financial solutions to its SME borrowers.

Identification and ranking of enablers to green technology adoption for manufacturing firms using an ISM-MICMAC approach

The debate about the adoption of green technologies (GTs) is trending due to increasing environmental concerns across the globe. In the context of the manufacturing industry, the research about enablers to GT adoption while using the ISM-MICMAC approach is scarce. Hence, the empirical analysis of GT enablers is being done in this study using a novel ISM-MICMAC method. Firstly, the research framework is developed by using the ISM-MICMAC methodology. Then, enablers to GTs were extracted from existing studies and validated by experts. Results showed that the most significant enabler to GT adoption is providing incentives for green manufacturers (1) in the ISM model. So, manufacturing firms must take initiatives for GTs to mitigate the negative environmental impact of industrialization without losing their earnings. This research brings substantial empirical scholarship to understand GT enablers and their contribution in GT enabler incorporation in the manufacturing industry of developing economies.

Women's and health providers' perceptions of companionship during labor and childbirth: a formative study for the implementation of WHO companionship model in Burkina Faso

INTRODUCTION

A key component of achieving respectful maternal and newborn care is labor companionship. Despite important health benefits for the woman and baby, there are critical gaps in implementing labor companionship for all women globally. The paper aims to present the perceptions and experiences of pregnant women, postpartum women, and health care providers regarding companionship during labor and childbirth, and to identify barriers and facilitating factors to the implementation of labor companionship in Burkina Faso.

METHODS

This is a formative study to inform the "Appropriate use of cesarean section through QUALIty DECision-making by women and providers" (QUALI-DEC) study, to design, adapt and implement a strategy to optimize the use of the cesarean section, including labor companionship. We use in-depth interviews (women, potential companions, and health workers) and health facility readiness assessments in eight hospitals across Burkina Faso. We use a thematic analysis approach for interviews, and narrative summaries to describe facility readiness assessment.

RESULTS

In all, 77 qualitative interviews and eight readiness assessments are included in this analysis. The findings showed that all participants acknowledged an existing traditional companionship model, which allowed companions to support women only in the hospital waiting room and post-natal room. Despite recognizing clear benefits, participants were not familiar with companionship during labor and childbirth in the hospital as recommended by WHO. Key barriers to implementing companionship throughout labor and birth include limited space in labor and delivery wards, no private rooms for women, hospital rules preventing companionship, and social norms preventing the choice of a companion by the woman.

CONCLUSION

Labor companionship was considered highly acceptable in Burkina Faso, but more work is needed to adapt to the hospital environment. Revisions to hospital policies to allow companions during labor and childbirth are needed as well as changes to provide private space for women. Training potential companions about their roles and encouraging women's rights to choose their companions may help to facilitate effective implementation.

Towards defining and supporting pharmacists' professional role associated with traditional and complementary medicines - A systematic literature review

BACKGROUND

A review conducted in 2015 reported community pharmacists are willing to adopt a professional role in counselling consumers about the appropriate and safe use of traditional and complementary medicines (T&CM) but faced multiple barriers in doing so; including the role being poorly defined. This current review aimed to update and extend these findings, by identifying studies published since 2015 that reported on pharmacists across any setting.

METHODS

Eligible studies published between January 01, 2016 and December 31, 2021 were identified across six databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). A grounded theory approach was used to thematically synthesize the data extracted.

FINDINGS

A total 64 studies representing pharmacists across 30 countries were included for review. Study designs varied including cross-sectional surveys (n = 36), qualitative studies (n = 14), and pseudo-patient studies (n = 3). Eight studies reported on practice and/or bioethical responsibilities and 19 studies reported on factors that would enable pharmacists to fulfill these responsibilities, while 37 studies reported about both.

CONCLUSION

These findings indicate research about pharmacists' responsibilities associated with T&CM is evolving from gap analysis towards research that is proactive in advocating for change in multiple areas. These findings can be used to inform a consensus discussion among pharmacists and key stakeholders regarding a set of professional responsibilities that would serve in the development of: a clearly defined role and associated practice standards, and competency requirements that inform educational learning objectives for inclusion in undergraduate, post-graduate and continuing professional pharmacy education.

Barriers and enablers to telehealth use by physiotherapists during the COVID-19 pandemic

OBJECTIVES

To investigate the perceived barriers and enablers experienced by physiotherapists whilst delivering community and outpatient services during the COVID-19 pandemic.

METHODS

Qualitative study undertaken at a University-affiliated hospital in Melbourne, Australia. Physiotherapists working in the outpatient setting participated in a semi-structured interview. Interviews were analysed using Framework Analysis, with themes mapped to the Theoretical Domains Framework (TDF).

RESULTS

From 19 interviews, we identified major themes and mapped these to the TDF domains: 1. The pandemic rapidly closed the knowledge-practice gap; 2. Adaptation of existing skills and integration of new skills were required; 3. Supportive senior leadership helped the transition; 4. Capabilities and confidence improved with time; 5. Environmental factors were crucial to success or failure of telehealth; 6. Access to and delivery of care improved for some; 7. Identification of appropriate patients and future hybrid models of care; 8. Changes in work practices, role certainty and identity; 9. Development of educational resources consolidated knowledge; 10. Socialisation of telehealth and optimism for the future. Within each domain, key barriers and enablers were also identified.

CONCLUSIONS

The findings of this study suggest that the delivery of community and outpatient physiotherapy via telehealth during the COVID-19 pandemic was an initial challenge. Growing knowledge, confidence and ability to problem solve barriers enabled physiotherapists to move along the continuum of 'fear' to 'triumph' as the pandemic progressed. These results can be used by clinicians, managers, and academics to guide future workforce planning, hospital environmental design, and service delivery. CLINICAL MESSAGE.

Barriers and enablers associated with participation in a home-based pragmatic exercise snacking program in older adults delivered and monitored by Amazon Alexa: a qualitative study

BACKGROUND

'Exercise snacking', which is characterised by shorter and more frequent exercise bouts compared with traditional exercise guidelines, may be an acceptable strategy for increasing physical activity and reducing sedentary behaviour in older adults.

AIM

The aim of this study was to evaluate the enablers and barriers for older adults associated with participation in a home-based exercise snacking program delivered and monitored using an Amazon Echo Show 5 device (Alexa).

METHODS

This study used an interpretive description qualitative design to conduct semi-structured interviews following a 12-week pilot study in 15 adults aged 60-89 years with at least one chronic condition. All participants were prescribed a home based, individualised, lower limb focussed 'exercise snacking' program (involving ≤ 10 min of bodyweight exercises 2-4 times per day) delivered and monitored by an Alexa. Qualitative interview data were analysed using thematic analysis.

RESULTS

All 15 participants (mean age 70.3 years) attended the semi-structured interview. Themes including time efficiency, flexibility, perceived health benefits, and motivation were enablers for participation in the 'exercise snacking' program. A lack of upper body exercises and omission of exercise equipment in the program, as well as a lack of time and motivation for performing exercise snacks three or more times per day, were barriers to participation.

CONCLUSION

While 'exercise snacking' is acceptable for older adults, future trials should provide equipment (e.g. adjustable dumbbells, exercise bands), prescribe whole-body exercise programs, and establish strategies to support participation in more than three exercise snacks per day.

Enabling urban systems transformations: co-developing national and local strategies

Transformative urban development is urgent to achieve future sustainable development and wellbeing. Transformation can benefit from shared and cumulative learning on strategies to guide urban development across local to national scales, while also reflecting the complex emergent nature of urban systems, and the need for context-specific and place-based solutions. The article addresses this challenge, drawing on extensive transdisciplinary engagement and National Strategy co-development processes for Australia. This includes generation of two frameworks as boundary objects to assist such transdisciplinary strategy development. An 'enabling urban systems transformation' framework comprises four generic overarching transformation enablers and a set of necessary underpinning urban capacities. This also built cumulatively on other sustainability and urban transformation studies. A complementary 'knowledge for urban systems transformation' framework comprises key knowledge themes that can support an integrated systems approach to mission-focused urban transformations, such as decarbonising cities. The article provides insights on the transdisciplinary processes, urban systems frameworks, and scoping of key strategies that may help those developing transformation strategies from local to national scales. Science highlights • Transdisciplinary national urban strategy development is used to distil generic frameworks and strategy scopes with potential international application. • The frameworks also build on other published framings to support convergent, cumulative and transdisciplinary urban science. • The 'enabling transformations' and 'urban knowledge' frameworks include the perspective of those developing sustainable urban systems strategies. • The enabling framework also informs 'National Urban Policy' and 'Knowledge and Innovation Hub' strategies, and prevailing power imbalances. • The knowledge framework can help frame urban challenges, missions and knowledge programs. Policy and practice recommendations • An urban 'transformation imperative' and 'strategic response' can be co-developed from local to national scales. • Local initiative is crucial to drive urban strategies, but sustained national leadership with coherent policy across sectors and scales is also key. • Diversity in engagement participation and processes generates whole-of-urban-systems and local-to-national perspectives. • Urban solutions are context-specific but generic frameworks can help collaborative issue framing and responses. • Collaborative issue framing informed by generic frameworks can bring broader perspectives to context-specific and contested policy and practice issues.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s42854-023-00049-9.

Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries

BACKGROUND

High salt intake is a major cause of hypertension and cardiovascular diseases. The out-of-home sectors have been identified as one of the contributors of high salt intake in the population. The National Salt Reduction Policy of Malaysia was initiated in 2015; however, out-of-home sectors are yet to be emphasized and perception by policy-makers and the food industries towards salt reduction are yet unknown. This study aimed to determine the perceptions, barriers and enablers towards salt reduction in the out-of-home sector in Malaysia, as well as among policy-makers and the food industries.

METHODS

This is a qualitative study via semi-structured in-depth interviews (IDI) and focus group discussions (FGD) involving several stakeholders consisting of policy-makers from five ministries, five nongovernment organizations (NGOs) and food science/food technology researchers from five regions (West, North, East, and South Peninsular and East Malaysia/Borneo), as well as the food industries. The IDI and FGD sessions were recorded, transcribed verbatim and analysed thematically using Nvivo software version 12.

RESULTS

All participants agreed that salt intake in Malaysia is high and leads to hypertension and cardiovascular diseases. Lack of awareness, poor eating culture and behaviour and frequent eating out were among the causes of high salt intake. Awareness campaigns and education, sodium content labelling and product reformulation were strategies that have been implemented by the government; whilst for the food industries, some of them have tried to reduce salt and labelled the sodium content on their food products. However, there were several barriers including perceived poor consumer acceptance, lack of knowledge and resources, and challenges in reformulation, as well as unavailability of guidelines and salt targets. Hence, several enablers have been suggested, which include prioritizing the salt reduction strategy, creating more awareness, collaboration and engagement, research and technology particularly for reformulation and shelf-life stability, incentives and salt tax.

CONCLUSIONS

Salt reduction efforts of the out-of-home sector in Malaysia could be achieved through several measures or enablers that can overcome the barriers currently faced by stakeholders, especially policy-makers, food industries and the consumers themselves. This study will benefit the policy-makers to improve the salt reduction policy of out-of-home sectors and highlight the concerns among the food industries on the policy.

Enablers and barriers to healthy eating among hospital nurses: A systematic review

BACKGROUND

Nurses are the largest health professional body globally. Despite the significant role they play in healthcare, nurses exhibit poor dietary habits and have high rates of chronic diseases. Understanding the factors underlying healthy eating for nurses in the workplace is important to implement effective interventions.

OBJECTIVE

To identify enablers and barriers related to healthy eating among nurses employed in a hospital setting.

DESIGN

A systematic literature review of qualitative, quantitative, and mixed methods research (PROSPERO ID: CRD42021290913).

DATA SOURCES

A comprehensive systematic search was conducted across PubMed, CINAHL, Embase, Web of Science and ProQuest databases for papers published after January 2015.

METHODS

Two authors independently screened titles and abstracts of 4139 deduplicated studies, performed critical appraisals on eligible studies using the Mixed Methods Appraisal Tool and extracted data relevant to the research question. This review includes papers that examined nurses' eating behaviours specifically, were conducted in a hospital setting and distinguished healthy eating from other behaviours. Data synthesis was conducted through descriptive summarisation of studies and enablers and barriers were classified according to the socio-ecological model.

RESULTS

A total of 29 studies were identified with 8024 participants. 8 studies were qualitative, 18 quantitative, and 3 were mixed method design. At an environmental level, barriers were high accessibility and availability of unhealthy foods, high cost and low availability of healthy foods and lack of storage and preparation facilities, while an enabler was close proximity to healthy options. Novel organisational enablers were considered roster planning which allowed for established routines around meals, and structured workplace programs that encouraged improvement in health behaviours, while barriers were shift work, inconsistent rosters and high work demands. An interpersonal enabler was supportive networks while barriers were work culture, social norms of celebrations and gifts of food from patients. Finally, intrapersonal barriers were stress and fatigue, personal values, beliefs, attitudes, and individual characteristics, with the latter two also acting as enablers.

CONCLUSIONS

This review identifies the complexity and interconnectedness of enablers and barriers to healthy eating across four domains of the socio-ecological model. Multi-faceted strategies which address factors across several domains are recommended for healthcare organisations to facilitate healthy eating among nurses. Further research is needed to assess these strategies and understand the extent to which eating behaviours can be improved.

Sex and educational level differences in physical activity and motivations to exercise among Spanish children and adolescents

Children and adolescents worldwide, especially girls, do not meet moderate to vigorous physical activity (MVPA) guidelines, a situation which is related to obesity and other comorbidities. Sex/gender differences in the practice of MVPA and motivations to engage in physical activity have not been previously examined among Spanish students considering different educational levels. Therefore, the purpose of this study was to explore these differences and analyse if motivations mediate the relationship between educational levels and MVPA in a large sample of students. From different schools in the Madrid region (primary: 11,122; lower secondary: 12,379; upper secondary: 3228) 26,729 students (13,491 boys and 13,238 girls; 9-19 years old) were recruited to participate in this study. The short form of the International Physical Activity Questionnaire and the third version of the Behavioural Regulation in Exercise Questionnaire were used to evaluate, MVPA and motivations to exercise, respectively. Two-way ANCOVA and a mediation analysis were performed. Female students were found to be less active than males (43.4±38.7 and 58.6±45.9 min of MVPA; p < 0.001; η_p² = 0.023) and showed lower intrinsic (η_p² = 0.003), and integrated (η_p² = 0.007) motivations than their male counterparts (p < 0.001). Primary school students were more active than lower and upper secondary students (53.3±44.2, 49.9±42.3 and 48.0±42.8 min of MVPA; p < 0.001; η_p² = 0.002) and also presented higher intrinsic (η_p² = 0.011) and integrated (η_p² = 0.010) motivation than secondary school students (p < 0.001).    Conclusion:   Among Spanish children and adolescents, females showed lower levels of MVPA and intrinsic and integrated motivation across all the educational levels, and among primary school students in comparison to secondary school. This suggests that inner motivation is more determinant of increased engagement in MVPA and thus, there is need to reinforce it before the transition to secondary school and with special focus on females' preferences. What is Known: •Many children and adolescents worldwide, do not meet physical activity (PA) recommendations. • Within the self-determination theory, autonomous motivation seems to be the main responsible of greater PA levels. What is New: •This study shows for the first time sex and educational level differences in PA levels in a representative sample of Spanish students (9-19 yrs). •Autonomous motivation decreased from primary school onwards and was lower in female students than in their male counterparts.

Understanding the barriers and enablers for postgraduate medical trainees becoming simulation educators: a qualitative study

INTRODUCTION : There is increasing evidence that Simulation-based learning (SBL) is an effective teaching method for healthcare professionals. However, SBL requires a large number of faculty to facilitate small group sessions. Like many other African contexts, Mbarara University of Science and Technology (MUST) in Uganda has large numbers of medical students, but limited resources, including limited simulation trained teaching faculty. Postgraduate medical trainees (PGs) are often involved in clinical teaching of undergraduates. To establish sustainable SBL in undergraduate medical education (UME), the support of PGs is crucial, making it critical to understand the enablers and barriers of PGs to become simulation educators.

METHODS

We used purposive sampling and conducted in-depth interviews (IDIs) with the PGs, key informant interviews (KIIs) with university staff, and focus group discussions (FGDs) with the PGs in groups of 5-10 participants. Data collection tools were developed using the Consolidated framework for implementation research (CFIR) tool. Data were analyzed using the rigorous and accelerated data reduction (RADaR) technique.

RESULTS

We conducted seven IDIs, seven KIIs and four focus group discussions. The barriers identified included: competing time demands, negative attitude towards transferability of simulation learning, inadequacy of medical simulation equipment, and that medical simulation facilitation is not integrated in the PGs curriculum. The enablers included: perceived benefits of medical simulation to medical students plus PGs and in-practice health personnel, favorable departmental attitude, enthusiasm of PGs to be simulation educators, and improved awareness of the duties of a simulation educator. Participants recommended sensitization of key stakeholders to simulation, training and motivation of PG educators, and evaluation of the impact of a medical simulation program that involves PGs as educators.

CONCLUSION

In the context of a low resource setting with large undergraduate classes and limited faculty members, SBL can assist in clinical skill acquisition. Training of PGs as simulation educators should address perceived barriers and integration of SBL into UME. Involvement of departmental leadership and obtaining their approval is critical in the involvement of PGs as simulation educators.

Exploratory Survey of Australian SMEs: an Investigation into the Barriers and Opportunities Associated with Circular Economy

Small- and medium-sized enterprises (SMEs) account for 97.4% of all businesses in Australia and, contribute, by revenue, 32% to the country's economy. In the last decade, Australian SMEs have become increasingly aware of the importance of sustainability and need to shift away from a linear to circular economy (CE). Since 2019, there has been considerable growth on CE adoption research in SMEs, but empirical research examining Australian SMEs has yet to be undertaken. This study has used a survey and aims to understand the enablers and barriers of CE adoption in Australian SMEs. The research addresses three specific research questions- What are the barriers that impact CE adoption in Australian SMEs?; What enablers facilitate CE adoption in Australian SMEs?; and What is the effect of industry type, geographic location and job roles on enablers and barriers identification for CE adoption in Australian SMEs? Based on 352 responses from the survey of Australian SMEs, the paper identifies and analyses the enablers and barriers that these organizations face as they transition towards circular economy. The impact that location, industry sector and the role respondents undertake within the organization provides some interesting insights into how Australian SMEs are managing the process of adoption of CE. The research demonstrates that there is an overwhelming need for the development of consistent, sectoral, industry and location-specific policies by the federal and state governments to support internal policy development and the acquisition of new technologies in order to stimulate Australian SME CE adoption. In addition, Australian SMEs need to have a better understanding of how budgetary constraints, the lack of customer awareness and an absence of clearly defined business process impact CE adoption.

Factors enabling and preventing farming practice change: An evidence review

With environmental degradation reaching emergency levels, urgent action for preventable behaviours is needed. There is limited scientific evidence available indicating key success factors that can be implemented to support lasting farming practice change. This study reports the outcomes of an evidence review that was undertaken to identify influential factors for farming practice change. The systematic literature review identified data sources derived from six databases (EBSCO All Databases, Emerald, ProQuest All Databases, Ovid All Databases, Web of Science and Scopus). The search yielded a total of 5044 results. After first and second-tier exclusion criteria, 363 articles were fully reviewed to determine which sources would inform this study. A total of 75 studies reported factors inhibiting or promoting farming practice change. A total of 26 barriers and enablers were identified across seven key dimensions, namely: Financial Support & Market forces; Information dissemination; Farmer & Farm characteristics; Institutional setting & Regulations, Stakeholder interactions; Farming practice; Beliefs, Attitudes and Individual Capabilities. Limitations and future research opportunities were identified.

What challenges and enablers elicit job satisfaction in rural and remote nursing in Australia: An Integrative review

AIM

To explore challenges and stressors experienced by rural and remote area nurses and identify any interventions that aided in decreasing stress and increasing job satisfaction.

BACKGROUND

Demand for a generalist nursing workforce in rural and remote locations exposes nurses to the same conditions as people residing there: higher mortality rates and higher incidence of chronic diseases and inadequacies in accessing health services.

DESIGN

Christmals and Gross's integrative review framework was used with specified inclusion and exclusion criteria. Four databases were searched with no date limits. Only Australian studies were searched as international scope of practice differences for nurses could have distorted findings.

FINDINGS

Eighteen studies identified three broad themes: access to education; isolation (geographical, professional and personal) and recognition of role.

DISCUSSION

Interlinked themes showed positives and negatives from differing viewpoints. Ambivalence to education stemmed from inadequate exposure to learning and was linked with geographical isolation. Isolation was found to be less of a challenge to nurses who had an existing emotional connection with the community.

CONCLUSION

The themes identified were recurrent and interconnecting. The benefits of working in small rural and remote communities are being used as a driver for recruitment. These benefits include higher wages, providing a sense of belonging and allowing nurses to work to their full scope and develop generalist nursing skills. The geographical isolation generates challenges through inequality in access to education and professional support, working outside their scope of practice, safety and vulnerability that comes with living remotely and adapting to extreme weather conditions.

TWEETABLE ABSTRACT

What are the challenges and enablers of rural and remote working and living that influence job satisfaction for rural and remote area nurses in Australia?

Food-based nutrition counselling and education intervention for improved diets of pregnant women in rural Malawi: a qualitative study of factors influencing dietary behaviour change

OBJECTIVE

We wanted to identify factors related to dietary behavioural change among impoverished pregnant women in the face of nutrition education and counselling, describing what creates an enabling environment and barriers for dietary change.

DESIGN

We used qualitative data from a cluster-randomised maternal education trial and conducted a thematic analysis using a social ecological framework to describe the factors that influenced dietary adherence.

SETTING

Mangochi district in rural Malawi.

PARTICIPANTS

We interviewed ten pregnant women and conducted four sets of focus group discussions with twenty-two significant family members (husbands and mothers-in-law) and twelve counsellors.

RESULTS

The participants' experiences showed that the main barriers of adherence to the intervention were taste, affordability and poverty. The use of powders and one-pot dishes, inclusion of both women and significant family members and a harmonisation with local food practices enabled adherence to the intervention. We found it crucial to focus the dietary education and counselling intervention on locally available ingredients and food processing methods.

CONCLUSIONS

Use of contextualised food-based solutions to combat maternal malnutrition was observed to be relatively cheap and sustainable. However, there is need for more research on local foods used as nutrition supplements. We suggest that investments need to be directed not only to nutrition education and counselling but also to the enabling factors that enhance adherence. The original cluster-randomised controlled trial was registered with Clinical trials.gov ID: NCT03136393.

Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review

BACKGROUND

Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries.

OBJECTIVES

We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research.

METHODS

We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately.

RESULTS

We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults.

CONCLUSIONS

We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.

Factors influencing the implementation of TB screening among PLHIV in selected HIV clinics in Ghana: a qualitative study

Background

Decreasing the burden of Tuberculosis (TB) among PLHIV through TB screening is an effective intervention recommended by the World Health Organization (WHO). However, after over a decade of implementation in Ghana, the intervention does not realize the expected outcomes. It is also not well understood whether this lack of success is due to implementation barriers. Our study, therefore, sought to examine the factors influencing the implementation of the intervention among people living with HIV (PLHIV) attending HIV clinics at district hospitals in Ghana.

Methods

This was a qualitative study conducted from 6th to 31 May 2019 in three regions of Ghana. We conducted 17 in-depth interviews (IDIs – comprising two regional, six districts and nine facility TB/HIV coordinators) and eight focus group discussions (FGD – consisting of a total of 65 participants) with HIV care providers. The Consolidated Framework for Implementation Research (CFIR) guided the design of interview guides, data collection and analysis. All responses were digitally audio-recorded and transcribed verbatim for coding and analysis using the Framework Approach. Participants consented to the interview and recording.

Results

The main barriers to TB screening relate to the low commitment of the implementers to screen for TB and limited facility infrastructure for the screening activities. Facilitators of TB screening include (1) ease in TB screening, (2) good communication and referral channels, (3) effective goals and feedback mechanisms, (4) health workers recognizing the need for the intervention and (5) the role of chemical sellers.

Conclusions

Key barriers and facilitators to the intervention are revealed. The study has shown that there is a need to increase HIV care providers and institutional commitment towards TB screening interventions. In addition, cost issues need to be assessed as they are drivers of sustainability. Our study also advances the field of implementation science through CFIR to better understand the factors influencing the implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08295-6.

Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review

Background

Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools.

Methods

Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines.

Results

A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers.

Conclusion

The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02270-7.

Patient and clinician perspectives of pelvic floor dysfunction after gynaecological cancer

Purpose

To explore and compare patient and clinician experiences, knowledge and preferences in relation to screening and management of pelvic floor (PF) dysfunction in the gynaecology-oncology setting.

Methods

Semi-structured interviews were conducted with women reporting PF symptoms after gynaecological cancer treatment, and gynaecology-oncology clinicians. Interviews were transcribed and thematically analysed and were conducted until data saturation was reached.

Results

We interviewed 12 patients and 13 clinicians. We identified two main themes: (1) Experience with PF symptoms, screening, disclosure and management and (2) Future hope of what should happen to screen and manage PF symptoms. Differences between what participants had experienced and what they felt should happen highlighted a perceived need for improving PF screening and management. A sub-theme that reflected relevant barriers and enablers was also identified. Barriers included time pressure, being focussed on cancer treatment and not side-effects, and patients feeling unwell, emotional, and overwhelmed with the logistics of oncology appointments. Enablers included the patient-clinician relationship, and opportunities for improving management included integrating nursing and PF physiotherapy with oncology appointments.

Conclusions

Gynaecological cancer survivors and clinicians perceive a need to improve screening and management for PF symptoms. While barriers and differences in perception exist, there are opportunities to improve how PF symptoms can be screened and managed in this population. Further studies exploring the feasibility of providing integrated multidisciplinary PF therapy services may be warranted.

Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research

Background

Ischemic heart disease causes a high disease burden globally and numerous challenges in treatment, particularly in developing countries such as China. The National Chest Pain Centers Program (NCPCP) was launched in China as the first nationwide, hospital-based, comprehensive, continuous quality improvement (QI) program to improve early diagnosis and standardized treatment of acute coronary syndromes (ACS) and improve patients’ clinical outcomes. With implementation and scaling up of the NCPCP, we investigated barriers and enablers in the NCPCP implementation process and provided examples and ideas for overcoming such barriers.

Methods

We conducted a nationally representative survey in six cities in China. A total of 165 key informant interviewees, including directors and coordinators of chest pain centers (CPCs) in 90 hospitals, participated in semi-structured interviews. The interviews were transcribed verbatim, translated into English, and analyzed in NVivo 12.0. We used the Consolidated Framework for Implementation Research (CFIR) to guide the codes and themes.

Results

Barriers to NCPCP implementation mainly arose from nine CFIR constructs. Barriers included the complexity of the intervention (complexity), low flexibility of requirements (adaptability), a lack of recognition of chest pain in patients with ACS (patient needs and resources), relatively low government support (external policies and incentives), staff mobility in the emergency department and other related departments (structural characteristics), resistance from related departments (networks and communications), overwhelming tasks for CPC coordinators (compatibility), lack of available resources for regular CPC operations (available resources), and fidelity to and sustainability of intervention implementation (executing). Enablers of intervention implementation were inner motivation for change (intervention sources), evidence strength and quality of intervention, relatively low cost (cost), individual knowledge and beliefs regarding the intervention, pressure from other hospitals (peer pressure), incentives and rewards of the intervention, and involvement of hospital leaders (leadership engagement, engaging).

Conclusion

Simplifying the intervention to adapt routine tasks for medical staff and optimizing operational mechanisms between the prehospital emergency system and in-hospital treatment system with government support, as well as enhancing emergency awareness among patients with chest pain are critically important to NCPCP implementation. Clarifying and addressing these barriers is key to designing a sustainable QI program for acute cardiovascular diseases in China and similar contexts across developing countries worldwide.

Trial registration

This study was registered in the Chinese Clinical Trial Registry (ChiCTR 2100043319), registered 10 February 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-022-01207-6.

Perceptions of Community Health Workers (CHW) on barriers and enablers to care for people with psychosis in rural Mozambique: findings of a focus group discussion study using the Capability, Opportunity, Motivation and Behaviour framework (COM-B framework)

BACKGROUND

Psychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care-taking for patients with psychosis in rural settings in Mozambique.

METHODS

A qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behaviour framework (COM-B).

RESULTS

Nine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care-taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers, and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care.

CONCLUSION

CHWs, with adequate support, could play an important role in the care of patients with psychosis in rural settings, including identifying patients requiring care and referring them to appropriate healthcare professionals, and following up medicated patients with psychosis. Training of CHWs should consider inclusion of basic mental health care competencies.

Enablers and barriers to effective parenting within the first 1000 days: an exploratory study of South African parents and primary caregivers in low socio-economic communities

Background

The first 1000 days is the period between conception and a child’s second birthday. Globally, research on parenting is in an advanced stage, but parenting research focusing specifically on parenting in this developmental phase is limited in South Africa. Therefore, this study explores the enablers and barriers to effective parenting within the first 1000 days through the lens of parents and caregivers in low socio-economic communities.

Methods

This study was conducted in communities in South Africa considered low socio-economic communities in the Western Cape Province of South Africa. An exploratory qualitative research design explored the enablers and barriers to effective parenting within the first 1000 days of life. Thirty participants were purposively selected and interviewed in this study. A semi-structured interview schedule was used for all interviews. The data were analysed using inductive thematic analysis.

Results

Two main categories emerged (effective parenting enablers and effective parenting barriers) during the data analysis. The main enablers of effective parenting within the first 1000 days of life include a support system, healthy behaviours/environment, unemployment/job opportunities, religion, information/knowledge, and professional assistance. On the other hand, the main barriers to effective parenting were low socio-economic circumstances, environmental circumstances, lack of partner’s support, the negative impact of technology, and lack of access to services.

Conclusion

Enablers that need to be promoted for effective parenting range from support systems to professional assistance for parents. Also, barriers that need to be removed for effective parenting range from low socio-economic circumstances to a lack of partner’s support for parents. This is because effective parenting is vital in improving developmental outcomes for children within the first 1000 days of life. Therefore, there is a need to develop policies and interventions to promote effective parenting within the first 1000 days in the communities.

Enablers and Constraints of STEM Programme Implementation: an External Change Agent Perspective from a National STEM Programme in Finland

An international need exists for effective programmes that will enhance learners' interest in studies and careers related to science, technology, engineering and mathematics, i.e. STEM. When considering the impact of STEM programmes, it is important to identify what can enable or constrain effective programme implementation. As such, enablers can be systematically supported and constraints tackled to maximise a programme's impact. This study considers a nationwide STEM programme in Finland that involved 450 teachers and their learning communities. The study followed an interpretative paradigm, collecting data through semi-structured interviews and analysed with data-driven thematic analysis. The study participants were 14 external change agents operating between participating learning communities and the national programme administration and, thus, had a valuable overview on how the programme evolved. The most important enablers of effective programme implementation were versatile support, programme flexibility and long-term vision. Two major constraints were limited resources and collaboration challenges. Considering the findings of this study can help design effective STEM programmes by providing various support mechanisms for educators, particularly scaffolding; peer and school administrator support; flexibility to enable embedding activities and adapting programme objectives to participants' everyday work; long-term vision to support both lifelong learning and a continuum between different STEM programmes; sufficient time and economic resources to achieve a long-term impact; and collaboration and networking opportunities at the local, regional, national and international levels.

Barriers and facilitators to access mental health services among refugee women in high-income countries: a systematic review

BACKGROUND

Based on the Global Trends report from the United Nations High Commissioner for Refugee, in high-income countries, there are 2.7 refuges per 1000 national population, girls and women account for nearly 50% of this refuge population. In these high-income countries, compared with the general population refuge women have higher prevalence of mental illness. Thus, this review was conducted to examine the barriers to and facilitators of access to mental health services for refugee women in high-income countries for refugee resettlement.

METHODS

We searched MEDLINE, EMBASE, PsycINFO, and CINAHL databases for research articles written in English with qualitative component. The last search date was on March 14, 2020. A narrative synthesis was conducted to gather key synthesis evidence. Refugee women (aged 18 and older) that could receive mental health services were included. Men and women under non-refugee migrant legal status were excluded. Studies were evaluated studies using the Critical Appraisal Skills Programme (CASP) qualitative checklist.

RESULTS

Of the four databases searched, 1258 studies were identified with 12 meeting the inclusion criteria. Three studies were cross-sectional by design, eight studies used a qualitative approach and one studies used mixed approach. The major barriers identified were language barriers, stigmatization, and the need for culturally sensitive practices to encourage accessing mental health care within a religious and cultural context. There were several studies that indicated how gender roles and biological factors played a role in challenges relating to accessing mental health services. The major facilitators identified were service availability and awareness in resettlement countries, social support, and the resilience of refugee women to gain access to mental health services.

CONCLUSION

This review revealed that socio-economic factors contributed to barriers and facilitators to accessing mental health among women refugees and asylum seekers. Addressing those social determinants of health can reduce barriers and enhance facilitators of access to mental health care for vulnerable populations like refugee women. A key limitation of the evidence in this review is that some data may be underreported or misreported due to the sensitive and highly stigmatizing nature of mental health issues among refugee populations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020180369.

Barriers and facilitators to the implementation of healthy eating, physical activity and obesity prevention policies, practices or programs in family day care: A mixed method systematic review

Family day care (FDC) services provide care to young children typically within the carer's own home and represents a unique setting to deliver public health programs to improve child health. To support the implementation of programs targeting healthy eating, physical activity and obesity prevention in the FDC setting, an understanding of the factors influencing their implementation is required. This mixed methods systematic review aimed to describe the barriers and facilitators to the implementation of healthy eating, physical activity or obesity prevention policies, practices and programs (hereafter referred to as programs) in the FDC setting, and synthesise these according to the Theoretical Domains Framework (TDF). Electronic searches were conducted in 7 databases up to July 2020 to identify studies reporting the barriers and/or facilitators to program implementation in the FDC setting. Methodological quality assessments of included studies were conducted using the Mixed Methods Appraisal Tool (MMAT). Twenty studies met the review inclusion criteria (12 qualitative, 6 quantitative, 2 mixed methods). Of the 20 included studies, 16 reported barriers and facilitators mapped to the 'environmental contexts and resources' TDF domain; 10 reported barriers mapped to the 'social influences' TDF domain. Ten of the 12 qualitative studies and none of the quantitative or mixed method studies met all relevant MMAT criteria. This review comprehensively describes barriers and facilitators that need to be addressed to improve the implementation of healthy eating, physical activity and obesity prevention programs in FDC to ensure the expected health benefits of such programs reach children attending FDC.

Co-designing a community pharmacy pharmacogenomics testing service in the UK

Introduction

Pharmacogenomics (PGx) testing services have been delivered through community pharmacies across the globe, though not yet in the UK. This paper is reporting a focus group study, the first stage of a participatory co-design process to increase the chance of a successful implementation of a PGx service through community pharmacy in the UK.

Aim

To identify the barriers and enablers to implementing a community pharmacy based PGx service in the UK.

Method

Three focus groups were conducted with community pharmacists (n = 10), prescribers (n = 8) and patients (n = 8) in England. The focus groups were recorded, transcribed and thematically analysed using the Braun and Clarke six phase reflexive thematic analysis approach.

Results

The analysis identified five themes about PGx testing in community pharmacies: (1) In- principle receptiveness, (2) Appreciation of the benefits, (3) Lack of implementation resources (4) Ambiguity about implications for implementation and (5) Interprofessional relationship challenges.

Conclusion

The identified enablers for implementation of a PGx service were at a macro health system strategic level; the concerns were more at a granular operational procedural level. Overall receptiveness was noted by all three participant groups, and both prescriber and pharmacist groups appreciated the potential benefits for patients and the healthcare system. Prior to implementation in the UK, there is a need to disambiguate health professional’s concerns of the guidance, resources, and knowledge required to set up and deliver the service and to resolve patient concerns about the nature of genomics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07730-y.

Barriers and enablers of older adults initiating a deprescribing conversation

OBJECTIVE

To examine older adults' perceptions and identify barriers and enablers to initiating a conversation about stopping medication(s) with their healthcare provider.

METHODS

We conducted one focus group (n = 3) and in-depth, face-to-face, individual interviews (n = 6) using an interview guide. Older adults aged ≥65 years in a retirement community who were taking ≥5 medications were recruited. Focus groups and interviews were audio-recorded and transcribed verbatim. Both a deductive analysis, informed by the Theoretical Domains Framework, and an inductive analysis were conducted.

RESULTS

Five themes and fourteen sub-themes were identified. Theme 1, 'older adult-related barriers', discusses limited or varying self-efficacy, past unsuccessful deprescribing experiences and limited familiarity with medications/deprescribing. Theme 2, 'provider-related barriers', discusses trust, short office visits, lack of communication and multiple providers. Theme 3, 'environmental/social-related barriers', involves limited availability of resources and access to telehealth/internet. The remaining themes (Themes 4-5) identified enablers including strategies to promote older adults' self-efficacy and improved healthcare communication.

CONCLUSION

Consumer-centric tools could improve older adults' self-efficacy to initiate deprescribing conversations.

PRACTICE IMPLICATIONS

Removing barriers and implementing enablers may empower older adults to initiate deprescribing conversations with providers to take fewer medications. Ultimately, this could be a catalyst for increased translation of deprescribing in practice.

Factors Influencing Attendees' Engagement with Group Psychoeducation: A Multi-stakeholder Perspective

Few studies have explored the problem of engagement in relation to group psychoeducation from a multi-site and multi-stakeholder perspective. The aim of the study was to explore the factors influencing service user and family engagement with group psychoeducation programmes. The study design was qualitative descriptive. Data were collected through individual and focus group interviews with key stakeholders (n = 75) involved with the programme within 14 mental health sites in the Republic of Ireland. Enablers and barriers to engagement were identified at participant, provider, programme and organization level. Motivated participants and engaged clinicians, peer co-facilitation and support, and skilled and responsive facilitators were some of the factors which enhanced engagement. Barriers to engagement included readiness among participants, concerns related to stigma and confidentiality, desire to distance oneself from mental health services, a lack of support for programme participation within families, group discomfort, the time and length of the programme, issues with transport, visibility of the programme, and structural supports for clinicians. Findings from the study illustrate the multifaceted nature of engagement as well as provide a greater understanding of the multifactorial influences on engagement. Strategies to enhance engagement should therefore reflect a multipronged approach. At the outset of programme implementation, organizations should address their readiness to engage, conduct local needs assessments to anticipate individuals’ needs and plan accordingly in order to maximize engagement, and bolster facilitators’ engagement skills through the provision of training and mentoring opportunities.

The COVID-19 vaccination campaign in Bhutan: strategy and enablers

Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15, 2021. With support from India, the United States, Denmark, the People's Republic of China, Croatia and other countries, Bhutan was able to conduct two rounds of nationwide vaccination campaign. While many countries struggle to overcome vaccine refusal or hesitancy due to complacency, a lack of trust, inconvenience and fear, escalated in some countries by anti-vaccine groups, Bhutan managed to inoculate more than 95% of its eligible populations in two rounds of vaccination campaign. Enabling factors of this successful vaccination campaign were strong national leadership, a well-coordinated national preparedness plan, and high acceptability of vaccine due to effective mass communication and social engagement led by religious figures, volunteers and local leaders. In this short report, we described the national strategic plan and enabling factors that led to the success of this historical vaccination campaign.

A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients

BACKGROUND

Congestive heart failure (CHF) is a significant health problem in Australia, and disproportionately affects rural Australians. Management of CHF in Australia is heavily centred around the general practitioner (GP). Australian and international literature indicates there is a gap between current and best practice in CHF management. There is little known about the non-pharmacological aspects of management, or CHF management in a rural Australian context. This study aimed to identify what Australian GPs practicing in the Northern Rivers Region of New South Wales, Australia, perceived were the barriers and enablers in the non-pharmacological management of CHF amongst community dwelling patients, to inform healthcare access, resourcing and delivery in Australian rural environments.

METHODS

Qualitative study involving a realist thematic analysis of data collected from semi-structured face-to-face interviews.

RESULTS

Fifteen GPs and GP trainees participated. Four interlinked key themes underpinning GPs' experiences with non-pharmacological management of CHF were interpreted from the interview data: (1) resources, (2) complexity of heart failure, (3) relationships, and (4) patient demographics, priorities and views affect how patients engage with non-pharmacological management of CHF.

CONCLUSION

Rural Australian GPs face considerable barriers to non-pharmacological management of CHF. The data suggests that increased rural Australian health services and community transportation, multidisciplinary management, and stronger professional networks have the potential to be invaluable enablers of CHF management. Further research exploring non-pharmacological management of CHF in other rural contexts may provide additional insights to better inform rural healthcare access and resourcing.

Barriers to and enablers of uptake of antiretroviral therapy in integrated HIV and tuberculosis treatment programmes in sub-Saharan Africa: a systematic review and meta-analysis

INTRODUCTION

Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients' access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA.

METHOD

A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers.

RESULTS

Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level.

CONCLUSIONS

In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.