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Relatively little is known about how physical and social environments influence access to and inclusion in educational and leisure activities for students with a mobility-related physical disability attending a post-secondary institution. Understanding how environments shape access is important because educational and leisure activities affect one’s emotional, social, mental, and physical health. The aim of this qualitative exploratory study was to gain an understanding of the lived experiences of access and inclusion for students with a mobility-related physical disability, and specifically, the barriers and facilitators within the physical and social environments which shape access and inclusion. One-on-one semi-structured interviews were conducted with nine students attending a post-secondary institution in Nova Scotia, Canada who self-identified as living with a mobility-related physical disability. From an analysis of the interviews, five themes emerged: 1) navigating disclosure; 2) invisibility (and passing) and visibility; 3) accommodations and supports; 4) the prevailing conceptualization of mobility-related disabilities; and 5) places and spaces for the “normal” body. Although there have been actions taken by the post-secondary institution to transform environments and improve access and inclusion, additional efforts are urgently needed, and it is suggested that Universal Design is one possible strategy.

Losing a sibling to suicide is a traumatic event. Sibling suicide survivors’ experiences are understudied and may be missed by health care providers. The purpose of this qualitative study with an interpretive phenomenological approach was to explore the lived experiences of individuals who have lost an adult sibling to suicide. The findings of individual in-depth interviews with 12 participants revealed that sibling bereavement is an evolving process, losing intensity with time, and resulting in a significant effect on the sibling survivors’ lifestyles and perceptions of life. Additionally, receiving professional support after the suicide was advantageous to survivors. The results further underscored that the suicide of a sibling can affect the sibling survivors’ relationships with themselves, family members, and others. This article formulates a comprehensive outlook for counselors to understand sibling suicide survivors’ unique grieving processes, identifies their special needs, and addresses the implications for mental health professionals.

OBJECTIVE: The purpose of this project was to investigate how well each member agency's standards complied with the Councils on Chiropractic Education International (CCEI) framework standards. METHODS: Each of the CCEI member agencies were provided with a mapping template that was approved by all representatives. A representative from each agency independently mapped their agency's standards to the CCEI framework standards using the template document. Discrepancies were explored and discussed among members. Member agencies discussed with their constituents the omissions and areas that did not comply or adequately match the CCEI document. Changes or additions to member agency standards were made, and updated versions of the mapping were agreed by all CCEI representatives. RESULTS: There were 12 sections containing 30 standards within the CCEI framework standards. The Council of Chiropractic Education Australasia and Council on Chiropractic Education Canada reported relevant standards for all 30 CCEI standards. The European Council on Chiropractic Education had 29 of 30 relevant standards, with no direct standard for service. The products that were created were an executive summary of our findings and a detailed map showing similarities for each of the member agencies. CONCLUSION: This mapping project demonstrated the similarities of the CCEI member agency standards and that these standards focused on outcomes-based chiropractic education. This quality improvement project resulted in useful dialogue among the member agencies during this project, which clarified areas of difference.

Objective The objective of this review is to assess the prevalence of musculoskeletal chronic pain among active and retired members of military forces and to characterize potential factors that could influence the frequency of musculoskeletal chronic pain. Introduction Inherent to military occupations is a diverse source of occupational hazards that affect the well-being of individuals at any stage of their military career (active and retired). Chronic pain may result from the continuous exposure to physically demanding tasks and other risks. Moreover, chronic pain has been associated with other comorbidities, including mental health conditions. Inclusion criteria Scientific papers in French or English reporting on chronic pain derived from a musculoskeletal cause in active and retired military personnel will be considered. There will be no restriction on participants' country, age, or length of service. Methods The published literature will be identified by exploring biomedical, pharmacological, and physiology bibliographic databases. The unpublished literature will be located through the search of thesis and gray literature repositories. This review will follow the condition-context-population approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The extracted data will include any detail about the anatomic location, diagnosis, types of studies, and risk factors. The review will follow JBI methods of critical appraisal, data extraction, and data synthesis for reviews containing prevalence data. If enough evidence is found, meta-regression analysis will performed, otherwise a narrative review will be completed. Systematic review registration number PROSPERO CRD42020153704.

Background. There is a lack of knowledge on the scope and nature of the research by faculty members in occupational science (OS) and/or occupational therapy (OT) programs in Canada. Purpose. To describe the research activities of faculty members in these programs and directions. Method. A cross-sectional survey was distributed to 173 faculty members across all 14 Canadian OT that addressed: 1) research topics and methods, 2) populations, and 3) funding. Findings. Based on respondents ( N = 121), research is focused on a range of topics and populations with most conducting qualitative research. Many conduct research examining the effectiveness of interventions, with few respondents focused on OS research. Federal and provincial grants agencies were the largest source of funding. Implications. Research topics studied were not always proportional to practice although emerging areas were being investigated that can expand the evidence base and scope of practice. Despite limited occupation-specific funding options, respondents were accessing funding from varied sources. Collaborations among faculty members, clinicians, and individuals with lived experience can create priorities for future OS and/or OT research in Canada.

Objective The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers. Introduction As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature. Inclusion criteria Sources that reported on the financial expenses incurred by older people with frailty living in the community or their caregivers were eligible for inclusion in the review. Methods We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019 located in databases including MEDLINE (Ovid), CINAHL (EBSCO), and Elsevier. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review. Results A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the US (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), Australia (n = 1), Brazil (n = 1), China (n = 1), Denmark (n = 1), Israel (n = 1), Italy (n = 1), The Netherlands (n = 1), Poland (n = 1), Portugal (n = 1), Singapore (n = 1), South Korea (n = 1), Taiwan (n = 1), and Turkey (n = 1). The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized control trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1).The included sources used the term "frailty" inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses. Conclusions Contextual factors are important to the experiences of out-of-pocket spending for older people with frailty. There is a need to develop a standardized approach to measuring out-of-pocket expenses in order to support further synthesis of the literature. We suggest a measure of out-of-pocket spending as a percentage of family income. The review supports education for health care providers to assess the out-of-pocket spending of community-dwelling older people with frailty and their caregivers, as well as to be aware of the local policies and resources to support older people with frailty address out-of-pocket spending.

Purpose: Bendamustine and rituximab (BR) has been established as a superior frontline therapy over R-CHOP in the treatment of follicular lymphoma (FL). Yttrium-90 Ibritumomab tiuxetan (90YIT) is an effective consolidation strategy after chemotherapy induction. This prospective, single-arm, multicenter, phase II trial evaluated the response rate, progression-free survival (PFS), and tolerability of BR followed by consolidation with 90YIT in patients with untreated FL. Patients and Methods: The study included grade 1 to 3a FL patients aged ≥18 years, chemotherapy-naïve, and requiring treatment for stage II–IV disease. Study treatment included an initial rituximab treatment, followed by four cycles of BR. Patients were eligible for consolidation with 90YIT, 6 to 12 weeks after BR, if they obtained at least a partial response after induction had adequate count recovery and bone marrow infiltration < 25%. Results: Thirty-nine patients were treated. Eighty-two percent had an intermediate or high-risk Follicular Lymphoma International Prognostic Index score, and 6 of 39 (15%) were grade 3a. The response rate was 94.8%, and the complete response(CR)/CR unconfirmed (CRu) rate was 77% in the intention-to-treat analysis. The conversion rate from PR to CR/Cru after 90YIT was 81%. After median follow-up of 45 months, the PFS was 0.71 (95% confidence interval, 0.57–0.89). Conclusions: This report demonstrates that four cycles of BR followed by consolidation with 90YIT achieve high response rates that are durable. In addition, consolidation with 90YIT results in a high conversion rate of PR to CR/CRu. A short course of BR followed by 90YIT is a safe and effective regimen for frontline treatment of FL.

Background Eribulin mesylate is a non–taxane microtubule inhibitor effective in the treatment of metastatic breast cancer refractory to anthracyclines and taxanes. In preclinical studies, additional mechanisms of eribulin included reversal of epithelial mesenchymal transition and tumor vascular remodeling. The present study compared the safety and efficacy of eribulin plus cyclophosphamide (ErC) to docetaxel plus cyclophosphamide (TC) as neoadjuvant therapy for operable HER2− breast cancer. Patients and Methods Women with invasive HER2− breast adenocarcinoma with no distant metastases were eligible. After a 10-patient safety lead-in, the patients were randomized 2:1 to receive either ErC (eribulin 1.4 mg/m2 on days 1 and 8 plus cyclophosphamide 600 mg/m2 on day 1) or TC (docetaxel 75 mg/m2 plus cyclophosphamide 600 mg/m2 on day 1) administered every 21 days for 6 cycles, followed by surgery. The pathologic complete response (pCR) rate was the primary endpoint. Tumor samples collected at baseline and at surgery were assayed for select epithelial mesenchymal transition and vascular density markers: E-cadherin, vimentin, and CD31 expression. Results A total of 76 patients were enrolled. Of the 76 patients, 10 received ErC in the lead-in phase and 66 were randomized to ErC (n = 44) or TC (n = 22). The pCR rates with ErC and TC were 13% and 9%, respectively. Both regimens produced frequent neutropenia and peripheral neuropathy. Both regimens increased vascular density as measured by CD31 staining. Conclusion The neoadjuvant regimens of ErC and TC resulted in relatively low pCR rates in this patient population. No unexpected toxicities were observed. Our results also provided no suggestion that ErC is a neoadjuvant treatment with greater efficacy than that of standard regimens.

BACKGROUND Living and working with chronic pain requires persons to alter lifestyles and have the knowledge as well as support to manage unforeseen challenges. Knowledge for persons living with pain who want to participate in meaningful paid and unpaid work is not easily accessible. While there is literature on chronic pain management, work transitions and return to work, less emphasis has been placed on the complexity of living and working with chronic pain. The Creating a Way Forward Project was envisioned to address this gap and to identify the informational needs of workers with pain, health/helping professionals (workers' advisors, return to work specialists, legal representatives), and stakeholders. The overarching aim of the project was to use evidence and experiential knowledge to inform the development of a foundation for educational guides and toolkits to support workers with pain to achieve their outcomes for remaining at work. METHODS Phase one of the project involved a scoping review of chronic pain and work. Phase two involved stakeholder consultations, a focus group and knowledge integration of the literature and experiential insights. Knowledge synthesis drew on a Template Analysis of multiple sources of data. RESULTS Knowledge domains and key components were identified for persons with pain and for the health/helping professions. CONCLUSION These domains reflect a foundation for knowledge in practical training and the development of curriculum for education in self-management program and in inter professional health profession education. These knowledge domains provide a basis for future research in integrated approaches and knowledge use toward improving transitions for persons living with chronic pain who want to participate in productive paid and unpaid work. Ongoing research in knowledge domains that health providers and persons with pain need will expand the potential for improving health outcomes in living with and managing pain.

Mental health and resilience are closely connected to issues of power and voice. Participatory action research (PAR) describes participatory approaches in research, where all parties are ideally involved in the knowledge creation, as collaborators and co-researchers in the research process. The authors conducted a scoping review and explored ten scientific data bases to understand how PAR studies promote participation of youth in studies of mental health and resilience. Analyses of n = 54 studies revealed the target populations, types of youth related methods, and the authentic involvement of youth and adolescents in stages of PAR. While many studies embraced the concepts of engagement in active research processes from inception to action, only 17 include youth on boards, 18 in preparation stage and 28 in data collection and/or analysis. The findings emphasize the potential of PAR to realize the voice of youth in all aspects of participatory research.

Background Lapatinib is an oral small molecule tyrosine kinase epidermal growth factor receptor-1/HER2 inhibitor that crosses the blood–brain barrier and is active against central nervous system (CNS) metastases. Cabazitaxel is a taxoid that is effective against taxane-resistant metastatic breast cancer (MBC) and has distinguished itself by its ability to cross the blood–brain barrier. The present phase II study ( ClinicalTrials.gov identifier, NCT01934894 ) evaluated the combination of these agents to treat HER2+ MBC patients with CNS metastases. Materials and Methods Patients with HER2+ MBC and ≥ 1 untreated or progressive, measurable CNS metastasis were eligible. Using a 3+3 dose escalation design, patients were treated with escalating doses of intravenous cabazitaxel every 21 days and oral lapatinib daily in 21-day treatment cycles. Intracranial disease restaging was performed every 2 cycles for the first 8 cycles and then every 3 cycles until progression or unacceptable toxicity. Results Eleven patients were treated at 2 dose levels. Six patients were treated at dose level 1 (intravenous cabazitaxel 20 mg/m2 plus oral lapatinib 1000 mg daily), and five were treated at dose level 2 (intravenous cabazitaxel 25 mg/m2 plus oral lapatinib 1000 mg daily). The most common treatment-related adverse events were myelosuppression, diarrhea, fatigue, and skin toxicity. A total of 5 dose-limiting toxicity events occurred. No intra- or extracranial objective responses were observed. Conclusion The combination of cabazitaxel plus lapatinib was not feasible because of toxicity and because no objective CNS activity was seen in the 5 evaluable patients. The role of cabazitaxel to treat breast cancer patients with CNS metastases remains undefined.

Life coaches benefitted from learning opportunities that increase their coaching effectiveness. Utilising critical self-reflection activities, life coaches created a continuing professional...

Introduction: Chronic pain is a persistent disease that causes personal and social economic problems when individuals are unable to return to work. Objective: This meta-synthesis investigated the perspectives of health professionals on the best mechanisms (triggering change) and approaches to support people with chronic pain on return to work. Method: Peer-reviewed articles published until October 2017 were searched in databases such as PsycINFO, EMBASE, CINAHL and Pubmed. The search was based on three concepts: “chronic pain”, “return to work” and “therapist”. Six articles were analyzed. Meta-ethnography was used to synthesize data extracted from qualitative studies. Results: Five second-order interpretations were revealed: social interactions contribute to rehabilitation and can interrupt the return to work; inadequate coordination and excessive bureaucracy complicates the return to work; communication between worker and other stakeholders is critical for return to work; health professionals are not clear about their roles; the congruence between health professionals and the workers’perspectives and goals on return to work impacts the treatment and its outcomes. A posterior analysis produced two third-order syntheses: 1. the need for assertive communication to lay the groundwork for best practices; and 2. inadequate coordination in the current system complicates return to work in cases of chronic pain. Conclusion: Stakeholders and health professionals need to understand their roles and responsibilities to consistently set goals and action plans for return to work. Keywords: Chronic Pain, Return to Work, Health Personnel

Purpose We investigated whether subthreshold retinal phototherapy (SRPT) was associated with recruitment of bone marrow (BM)-derived cells to the neurosensory retina (NSR) and RPE layer. Methods GFP chimeric mice and wild-type (WT) mice were subjected to SRPT using a slit-lamp infrared laser. Duty cycles of 5%, 10%, 15%, and 20% (0.1 seconds, 250 mW, spot size 50 μm) with 30 applications were placed 50 to 100 μm from the optic disc. In adoptive transfer studies, GFP+ cells were given intravenously immediately after WT mice received SRPT. Immunohistochemistry was done for ionized calcium-binding adapter molecule-1 (IBA-1+), CD45, Griffonia simplicifolia lectin isolectin B4, GFP or cytokeratin). Expression of Ccl2, Il1b, Il6, Hspa1a, Hsp90aa1, Cryab, Hif1a, Cxcl12, and Cxcr4 mRNA and flow cytometry of the NSR and RPE-choroid were performed. Results Within 12 to 24 hours of SRPT, monocytes were detected in the NSR and RPE-choroid. Detection of reparative progenitors in the RPE occurred at 2 weeks using flow cytometry. Recruitment of GFP+ cells to the RPE layer occurred in a duty cycle-dependent manner in chimeric mice and in mice undergoing adoptive transfer. Hspa1a, Hsp90aa1, and Cryab mRNAs increased in the NSR at 2 hours post laser; Hif1a, Cxcl12, Hspa1a increased at 4 hours in the RPE-choroid; and Ccl2, Il1b, Ifng, and Il6 increased at 12 to 24 hours in the RPE-choroid. Conclusions SRPT induces monocyte recruitment to the RPE followed by hematopoietic progenitor cell homing at 2 weeks. Recruitment occurs in a duty cycle-dependent manner and potentially could contribute to the therapeutic efficacy of SRPT.

1018 Background: H3B-6545, a selective, small molecule covalent antagonist of ERα demonstrated preclinical and preliminary clinical activity against ER+ breast cancer (Hamilton EP, SABCS, 2020). This study evaluated the activity and tolerability of H3B-6545 in patients (pts) with metastatic ER+, HER2-, breast cancer refractory to endocrine therapy. Methods: Patients received H3B-6545 once daily at the recommended phase II dose of 450 mg. The primary objective of the phase II is to estimate the objective response rate (ORR), progression-free survival (PFS), clinical benefit rate (CBR) and secondary objectives include safety. Results: 83 pts were treated with 450 mg in the phase II part of the trial. Additionally, 11 pts were treated with 450 mg in the phase I part of the trial and are included in this analysis. Median age was 62 years (range: 38 to 87 years), 81% had liver and/or lung metastases, and the median number of prior therapies for metastatic disease was 3 (range: 1 to 8). Prior CDK4/6 inhibitors, aromatase inhibitors, fulvestrant, and chemotherapy were received by 85%, 80%, 72%, and 50% of the pts, respectively. 58 pts (62%) had detectable ESR1 mutations in liquid biopsies, including 10 (11%) and 19 pts (20%) who had clonal Y537S and clonal D538G mutation, respectively. As of January 29, 2021, grade (gr) 2 or higher adverse events (AE) reported in ≥10% were anemia (19%), fatigue (16%), nausea (17%), and diarrhea (12%). Laboratory gr 2 or higher abnormalities reported in ≥10% pts were creatinine clearance decrease (38%), hemoglobin decrease (37%), bilirubin increase (12%), ALT increase (14%), AST increase (13%), and creatinine increase (11%). AE of gr 1 sinus bradycardia (asymptomatic) was reported in 34% and gr 2 (symptomatic, no intervention needed) was reported in 5%. Gr 2 and 3 QTcF prolongation were reported in 2 and 3 pts, respectively. There were no treatment-related deaths. Efficacy estimates are presented in the table below. Responses were observed in heavily pretreated pts, pts with visceral metastases and in pts who received prior fulvestrant, CDK4/6 inhibitor, and/or chemotherapy in the metastatic setting. Conclusions: H3B-6545 has a manageable safety profile and demonstrated single-agent anti-tumor activity in heavily pretreated ER+, HER2- mBC patients. Clinical activity was observed in pts with ESR1 mutations. Clinical trial information: NCT03250676 .[Table: see text]

1061 Research Funding: Odonate Therapeutics, Inc. Background: T is a novel, oral taxane with unique properties, including: oral administration with a low pill burden, a long (8-day) half-life in humans, once-every-3-weeks dosing, no observed hypersensitivity reactions and significant activity against chemotherapy (CT)-resistant breast cancer cell lines. T had encouraging monotherapy activity in a phase 2 study in 38 pts with HR+, HER2- MBC, with a confirmed objective response rate (ORR) per RECIST 1.1 of 45% (Seidman, 2018 ASCO Annual Meeting, Abstract 1042). In CONTESSA, a randomized phase 3 study in 685 pts with HR+, HER2- MBC previously treated with a taxane, T plus a reduced dose of C improved progression-free survival (PFS) as assessed by the Independent Radiologic Review Committee (IRC) vs. the approved dose of C alone: median of 9.8 months (mo) vs. 6.9 mo, an improvement of 2.9 mo (HR=0.716; p=0.003) (O'Shaughnessy, SABCS 2020, GS4-01). Methods: CONTESSA 2 is a multinational, multicenter, phase 2 study of T (27 mg/m2 on day 1 of a 21-day cycle) plus a reduced dose of C (1,650 mg/m2/day for 14 days of a 21-day cycle) in pts with HR+, HER2- MBC previously treated with 0-1 prior CT regimens for MBC and not previously treated with a taxane. The primary endpoint is ORR as assessed by the IRC. The secondary efficacy endpoints are duration of response (DoR), PFS and disease control rate (DCR) as assessed by the IRC, and overall survival (OS). Results: 150 pts were enrolled and treated. 80% had visceral disease, 46% had de novo MBC, 52% were previously treated with a CDK 4/6 inhibitor and 33% were ≥65 years old. At the prespecified interim analysis approx 4 mo after the last patient enrolled, the confirmed ORR was 51% (95% CI: 42%-60%), and the unconfirmed ORR was 63% (95% CI: 54%-71%). The median DoR was 9.5 mo (95% CI: 5.4-11.5 mo), the median PFS was 12.9 mo (95% CI: 8.1 mo-NR) and the DCR was 71% (95% CI: 62%-79%). OS data are immature. Grade (Gr) ≥3 treatment-emergent adverse events (TEAEs) occurring in ≥5% of pts were: neutropenia (74.0%), leukopenia (10.7%), hypokalemia (7.3%), anemia (6.7%), hand-foot syndrome (6.0%) and diarrhea (5.3%). Gr 2 alopecia occurred in 11.3% of pts, febrile neutropenia occurred in 4.7% of pts and Gr ≥3 neuropathy occurred in 2.0% of pts. Discontinuation of T and C due to any adverse event occurred in 13.3% of pts. Conclusions: An all-oral regimen of T plus a reduced dose of C demonstrated a high level of antitumor activity in pts with HR+, HER2- MBC not previously treated with a taxane. The confirmed ORR was 51%, median DoR was 9.5 mo and median PFS was 12.9 mo. Neutropenia was the most frequent Gr ≥3 TEAE; the rate of febrile neutropenia was 4.7%. Rates of clinically significant alopecia and neuropathy were low. Clinical trial information: NCT03858972 . Clinical trial information: NCT03858972 .

BACKGROUND Parents who care for young children with chronic conditions are knowledge users. Their efforts, time, and energy to source, consider and monitor information add to the 'invisible' work of parents in making decisions about care, school transitions, and interventions. Little is known or understood about the work of parents as knowledge users. OBJECTIVE To understand the knowledge use patterns and how these patterns may be monitored in parents caring for their young children with cerebral palsy (CP). METHODS An embedded case study methodology was used. In-depth qualitative interviews and visual mapping were employed to collect and analyze data based on the experiences of three mothers of young children with CP. RESULTS Knowledge use in parents caring for their young children with CP is multi-factorial, complex and temporal. Findings resulted in a provisional model elaborating on the ways knowledge is used by parents and how it may be monitored. CONCLUSIONS The visual mapping of pathways and actions of parents as end users makes the processes of knowledge use more visible and open to be valued as well as appreciated by others. The provisional model has implications for knowledge mobilization as a strategy in childhood rehabilitation and the facilitation of knowledge use in the lives of families with children with chronic health conditions.

This lectureship explores how futures research might be used by occupational scientists to open up a dialogue about what people ‘will do’. Futures research offers alternative ways to explore ideas, viewpoints, schools of inquiry and knowledge that might contribute to the prevention of known, yet unsolved, occupational injustices experienced by groups of people in society. One such global injustice is the burgeoning work disparity of under- and unemployment experienced by young people. The goal of futures research methods is to create transformative spaces for thought, through multiple ways of knowing and analysis across paradigms of knowledge, to inform what groups of people or populations might do differently to achieve a better quality of life or circumstances. In this lectureship, the future of employment for young people in Canada is used as an example to introduce the potential of using Causal Layered Analysis (CLA; Inayatullah, 1998, 2004), a futures research method, in transformative thinki...

Background and Purpose: When life disruptions occur, people's occupational identity shifts to reflect their changed abilities and health. There may also be changes in the range of occupations judged as meaningful. The purpose of this study was to clarify the nature of the process that underpins shifts in occupational identity following a traumatic brain injury (TBI). Data Collection and Analysis: Participants were adults with TBI recruited from a centre for brain injury survivors. Interview data were analyzed through an objectivist grounded theory approach to uncover emergent categories. Findings: The nine participants suggested that the shift in occupational identity was impacted by occupational choices, re-engagement in occupations, and the development of competence. The shift was marked by Facing the Reality of Limitations and Challenges (returning to previous occupations, reflecting on changed abilities or performance), Grappling with Negative Labels (encountering labels and walls, discontinui...

Background: The marginalisation of youth with disabilities from employment opportunities is evident from literature in as far as they form part of the larger groups ‘people with disabilities’ and ‘youth’. A focused view of programmes that assist youth with disabilities into employment has not been presented, despite the worldwide crisis of youth unemployment.Aim: This review aimed to identify evidence on work transition programmes that are effective in assisting people with disabilities into open labour market (competitive) employment, as well as to highlight gaps in knowledge to inform future research on this topic.Methods: Literature and policy on programmes that support such transitions were considered, firstly from a global perspective and then with a view from developing countries. The SALSA (Search, Appraisal, Synthesis and Analysis) framework was used to source and analyse information from a diverse set of documents. Various online databases were searched for research papers published between 1990 and 2016, and websites were searched for reports pertaining to this topic.Results: Ninety-nine documents were selected to inform the review, out of an identified 259 scientific journal articles, policy documents, acts, organisational reports and book chapters.Conclusion: A synthesis of findings was presented in a narrative that reflects the themes of youth with disabilities and employment in the world, work transition endeavours in the developing world and a specific focus on this group in South Africa. The review revealed a gap in knowledge and evidence pertaining to youth with disabilities and employment, highlighting these as research foci, and emphasising the need for youth-focused research that generates knowledge about disability and transitions into the labour force.

Introduction: Occupation-based approaches are a hallmark of excellence in occupational therapy practice. This article focuses on the disjuncture between how women with rheumatoid arthritis go about their daily lives, that is to say their occupations, and what is addressed during routine visits at a specialized rheumatology outpatient clinic. Method: Institutional ethnography was employed as a method of inquiry to identify the occupations and related issues that were or were not accounted for in health records and addressed within institutional processes. Interviews and participant observations were conducted with seven women with rheumatoid arthritis who were mothers. Hospital records were analysed as texts mediating between the women's daily lives and the rheumatology outpatient clinic. Findings: The analysis revealed that despite the diversity in the ways that the women managed their daily lives, the things that they did were viewed, understood, and addressed only within the boundaries of the standardizing relations that ruled practice in this clinical setting. Institutional processes grounded in biomedical concepts such as functional status or disease activity, as well as clinical assessments that depict these concepts, both shape and limit opportunities for occupational therapists to advance and enact occupation-based practice. Conclusion: In this setting, the complexity of the participants' daily lives and the occupations they engage in remain unaddressed.

This book examines the many influences of the digital revolution on the future of productive work occupations and who will work. The overall purpose of the book is to explore the way the lives of p...

Institutional ethnographers and occupational scientists share a common interest in studying what people do in their daily lives. Institutional ethnographers start inquiry at the standpoint of people as they are situated in the actualities of everyday life and then turn their gaze from the individual to the social. We aim to outline in this paper some key tenets of institutional ethnography to argue its relevance for studying human occupation. More specifically, we posit that institutional ethnography provides a promising social theory and method to further understandings of the situated nature of human occupation.

Drawing on data from a larger study, the aim of this paper is to illuminate how the everyday doings of women with disabilities are coordinated to and shaped by organizational processes and social context, particularly as these relate to the potential of being labelled disabled.An institutional ethnography was conducted with seven Austrian women diagnosed with rheumatoid arthritis (RA). Interviews and participant observations were conducted, and texts about the historical development of disability policies were identified. Data analysis included grouping similar doings of participants together to subsequently explore links between what the women did and how their doings are shaped by disability policies and the social context.The women, who participated in this study, spent time and effort to keep the disease invisible, resist disability and negotiate a disability pass. By drawing upon the historical development of Austrian disability policies, the interpretation reveals how this development infiltrates into participants' lives and shapes their everyday doing.This study furthers understanding of how broader policies and practices, shaped over historical time, infiltrate into the daily lives of women with disabilities. It illustrates how full participation may not necessarily be a lived reality for people with disabilities at this point in Austria. Implications for Rehabilitation Maximising full participation for people with rheumatoid arthritis is important. This requires focusing not only on the bodily health of people with rheumatoid arthritis but also on their interaction with the social, cultural and political context in their daily lives. This requires also understanding how knowledge about disability is passed on from previous generations.

Public policy impacts on the occupational life spectrum of individuals and communities are ubiquitous. This paper explores the nexus between policy science and occupational science. Public policy is defined and the relevance to occupational life and occupational salience is explored. Two occupational science meta-value propositions are put forward to support interdisciplinary dialogue within policy science that can be used to respond to societal transformations and the development of public policy. Economic downturns and globalization are two scenarios used to provide examples of the intersections of occupational science and policy science. These scenarios are used to expand on the value and potential of occupational science to inform public policy through the application of policy levers. This paper opens the door for occupational scientists and public policy scientists to begin to engage in dialogue on the benefits of interdisciplinary approaches that can support the holistic consideration of knowledge ...

Objective: Persons with brain injury experience a shift in their self identity that is underpinned by work loss and changes to their worker role. However, little is known on how to assist a worker with a brain injury re-establish their occupational identity. Thus, the objective of this article is to present the results of a scoping review undertaken to examine the literature on occupational identity and self identity after a brain injury. Methods: A scoping review was performed using the keywords traumatic, acquired brain injury, occupational, and self identity. Articles were narrowed through three phases which involved reviewing articles to ensure a thorough discussion of identity after a brain injury was included and to highlight the research questions. Results: In total 16 articles and 3 theses were included. No articles were retrieved on occupational identity after a brain injury. Fourteen articles discussed the loss of self identity experienced after a brain injury while three articles highlighted rehabilitation programs. Conclusions: Research indicates there are extensive changes to identity after a brain injury and this impacts returning to previous occupations. This knowledge can further our understanding of returning to occupations after a brain injury and the impact on occupational identity.

The world of work is transforming. Where work is performed, who performs work or has the right to work is changing. Along with these changes workers are experiencing shifts in the knowledge needed to work, the dissolving of contracted benefits, and the disappearance of traditional opportunities for work such as in manufacturing. Moreover, there are many influences that shape what workers can do, are expected to do, what they can expect from work and the types of work they can expect to do in the future. Some of these changes give rise to new meanings of work or what it means to be productive within a society or community. Currently, some of the factors shaping the world of work and its situated nature include global shifts in the economy, mandatory retirement changes, the growing number of immigrant or older or migrant workers, the offshoring of work from one country to another, and the discourses about future work possibilities (e.g. the demise of manufacturing in the western world, unemployment as a common phenomenon and the emergence and acceptance of service work or knowledge work as the norm). All of these are changing the occupational salience or valuing of goal directed activities within a community or society [1]. Shifts in occupational salience in work occupations can be changes in the jobs that are considered valued or meaningful or accessible to workers as well as aspects about the nature of working that create new meanings about participation in goal directed activities. For instance, in developed countries one of the most common problems is that global shifts in the economy and the discourse in the popular media about high rates of unemployment raise the expectation of unemployment not only for young people but, also for current workers across all employment sectors. We have even seen the emergence of disparaging or marginalizing lexicons used to describe workers such as discouraged workers [2], undocumented workers, alien workers or injured workers. Workers today can expect more periods of intermittent work disruption and disengagement as part of their employment trajectory due to the unpredictability of and unstable global economies. Unemployment is not new, however what is new is the anticipation of unemployment as an expected part of work life and the rise in the numbers of people from all employment sectors that will experience unemployment. The shift in the availability of work or lack of work has many important consequences for governments, employment insurance programs, labour organizations and for workers. For example, many workers have not previously approached employment with the view of considering and anticipating the need to plan for intermittent or prolonged periods of work disruption. In turn, more peoplewill likely use or rely on unemployment types of benefits during their working years. On the more positive side, workers today can also expect to experience

Participation in the labour force with a hearing impairment presents a number of challenges. This study describes how Canadian newspapers represent workers with hearing loss.Taking a critical framing theory approach, thematic analysis was performed through coding relevant articles, abstracting and hierarchically categorising themes.Seven English-language Canadian newspapers were searched for publications between 1995 and 2016. Twenty-six articles met our criteria: discussing paid workers with hearing loss who used English rather than sign language on the job and making reference to workers' competence.We identified a global theme, Focussing on a good worklife or focussing on a limited worklife, composed of three organising themes (1) Prominent individuals struggle, take action, and continue despite hearing loss, (2) Workers with hearing loss in the community create their best day themselves, and (3) Workers with hearing loss, as a generalised whole, are portrayed as either competent or limited.The dominant framing portrays individual workers as ingenious, determined, and successful. Negative framings were predominantly generalisations to these workers as a group. To generate more positive framings, professionals can build relationships with consumer groups and, when contacted by the media, direct journalists to interview workers with hearing loss.

Introduction: Occupational therapists' intention of enabling women with rheumatoid arthritis to participate in everyday life is fraught with challenges in everyday practice. Method: Inspired by institutional ethnography, this paper aims to make explicit how the work of occupational therapists in an outpatient rheumatology hospital setting is governed within invisible, ruling relations. An analytical description of the first author's clinical experience was a standpoint from which to explicate how occupational therapy is coordinated to the ruling relations of the Austrian health care system. Findings: Occupational therapy practice and research are ruled within a positivist, body-focused, medical apparatus, which renders largely invisible occupational therapists' knowledge of enabling people to engage in occupations that are meaningful to them. Conclusion: Occupational therapists have professional power that can be asserted by strategically using occupational therapy specific knowledge and language in textually mediated practices, from assessments and case files to media images, to give greater visibility and influence to the profession's work of enabling occupation.

Objective: This article presents a review of the current literature on knowledge transfer in the use of technology, amongst children and adolescents. Participants: Researchers, teachers, children, adolescents, and related stakeholders are the targeted users of this paper. Methods: A scoping review and detailed analysis of the review based on ergonomic outcomes of comfort, safety and productivity. Results: The review revealed very few studies addressing the knowledge use and transfer with children or adolescents in this topic area. Current literature on knowledge transfer requires more rigorous evaluation, as well as use of explicit health, occupational and ergonomic outcomes. Conclusions: This paper concludes the need for a call for future research in the area of knowledge transfer to promote healthy and safe use of technology, in the population of children and adolescents.

Objectives: The purpose of this articleis to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. Participants: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. Methods: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. Findings: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. Conclusions: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

OBJECTIVE This feature article on knowledge transfer presents principles and strategies to support the development of short communiques to end-users. PARTICIPANTS Formal and informal knowledge brokers are the targeted users of the strategies. METHODS Research studies and conceptual literature in knowledge transfer informed the development of brief-Knowledge Transfer (b-KT) principles. Principles are explained and a sample of how they informed the development of KIT-Tip Sheets is offered to promote ways to use principles in knowledge dissemination. RESULTS b-KT principles can be used as a framework to guide the development of short communiques by knowledge brokers in work practice but also in the health, social and rehabilitation domains. In addition, these principles promote the participation of end-users in the development of knowledge transfer. CONCLUSIONS Formal evaluation is needed on the use of these principles in achieving the uptake and use of knowledge by end-users.

When selected, accepted and used appropriately, low vision assistive technology devices (ATDs) have the potential to facilitate the performance of occupations that lead to posi tive outcomes. Objective: This paper identifies some low vision ATDs currently used and explores their relative importance for the performance of daily occupation from participants' perspectives. Participants: 17 adults (M = 56 years old, SD = 15.8) with low vision we0re recruited through a purposeful sampling strategy. Methods: Through one-on-one semi-structured telephone interviews, ATD usage data, ranking of perceived importance of ATDs and verbal data were collected from the participants. Results: A total of 124 devices were identified by the participants of w hich 104 (83.9%) were used and 20 (16.1%), mostly adaptive computer technologies, were not. 22 (21%) mainstream aids to daily living were identified (large monitor, larg e screen TV, DVD player) and they ranked high in terms of perceived importance by the participants for daily activities. Verbal fe edback from participants supplemented this finding. Conclusion: Concepts related to usage and ranking of importance of ATDs for daily occupations are multi-faceted and complex (e.g. combination of devices used, multiple equal rankings, etc.). The authors suggested future research opportuniti es to examine these concepts through qualitative means.

This study explored experiences surrounding hearing aid use and non-use in older women with hearing loss. A narrative approach was used to gain an in-depth understanding of the meaning and contextual issues that impact upon the adaptation process of older adults and their transitions in using hearing devices. Four women over the age of sixty who were identified as being consistent hearing aid users took part in three face-to-face interviews. Wengraf's (2001) biographic-narrative-interview guiding framework was used to gather data in this study. Data were analyzed both holistically and thematically from a phenomenological perspective to identify the meaning and essence of the participants' experiences. The results revealed an overarching theme of meaningful participation in life situations and events that were linked to purposeful use and non-use of hearing aids. Barriers and facilitators related to participation, which in turn affect hearing aid use and acceptance, were uncovered. The results of this study have implications for audiologic research, and practice.

The investigation of vehicle safety needs for older drivers and passengers is integral for their safe transportation. A program of research on safe transportation for seniors was launched through AUTO21, a Canadian Network of Centres of Excellence. This national research network focuses on a wide range of automotive issues, from materials and design to safety and societal issues. An inductive qualitative inquiry of seniors’ driving experiences, safety feature use, and strategies to prevent injury and manage risks was a first step in this program. We conducted interviews and focus groups with 58 seniors without disabilities and 9 seniors with disabilities. We identified a lack of congruity between the vehicle and safety feature design and seniors’ needs. Seniors described strategies to manage their safety and that of others. Specific aspects of vehicle design, safety features, and action strategies that support safer use and operation of a vehicle by seniors are outlined.

Background: There is a need for tools by which to evaluate the beliefs, behaviors, and attitudes that underlie interprofessional socialization and collaborative practice in health care settings. Method: This paper introduces the Interprofessional Socialization and Valuing Scale (ISVS), a 24-item self-report measure based on concepts in the interprofessional literature concerning shifts in beliefs, behaviors, and attitudes that underlie interprofessional socialization. The ISVS was designed to measure the degree to which transformative learning takes place, as evidenced by changed assumptions and worldviews, enhanced knowledge and skills concerning interprofessional collaborative teamwork, and shifts in values and identities. The scales of the ISVS were determined using principal components analysis. Results: The principal components analysis revealed three scales accounting for approximately 49% of the variance in responses: (a) Self-Perceived Ability to Work with Others, (b) Value in Working with Others, and (c) Comfort in Working with Others. These empirically derived scales showed good fit with the conceptual basis of the measure. Conclusion: The ISVS provides insight into the abilities, values, and beliefs underlying socio-cultural aspects of collaborative and authentic interprofessional care in the workplace, and can be used to evaluate the impact of interprofessional education efforts, in house team training, and workshops.

Objectives: A historical review of the editorial board and the founding editor of WORK: A Journal of Prevention, Assessment and Rehabilitation was conducted to examine the understanding of the editorship and contributions of this team to the knowledge in WORK. Participants: The team of four authors worked together to identify an approach to evaluate the contributions and impact of WORK's editorial board (EB) on the journal's scholarship. The editor-in-chief (EIC) and editorial board members were participants in this evaluation. Methods: Informative and formative evaluations were used to investigate how knowledge was shaped through the development of an epistemic community of scholars in the field of work. Metrics of the EB composition and participation in the journal as well as surveys and interviews with the board and the editor-in-chief were analyzed. Results: The EB represents an international community of scholars with a common interest in work and who contribute academically both within WORK and beyond. The epistemic community that has evolved through the editorial board represents a pluralistic perspective on work that is needed to inform practice, and knowledge. Conclusion: Future directions to continue to advance knowledge through WORK's editorial board and EIC are elaborated.

EnglishBackground. An emerging trend in work practice is to move knowledge into the hands and minds of the end-users-our clients. Purpose. The purpose of this study was to investigate clients' perspectives on their experiences, needs, and preferences for accessing and using information to make decisions in resuming work and living with disability. Methods. Data from a grounded theory study with a sample of 14 participants with chronic disabilities from three regions across Canada were analyzed using the constant comparative method. Findings. Barriers revealed the pervasive struggles of clients in accessing and communicating information. Clients need places, resource people as well as access to diverse formats, and material to support knowledge use. Clients engaged themselves in interpreting or acting upon knowledge through planning for contingencies, appraising the self in context, and reflecting and learning from others. Implications. Findings advance the conceptual understanding of knowledge translation principles and processes needed to support clients in making decisions about return-to-work. Opportunities for policy change and for occupational therapists to support knowledge brokering and translation are elaborated. francaisDescription. La nouvelle tendance enmatiere de pratique professionnelle est de remettre les connaissances entre lesmains des principaux interesses : nos clients. But. Cette etude a pour but d'analyser les differents points de vues des clients en ce qui concerne leurs experiences, leurs besoins ainsi que leurs preferences, lorsqu'il s'agit d'obtenir et d'utiliser l'information pouvant les aider a vivre avec leur handicap et a reintegrer lemarche du travail.Methodologie. Lamethode comparative constante a ete utilisee afin d'analyser les donnees d'une etude par theorisation ancree, qui a ete realisee sur un echantillon de 14 participants de trois regions differentes du Canada presentant une deficience chronique. Resultats. Les obstacles rencontres ont revele que les clients avaient constamment de la difficulte a obtenir et a communiquer l'information. En effet, les clients ont besoin d'emplacements adequats et de personnes-ressources et ils doivent egalement avoir acces a divers formats ainsi qu'a dumateriel particulier pour pouvoir utiliser ces connaissances. Par ailleurs, les clients parviennent a s'investir dans l'interpretation ou l'application des connaissances en se preparant aux differentes eventualites, en evaluant leur situation selon le contexte et en reflechissant a leurs experiences, tout en apprenant des autres. Consequences. Les resultats de l'etude permettent de mieux comprendre les principes et les processus d'application des connaissances requis pour que le client puisse prendre une decision face a son retour au travail. Des possibilites de changement de politique et des strategies pour aider les ergotherapeutes a favoriser la transmission du savoir et l'application des connaissances sont actuellement en voie d'elaboration.

Background. Despite occupational therapists' role in work-related evaluations, there are no guidelines for evaluating clients' work readiness. Purpose. This study explored how occupational therapists evaluate work readiness following acquired brain injury in order to develop an integrated model of the factors, processes, stakeholders, and contextual elements relevant to this evaluation. Methods. Ten occupational therapists with expertise in vocational and brain injury rehabilitation were interviewed. Data were analyzed using grounded theory methods to develop the work readiness evaluation model. Findings. This model describes five processes formative to therapists' evaluation: (1) drawing upon diverse sources of information and perspectives; (2) assessing occupational capacity; (3) contextualizing occupational potential; (4) building a shared understanding of work readiness among stakeholders, including, clients, employers, insurers, and rehabilitation teams; and (5) transforming the work readiness question. Implications. The model highlights the importance of building a shared understanding amongst stakeholders and provides a provisional framework to guide practice.

Today, the distinction between cyberspace and real space represents a false dichotomy. Wireless laptop computers, personal digital assistant devices and similar emergent information and communication technology (ICT) objects, along with the cyberspace/ internet information they mediate, may be intervening between what and how we are able to ‘do’ in real places. This phenomenon is seen in many contemporary occupations in the westernized world and intensifies the connections among occupation, place, and the internet. In this article, we begin to examine this connection, starting from Hocking's person‐object interaction model. Advocating the addition of an informational domain to objects in the model, we discuss its application to internet informational mediating ICT objects. Examples are used to illustrate the complexities of introducing ICT objects and the information they mediate, to a place or across different places, and how their inclusion in occupational scientists’ conscious consideration may contrib...

This article presents personal reflections on experiences in constructing a cabin by the sea to explore enablers and constraints affecting women's participation in novel occupations, and to understand connections between place and occupation. Insights gained as a result of reflection suggest that catalysts for participation in new and unconventional occupations include elements such as being in a new place away from daily routines as well as feelings of freedom and safety. Resources in a place can support enactment of new skills and help to develop competence. The values espoused in a place can facilitate meaningful and ongoing participation. More research is needed in various settings to better understand how place and context can act as catalysts promoting the occupational participation of women in learning skills, meeting the demands of different occupations and gaining confidence when choosing to do something novel.

The 4th Canadian Occupational Science Symposium included a new feature – a community panel on economic occupational opportunities outside major urban centres. The panel connected symposium participants with the local community to generate a dialogue on the broad concepts of occupation and place relevant to employment transitions in Northern Ontario. Presentations on occupational patterns in Northern Ontario, and on what counts as occupation provided a backdrop to the dialogue. Small groups were invited to reflect on their daily and weekly occupations, possibilities for economic development, current approaches to economic occupational transitions, and possible research areas and partners to examine occupational transitions in the region. This paper summarizes the event, the two presentations, and key discussion points. It ends with a discussion of the benefits of involving the community at occupational science symposia and recommendations for panels with community involvement.

Background: Historically the supports available to help injured workers transition back to pre-injury jobs focused primarily on the medical treatment of the injury and modifications in the workplace. However, for many injured workers, with chronic disabilities, the need for support extends to learning to live with newly exposed disabilities, managing changes within family and social life as well as meeting new expectations in claims and health management. Supports that many injured workers require to resume employment are not adequately addressed. Objective: A critical social perspective was used to engage a partnership with injured worker group members in the design, implementation and evaluation of injured worker needs to promote social change. This paper reflects a program of research established in partnership with the Canadian Injured Worker Alliance to develop and examine a conceptual framework of supports for use in meeting the transitional needs of injured workers with chronic disabilities. Occupational and educational perspectives were used to develop a conceptual framework comprised of 8 dimensions of support. Method: A regional needs assessment using multi-methods, including surveys, interviews and focus groups, was conducted in British Columbia (BC). Priorities of three stakeholder groups were mapped to the 8 dimensions of support. This conceptual framework was also tested nationally to evaluate the distribution of supports that exist and identify further needs for support to help injured workers manage multiple transitions. Findings: Access to the range of supports that injured workers need in transitioning to and from work is inconsistent and inequitable across Canada. Conclusion: Collaborative approaches and a broader spectrum of resources and supports are needed to help injured workers and their families in resuming meaningful participation in daily, social and productive occupations. Language: en

Background. A qualitative meta-synthesis is an approach to synthesizing relevant findings from across qualitative studies on a particular topic using methods consistent with qualitative research.Purpose. Using examples of recently completed qualitative meta-synthesis projects, the purpose of this paper is to present the meta-synthesis approach; highlight the key steps, processes, and issues involved; and demonstrate its potential to advance knowledge about occupation and occupation-based practice.Key Issues. The qualitative meta-synthesis approach allows us to take stock of the current state of knowledge in a given area in order to ensure that we have explored the phenomenon from different perspectives and to begin to push the field forward by allowing us to develop deeper insights and understandings.Implications. Despite certain limitations and challenges associated with the approach, qualitative meta-syntheses can provide new knowledge through critical analysis and interpretation to inform client, practitioner, and policy audiences.

Background. Occupational therapists need tools to identify barriers and facilitators to participation in societal roles. Purpose. The purpose of this study was to examine the potential of the International Classification of Functioning, Disability and Health (ICF) two-level classification for use in occupational therapy. Methods. A secondary analysis of an existing dataset was conducted to identify participation barriers and facilitators that mapped to the ICF and those that did not. Results. A broad range of factors was captured across the components of the ICF. Findings also revealed enabling and disabling factors thatwere not evident in the ICF. Practice Implications. The ICF can support the identification of a broad range of external barriers and facilitators relevant to participation and of interest to occupational therapy. However, therapists must use other strategies to gain a comprehensive understanding of the nature, extent and consequences of barriers and facilitators that may exist in a given context.