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Background Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Objectives Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Methods Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Data sources Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. Review methods In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Results Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women’s economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. Limitations In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. Conclusions The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. Recommendations for health policy and practice These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Future work Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information. Plain language summary Mental health problems affect one in five women during pregnancy and the first year after birth (the perinatal period). These include anxiety, depression and stress-related conditions. Mental health problems can have a negative effect on women, their partners and their children. They are also a leading cause of maternal death. It is therefore important that women who experience mental health problems get the care and treatment they need. However, only about half of women with perinatal mental health problems are identified by health services and even fewer receive treatment. This research aimed to understand what factors help or prevent women getting care or treatment for perinatal mental health problems. We did this by pulling together the findings from existing research in three phases. In phase 1 we reviewed the evidence from research studies to understand why it has been difficult for health services to assess, care for and treat women with perinatal mental health problems. In phase 2 we reviewed evidence from women’s perspectives on all of the factors that prevent women from being able to get the care and treatment they need. In phase 3 we worked with a panel of women, health professionals (such as general practitioners and midwives) and health service managers to look at the findings from phases 1 and 2. We then developed frameworks that give a clear overview of factors that help or prevent women getting care and treatment. These frameworks show 39 factors that help women access services, and 66 factors that prevent access. Based on these results we have developed guidance for government, NHS service managers and health professionals, such as general practitioners, midwives, health visitors, nurses and wider teams such as receptionists. This will be shared widely with health services and professionals who support women during pregnancy and after birth to improve perinatal mental health services so that care meets women’s needs. Scientific summary Background and objectives Perinatal mental health (PMH) difficulties can occur during pregnancy or after birth. They commonly consist of anxiety disorders, depression, post-traumatic stress disorder (PTSD) and stress-related conditions such as adjustment disorder. PMH difficulties are particularly important because of the potential negative impact on women, their partners and children. For example, they are associated with an increased risk of maternal suicide, a decline in relationship satisfaction and long-term impacts on children’s development. It is therefore important that women with PMH difficulties can access care and treatment. However, research suggests only half of women with PMH problems are identified by health services and even fewer receive treatment. This research therefore aimed to identify potential barriers and facilitators to PMH care across the care pathway, both in terms of women accessing care, and in terms of health services implementing new PMH assessment and treatment initiatives. Our primary research objective was to develop a conceptual framework of barriers and facilitators to PMH care (defined as identification, assessment, care and treatment) to inform PMH services, and highlight where further research is needed. This was done through two systematic reviews which synthesised the evidence on: Review 1 (R1) barriers and facilitators to implementing PMH care; and Review 2 (R2) barriers to women accessing PMH care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders (e.g. women, general practitioners, midwives, health visitors, psychiatrists, commissioners, third-sector organisations, etc.). Results were used to inform recommendations for policy, practice and future research in PMH care. Secondary research objectives were to: (1) determine the barriers and facilitators to implementing PMH care in health and social care services; (2) identify differences in barriers and facilitators across different health and social care settings; (3) evaluate the quality of this evidence; (4) extract recommendations for implementation, practice and research based on the barriers and facilitators identified; (5) determine the barriers and facilitators to women accessing PMH care; (6) evaluate the quality of these reviews; and (7) map the geographical distribution of the research to establish generalisability and gaps in the evidence. Review methods For both reviews pre-planned searches were carried out in MEDLINE (1946–present), EMBASE (1974–present), PsychInfo (1806–present) and CINAHL (1982–present). R2 also used Scopus and Cochrane Database of Systematic Reviews (Issue 8 of 12, August 2021). MeSH terms (i.e. prenatal care/anxiety/diagnosis) and Boolean operators ‘OR’ and ‘AND’ were used. Eligibility criteria for R1 were empirical studies that examined factors that either facilitated or impeded implementation of PMH care in health or social care services. These could be qualitative interviews with health professionals (HPs) or women about services; or studies describing the implementation of PMH care services. Eligibility criteria for R2 were reviews of literature on barriers and facilitators for women in the perinatal period (defined as conception to one year postpartum) to access assessment, care or treatment. Information on barriers and facilitators had to be directly drawn from perinatal women’s experiences. Only systematic reviews with a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search strategy were included. Search results were imported into Endnote and duplicates were removed. Remaining studies were then imported into Eppi-Reviewer. In R1 10% of the results were double screened. In R2 all studies were double screened. For both reviews, 10% of included studies had their data extracted in duplicate. Methodological quality appraisal was conducted using the Joanna Briggs Critical Appraisal Tools for R1, and dual appraisal was conducted for 35% of included papers. Most studies (n = 44) had a quality rating above 70% suggesting that studies were well-conducted with low risk of bias. For R2, methodological quality of reviews was appraised using A measurement tool to assess systematic reviews-2 (AMSTAR) tool, and dual appraisal was carried out for all included reviews. The majority of reviews were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Therefore, a qualitative sensitivity analysis was carried out to assess whether themes remained consistent across all reviews regardless of their quality rating. Only qualitative papers were identified. Results were analysed using a thematic synthesis and mapping themes on to a systems level model adapted from Ferlie and Shortell’s Levels of Change framework (e.g. individual level factors, HP factors, organisational factors and larger system factors) (Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 2001;79(2):281–315. https://doi.org/10.1111/1468-0009.00206) and then grouped to reflect different stages of the care pathway adapted from Goldberg and Huxley’s Pathways to Care model (e.g. deciding to disclose, assessment, access to care, treatment) (Goldberg D, Huxley P. Common Mental Disorders: A Bio-Social Model. New York, NY: Tavistock/Routledge; 1992.). Review results Review 1 searches identified a total of 21,535 citations. After screening by title and abstract 10,130 records were excluded, leaving 931 papers to be screened by full text. Screening of full texts identified 43 studies to be included in the review. Forward and backward searches identified a further three papers. Therefore, 46 qualitative studies were included in the qualitative synthesis. Studies were mainly carried out in higher income countries (HICs). Implementation occurred in a wide range of settings including hospitals (n = 14); primary care (n = 12); and community-based care (n = 12). Most studies (n = 22) looked at the implementation of comprehensive care services (including screening, referral and treatment). Review 2 searches identified a total of 4086 citations. After removing duplicates and studies not meeting inclusion criteria, 2028 articles were left to be screened. Screening by title and abstract led to 1962 records being excluded, leaving 66 papers to be screened by full text. Screening of full texts identified 32 reviews of qualitative studies to be included in the meta-review. Reviews were conducted between 2006 and 2021. The number of studies included in each review varied from 4 to 40 with a total of 344 studies included across all the reviews. The reviews included studies carried out in 24 different countries. Most reviews focused on perinatal depression. Qualitative sensitivity analysis found that most themes were supported in both the higher quality and lower quality reviews. Including all reviews meant the data was richer and included marginalised women, such as refugees, migrants and women living in sub-Saharan Africa. This suggests results from R2 can be interpreted with reasonable confidence. Overall, in terms of geographical distribution and type of mental illness most studies were carried out in HICs (R1: n = 38; R2: n = 28), and the majority focused on perinatal depression (R1: n = 32; R2: n = 23). Barriers and facilitators to PMH care were identified from R1 and R2. Results from both reviews were merged together and mapped on to seven levels informed by Ferlie and Shortell’s (2001)40 framework (Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q 2001;79(2):281–315. https://doi.org/10.1111/1468-0009.00206). These were: (1) Individual factors; (2) HP factors; (3) Interpersonal factors; (4) Organisational factors; (5) Commissioner factors; (6) Political factors; and (7) Societal factors. Factors at these levels impacted on PMH care at different stages of the care pathway. Individual level factors were the most influential in women’s decision to consult. Women not understanding HPs roles (n = 12) or not understanding what perinatal mental illness (PMI) was (n = 14) were the most cited barriers. The largest individual level facilitator to deciding to consult was recognising something was wrong (n = 8). In terms of first contact with HPs, the most commonly cited reason for women dropping out of the care pathway was if HPs were dismissive about mental illness or normalised women’s symptoms (n = 8). Assessment of PMH was influenced by multiple factors. At the individual level, the most cited barrier was the presence of family and friends with negative beliefs about mental illness (n = 7). At the HP level, assessment specific behaviours such as carrying it out in a tick box way (n = 12) was the most cited barrier. At the interpersonal level, women and HPs being able to speak openly and honestly about assessment was the most cited facilitator (n = 5). At the organisational level, the most common facilitator was the acceptability of assessment or screening for both HPs and women (n = 17). Women deciding to disclose their symptoms was also affected by multiple factors. At the individual level, fear of being judged as a bad mother (n = 7) was the most cited barrier. HPs appearing too busy was the most cited barrier (n = 5) at the HP level. A lack of a trusting relationship between women and HPs (n = 10) was the most cited interpersonal barrier. Linked to this, at the organisational level, a lack of continuity of carer (n = 8) was the most cited barrier. Stigma (n = 18), culture (n = 13) and maternal norms (n = 15) were all societal level barriers preventing the disclosure of PMH symptoms. The most commonly cited factors affecting referral were collaborative working across services (n = 7) and organisational referral procedures (n = 7). Multiple factors influenced access to treatment. At the individual level, the most cited barriers to accessing care were logistical issues such as not having childcare (n = 14), the location of the care and difficulties travelling there (n = 13). Language barriers were the biggest interpersonal barrier to women accessing care (n = 4) and related to this, a lack of culturally sensitive care was the most cited organisational barrier to access (n = 7). At the commissioner level, the most cited barrier to access was a lack of appropriate or timely services for women (n = 11). At the political level a lack of financial resources to pay for health care (n = 14) was a barrier to access. In terms of provision of optimal care, at the HP level, HPs possessing valued characteristics (n = 9), such as being trustworthy and caring, were facilitators to the provision of optimal care. At the interpersonal level, a lack of trusting relationship was a barrier to optimal care provision (n = 5). At the organisational level, the provision of individualised care (n = 11) that was appropriate to women’s needs (n = 12) was a facilitator. A lack of training related to PMI and treatment was the most cited organisational barrier (n = 15). At the wider levels, immigration status (n = 5), stigma (n = 8) and culture (n = 6) were barriers to optimal care. Multiple factors impacted women’s experience of treatment or care. At the individual level, social isolation (n = 7) was a barrier to women’s experience of care as it exacerbated their mental health difficulties further. HPs who provided hope to mothers, were caring, supportive, empathetic and went above and beyond meant women had a positive care experience (n = 9). Individualised and person-centred (n = 11) care was also associated with a positive care experience. In terms of barriers and facilitators within different health and social care settings, within hospitals the most cited factors influencing implementation were lack of time or a heavy workload (n = 8), and whether HPs were positive about the care being implemented (n = 8). In primary care, the most commonly cited factors that influenced implementation were stigma (n = 8) and family presence (n = 8). In community settings the most important factors were training (n = 8) and the characteristics of the person providing the care (n = 6). Across low-income countries, stigma (n = 4) and lack of training (n = 4) were the most cited barriers to implementation. Similarly, when health services were located in higher income countries, but women from a refugee or different cultural background accessed them, stigma (n = 6) and lack of HP training (n = 6), along with HP’s heavy workload (n = 6) and lack of collaborative working (n = 6) were the most cited barriers. The MATRIx conceptual frameworks Results from both reviews were synthesised to develop two conceptual frameworks. Eight stages outlined by Jabareen were followed to develop the frameworks: (1) mapping the selected data sources; (2) extensive reading and categorising of the selected data; (3) identifying and naming concepts; (4) deconstructing and categorising the concepts; (5) integrating concepts; (6) synthesis, resynthesis and making it all make sense; (7) validating the conceptual framework using stakeholder meetings and the Confidence in the Evidence from the Reviews of Qualitative research (CERQual) approach; and (8) rethinking the conceptual framework. Two MATRIx conceptual frameworks were developed that highlight the importance of 66 barriers and 39 facilitators to PMH care at multiple levels and that intersect across the care pathway. These conceptual frameworks informed the development of evidence-based recommendations on how to address barriers to ensure that all women are able to access the care and support they need. Recommendations were made for health policy, practice and research. Conclusions The MATRIx conceptual frameworks on barriers and facilitators highlight the need for women-centred, flexible care, delivered by well-trained, knowledgeable, and empathetic HPs working within an organisational and political structure that enables them to deliver quality care. Results also suggest a need for international efforts to reduce stigma associated with mental health difficulties. Recommendations for practice and policy were made. While recommendations are based on the evidence, they may be more or less achievable, depending on the local and national context and pressures on services. Based on the evidence, it is suggested that policy makers: (1) review the conceptual frameworks and take comprehensive, strategic and evidence-based steps to ensure there is an effective system of PMH care; (2) ensure services are adequately funded and there are enough trained staff in order to ensure every woman with PMH difficulties is able to access appropriate treatment in a timely fashion; and (3) improve access to health care for all through free health care and a fair and easy-to-access welfare system. The evidence suggests that recommendations for healthcare practice include: (1) designing care with women to ensure it meets their needs; (2) providing culturally sensitive care and increasing the accessibility of care through pictorial aids and translators; (3) ensuring chosen technology is fit for purpose, and co-designed with HPs; (4) services working together; (5) employment of enough staff from a variety of health disciplines; and (6) HPs receiving high-quality training, with protected time to complete it. Limitations In R1 only 10% of abstracts were double screened and, given the large number of citations to screen, some papers may have been missed. Similarly, in R1 only 10% of included papers were methodologically appraised by two reviewers. Both reviews only included papers published in academic journals and written in English. Relevant reviews from health services, charities, third-sector organisations and other grey literature may have been missed. Furthermore, the majority of reviews in R2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. However, this was mitigated through the use of a qualitative sensitivity analysis. Future work Further research is needed to examine access to PMH care for specific groups, such as fathers, immigrants or those in lower income countries. More research is needed on facilitators to implementing and accessing PMH care, as well as appropriate measures to help service managers assess whether a service is working effectively. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.

Background: Worldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery. Methods: The Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature. Discussion: Despite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care. Systematic review registration: This scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ [ABSTRACT FROM AUTHOR]

Immigrant women of Pakistani origin are among the most at-risk groups for type 2 diabetes, obesity, and heart failure in Catalonia. As the incidence of these diseases is associated with lifestyle factors, we approached this community with participatory research and conducted six focus groups (N = 36) among Pakistani women participating in the PakCat Program. The research process of this paper adhered to the COREQ checklist. Through the thematic analysis, we identified six main themes: social beliefs and attitudes, family environment, personal factors, dietary acculturation, traditional dietary patterns, and economic factors. We discovered both facilitators and barriers associated with each theme, but the findings indicated that Pakistani women encounter more inhibitors than enablers to following a healthy diet. The determination of these factors can facilitate the reinforcement of the aspects that help Pakistani women to follow a healthy diet and provide adequate tools to overcome the barriers. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer screening has demonstrated high efficacy in reducing cervical cancer mortality worldwide. However, clinician sampling is often perceived as an uncomfortable procedure that could reduce screening uptake. Self-sampling methods for HPV diagnosis have shown high sensitivity, which could increase acceptance and screening rates among women. Purpose: This study aims to identify the perceived barriers and advantages of self-sampling methods versus clinician sampling for cervical cancer screening in a rural setting in Ecuador. Patients and Methods: A qualitative study was conducted. Seven focus group discussions took place in the rural Parish of El Valle in Azuay Province, Cuenca, Ecuador. Women native to this rural area were included in the study. FGDs were recorded and transcribed, and content analysis was performed to categorize and analyze the data. Results: A total of 45 women participated in the study. Clinician sampling was perceived as a painful and intrusive method. However, participants believed that it is more reliable compared to self-sampling methods, attributing this to the direct visualization of the cervix, which facilitates the detection of cervical pathologies. The perceived advantages of self-sampling included increased comfort, pain reduction, time savings, the ability to perform the test at home, and the potential for widespread availability through pharmacies or local traditional healers. Nevertheless, doubts about the test's reliability as well as the user's proficiency in self-testing posed barriers to the adoption of this technique. Conclusion: Self-sampling methods offer several advantages over clinician sampling, such as enhanced privacy, comfort, and accessibility to cancer screening. Barriers primarily revolved around users' proficiency in performing the test and the reliability of the results. Providing training for using self-sampling tests could address these barriers. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) is a burgeoning technology within healthcare, though routine implementation of VR within hospital settings remains limited. Health professionals are key stakeholders in knowledge translation, though limited research has explored their knowledge and attitudes towards using VR for different purposes within healthcare. This study aimed to scope health professionals' knowledge of, and attitudes towards, the use of VR applications in a public hospital setting. Methods: A cross-sectional survey of multidisciplinary health professionals (medical, nursing, allied health professionals) was conducted in a major metropolitan public hospital in Australia. The custom survey was comprised of 28 mixed categorical and free-text fields designed to scope levels of knowledge, prior experience, and interest in VR; the perceived utility of VR within a hospital context; and perceived barriers and enablers of VR use within the hospital setting. Data were analyzed via descriptive and non-parametric statistics. Results: One hundred and thirty-seven health professionals participated (38% allied health, 37% nursing, 24% medical). The majority had no prior exposure to VR in clinical (95%) or recreational (67%) settings; and only 16% were aware of any clinical research evidence for VR. Despite limited awareness, participants expressed support for VR use in hospitals. 99% reported VR had potential utility in healthcare, most commonly for clinical simulations (81%), clinical education (80%) and as a physical therapy tool (68%). Participants identified multiple barriers to VR implementation most commonly relating to perceived cost, lack of required infrastructure, time, knowledge and technical skill. Prominent enablers related to increasing capability at provider and system levels. Participants' familiarity with VR was associated with stronger support for its' use (Rho = 0.4, p < 0.001). Conclusions: Health professionals in the hospital workforce reported limited knowledge and familiarity with VR; yet they perceived VR had broad utility and expressed overall support for different VR applications within hospitals. Health professionals appear interested in VR though face multiple barriers to its use in a hospital context. Increasing capability among multidisciplinary health providers and the wider hospital system appear to be important considerations for the success of future VR implementation in public hospitals. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS. Methods: Analysis of the degree of implementation of integrated social and health HCS perceived by social care services (SCS) and primary health care centers (PHCs) between December 2020 and June 2021 in two phases. First, the perception of integration by social workers within SCS and PHCs was assessed using a screening questionnaire. Then, SCS in counties with the highest integration scores received a customized questionnaire for an in-depth assessment. Results: A total of 105 (100%) SCS and 94 (25%) PHCs answered the screening questionnaire, and 48 (45.7%) SCS received a customized questionnaire. The most frequent barrier identified was the lack of shared protocols, with the most frequent facilitator being the recognition of the importance of integrated HCS. Conclusions: Our study showed that the degree of implementation of integrated health and social HCS offered by the Government of Catalonia was perceived as low. The identified barriers and facilitators can be used to facilitate such implementation. Further studies should include professionals other than social workers in PHC assessments. [ABSTRACT FROM AUTHOR]

Objectives: To explore the opinions and beliefs of physicians about integrating families into the care system of hospitalized preterm neonates. Methods: The setting was Neonatal Intensive Care Unit (NICU) of a tertiary care center in North India. Focus group discussions (FGDs) were conducted with the physicians using a pre-validated FGD topic guide. The FGDs were audio-recorded and transcribed. The meanings were drawn, and dependability was ensured. Themes and sub-themes were generated and finalized with a common consensus. Results: Five FGDs were conducted involving 28 physicians. The physicians opined that making families a part of the care system has several benefits, though they brought out some concerns. They opined that involving parents gives them confidence and satisfaction as they get empowered about neonatal care at the hospital and home after discharge. They reported difficulties in communication due to perceived inadequacy in counseling skills, language barriers and literacy levels of families, and lack of adequate time due to clinical overload. They identified nurses and public health nurses as an important bridge between physicians and families, and peer support as a useful facilitator. They suggested that role assignments to team members, training in counseling and communication, improving the comfort of parents and organizing information in easy-to-understand audio- visual content can help improve the family integration. Conclusions: The physicians highlighted practical barriers, facilitators, and remedial measures to effectively integrate the families into the care system of preterm hospitalized neonates. There is a need to address the concerns of all stakeholders including the physicians for successful implementation of family integration. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlighted the need for advance care planning (ACP) as a way to help mitigate the various care concerns that accompanied the healthcare crisis. However, unique obstacles to typical ACP practice necessitated the need for guidance and innovation to help facilitate these vital conversations. The aim of this systematic review was to identify the various ACP barriers and facilitators that arose during the pandemic and determine how ACP practice was affected across different contexts and among different populations. This systematic review (PROSPERO registration number: CRD42022359092), which adheres to the PRISMA guidelines for reporting systematic reviews, examined studies on ACP in the context of the COVID-19 pandemic. The review involved searches of five databases, including MEDLINE and Embase. Of the 843 identified studies, 115 met the inclusion criteria. The extracted ACP barriers and facilitators were codified and quantified. The most frequently occurring ACP barrier codes were: Social distancing measures and visitation restrictions, Uncertainty surrounding the COVID-19 prognosis, and Technological/Telehealth barriers. The most frequently occurring ACP facilitator codes were the following: Telehealth/virtual ACP platforms, Training for clinicians, and Care team collaboration. Identifying the ACP barriers and facilitators is essential for developing effective, resilient ACP promotion strategies and improving its delivery, accessibility, and acceptability. [ABSTRACT FROM AUTHOR]

Background: The Veterans Administration (VA) is transforming its historically male-dominated health care system to better serve women veterans, few of whom, nevertheless, use VA health care. We describe the factors affecting women veterans' use of VA-provided health care. Methods: We conducted in-person interviews with 22 women veterans in Los Angeles, California, from 2013 to 2015 who received some non-VA health care. Using grounded theory, we inductively identified the major themes and selected illustrative quotations. Results: Why women veterans do not use VA health care is shaped by factors related to the safety, quality, and value of health care, including poor linkage to VA services during and after military service, limited knowledge and inaccurate beliefs regarding eligibility for VA services, bureaucratic barriers impeding receipt of VA care, VA environments triggering memories of negative military experiences, negative interpersonal experiences with VA staff, and perceiving VA settings as unsafe, ill-equipped to address addiction, and insensitive to women-specific needs and preferences. Women are attracted to VA health care for its whole health care capacity, peer social support, and proactive clinicians. Conclusion: Findings can inform improvements to VA health care design and delivery, thereby bolstering those aspects of VA care that women veterans value while reducing health care utilization barriers. [ABSTRACT FROM AUTHOR]

*OBJECTIVE: To identify barriers and facilitators for using intervention reporting guidelines (CERT and TIDieR) from authors of randomized controlled trials in sports and exercise medicine journals. *DESIGN: Mixed-methods cross-sectional online survey. *METHODS: We recruited authors of randomized controlled trials published from June 2, 2018, to June 2, 2022, in the 10 leading sports and exercise medicine journals. We invited authors of eligible trials to complete an online survey that included multiple-choice and Likert-scale questions, as well as open-ended free-text questions on the barriers and facilitators to using intervention reporting guidelines. We used descriptive analysis to summarize the quantitative data and a hybrid deductive-inductive thematic analysis to identify barriers and facilitators from the qualitative data. We conducted a subgroup analysis to explore differences in barriers and facilitators between early-mid career researchers and senior researchers. &RESULTS: Eighty-four participants from 21 countries completed the survey (44 early-mid--career researchers, 40 senior researchers). We identified 8 themes relating to using intervention reporting guidelines. Themes classi- fied as barriers related to publication constraints (word count limits), low awareness of intervention reporting guidelines, unclear benefits of the guidelines, and the increased burden imposed upon the researcher. Themes classified as facilitators related to journal requirements for guidelines use, the desire to accurately describe interventions, recommendations from other researchers, and reporting guideline use indicating "quality" of work. *CONCLUSION: Barriers to using intervention reporting guidelines are largely modifiable and could be addressed by journals mandating their use, and educational initiatives. [ABSTRACT FROM AUTHOR]

Background: Optimal adherence is crucial for ensuring both therapeutic and preventative benefits of antiretroviral therapy (ART). Sub-optimal adherence is common in prisoners and little information is available about its predisposing circumstances in resource-limited settings. We explored lived experiences of inmates living with HIV (ILWH) and experiential accounts of service providers in South Ethiopia to identify barriers to and facilitators of HIV care use in the prison context. Methods: We conducted qualitative in-depth interviewing with eleven ILWH and eleven service providers. Audio recorded interview data were transcribed verbatim in Amharic language, translated into English and coded based on emerging concepts. We employed a descriptive phenomenological approach to abstract meaning attributed to the prisoners' lived experiences in relation to HIV care use and service providers' experiential account regarding care provision as presented to our consciousness. Findings: Several concepts emerged as barriers to HIV care use amongst ILWH in South Ethiopia including: limited access to standard care, insufficient health staff support, uncooperative security system, loss of patient privacy, a lack of status disclosure due to social stigma, and food supply insufficiency. In addition to a unique opportunity offered by an imprisonment for some ILWH to refrain from health damaging behaviours, the presence of social support in the prison system facilitated care use. Conclusions: This study identified important structural and social contexts that can both hinder and enhance HIV care use amongst ILWH in South Ethiopia. Given the disproportionate burden of HIV in prisoners and the potential of transmission to others during and after incarceration, development of contextually-responsive strategies is required to address the barriers and to also strengthen the enablers. [ABSTRACT FROM AUTHOR]

Background: India has rolled out Early Infant Diagnosis (EID) program for HIV infection in all states. EID program consists of testing of Infants exposed to HIV periodically over 18 months of age which is a multi-step complex testing cascade. Caregivers represent the primary beneficiary of EID program i.e., infants exposed to HIV and face multiple challenges to access EID services. As part of national EID program outcome assessment study, this study narrates caregivers' perspectives on barriers and facilitators to access and utilize EID services. Methods: The study was conducted in 31 integrated counselling and testing centres (ICTCs) located in 11 high burden HIV states. A total of 66 in-depth interviews were conducted with caregivers' of infants enrolled in EID program. Thematic analysis was carried out to help identify themes underlying barriers and facilitators to access EID services and utilization from caregivers' perspectives. Results: The stigma and discrimination prevalent in society about HIV remains a key demand side (caregiver-level) barrier. Non-disclosure or selective disclosure of HIV status led to missed or delayed EID tests and delayed HIV diagnosis and initiation of Anti-Retroviral Therapy (ART) for infants exposed to HIV. On supply side (health system-level), accessibility of healthcare facility with EID services was reported as a key barrier. The distance, time and cost were key concerns. Many caregivers faced difficulties to remember the details of complex EID test schedule and relied on a phone call from ICTC counsellor for next due EID test. Delayed EID test results and lack of communication of test results to caregiver were reported as primary barriers for completing the EID test cascade. Discussion: The study reports caregiver-level and health system-level barriers and facilitators for access to EID services from the caregivers' perspectives. While, decentralisation and single window approaches can improve the access, timely communication of test results to the caregiver also need to be built in with appropriate use of technology. A holistic intervention including PLHIV support networks and the peer-led support mechanisms would be useful to address societal factors. Conclusion: The study findings have high significance for developing program implementation strategies to improve access and to build right-based and patient-centred EID services. [ABSTRACT FROM AUTHOR]