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Language barriers are major obstacles that Asian American immigrants face when accessing health care in the USA. This study was conducted to explore the impact of language barriers and facilitators on the health care of Asian Americans. Qualitative, in-depth interviews and quantitative surveys were conducted with 69 Asian Americans (Chinese, Filipino, Japanese, Malaysian, Indonesian, Vietnamese, and mixed Asian backgrounds) living with HIV (AALWH) in three urban areas (New York, San Francisco, and Los Angeles) in 2013 and from 2017 to 2020. The quantitative data indicate that language ability is negatively associated with stigma. Major themes emerged related to communication, including the impact of language barriers on HIV care and the positive impact of language facilitators-family members/friends, case managers, or interpreters-who can communicate with healthcare providers in the AALWH's native language. Language barriers negatively impact access to HIV-related services and thus result in decreased adherence to antiretroviral therapy, increased unmet healthcare needs, and increased HIV-related stigma. Language facilitators enhanced the connection between AALWH and the healthcare system by facilitating their engagement with health care providers. Language barriers experienced by AALWH not only impact their healthcare decisions and treatment choices but also increase levels of external stigma which may influence the process of acculturation to the host country. Language facilitators and barriers to health services for AALWH represent a target for future interventions in this population.

RATIONALE & OBJECTIVE: Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners. STUDY DESIGN: Individual, in-depth, cognitive interviews were conducted separately for patients and care partners through secure web-conferencing. SETTING & PARTICIPANTS: Twenty-three patients (≥50 years of age, treated with dialysis from the University of San Francisco kidney transplantation clinic, with a short physical performance battery of ≤10) and their care partners. ANALYTICAL APPROACH: All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior model. RESULTS: Patients median age was 60 years (57 ± 63.5) and care partners median ages was 57 years (49.5 ± 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as African American, and 47% of dyads were spouse or partner relationships. Major themes for barriers to pretransplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized or structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence or functionality or to promote successful transplantation. LIMITATIONS: Participants geographically limited to Northern California. CONCLUSIONS: Although patients and care partners report numerous barriers to pretransplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pretransplant physical function.

Identifying factors that influence physical activity (PA) among individuals with Down syndrome is essential for PA promotion. Insight can be gained from guardians and health professionals. The purpose of this study was to explore the perspectives of guardians and health professionals on facilitators and barriers of PA in individuals with Down syndrome. Interviews were conducted with 11 guardians (five mothers, four fathers, and two legal guardians) and 11 professionals (four PA specialists, three physical therapists, and four occupational therapists). Grounded theory was applied. Barriers and facilitators fit the levels of the ecological model of health behavior: (a) intrapersonal (perceived rewards), (b) interpersonal (interaction), (c) community (availability of programs), (d) organizational (school systems), and (e) policy (education). Guardians and professionals agreed on the importance of enjoyment, interaction, and programs to promote PA. Differences between groups were identified at the organizational and policy levels. PA in persons with Down syndrome is influenced by interactions between individual and environmental factors. [ABSTRACT FROM AUTHOR]

Background: Adolescence is commonly perceived as a distinct and typically healthy stage of life. However, in regions with a high prevalence of HIV, like Ethiopia, numerous adolescents are contracting the virus. Upon testing and diagnosis, they encounter care-related issues, particularly barriers and facilitators of the healthcare transition from adolescent to adult clinics. Hence, the study aimed to investigate the barriers and facilitators influencing the transition of adolescents living with HIV (ALWHs) in the resource-limited settings of Southern Ethiopia. Methods: The research employed a phenomenological study design with a qualitative methodology. Purposive sampling was used to gather data through in-depth interviews (IDIs) and focus group discussions (FDGs) involving ALWHs and their parents. The data analysis followed Van Manen's principles. Results: Following Van Manen's guidelines, the data analysis revealed a conceptual framework with two major themes: "Barriers" and "Facilitators". The theme barrier was derived from three sub-themes including behavioral barriers, social barriers, and system barriers in the transition. The theme facilitator was derived from four sub-themes including self-acceptance as an adult, a desire to experience new things, a supportive family, and friendly healthcare services. The study identified three levels of factors influencing the transition into adult clinics: individual, family/peer, and healthcare-related factors. The barriers to transition included lack of knowledge, being in a romantic relationship, psychosocial struggles, perceiving us as immature, stigma, negative peer pressure, lack of timely disclosure, absence of transition guidelines, disrespectful treatment, and absence of separate clinics. On the other hand, facilitators such as self-acceptance as an adult, desire for new experiences, family support, informed support and promising outcomes, flexible appointment scheduling, and psycho-social support groups were found to improve the transition process and enhance the overall well-being of adolescents living with HIV. Conclusion: The study highlights the complex transition process for ALWHs into adult healthcare. Barriers such as lack of knowledge, stigma, and disrespectful treatment pose challenges during this critical period. Conversely, facilitators like self-acceptance, family support, and youth-friendly healthcare services can enhance the transition experience and well-being of ALWHs. Collaborative efforts among ALWHs, families, and healthcare providers are crucial for successful transitions and improved health outcomes. Separated clinics catering to the unique needs of ALWHs are recommended to address privacy concerns. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONIndividuals with spinal cord injury (SCI) are dissatisfied with their bowel care, but 71% have not changed their care for at least 5 years. Recently, individuals with SCI expressed a need for knowledge about bowel care options. Healthcare providers (HCP) play a crucial role in supporting bowel care changes.We aimed to understand the barriers and facilitators HCP face when discussing changes in bowel care with individuals with SCI.Semi-structured interviews were conducted with HCP in partnership with Spinal Cord Injury British Columbia and key community stakeholders. Barriers and facilitators were extracted, deductively coded using the Theoretical Domains Framework, then inductively analysed for themes.Themes highlighted that effective bowel care requires diverse knowledge from a multidisciplinary team. Lack of time to prioritise bowel care and limited healthcare resources were barriers to improving care, which may be augmented through regular bowel care review of both medical and person-centered priorities. Facilitators were accessible and tailored knowledge sharing of care options, complemented by peer support.This study highlights the need for targeted interventions that reduce barriers and enhance facilitators to changing care routines, supporting individuals with SCI to change bowel care when needed, and improving quality of life.Challenges exist in effectively sharing information about bowel care between healthcare providers and individuals with spinal cord injuries.Various elements involving psychological capability, reflective motivation, and social and physical opportunities impact the likelihood of healthcare providers discussing modifications to bowel care with their patients.This study highlights the need for targeted interventions that will reduce barriers and enhance facilitators to changing care routines.Addressing these challenges will empower individuals with spinal cord injury to change bowel care when needed, improving their quality of life.Challenges exist in effectively sharing information about bowel care between healthcare providers and individuals with spinal cord injuries.Various elements involving psychological capability, reflective motivation, and social and physical opportunities impact the likelihood of healthcare providers discussing modifications to bowel care with their patients.This study highlights the need for targeted interventions that will reduce barriers and enhance facilitators to changing care routines.Addressing these challenges will empower individuals with spinal cord injury to change bowel care when needed, improving their quality of life. [ABSTRACT FROM AUTHOR]

Purpose: To identify barriers and facilitators to accessing post-stroke rehabilitation services six months after discharge from the stroke unit of a Brazilian public hospital. Materials and Methods: This cross-sectional and descriptive study collected sociodemographic and clinical-functional data during hospitalization. Then, barriers and facilitators for accessing the post-stroke rehabilitation services were collected six months after discharge. We considered economic conditions and displacement, the quality and organization of post-stroke rehabilitation services, and personal conditions. Results: A total of 174 patients were included. Among the 20 aspects analyzed, 17 (85.0%) were reported as facilitators, while three (15.0%) were as barriers. The identified barriers included financial income available for healthcare (49.4%), waiting time to schedule or to be seen (47.0%), and process to scheduling (45.4%). The main facilitators (> 79.0%) were the expectation of the patient with the treatment and assistance from family and friends. Moreover, most patients indicated as facilitators all aspects related to the quality of post-stroke rehabilitation services. Conclusion: Access to post-stroke rehabilitation services presented more facilitators than barriers. Public policies to subsidize health costs, optimize waiting time, and process for scheduling post-stroke rehabilitation services should be considered to reduce barriers. Likewise, human and financial resources must promote the facilitators. Implications for Rehabilitation: Public policies to subsidize health costs, optimize waiting times and scheduling in post-stroke rehabilitation services should be considered to facilitate access to rehabilitation services for post-stroke patients. The involvement of family and friends in the treatment of post-stroke patients should be encouraged. Patients' motivation and positive expectations can facilitate access to post-stroke rehabilitation services. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence that spending time with or in nature can be beneficial for health and wellbeing. Emerging evidence suggests potential benefits for staff and service users in healthcare settings, yet little is known about how to put Nature-based approaches (NBAs) into practice within the Child and Adolescent Mental Health Services (CAMHS) setting. The CAMHS Goes Wild project in Southwest England aimed to explore the implementation of NBAs within CAMHS, examining staff attitudes and understanding to identify potential benefits and challenges through a mixed methods study. Methods: The study involved three phases of data collection: an online survey with two waves, the first wave prior to the training, and the second four months post-training, and semi-structured interviews. Data collection was designed to fit around NatureWell training, attended by sixty-four CAMHS staff, which took place alongside the study. All participants were sampled from one NHS Trust and the study was open to both those who had attended the NatureWell training and those who had not. Data were synthesised to produce an understanding of staff attitudes towards NBAs and perceived barriers and facilitators to the implementation of this approach. Results: Ninety-seven staff responded to the wave 1 survey and 57 responded to the wave 2 survey. Fourteen staff members were interviewed. Data synthesis generated three themes: Tension between the culture of CAMHS and NBAs (Theme 1) and the need for buy-in and governance support (Theme 2). Theme three described the potential benefits of NBAs for staff and service users in CAMHS and is presented in a separate paper. The first two themes are presented in this paper. Conclusions: The implementation of NBAs in mental health service settings for CYP presents both significant challenges and opportunities. Our findings suggest multiple barriers to implementation, often in the form of organisational or cultural factors, such as the risk averse nature of the service. Our work also elucidates several potential facilitators which may address or mitigate some of these barriers. These potential enablers, such as harnessing the role of firsthand experience, warrant further exploration in the implementation of NBAs in CAMHS. [ABSTRACT FROM AUTHOR]

Retention in HIV care is a critical precursor to ending the epidemic yet remains suboptimal in the United States. Gaining an understanding of the challenges faced by adolescents and young adults (AYA) living with HIV is essential to improving retention in HIV care. This study explored the barriers and facilitators to retention in care among Black and Hispanic AYA living with HIV. Audio-recorded semi-structured interviews were conducted with 20 AYA living with HIV ages 16–29 years in New York City. Our methods entailed an inductive content analysis to explore key concepts, reconcile codes, and identify a theme, categories, and subcategories. Bronfenbrenner's socioecological model evolved as an organizing framework around barriers and facilitators to retention in care at the individual, interpersonal, healthcare system, and structural level. Data analysis yielded one overarching theme—the influence of psychosocial factors on retention in HIV care. Psychological struggles, powerlessness, clinic-level characteristics, and socioeconomic struggles were barriers reported by participants. Self-responsibility, social support, patient-friendly healthcare services, and socioeconomic resources emerged as facilitators. Retention in HIV care among AYA living with HIV is a multifaceted and complex phenomenon that involves multiple systems. Strengthening patients, healthcare system, and community partnerships can help address some of the HIV-related health disparities. [ABSTRACT FROM AUTHOR]

Participation in Organised Extracurricular Social Activities (OESA) can provide positive outcomes for children. This study investigated whether children aged 4 to 12 years diagnosed with autism differ in their OESA participation and experience compared to neurotypical peers. Parents of autistic children (n = 35) and those of neurotypical peers (n = 171) responded to questions that asked them to reflect on their child's participation and experiences in OESAs. Parents of autistic children reported significantly less OESA participation compared to parents of neurotypical children. Additionally, when evaluating factors that facilitated OESA participation, parents of autistic children rated their child's individual abilities and behaviour, the OESA's features, and the social environment less positively, compared to parents of neurotypical children. OESA participation and experiences differ for autistic and neurotypical children. This study identifies factors that can be adjusted to mitigate this difference. [ABSTRACT FROM AUTHOR]

Adolescent obesity continues to be a public health challenge with poor quality diets contributing to its etiology. As part of the process to plan health promotion and policy interventions, understanding adolescents perceived facilitators and barriers to healthful eating is important. An integrative convergent mixed‐methods systematic review was used to synthesize qualitative and quantitative evidence from studies among adolescents aged 10–19 years in high‐income countries. Medline, Embase, PsycInfo, and Scopus were searched for peer‐reviewed articles published between 2010 and 2023 and exploring adolescents' perspectives on healthful eating and contemporary contextual factors. Transformed quantitative data were integrated with qualitative data. Text was coded into subthemes and themes using an inductive approach. Key facilitators included health and physical appearance; motivation; taste; nutrition knowledge, awareness, and skills; nutrition education access; availability and accessibility of healthful foods; family; and social influences and digital media. Key barriers included taste and cravings for unhealthful foods; mood; lack of motivation, awareness, knowledge, and skills; high availability and low cost of unhealthful foods; peers and social influences; ineffective school policies; high density of fast‐food outlets; unhealthful food advertising; digital influences; and time constraints. Social, behavioral, digital, and food environmental factors should be considered from an adolescent perspective in the design of education, health promotion, and policy interventions. [ABSTRACT FROM AUTHOR]

This rapid review aimed to present a comprehensive overview of barriers, facilitators, and effective interventions that promote vaccination uptake by older adults in the Asia-Pacific region. Rapid review methodology was applied, using two databases (PubMed, Embase). Articles were included if studies were conducted in Australia, Singapore, Indonesia, and the Philippines; included human population ≥50 years of age, and was published from 2016 to August 2022. Related articles were not found from Indonesia and Philippines. A total of 23 articles met the inclusion criteria, with 19 reporting on barriers and facilitators, whereas, four articles reported effective interventions to promote vaccination uptake. Among the 19 studies that identified barriers and facilitators to vaccination uptake, the more common factors were social influences (n = 8/19), perceived benefits of vaccine (n = 7/19), and perceived vaccine safety (n = 6/19). Interventions that focused on supporting clinicians were found to be effective in leading them to recommend vaccinations among older adults, such as creating awareness on the low baseline vaccination rates among older adults, provision of structured health assessment, and nurse reminders. More studies are needed to ascertain the barriers and facilitators to uptake, as well as to identify effective interventions influencing vaccine uptake among older adults in the Asia-Pacific region. [ABSTRACT FROM AUTHOR]

This study aims to explore the challenges and facilitators of implementing rapid trauma response strategies in primary health care and their impact on patient outcomes. The study seeks to understand the obstacles facing healthcare providers in managing trauma quickly and efficiently, such as lack of resources and inadequate training, as well as challenges related to coordination between different health sectors. On the other hand, some facilitators emerge, such as trauma response training, collaboration between multidisciplinary teams, and the use of technology. The study showed that effective implementation of rapid response strategies can improve patient outcomes, including reducing mortality and psychological and physical complications, and contributes to accelerating the recovery process and reducing costs. The study emphasized the importance of enhancing collaboration between different healthcare providers and adopting technologies such as electronic health records and telemedicine to improve coordination and care. The study recommends providing more training and support to primary care providers and allocating additional resources to ensure an effective and rapid response to trauma, which contributes to improving public health and enhancing community confidence in the health system. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship (AMS) involves a coordinated set of actions aimed at promoting the appropriate use of antibiotics within healthcare settings. This systematic review of qualitative studies assessed nurses' knowledge and perceptions of the barriers and facilitators that impact their involvement in AMS programs. Methods: This meta-synthesis followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. Relevant studies published between 2018 and 2023 were identified through searches on PubMed, CINAHL, EMBASE, PsycINFO, and Google Scholar. The studies were critically appraised using the CASP checklist, with 19 articles meeting the inclusion criteria from five continents. Results: Six recurring themes emerged from the analysis of nurses' experiences and opinions regarding their roles in AMS programs. These themes included the organization of AMS programs, availability of resources, training and education, communication, and the evolving role of nurses in AMS. Conclusions: Nurses at every level of the profession might play a crucial role in antimicrobial stewardship. Although active involvement of nurses in antibiotic stewardship requires further exploration and research, this topic is being examined internationally. The literature on this subject primarily analyzes the phenomenon from a quantitative perspective rather than a qualitative one, and it is contextualized more within hospital settings rather than community settings. [ABSTRACT FROM AUTHOR]

Access to food products is becoming more and more complex due to population growth, climate change, political and economic instability, disruptions in the global value chain, as well as changes in consumption dynamics and food insecurity. Therefore, agri-food chains face increasingly greater challenges in responding to these dynamics, where the digitalization of agri-food systems has become an innovative alternative. However, efforts to adopt and use the technologies of the fourth industrial revolution (precision agriculture, smart agriculture, the Industrial Internet of Things, and the Internet of Food, among others) are still a challenge to improve efficiency in the links of production (cultivation), processing (food production), and final consumption, from the perspective of the implementation of Food Informatics technologies that improve traceability, authenticity, consumer confidence, and reduce fraud. This systematic literature review proposes the identification of barriers and enablers for the implementation of Food Informatics technologies in the links of the agri-food chain. The PRISMA methodology was implemented for the identification, screening, eligibility, and inclusion of articles from the Scopus and Clarivate databases. A total of 206 records were included in the in-depth analysis, through which a total of 34 barriers to the adoption of Food Informatics technologies (13 for the production link, 12 for the processing link, and 9 for the marketing link) and a total of 27 enablers (8 for the production link, 11 for the processing link, and 8 for the marketing link) were identified. Among the barriers analogous to the three links analyzed are privacy and information security and high investment and maintenance costs, while the analogous enablers are mainly government support. [ABSTRACT FROM AUTHOR]

Background: In clinical oncology practice, patient-reported outcomes (PROs) are essential for assessing the symptom burden, quality of life, and psychological status of patients. However, there remains a gap between the use of PROs in an oncologic setting and its implementation. Furthermore, numerous reviews in PRO implementation are often based on one particular technology, setting, or health condition, making it difficult to obtain a comprehensive and coherent summary of available evidence to help plan and undertake implementation. This systematic review aims to identify and integrate enablers and barriers to PRO implementation through the comprehensive framework for implementation research (CFIR) to provide a reference for implementing patient-reported outcomes management in oncology settings. Methods: This review strictly observed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Web of Science, CINAHL, Embase, and PsycINFO databases were systematically searched using a three-step search strategy. The search was limited from the inception of each database to April 2024. Articles describing facilitators and barriers to implementing PROs in clinical oncology practice were included. Two researchers screened the literature independently, and the quality assessment of cross-sectional, qualitative, and mixed studies was completed using the critical appraisal tools recommended by Joanna Briggs Institute (JBI) and the mixed methods assessment tool, respectively. Basic information about the included studies and determinants affecting PRO implementation was extracted, and coding categorization of facilitators and barriers was completed based on the 48 constructs provided by the CFIR framework. Results: We included 30 studies from 5,649 search results, including 25 original and 5 review studies. The quality of the literature for qualitative studies was generally good, and the quality for quantitative and mixed studies was assessed as fair. We identified 52 facilitators and 50 barriers in the included literature, covering the domains used in the CFIR framework and 39 constructs, mainly including "Innovation Evidence-Base", "Innovation Complexity", "Innovation Design", "Structural Characteristics", "Compatibility", "Incentive Systems", "Access to Knowledge & Information", "Innovation Deliverers", "Innovation Recipients", and "Planning". Conclusions: This systematic review integrated facilitators and barriers affecting PRO implementation in routine oncology clinical practice settings and categorized them through the CFIR framework. These influencing factors should be fully considered in future clinical practice to ensure the successful implementation of PROs. Trial registration: It has been registered prospectively in PROSPERO under the registration number 42024532983. [ABSTRACT FROM AUTHOR]

Background: Long COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access. Methods: Applying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive 'access to health care' model. Results: Based on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas. Conclusions: The findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research. [ABSTRACT FROM AUTHOR]

Despite evidence supporting genetic testing's utility in hereditary cancer risk management, uptake remains low among at-risk relatives of a hereditary cancer patient. The qualitative systematic review aims to identify the psychosocial barriers and facilitators associated with the uptake of genetic counselling services and/or genetic testing (GC/GT). A systematic literature search was performed across six databases in June 2023, limited to studies published in English from 2010 onwards. Qualitative studies interviewing hereditary cancer patients, their relatives, and/or healthcare providers to identify the psychosocial barriers and facilitators associated with the uptake of genetic testing for hereditary cancer syndrome were eligible for inclusion. A thematic analysis was conducted on the extracted data from 41 eligible qualitative studies. 54% of the studies were from the United States and 75% of the participants were female. 14 psychosocial barriers and nine facilitators to the uptake of genetic testing services were identified. The most frequently cited psychosocial barriers to genetic testing uptake were ‘emotional roller coaster’, ‘threat of genetic discrimination’, and ‘no perceived benefit of genetic testing’. In contrast, the most common facilitators were ‘concern for family’, ‘easing personal worries’, and ‘knowledge is empowering’. Our findings reveal complex factors affecting GC/GT service uptake, some with dual effects. [ABSTRACT FROM AUTHOR]

Generating and translating high‐quality evidence is integral to providing safe and effective medication management for residents of aged care homes. Residents are often under‐represented in trials of medication effectiveness and safety. This paper reviews opportunities and challenges for generating and translating evidence for safe and effective medication management in aged care homes. There are an increasing number of randomized controlled trials (RCTs) being conducted in aged care homes. Observational studies can also help address the evidence‐practice gap arising from underrepresentation of residents in RCTs. Stepped‐wedge and helix counterbalanced designs may help overcome limitations of traditional RCTs for evaluating medication management interventions in the aged care setting. Strategies for generating evidence include building effective partnerships with aged care homes and organizations, using novel trial designs, leveraging existing data and knowledge sharing through international platforms. Strategies for translating evidence include using quality indicators for audit and feedback, provision of education and training, engaging internal and external stakeholders, and development of local action plans and guideline implementation tools. There is an emerging interest in the role of knowledge brokers to facilitate knowledge translation. Future directions for generating and translating evidence include strengthening international research collaboration, industry partnerships, standardizing aged care home data to support national and international comparisons, and optimizing the use of technology. Initiatives may include improving access to routinely collected administrative health and medication data for conducting high‐quality observational studies. Future studies should assess outcomes prioritized by residents to ensure that medication management strategies are tailored to their needs. [ABSTRACT FROM AUTHOR]

Background/Objectives: Addictive and substance-related disorders represent a substantial public health challenge, marked by rising incidence and prevalence rates. Men and women exhibit different patterns of help-seeking for health and social issues including addictions. This research aimed to analyze the help-seeking process among men with addiction to improve understanding and develop more effective, person-centered treatments. Methods: This systematic review was performed based on the Cochrane Collaboration guidelines and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of the revision was registered in advance in PROSPERO. Searches were conducted in the PubMed, Scopus, and Web of Science (WOS) databases. Results: Based on the literature search, 16 studies were included in the current systematic review. The analyzed studies included seven on substance-use disorders, three on gambling disorder, two on tobacco-use disorder, two addressing substance-related disorders in general, one on opioid-use disorder, and one focused on marijuana use. Gender differences influenced help-seeking behavior, with women generally exhibiting a higher propensity to seek assistance for addiction-related issues than men. Seeking help for addiction—whether substance use or gambling—can be hindered by several barriers, particularly public stigma and discrimination, which tend to be more pronounced for alcohol and gambling compared to tobacco. Additional barriers in the help-seeking process include negative beliefs and attitudes toward seeking help, often associated with traditional male gender roles. Each substance-use disorder was analyzed in depth to gain a better understanding of the barriers faced by this population. Conclusions: Integrating a gender perspective into the diagnosis, prevention, and treatment of addiction is essential. As addiction patterns vary between men and women, approaches must be tailored accordingly. Recognizing men as a distinct group in research and clinical practice is also crucial for developing more effective and personalized treatments. [ABSTRACT FROM AUTHOR]

Purpose: Therapeutic group interventions are commonly provided in acquired brain injury (ABI) inpatient rehabilitation settings, but little is known about the extent of therapeutic groups run for community-dwellers with ABI. This paper seeks to review current literature concerning the nature of therapeutic groups run for community-dwellers with ABI and the involvement of occupational therapists. Materials & Methods: A scoping review was conducted with systematic searching of relevant databases guided by Arksey and O'Malley's framework. Studies were included if they reported on therapeutic groups for community-dwellers with ABI. Articles were collated and summarised with key findings presented in narrative form with accompanying tables. Results: Seventy articles met inclusion. Groups are used as therapeutic change agents for community-dwellers with ABI and target a diverse range of participation barriers. Participants valued group programs that established safe environments, a sense of belonging, growth opportunities and social connections. Group accessibility needs to be improved, with better funding avenues available for service providers, as well as greater consumer involvement in group design and facilitation. Conclusions: Groups are a valuable therapeutic modality supporting community-dwellers with ABI. Further research is warranted into the use of groups by occupational therapists working with community-dwellers with ABI. IMPLICATIONS FOR REHABILITATION: Therapeutic groups can support the development of social connections, community participation and help community-dwellers with ABI re-establish a positive self-identity. Conducting groups in community settings and involving consumers in group design and facilitation may enhance the group experience for participants. Occupational Therapists should be involved in the design and delivery of occupation-based and participation focused group-based programs. [ABSTRACT FROM AUTHOR]

Background: Young people (YP) are disproportionately affected by the HIV pandemic in sub-Saharan Africa (SSA), but testing rates remain low despite global targets of testing 95% of people with HIV infection by 2030. HIV self-testing (HIVST) has been recently introduced to reach high-risk population groups such as these. Thus, synthesis of emerging evidence on the acceptability and use of HIVST among YP in SSA is needed so that comprehensive information can be generated to inform policy and practice. Methods: We employed a mixed methods systematic review of quantitative and qualitative literature reporting on HIVST among YP involving any design and published in English by 31st of October 2023. The review synthesized quantitative evidence on acceptability and use of HIVST, and qualitative evidence on perspectives of YP about HIVST. We searched databases of published articles (e.g. MEDLINE, CINAHL) and Gray literature sources (e.g. Google, Google Scholar). The concepts for the search included self-testing, HIV/AIDS, and countries in SSA. Two authors independently screened, retrieved full-text, and assessed quality of the studies. Results: A total of 4150 studies were retrieved and 32 studies were finally included in the review. Acceptability of HIVST computed from a single item asking YP on their preference or willingness or demand for HIVST was moderate (34–67%) to high (≥ 67%) among YP in SSA. Nine of the fourteen studies that reported on acceptability found high acceptability of HIVST. Use of HIVST ranged from 0.8 to 100% while in most studies the use rate was below 50%. Key barriers to HIVST use were coping with a positive test in the absence of counselling and support, physical discomfort, and cost of kits. Perceived enablers included perceptions of HIVST as promoting personal empowerment and autonomy; privacy and confidentiality; and convenience in location, time, and skill. Conclusions: HIVST was highly accepted but not well utilized among YP in SSA. YP showed diversified needs with mixed preferences for location, and modalities of service provision. Overall, the review identified heterogeneous evidence in terms of methods, population, outcome measures, and results. The review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: ID = CRD42021278919). [ABSTRACT FROM AUTHOR]

The limited accessibility of mental healthcare providers highlights the need for innovative approaches to provide effective and efficient care. Digital mental health applications (DMHAs) can improve patient access to evidence-based treatments and reduce burden on the healthcare system. Here, we examined the provider and patient barriers and facilitators to integration of DMHAs in a healthcare system. Patients (n = 57) and providers (n = 100) were recruited from a large healthcare system over five months. Participants completed a survey assessing attitudes towards DMHAs, and perceived facilitators and barriers to adoption and utilization of DMHAs in mental healthcare. DMHA credibility was a key facilitator for provider adoption, while usability and accessibility were identified as key facilitators for patient utilization. Provider barriers included patient cost/provider reimbursement, limited knowledge, perceived limits to credibility, patient outcome enhancement, and personalization of DMHAs for patient needs. Patients identified privacy concerns as the top barrier for using DMHAs. The self-report survey nature of this study, modest sample size, and majority of sample identifying as White and upper middle class make results subject to biases and limitations. Given the potential of DMHAs to address disparities in access to mental healthcare, more research is needed including populations who are at greatest risk. Findings provide new insights to inform the development of intervention strategies to improve the integration of DMHAs within healthcare systems. Additional research examining key stakeholders at different levels of care is critical to address barriers, optimize facilitators, and develop roadmaps for best-practice use in healthcare systems. • DMHA credibility, usability, and accessibility are important facilitators to adoption and use. • Barriers include concerns related to cost/reimbursement, DMHA knowledge, credibility, benefit, personalization, and privacy. • Provider/patient discrepancies around timing of DMHA integration in stepped-care models require further exploration. • Findings can help inform development of roadmaps for best-practice use of DMHAs in healthcare systems. [ABSTRACT FROM AUTHOR]

In recent decades, meat consumption has faced growing scrutiny from an environmental, health, and animal welfare perspective. As a result, reducing meat consumption has emerged as an important strategy to mitigate its negative effects. Flexitarians, a growing group of meat reducers, have attracted attention for potentially shaping future dietary trends. This study uses a qualitative approach and draws on 15 in-depth interviews with young flexitarians in Slovenia (YFS) to identify the main facilitators and barriers to meat reduction by exploring their motivations, capabilities, and opportunities as described in the COM-B behavioral model. This study fills the gap in studies on flexitarians using the COM-B model by looking at capabilities and opportunities, not solely motives. In addition, it fills the gap in qualitative in-depth studies on all three COM-B categories, as well as a gap in studies conducted outside northwest Europe and other primarily western geographical contexts. This study highlights important findings for the central and eastern European context that industry and governments should consider when developing behavior change strategies for healthy, sustainable diets. This study shows that strong rural family ties and limited access to meat alternatives are the major barriers to meat reduction in Slovenia. The YFS preferred whole, unprocessed foods (legumes, vegetables, grains) over processed meat alternatives and reduced their meat consumption primarily for health and environmental reasons, relying on social support from peers and information from popular documentaries and social media influencers. [ABSTRACT FROM AUTHOR]

Background: Rehabilitation can help long-term care (LTC) residents with dementia maintain their independence. However, many residents do not receive rehabilitation. This study aimed to identify the barriers and facilitators to providing rehabilitation for LTC residents with dementia and propose practical interventions for overcoming them. Methods: Using a phenomenological research design, we conducted a qualitative study involving 17 privately owned LTC homes in Nova Scotia, Canada. Data were collected through individual interviews and a focus group with residents with dementia (n = 3), family members (n = 4), rehabilitation providers (n = 6), and other staff (n = 3). We analyzed the data using inductive thematic content analysis and mapped the results onto the socioecological framework and the Behaviour Change Wheel (BCW) to classify and analyze barriers and facilitators to rehabilitation. The APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity) in the BCW were used to identify feasible interventions and policies linked to the identified barriers and facilitators. Results: Barriers at the intrapersonal level included communication difficulties, comorbidities, and lack of motivation among residents. Interpersonal factors encompassed the availability of family support and lack of interdisciplinary practice. Policy/environmental factors involved limited resources, complex admission processes, low staff ratios, and restrictive restraint policies. Enhancing communication, reducing the use of restraints, promoting interdisciplinary practice, and increasing accessibility to activity spaces and equipment will improve the provision of rehabilitation for the residents. Conclusion: Enhancing the capabilities, opportunities, and motivations of all actors in LTC homes can potentially minimize these barriers. Interventions such as staff training on effective communication and dementia care, promoting person-centred and meaningful activities, and improving interdisciplinary collaboration are crucial. Policy measures to improve hospital-to-LTC transitions, increase volunteer involvement, educate families and communities, and recruit more staff are recommended. Addressing these barriers through targeted interventions and policy changes can significantly improve rehabilitation provision for residents with dementia in LTC settings. [ABSTRACT FROM AUTHOR]

Introduction: International literature has documented significant underutilisation of mental health services among Indian immigrants. This study aimed to identify facilitators and barriers to mental health help-seeking among Indian immigrant youth in South Africa by evaluating their personal and lived experiences. Methods: A qualitative study with a phenomenological design was conducted to understand the lived experiences of Indian immigrant youth regarding mental health help-seeking. Nine participants were recruited through purposive sampling from Gauteng. Data collection was performed through online interviews exploring participants' lived experiences. Thematic analysis was used to analyse the data. Results: Five facilitator subthemes were identified: encouragement to seek help for mental health difficulties, social media and mass media influence, university and school environments, availability and awareness of resources, and open conversations about mental health. Four barrier subthemes emerged: individual perspectives on mental health, lack of access to resources, parental factors discouraging help-seeking, and community factors discouraging help-seeking. Discussion: An improved understanding of these barriers and facilitators may allow other Indian immigrant youth to better manage their help-seeking processes while increasing awareness about similar experiences within the community. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Hematopoietic cell transplant (HCT) survivorship care includes recommendations for post‐HCT revaccination to restore immunity to vaccine‐preventable diseases (VPDs). However, not all survivors agree to be vaccinated. No existing studies have comprehensively reported barriers and facilitators to adult HCT survivors completing revaccination.A cross‐sectional survey of 194 adult HCT survivors was analyzed using convergent mixed methods. The analysis used various statistical methods to determine the prevalence of barriers and facilitators and the association between revaccination and the number and specific type of barriers and facilitators. Content analysis was applied to open‐ended item responses. Integrated analysis merged quantitative and qualitative findings.The most frequent barriers included the inability to receive live vaccines because of immunosuppression, identifying a suitable community location for administering childhood vaccines to adults, and delayed immune recovery. The most frequent facilitators were having healthcare insurance and a clear calendar of the revaccination schedule. Complete revaccination rates were lower with each additional reported barrier (OR = 0.58; 95% CI 0.459–0.722) and higher with each additional reported facilitator (OR = 1.31; 95% CI 1.05–1.63). Content analysis suggested that most barriers were practical issues. One significant facilitator highlighted by respondents was for the transplant center to coordinate and serve as the vaccination location for revaccination services. Merged analysis indicated convergence between quantitative and qualitative data.Practical barriers and facilitators played a consequential role in revaccination uptake, and survivors would like to be revaccinated at the transplant center. [ABSTRACT FROM AUTHOR]

Background: The demand for nursing professionals with advanced education and specialized knowledge is growing, which encourages nursing undergraduates to pursue postgraduate studies. Therefore, an in-depth investigation into the barriers and facilitators affecting the motivation of nursing undergraduates to take postgraduate entrance exams was necessary. This may provide more targeted recommendations for the formulation of relevant policies and the provision of student support. The purpose of this study is to explore the barriers and facilitators affecting the motivation of nursing undergraduates for postgraduate entrance examination. Methods: Data for this study were collected from in-depth semi-structured interviews with 15 nursing undergraduates from Nantong University between October and December 2023. Thematic analysis was employed to analyze the data. Results: Four barriers were identified, including study pressure and internship fatigue, self-doubt and fear of failure, employment pressure, and lack of information and resources. Four facilitators were also identified, including the desire to upgrade academic qualifications and professional skills, career development and transition, escaping clinical work and delaying employment, as well as the power of role models, and social support. Conclusions: The findings may help nursing undergraduates navigate the path to postgraduate entrance exams more effectively and ultimately succeed in their studies and future careers. The study underscores the importance of addressing these barriers and leveraging these facilitators to support the holistic development of nursing students. [ABSTRACT FROM AUTHOR]

Background: Mexico reports low follow-up completion rates among women with abnormal cervical cancer screenings. This study aimed to identify barriers and facilitators to follow-up adherence among women with human papillomavirus (HPV) infection and premalignant cervical lesions in Mexico. Methods: A mixed-methods study was conducted from February to April 2019. Participants included women undergoing follow-up care for high-risk human papillomavirus (HR-HPV) and premalignant lesions, along with health personnel from the Women's Healthcare Center (CAPASAM) in Mexico. Quantitative data were obtained from the Women's Cancer Information System and through a questionnaire about factors affecting follow-up adherence. Additionally, the health personnel involved completed a compliance checklist regarding care regulations. Descriptive statistics were used for analysis. Qualitative data were collected via semi-structured interviews with both groups, followed by a content analysis based on identified categories. The Hazard Analysis and Critical Control Point System confirmed care process risks. Proposals to enhance the Early Detection Program for Prevention and Control of Cervical Cancer were collected from a CAPASAM health personnel nominal group. Results: Identified barriers to follow-up included low income among CAPASAM users, family provider roles limiting time for appointments, long waits for testing and results delivery, distant facilities, insufficient service hour communication, inadequate health personnel training, and a lack of systematic counseling. Hesitation toward follow-up was also linked to shame, apprehension, uncertainty, test aversion, fear of positive results, and limited cervical cancer and screening knowledge. Patriarchal attitudes of partners and limited access to the now-discontinued PROSPERA government program further discouraged follow-up. Facilitators comprised respectful treatment by CAPASAM staff, no-cost services, health campaigns, and positive user attitudes. Conclusions: The study found more barriers than facilitators to follow-up adherence, highlighting the need for strategies to bolster the Early Detection Program. Future strategies must address the comprehensive array of factors and incorporate stakeholder perspectives. [ABSTRACT FROM AUTHOR]

Summary: Understanding healthcare professionals' perceptions and approaches to obesity management is limited, as are the barriers impeding effective care. A questionnaire was developed to explore the perception, and barriers to obesity management. To ensure content validity, an expert and stakeholder panel evaluated the relevance and comprehension of each item. Consequently, a cross‐sectional survey was administered to endocrinologists (Endo), general practitioners (GP), and pharmacists (Pharm). A 46‐item questionnaire was developed, validated, and completed by 502 healthcare professionals (Endo: n = 127; GP: n = 138; Pharm: n = 237). The majority agreed that obesity is a chronic disease (Endo = 96%; GP = 92.7%; Pharm = 87%). The conversation about obesity management is mostly initiated by the healthcare professional (Endo = 95.3%; GP = 73.9%; Pharm = 5.9%) instead of the patient (Endo = 55.1%; GP = 21.7%; Pharm = 11.8%). All professionals stated unanimously that there is a need to optimise obesity care in Belgium with identified barriers: motivational (Endo = 90.8%; GP = 90.8%; Pharm = 89.2%), financial (Endo = 96.9%; GP = 88.5%; Pharm = 76.3%), and a lack of structure (Endo = 81.5%; GP = 78.6%; Pharm = 81.5%). A total of 42.4% of the healthcare providers indicated that they did not follow any additional training. These findings highlight that healthcare professionals recognise obesity as a chronic disease, but that barriers need to be addressed to enhance effective care and support for people living with obesity. [ABSTRACT FROM AUTHOR]

Background: Effective interventions to improve patient outcomes in comorbid alcohol use disorder (AUD) and alcohol‐related liver disease (ARLD) remain a clinical unmet need. While the choice of abstinence is the cornerstone for the prevention of disease progression and mortality, evidence suggests a suboptimal engagement with treatment supporting recovery. This qualitative investigation aims to understand barriers and facilitators to treatment as experienced by this clinical population by applying a multidimensional adherence model proposed by the World Health Organization. Methods: Twenty‐four participants with comorbid AUD and ARLD were recruited from an inpatient clinical setting. Data for this study were collected through semistructured, in‐depth interviews. Deductive analysis was organized by the Framework method, and theory‐driven themes were identified according to the multidimensional adherence model. This included factors across the social and economic, patient, condition, treatment, and healthcare system levels. Results: The findings in this study indicate systematic challenges in maintaining continuity between primary, secondary, and community care. Aspects related to social and economic context, treatment, and healthcare systems were found to hinder engagement. Identified facilitators to engagement included the participatory role of family, shared lived experience of addiction/recovery, and therapeutic alliance with healthcare providers. Conclusion: The understanding of these barriers and facilitators from a service user's perspective can bridge the treatment gap for this clinical population. This can provide an opportunity for the implementation of effective interventions and inform the development of policies promoting accessible care. Government and public health bodies have fundamental roles in shifting treatment paradigms in comorbid AUD and ARLD. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is recommended for people with persistent musculoskeletal pain due to its benefits on symptoms, function and general health. This systematic review aimed to identify the barriers and facilitators to PA for people with persistent musculoskeletal pain and categorise these using the Theoretical Domains Framework (TDF). It also aimed to identify the prominence of each TDF domain and similarities and differences between included conditions and PA types. Methods: Eligible studies reported barriers and/or facilitators to PA for adults with persistent musculoskeletal pain. Barriers and facilitators were coded using the TDF. Thematic analysis was then conducted within each TDF domain. TDF domains and barrier and facilitators were then compared across the different conditions and PA types. Results: Thirty articles were included. 'Environmental context and resources', 'social influences' and 'beliefs about consequences' are the most prominent TDF domains for both barriers and facilitators, whereas 'beliefs about capabilities' and 'emotion' are prominent domains specifically for barriers, and 'reinforcement' and 'behavioural regulation' for facilitators. These domains were consistent across conditions and most PA types. Conclusions: These findings can inform future intervention development. Healthcare professionals may benefit from prioritising addressing the more prominent TDF domains to enhance patients' PA. [ABSTRACT FROM AUTHOR]

Purpose: Throughout the world, mobility devices are usually distributed using product-based business models, where a device is provided to a user, and serviced or replaced when the user returns to the clinic with an issue. Moving to a service-based business model can provide continuous and customised support for the user, and provide the clinicians and manufacturers with better data to base their decisions on. This study reviews papers on assistive technology service-based business models and considerations in designing such a model to optimise economic and social value. It then applies the findings to the mobility device space. Method: A systematic literature search was undertaken in PubMed, Web of Science, and OVID databases to analyse studies that discuss service delivery models used to provide assistive products. Inductive thematic analysis determined the themes, facilitators and barriers associated with providing a service. Findings were applied to mobility device service provision. Results and conclusion: Themes from the 29 relevant papers were grouped into four categories: Access (affordability/availability/education), Utility (customisability/usability/adaptability), Integrity (quality/sustainability/impact), and Compliance (policy/privacy/security). The most common themes were customisability, affordability, availability, and education. There is a need for service-based delivery models to replace conventional product-based models, and many considerations to optimise their design. No publications discussed the design and implementation of a service-based model for mobility device provision that uses modern sensors, software and other digital technologies to optimise the service. Service-based models that use modern digital technologies are new for the mobility device field, but much can be learnt from other fields. IMPLICATIONS FOR REHABILITATION: Service-based business models that make use of modern digital technologies are likely to improve ongoing individual rehabilitation, but they are new for the mobility device field and currently lack research and evidence-based practice. The systematic review found that modern digital technologies like sensors, apps, and AI might be useful for providing ongoing support and more personalised rehabilitation for users of assistive products. To provide ongoing support for end-users, a successful design of service-based business model for assistive products should be accessible, both physically and financially, as well as easy to customise and adapt over time. [ABSTRACT FROM AUTHOR]

Background: Cannabis use can generate potential avoidable harms, hence the need for effective preventive measures and treatment. Studies show the efficacy of harm reduction (HR) in minimizing undesirable consequences associated with this use. Despite its proven efficacy, HR in cannabis use remains poorly applied by many health and social services (HSS) practitioners, especially with young people. However, knowledge regarding the underlying reasons for this is limited. To fill this gap, we aimed to identify facilitators of and obstacles to HSS practitioners' adoption of HR in cannabis use across OECD countries. Methods: We conducted a scoping review, guided by Arksey and O'Malley's model. The search strategy, executed on health databases and in the grey literature, captured 1804 studies, of which 35 were retained. Data from these studies were extracted in summary sheets for qualitative and numerical analysis. Results: Facilitators and obstacles were grouped into four themes: stakeholders' characteristics (e.g., education, practice experience); clients' characteristics (e.g., personal, medical); factors related to HR (e.g., perceived efficacy, misconceptions); factors related to the workplace (e.g., type of workplace). Data were also extracted to describe the populations recruited in the selected studies: type of population, clientele, workplace. Conclusion: Several factors might facilitate or hinder HSS practitioners' adoption of HR in cannabis use. Taking these into consideration when translating knowledge about HR can improve its acceptability and applicability. Future research and action should focus on this when addressing practitioners' adoption of HR. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) is a harmful practice that has long-lasting negative impacts on the physical and psychological health of victims. Deemed a global concern, this practice persists in high-income countries (HIC) among certain migrant communities. Given the deleterious effects of the practice, we conducted an updated systematic review of the facilitators and barriers associated with the prevention of FGM in HIC. Method: A systematic review of published qualitative studies of FGM in HIC was conducted from 2012 to 2022. The search resulted in 276 studies. Of these, the majority were from low- and middle-income countries (LMIC) and excluded. A total of 14 studies were deemed fit for inclusion and none were excluded during quality appraisal. Relevant data were extracted from the studies and thematically analyzed to identify prevalent themes. Results: A total of 12 themes were identified and the majority reflected barriers to the prevention of FGM including beliefs about female virtue, beliefs about social sanctions, and the preservation of culture, among others. Facilitators to the prevention of FGM were fewer and included memory and trauma from experiencing FGM, knowledge and awareness of the female anatomy, and legislative protection from FGM due to migration. A few themes, such as religious beliefs, acted as both facilitators and barriers. Conclusion: Findings highlight the importance of shared cultural and social threads among FGM practicing communities in HIC. Interventions can use these findings to guide the development of sociocultural strategies centered on community-level prevention and reduction of FGM in HIC. [ABSTRACT FROM AUTHOR]

Introduction: Telemedicine infectious diseases consultations (tele-ID consults) improves access to healthcare for underserved/resource-limited communities. However, factors promoting or hindering implementation of tele-ID consults in low-resource settings are understudied. This study sought to fill this gap by describing perceived barriers and facilitators tele-ID consults at three rural hospitals in southeastern Missouri. Methods: Twelve in-depth, semi-structured interviews were conducted with a purposively sampled group of information-rich hospital stakeholders from three rural, southeastern Missouri hospitals with partial or no on-site availability of ID physicians. Our literature-informed interview guide elicited participants' knowledge and experience with tele-ID consults, perceptions on ID consultation needs, and perceived barriers to and facilitators of tele-ID consults. Interview transcripts were coded using an iterative process of inductive analysis to identify core themes related to barriers and facilitators. Results: Perceived barriers to adopting and implementing tele-ID consults included logistical challenges, technology and devices, negative emotional responses, patient-related factors, concerns about reduced quality of care when using telemedicine, lack of acceptance or buy-in from physicians or staff, and legal concerns. Key facilitators included perceived need, perceived benefits to patients and physicians, flexibility and openness to change among staff members and patients, telemedicine champions, prior experiences, and enthusiasm. Discussion: Our findings demonstrate that rural hospitals need tele-ID consults and have the capacity to implement tele-ID consults, but operational and technical feasibility challenges remain. Adoption and implementation of tele-ID consults may reduce ID-physician shortage-related service gaps by permitting ID physician's greater geographic reach. [ABSTRACT FROM AUTHOR]

To explore pediatricians' perspectives on supporting intimate partner violence (IPV) survivors, including (a) clinical practices and resource use, (b) ideal resources, and (c) barriers to the use of existing resources, we conducted dyadic and individual virtual interviews with pediatricians recruited through Twitter and the American Academy of Pediatrics Council, section, and chapter listservs. The interviews were approximately 60 minutes in length, audio recorded, and transcribed verbatim. We used a thematic analysis approach and hybrid deductive–inductive coding. Twenty-three pediatricians participated in 14 interviews. We identified four themes. Participants' current practices primarily focused on IPV screening and response to disclosure. They described strategies for IPV resource provision and decision-making involving child protective services. They identified multilevel barriers to addressing IPV, including barriers, such as time, identified in previous studies as well as barriers related to the COVID-19 pandemic, telehealth, the electronic health record, and disclosure-focused approaches. The participants desired provider-facing and caregiver-facing resources to strengthen the capacity to address IPV; some were unaware of currently available resources. They noted the need for continued attention to optimizing systems to enhance their capacity to support IPV survivors. Pediatricians report varying practices to address IPV and identify several surmountable barriers to supporting IPV survivors. Our study suggests that disclosure-driven clinical practices, confidentiality concerns, and lack of resources limit pediatricians' capacity to address IPV. Additional resource development and dissemination efforts are needed to improve the awareness of IPV resources currently available to pediatricians and families. [ABSTRACT FROM AUTHOR]

The objective of this study was to analyse the barriers and facilitators that students with disabilities encounter in Physical Education and sports in Chile, Colombia, Spain and Peru. An exploratory, correlational and cross-sectional study was designed, involving 362 children and adolescents with disabilities from Chile (41.1%), Colombia (14.6%), Spain (11.6%) and Peru (32.5%), who completed the questionnaire "Barriers and Facilitators of Sports in Children with Physical Disabilities" (BaFSCH) in its Spanish-translated version. Concerning the results, 72.7% practice physical activity at school, with a higher tendency in Colombia (88.7% χ² = 11.17, p = .02), where 72.0% participate in Physical Education classes while 38% practice physical activity and sports workshops. The main facilitators of inclusion are parents and guardians, along with friends in the school environment, while barriers are associated with accidents or falls and/or their disability and/or impairment. Additionally, biological sex (OR = 1.893, IC = 1.19-3.00, p = .007) is associated with being a facilitator for physical activity, whereas having an intellectual disability (OR = .437, IC = .20 - .94, p = .03) and a physical disability (OR = .298, IC = .15-.58, p = .0002) are associated with barriers to inclusion. This research revealed that Physical Education classes are fundamental for engaging in physical activity within the educational setting for children and adolescents with disabilities, as well as the environment, which acts as a protective factor at the environmental level. [ABSTRACT FROM AUTHOR]

Objectives: To understand how psychosocial factors associated with physical activity differ based on disease severity in people with dementia, and how these factors are associated with physical activity participation. Methods: Eighty‐seven people with dementia, alongside their family carer were asked to complete a series of questions related to physical activity participation, including barriers, motivators, and facilitators. Regression models were developed to understand how psychosocial factors were associated with physical activity participation in the cohort. Results: In the final models, only the absence of intrapersonal barriers was associated with overall physical activity and regular moderate‐to‐vigorous physical activity. Feelings of relatedness were associated with regular moderate‐to‐vigorous physical activity only. Conclusion: Reducing intrapersonal barriers would appear to be a potentially useful strategy to promote physical activity in people with dementia. However, a tailored approach is needed depending on the desired physical activity outcome. [ABSTRACT FROM AUTHOR]

Objectives: The progressive and unpredictable course of heart failure (HF) has made the provision of palliative care (PC) services to older adults with HF a serious challenge. This study aimed to explain the barriers and facilitators of PC in older adults with HF. Methods: This qualitative study was conducted using the content analysis approach. A sample of 15 participants, including 6 patients, 2 family caregivers, and 7 healthcare team members (4 nurses, a psychiatric nurse, a nutritionist, and a PC physician) were selected by purposive sampling over 10 months (November 21, 2020 to September 1, 2021). The data were collected using semistructured in-person interviews until data saturation and analyzed with conventional qualitative content analysis. Results: The findings revealed the main category of "neglecting the provision of PC," with 4 subcategories of "weak organizational structure," "poor social support," "older adults' and healthcare teams' poor knowledge," and "limited financial resources" as the barriers of PC and the main category of "enjoying support potentials" with 3 subcategories of "the cooperation of the government, benefactors, and nongovernmental organizations," "empathy from the family and relatives," and "benefiting from the presence of healthcare workers" as PC facilitators. Conclusions: The findings of this study explained the barriers and facilitators of PC in older adults with HF. Removing the barriers and supporting the facilitators give older adults with HF better access to PC. Therefore, to expand PC centers for older adults with HF, health system officials, and policy-makers should pay attention to organizational infrastructures and remove the barriers at organizational, social, educational, and economic levels with the cooperation of governmental organizations, benefactors, and nongovernmental organizations. [ABSTRACT FROM AUTHOR]

Objective: The objective was to systematically review all studies focusing on barriers, facilitators, and tools currently available for shared decision making (SDM) in emergency departments (EDs). Background: Implementing SDM in EDs seems particularly challenging, considering the fast‐paced environment and sometimes life‐threatening situations. Over 10 years ago, a previous review revealed only a few patient decision aids (PtDAs) available for EDs. Methods: Literature searches were conducted in MEDLINE, Embase, and Cochrane library, up to November 2023. Observational and interventional studies were included to address barriers or facilitators for SDM or to investigate effects of PtDAs on the level of SDM for patients visiting an ED. Results: We screened 1946 studies for eligibility, of which 33 were included. PtDAs studied in EDs address chest pain, syncope, analgesics usage, lumbar puncture, ureterolithiasis, vascular access, concussion/brain bleeding, head‐CT choice, coaching for elderly people, and activation of patients with appendicitis. Only the primary outcome was meta‐analyzed, showing that PtDAs significantly increased the level of SDM (18.8 on the 100‐point OPTION scale; 95% CI 12.5–25.0). PtDAs also tended to increase patient knowledge, decrease decisional conflict and decrease health care services usage, with no obvious effect on overall patient satisfaction. Barriers and facilitators were identified on three levels: (1) patient level—emotions, health literacy, and their own proactivity; (2) clinician level—fear of medicolegal consequences, lack of SDM skills or knowledge, and their ideas about treatment superiority; and (3) system level—time constraints, institutional guidelines, and availability of PtDAs. Conclusions: Circumstances in EDs are generally less favorable for SDM. However, PtDAs for conditions seen in EDs are helpful in overcoming barriers to SDM and are welcomed by patients. Even in EDs, SDM is feasible and supported by an increasing number of tools for patients and physicians. [ABSTRACT FROM AUTHOR]

Restorative justice (RJ) is a way of doing justice following an offense that is oriented toward repairing individual, relational, and social harm. Despite indications of their contribution to rehabilitation, RJ is still used infrequently, especially in serious offenses. We believe implementing them in prison is likely to provide access to RJ to a wider population. Twenty-three adult correctional clients were interviewed about their attitudes toward participation in RJ while in custody. Specifically, the study examined facilitators and barriers affecting their willingness to participate. The facilitators found included the following: (1) Desire to seek forgiveness; (2) Expressing respect for the victim; (3) Reciprocity—the correctional client as a victim; and (4) Desire to renew relationships. The barriers identified were as follows: (1) Fear of the victims' reactions; (2) Disbelief in the victim's ability to forgive; and (3) Unwillingness to include their supporters. These facilitators and barriers are discussed with a view to implementing RJ in prisons. [ABSTRACT FROM AUTHOR]

Mozambique implemented in 2021 a formative assessment in 22 prisons to identify the operational and logistical needs for the second round of the Biobehavioral Survey (BBS). Barriers and facilitators that could be anticipated in conducting BBS in prisons, in preparation for implementation, was evaluated using semi-structured questionnaires administered to key informants (directors and other kind of managers staff). The data were cleaned and analyzed using Microsoft Excel, and the categorical variables were summarized by means of simple frequencies and percentages. In most prisons the current prison capacity far exceeds the theoretical capacity, 40.9% have a theoretical capacity of ≥ 50 inmates, 81.8% have inmates who exceed their theoretical capacity. In the country half of the prisons receive only male inmates, and only one female, 54.5% of the prisons visited have inmates under 18 years of age, 72.7% of the prisons had a private space available for the survey, the penitentiary establishments have the physical space for study; ensuring the safety of staff within the facilities; involvement of correctional officers and a clinical focal point. However, barriers such as time management due to prison opening hours, prison laws, restrictions, or permits for research may change without notice due to security, lockdowns, riots, or other situations that may hinder the implementation of research. The implementation of successive and regular rounds of BBS in different environments, contexts and populations constitute opportunities for generating information and indicators not always captured by programmatic data and not only as an opportunity for offering and making healthcare available in prison environments that in a routine context, but these populations normally have also not had equal opportunities. Currently, little is known about the implementation of a BBS in a correctional environment and only a few barriers can be anticipated, for Mozambique's context, these challenges and obstacles can be overcome through clear communication and collaboration with officials at all levels. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) and its treatments cause significant acute, chronic, or latent adverse effects, leading to decreased physical function and quality of life. Robust evidence supports the positive effects of physical activity (PA) on various health outcomes in CRC patients. However, there is limited understanding regarding the factors that influence PA engagement, including facilitators, preferences, and barriers in this population. Purpose: This scoping review aims to document the breadth and depth of literature concerning the various aspects of PA participation among patients with CRC. We conducted a scoping review of PA among CRC patients. Methods: We searched several databases, including PubMed, Web of Science, Embase, and Cochrane, from their inception to 25 July 2023. Multiple reviewers were involved in all screening and data abstractions. The search yielded 834 individual citations after removing duplicates. After screening the titles and abstracts, 20 articles underwent full-text review, and 11 were included. Results: Our research findings indicate that among CRC patients, the most prevalent facilitators/preferences for PA are understanding its importance and perceiving its benefits, whereas treatment-related effects and lack of time are the most common barriers. Conclusion: CRC patients have unique facilitators and barriers concerning PA. Further research and clinical interventions are required to support and encourage this population to participate in and maintain regular PA. [ABSTRACT FROM AUTHOR]

Background: Preoperative visit-care for transcatheter aortic valve replacement (TAVR) plays a crucial role in improving the quality of care and patient safety. However, preoperative care for TAVR patients is still in its early stages in China, with the care often being experience-based. The application of relevant evidence in nursing practice is necessary. Little is known regarding the facilitators and barriers to apply and compliance to the evidences about preoperative visit-care for TAVR in nursing. Methods: The Nurse's Compliance Checklist was used to investigate the evidence-based compliance of nurses (n = 21) who worked in the TAVR team in the evidence-based implementation setting. Meanwhile, an Evidence-Based Practice Beliefs Scale, and Influencing Factors Checklist were used to investigate all nurses (n = 66) who work in the same setting. Stakeholders (Middle and senior-level nursing administrators, frontline clinical nurses, and patients) interview was carried out to further disclose the barriers and facilitators in the process of evidence-based practice. Results: The results of this study showed that only 1 evidence implemented fully (100%) by nurses, 3 evidences with 0% implementation rate, and implementation rate of the other evidences were 9.5∼71.4%. The overall score of nurses' evidence-based nursing belief level was (3.52 ± 0.82). Three domains of barriers were identified: the Context Domain included lack of nursing procedures, inadequate health education materials, insufficient training; the Practitioner Domain included insufficient attention, lack of relevant knowledge, high work pressure and uncertainty of expected results, and Patient Domain included lack of relational knowledge. Facilitating factors included leadership support, nurse' high evidence-based nursing belief, high executive ability and enthusiasm for learning. Conclusion: The study indicated that the nurses' compliance of evidence-based practice in preoperative visit-care for TAVR was in lower level. There were some factors influencing the application of the evidences. The study revealed potential modifiable barriers to the successful implementation of evidence-based preoperative visit-care, including a lack of preoperative visit- care routine, related knowledge and training. Leadership support and nurse training should be considered to improve nurses' compliance with evidence-based practice. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Surveillance colonoscopy is recommended 1‐year after surgical resection for patients with stage I‐III CRC; however, only 18%–61% of CRC survivors complete this test. This study describes clinician‐identified barriers and facilitators to surveillance colonoscopy among CRC survivors. Methods: We conducted semi‐structured interviews with clinicians until thematic saturation was achieved. Interviews were analyzed using the social cognitive theory. Results: Thirteen clinicians were interviewed, and all identified health system‐level barriers to surveillance colonoscopy completion; the most common being fragmented care due to patients receiving care across many health systems. Clinicians also identified social determinants of health barriers (e.g., geographical distance between patients and health systems) to 1‐year surveillance colonoscopy completion. Conclusions: Clinicians identified several potentially modifiable barriers to 1‐year surveillance colonoscopy completion which, if addressed, could improve post‐treatment care and outcomes among stage I‐III CRC survivors. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsDiscussionOccupational therapy has recently begun promoting population-based practice (PBP), which would allow them to address the myriad of factors impacting older adults’ health. The purpose of this qualitative study was to describe occupational therapists’ engagement in PBP and factors they perceive influence engagement.Semi-structured interviews were conducted with 21 occupational therapists.Qualitative content analysis revealed PBP was facilitated by personal interests and volunteerism or by employer-provided opportunities. Therapists’ knowledge and skills, understanding of OT, employer support, resources, and features of the US healthcare system all influence engagement.There is limited understanding of PBP among occupational therapists. These professionals have the foundational knowledge and skills to participate, but additional education and employer support is needed to increase engagement. Barriers must be overcome, and facilitators of engagement promoted, to enable the incorporation of PBP in everyday OT practice, and subsequently, improve health outcomes for the older adult population. [ABSTRACT FROM AUTHOR]

Phenylketonuria (PKU) is an inherited metabolic disorder that requires lifelong adherence to a low-phenylalanine (Phe) diet to prevent severe neurological complications. However, maintaining dietary adherence can be challenging for patients and their families. This systematic review aimed to comprehensively evaluate the factors affecting adherence to a low-Phe diet in patients with PKU. A systematic search of multiple databases was conducted, and 49 studies were included in the final analysis. The quality of evidence was assessed using the Joanna Briggs Institute levels of evidence and the Quality Assessment with Diverse Studies tool. The review identified four main categories of factors influencing dietary adherence: family-related factors (social, psychological, behavioral, and educational), patient-specific factors (psychological, behavioral, educational, and demographic), environmental factors (healthcare professional support, educational and camp-based interventions, and the COVID-19 pandemic), and therapy-related factors (protein substitute formulation, clinic visits, blood tests, and telemedicine). The findings highlight the complex interplay between elements contributing to dietary adherence in PKU patients and underscore the importance of a multifaceted approach to support patients and their families. Future research should prioritize high-quality longitudinal and experimental studies to provide stronger evidence for the PKU community. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer continues to threaten women's health, especially in low-resource settings. Regular follow-up after screening and treatment is an effective strategy for monitoring treatment outcomes. Consequently, understanding the factors contributing to patient non-attendance of scheduled follow-up visits is vital to providing high-quality care, reducing morbidity and mortality, and unnecessary healthcare costs in low-resource settings. Methods: A descriptive qualitative study was done among healthcare providers and patients who attended the cervical cancer screening clinic at Mbarara Regional Referral Hospital in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analysed in line with the social-ecological model to identify barriers and facilitators. Results: We conducted 23 in-depth interviews with 5 healthcare providers and 18 patients. Health system barriers included long waiting time at the facility, long turnaround time for laboratory results, congestion and lack of privacy affecting counselling, and healthcare provider training gaps. The most important interpersonal barrier among married women was lacking support from male partners. Individual-level barriers were lack of money for transport, fear of painful procedures, emotional distress, and illiteracy. Inadequate and inaccurate information was a cross-cutting barrier across the individual, interpersonal, and community levels of the socio-ecological model. The facilitators were social support, positive self-perception, and patient counselling. Conclusions: Our study revealed barriers to retention in care after cervical cancer screening, including lack of partner support, financial and educational constraints, and inadequate information. It also found facilitators that included social support, positive self-perception, and effective counselling. [ABSTRACT FROM AUTHOR]

Background: Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. Methods: 440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated. Results: Overall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption ability. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness. Conclusion: This large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research. [ABSTRACT FROM AUTHOR]