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Africa is home to 27 of the world's 28 poorest, marginalised and most vulnerable countries. There are limited studies on the challenges and opportunities of researching marginalised consumers in Africa, even though more than 440 million marginalised consumers consume products and services that require market research. This paper aims to critically identify and discuss the challenges and opportunities for researching marginalised consumers in Africa using insights from empirical studies conducted in various countries between 2009 and 2022. The paper proposes a conceptual framework that outlines the methodological and operational challenges and enablers for market research and concludes with practical guidelines of considerations that researchers should take for researching the marginalised in Africa. [ABSTRACT FROM AUTHOR]

Background: The introduction of the COVID-19 vaccine influenced discussions to explore integrating COVID-19 vaccination into routine immunization (RI) programs. Subsequently, the WHO Strategic Advisory Group Experts (SAGE) on immunization plausibly advised countries to leverage the COVID-19 vaccination rollout as a transformative opportunity to establish a resilient immunization system, through an integrated immunization system, resulting in strengthened primary healthcare services. Objective: This study assessed the enablers and barriers to integrating COVID-19 vaccination into the routine immunization programme in Ekiti state, Nigeria. Methods: This study utilized a qualitative research approach to obtain information from 40 participants selected purposively across the primary healthcare facilities, LGA, and state levels. A three-tier approach was employed to select the LGAs. At the same time, In-depth interviews were conducted to elicit relevant information on the assessment of enablers and barriers to integrating COVID-19 vaccination into routine immunization through an interview guide. All the audio interview files were transcribed into English Language, coded, and presented using a thematic approach. Results: A total of 40 healthcare workers across Ekiti state were selected to participate in this study. Our study found the enablers of integrating COVID-19 into routine immunization to include demand generation and social mobilization, health education, health workers training, data validation, financing, and supervision. However, rumors, demand for incentives, Adverse Events Following Immunization (AEFI), manpower shortage, poor internet network services, and bad road networks were reported as barriers to integrating COVID-19 vaccination into routine immunization in Ekiti state. Conclusion: While the enablers of integrating COVID-19 vaccination into routine immunization may outweigh its barriers, it is pertinent to know that the efforts towards integrating COVID–19 vaccination in the RI Program is a call to all stakeholders to ensure sustainability. The identified barriers in the study must be addressed to ensure a strengthened health system. Therefore, achieving a successful integration and uptake of vaccination/immunization is anchored on driving demand generation, social mobilization, health education, availability of healthcare workers, integrated supervision, and financing. [ABSTRACT FROM AUTHOR]

The purpose of this study is to understand the reasons why Japanese higher education institutions show a lack of digital marketing activities. Specifically, we focused on the challenges faced by institutions with management and business faculties when implementing digital marketing. To achieve this purpose, the research invited 167 Japanese higher education institutions to respond to a self-administered online questionnaire followed by semi-structured interviews. 49 valid responses were obtained and then 11 interviews were performed. After analyzing the data collected using text coding, the results indicate the emergence of nine digital marketing enablers and barriers, namely training & knowledge, tools, financial resources & measurement results, human resources, leadership, process, internal public relations, organization strategy and external stakeholders. A comparison between the various factors shows a significant dominance of barriers with respect to enablers, reflecting the concerns of Japanese higher education institutions with respect to digital marketing. In addition, the interviews reveal the existence of four environmental factors which have motivated Japanese higher education institutions to adopt digital marketing. [ABSTRACT FROM AUTHOR]

Objective Setting Participants Design Results Conclusion Identify barriers and enablers for remote Tasmanians participating in bowel cancer screening through the National Bowel Cancer Screening Program.A small remote Tasmanian community.Tasmanian remote community members aged 50 years and over.A qualitative study conducted 16 semi‐structured interviews. Two researchers conducted in‐person and telephone interviews. Questions were directed by an interview guide developed using the Theoretical Domains Framework for behaviour change and Behaviour Change Wheel. Two researchers analysed data using directed content analysis with a flexible inductive approach.Four themes related to barriers and enablers to completing the National Bowel Cancer Screening Program screening kit in remote Tasmania. Themes included the subject of screening, physical screening kit, the process and outcome of the kit. Several barrier and enabler sub‐themes overlapped or were linked, as many enablers mitigated barriers. For example, social influences, awareness level, steps in completing screening, and planning and timing to screen. Social support and discussing screening with others were key enablers, whereas lack of these were barriers. For remote communities, taking the kit to the post office was a barrier from often knowing the post officer. A bowel bus providing screening and information support services may reduce the travel burden of follow‐up diagnostic tests and support low‐literacy individuals to screen.Barriers and enablers exist within each stage of the screening process, from what influences an individual decision to screen, through to the outcome. To improve screening rates in rural/remote Tasmania, barriers and enablers to screening must be considered. [ABSTRACT FROM AUTHOR]

Background: The Acquired Immune Deficiency Syndrome (AIDS) pandemic has created a lot of devastation over the last four decades and continues to be a public health threat. Anti-retroviral treatment (ART), a group of medications that people who have been diagnosed with the Human Immunodeficiency Virus (HIV) infection take, has been shown to be efficacious and has significantly improved the fight against the disease. In Ghana, women carry a higher prevalence and incidence of HIV. The study's objectives were to understand the experiences of women living with HIV/AIDS on ART and determine the barriers and enablers for ART uptake from the perspective of both the females living with HIV and their healthcare providers in the Upper East Regional Hospital of Ghana. Methods: This was a qualitative study that used interviews to acquire data from women living with HIV on the perceived barriers and enablers for ART. The Upper East Regional Hospital in Ghana was the study site. We used a phenomenological approach to explore the lived experiences, perceptions, and meanings associated with ART among women. We collected data until we reached thematic saturation, interviewing a total of sixteen women living with HIV. We conducted a focus group discussion with nine healthcare workers providing care at the ART clinic. Data were analysed using thematic analysis. Results: Women living with HIV and their healthcare providers viewed an environment that provided encouragement and support from healthcare workers and patients' relatives, the ability to conceal HIV status, peer counselling, and the perceived benefits of therapy as enablers of ART uptake and medication adherence. The following were barriers to ART uptake and adherence: ill health, forgetfulness, long distances to ART clinics, cultural and spiritual beliefs, and fear of stigma. Conclusions: Enablers of ART uptake should be expanded upon and encouraged so that women living with HIV/AIDS can access drugs in a timely and stress-free manner. On the other hand, the barriers identified can be addressed through education, the expansion of healthcare infrastructure, and the economic empowerment of women. [ABSTRACT FROM AUTHOR]

Nowadays, industries across the globe are acknowledging the need for a Net Zero Supply Chain (NZSC) by 2050, particularly within the Manufacturing Supply Chain (MSC) due to its significant contribution to Greenhouse Gas (GHG) emissions. Government and regulatory bodies pressure the industry to reduce GHG emissions. Industries focus on cleaner and sustainable production by adopting net zero technique practices. Achieving the net zero goal needs technological integration, such as Caron Capture Technology (CCT) and Life Cycle Assessment (LCA). Are LCA and CCT unlocking the potential for net-zero practices in MSC? This still needs to be answered. Therefore, this study aims to identify and prioritize potential enablers of Life Cycle Assessment (LCA) to facilitate the NZSC. We identified potential enablers using a Systematic Literature Review (SLR) and expert opinion. An empirical study validated these enablers, followed by the application of the "Best-Worst Method (BWM)" to rank them and the "Fuzzy Decision-making trial and evaluation laboratory (F-DEMATEL)" to identify causal relationships. The outcomes of this study reveal that 'Energy Management and Emission Reduction' is the most critical category of enablers, followed by 'Governance and Collaboration', 'Assessment and Digitalization', and 'Sustainable Materials and Production'. Outcomes highlight the importance of integrating technological innovations and stakeholder engagement to achieve net-zero goals. The implications of this study provide valuable insights for policymakers and practitioners. By focusing on the prioritized enablers, the manufacturing industry can effectively implement LCA, develop the NZSC business model, and enhance competitiveness in the global market. This study contributes to the ongoing discourse on sustainable manufacturing practices and offers a strategic framework for achieving NZSC by 2050. [ABSTRACT FROM AUTHOR]

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

Objective: To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. Design: A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Setting: Victoria, Australia. Participants: Semi‐structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Results: Providers reported multi‐level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Conclusion: Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity‐based funding models for perinatal services regardless of geographical location. [ABSTRACT FROM AUTHOR]

Urban designers have considerable potential to take important climate change actions in the built environment. Based on interviews with urban designers across Australia, it was found that the main actions taken were: development and use of policies and strategies; education and research; appropriate project designs; reduction of carbon footprints; advocacy and lobbying; the use of sustainability measures and ratings; and taking on projects oriented to climate change action. Key facilitators of these actions that overcame barriers were strong leadership, establishment of targets and measures, effective regulation, financial and other incentives, and access to trustworthy, practical information. [ABSTRACT FROM AUTHOR]

High dropout rates and a lack of academic resilience continue to plague South African higher education. Often, this is more prevalent in practical disciplines that have been subjected to curriculum changes in recent years, such as engineering. It is challenging to understand academic resilience in university settings due to insufficient research. Therefore, more information is needed on the role of personal characteristics and the socio-ecological university environment in enabling and constraining students' academic resilience. To assist higher education institutions in theorising academic resilience, this article presents a novel conceptual framework of Ungar's social-ecological theory, and Ebersöhn's Flocking theory. As part of this theorisation, this article also provides diverse perspectives on academic resilience from engineering students, lecturers, and support staff through semi-structured interviews. An analysis of this qualitative data was conducted using thematic analysis. A major finding of the study was that enabling factors were principally personal, whereas constraining factors were principally socio-ecological. Findings led to the development of an original framework for conceptualising the enablers and constraints of academic resilience in engineering students. This conceptual framework could guide towards the identification of areas of priority for academic resilience and in doing so contribute to interventions to reduce student dropout. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionsDespite well-documented benefits of physical activity (PA), people with brain injury face numerous PA barriers. This mixed methods systematic review aimed to summarize barriers and enablers that individuals with traumatic brain injury (TBI) experience when participating in PA.Primary studies investigating barriers and/or enablers to PA in adults living with TBI were included. Literature search in MEDLINE, EmCare, Embase, PsychINFO, PEDro, and OTSeeker was initially conducted in December 2021 and January 2022, and updated in June 2022. Methodological quality of the included studies was assessed using Joanna Briggs Institute critical appraisal tools. A customized data extraction form was utilized. Descriptive synthesis was used to summarize the findings.Twelve studies of various methodological qualities were identified. Barriers to PA included personal issues, changing health status, external factors, lack of support, and lack of knowledge. Identified enablers included personal drivers, social support, professional support, accessibility, and education.The shared similarities between barriers and enablers across several themes suggest that multiple barriers may be amenable to change. Given the diverse barriers to PA, health professionals should use person-centered, holistic approach with ongoing review and monitoring, when engaging with individuals with TBI. [ABSTRACT FROM AUTHOR]

Background Aim Design Methods Results Conclusion Implications for Practice Reporting Method Patient or Public Contribution National health and social care standards are complex, quality improvement interventions. Standards typically describe a process and/or outcome of safe, quality, person‐centred care according to best evidence. Currently, there are 11 national standards that apply to diverse services in Ireland including residential centres, acute hospitals and rehabilitation and community inpatient healthcare services. A better understanding of contextual factors influencing implementation will inform decision‐making when selecting implementation strategies to enhance the implementation of standards.To explore experiences of implementing national health and social care standards and secondly, to identify enablers and barriers to implementation with stakeholders from across multiple levels of the health system.A qualitative descriptive study.We conducted six focus groups and eight individual interviews from October to November 2021 with stakeholders at system level (n = 14), organizational level (n = 14) and individual level (n = 10). Focus groups and interviews were audio‐recorded, transcribed verbatim and analysed using reflexive thematic analysis.Six themes were generated; (1) Top‐down, bottom‐up, a team approach: everybody together, we are all involved, we are all responsible, (2) Support tools: accessible tools and bite‐size material pertaining to standards will support us to implement standards, (3) Empower with knowledge: increase awareness and understanding of standards, make them relatable in practice so we can make sense of them, (4) A system‐wide malaise: we do not have the bandwidth to implement standards, (5) Follow the leader: we need a lead person at every level to inspire implementation, (6) A bi‐directional influence: we know inspections drive quality improvements but we still feel trepidation around inspection outcomes.Key enablers identified related to teamwork, support tools, leadership and inspections. Key barriers related to workforce issues, a lack of awareness of standards and fear of inspection outcomes. Our findings can be incorporated into strategies to support implementation of standards, ultimately for the benefit of service‐users.The enablers and barriers described in this study reflect the importance of organizational factors in the implementation of standards. Interdisciplinary teams can infer from these findings, which enablers and barriers apply to their own context. These findings can inform decision‐making when selecting strategies that can be effective in supporting the implementation of standards.We have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Floodplains are regularly inundated areas of land that provide ecosystem benefits for the entire catchment area, along with numerous benefits for communities making them ideal for human settlement. The management of floodplains involves an ongoing dilemma; how best to balance the need to protect urban settlements from significant flood events with the benefits that inundation brings to the environmental and cultural values of the floodplain. These flood events have been traditionally addressed using technical flood protection measures. However, nature‐based solutions (NbS), provide a potential alternative approach. In this research, we analyze 29 global case studies centered on river floodplain management to investigate the barriers and enablers that affect the implementation of NbS, including floodplain restoration, mangroves, riparian forest restoration, wetland green infrastructure, among other strategies. The aim of this paper is to gain insights into improving floodplain management through the assessment of barriers and enablers evident in these case studies. The barriers and enablers were divided into six categories: social, technical, financial, political, institutional and economic and further into several sub‐divided categories. Social and technical categories were the most commonly described barriers and enablers closely followed by the institutional category. The discussion is centered around four topics: understanding community and decision‐maker risk perceptions, increased focus on stakeholders, managing multiple conflicting objectives, and consideration of multiple spatial scales. Further research on the uptake of NbS needs to focus on addressing risk communication and modeling, managing trade‐offs, and demonstration of delayed benefits. This article is categorized under:Water and Life > Conservation, Management, and AwarenessScience of Water > Water and Environmental Change [ABSTRACT FROM AUTHOR]

The implementation of a circular economy (CE) in the construction sector faces several challenges that hinder its progress. Research on the awareness, key enablers, and potential benefits of CE in Saudi Arabia's construction of mega-projects that could contribute and promote a successful transition is still at its early stages and remains limited. This study delves into CE awareness and understanding, identifying the key enablers that could support its successful adoption in Saudi Arabian mega-projects and the potential benefits associated with it. To achieve this, a comprehensive literature review was conducted, followed by 18 semi-structured interviews across three case studies, which involved the main stakeholders in building, urban development, and infrastructure projects. The findings, which are thematically analysed, revealed that CE awareness mostly focuses on reuse, recycle, and waste reduction. A significant gap in the knowledge of circularity throughout projects' lifecycles has been identified. As such, this study concludes that the key enablers for CE include establishing regulatory frameworks, enhancing professionals' awareness and education, promoting the use of advanced technology, ensuring a mature market, and supporting CE initiatives. Moreover, the potential environmental and socio-economic benefits of CE, such as cost reduction, environmental impact reduction, and better-improved quality of life are crucial for encouraging a wider implementation of CE in the construction of mega-projects in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis (LF) is a significant public health issue in India. Despite 10–15 rounds of mass drug administration (MDA) in India, the global LF elimination target of 2030 appears challenging. To strengthen the program, community and provider perspectives on ways to bridge a gap in MDA are needed. Through the motivation–opportunity–ability–behaviour (MOAB) lens, we systematically reviewed the facilitators and barriers encountered in LF elimination in India. We followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. We searched PubMed, Embase, ProQuest and Google Scholar databases to explore factors related to MDA program implementation in India through 30 June 2021. We analysed the data using a thematic framework. We identified 576 studies; of these, 20 studies were included. This review revealed that the public health system for distributing MDA drugs in India created a better enabling environment, including zero out-of-pocket expenditure, door-step distribution of medicines and ample capacity-building training and follow-up. However, community members were unaware of the rationale for drug consumption, leading to a gap in drug distribution and consumption. Motivation is required among community members, which suggests capacity-building training for service providers to counsel the community. [ABSTRACT FROM AUTHOR]

The purpose of the study was to examine the supply chain enablers and barriers in the agricultural industry of Vhembe District in Limpopo Province. Interpretivism was the philosophical foundation of the study. The study was explorative, qualitative, and descriptive. The target population for this research comprised of personnel drawn from the agricultural industry in Limpopo Province. A non-probability purposive sampling method was employed to select 16 research participants. Primary data was gathered using a semi-structured interview guide. Atlas-ti 23 was utilized to analyze qualitative data. The results revealed that enabling factors were farmers’ collaboration, information sharing, and proper packaging. Factors hindering effective supply chain management processes included competition and inadequate resources. To achieve a competitive advantage, it is recommended that mills and storage facilities be located closer to suppliers and customers. In addition, training in change management and supply chain management (SCM) should be prioritised. Disaster response strategies must be established to address potential catastrophes and disease outbreaks. Marketing should include the provision of incentives and discounts as well as the adoption of more aggressive global marketing strategies to create viable export avenues for locally produced agricultural products.

Abstract Background The Acquired Immune Deficiency Syndrome (AIDS) pandemic has created a lot of devastation over the last four decades and continues to be a public health threat. Anti-retroviral treatment (ART), a group of medications that people who have been diagnosed with the Human Immunodeficiency Virus (HIV) infection take, has been shown to be efficacious and has significantly improved the fight against the disease. In Ghana, women carry a higher prevalence and incidence of HIV. The study’s objectives were to understand the experiences of women living with HIV/AIDS on ART and determine the barriers and enablers for ART uptake from the perspective of both the females living with HIV and their healthcare providers in the Upper East Regional Hospital of Ghana. Methods This was a qualitative study that used interviews to acquire data from women living with HIV on the perceived barriers and enablers for ART. The Upper East Regional Hospital in Ghana was the study site. We used a phenomenological approach to explore the lived experiences, perceptions, and meanings associated with ART among women. We collected data until we reached thematic saturation, interviewing a total of sixteen women living with HIV. We conducted a focus group discussion with nine healthcare workers providing care at the ART clinic. Data were analysed using thematic analysis. Results Women living with HIV and their healthcare providers viewed an environment that provided encouragement and support from healthcare workers and patients’ relatives, the ability to conceal HIV status, peer counselling, and the perceived benefits of therapy as enablers of ART uptake and medication adherence. The following were barriers to ART uptake and adherence: ill health, forgetfulness, long distances to ART clinics, cultural and spiritual beliefs, and fear of stigma. Conclusions Enablers of ART uptake should be expanded upon and encouraged so that women living with HIV/AIDS can access drugs in a timely and stress-free manner. On the other hand, the barriers identified can be addressed through education, the expansion of healthcare infrastructure, and the economic empowerment of women.

Educators and researchers have increasingly recognized the importance of AI literacy. Despite the growing body of AI literacy literature, the challenges and enablers for introducing AI literacy for kindergarten children is still underexplored and undertheorized in early childhood education. It is critical to understand the challenges and enablers associated with promoting AI literacy and perceptions in kindergartens needs to be further researched and evaluated. This study aims to identify teachers' views on the importance of AI literacy in kindergartens and the challenges and enablers of promoting AI literacy in kindergartens. Data was collected from 15 teachers through individual interviews. It was found that the four main challenges of promoting AI literacy in kindergarten classrooms, including lack of school support, lack of children's comprehensive ability, insufficient teacher knowledge of AI, and lack of curriculum guidelines. The three main enablers of promoting AI literacy in kindergarten classrooms are government support, school support, and social needs. We also found that more than half of teachers in this study considered AI literacy education is crucial for kindergarten children. This study develops an AI literacy policy framework for young children that includes three dimensions—governance, pedagogical, and operational and management. Based on the findings, suggestions for educators, curriculum developers, policymakers, and researchers are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background The Ethiopian Primary Healthcare Clinical Guidelines (EPHCG) seek to improve quality of primary health care, while also expanding access to care for people with Non-Communicable Diseases and Mental Health Conditions (NCDs/MHCs). The aim of this study was to identify barriers and enablers to implementation of the EPHCG with a particular focus on NCDs/MHCs. Methods A mixed-methods convergent-parallel design was employed after EPHCG implementation in 18 health facilities in southern Ethiopia. Semi-structured interviews were conducted with 10 primary healthcare clinicians and one healthcare administrator. Organisational Readiness for Implementing Change (ORIC) questionnaire was self-completed by 124 health workers and analysed using Kruskal Wallis ranked test to investigate median score differences. Qualitative data were mapped to the Consolidated Framework for Implementation Science (CFIR) and the Theoretical Domains Framework (TDF). Expert Recommendations for Implementing Change (ERIC) were employed to select implementation strategies to address barriers. Results Four domains were identified: EPHCG training and implementation, awareness and meeting patient needs (demand side), resource constraints/barriers (supply side) and care pathway bottlenecks. The innovative facility-based training to implement EPHCG had a mixed response, especially in busy facilities where teams reported struggling to find protected time to meet. Key barriers to implementation of EPHCG were non-availability of resources (CFIR inner setting), such as laboratory reagents and medications that undermined efforts to follow guideline-based care, the way care was structured and lack of familiarity with providing care for people with NCDs-MHCs. Substantial barriers arose because of socio-economic problems that were interlinked with health but not addressable within the health system (CFIR outer setting). Other factors influencing effective implementation of EPHCG (TDF) included low population awareness about NCDs/MHCs and unaffordable diagnostic and treatment services (TDF). Implementation strategies were identified. ORIC findings indicated high scores of organisational readiness to implement the desired change with likely social desirability bias. Conclusion Although perceived as necessary, practical implementation of EPHCG was constrained by challenges across domains of internal/external determinants. This was especially marked in relation to expansion of care responsibilities to include NCDs/MHCs. Attention to social determinants of health outcomes, community engagement and awareness-raising are needed to maximize population impact.

Abstract Background Deprescribing is a clinical intervention aimed at managing polypharmacy and improving older adults’ health outcomes. However, evidence suggests that healthcare professionals (HCPs) may face challenges in implementing the intervention. This study aimed to explore the considerations, barriers and enablers of deprescribing among HCPs in Southwest Nigeria. Methods A quantitative cross-sectional survey was carried out among consecutively sampled HCPs including physicians, pharmacists and nurses in two public tertiary healthcare hospitals in Ogun State, Southwest, Nigeria. A structured 43-item self-administered questionnaire was used to explore the participants’ sociodemographics, HCPs’ experience, considerations, barriers and enablers of deprescribing in older adults. The data were summarised using descriptive statistics including frequency and percentage. The Kruskal–Wallis test was used to determine differences in perceptions among the groups on a Likert scale. A p-value

Abstract Background School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. Methods The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. Results The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. Conclusions The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Abstract Background Despite modest efforts to study and document the complications that arise after acute treatment of patients with coronavirus disease, its ramifications and regional variations are yet to be clearly understood. Progress in sub-Saharan Africa, notably Nigeria, has been impeded by patient disengagement from care and insufficient or non-existent follow-up arrangements. The aim of this study was to describe the barriers and enablers for follow-up services after discharge from COVID-19 care pathway in Nigeria. Methods Seventeen experts involved directly in the care of patients with COVID-19 participated in brainstorming using the nominal group technique during a national workshop to review the new guidelines for COVID-19 case management in Nigeria. Participants discussed the barriers and facilitators of post-acute care follow-up of patients discharged from COVID-19 pathway and ranked their recommendations to arrive at three major factors per question. Results Participants were mostly middle aged and predominantly clinicians. The top three barriers were patients’ perception of their symptom severity, lack of organizational clarity/structure/policies on follow-up care after discharge, and financial constraints. Similarly, participants identified providers’ initiated education on the reasons for follow-up at discharge, written organizational policies/structure and clarity and free follow-up services as the top three facilitators. Conclusion This study has enumerated barriers to follow-up care after discharge patients with coronavirus disease and highlighted providers, institutional and governmental responses that will facilitator follow-up care after discharge of patients with COVID-19. The implication is that, there is need for clear institutional guidelines for tracking and documenting post-COVID condition. In the future, it would be necessary to assess the achievements and shortcomings of post-COVID condition tracking in Nigeria through the use of implementation science outcomes.

Background: With an increasing number of grandparents providing care to their grandchildren, calls have been made for these caregivers to be considered important stakeholders in encouraging children's engagement in health-promoting behaviors, such as physical activity. Understanding the perspectives of grandparents who provide care is crucial to informing efforts that aim to increase children's physical activity, yet little is understood about their perceptions of specific barriers and enablers to promoting children's physical activity and reducing screen time. The present study sought to explore these perceptions. Methods: Semi-structured focus groups and individual interviews were conducted with grandparents who reported providing care to a grandchild aged 3 to 14 years. A total of 20 grandparents were sampled (mean age = 67.8 years). Data were subjected to reflexive thematic analysis. Results: Key reported barriers to physical activity included (i) the effort (physical and logistical) and financial cost associated with organizing physical activities, (ii) grandparents' age and mobility issues (e.g., due to injury or illness), (iii) caring for children of different ages (e.g., older children having different physical activity interests than younger children), and (iv) a local environment that is not conducive to physical activity (e.g., lack of appropriate facilities). Barriers to reducing screen time included (i) parents sending children to care with electronic devices and (ii) children's fear of missing out on social connection that occurs electronically. Strategies and enablers of physical activity included (i) integrating activity into caregiving routines (e.g., walking the dog), (ii) involving grandchildren in decision making (e.g., asking them in which physical activities they wish to engage), (iii) encouraging grandchildren to engage in activity with other children, and (iv) creating a physical and social environment that supports activity (e.g., owning play equipment). A common strategy for reducing screen time was the creation of a home environment that is not conducive to this activity (e.g., removing electronic devices from view). Conclusions: Findings suggest that grandparents may benefit from resources that assist them to identify activities that are inexpensive and require minimal effort to organize. Activities that account for grandparents' age and health status, as well as any environmental barriers, are likely to be well-received. [ABSTRACT FROM AUTHOR]

Green concrete is a concept of concrete that uses waste materials to reduce its environmental impact and has various benefits for the environment, economy, and society, such as lower construction cost, less landfill waste, new waste markets, and better quality of life. This study aims to investigate and analyze the barriers and enablers for green concrete development and implementation, based on a mixed-method approach that combines a scientometric analysis and a literature review. The Scopus database was explored first and then these data were used to investigate and capture six categories of barriers and enablers: awareness, technical, economic and market, implementation, support/promotion, and social. Results reveal that the technical and operational aspects are the main challenges for green concrete, while the awareness and social acceptance are not major issues. The current study surpasses the mere popularization of green concrete. Instead, it delves into its multifaceted dimensions, that is, technical, economic, social, and institutional. By meticulously analyzing a diverse group of research articles, key challenges and opportunities associated with green concrete are pinpointed. The findings not only deepen our understanding of the barriers impeding the widespread adoption of green concrete, but also shed light on potential solutions. In summary, this work bridges theory and practice, providing invaluable insights for future researchers, practitioners, and policymakers in the sustainable construction domain. [ABSTRACT FROM AUTHOR]

The growing use of telerehabilitation within the healthcare community has garnered substantial attention. In congruence with other healthcare fields, examining perceptions, barriers, and facilitators assumed paramount significance in the continuation and fortification of telerehabilitation practices among physiotherapists. In this scoping review, we aimed to systematically map the literature on the perceptions of physiotherapists as well as the barriers and enablers of telerehabilitation in their daily practice. The five-stage methodological framework recommended by Arksey and O’Malley (2005) was used for this scoping review. In the framework, eight databases were searched using key search terms such as “telerehabilitation”, “physiotherapists”, “readiness”, “enablers” and “barriers” All findings were organised into perceptions and readiness, enablers, and barriers. Fourteen articles met the inclusion criteria and were categorized as: (1) perception and readiness, (2) enablers, and (3) barriers. In the perception and readiness category, new trends in healthcare, advancement in physiotherapy practices and the benefits to clients were identified. The enablers identified included prior training, personal experience, familiarity with technology, functional equipment and space, and client selection. The barriers to the adoption of telerehabilitation in physiotherapy practice are pinpointed to poor technology, communication hurdles, limited availability, lack of familiarity, and client-related concerns. While initial evidence suggests a generally positive perceptions it is important to consider both facilitators and barriers when understanding adoption. This review’s findings revealed a wide research gap, with unequal weightage towards barriers compared to enablers, and highlights the need for further research. Developing telerehabilitation guidelines that cater to both physiotherapists and clients is necessary. [ABSTRACT FROM AUTHOR]

What is the global social context for the insertion of kleptocratic elites into the putatively liberal international order? Drawing on cases from our work on Eurasia and Africa, we sketch a concept of 'transnational uncivil society', which we contrast to 'transnational activist networks'. While the latter denotes the liberalizing practices of global civil society, the former suggests a specific series of clientelistic relations across borders, which open space for uncivil elites. This distinction animates a growing line of conflict in global politics. These kleptocrats eject liberal activists from their own territories and create new spaces to whitewash their own reputations and build their own transnational networks. To do so, they hire political consultants and reputation managers, engage in public philanthropy and forge new relationships with major global institutions. We show how these strategies of reputation-laundering are neither illicit nor marginal, but very much a product of the actors, institutions and markets generated by the liberal international order. We compare and contrast the scope and purpose of civil and uncivil society networks, we explore the increasing globalization of Eurasian and African elites as a concerted strategy to distance themselves from associations with their political oppression and kleptocracy in their home countries, and recast themselves as productive and respected cosmopolitans. [ABSTRACT FROM AUTHOR]

This mixed method study with sequential explanatory design aimed to explore enablers and disablers of online learning environments in medical education and was conducted from August 2021 to January 2022. A cross-sectional survey was conducted on 64 medical teachers and 66 medical students from Pakistan followed by 2 focus group interviews involving 6 participants from each cohort. The mean online education experience scores for medical students and teachers were 2.188 + 1.361 years and 1.881 + 1.145, respectively. Most participants perceived that online modalities are underutilised. Online video was utilised more by students compared to the teachers (p < 0.05) and quizzes were the most utilised online assessment tools for both groups (p < 0.05). Thematic analysis unearthed 27 enablers and 23 barriers to the online learning environment. "Ease for use" was the most cited enabler for a productive online learning environment by both groups followed by "organisation of learning" among the teachers and "feedback provision" among the students. Among barriers, both students and teachers talked about "feelings of isolation" as the main barrier to learning, followed by "distractions" quoted by students and "lack of academic honesty" quoted by teachers. The identified enablers and barriers of learning in online learning environments provide a practical map for institutions to evaluate their online ecosystems. The results endeavour to contribute to the ongoing efforts of educators, administrators, and policymakers in creating inclusive, and effective online learning environments. [ABSTRACT FROM AUTHOR]

This exploratory descriptive study investigated barriers and enablers to the provision of leisure activities for people living in three Australian residential aged care facilities (RACFs) that operated under a household model of care. This research is unique in the international context, as few studies have explored the understandings and experiences of personal care attendants' (PCAs) perceptions of what impacts leisure provision for people living in RACFs. Qualitative data were collected from 17 PCAs via four focus groups. Barriers to leisure provision were identified as PCA–resident ratios, competing demands of the PCA role and a prioritisation of physical care tasks over leisure-related activities. The severity of residents' dementia (cognitive and functional deficits) as well as behavioural and psychological symptoms of dementia were also framed as barriers to participation in and the provision of leisure. Participants identified enablers of leisure provision as related to perceptions of leisure, the experiential knowledge of staff, organisational support and resourcing. The study findings suggest that enhancing leisure provision for people living with dementia will require attention to system issues (i.e. staffing levels, ratios, PCA role demands) as well as PCA knowledge and capability to facilitate person-centred leisure. [ABSTRACT FROM AUTHOR]

The number of students with autism spectrum disorder in university is progressively increasing, which implies great challenges for higher education. Existing literature indicates that students with Autism Spectrum Disorder face many barriers to their participation and learning, some of which are attributed to teaching practices. Thus, this keeps us still on the road towards achieving genuinely inclusive institutions. With the purpose of promoting more inclusive practices according to students' preferences, this article aims to analyse the learning enablers for students with autism, which are related to inclusive teaching practices based on the Universal Design for Learning (UDL). A qualitative approach was selected, which allowed to gather the testimonies of seven university students with this disorder through semi-structured interviews conducted at a university in Spain. These students reported several enablers that supported their learning at university. Many of them indicated highlighting key concepts or receiving the information progressively. The majority described feeling more engaged when teachers considered their opinions and valued their efforts, among other facilitators. The study concludes with valuable recommendations, based on students' testimonies, for teachers to incorporate into their teaching practices. The perspectives of students with ASD have highlighted the significance of their voices. However, there is still a need to develop a shared speech that directly impacts the transformation of practices. The UDL approach could benefit students with ASD and others. Therefore, investigating how to introduce these practices into teacher training programs in higher education should be a priority for future research. [ABSTRACT FROM AUTHOR]

Introduction: Globally, there is an increasing demand for quality medical rehabilitation services. This is the first article of a two‐part series showing the findings from the Rehabilitation Choices study in which the main aim was to understand the current landscape of decision‐making, enablers and barriers to access appropriate rehabilitation services in the Australian setting. In Part 1, these insights were sought from a healthcare professionals' perspective. Methods: This was an exploratory, qualitative study, using semi‐structured interviews with a discussion guide that was codesigned together with rehabilitation clinicians and rehabilitation researchers. Themes and sub‐themes were identified using an inductive approach. Results: We interviewed a heterogeneous group of 31 professionals who are involved in making referral decisions about rehabilitation or who design and deliver rehabilitation programs, including specialist rehabilitation physicians and other medical doctors across in‐patient, outpatient, and primary care settings, allied health professionals, rehabilitation service managers, nurses, multicultural health liaison officers and rehabilitation research scientists. Three key themes relevant to barriers and enablers to service access were identified from the data: defining rehabilitation; a lack of timely access to patient and rehabilitation service data; and patient diversity not expected by the system. Conclusions: Healthcare professionals who make decisions about rehabilitation referrals and services feel that it was necessary for them to keep up to date with information relating to rehabilitation services. There was some concern regarding what rehabilitation constituted and what services were available for different clinical indications. They also indicated that current systems did not consider diversity among patients' needs and goals. Their recommendations included the need for better communication pathways, improved referral systems and resources that could help provide best practice of rehabilitative care in the future. Patient or Public Contribution: Three study team members had a lived experience of rehabilitation as a patient or carer, and previous experience participating in qualitative research. They worked with the study team to codesign the recruitment strategy, participant‐facing communications, the interview discussion guide, and the approach to the conduct of activities with participants and in the interpretation and contextualization of findings and all were involved in writing this manuscript. [ABSTRACT FROM AUTHOR]

In India, the population of persons with disabilities is estimated as 26.8 million of whom 15.7 million are in the age range 15-59 years (Census 2011). This has proved to be a challenge to the right to education, particularly when there is a situation of poverty and gender-specific issues, which along with disability, lead to further marginalisation. The study reported investigated factors that enabled and/or inhibited progress in the lives of people with disabilities who are doubly disadvantaged. The authors focused on the lived experiences of 14 persons with disabilities and collected data from them using semi-structured interviews. Interview responses were transcribed and coded and validated before grouping into themes of facilitators, inhibitors and opportunities for a better future. The results revealed that family support, support from members in the community and the confidence of persons with disability on their own capabilities were enabling factors. Lack of public awareness, poor facilities for continuing education, untrained teachers, lack of accessible environment and resources, the trauma of having to prove themselves to gain acceptance were inhibitors of their progress. Caregivers of persons with intellectual and developmental disabilities expressed concern for their child's future. Poverty, living in remote areas and/or being a female formed further obstacles to accessing higher education and employment. [ABSTRACT FROM AUTHOR]

Objectives: Informal carers are an integral part of any health care system. However, provision of informal care is associated with caregiver burden and decreased wellbeing. Mindfulness programs can reduce caregiving burden and improve wellbeing among informal carers, but they face challenges when participating in face-to-face programs. Studies have explored the effects of online delivery of mindfulness programs for informal carers. However, the enablers and barriers for participation are not well understood. This review aimed to synthesise the evidence and provide a comprehensive understanding of the enablers and barriers to participation in online mindfulness programs among this population. Methods: A mixed-methods systematic review was conducted following the Joanna Briggs Institute mixed-methods systematic review approach and using eight databases. All empirical studies published in English and involving informal carers aged over 18 years were included. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Thematic analysis was conducted to integrate the data. Results: Nine studies were included: three quantitative, two qualitative, and four mixed methods. Three subthemes for enablers and barriers were developed. Three subthemes for enablers included self-motivation, positive experience of mindfulness, and program structure and delivery. Three subthemes for barriers included lack of self-motivation, external factors preventing participation, and program structure and delivery. The enablers and barriers were interrelated within and across the identified themes. Conclusions: A comprehensive synthesis of current evidence was provided for consideration when developing online mindfulness-based interventions for informal carers. Further investigation is recommended, particularly in relation to the enablers and barriers to engagement by informal carers. Preregistration: The review protocol was registered with PROSPERO (CRD42023409311). [ABSTRACT FROM AUTHOR]

BACKGROUND: Considerable progress has been made globally in improving maternal and child health. However, Sub-Saharan Africa (SSA) and South Asia together accounted for 86% of all maternal deaths in the world during the 2000–2017 period. It is estimated that more than 60% of global maternal deaths occur during the postnatal period. The utilization of postnatal care (PNC) services remains low in SSA. This scoping review aimed to determine factors that influence PNC utilization among women in SSA. METHODS: Peer-reviewed articles published in English from 2018 to 2023 were searched from Google Scholar, ScienceDirect, MEDLINE, African Journals Online, SCOPUS, and PubMed databases. Two authors independently screened the articles and extracted the data. RESULTS: Thirty-nine articles were included in this review. Thirty-three of the studies were of a quantitative cross-sectional study design, four were mixed-methods, and two were qualitative studies. The review identified several enablers and barriers to PNC utilization among women, which were categorized into individual, community-level, and healthcare system factors. Some of the individual factors included the place of residence, marital status of the woman, employment status, educational level of both the woman and her partner, and household income. Health system factors included accessibility of healthcare facilities, availability of resources, and the quality of healthcare. CONCLUSION: To improve PNC utilization in SSA, several strategies should be implemented. These strategies should address issues such as women's empowerment, accessibility of healthcare facilities, the quality of healthcare services, and healthcare services financing. [ABSTRACT FROM AUTHOR]