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Many US consumers wanting a healthy lifestyle are interested in cannabidiol (CBD) products, but these products remain somewhat controversial. This study investigates how product factors, consumer knowledge, and external cues to action influence the perceived benefits of, and barriers to, CBD, driving adoption intention. Study 1 explores important factors influencing CBD adoption. Study 2, which relies on experimental studies, reveals that certification labels, subjective knowledge, usage experience, and external cues to action influence the perceived benefits and barriers, further impacting adoption intention. The impact of the perceived benefits and barriers on adoption intention is stronger in consumers with greater concerns about their overall health. Insights into factors influencing consumer perceptions and adoption of CBD extend our knowledge of consumer responses to CBD and highlight valuable implications for marketers and policymakers. [ABSTRACT FROM AUTHOR]

Introduction: In today's era, conducting nursing research is crucial for the advancement of the nursing profession. Scientific publications in clinical research aim to improve patient care outcomes and foster a sense of importance for nurses within the healthcare team. However, clinical nurses often fall behind due to factors such as limited familiarity, attitudes toward research, and encountered barriers. Objectives: This study was conducted to assess the knowledge, attitude, and perceived barriers regarding scientific research publications among clinical nurses at tertiary care hospitals in western Rajasthan. Methodology: A cross-sectional descriptive study was conducted among the clinical nurses. The participants were assessed for their knowledge, attitude, and perceived barriers regarding scientific research publications through a self-administered questionnaire. Results: The study revealed that 92% of the participants lacked sufficient knowledge about scientific research publications and 78.3% experienced moderate perceived barriers. Pearson's correlation coefficient indicated a weak positive correlation (r = 0.143, p = 0.007) between knowledge and attitude and a significant negative correlation (r = −0.143, p = 0.012) between knowledge and perceived barriers. However, multiple linear regression analysis showed no significant relationship among the clinical nurses in terms of knowledge, attitude, and perceived barriers toward scientific research publications. Conclusion: This study on clinical nurses revealed that the majority had insufficient knowledge about scientific research, while over half had neutral attitudes toward research publications. In addition, a significant portion of the clinical nurses reported experiencing moderate perceived barriers. [ABSTRACT FROM AUTHOR]

AbstractAdvancements in technology have made autonomous delivery vehicles (ADVs) a feasible option for “last-mile” delivery, improving logistic efficiency in the global digital age. The promotion and popularization of ADVs must be based on widespread user acceptance. This study combines the technology readiness theory and innovation resistance theory to construct a research model to explore the key factors influencing users’ use and recommendation of ADVs. We collected 349 valid samples through a questionnaire survey and used partial least squares-based structural equation modeling (PLS-SEM) to validate the model. The results showed that (1) positive technology readiness reduces users’ perceptions of value barrier, tradition barrier, and image barrier, while negative technology readiness increases users’ perceptions of the five categories of innovation barriers: usage barrier, value barrier, risk barrier, tradition barrier, and image barrier; (2) users’ intention to use and recommend ADVs is negatively affected by the usage, value, and tradition barriers; (3) users of different genders have varying perceptions of the relationship between technology readiness, barrier factors, and the decision to use ADVs. This study reveals the influencing factors that hinder users from using and recommending ADVs and their functioning mechanisms from the perspective of barriers and examines the impact of gender differences between males and females. The study enriches the empirical research in ADVs, providing theoretical support and practical guidance for logistics companies and the government to develop autonomous delivery technology and publicize and promote ADVs. [ABSTRACT FROM AUTHOR]

Background: Self-directed learning (SDL) is an internationally accepted principle of adult education. CBME curriculum implemented by the Government of India has allotted 280 hours of SDL in all subjects for undergraduate medical students. SDL is yet to root into the student community as norms and a definitive program evaluation is still not in shape. Aim and Objective: To identify students’ readiness and perceived barriers towards SDL. Materials and Methods: This questionnaire-based study was conducted between January 2023 to May 2023 among faculties and students. The 12 items of self-directed learning readiness instrument were adopted from Shen et al. Results: A total of 480 MBBS students participated. 97.7% of students were aware of SDL in their first year. The highest score was in the “self-monitoring” domain (Mean ± SD = 3.89 ± 0.64) and the lowest score was in “Planning and Implementation” (3.56 ± 0.80). Students perceived that SDL would enhance their communication (50.41%), critical thinking (49.2%), problem solving (40.4%), research (39.8%) and cognitive skills (37.1%). Among barriers the most significant was lack of guidance and resource deficiency (30.4%, 29%). In this study 52 CISP completed faculty participated and 82.69% agreed students were ready for SDL. The suggested resource materials were reference books and online materials (90.38% & 26.92%). Conclusion: Medical students’ readiness for SDL is quite encouraging which was also attested by 83% of faculty. Given the fertile nidus of growing young minds if deficiencies are addressed, the medical curriculum would be fortified with SDL ensuring long term benefits.

This study aimed to examine the causal model of eating behaviors among pregnant women working in industrial factories.

Objective: To evaluate knowledge about HPV and its vaccine, additionally, to examine the effect of knowledge about HPV and its vaccine on perceived benefits and barriers to HPV vaccination among individuals in the western region of Saudi Arabia. Methods: A cross-sectional design was employed in the western region of Saudi Arabia through a self-administered web-based survey. The survey assessed knowledge, perceived benefits, and perceived barriers to HPV vaccination. Results: A total of 1149 eligible participants completed the survey. Participants exhibited limited knowledge of HPV and its vaccine, with an average total score of 4.76 out of 15. Over 80% of participants were unaware that HPV may not show symptoms, cannot lead to HIV, and is not treatable with antibiotics. Over half were unaware that HPV can cause cervical cancer, oral cancer, or genital warts. Unmarried and graduate-educated participants demonstrated greater knowledge. Perceived benefits were positively associated with knowledge levels, while perceived barriers were negatively associated with knowledge levels after controlling for other variables. Conclusions: This study highlights the need for education and healthcare efforts to raise knowledge about HPV and its vaccine in the western region of Saudi Arabia. Also, this study indicated that enhanced knowledge boosts positive attitudes towards HPV vaccination, while reducing perceived barriers, thereby increasing vaccination rates. [ABSTRACT FROM AUTHOR]

With the advancement of technology, the metaverse, as the future of the Internet, has gained popularity. As a result, numerous opportunities have been created, and the tourism industry is eager to take advantage of them. While it is critical to understand how the metaverse can influence tourism, tourists also need to be aware of its benefits. Therefore, this study is undertaken to empirically investigate the factors influencing the adoption of the metaverse due to its perceived benefits. To operationalise the constructs, qualitative methodology was performed. Subsequently, the source data were collected from 315 tourists, and the analysis was performed using quantitative methodology. The findings reveal that by virtually visiting hotels and other resources before making a reservation, the metaverse offers new sources of travel inspiration. The booking process is made more enjoyable and engaging by the metaverse. Metaverse-enabled enhanced travel inspiration and booking experiences lead to an increase in booking volume. [ABSTRACT FROM AUTHOR]

IntroductionIn today's era, conducting nursing research is crucial for the advancement of the nursing profession. Scientific publications in clinical research aim to improve patient care outcomes and foster a sense of importance for nurses within the healthcare team. However, clinical nurses often fall behind due to factors such as limited familiarity, attitudes toward research, and encountered barriers.ObjectivesThis study was conducted to assess the knowledge, attitude, and perceived barriers regarding scientific research publications among clinical nurses at tertiary care hospitals in western Rajasthan.MethodologyA cross-sectional descriptive study was conducted among the clinical nurses. The participants were assessed for their knowledge, attitude, and perceived barriers regarding scientific research publications through a self-administered questionnaire.ResultsThe study revealed that 92% of the participants lacked sufficient knowledge about scientific research publications and 78.3% experienced moderate perceived barriers. Pearson's correlation coefficient indicated a weak positive correlation (r = 0.143, p = 0.007) between knowledge and attitude and a significant negative correlation (r = −0.143, p = 0.012) between knowledge and perceived barriers. However, multiple linear regression analysis showed no significant relationship among the clinical nurses in terms of knowledge, attitude, and perceived barriers toward scientific research publications.ConclusionThis study on clinical nurses revealed that the majority had insufficient knowledge about scientific research, while over half had neutral attitudes toward research publications. In addition, a significant portion of the clinical nurses reported experiencing moderate perceived barriers.

BackgroundThe Sustainable Development Goals (SDGs) in health focus on achieving equity to reduce maternal mortality disparities among subpopulations globally. The goal is to lower the maternal mortality ratio (MMR) to below 70 per 100,000 live births by 2030 for countries with an MMR below 420 in 2010. For those exceeding 420, the target is to keep the MMR below 140 by 2030. This target could not be achieved unless quality maternal health care service is implemented in all health care settings. This study aimed to assess the quality of maternal care and perceived barriers based on women’s perspectives among women who receive delivery services in hospitals of South Gondar Zone, Northwest, Ethiopia.MethodsA phenomenological method was implemented to explore women’s perspectives on quality maternal care and its perceived barriers. An in-depth interview (IDI) was used to collect data using a semi-structured in-depth interview guide. The study was conducted from January 1–30, 2021. All in-depth interview notes were translated into meaningful notes. Then notes were organized by coding texts into meaningful elements using open code version 4.03 software.ResultsThe majority (14 in 20) tried to interpret quality care in terms of respect during procedures, providing family support, and timely care. Some (6 in 20) tried to associate quality care with the competency of care providers, the cleanliness of the procedure, and privacy during care. With regards to perceived barriers to quality care, the majority (15 in 20) of the IDI participants agreed that a high caseload, limited drugs, and administrative problems were barriers to providing quality maternal care.ConclusionParticipants articulate a multifaceted understanding of quality maternal care that encompasses emotional support, accessibility, cleanliness, timely interventions, and respectful treatment. They also identify significant barriers that stem from facility limitations, provider attitudes and knowledge, and administrative inefficiencies. Addressing these barriers is essential for enhancing the quality of maternal health services.

Tuberculosis (TB) is a major worldwide health problem, particularly in India, where it accounts for a quarter of infections. Adherence to the directly observed treatment, short-course (DOTS), which is necessary for TB treatment, is difficult in resource-limited circumstances. This study addressed the knowledge, attitude, and perceived barriers related to TB and DOTS adherence among patients and caregivers. A cross-sectional survey was undertaken at the selected TB clinics between November 2023 and March 2024. Purposive sample yielded 180 patients and 217 caregivers. Data were obtained using validated, self-structured questionnaires that assessed knowledge, attitude, and perceived barriers to TB and DOTS adherence. Statistical analysis was carried out with IBM SPSS version 23.0. The study found that caregivers had considerably greater TB knowledge than patients (p

Background: Preconception care (PCC) is of paramount importance in reducing maternal and child morbidity and mortality. A new ‘Package of interventions for PCC’ has been introduced in 2012, which is delivered through the existing public health system. Objectives: To assess the knowledge, practices, associated factors and perceived barriers of public health midwives (PHMM) on implementing the PCC package in the Colombo district. Methods: Descriptive cross-sectional study was carried out using a pretested self-administered questionnaire among all PHMM in Colombo district (N=366). Identification and fine tuning of the perceived barriers was done through focus group discussions with PHMM outside the study setting. A checklist was used in four randomly selected MOH areas to assess the practices. Data was described using mean values and frequency. Chi-square test was used for associations (P

Abstract Background The need for primary care physicians to be heavily involved in the provision of palliative care is growing. International agencies and practice standards advocate for early palliative care and the use of specialized palliative care services for patients with life-threatening illnesses. This study was conducted to investigate physicians’ referral practices and perceived barriers to timely referral at the Korle Bu Teaching Hospital. Methods A cross-sectional study design was employed using a convenience sampling technique to recruit 153 physicians for the study. Data on socio-demography, referral practices, timing and perceived barriers were collected using a structured questionnaire. Binary Logistic regression using crude and adjusted odds was performed to determine the factors associated with late referral. Significance was set at p

Background: The need for primary care physicians to be heavily involved in the provision of palliative care is growing. International agencies and practice standards advocate for early palliative care and the use of specialized palliative care services for patients with life-threatening illnesses. This study was conducted to investigate physicians' referral practices and perceived barriers to timely referral at the Korle Bu Teaching Hospital. Methods: A cross-sectional study design was employed using a convenience sampling technique to recruit 153 physicians for the study. Data on socio-demography, referral practices, timing and perceived barriers were collected using a structured questionnaire. Binary Logistic regression using crude and adjusted odds was performed to determine the factors associated with late referral. Significance was set at p < 0.05. Results: The prevalence of late referral was reported to be 68.0%. There were poor referral practices among physicians to palliative care services, and the major barriers to late referral were attributed to the perception that referring to a palliative care specialist means that the physician has abandoned his patient and family members' decisions and physicians' personnel choices or opinions on palliative care. Conclusion: The healthcare system needs tailored interventions targeted at improving physicians' knowledge and communication strategies, as well as tackling systemic deficiencies to facilitate early and appropriate palliative care referrals. It is recommended that educational programs be implemented, palliative care training be integrated into medical curricula and culturally sensitive approaches be developed to address misconceptions surrounding end-of-life care. [ABSTRACT FROM AUTHOR]

The current study applies a hybrid model to investigate the combined effects of perceptions towards benefits and barriers and policy interventions on behavioral intention to use electric vehicles (EVs) in Vietnam, a country where the EV market is still in its infancy, and transportation is becoming a significant greenhouse gas (GHG) emitter. A total of 1337 questionnaires were randomly distributed to people in twelve districts in Hanoi, Vietnam. The results showed that 25.8% of respondents were more likely to adopt EVs, in contrast to 74.2% indicating that they would not mind EVs. Economic and operational barriers were two key factors excluding people from adopting EVs. On the other hand, consumer subsidies have been identified as the most favorable solution to the widespread adoption of EVs. The findings of the study suggest that environmentalism and socio-demographics were not reliable indicators of the level of EV adoption in the early stages of the EV market. This provides new insight into the infant EV market not only specifically in Vietnam but also in other countries that despite having a high level of education and a strong commitment to the environment, many people view electric mobility as a minor aspect of their lives. However, financial incentives act as amplifiers in promoting the uptake of EVs in the infant EV market. Based on our findings, the government should consider providing consumer subsidies as a policy intervention to increase the market share of EVs and address the issues of pollution abatement. [ABSTRACT FROM AUTHOR]

People with good self-management skills can effectively regulate and control their feelings, thoughts, and actions in a range of situations. Strong self-management skills allow employees to set goals on their own while making every effort to achieve them. Such employees understand how important it is to control their emotions and behavior at work. Employers like people with high self-management skills since it can be challenging for someone to control their emotions and thoughts. As a result, they might end up shouting at a client and saying harsh things to their coworkers. Self-management skills enable people to exercise more selfcontrol, which leads to wiser professional judgements. Important jobs and activities, as well as fulfilling research goals, call for little diversion and a good capacity for concentration (4). The most crucial tasks are identified, prioritized, and concentrated on by researchers, who also try to avoid distractions. In order to efficiently handle their time, simplify daily tasks, and keep crucial information and things close at hand, researchers create organizational systems. Finally, they get ready to start the job at hand. They arrive early for classes, meetings, and presentations. After leaving for the day, they make plans for the next day. A novel and effective MCDM is designed based on the separation to the mean solution evaluations (EDAS). In this manner, alternatives are chosen depending on how much they deviate analysis, the EDAS approach (Avg evaluation adjusted for distance from solution) is the best choice. The solution with the greatest separation from the ideal is short range and negative, although the comparison between these distances is insignificant. Alternative: Overall sample n 605, 6th graders in 309, 8th graders in 296. Self-management strategies, perceived barriers, Perceived barriers, Outcome expectancy. Results: From the result it is seen that Outcome expectancy is got the first rank where as is the perceived barriers is having the lowest rank. Conclusion: As a result Outcome expectancy ranked first while perceived barriers ranked lowest [ABSTRACT FROM AUTHOR]

(1) Background: Climate change and a sedentary lifestyle have been associated with negative effects on global health and sustainable development. Active commuting (AC) represents an important solution for mitigating global warming and improving health. Thus, policies that encourage this behavior could have an impact on health and sustainability. Therefore, the aims of this study were (a) to describe the mode of commuting in university staff and students; (b) to analyze the influences of this behavior; and (c) to compare perceived barriers by mode of commuting. (2) Methods: A cross-sectional study with a descriptive design was conducted. In total, 384 university community members (79.4% students and 20.6% staff) were recruited via non-probability sampling and completed an online questionnaire. Mode of commuting, sociodemographic data, and perceived barriers were analyzed. (3) Results: Most of the sample commuted passively to university. This behavior was significantly higher in those who those lived in rural residences and a distance more than 15 km from the university, owned one vehicle, perceived higher psychosocial and environmental barriers, and were women. (4) Conclusions: Universities play a key role in health promotion and sustainable development. Therefore, they should design specific measures according to their characteristics, and barriers. [ABSTRACT FROM AUTHOR]

The escalating global concerns regarding sustainable development issues have transformed the landscape of consumer behaviour, urging businesses to incorporate green practices and raise awareness among consumers. There is an ongoing debate concerning attitude-intention and product category gap. The study aims to bridge this gap by investigating the green cosmetic purchase behaviour of female consumers in South Africa by exploring factors such as awareness, product information, product availability, environmental concern, perceived barriers, perceived price, and attitude. The study employs the alphabet theory, previously utilised in qualitative research, to quantitatively examine the relationship between various factors and green cosmetic purchase intention. By applying this theory, the study contributes to its expansion and offers a unique framework for understanding consumer behaviour in the green cosmetic industry.This study collected data by conducting an online and face-to-face survey with 295 South African consumers. The results revealed that perceived price and attitude significantly influence the purchase intention of green cosmetic products amongst females in South Africa. While awareness, product information, product availability, environmental concern and perceived barriers needed a mediating variable (attitude) to influence the purchasing intention of green cosmetic products of female consumers in South Africa. The study highlights the practical implications for marketers by providing insights into designing effective green marketing strategies. The study's findings can aid marketers in tailoring their communication and developing a targeted green marketing mix that resonates with female consumers in South Africa.

Abstract Occupational noise exposure is a pervasive issue in many industries, leading to a range of health issues and sleep disturbances among workers. Additionally, there is a strong desire among these workers to prevent industrial accidents. This study, aimed at enhancing worker health and well-being, utilized a survey distributed by the Korean Confederation of Trade Unions to field workers. Data from 1285 workers were collected and analyzed using partial least squares structural equation modeling (PLS-SEM) to identify and understand the factors affecting prevention intention in noisy work environments. Our findings indicate that health problems resulting from occupational noise exposure significantly influence insomnia, perceived severity of potential accidents, perceived benefits of preventive measures, and perceived barriers. Perceived severity was significantly correlated with prevention intention, emphasizing the role of risk perception in motivating preventive behaviors. Perceived benefits were also significantly associated with prevention intention, highlighting the importance of positive outcomes in influencing workers’ behaviors. Additionally, perceived barriers showed a significant relationship with prevention intention, suggesting that overcoming these barriers is crucial in promoting preventive behaviors. Demographic factors such as gender displayed a significant association with prevention intention, while age did not. This study provides valuable insights into the multifaceted factors influencing workers’ intention to prevent industrial accidents in noisy environments, underlining the importance of comprehensive data collection tools in understanding these dynamics.

Abstract Background This study examined the perceived barriers of migrants and refugees to vaccinating their children against measles and polio in Iran. Methods First, an instrument was developed and validated through several steps. Next, 1,067 parents who had not vaccinated their children against polio and measles or had delayed receiving any dose of these two vaccines until the age of 15 were selected from 16 provinces and completed the instrument. Finally, the data were analyzed. Results The results of the explanatory factor analysis showed that the perceived barriers affecting vaccination against polio and measles vaccines were categorized into five factors: low knowledge, negative attitude, communication challenges, lack of participation in vaccination programs, and problems related to migration and refugees. Additionally, the results indicated a significant difference in the mean score of perceived barriers based on participants’ level of education, economic status, and nationality. Conclusion The identified barriers may provide a perspective for developing effective efforts in this area. Interventions should focus on parents with low education and poor economic status.

BACKGROUND: Breast self-examination (BSE) is an inexpensive, harmless screening tool for finding breast cancer. This study examines the knowledge, practices, and perceived barriers of female college students from a local higher education institution (HEI) regarding BSE, focusing on those in the reproductive age group. MATERIALS AND METHODS: Three hundred sixty (360) female college students, including 226 health sciences majors and 134 non-health sciences majors, were selected through criteria sampling. Data were collected using a self-administered questionnaire to assess knowledge, practices, and perceived barriers. RESULTS: Key findings reveal that despite excellent BSE practices (52.5%), a significant proportion of respondents (51.7%) demonstrated insufficient knowledge about BSE. The main barriers to BSE execution were fear of discovering concerning findings and fear of being diagnosed with breast cancer. Health science majors exhibited significantly higher knowledge and practices than non-health science students, perceiving lower barriers. Age was found to have no significant impact on the variables examined. Majors and perceived barriers were not associated with BSE, but knowledge showed a significant association. Despite their excellent practices, participants’ unsatisfactory knowledge regarding BSE suggests the need for effective interventions. Barriers primarily stemmed from fear, including the fear of a breast cancer diagnosis and the fear of learning about potential issues. CONCLUSION: The study highlights the association between knowledge and BSE practices, emphasizing the importance of knowledge development and overcoming perceived barriers to improve BSE practices and encourage greater engagement.

Background: The aim of this study was to examine the intrapersonal, social, and physical environmental factors associated with physical activity (PA) practice in Thai adolescents. Methods: A total of 5536 adolescents aged 14–17 years participated in the survey. Confirmatory factor analyses and structural equation modeling were conducted to determine associations between intrapersonal, social, and physical environmental factors with PA. Results: The mean age of participants was 15.50 (1.12) years. Community environment had an overall effect on PA (β = 0.08). Perceived family support had direct (β = −0.14) and indirect (β = 0.17) effects on PA through perceived barriers (β = 0.14). Perceived barriers were directly related to PA (β = −0.23) and indirectly (β = −0.16) related to PA through self-efficacy (β = −0.14) and through perceived benefits and self-efficacy (β = −0.02). Perceived usefulness was indirectly related to PA through self-efficacy (β = 0.07). Self-efficacy was directly related to PA (β = 0.43). Girls were more likely to report more perceived barriers (βtotal = 0.13). The model explained 45% of the variance in PA. Conclusion: Self-efficacy and perceived barriers are important intrapersonal factors, whereas perceived family support is an important interpersonal factor for PA among Thai adolescents. [ABSTRACT FROM AUTHOR]

Vaccination is a global health development success story that saves millions of lives every year and reduces the risk of getting various infectious diseases, including COVID-19. At the end of 2021, a rapid increase in the size of the population infected with COVID-19 and a low vaccination coverage were observed in Latvia (Centre for Disease Prevention and Control, 2021). Also, despite the available vaccines, by the beginning of May 2022, only 60.6% of the population of Latvia had completed the full course of vaccination against COVID-19. According to the Ministry of Health, the vaccination process is characterised by variability and flexibility, and in general, vacci-nation rates have declined in recent years. Therefore, the aim of the study was to investigate the vaccination predicting factors of unvaccinated adults in Latvia using the Health Belief Model (HBM) during the COVID-19 pandemic. The study sample consisted of 539 respondents aged 18 to 75 years (M = 45.35, SD = 15.70), who were not vaccinated against COVID-19 and who had to make a decision to vaccinate or not, and who were part of a representative sample of Latvian residents (n = 1017). The data was collected in September and were analysed using Spearman's rank correlation coefficient and multivariate linear regression analysis. A statistically significant moderate strong positive correlation was shown between vaccination intention and all six vaccination motives as perceived benefits (r = 0.40–0.44, p < 0.01); statistically significant but weak positive correlation between vaccination intention and risk appraisal as perceived threat (r = 0.20, p < 0.01) and COVID-19 experience as cues to action (r = 0.20, p < 0.01); and statistically significant negative but weak correlation for vaccination intention and fear of vaccination as perceived barriers (r = –0.21, p < 0.01). The results revealed a statistically significant positive association of vaccination intention and the components of HBM: perceived threats, perceived benefits and cues to action, as well as a statistically significant negative association with perceived barriers. The results revealed several factors that predict vaccination intention, explaining 32% of the variation in vaccination intention: education level, perceived threats, perceived benefits, perceived barriers, and cues to action. Higher levels of education, higher perceived threat of contracting COVID-19, many different social motives for vaccination (e.g., to be able travel), confidence that the vaccine will not cause significant side effects and long-term consequences, and experience with COVID-19 are factors that predicts an individual's intention to vaccinate against COVID-19. [ABSTRACT FROM AUTHOR]

Occupational noise exposure is a pervasive issue in many industries, leading to a range of health issues and sleep disturbances among workers. Additionally, there is a strong desire among these workers to prevent industrial accidents. This study, aimed at enhancing worker health and well-being, utilized a survey distributed by the Korean Confederation of Trade Unions to field workers. Data from 1285 workers were collected and analyzed using partial least squares structural equation modeling (PLS-SEM) to identify and understand the factors affecting prevention intention in noisy work environments. Our findings indicate that health problems resulting from occupational noise exposure significantly influence insomnia, perceived severity of potential accidents, perceived benefits of preventive measures, and perceived barriers. Perceived severity was significantly correlated with prevention intention, emphasizing the role of risk perception in motivating preventive behaviors. Perceived benefits were also significantly associated with prevention intention, highlighting the importance of positive outcomes in influencing workers' behaviors. Additionally, perceived barriers showed a significant relationship with prevention intention, suggesting that overcoming these barriers is crucial in promoting preventive behaviors. Demographic factors such as gender displayed a significant association with prevention intention, while age did not. This study provides valuable insights into the multifaceted factors influencing workers' intention to prevent industrial accidents in noisy environments, underlining the importance of comprehensive data collection tools in understanding these dynamics. [ABSTRACT FROM AUTHOR]

Key Points: We conducted semi‐structured interviews with providers at four New York‐Presbyterian (NYP) hospitals: Weill Cornell Medicine (WCM), NYP‐Queens, NYP‐Brooklyn Methodist Hospital, and Columbia University Medical Center.Emergent themes identified factors that influenced healthcare delivery at the institutional, provider, and patient levels.Most frequently reported barriers included a lack of formal protocols for communicating and offering psychosocial resources to patients (institutional), lack of vital staff such as, social workers and patient navigators (institutional), time constraints (provider), and stigma regarding mental health care (patient).Most frequently cited facilitators to delivering psychosocial care included having a trained social worker on staff (institutional), awareness of psychosocial needs (provider), and engagement (patient).Our findings highlight opportunities to improve the provision of psychosocial care for adults with metastatic breast cancer (mBC) at multiple levels. [ABSTRACT FROM AUTHOR]

Background: This study examined the perceived barriers of migrants and refugees to vaccinating their children against measles and polio in Iran. Methods: First, an instrument was developed and validated through several steps. Next, 1,067 parents who had not vaccinated their children against polio and measles or had delayed receiving any dose of these two vaccines until the age of 15 were selected from 16 provinces and completed the instrument. Finally, the data were analyzed. Results: The results of the explanatory factor analysis showed that the perceived barriers affecting vaccination against polio and measles vaccines were categorized into five factors: low knowledge, negative attitude, communication challenges, lack of participation in vaccination programs, and problems related to migration and refugees. Additionally, the results indicated a significant difference in the mean score of perceived barriers based on participants' level of education, economic status, and nationality. Conclusion: The identified barriers may provide a perspective for developing effective efforts in this area. Interventions should focus on parents with low education and poor economic status. [ABSTRACT FROM AUTHOR]

Healthy diet is an important tool to lower the risk and severity of COVID-19 infection. Low diet quality is usually caused by perceived barriers that stop people to do certain behavior. Perceived barriers can be overcome by implementing proper method such as conducting nutrition education. This study aimed to analyze the impact of nutrition education on perceived barrier to healthy diet among adults with and without covid-19 history in Padang, Indonesia. This study was a pre-experimental study using pre and post-design. This study was conducted on 70 adults with or without COVID-19 infection history, residing in Padang, Indonesia. The intervention was given in the form of nutrition education. Difference test was conducted to assess the impact of nutrition education on respondents' nutrition knowledge and perceived barriers. The majority of the respondents both with and without COVID-19 history (71.4 and 80%) had medium level of nutritional knowledge before the intervention. After the intervention, there was a significant (P<0.05) improvement on respondents' nutritional knowledge for both groups (100%). The result also showed 40% of the respondents with COVID-19 history had medium level of perceived barriers, while 28.6% respondents without COVID-19 history (65.7%) had medium level of perceived barriers before the intervention. A significant improvement (P<0.05) also showed on respondents' perceived barriers after the intervention. On both groups more 90% of the respondents only had low level of perceived barriers. The result shows that nutrition education has significant impact both on respondents' nutritional knowledge and perceived barriers. [ABSTRACT FROM AUTHOR]

This cross-sectional study aims to explore the relationships between food habits, perceived barriers to healthy eating, and sports nutrition knowledge among adolescent swimmers. The study focuses on understanding how these factors interact and influence dietary choices in young athletes. A cohort of 52 adolescent swimmers aged 12–18 from Al Hussein Youth Club in Al-Hussein Sport City participated in the study. Data were collected through surveys assessing food habits, perceived barriers to healthy eating, and sports nutrition knowledge. Pearson Correlation analysis was employed to examine associations between variables, and stepwise regression analysis was used to identify predictors of food habits. The analysis revealed a significant positive association between food habits and sports nutrition knowledge (r = 0.393, p = 0.004). Knowledge emerged as a significant positive predictor of food habits (β = 0.393, p = 0.004), highlighting the influential role of sports nutrition knowledge in shaping the dietary choices of adolescent swimmers. However, the introduction of Barriers lacked significance, and individual predictors did not reach statistical significance. These findings underscore the importance of targeted interventions aimed at enhancing nutritional education among adolescent swimmers. Understanding the interplay between knowledge, barriers, and food habits provides valuable insights into the complex dynamics that influence the dietary choices of young athletes. Addressing these factors through tailored educational programs can promote healthier eating habits and optimize performance among adolescent swimmers. This study highlights the critical role of sports nutrition knowledge in shaping the dietary behaviors of adolescent swimmers. By addressing knowledge gaps and overcoming perceived barriers, targeted interventions can help improve food habits and enhance the overall health and performance of young athletes.

Abstract Introduction Individuals who have a low socio-economic position (SEP) are more likely to smoke and face greater barriers to quitting tobacco. However, the effectiveness of tailored interventions has been limited probably due to specific challenges relative to this population. We conducted a mixed-method study to better understand health professionals’ perceptions and barriers when implementing a preference-based smoking cessation (SC) intervention among disadvantaged smokers. Methods A self-administered online questionnaire was sent to health professionals (doctors’ and other health professionals specialized in SC) participating in “STOP” a pragmatic multicentre randomized controlled trial. Perceptions regarding patient eligibility, the doctor-patient relationship, general study organization, and satisfaction were measured. Results Twenty-eight STOP study investigators responded. Health professionals prioritize smoking cessation for disadvantaged patients, but face challenges in approaching and following them. A research intervention providing cessation tools based on preference was deemed useful but generally undermined by time constraints. Health professionals’ preconceptions regarding patients in low SEP having other “pressing problems” which might be exacerbated by quitting smoking were also identified. Further, participation in a research intervention was perceived as not satisfactory due to workload and lack of time. Conclusion Our results highlight general barriers inherent to implementing pragmatic trials. They also present specific challenges in smoking cessation trials among disadvantaged population, essential to advance equity in tobacco control.

BackgroundA 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of acceptance and completion of 3HP treatment from the perspective of people living with HIV (PLHIV) and health workers in a routine HIV care setting in Kampala, Uganda.MethodsWe conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence the willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions.ResultsFacilitators of acceptance and completion of 3HP treatment among PLHIV were fear of contracting TB, awareness of being at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of directly observed therapy (DOT) and self-administered therapy (SAT) 3HP delivery strategies. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about the effectiveness of 3HP, and the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality for PLHIV, fear of getting TB, and trust in the health workers by PLHIV, the advantages of once-weekly 3HP dosing, and the benefits of DOT and SAT 3HP delivery strategies. Health worker-reported barriers for PLHIV included inadequate understanding of TB and benefits of TPT, TB-associated stigma, potential side effects pill burden, and challenges of DOT and SAT 3HP delivery strategies. Lack of experience in the use of digital technology to monitor patient care was identified as a health worker-specific barrier. Identified intervention functions to address the facilitators or barriers included education, persuasion, environmental restructuring, enablement, and training.ConclusionsUsing a formative qualitative and comprehensive theoretical approach, we identified key barriers, facilitators, and appropriate interventions, including patient education, enhancing trust, and patient-centered treatment support that could be used to optimize the delivery of 3HP to PLHIV in our setting. These interventions are likely generalizable to other clinical interventions in similar populations in sub-Saharan Africa and other TB high-burden settings.

The deployment of autonomous shuttles (ASs) holds health and safety benefits for people with and without disabilities. Transportation is critical in helping people with disabilities (PWDs) access health care, services, and jobs, but the current transportation system has not afforded them ubiquitous access. To understand the acceptance of ASs, we (1) quantified PWDs’ (N = 42) perceptions before and after riding in an AS (Level 4) and (2) developed a model of facilitators and barriers from 143 participants. For Objective 1, after riding in the AS, PWDs (n = 42) expressed increased Intention to Use (p < 0.001) and Acceptance (p < 0.001), and decreased Perceived Barriers (p < 0.001), compared with baseline. For Objective 2, four multiple linear regression models were conducted to predict the outcomes for Intention to Use, Perceived Barriers, Well-being, and Acceptance among all participants (N = 143). The results indicated that optimism and ease of use negatively predicted Perceived Barriers and positively predicted Intention to Use, Well-being, and Acceptance. Driving status (i.e., active driver) negatively predicted Intention to Use, Well-being, and Acceptance. Predictors of user Acceptance included optimism, perceived ease of use, driver status, and race/ethnicity—with 30.7% of the variance in Acceptance explained. We also recommended deployment strategies to project stakeholders.

The study aims to examine the readiness of Indian parents towards online classes at kindergarten and junior school levels, by identifying the perceived barriers, perceived effectiveness and health impact of online classes on young children. The study is based on data collected across a random sample of 750 parents of students studying at junior and kindergarten levels in urban private schools which offer online classes. The data was analyzed through exploratory factor analysis, ANOVA and multiple regression analysis. Technological, infrastructural, and personal barriers related to students, and parents, were identified as perceived barriers by parents in availing online classes for their kids. Parents’ attitude towards online classes at kindergarten and primary levels gets negatively influenced by the barriers they face, and the perceived negative impact of technology usage on their kids’ health, while; perceived effectiveness was found to have a positive impact on the parents’ attitude. The study is unique as it includes the interest of such young stakeholders of the education system. The study highlights the barriers faced by parents related to online classes and the health-related concerns which play a major role in the adoption of online mode of education for their kids. Research gives insights to school authorities and the government to work on these barriers and make the online education system effective which is the need of the hour during COVID-19.

Healthy diet is an important tool to lower the risk and severity of COVID‑19 infection. Low diet quality is usually caused by perceived barriers that stop people to do certain behavior. Perceived barriers can be overcome by imple‑menting proper method such as conducting nutrition education. This study aimed to analyze the impact of nutrition education on perceived barrier to healthy diet among adults with and without covid‑19 history in Padang, Indonesia. This study was a pre‑experimental study using pre and post‑design. This study was conducted on 70 adults with or without COVID‑19 infection history, residing in Padang, Indonesia. The intervention was given in the form of nutrition education. Difference test was conducted to assess the impact of nutrition education on respondents' nutrition knowledge and perceived barriers. The majority of the respondents both with and without COVID‑19 history (71.4 and 80%) had medium level of nutritional knowledge before the intervention. After the intervention, there was a significant (P0.05) improvement on respondents' nutritional knowledge for both groups (100%). The result also showed 40% of the respondents with COVID‑19 history had medium level of perceived barriers, while 28.6% respondents without COVID‑19 history (65.7%) had medium level of perceived barriers before the intervention. A significant improvement (P0.05) also showed on respondents' perceived barriers after the intervention. On both groups more 90% of the respondents only had low level of perceived barriers. The result shows that nutrition education has significant impact both on respondents' nutritional knowledge and perceived barriers.

Introduction: Individuals who have a low socio-economic position (SEP) are more likely to smoke and face greater barriers to quitting tobacco. However, the effectiveness of tailored interventions has been limited probably due to specific challenges relative to this population. We conducted a mixed-method study to better understand health professionals' perceptions and barriers when implementing a preference-based smoking cessation (SC) intervention among disadvantaged smokers. Methods: A self-administered online questionnaire was sent to health professionals (doctors' and other health professionals specialized in SC) participating in "STOP" a pragmatic multicentre randomized controlled trial. Perceptions regarding patient eligibility, the doctor-patient relationship, general study organization, and satisfaction were measured. Results: Twenty-eight STOP study investigators responded. Health professionals prioritize smoking cessation for disadvantaged patients, but face challenges in approaching and following them. A research intervention providing cessation tools based on preference was deemed useful but generally undermined by time constraints. Health professionals' preconceptions regarding patients in low SEP having other "pressing problems" which might be exacerbated by quitting smoking were also identified. Further, participation in a research intervention was perceived as not satisfactory due to workload and lack of time. Conclusion: Our results highlight general barriers inherent to implementing pragmatic trials. They also present specific challenges in smoking cessation trials among disadvantaged population, essential to advance equity in tobacco control. [ABSTRACT FROM AUTHOR]

Music therapy is a newer profession within hospice, with limited evidence of other disciplines' perceptions of a music therapist's role in hospice care. The purpose of this study was to examine if perception differences exist between music therapists and interdisciplinary team (IDT) members regarding how 25 job tasks related to the music therapist's role within a clinical interdisciplinary hospice team. Two groups consisting of board-certified music therapists (MT-BC) and IDT members completed an online Qualtrics survey to rate how 25 job tasks were perceived to pertain to the music therapist's role in hospice care. A two-way mixed ANOVA indicated the significant differences between the 2 groups for 13 of the 25 tasks, suggesting less understanding of an MT-BC's role within a hospice IDT. For the 13 tasks perceived significantly different, a one-way ANOVA was run and indicated significant between discipline perceptual differences for nine of the 13 tasks. Qualitative statements indicated contracted and employed MT-BCs experienced similar perceived barriers of IDT colleagues lack of understanding music therapy and the MT-BC not being able to attend IDT or participate regularly. Overall, required IDT groups' qualitative statements were positive, with the most common responses across disciplines indicating that MT-BCs elicited positive responses from patients and caregivers, provided a distraction from pain or agitation, and increased patients' quality of life. The current study's outcomes highlight the need for music therapists to provide more education to colleagues regarding a music therapist's role in the hospice setting. [ABSTRACT FROM AUTHOR]

Abstract Background Regular physical activity and exercise have been shown to be of benefit in managing the HIV disease, its complications and the side effects of HAART. The perceptions of those living with HIV toward physical activity and exercises is a key factor in advocating for participation of rehabilitation personnel in the management of this disease. However, this domain remains underexplored in Zimbabwe. Methods A descriptive cross-sectional quantitative study was conducted with 327 people living with HIV. Participants were consecutively sampled from Chitungwiza Central Hospital Opportunistic Clinic. The International Physical Activity Questionnaire (IPAQ) and the Exercise Benefits/Barriers Scale (EBBS) were respectively used to measure the physical activity level and perceived benefits/barriers of physical exercise among adults living with HIV. The tools were self-administered. The analyses were done for 323 participants using the Statistical Package for the Social Sciences (SPSS). Results The mean age was 41.1 ± 11.0. Females constituted 69.7% (n = 225) of the sample. The majority of participants (n = 184; 57%) described themselves as being highly physically active (3204;IQR = 2139–4441 MET-minutes/week). Most of the participants agreed that physical activity prevented heart attacks with a mean value of 3.34 ± 0.65. The majority perceived psychological outlook as the greatest benefit from physical activity among the benefit sub-scales. Furthermore, most of the participants agreed that it cost too much for them to exercise which had a mean of 3.00 ± 0.88. Family discouragement was the most agreed perceived barrier to physical activity with a mean of 2.91 ± 0.67. Those who perceived physical activity as being beneficial reported less barriers. A statistically significant association was found between level of physical activity and CD4 cell count (p = 0.035) as well as with employment status (p

Abstract Background Active school transport (AST) can increase children’s and adolescents’ physical activity. The proportion of children and adolescents who engage in AST has declined internationally in recent decades. This study examines the prevalence, correlates, and perceived barriers to AST in the city of Leipzig, Germany. Methods The study sample includes 1070 participants, 364 children and 706 adolescents, aged between 6 and 18 years, as well as their parents. The parents as well as adolescents age 10 and above completed questionnaires concerning sociodemographic variables, means of transport/AST and perceived barriers to AST. The distance between home and school was calculated as the network distance from the home to school address using the Dijkstra algorithm. Based on these data, logistic models were fitted in a two-step variable selection process, using AST as the dependent variable. Results Approximately half of the children (59%) and adolescents (51%) engaged in AST. The prevalence of AST exhibited a negative correlation with age (Odds Ratio (OR) = 0.94, 95% confidence interval (CI) = 0.9–0.99, p = 0.015) and did not significantly differ by gender (children: ORgirls = 1.5, CI = 0.95–2.25, p = 0.075, adolescents: ORgirls = 1.01, CI = 0.75–1.37, p = 0.924). A high socioeconomic status was positively correlated to AST on the morning trip (OR = 1.7, CI 1.3–2.21, p

Abstract Background Ensuring access to healthcare services is a key element to achieving the Sustainable Development Goal 3 of “promoting healthy lives and well-being for all” through Universal Health Coverage (UHC). However, in the context of low- and middle-income countries, most studies focused on financial protection measured through catastrophic health expenditures (CHE), or on health services utilization among specific populations exhibiting health needs (such as pregnancy or recent sickness). Methods This study aims at building an individual score of perceived barriers to medical care (PBMC) in order to predict primary care utilization (or non-utilization). We estimate the score on six items: (1) knowing where to go, (2) getting permission, (3) having money, (4) distance to the facility, (5) finding transport, and (6) not wanting to go alone, using individual data from 1787 adult participants living in rural Senegal. We build the score via a stepwise descendent explanatory factor analysis (EFA), and assess its internal consistency. Finally, we assess the construct validity of the factor-based score by testing its association (univariate regressions) with a wide range of variables on determinants of healthcare-seeking, and evaluate its predictive validity for primary care utilization. Results EFA yields a one-dimensional score combining four items with a 0.7 Cronbach’s alpha indicating good internal consistency. The score is strongly associated—p-values significant at the 5% level—with determinants of healthcare-seeking (including, but not limited to, sex, education, marital status, poverty, and distance to the health facility). Additionally, the score can predict non-utilization of primary care at the household level, utilization and non-utilization of primary care following an individual’s episode of illness, and utilization of primary care during pregnancy and birth. These results are robust to the use of a different dataset. Conclusion As a valid, sensitive, and easily documented individual-level indicator, the PBMC score can be a complement to regional or national level health services coverage to measure health services access and predict utilization. At the individual or household level, the PBMC score can also be combined with conventional metrics of financial risk protection such as CHE to comprehensively document deficits in, and progress towards UHC.

ObjectiveThis study evaluated strength-based motivators within Hispanic families that support the creation of health in their children. A mixed-methods approach was used to understand differences in Hispanic parental factors between caries-free (CF) and caries-active (CA) children.MethodsA cross-sectional survey was conducted with 200 parent-child triads (primary child: between 0 and 6 y; reference child: between 0 and 10 y) recruited from health centers in the Denver Metro area. All the participating children received an oral examination, and the triads were grouped as CF or CA based on the caries status of the primary child. Qualitative data were collected through in-depth individual interviews with the parents. The analysis only involved the primary child. Bivariable analysis were conducted between parent factors (independent variables) and presence or absence of caries (outcome variable). The variables with P < 0.20 in the bivariable analysis were subjected to 2 multivariable logistic regression models. The children in the CF group had mean (SD) age of 2.8 (1.28) y compared to the CA group at 4.0 (1.55) y (P < 0.001). Bivariable analysis demonstrated that parents in the CF group reported higher oral hygiene behavior scores (P = 0.047), perceived fewer barriers (P = 0.009) to accessing preventive dental care, and considered their children more susceptible to cavities (P = 0.001) compared to parents in the CA group. Multivariable model (adjusting for socioeconomic characteristics) demonstrated that parents of CF children perceived high susceptibility to caries for their children (P = 0.040). Multivariable model (adjusting for acculturation) demonstrated an association of parental oral hygiene behavior (P = 0.040) and parent-perceived susceptibility to caries (P = 0.010) with CF child status. Qualitative interviews revealed that parents in the CF group were concerned about their children's higher susceptibility to caries and tried to establish good oral hygiene routines for their children.ConclusionThe results of this study demonstrated that parental behaviors and health beliefs could be significant determinants of caries status in Hispanic children.Knowledge transfer statementResults of this study indicate that parental oral health beliefs and behaviors are significant determinants of caries status in children of Hispanic population. Parental beliefs could motivate them to take action or establish behavior that prevents dental caries in their children. Health care providers and caries prevention efforts can incorporate this information to tailor oral health promotional messaging and approaches to improve the oral health of Hispanic children.

Background: Pharmacists are aptly positioned to provide first aid‐level assistance to patients experiencing a mental health problem or crisis, yet often lack confidence or perceive barriers to intervention. One potential solution is Mental Health First Aid (MHFA) training—an evidence‐based psycho‐educational programme. This study evaluates MHFA training within pharmacy by (1) assessing pharmacists' perceptions of the prevalence of patients experiencing a mental health‐related problem or crisis, (2) investigating whether MHFA is associated with increased confidence, intervention and assistance quality and (3) examining perceived intervention barriers. Methods: Pharmacists working in Australia were surveyed. The survey included validated measures and research objectives were assessed using descriptives and ANOVAs. Results: One hundred sixty‐one pharmacists were included; 90 MHFA trained and 71 untrained. Overall, 86% of reported encountering at least one patient perceived to be experiencing a mental health problem or crisis in the last year. MHFA trained pharmacists reported being more confident, with notable differences in their confidence to recognize signs, approach and ask someone about suicide. Pharmacists did not intervene ~25% of the time in which a problem/ crisis was identified. When they did intervene, results suggest the assistance was similar in content. Intervention barriers were reported to impede MHFA trained pharmacists significantly less than untrained pharmacists. Conclusion: Results suggest pharmacists frequently encounter patients experiencing a mental health problem or crisis and that MHFA training may support pharmacists in helping these patients. Future research can utilize experimental methods to provide causal evidence as to the utility of MHFA training for pharmacists and patients. [ABSTRACT FROM AUTHOR]

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The deployment of autonomous shuttles (ASs) holds health and safety benefits for people with and without disabilities. Transportation is critical in helping people with disabilities (PWDs) access health care, services, and jobs, but the current transportation system has not afforded them ubiquitous access. To understand the acceptance of ASs, we (1) quantified PWDs' (N = 42) perceptions before and after riding in an AS (Level 4) and (2) developed a model of facilitators and barriers from 143 participants. For Objective 1, after riding in the AS, PWDs (n = 42) expressed increased Intention to Use (p < 0.001) and Acceptance (p < 0.001), and decreased Perceived Barriers (p < 0.001), compared with baseline. For Objective 2, four multiple linear regression models were conducted to predict the outcomes for Intention to Use, Perceived Barriers, Well-being, and Acceptance among all participants (N = 143). The results indicated that optimism and ease of use negatively predicted Perceived Barriers and positively predicted Intention to Use, Well-being, and Acceptance. Driving status (i.e., active driver) negatively predicted Intention to Use, Well-being, and Acceptance. Predictors of user Acceptance included optimism, perceived ease of use, driver status, and race/ethnicity—with 30.7% of the variance in Acceptance explained. We also recommended deployment strategies to project stakeholders. [ABSTRACT FROM AUTHOR]

The goals established by the 2030 Agenda for Sustainable Development, and the new needs that globalization has created, have prompted researchers to examine young people's educational and professional experiences in the context of economic and social disadvantages, considering agency capacities and psychological factors. Following these research interests, this study aimed to evaluate Italian university students' perceptions of socioeconomic barriers to achieving professional goals and the effects of these perceived barriers on some indicators of adaptation. The study included 401 Italian university students (M = 24.18, SD = 3.33). The results demonstrated that economic constraints can be a psychological barrier to career advancement by negatively influencing the perception of being able to actively choose one's professional future and by diminishing the psychological resources required to adapt to complex environments. In turn, this can indirectly affect the perceived gap between a person's career goals and their progress toward achieving them, thereby impeding their adaptation processes. The implications of the research are discussed. [ABSTRACT FROM AUTHOR]