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This chapter documents our experiences of pivoting research on sexual and gender minority youth towards an online protocol using digital methods. Digital diaries presented an opportunity to conduct virtual longitudinal qualitative research on how youth describe their experiences of living through the COVID-19 pandemic in Vancouver, Canada. Our digital diary process, supplemented with remote interviews, allowed us to capture shifting health-related patterns and trends, establish capacity to identify and explore unanticipated areas of inquiry, and evaluate participants’ impressions of the method itself. While going digital allowed us to overcome some immediate constraints to participation, it also introduced new uncertainties, including equity concerns and issues around consistent, secure and safe digital access for research participants. We describe how features of young people’s lives remain important factors associated with their ability to participate in digital and remote research. We offer solutions to the challenges and conclude that to counteract the inequities arising from the shift to digital methods, we need flexible, adaptive and population-tailored digital and remote approaches to data collection.
This cross-sectional study examined the barriers and facilitators that influence vegetarian menu choices in a university cafeteria in Geneva, Switzerland. As a first step, an online survey developed by the authors based on the Capability, Opportunity, and Motivation Behaviour (COM-B) model was e-mailed to all university students and staff. In the second step, focus groups (FG) were held to complete the survey responses and identify what needed to be changed to promote the choice of the vegetarian menu in the cafeteria. Data from 304 participants collected through the survey was analysed. The main mentioned barriers were lack of vegetarian options, tastelessness and insufficient satiation. The facilitators that emerged from the survey were the price of the vegetarian menu for students and health and environmental benefits. Thirteen people participated in four FG sessions, which were analysed using thematic analysis. Five themes were identified: spontaneous menu selection, predefined menu selection, influence of opportunity on menu selection, influence of environmental sensitivity on menu selection, and threat to identity in menu selection. The choice of a vegetarian menu in a university cafeteria was mainly influenced by the attractiveness and taste of the plate. Future strategies to reduce food-related greenhouse gas emissions should (a) ensure the quality and attractiveness of the vegetarian menu, especially to appeal to the more resistant, such as men and omnivores, and (b) inform consumers about the guarantee of balanced nutrient intake of the vegetarian menu offered in the cafeteria, and about health and environmental benefits.
Academic psychiatry is essential for advancing mental health understanding and treatments. However, women encounter more obstacles hindering their progress in academia than men. This Editorial aims to highlight these obstacles and propose strategies to address them, advocating for a more supportive environment for women psychiatrists’ ongoing growth and development. The importance of supportive environments, fair access to opportunities and structural changes, including initiatives for mentorship, funding and flexible work arrangements, are crucial. Collaboration among governments, institutions and organisations is needed to enhance research infrastructure and promote gender equality. Encouraging and recognising women's contributions in research fosters inclusivity and innovation. Prioritising these efforts is vital for the existence, well-being and success of women in academic psychiatry.
To understand young women’s views of cervical screening, what obstacles they face, and what encourages them when considering attending their cervical screening.
Background:
Cervical screening figures have been steadily decreasing in the United Kingdom (UK). There is limited research on this trend, especially around views and knowledge of young women, aged 20–24 years, have before they are eligible for cervical screening.
Methods:
This qualitative study conducted 15 semi-structured Zoom in-depth interviews to discuss young women’s knowledge and perceptions of cervical screening in 2022. Participants were based in the UK. Thematic analysis was used to systematically manage, analyse, and identify themes including cervical screening knowledge; perceptions of cervical screening; barriers to cervical screening; and facilitators of cervical screening.
Findings:
The findings demonstrate significant gaps in knowledge and negative perceptions of cervical screening. Barriers to attending cervical screening were perceived pain and embarrassment. Facilitators suggested to promote attendance were ensuring access to appointments, creating pop-up clinics, and utilising incentives. The level of knowledge demonstrated by the participants, their negatively framed perceptions; and the vast number of barriers identified present substantial factors that could affect future attendance to cervical screening. Overall, action needs to be taken to prevent decreasing cervical screening attendance rates and eradicate any barriers women may experience.
Maternity outcomes for women from certain ethnic groups are notably poor, partly owing to their not receiving treatment from services.
Aims
To explore barriers to access among Black and south Asian women with perinatal mental health problems who did not access perinatal mental health services and suggestions for improvements, and to map findings on to the perinatal care pathway.
Method
Semi-structured interviews were conducted in 2020 and 2021 in the UK. Data were analysed using the framework method.
Results
Twenty-three women were interviewed, and various barriers were identified, including limited awareness of services, fear of child removal, stigma and unresponsiveness of perinatal mental health services. Whereas most barriers were related to access, fear of child removal, remote appointments and mask-wearing during COVID-19 affected the whole pathway. Recommendations include service promotion, screening and enhanced cultural understanding.
Conclusions
Women in this study, an underrepresented population in published literature, face societal, cultural, organisational and individual barriers that affect different aspects of the perinatal pathway.
Non-specialist mental health interventions serve as a potential solution to reduce the mental healthcare gap in low- and middle-income countries, such as Sri Lanka. However, contextual factors often influence their effective implementation, reflecting a research-to-practice gap. This study, using a qualitative, participatory approach with local mental health workers (n = 9) and potential service users (n = 11), identifies anticipated barriers and facilitators to implementing these interventions while also exploring alternative strategies for reducing the mental healthcare gap in this context. Perceived barriers include concerns about effectiveness, acceptance and feasibility in the implementation of non-specialist mental health interventions (theme 1). The participants’ overall perception that these interventions are a beneficial strategy for reducing the mental healthcare gap was identified as a facilitating factor for implementation (theme 2). Further facilitators relate to important non-specialist characteristics (theme 3), including desirable traits and occupational backgrounds that may aid in increasing the acceptance of this cadre. Other suggestions relate to facilitating the reach, intervention acceptance and feasibility (theme 4). This study offers valuable insights to enhance the implementation process of non-specialist mental health interventions in low-and middle-income countries such as Sri Lanka.
Barriers to innovation (e.g., obstacles causing not to innovate) are another critical concept that may affect the implementation of innovation. Innovation in the public sector has traditionally been viewed as something of an oxymoron. Burdened by a slow and stubborn bureaucracy, this traditional view concluded that innovation was essentially anathema to the public sector. More recently, however, careful research has subjected public sector innovation to scrutiny, and concluded that the perception of impervious barriers inhibiting innovative activity in the public sector is a mischaracterization. This chapter explains the differences between the public and private sectors and how this distinction is essential to understand barriers to innovation. Then, it explains the overall barriers to innovation in the public sector. After this explanation, the chapter provides more discussion based on the levels of analysis. Then, it discusses a relatively recent and novel concept: whether barriers to innovations are deterring or revealed. Finally, it provides strategies to policymakers about how to reduce barriers in the public sector.
Legume and pulse consumption is currently recommended for health and sustainability purposes, but barriers to consumption can include low enjoyment and poor sensory properties. This work aimed to investigate the relative importance of a number of barriers and facilitators towards legume, including pulse, consumption with a specific focus on enjoyment, sensory properties and a possible role for perceived cooking abilities in these relationships.
Design:
A cross-sectional questionnaire study assessed legume and pulse consumption, agreement and disagreement with statements relating to enjoyment, sensory properties, cooking abilities, practical aspects, healthiness, upbringing, social influences and quality issues, and four demographic characteristics. Complete responses were gained from 633 respondents with a mix of genders, ages, usual cooking responsibilities and usual eating habits.
Setting:
UK, March 2021 – September 2022.
Participants:
General UK adult population.
Results:
Using multiple regression analyses, enjoyment and cooking abilities were found to be important for both legume and pulse consumption (smallest beta = 0·165, P < 0·01), and the sensory properties of these foods were also important for the consumption of pulses (beta = 0·099, P = 0·04). Perceived cooking abilities also reduced the importance of enjoyment and sensory properties for consumption, mitigated effects due to upbringing and practical aspects and increased the value of perceived health benefits (smallest beta = 0·094, P = 0·04).
Conclusions:
These findings demonstrate a clear role for enjoyment, sensory properties and perceived cooking abilities in legume and pulse consumption and suggest benefits for increasing cooking abilities for improved legume and pulse consumption, as result of both direct and indirect effects.
In the United Kingdom (UK), racially-minoritised (non-White) people are more likely to have poorer health outcomes and greater difficulties with accessing healthcare (Dyer, 2019). People face individual and societal adversity that can affect their physical and mental wellbeing (Gibbons et al., 2012). There are clear mental health needs for racially-minoritised people, and we must go further in understanding the barriers to help to adequately meet the needs of diverse communities. The aim of this systematic review was to understand the barriers to accessing formal mental health support for racially-minoritised people within the UK. Qualitative empirical studies published between January 1970 to December 2020 were searched for using two databases: PsycINFO and Web of Science. Studies were searched for written in English, using a clinical or non-clinical population of adults with qualitative data collection and analysis methods. Database searches and reference mining gave a total of 283 studies, with 31 duplicates removed. Considering inclusion and exclusion criteria there were 15 final studies. A second researcher (S.O’H.) was used throughout, when selecting papers, quality assessment using the Critical Appraisal Skills Programme (CASP) checklist, coding and developing themes using thematic synthesis. The final four themes are ‘internal and external stigma’, ‘understanding of distress and coping’, ‘competence of professionals and services’ and ‘perception and accessibility’. There are various barriers making it harder for racially-minoritised people to access mental health support. Further research is needed with individual communities and action must be taken by commissioners, services, CBT practitioners, and others to eliminate barriers and improve mental health care.
Key learning aims
(1) To better understand the barriers to accessing mental health services, including Talking Therapies, for racially-minoritised communities.
(2) Low and high intensity CBT practitioners to better understand the factors that impact the wellbeing of racially-minoritised communities and how to better support different communities.
(3) Consider how to address these barriers to accessing support such as Talking Therapies services, with implications for practice and policy development.
The long-term impermeability of clay barriers in waste disposal facilities and hydraulic structures is of critical importance to environmental, agricultural, and industrial concerns. Changes in the oxidation state of Fe in the constituent clays of compacted clay barriers may degrade the hydraulic conductivity of these structures because other properties related to hydraulic conductivity, such as swelling, gel microstructure, and particle size, are greatly altered by the oxidation state. Two Na-saturated smectites (SWa-1 and API 25) were reduced by sodium dithionite (Na2S2O4), both in suspension and in situ after consolidation, to examine the effects of structural Fe reduction on hydraulic conductivity. Results indicated that the hydraulic conductivity depended on both the oxidation state and the consolidation history of the clay. The hydraulic conductivity of clay reduced in suspension before consolidation was lower than that of oxidized clay. Initially reduced smectite, thus, may be compactable to a less-permeable material with higher bulk density. But reduction of smectite in situ after consolidation increased the hydraulic conductivity and its variability. The oxidized state of clay liners should, therefore, be preserved.
In England, Bangladeshi men are amongst the lowest number of people referred to primary care NHS Talking Therapies services and amongst the most likely to have deteriorated (NHS Digital, 2020). Factors related to culture, religion and gender influence stigma and help-seeking (Robinson et al., 2011). Furthermore, a lack of knowledge from services and professionals on cultural understandings of mental distress facilitate a failure to fully understand the needs of individual populations (Faheem, 2023). The aim of this research study was to qualitatively explore stigma and help-seeking for mental health difficulties, within British-Bangladeshi Muslim men in London. Recruitment consisted of men aged 22–59 years, experiencing symptoms of anxiety and/or depression but not accessing formal support. Ethical approval was obtained from Royal Holloway, University of London. After an online screening questionnaire, individual semi-structured video interviews were completed between May and October 2020. Reflexive thematic analysis presented six over-arching themes: ‘different understanding of mental health’, ‘traditional cultural expectations’, ‘fear and loss’, ‘coping resources’, ‘barriers to access’ and ‘community outreach and collaboration’. Many factors were highlighted as barriers accessing support, such as stigma and trust in services. Key practice implications are highlighted for services and practitioners. Professionals must understand the factors which impact the wellbeing of Bangladeshi men, how to better meet the needs of the community, and remove barriers to help. Participants also suggested initiatives to raise mental health awareness and reduce stigma, as an inclusive approach is needed with greater listening to communities and partnerships with local authorities.
Key learning aims
(1) To better understand the needs of the population and factors which impact wellbeing.
(2) To consider the muti-faceted barriers to access mental health support, such as CBT, and how to address these.
(3) To unpack what stigma means (internally and externally) for men in the population.
(4) How to support low- and high-intensity CBT practitioners to better work therapeutically to support Bangladeshi men.
To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.
Design:
A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.
Setting:
Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.
Participants:
Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.
Results:
Consumers and food operators perceived a high-salt intake within Malaysia’s out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.
Conclusions:
These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia’s out-of-home sectors.
The duration of untreated psychosis (DUP) continues to be a global priority. Early intervention services were established to reduce treatment delays but have had limited impact. This systematic review examines barriers and facilitators to seeking access to these services, to identify targets for service level change.
Methods
We conducted a systematic review of relevant databases (PsychINFO, MEDLINE, CINAHL, and PsychARTICLES) using pre-defined search terms for psychosis, early intervention, and barriers and facilitators. Given the majority of qualitative studies, a thematic synthesis rather than meta-analysis was indicated.
Results
The search yielded 10 studies. Mental health stigma and discrimination predict DUP, compounded by structural barriers which limit the impact of early intervention services on timely access to recommended treatments. Synthesis of the qualitative studies generated three themes: knowledge, relationships, and stigma. Lack of knowledge, absence of supportive relationships (social and professional), and self-stigma constitute significant barriers to seeking access to early intervention services.
Conclusions
This is the first review of the barriers and facilitators to seeking access to early intervention services. The findings highlight public health and secondary care service targets to expedite access to recommended treatments and thereby reduce the DUP.
Many veterinary practices around the world do not meet basic post-operative cat care, thereby compromising cat welfare. Understanding why the appropriate care is not always given is important. The current study used a mixed methods approach of two phases, to investigate the barriers Malaysian veterinarians face in seeking to provide good cat care in practice. Phase 1 involved a survey consisting of 14 questions which were divided into three sections (demographic details, basic management and barriers experienced by practices) and emailed to 143 Malaysian veterinarians. While for phase 2, 20 interviews were undertaken (recruited from the survey sample) to further elaborate on the results. A Thematic Analysis was conducted to extract the main barriers experienced by participants. A total of 49 veterinarians completed the survey. Over half of the respondents were senior veterinarians (i.e. those with two or more years in practice) (53.1%; n = 26) who were aware of the basic environmental provisions that cats need post-surgery such as bedding and toileting facilities (57.1%; n = 28). Cost (47%; n = 23) was the biggest restriction to good care provision. Interview findings showed that participants were aware of comfortable post-surgery environments helping recovery, but barriers were highlighted: workload factors and a lack of understanding of cat pain behaviours and associated stress. This suggested that participants had the knowledge required to provide good cat care but experienced difficulties putting this into practice. Therefore, to improve cat welfare in veterinary practice, instead of focusing purely on education, interventions to increase good cat care could include targeted elements that support behaviour change to overcome the barriers.
As mental health issues continue to rise in Latin America, the need for research in this field becomes increasingly pressing. This study aimed to explore the perceived barriers and resources for research and publications among psychiatrists and psychiatry trainees from nine Spanish-speaking countries in South America. Data was collected through an anonymous online survey and analyzed using descriptive methods and the SPSS Statistical package. In total, 214 responses were analyzed. Among the participating psychiatrists, 61.8% reported having led a research project and 74.7% of them reported having led an academic publication. As for the psychiatry trainees, 26% reported having conducted research and 41.5% reported having published or attempted to publish an academic paper. When available, having access to research training, protected research time and mentorship opportunities were significant resources for research. Further support is needed in terms of funding, training, protected research time and mentorship opportunities. However, despite their efforts to participate in the global mental health discussion, Latin American psychiatrists and psychiatry trainees remain largely underrepresented in the literature.
Children and young people with CHD benefit from regular physical activity. Parents are reported as facilitators and barriers to their children’s physical activity. The aim of this study was to explore parental factors, child factors, and their clinical experience on physical activity participation in young people with CHD.
Methods:
An online questionnaire was co-developed with parents (n = 3) who have children with CHD. The survey was then distributed in the United Kingdom by social media and CHD networks, between October 2021 and February 2022. Data were analysed using mixed methods.
Results:
Eighty-three parents/guardians responded (94% mothers). Young people with CHD were 7.3 ± 5.0 years old (range 0–20 years; 53% female) and 84% performed activity. Parental participation in activity (X2(1) = 6.9, P < 0.05) and perceiving activity as important for their child were positively associated with activity (Fisher’s Exact, P < 0.05). Some parents (∼15%) were unsure of the safety of activity, and most (∼70%) were unsure where to access further information about activity. Fifty-two parents (72%) had never received activity advice in clinic, and of the 20 who received advice, 10 said it was inconsistent. Qualitative analysis produced the theme “Knowledge is power and comfort.” Parents described not knowing what activity was appropriate or the impact of it on their child.
Conclusion:
Parental participation and attitudes towards activity potentially influence their child’s activity. A large proportion of young people performed activity despite a lack and inconsistency of activity advice offered by CHD clinics. Young people with CHD would benefit from activity advice with their families in clinics.
Older adults have a high disease burden but are often underrepresented in research studies due to recruitment and retention obstacles, among others. Geriatric research specialists have identified solutions to these challenges and designed frameworks to help other researchers. Our team utilized three frameworks to create an interactive webinar series aimed to educate research team members on Age-Friendly practices.
Methods:
We recruited 40 non-aging-trained research team members to participate in a six-session, real-time webinar series from October to November 2022. Sessions were comprised of 20–30 minute didactics and 30–40 minute group discussions. Participants completed pre- and post-program surveys, commitment to change forms, and post-webinar session surveys. Responses were examined for strengths and areas for improvement. Wilcoxon signed-rank tests assessed differences in confidence scores.
Results:
Self-reported confidence scores improved after the webinar series. Most participants provided positive feedback and high likeliness to use what they learned and recommend the webinar to others. The strengths were practical tips, applicable tools, and real-world examples. The major area for improvement was information on industry-sponsored trials. The commitment to change responses varied from pledging to use more inclusive language to adapting materials to improve the consent process.
Conclusion:
This interactive Age-Friendly Research webinar series was feasible and well received by participants. We created an Age-Friendly Research community fostering commitment to change clinical and translational research to be more inclusive of older adults. Future work will include more information on industry-sponsored trials and expand to other research centers.
Policy effectiveness is a critical measure for assessing whether policies are working and determining necessary adjustments. However, understanding the effectiveness of plastic policies is a significant gap in the toolkit driving solutions to the plastics crisis. This review examines effectiveness evaluations and existing tools for assessing policy effectiveness. The review further identifies the barriers to understanding effectiveness before proposing ways forward. Most studies focus on plastic bag bans or taxes, neglecting other policy instruments. Additionally, these studies often employ simple attribution approaches, rather than causal inference methods, limiting our ability to determine the true impact of policies on desired outcomes. The lack of monitoring and evaluation of plastic policies further hampers knowledge acquisition. The global understanding of the plastics economy and measurable success metrics is insufficient, hindering the design of systemic interventions. These findings highlight the development and evaluation of plastic policies with limited information. A more nuanced understanding of effective plastic policies is necessary, including a harmonised approach to evaluations, a shared definition of effectiveness, the use of rapid assessment tools and the integration of monitoring and evaluation into policy instruments.
This study aims to measure and explore the barriers to translating theoretical knowledge of palliative care into clinical practice.
Methods
A mixed-method study, combining a cross-sectional survey and key interviews was conducted. The quantitative data were obtained from 173 nurses and the key interviews were conducted with 42 health professionals drawn from multiple settings. For quantitative data analysis, Statistical Package for the Social Sciences software were conducted, and a thematic analysis supported with NVivo software were used for analyzing qualitative data.
Results
Of the 220 nurses invited, 173 completed the survey (79%). Most (78%) had a bachelor’s degree in nursing. Fewer than half, 69 (40%) scored 75% or more for the knowledge test; 173 (100%) scored 50% or greater for attitude; and only 32 (18.5%) scored 75% or greater for self-reported practice. While there was a small, positive correlation between palliative care attitudes and self-reported practice (r = 0.22, p = 0.003), the qualitative findings indicated that nurses had significant challenges in translating their theoretical knowledge into clinical practice. Limited clinical practice was linked to inadequate knowledge resulting from insufficient integration of palliative care content in undergraduate curricula and a lack of follow-up training. This was further exacerbated by shortages of medicine, staff, and financial resources and was linked to limited attention accorded to palliative care by the government.
Significance of results
While the results showed the majority held positive views toward palliative care, improving palliative care practices requires, and enhancing nurses’ knowledge of palliative care. This requires changing teaching methods and engaging policymakers.