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Due of their near closeness to COVID-19 patients, healthcare workers (HCWs) have a great desire to utilize proper personal protective equipment (PPEs).
Investigating HCWs’ perceptions of PPE compliance and barriers, as well as influencing factors, in order to develop methods to combat the rise in their infection rates.
During the ‘second wave’ surge, a cross-sectional correlational analysis was conducted over a one-month period. It consists of HCWs from various hospital sectors that admit COVID-19 patients using an online self-administered predesigned tool.
Of the 285 recruited participants, 36.1% had previously been diagnosed with COVID-19. Around 71% received training on PPEs use. The perceived compliance was good for (PPEs) usage (mean 2.60 ± 1.10). A significant higher compliance level was correlated with previous diagnosis with COVID-19, working with patients diagnosed with COVID-19, and having a direct contact with a family member older than 45 years old (p<0.01). The main perceived barriers to the use of PPEs were: unavailability of full PPEs (35%), interference with their ability to provide patient care (29%), not enough time to comply with the rigors of PPEs (23.2%), and working in emergency situation (22.5%). With regards to perceived barriers those working with patients diagnosed with COVID-19 and those who reported having a direct contact with a family member older than 45 years old showed significantly higher level of barriers.
A series of measures, including prioritization of PPE acquisition, training, and monitoring to guarantee appropriate resources for IPC, are necessary to reduce transmission.
Elder abuse is a serious public health concern requiring immediate intervention; however, the under-reporting of elder abuse by victims to formal and informal networks remains a major obstacle. This scoping review aims to identify barriers to help seeking that older adults experiencing abuse confront. The goal is to inform public policies and practices in the Canadian context and identify research gaps in the extant literature. Seven scholarly databases were searched from which 12 articles met the inclusion criteria and were extracted for analysis. The findings from this scoping review revealed three levels at which barriers exist: individual focused, abuser/family focused, and community/culture focused barriers. The results suggest that there are several complex obstacles that older adults face when contemplating disclosure of abuse. Future research into help seeking in the Canadian context should more readily incorporate the voices of elder abuse victim-survivors to develop effective assessment strategies and responsive service provisions.
Collaboration between psychiatrists and psychologists (counsellors) is one of the key factors impacting efficiency of services in child and youth mental health. Despite the clear benefits, a teamwork approach is still limited and has some difficulties.
The objective of the study was to explore potential barriers in the collaboration between professionals with different backgrounds.
Anonymous online survey for staff from various mental health clinics across Russia was completed by 142 psychologists and 70 psychiatrists (Σ =212).
77.7% participants reported that collaboration is helpful in adult mental health services; 91.3% see partnership as an essential part of child and youth mental health. 61.6% specialists work together; 44.7% described it as a successful experience. At the same time 58.4% believe that pharmacological treatment should start first, and counselling may be postponed. 49.5% believe that doctors often diminish the importance of counselling. Fears and biases towards psychiatrists were reported by 28.9% of the sample. 25.4% participants reported lack of trust and limited understanding of counselling methods. Top barriers for collaboration that were reported: lack of opportunities on an organizational level (20% doctors and 45% psychologists), unclear professional boundaries and responsibilities (28.5% doctors and 15.4% psychologists), lack of motivation (20% doctors and 7% psychologists), lack of positive experience (11.2% psychologist and 0% doctors). The main reported benefit of collaboration by 39.6% was improved compliance and better treatment outcomes.
In order to make collaboration among mental health professional more efficient, there is a need to address the barriers listed above.
In the context of falling recruitment to Initial Teacher Education programmes in the UK, this article focuses on motivators and demotivators affecting undergraduate students’ attitudes towards training as a teacher and considers these under the broad headings of altruistic (such as wanting to share a love of the subject and working with young people) and pragmatic (stable career, regular salary, good holidays). A review of the literature suggests that there are differences between the US and the UK in terms of the extent to which students can develop an identity as a teacher during their formative undergraduate years. An online survey was distributed to undergraduates in UK higher education institutions, the results were related to the issues identified in the literature and the differences between genders examined. The results suggested that there was no single significant barrier to undergraduate students deciding to train as secondary music teachers, but that there are opportunities to increase the number of students developing an identity as a music teacher while studying for their undergraduate degrees, and some gender-specific issues which could be addressed.
Adults with congenital heart disease (CHD) face a unique set of medical, psychological, and social challenges, and access to specialised adult congenital heart disease care has been associated with improved outcomes. Rural adults with CHD may represent a uniquely disadvantaged group given additional challenges when accessing specialised care. The aim of this study was to investigate the challenges faced by adults with CHD in accessing outpatient cardiac care, with a specific focus on understanding differences between urban- and rural-dwelling patients.
This cross-sectional, survey-based study took place in the adult congenital heart disease clinic at an urban academic medical center. Additional medical information was abstracted in a retrospective manner from the electronic health record. In addition to descriptive statistics, t-tests and Chi-square tests were performed to investigate differences between urban and rural dwelling patients.
A total of 100 patients participated in the study (mean age 40 ± 13 years, 60% female, 18% rural dwelling). Across the total sample, the median driving distance to clinic was 20 miles (interquartile range 12–77); it was 15 miles for urban dwellers and 77 miles for rural dwelling patients (p < 0.001). The most commonly identified barriers to cardiac clinic visits were financial losses related to taking time off from work (39%), distance of clinic from home (33%), and weather (33%). Compared to urban dwelling patients, on average those who were rural dwelling had a lower level of education (p = 0.04), more difficulty paying insurance premiums (p < 0.001) and copays (p = 0.005), and were more likely to identify the distance from clinic (p = 0.05) and having to go into the city (p = 0.02) as barriers to clinic appointments.
The financial impact and distance to clinic were the most commonly identified barriers to outpatient cardiac care in this cohort of adults with CHD. These barriers, along with difficulty paying insurance premiums, are more common in rural dwelling patients. Initiatives such as telemedicine visits or providing financial subsidies for travel and treatment could help to expand specialty adult congenital heart disease care and better serve this growing patient population.
This paper concerns mental health services in The Gambia. It describes local concepts, experiences and knowledge about mental illness and the implications of such beliefs and attitudes for access to mental health services. A pretested questionnaire and interview guide were administered to a sample of patients/family members. Barriers to accessing mental health services were identified. These included beliefs about the causes of mental illness; family decision-making; the scarcity and high cost of services. Obtaining access to mental health services in The Gambia is currently challenging. Importantly, increased community and family education about the causes and treatment of mental illnesses will be required to address these issues.
With 40% of global amphibian species threatened with extinction, captive breeding programmes are an increasingly important conservation tool. The highest priority species occur in tropical countries, which presents a number of challenges. We conducted semi-structured interviews with 25 practitioners in Latin America, Africa and Asia to investigate how the effectiveness of amphibian captive breeding programmes could be improved. A thematic analysis identified 94 barriers and enablers across 13 themes. We found that existing programmes commonly followed a reactive and often ineffective four-stage operational model. Subsequently, we developed a proactive operational model, using the barriers and enablers identified by this study, to support programme managers in the implementation of effective programmes. Our findings suggest human dimensions are often critical barriers or enablers across all stages of captive breeding programmes. We recommend the development of strategic partnerships between institutions, including zoos, NGOs, governments and captive breeding programmes, to help overcome these critical barriers and improve the effectiveness of global amphibian conservation. This operational model could be translated to captive breeding programmes for other taxa.
Approximately 25 % of Canadian children aged 4–8 years fail to meet the recommended dietary allowance (RDA) of calcium (Ca). Young children’s food choices are primarily determined by their parents. No interventions have directly targeted parents as a medium through which to increase children’s Ca consumption. This study compared the effectiveness of a Ca-specific intervention targeted towards parents, with generic dietary advice on the Ca consumption of children aged 4–10 years.
A parallel two-arm randomised controlled trial was conducted.
The study was conducted across Canada. Both conditions received information on the RDA of Ca and an index of intake requirements. Material sent to the intervention condition included behavioural strategies to increase dietary Ca consumption, information on the benefits of dietary Ca intake and messages addressing perceived barriers to the consumption of Ca-rich foods.
A total of 239 parents (93 % mothers) of children aged 4–10 years who consumed less than the RDA of Ca were randomly assigned in a 1:1 allocation ratio.
There was a significant increase in total Ca intake and Ca from dairy for children at weeks 8, 34 and 52 (P ≤ 0·001) in both conditions. Parental Ca intake and amount spent on dairy products did not significantly increase following the intervention.
Provision of daily Ca requirements with regular reminders could impact parents’ delivery of Ca-rich foods to their children. This finding is important for public health messaging as it suggests that parents are a potent medium through which to promote Ca intake in children.
This chapter reviews the current status of implementation efforts in the field of family-based interventions for child and adolescent mental health. First, an overview of the implementation framework is provided, with an emphasis on the theoretical models that have previously been applied to family studies. Next, a comprehensive framework which integrates the common findings of individual models is introduced. Thereafter, specific research on the implementation of family-based intervention is reviewed. Strongest evidence exists for treatment fidelity and staff training as factors promoting successful implementation. Although some studies indicate that program fit with organizational characteristics is an important factor in both the adoption and sustainment phases, studies examining moderating effects between potential factors influencing the implementation process are lacking at this time. Future studies need to pursue implementation factors unique to family-based programs, as well as develop a consensus on the terminology and operational definitions of relevant constructs and sound methodology for measurement.
We have now come to the end of the book, with much discussion and a lot to absorb along the way. As we noted in chapter 1, the philosophy that marcoms campaigns must be both effective and efficient underpins this book. To be effective and efficient, many elements need to work together. This integrative review chapter provides an overview of the lessons you have learned in this book, summarised into different core themes. Yet this knowledge is useless if they cannot be implemented. In this chapter, we also discuss why IMC implementations have often failed. Finally, we conclude with a word on ethics in IMC and a look into the future of marketing as it becomes more technologically driven.
Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA).
An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal–Wallis non-parametric tests.
Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients’ normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann–Whitney U = −18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann–Whitney U = −12.82, P = 0.035) and Mexican respondents (Mann–Whitney U = −13.56, P = 0.018).
The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.
Seeking help for mental health concerns is critical for improving wellbeing and preventing the development of mental health disorders, yet many adolescents with mental health problems fail to seek professional help. It is well established that young people with mental health problems face a variety of barriers to help-seeking; however, little is known about the ways in which these barriers interact to impact upon the help-seeking process. Guided by the reasoned action approach, this study investigated the predictive relationship between factors that influence help-seeking. Results revealed that mental health knowledge significantly predicted help-seeking intentions, while attitudes did not. Gender differences were identified for help source preferences. The current study contributes to knowledge on the relationship between key variables that influence the adolescent help-seeking process. Findings highlight the importance of mental health knowledge in predicting help-seeking intentions and provide support for interventions that focus on improving mental health literacy in adolescents.
While organisational change in substance use disorder (SUD) treatment has been extensively studied, there is no research describing facility-wide changes related to nutrition interventions. This study evaluates staff-perceived barriers to change before and after a wellness initiative.
A pre-intervention questionnaire was administered to participating staff prior to facility-wide changes (n 40). The questions were designed to assess barriers across five domains: (1) provision of nutrition-related treatment; (2) implementation of nutrition education; (3) screening, detecting and monitoring (nutrition behaviours); (4) facility-wide collaboration and (5) menu changes and client satisfaction. A five-point Likert scale was used to indicate the extent to which staff anticipate difficulty or ease in implementing facility-wide nutrition changes, perceived as organisational barriers. Follow-up questionnaires were identical to the pre-test except that it examined barriers experienced, rather than anticipated (n 50).
A multisite SUD treatment centre in Northern California which began implementing nutrition programming changes in order to improve care.
Staff members who consented to participate.
From pre to post, we observed significant decreases in perceived barriers related to the provision of nutrition-related treatment (P = 0·019), facility-wide collaboration (P = 0·036), menu changes and client satisfaction (P = 0·024). Implementation of nutrition education and the domain of screening, detecting and monitoring did not reach statistical significance.
Our results show that staff training, food service changes, the use of targeted curriculum for nutrition groups and the encouragement of discussing self-care in individual counselling sessions can lead to positive shifts about nutrition-related organisational change among staff.
The inclusion of students with autism spectrum disorder (ASD) is increasing, but there have been no longitudinal studies of included students in Australia. Interview data reported in this study concern primary school children with ASD enrolled in mainstream classes in South Australia and New South Wales, Australia. In order to examine perceived facilitators and barriers to inclusion, parents, teachers, and principals were asked to comment on the facilitators and barriers to inclusion relevant to each child. Data are reported about 60 students, comprising a total of 305 parent interviews, 208 teacher interviews, and 227 principal interviews collected at 6-monthly intervals over 3.5 years. The most commonly mentioned facilitator was teacher practices. The most commonly mentioned barrier was intrinsic student factors. Other factors not directly controllable by school staff, such as resource limitations, were also commonly identified by principals and teachers. Parents were more likely to mention school- or teacher-related barriers. Many of the current findings were consistent with previous studies but some differences were noted, including limited reporting of sensory issues and bullying as barriers. There was little change in the pattern of facilitators and barriers identified by respondents over time. A number of implications for practice and directions for future research are discussed.
This chapter introduces the larger themes of the volume. Connections and barriers within the Trans-Saharan region (and the interrelationship between these two aspects) form one focus. The introduction presents an overview of crucial themes and considerations which cross-cut all or many of the contributions. Fundamentally, this book seeks to explore what defines technology, how technological knowledge spreads and how technological change has happened in Saharan societies. After reviewing how the Sahara serves as a linking space for the wider Trans-Saharan region, the chapter discusses broad issues of technological mobility and transfers and foregrounds the coming discussing on issues relating to farming technology (plants and animals), textiles (further discussed in Part II), metals (Part III), glass (Part IV) and pottery (Part V).
The number of transnational corporations - including parent companies and subsidiaries - has exploded over the last forty years, which has led to a correlating rise of corporate violations of international human rights and environmental laws, either directly or in conjunction with government security forces, local police, state-run businesses, or other businesses. In this work, Gwynne Skinner details the harms of business-related human rights violations on local communities and describes the barriers, both functional and institutional, that victims face in seeking remedies. She concludes by offering solutions to these barriers, with a focus on measures designed to improve judicial remedies, which are the heart of international human rights law but often fail to deliver justice to victims. This work should be read by anyone concerned with the role of corporations in our increasingly globalized society.
The number of transnational corporations (TNCs) – including parent companies and subsidiaries – has exploded over the last forty years. In 1970, there were approximately 7,000 TNCs in the world; today, there are more than 100,000 with over 900,000 foreign affiliates.1 TNCs are now so complex and amorphous in their structure – even compared to ten years ago – that it is difficult for even the most sophisticated legal systems to adequately hold TNCs accountable for the harms they create in countries where they operate, even as the TNCs make enormous profits at the expense of often vulnerable communities. The truth is, certain legal doctrines, often devised nearly a century ago or longer, are too outdated to sufficiently assure that TNCs are held accountable for harms they create in today’s world, where TNCs operate globally, and often have structures that transcend a single country or jurisdiction.
For the past 4 years, as part of the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) grant award number UL1TR001436, the Clinical Translational Science Institute of Southeast Wisconsin (CTSI) has used process engineering approaches to identify and understand barriers that local researchers and other stakeholders face when engaging in clinical and translational science. We describe these approaches and present preliminary results. We identified barriers from published and unpublished work at other CTSA hubs, supplemented by surveys and semi-structured interviews of CTSI faculty. We then used a multifaceted approach to organize, visualize, and analyze the barriers. We have identified 27 barriers to date. We ranked their priority for CTSI to address based on the barrier’s impact, the feasibility of intervention, and whether addressing the barrier aligned with CTSI’s institutional role. This approach provides a systematic framework to scope and address the “barriers to research problem” at CTSI institutions.
Lower participation rates of ethnic minorities in health research studies and potential participation barriers are commonly reported.
Four semi-structured focus groups of individuals with Turkish migration backgrounds living in Germany were conducted to identify potential participation barriers. Documented statements and superscripted presentation cards by the participants were evaluated with a qualitative content analysis.
The following eight potential reasons for the lower participation rates were identified: role of women, lack of knowledge, lack of interest, German-Turkish interactions, mistrust, anxiety, data privacy protection and benefits of the study. Additionally, the following recruitment strategies to enhance participation rates were found: public relations, especially word-of-mouth promotion and contacting Turkish key figures, (non-) tangible incentives and trust building through transparent communication of the project and its conditions.
The findings provide a wide range of potential participation barriers and implications that should be considered to enhance the participation rates of minority populations.
The willingness to participate in health research studies can be increased through particular efforts, which should be tailored to the recruitment of the underrepresented target population.
Adoption of better technologies is a crucial way for developing countries to close productivity gaps with leading economies. However, the possibility of growing through technological adoption depends decisively on the country’s absorptive capacity. We build a theoretical model of technology adoption that focuses on four factors that shape the countries’ technological absorptive capacity, namely: (i) years of education; (ii) quality of the educational system; (iii) barriers that impede the entry and exit of firms; and (iv) the institutions that enhance or impede the diffusion of new technologies. We calibrate the model for a sample of 86 economies. The USA is our benchmark leading economy. We disentangle the relative weight of each development factor in explaining per capita income differences and study patterns in relationships between the type of development barrier and the level of development. Our results show that in relative terms, years of education and education system quality along with high barriers to opening new firms are the main impediments that middle- to high-income economies face in closing the gap with the USA. Education as a whole (quality plus years of education) explains 50% of the gap between high-income countries (HICs) and the USA, while the entry costs account for nearly 25% of this gap. A remarkable result is the small effect that individual reforms have on steady-state productivity in low-income countries (LICs). Outside of institutional framework, the remaining three factors are individually responsible for less than 15% of the gap. This result is explained by poor global absorptive capacity that reduces the effect of each factor when implemented individually. In fact, there are significant nonlinearities between development level and the effects of individual reforms, which are due to the strong complementarities between the different development factors.