Understanding the Practical and Psychological Barriers to Clinical Trial Diversity and Accessibility

Australian women's cervical cancer screening attendance as a function of screening barriers and facilitators

BackgroundMental health problems are common and impairing among university students, yet only a minority of students with psychological disorders access treatment. Understanding barriers to treatment is integral to planning services, especially in resource constrained settings like South Africa (SA).MethodsData collected across 17 institutions in the online SA National Student Mental Health Survey were used to: (1) estimate 12-month prevalence of common mental health problems and self-harm; (2) estimate the proportion of students receiving treatments for the various mental health problems; (3) explore barriers to treatment; and (4) investigate sociodemographic predictors of treatment mediated through the various barriers endorsed by students with mental health problems. Prevalence analyses were carried out using cross-tabulations and prediction analyses using modified Poisson regression models.ResultsPrevalence of clinically significant mental health problems is high relative to international comparisons, with the prevalence of severe, mild and moderate symptoms of any disorder and/or self-harm of 24.8% (SD = 0.3), 18.8% (SD = 0.3) and 27.6% (SD = 0.4) respectively. Treatment rates were 35.2% (S.E. = 0.6) among students with mental health problems who perceived need for treatment and 21.3% (S.E. = 0.4) irrespective of perceived need. Treatment rates were highest for mood disorders (29.9%, S.E. = 0.6) and lowest for externalising disorders (23.8%, S.E. = 0.5). Treatment rates were much less variable across disorder types among students with perceived need than irrespective of perceived need, indicating that perceived need mediated the associations of disorder types with received treatment. Adjusting for disorder profile, probability of obtaining treatment was significantly and positively associated with older age, female gender, study beyond the first year, traditional sexual orientation, and diverse indicators of social advantage (full-time study, high parent education, and attending Historically White Institutions). Among students with mental health problems, numerous barriers to treatment were reported adjusting for disorder profile, including lack of perceived need (39.5%, S.E. = 0.5) and, conditional on perceived need, psychological (54.4%, S.E. = 1.0), practical (77.3%, S.E. = 1.1), and other (79.1%, S.E. = 1.1) barriers. Typically, students reported multiple barriers to treatment. Differences in perceived need explained the gender difference in treatment, whereas practical barriers were most important in accounting for the other predictors of treatment.ConclusionMental health problems are highly prevalent but seldom treated among SA university students. Although many barriers were reported, practical barriers were especially important in accounting for the associations of social disadvantage with low rates of treatment. Many of these practical barriers are however addressable.

Clean intermittent catheterization (CIC) is the standard of care for patients with chronic retention of urine, particularly those with spinal cord injury, multiple sclerosis, and other causes of neurogenic lower urinary tract dysfunction, as well as in cases of idiopathic and non-neurogenic bladder dysfunction. The aim of this literature scoping review was to analyze the functional, practical, and psychological barriers to successful adoption and continuation of CIC among eligible patients. It also considers key principles of education on CIC for patients and healthcare professionals and the potential value of specific educational interventions. We conducted a literature scoping search on PubMed and Embase. The findings have been classified into the following four main categories: (A) functional ability as a driver of success or failure; (B) practical and psychological barriers; (C) guiding principles for designing patient education and training the trainers; (D) value of specific educational interventions. (A) Physical challenges can fundamentally affect ability to implement CIC. A number of studies focus specifically on degree of functional ability as a driver of success or failure. (B) As for practical and psychological barriers, specific numbers of common themes emerged from the studies, including education and support, access to choice of products, urinary tract infections and other medical complications, planning timings and opportunities for catheterization, and emotional adjustment. (C) Several studies highlight the need for evidence-based care and a structured, consistent approach, along with the need of verbal explanation, practical instruction, and written information. It has been noted that clinical staff who teach CIC should themselves be trained in a standardized way. (D) Relatively few studies have investigated specific educational interventions like web-based support, a centralized education system, or a simulator. Despite CIC is a widely recognized and accepted tool, its acceptance and long-term integration into patients' daily lives is often challenging. Functional, practical and psychological barriers may affect patients' adherence. Further studies are needed to gain a more in-depth knowledge of this specific issue. Not applicable.

Nature-based interventions (NBIs) are becoming a common mental health care referral option; however, little is known about the barriers to participation. Research reveals a concentration of evidence on the practical barriers with a paucity of guidance on the personal barriers as experienced by service users. This review explores what is known on the psychological, psychosocial and physical barriers as disclosed by adult mental health service users and the various stakeholders involved in NBI. Nine of the 104 articles screened met the inclusion criteria. The review identified a total of 47 barriers in which the majority were standalone barriers unique to the individual article or participant that generated them. However, other barriers suggest a level of universality with the greatest array of barriers identified in the psychosocial category. The review highlights an urgent need for further research on the psychological, psychosocial and physical barriers to NBI participation.

Psychotherapeutic interventions for depressed, low-income women: A review of the literature

Pregnant adolescent women's perceptions of depression and psychiatric services in the United States.

Diabetes mellitus is characterised by hyperglycaemia, requiring strict management regimens to avoid associated health complications. Diagnosis and/or management of diabetes during young adulthood can be particularly challenging, potentially contributing to significant psychological distress and struggles with management, culminating in poor physical and mental health outcomes. This service evaluation sought feedback from young adult patients (19–25 years old) on diabetes service accessibility and to understand the impact of offering virtual appointments during the COVID‐19 pandemic. All young adult patients (n=101) were invited to complete an online questionnaire about their experience of service accessibility and offered the opportunity to discuss their feedback in a telephone interview. Data were collected from 15 patients. Analysis using content and thematic analyses revealed three main themes regarding service accessibility: practical barriers, psychological barriers, and patients’ relationship with the diabetes team. Recommendations are made for several service developments concerning appointment scheduling, appointment set‐up, and developments around service provision more widely. Further research is needed to gain a wider range of feedback to inform future developments and should prioritise patient involvement to increase patient response rate. Copyright © 2022 John Wiley & Sons.

This research applied discursive psychological analysis to discussions about cervical screening on Facebook and Twitter. The analysisfocused on how people justify not attending cervical screening. Previous research lias identified barriers to attending cervical screening such as embarrassment, fear of pain, and the procedure being too triggering for survivors of sexual assault. Findings identified three discourses around how social media users positioned attendance and non-attendance: (i) practical barriers such as the length of time waiting for results; (ii) psychological barriers such as cervical screenings being triggering for survivors of sexual assault; (iii) taking accountability for non-attendance. Findings are discussed in light of how non-attendance to cervical screenings is accounted for, which campaigners could consider when promoting the importance of attending cervical screening.

This study is mainly purposed to investigate the teaching method and approach used by the teachers in teaching special needs students in TK Al-Faizin, the learning problems (barriers) faced by teachers and the ways to solve these learning problems (barriers) of special needs student in TK Al-Faizin. This research is a descriptive qualitative research using observation, interview, and documentation to collect the data. 3 steps of analyzing the data involves data reduction, data display, and conclusion by Miles and Huberman. The results revealed that the teacher used the model of group learning with safety activities and various learning methods based on theme-based approach. The problems (barriers) faced by teachers included value barriers, power barriers, practical barriers, and psychological barriers. To solve the problems, teachers adapt the curriculum, collaborate with the parent, improve their teaching competence through independent learning, share with their peer teachers, and hold a parenting program once a month.

Perspectives on postpartum diabetes screening among patients with gestational diabetes in an integrated healthcare system

Behavioral change interventions in restaurants towards sustainable food choices are a promising avenue towards attaining climate goals. In this research, we investigated how these interventions can successfully be implemented in a restaurant context to promote sustainable food choices. In a multiple-year co-creation project with 32 restaurants and consultant chefs, we provided knowledge on sustainable meal preparation and on using behavioral interventions, collaborated to design suitable interventions for the individual restaurants, and tested these interventions in a mixed methods approach. We provided support from researchers and consultant chefs throughout this process. The four restaurants that ultimately implemented an intervention were all successful in increasing uptake of their sustainable menu options. While participants' overall support and enthusiasm for knowledge of sustainability interventions was high, especially towards more sustainable meal preparation, many restaurants dropped out of the project. Despite using a time- and resource-intensive approach, it remained difficult to overcome both psychological barriers (no perceived responsibility and the sense of already "doing enough") as well as practical hurdles (fear of customers' response and lack of time) for restaurants. As implementation of the co-created solutions proved very challenging, future research on interventions promoting sustainable food choices should therefore specifically focus on taking away practical barriers. Possible avenues for doing so are focusing on more sustainable meal preparation, involving customers in cocreation, and a greater focus on the responsibility of the sector in culinary and hospitality education to instill sustainable habits there, which are then more easily practiced when working in the field.

To explore differences in barriers to attendance at cervical screening across age groups because coverage of the cervical screening programme in England has been falling, particularly among women in the youngest age group (25-29 years). A qualitative study. A university in London. Professionals working in the screening field (n=12) and women of varying ages who had either never attended for cervical screening or did not attend regularly (n=46). In Study 1 we interviewed professionals to elicit their views on the reasons for lower screening attendance in young women. In Study 2, we carried out four focus groups (n=27) and 19 individual interviews with under-screened women to explore their barriers to attendance. Verbatim transcripts were analysed using Framework Analysis. Reasons for nonattendance were many and varied. Health professionals identified population-level factors, service provision issues, time pressures, risk perceptions, lack of knowledge and psychological barriers. The nonattenders fell into two groups: those who had made an active decision not to take part (who tended to be older), and those who intended to be screened but did not attend (predominantly younger women). Practical barriers were raised more often by younger women whereas older women had more negative attitudes to screening. This study provides rich data on the complex reasons why women do not attend for cervical screening. It points to age differences in barriers to screening, and suggests that addressing practical issues such as appointment systems and clinic times may have a positive impact on attendance in young women.

Introduction: A growing number of qualitative and quantitative studies have been conducted applying mindfulness-based interventions (MBIs) to treat psychological and physical manifestations in people with Chronic Obstructive Pulmonary Disease (COPD). Evidence on their effectiveness is still conflicting. Understanding the experiences of people affected by COPD attending the MBI program could help to design interventions suitable to these population and improve their effectiveness. Aim: A qualitative systematic review was conducted aimed at exploring the barriers and facilitators at the participation of MBI programs from the perspective of people with COPD. Methods: Systematic research on relevant databases was conducted including COPD individuals at any disease stage and any MBI program. Qualitative study designs were included. A meta-aggregative approach was used following the Joanna Briggs Institute approach. Results: Three qualitative and two mixed methods studies were identified and included. The participation at mindfulness-based programs was hampered by psychological barriers, such as disbelief and lack of trust, and practical barriers, such as difficulties in attending the classes. Also, cultural barriers hinder trusting the programs Having shorter sessions, distance session via skype and compassionate coaches could promote the retention and the adherence at the mindfulness practice. The absence of group physical presence could deter individuals to continuing the programs. Conclusion: Specific MBI programs considering COPD patients’ preferences should be tested to optimise the retention and adherence and to maximise their effectiveness.

BackgroundAdolescent pregnancies present a great public health burden in Kenya and Sub-Saharan Africa (UNFPA, Motherhood in Childhood: Facing the challenge of Adolescent Pregnancy, 2013). The disenfranchisement from public institutions and services is further compounded by cultural stigma and gender inequality creating emotional, psychosocial, health, and educational problems in the lives of vulnerable pregnant adolescents (Int J Adolesc Med Health 15(4):321–9, 2003; BMC Public Health 8:83, 2008). In this paper we have applied an engagement interview framework to examine interpersonal, practical, and cultural challenges faced by pregnant adolescents.MethodsUsing a qualitative study design, 12 pregnant adolescents (ages 15–19) visiting a health facility’s antenatal services in Nairobi were interviewed. All recruited adolescents were pregnant for the first time and screened positive on the nine-item Patient Health Questionnaire (PHQ-9) with 16% of 176 participants interviewed in a descriptive survey in the same Kangemi primary health facility found to be severely depressed (Osok et al., Depression and its psychosocial risk factors in pregnant Kenyan adolescents: a cross-sectional study in a community health Centre of Nairobi, BMC Psychiatry, 2018 18:136 https://doi.org/10.1186/s12888-018-1706-y). An engagement interview approach (Social Work 52(4):295–308, 2007) was applied to elicit various practical, psychological, interpersonal, and cultural barriers to life adjustment, service access, obtaining resources, and psychosocial support related to pregnancy. Grounded theory method was applied for qualitative data sifting and analysis (Strauss and Corbin, Basics of qualitative research, 1990).ResultsFindings revealed that pregnant adolescents face four major areas of challenges, including depression, anxiety and stress around the pregnancy, denial of the pregnancy, lack of basic needs provisions and care, and restricted educational or livelihood opportunities for personal development post pregnancy. These challenges were related both to existing social and cultural values/norms on gender and traditional family structure, as well as to service structural barriers (including prenatal care, mental health care, newborn care, parenting support services). More importantly, dealing with these challenges has led to negative mental health consequences in adolescent pregnant girls, including feeling insecure about the future, feeling very defeated and sad to be pregnant, and feeling unsupported and disempowered in providing care for the baby.ConclusionsFindings have implications for service planning, including developing more integrated mental health services for pregnant adolescents. Additionally, we felt a need for developing reproductive education and information dissemination strategies to improve community members’ knowledge of pregnant adolescent mental health issues.

The application of metrology in chemical analysis is today hampered by psychological and practical barriers. The argumentation is based on the differences in physical and chemical metrology, which arises mainly from the objects of the measurements. The term “measurement” is discussed in the realm of analytical chemistry with a special focus on the inherent relation between chemical identification and determination as well as the consequent use of the concept of traceability and uncertainty.