Barriers To Attendance Research Articles

Barriers of attendance to dog rabies static point vaccination clinics in Blantyre, Malawi.

Rabies is a devastating yet preventable disease that causes around 59,000 human deaths annually. Almost all human rabies cases are caused by bites from rabies-infected dogs. A large proportion of these cases occur in Sub Saharan Africa (SSA). Annual vaccination of at least 70% of the dog population is recommended by the World Health Organisation in order to eliminate rabies. However, achieving such high vaccination coverage has proven challenging, especially in low resource settings. Despite being logistically and economically more feasible than door-to-door approaches, static point (SP) vaccination campaigns often suffer from low attendance and therefore result in low vaccination coverage. Here, we investigated the barriers to attendance at SP offering free rabies vaccinations for dogs in Blantyre, Malawi. We analysed data for 22,924 dogs from a city-wide vaccination campaign in combination with GIS and household questionnaire data using multivariable logistic regression and distance estimation techniques. We found that distance plays a crucial role in SP attendance (i.e. for every km closer the odds of attending a SP point are 3.3 times higher) and that very few people are willing to travel more than 1.5 km to bring their dog for vaccination. Additionally, we found that dogs from areas with higher proportions of people living in poverty are more likely to be presented for vaccination (ORs 1.58-2.22). Furthermore, puppies (OR 0.26), pregnant or lactating female dogs (OR 0.60) are less likely to be presented for vaccination. Owners also reported that they did not attend an SP because they were not aware of the campaign (27%) or they could not handle their dog (19%). Our findings will inform the design of future rabies vaccination programmes in SSA which may lead to improved vaccination coverage achieved by SP alone.

The motives and barriers of association conference attendance: Evidence from an Australasian tourism and hospitality academic conference

This paper reports on the motives and barriers to association conference attendance. Anecdotal evidence suggests that academics are facing increasingly constrained budgets for conference attendance. This paper seeks to confirm if this is indeed the case in reference to data drawn from an Australasian academic tourism and hospitality conference. The paper contributes to the growing body of literature on conference attendance motivations and supplements the lesser body of work on conference attendance barriers. The findings suggest that the delegates sampled were indeed receiving less support to attend conferences and this variously affected the prominence given to some motives and barriers for association conference attendance, with the motives more salient than the barriers in determining attendance. The paper concludes in proposing a research agenda aimed at ensuring the personal and professional benefits of attending academic association conferences continue into the foreseeable future.

An ounce of prevention: A pre-randomization protocol to improve retention in substance use disorder clinical trials

BackgroundMissing data in substance use disorder (SUD) research pose a significant threat to internal validity. Participants terminate involvement or become less likely to attend intervention and research visits for many reasons, which should be addressed prior to becoming problematic. During a 9-month study targeting stimulant abuse, early dropouts and participant reported attendance barriers led to implementing a structured, pre-randomization protocol with participants about retention and solution-focused strategies (the “Fireside Chat”). Our aim is to outline this approach and present data on intervention participation and research visit attendance after implementation. Methods/designSTimulant Reduction using Dosed Exercise (STRIDE) was a two-arm, multisite randomized clinical trial testing treatment-as-usual for stimulant abuse/dependence augmented by Exercise or Health Education. For both groups, study intervention visits at the site were scheduled 3/week for 12weeks followed by 1/week for 24weeks. During The Chat, research staff thoroughly reviewed participants' expectations, and barriers and solutions to retention. Fifteen participants were randomized (to Exercise or Health Education) prior to and fourteen were randomized after Chat implementation. Intervention and monthly follow-up attendance (before and after implementation) were compared at the site (N=29) that developed and rigorously implemented The Chat. ResultsIndividuals who participated in The Chat (n=14) attended significantly more intervention visits during weeks 1–12 (p<0.001) and weeks 13–36 (p<0.05) and attended more research visits (p<0.001). DiscussionProactive discussion of expectations and barriers prior to randomization was associated with greater study attendance. SUD researchers should consider tailoring this approach to suit their needs. Further investigation is warranted.

Recall for postpartum follow-up of women with gestational diabetes mellitus: Climbing a mountain.

Recall for postpartum follow-up of women with gestational diabetes mellitus: Climbing a mountain.

Mindfulness-based Intervention for Perinatal Grief after Stillbirth in Rural India

We explored the concept of using a Mindfulness-based intervention to reduce perinatal grief among Indian women. Data were collected using mixed methods to explore concept acceptability, receptivity, modality, and feasibility of the intervention. The intervention was piloted and evaluated with measures of perinatal grief, psychosocial wellbeing, religious coping, perceived social provision of support, and mindfulness. The intervention was well received and effective in teaching skills to help women deal with high levels of grief and subsequent mental health challenges. To overcome attendance barriers modification is necessary. Partnership with a local nursing school is critical to enhance sustainability of the intervention.

"There are several different castes, you know?" South Asian tutors’ experiences of delivering a self-management programme to Punjabi Sikhs

Structured, group-based, psycho-educational self-management interventions, such as the Chronic Disease Self-Management Programme (CDSMP), are designed to help people living with a long-term condition to better manage their daily lives. However, in the UK, the uptake of these interventions among South Asian people is low. Internationally, cultural and structural adaptations of CDSMPs for members of Black and Minority Ethnic (BME) communities show encouraging outcomes. However, scant attention has been paid to the experiences of tutors delivering CDSMPs to these populations and the insight that they could contribute is largely unrecognised. By examining the experiences and understandings of these tutors, more refined cultural and structural modifications may be identified. The aim of this study was, from the perspectives of South Asian tutors, to describe their experiences of delivering CDSMPs that had included South Asian attendees. Richly informative interview data were analysed using Interpretative Phenomenological Analysis. Findings revealed substantial barriers to South Asian people attending, engaging and understanding elements of the intervention. We provide experiential examples to support tutors’ arguments for highly tailored courses, targeted at specific sub-groups of particular communities, and offer insight into practical steps to achieve this. Attendance barriers included lack of awareness about the intervention, and the social influence of the highly refined Sikh caste system, whilst comprehension barriers related to the language of the course manual, medical terminology and concepts. Tutors’ identified pragmatic facilitators to South Asian people’s participation in, and understanding of, the intervention. These included having single-language and single-religion courses, pictorial content in the course manual, and culturally competent recruitment strategies. Further research with South Asian SMP attendees may reveal additional insights into South Asian people’s attendance and performance of self-management behaviours. Policy-makers, providers and commissioners should work with BME communities to adapt SMPs, in order to improve access and understanding, and reduce health inequalities.

Factors Influencing Latino Participation in Community-Based Diabetes Education

An Extension diabetes program (DP) was revised for Latinos; however, participation was limited. Factors influencing low participation rates were examined. Five Latinos interested in the DP participated in a focus group discussion. Transcripts were analyzed for themes. Preferred education programs were multi-session, local, group classes led by an engaging teacher during the summer. Participants learned of the DP through friends and Extension; preferred marketing strategies were Spanish radio, local health clinics, and Spanish-print media. Attendance barriers included scheduling conflicts. Limited use of culturally preferred marketing and scheduling conflicts were likely barriers. Culturally appropriate programs should use culturally preferred marketing strategies to be successful.

Barriers to completing TB diagnosis in Yemen: services should respond to patients' needs.

Objectives and BackgroundObtaining a diagnosis of tuberculosis (TB) is a prerequisite for accessing specific treatment, yet one third of estimated new cases are missed worldwide by National Programmes. This study investigated economic, geographical, socio-cultural and health system factors hindering adults' attendance and completion of the TB diagnostic process in Yemen, to inform interventions designed to improve patient access to services.MethodologyThe study employed a mixed methods design comprising a cross-sectional survey and In-Depth-Interviews (IDIs) and Focus Group Discussions (FGDs) among patients abandoning the diagnosis or registering for treatment. Adults with cough of ≥2 weeks attending a large governmental referral centre in Sana'a, Yemen, between 2009 and 2010, were eligible to participate.Results497 and 446 (89.7%) participants were surveyed the first and second day of attending the services and 48 IDIs and 12 FGDs were also conducted. The majority of patients were disadvantaged and had poor literacy (61% illiterate), had travelled from rural areas (47%) and attended with companions (84%). Key barriers for attendance identified were clinic and transport costs (augmented by companions), distance from home, a preference for private services, strong social stigma and a lack of understanding of the diagnostic process. There were discrepancies between patient- and doctor-reported diagnosis and 46% of patients were unaware that TB treatment is free. Females faced more difficulties to attend than men. The laboratory practice of providing first-day negative smear results and making referrals to the private sector also discouraged patients from returning. Strategies to bring TB diagnostic services closer to communities and address the multiple barriers patients face to attend, will be important to increase access to TB diagnosis and care.

The IAPT@Flinders Service: adapting the Improving Access to Psychological Therapies model to the emergency department setting in Australia

To describe the implementation of an Improving Access to Psychological Therapies (IAPT) service at Flinders Medical Centre emergency department (IAPT@Flinders). IAPT, a population-based model of guided self-help for anxiety and depression delivered mainly by phone, was rolled-out nationally in the UK in 2010. There is a growing body of evidence demonstrating its clinical effectiveness and efficiency that can improve treatment adherence, reduce stigma, remove appointment attendance barriers and improve access for hard-to-reach populations. IAPT@Flinders was the test site for the first IAPT in Australia and also the first IAPT service that was integrated with an emergency department (ED). IAPT@Flinders offers rapid access, low-intensity cognitive behavioural therapy, social prescribing and signposting to clients with adjustment disorders, anxiety and/or depressive symptoms. Successful implementation within an Australian crisis setting has demonstrated that many IAPT structures and protocols are applicable to ED settings and the model can be implemented with fidelity. Adaption required consideration of positioning of the service within the Australian mental health framework; staff qualifications; the referral pathways; and exclusion criteria. It is recommended additional test sites and larger scale trials are conducted to provide further evidence of the applicability of large-scale adoption of the UK IAPT model into Australian ED settings.

Exercise-Based Cardiac Rehabilitation for the 21st Century

Exercise-based cardiac rehabilitation (CR) is efficacious in reducing mortality and hospital admissions; however it remains inaccessible to large proportions of the patient population. Removal of attendance barriers for hospital or centre-based CR has seen the promotion of home-based CR. Delivery of safe and appropriately prescribed exercise in the home was first documented 25 years ago, with the utilisation of fixed land-line telecommunications to monitor ECG. The advent of miniature ECG sensors, in conjunction with smartphones, now enables CR to be delivered with greater flexibility with regard to location, time and format, while retaining the capacity for real-time patient monitoring. A range of new systems allow other signals including speed, location, pulse oximetry, and respiration to be monitored and these may have application in CR. There is compelling evidence that telemonitored-based CR is an effective alternative to traditional CR practice. The long-standing barrier of access to centre-based CR, combined with new delivery platforms, raises the question of when telemonitored-based CR could replace conventional approaches as the standard practice.

Socio demographic and clinical predictors of absenteeism A cross sectional study of urban industrial employees

Context:Public sector undertakings are facing a threat of privatization due to unsatisfactory performance putting pressure on management and in turn to employees. There is an increasing trend of absenteeism observed amongst employees citing job stress.Aim:To find an association between job stress and absenteeism in relation to socio-demographic and clinical profile.Materials and Methods:The study was conducted in an urban aeronautical industry with 68 employees who mentioned stress at workplace during evaluation. Job stress was assessed using Professional Life Stress Scale (David Fontana). Those who scored more than 30 (n = 43) were taken up for the study after an informed consent. A semi-structured questionnaire was administered to find socio-demographic and clinical profile. Employees who reported taking leave in last six months just to avoid work or workplace constitute the “absenteeism” group. The absenteeism group was compared to non-absenteeism group using Fisher exact/Chi-square test or independent t-test depending on type of variables.Results:Out of 43 subjects, 18 had absenteeism while 25 did not have absenteeism. Comparing the two groups, interstate migration, having more than one previous job, commuting time more than an hour, co-morbid anxiety/depression, and alcohol abuse were significantly associated with absenteeism (P < 0.05). Absentees complained more about fatigue and relationship problem with colleagues than non-absentees (P < 0.05). Factors like age, sex, marital status, education, gross pay, job tenure, past or family history of psychiatry illnesses had no significant association with absenteeism (P > 0.05).Conclusion:In absenteeism research, one of the widely accepted models is Steer and Rhode's “Process model of absenteeism.” The model postulates job stress as one of the barriers for attendance. Thus, knowing the factors for absenteeism would help in preventing absenteeism.

Do open day events develop art museum audiences?

For museums, developing audiences means both attracting non-visitors to their venues, and improving repeat visitors’ attendance patterns and experience. Audience development strategies encourage museums to create open door events in order to deal with barriers preventing a wider audience from becoming their visitors, and to build stronger relationships with their current visitors. Satisfaction is expected to influence future buying decisions – i.e., intention to return and to recommend. Will a satisfying experience at a museum event improve event goers’ visiting patterns? This research aims to ascertain the effects of attending open day events on the development of art museum audiences. We present the findings of exploratory quantitative research using the personal interview survey method. Our results indicate that open day events have potential to develop audiences, as such events eliminate attendance barriers, attract first time visitors and provide trial experiences for potential museum visitors. However, the positive association between event experience and intention to return to the museum on an ordinary day was not statistically supported by this study.

Clinician's Commentary on LaPier

Clinician's Commentary on LaPier

Impact of Management Development on Nurse Retention

Nurse retention is essential to maintain quality healthcare organizations. In an effort to mitigate the loss of nurse managers, a management education program was created for new and transitioning nurse managers that included scholarships for nurses from long-term and rural acute care settings. Program evaluation was based upon the outcomes of anticipated turnover and employee satisfaction. Using a preprogram and postprogram evaluation, the Index of Work Satisfaction (IWS) and the Anticipated Turnover Scale (ATS) were used to survey participants. Descriptive statistics as well as Wilcoxon statistics for group comparisons were used for analysis. ATS scores were significantly reduced (P < .05) for all program participants. Further analysis of scholarship recipients indicated that the management program significantly increased their intent to stay (P < .08) in their current positions. However, because of a large rate of attrition, findings can only be considered preliminary. While the high level of attrition among the scholarship recipients is disappointing, potential attendance barriers are discussed, particularly from long-term care settings. Management development programs may improve the satisfaction and retention of critically needed managers and enhance development of future nursing leaders.

Age, Gender, and Treatment Attendance Among Forensic Psychiatric Outpatients

The records of 1,185 female and 5,114 male forensic psychiatry outpatients, within the age range of 15-44 years, were used to evaluate absenteeism from treatment in relation to age and gender. Age was divided into the 3 age groups 15-24, 25-34, and 35-44. Females had a significantly higher absentee rate than males in all age groups (p < .05). This gender difference is likely due to varying social roles as well as differential perceptions of treatment relevance. For both males and females, missed appointments declined significantly with age (p < .05). This age effect likely results from the decline in risk-taking and impulsivity with age. Because the efficacy of any treatment lies in a client's continued participation, it is important to address program attendance barriers and commitment to treatment issues. Commitment to treatment can be increased by active follow-up on non-attendance and by providing a positive therapy experience.

Causes of low attendance at national immunization days for polio eradication in Bushenyi district, Uganda.

The purpose of this study was to investigate the factors influencing attendance for polio National Immunization Days (NIDs) using the Attitudes-Social-influence-self-Efficacy (ASE) model as a guiding theoretical framework. The data was collected in Bushenyi district of south-western Uganda in 6 focus group discussions about outcomes of attendance at NIDs, about who decides on attendance, and about attendance barriers and supports. The purpose of NIDs - eradicating polio - was not known to the informants. The main reason mentioned for attending NIDs and other immunization was to weaken childhood diseases or to strengthen the children's capability in fighting diseases, whether they are immunizable or not. However, it was strongly believed that the previous NIDs had caused a severe malaria epidemic with a very high mortality, and this led to most parents not attending the next. Sources of social influence were mostly opinion and local leaders in communities, health workers, friends and relatives. Opinion leaders who did not immunize their children were said to hinder attendance at NIDs by other lay people. NIDs cards, on the other hand, were regarded as valuable means of support for attendance. Thus to improve immunization coverage, there is need for issuing NIDs cards, for using health education to change the belief that NIDs cause malaria, and to encourage local leaders to attend NIDs.