Barriers To Participation Research Articles

Qualitative Study of Participation Facilitators and Barriers for Emergency School Meals and Pandemic Electronic Benefits (P-EBT) in an Urban Setting during COVID-19.

During the COVID-19 pandemic, significantly fewer of New York City’s (NYC’s) 1.1 million public school children participated in emergency grab-and-go meals—heightening the risk of inadequate nutrition security for many of NYC’s most vulnerable residents. This study sought to examine student families’ facilitators and barriers to participation in the grab-and-go meal service and their experiences with pandemic-electronic benefit transfer (P-EBT) funds, a cash benefit distributed when schools were closed. We recruited 126 parents of children in NYC public schools who had participated in the grab-and-go service. Using opened-ended questions, we interviewed 101 parents in 25 1-h online focus groups. We identified four main themes which broadly impacted school meal participation: communication, logistics, meal appeal, and personal circumstances. Key facilitating subthemes included clear communication, ease of accessing sites, and high variety. Key sub-themes negatively impacting participation included limited communication and low meal variety. Accurate, timely communication; easily accessible distribution locations; and convenient distribution times could have increased participation and satisfaction. For P-EBT, parents welcomed the funds and used them readily, but some experienced difficulties obtaining payments. The simultaneous inclusion of community-based research in the evaluation of emergency feeding programs could improve future outcomes for school meal participation and electronic benefits.

Pandemic Perils and Promise: Implementation of a Virtual Parenting Intervention during COVID-19 among Children with Early Neurological Conditions

ABSTRACT Objective In this study, we examined feasibility, acceptability, and preliminary efficacy of a telepsychological positive parenting intervention (I–InTERACT-North, Internet-basedInteracting Together Everyday: Recovery After Childhood Traumatic Brain Injury) during the COVID-19 pandemic among Canadian families of children at-risk for neurodevelopmental challenges given congenital or neonatal conditions. I–InTERACT-North was developed to improve behavioral and emotional outcomes in children with neurological conditions by utilizing and adapting parenting strategies from several established family-focused programmes. Methods A pragmatic prospective pre-post single-site pilot study design was used to assess feasibility, acceptabilty, and preliminary efficacy of I-InTERACT North during the COVID-19 pandemic. Results Thirty-five families of children ages three to nine years were referred between March 2020 and January 2021. Eighteen families enrolled, and 12 (67% adherence) completed the programme. Parents reported strong therapeutic alliance and programme acceptability with barriers due to competing time demands. Therapists reported high acceptability but perceived parental burnout. Parenting confidence (d = 0.70), and child behavior (d = 1.30) improved following the intervention. Conclusions Results demonstrate the programme’s value to families during the pandemic, while underscoring unique participation barriers. Future research and clinicial implications are discussed.

Evaluation of Electronic and Pen-and-Paper Formats of the Inventory of Physical Activity Barriers: A Randomized Crossover Study.

The Inventory of Physical Activity Barriers (IPAB) assesses physical activity participation barriers. Development, refinement, and psychometric evaluation of the IPAB occurred via an electronic format. However, various circumstances may require using a pen-and-paper format. As instrument formats are not always interchangeable, the authors aimed to establish whether 2 different formats (electronic and pen and paper) can be used interchangeably for the IPAB. This randomized crossover study included 66 community-dwelling adults aged 50years and older (mean age = 73 [SD = 7.6]). Half the sample completed the electronic format of the IPAB first and the pen-and-paper format second, and the other half completed them in reverse order. Tests of equivalence and a Bland-Altman plot were performed. The intraclass correlation coefficient between formats was .94, and kappa was .68. The mean difference between the 2 administration forms of the IPAB was 0.002 (P = .96). Both administration formats had high internal consistency (Cronbach alpha = .92 and .93) and illustrated construct validity (P ≤ .001 for both administration formats). Pen-and-paper and electronic formats of the IPAB are equivalent and, thus, can be used interchangeably among non-Hispanic whites who are highly educated. The format should be used consistently if completing preintervention and postintervention evaluations or comparing scores.

Deployment of an End-to-End Remote, Digitalized Clinical Study Protocol in COVID-19: Process Evaluation.

BackgroundThe SARS-CoV-2 (COVID-19) pandemic may accelerate the adoption of digital, decentralized clinical trials. Conceptual recommendations for digitalized and remote clinical studies and technology are available to enable digitalization. Fully remote studies may break down some of the participation barriers in traditional trials. However, they add logistical complexity and offer fewer opportunities to intervene following a technical failure or adverse event.ObjectiveOur group designed an end-to-end digitalized clinical study protocol, using the Food and Drug Administration (FDA)–cleared Current Health (CH) remote monitoring platform to collect symptoms and continuous physiological data of individuals recently infected with COVID-19 in the community. The purpose of this work is to provide a detailed example of an end-to-end digitalized protocol implementation based on conceptual recommendations by describing the study setup in detail, evaluating its performance, and identifying points of success and failure.MethodsPrimary recruitment was via social media and word of mouth. Informed consent was obtained during a virtual appointment, and the CH-monitoring kit was shipped directly to the participants. The wearable continuously recorded pulse rate (PR), respiratory rate (RR), oxygen saturation (SpO2), skin temperature, and step count, while a tablet administered symptom surveys. Data were transmitted in real time to the CH cloud-based platform and displayed in the web-based dashboard, with alerts to the study team if the wearable was not charged or worn. The study duration was up to 30 days. The time to recruit, screen, consent, set up equipment, and collect data was quantified, and advertising engagement was tracked with a web analytics service.ResultsOf 13 different study advertisements, 5 (38.5%) were live on social media at any one time. In total, 38 eligibility forms were completed, and 19 (50%) respondents met the eligibility criteria. Of these, 9 (47.4%) were contactable and 8 (88.9%) provided informed consent. Deployment times ranged from 22 to 110 hours, and participants set up the equipment and started transmitting vital signs within 7.6 (IQR 6.3-10) hours of delivery. The mean wearable adherence was 70% (SD 19%), and the mean daily survey adherence was 88% (SD 21%) for the 8 participants. Vital signs were in normal ranges during study participation, and symptoms decreased over time.ConclusionsEvaluation of clinical study implementation is important to capture what works and what might need to be modified. A well-calibrated approach to online advertising and enrollment can remove barriers to recruitment and lower costs but remains the most challenging part of research. Equipment was effectively and promptly shipped to participants and removed the risk of illness transmission associated with in-person encounters during a pandemic. Wearable technology incorporating continuous, clinical-grade monitoring offered an unprecedented level of detail and ecological validity. However, study planning, relationship building, and troubleshooting are more complex in the remote setting. The relevance of a study to potential participants remains key to its success.

Enabling Factors, Barriers, and Perceptions of Pneumococcal Vaccination Strategy Implementation: A Qualitative Study.

Invasive pneumococcal disease (IPD) is a leading cause of disability and mortality worldwide, particularly in the elderly population. With the implementation of the Government Vaccination Programme (GVP) and the Vaccination Subsidy Scheme (VSS), enabling factors and barriers in service provider scheme participation and vaccination uptake were examined in 32 interviews with doctors and 16 interviews with vaccine recipients. Interview data were analysed in NVivo 11.0 with reference to the Consolidated Framework for Implementation Research (CFIR) and the REAIM Framework to develop codes and themes. Barriers to pneumococcal vaccination uptake included concerns on vaccine efficacy and poor understanding of the disease and vaccine schemes, whilst service provider participation was hindered by ill-defined parameters for patient eligibility and time, location, and logistical constraints. Enabling factors to improve intervention implementation were involvement of the government and physicians to encourage participation, clarifying eligibility criteria, and improving individual knowledge of IPD and vaccination schemes. As participation rates in the GVP and VSS remains low in Hong Kong, efforts concentrating on health promotion strategies encouraging pneumococcal vaccination amongst the elderly population are recommended.

Drivers and barriers of women participation in agricultural activities in Nigeria

The study examined the drivers of women participation in agricultural activities in Nigeria. A total of 636 women farmers were used for the study and data were collected through interview and questionnaire process. Descriptive statistics, Participation index and Ordered Logit regression were used to analyze the data. The results revealed that the mean age, household size, farming experience and farm size were 44 years, 8 members, 18 years and 3.1 ha respectively. The result also revealed that women farmers in Nigeria engaged themselves in agricultural activities such as crop farming, livestock farming, agricultural trading, poultry farming, horticultural farming and aquaculture farming. Result of the participation index revealed that women farmers were actively involved in agriculture with 49.06 % of the women with high level of participation. The regression analysis revealed that the positive drivers of women participation in agricultural activities were household size, marital status, level of education, farming experience, disposable income, extension service and membership of association. In the contrary, distance to farm is a negative driver of women participation in agricultural activities in the study area. In addition, inadequate financial opportunities and inadequate access to extension services were among the serious constraints that hindered women participation in agricultural activities.

O16 Understanding Barriers and Facilitators to Virtual Culinary Nutrition Instruction for Youth

<h3>Background</h3> The COVID-19 pandemic caused FamilyCook Productions to re-design its evidence-based curriculum, Teen Battle Chef (TBC), to be taught virtually in a feasible format that allows culinary skill development that could result in positive behavior changes. <h3>Objective</h3> Examines barriers and facilitators to achieving a well-delivered and well-received, live, virtual format for an evidence-based, teaching kitchen program for youth. <h3>Study Design, Settings, Participants</h3> Twelve adolescent cohorts received a virtual version of TBC April to August 2020 (n = 145) Quantitative and qualitative process data examined participation barriers and facilitators, progress in gaining cooking skills, the use of the Framework for 10 Experimental Drivers of Behavior Change, identifiers of behavioral and attitudinal changes. Participant post-survey and instructor interviews assessed capabilities and barriers to participation. <h3>Measurable Outcome/Analysis</h3> Session observation measured attendance, cooking with instructor, instructor's use of visual aids. Post served measured youth attitudes and behaviors. <h3>Results</h3> Instructors (91.6%) used new visual aids to facilitate virtual learning (PowerPoints/videos). Adolescents attended a mean of 8.2 of 12 sessions. The percentage of adolescents cooking with the instructor was 37.3%. The post-survey (n = 28) revealed 92.9% of adolescents felt empowered to prepare meals on their own; 57.1% reported regularly trying to get more ‘colors' of fruits/vegetables in their meals. Difficulty obtaining ingredients was the largest participation barrier (42.9%). An average of 8.4 of the 10 Experiential Drivers of Behavior change were used in these virtual sessions. Instructor interviews revealed 100% felt they were effective in supporting students to cook at home and 90% reported advantages of students using home kitchens. <h3>Conclusions</h3> Virtual live culinary education elicited student participation and skills development, despite barriers of online education. Educators found students being in their own home kitchens facilitated their ability to develop the targeted culinary/life skills and adopt them in their lifestyle more quickly than in classroom instruction. These positive findings suggest future evaluation of virtual culinary nutrition education is warranted. <h3>Funding</h3> None.

CAN A PHYSICAL ACTIVITY PROGRAMME IMPROVE THE QUALITY OF LIFE IN YOUTH WHO LIVE IN AN ORPHANAGE? A MIXED METHODS STUDY

Physical activity (PA) is thought to positively contribute to the improvement of the (poor) Quality of Life (QoL) of youth living in institutions. However, youth’s participation in PA can be affected by the “significant others” in their life. The aim of this study was to (a) investigate the impact of a PA programme on the QoL of youth hosted in an orphanage and (b) understand the role of the relationships formed in this institution in the outcome of the programme objectives. For that purpose, a mixed methods approach was adopted. The study was conducted in an orphanage in Attica, Greece. Twelve of the 13 male orphans (Mage= 13.08 ± 2.43 years) participated in a 10-week PA programme implemented in the institution. The KINDL® questionnaire was completed by the orphans and one caregiver before and after the PA intervention. The qualitative data were collected through observation and semi-structured interviews with 12 orphans and 6 members of the orphanage staff. The results showed that orphans’ QoL levels were poor; whereas a statistically significant decline in their total KINDL® scores (p= .033) and the Emotional Well-Being subscale (p= .013) was identified. Quality data revealed that orphans’ participation in the PA programme was inconsistent, although they estimated that it was valuable. Intra- and inter-personal factors emerged as barriers for PA participation. It seems that living in an institution results in deep deteriorations in youth’s QoL that cannot be surmounted by their participation in a PA programme.

Digital poverty as a barrier to access

Over the last 18 months, media coverage has revealed a concern that the increasing proliferation of digital learning at all universities (amplified by COVID-19 lockdowns) has compounded access and participation barriers for students impoverished by socio-economic challenges. This reflects the importance of digital capital as an aspect of learner disadvantage (Park, 2017) and increased understanding of intersectional disadvantage (Nichols and Stahl, 2019), through which digital disadvantage may add to pre-existing inequalities. The Quality Assurance Agency (2020) report how institutional action against digital poverty correlates with greater student satisfaction and higher levels of attainment. This article synthesises data from the authors' scholarship into digital barriers facing adult students returning to education. Challenges in relation to disposable income often compound challenges intersecting with other aspects of disadvantage (Butcher and Rose-Adams, 2015), and a lack of confidence and inadequate digital readiness amongst learners from disadvantaged backgrounds seeking an Access entry route has been identified (Curry and Butcher, 2020; Fowle and Butcher, 2019; Butcher and Fowle, 2018). Recommendations are made to promote greater inclusion amongst students from poor socio-economic backgrounds and to support the progression of a more diverse (and representative) adult learner cohort.

Members’ Perceptions Regarding Diversity and Inclusion within the American Association for Agricultural Education

Professional scientific societies, such as the American Association for Agricultural Education (AAAE), have not been immune to struggles with diversity, equity, and inclusion (DEI), even as it has come to the forefront of national conversation. In response to the 2017-2020 AAAE Strategic Plan, specifically goal one to build a more inclusive culture within the society, this study describes members’ perceptions of organizational climate regarding diversity and inclusion within the AAAE organization. This manuscript reports the quantitative survey findings from the AAAE membership to determine perceptions of opportunities and barriers for participation in AAAE, as well as perceptions of AAAE’s progress toward diversity and inclusion. Data are provided as a benchmark to describe the membership demographics of the organization. Member perceptions of opportunities to share diverse perspectives, become involved in leadership, and to be awarded and recognized by AAAE are varied. Many barriers to engagement in AAAE seem to create a dichotomy between persons who feel fully included and those who do not in the organization. Over half of the respondents do not consider AAAE’s membership to be diverse. Perceptions of progress toward diversity and inclusion across the dimensions of sexual orientation, socio-economic status, disciplinary focus, gender/gender identity, faculty rank, race/ethnicity, institution type, and religious representation reveal some areas of success and opportunities for growth in the organization. The profession should be challenged to examine how our practices and scholarship may perpetuate exclusivity as AAAE works toward meeting the goal of building a more diverse and inclusive culture within the society.

Socio-Cultural Interest and Motivational Barriers for Female Sports Participation in Pakistan: A Comparative Study of Universities and Colleges

Purpose: The core objective of this study was to analyze the situation of Pakistani females' sports participation and examines which different Socio-Cultural, Interest and Motivational barriers currently play negative role towards their sports participation and how these barriers can be reduced by taking up the steps under the feministic approach in sports which is based on the social cognitive theory of Bandura.&#x0D; Methodology/Evidence Acquisition: In order to get deep insight, the researcher employed mix-method research methodology which was based on both qualitative and quantitative research design. Qualitative data of 8-HODs and quantitative data of 592-female students from the 8 selected public colleges and universities in Southern Punjab-Pakistan was collected through close-ended and open ended questionnaires with convenient sampling technique. For quantitative data analysis, SPSS v.20 and for qualitative data analysis MS Excel v.10 were used as statistical tools.&#x0D; Conclusionsː Regarding socio-cultural factors (Family Support, Religious &amp; Cultural Limitations), findings of this study show that the relationships of family support, interest and motivation with their sports participation is significant and positive but the religious &amp; cultural limitations has insignificant and negative impact on female sports participation. Although these socio-cultural factors are not much supportive in the colleges as compare to the universities, but overall, their parents’ negative attitude, expectations for academic performance and unawareness regarding sports benefits, females feel uncomfortable, less passion and interest in sports participation. Further, it was also found, in both universities and colleges, that Islamic dress code, male permission, no proper changing rooms, cultural conflicts, mix-gender sports, vulgarity, less freedom of solely movement, discouragement by society/culture are the major dimensions of religious and cultural limitations towards sports participation. Along with new dimensions and locality, the current study was a first attempt to provide the practitioners, policy makers and researchers to understand the issues of cultural and religious, interest and motivation and family support towards female sports participation in Pakistan.

Challenges and Barriers to the Participation of Non-Governmental Organizations (NGOs) in Flood Management: A Qualitative Study from Iran.

Floods are one of Iran's most important natural hazards, which cause a lot of damage every year. Various organizations, including non-governmental organizations (NGOs), participate in flood management. The present study aimed to explore the challenges and barriers of NGOs' participation in the management of the flooding in Iran based on stakeholders' experiences. This qualitative study is a case study that was conducted using the content analysis approach. Fifteen participants, including 3 national managers, 2 volunteers active in responding to recent floods, and 10 NGO managers/secretaries who had the knowledge or operational experience of participating in disaster management, were approached for interviews. Data were collected using a purposeful sampling method and continued until reaching data saturation. Challenges and barriers to NGOs' participation in flood management were categorized into 4 main categories and 14 subcategories, including policy-making challenges, managerial challenges, executive challenges, and socio-cultural challenges. As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a measurement tool for assessing the effectiveness of NGOs' activities during disasters.

Cross-Cultural Translation and Application of the Lieberman-Brian Inclusion Rating Scale for PE in German-Speaking Countries.

Overcoming participation barriers of students with disabilities in physical education is of great importance and an internationally recognized goal. Research highlights that students with disabilities have mixed feelings about their inclusion experiences in physical education. Physical education teachers often do not feel prepared to appropriately support all students. In German-speaking countries in particular, there is a strong tradition of segregation, with varying interpretations of inclusion. In this light, an instrument to reliably assess the inclusive potential of physical education is needed, thereby providing data on the efficacy of teachers’ practices. Such an assessment scale would be important to identify barriers to inclusive physical education while providing teachers with data that could potentially enhance the learning environment. The purpose of this study was to outline initial insights into the cross-cultural translation process of the Lieberman/Brian Inclusion Rating Scale for PE in German-speaking countries. The translation process followed suggestions for transcultural validation. Expert review was provided to check content and face validity. Major item challenges centered around paraeducators, gym management, and conceptual differences regarding physical education.

Participation of children and young people with cerebral palsy in activities of daily living in rural Uganda.

To compare the participation attendance and involvement of children and young people with and without cerebral palsy (CP) in a low-resource area of Uganda. Eighty-two children and young people with CP aged 6 to 22 years (49 males, 33 females) and 81 age- and sex-matched peers without CP (6 to 22 years; 48 males, 33 females) participated in this population-based, cross-sectional study. Data on attendance and involvement in 20 home and community activities were obtained using Picture My Participation, an instrument intended to measure participation in children with disabilities, particularly in low- and middle-income countries. Non-parametric statistical methods were used to assess between-group differences. Effect size estimates were calculated. Pooled attendance across all activities was lower in children and young people with CP than in children and young people without CP (p < 0.001) and for each activity item (p=0.004 to p < 0.001). The effect sizes for each activity were 0.2 to 0.7. Between-group differences were larger for community activities than for home activities. Pooled involvement across all activities was less in the group with CP (p < 0.001) and for each activity (p=0.014 to p < 0.001). The effect sizes for each activity were 0.2 to 0.5. Children and young people in Gross Motor Function Classification System (GMFCS) levels I and II had higher attendance (p < 0.001) and involvement (p=0.023) than those in GMFCS levels III to V. Participation of young people living with CP in Uganda was restricted, especially for community activities. There is a need to identify context-specific participation barriers and develop strategies to overcome them. Children and young people with cerebral palsy (CP) attended all activities less than their peers without CP. Differences in attendance were larger for community-based activities than home activities. When attending activities, children and young people with CP were less involved than their peers. Children and young people with milder impairments attended less frequently than their peers without CP. Children and young people with milder impairments attended more frequently than their peers with severe impairments.

Learning Theory-Driven Tips for Designing Effective Learning Solutions for the Continuous Education of Community Pharmacists to Enhance Patient-Centered Care-A Qualitative Study.

The constant development of medical and pharmaceutical sciences and the changing roles of pharmacists highlight the importance of lifelong learning in their profession. Given the identified knowledge gaps in the literature in terms of pharmacists’ preferences for lifelong learning, the study aimed to evaluate the opinions and attitudes of community pharmacists towards lifelong learning, including their previous experiences and educational needs, in order to propose evidence-based tips for designing such solutions and interventions intended for them both in face-to-face and online forms. For this purpose, ten semi-structured in-depth interviews were conducted with Polish community pharmacists on the topic using a thematic guide. Subsequently, they were subjected to literal transcription and interpretative phenomenological analysis by two independent researchers using phenomenology as the qualitative approach. The identified themes covered the topic’s relevance for pharmacists’ work, practice-oriented form and content, previous learners’ experiences as a foundation for further learning, commercial initiatives’ risks, motivation sources, and barriers for participation in lifelong learning solutions so far. Based on the insights provided by the respondents, as well as scientifically proven learning theories and educational principles, ten tips were formulated for designing recipient-friendly learning solutions and interventions within the framework of postgraduate lifelong learning of pharmacists.

Sociocultural variables have a major impact on participation in patients treated for paediatric posterior fossa tumours.

This study investigates the severeness of participation barriers in patients surviving paediatric posterior fossa tumours (PFT) many years after treatment. In the past, aetiological studies on adverse outcome have primarily focused on pathobiological risk factors. The current analysis aims to investigate the importance of environmental variables. On average, 10 years after diagnosis, educational and social difficulties of 42 patients surviving paediatric PFT (mean age 17 years) were inquired using a self-constructed questionnaire following the Psychosocial Resource-Orientated Assessment (PREDI). Educational or social participation barriers were defined by self- and/or proxy-reported difficulties in school or in peer relationships. Accordingly, the children and adolescents were categorized into groups of adequate and limited participation. Subsequently, the study identified potential pathobiological (treatment type, hydrocephalus, tumour relapse, gender, age at diagnosis, seizures and cerebellar mutism) and environmental (parental and maternal education, siblings, main language, discrepancies between personal and environmental values, regular physical activity and private living space) risk factors and investigated whether patients with adequate and limited participation differed in the number of risk factors. Almost one decade after treatment, two thirds of patients experienced educational and/or social difficulties. Patients with limited participation were more frequently associated with environmental factors such as low maternal education degree, siblings, main language other than German, discrepancies between societal and personal values and irregular physical activity, as well as the pathobiological risk factors treatment type, hydrocephalus, tumour relapse, cerebellar mutism and seizures. These variables significantly discriminated between patients with and without limited participation. Limited participation in patients treated for paediatric PFT is common. Next to pathobiological, also environmental risk factors play a major role in educational and social participation barriers. This highlights the fact that solely considering pathobiology is not sufficient when investigating risk factors for the emergence of late sequelae. Future aetiological studies must adopt a biopsychosocial perspective.

Research-Driven Guidelines for Delivering Group Exercise Programs via Videoconferencing to Older Adults

Telehealth holds much potential for supporting older adults’ physical and social health. In particular, telewellness interventions to support the physical and social wellness of older adults are needed to overcome participation barriers with in-person programs. This paper presents guidelines for delivering telewellness interventions to older adults, which were informed by a human factors approach to developing a Tele Tai Chi intervention for older adults with mobility disabilities, including reviewing user needs literature and conducting user-centered needs assessment research. From these findings, we developed a protocol and support materials for delivering a telewellness intervention and conducted a feasibility study. We also established an adaptation committee to provide recommendations on the intervention. The outcome of our human factors approach was the establishment of research-driven design guidelines for delivering group exercise programs to older adults using videoconferencing. The guidelines provide direction for designing a telewellness protocol, supporting remote participation, and promoting socialization and engagement. These guidelines can be used to deliver interventions that increase access to socially-engaging, physical activity programs for older adults, which can ultimately help support their physical health, mental health, and quality of life.

QOL-27. Sociocultural variables have a major impact on participation in patients treated for pediatric posterior fossa tumors

Abstract OBJECTIVE: This study investigates the extent of participation barriers in patients with pediatric posterior fossa tumors (PFTs) at long-term follow-up. While most studies focus on pathobiological variables that promote the occurrence of adverse late effects, the present analysis aims to investigate the importance of environmental variables. METHOD: Ten years after tumor diagnosis, 42 patients (mean age: 17 years) treated at our pediatric neuro-oncology unit were assessed for school and social difficulties using a questionnaire developed within the framework of this study. Participation barriers were assumed if patients and/or their parents reported difficulties at school or with peers. The children and adolescents were classified into groups with adequate and limited participation. Potential pathobiological (treatment type, hydrocephalus, tumor recurrence, gender, age at diagnosis, seizures, cerebellar mutism) and environmental risk factors (parental and maternal education, siblings, primary language, discrepancies between personal and environmental values, regular physical activity, private housing) were identified and examined to see if the participation groups differed in the amount of risk factors. RESULTS: Almost a decade after treatment, two thirds of the patients had school and/or social difficulties. Not only pathobiological risk factors (type of treatment, hydrocephalus, tumor recurrence, cerebellar mutism and seizures), but also environmental factors (low maternal education level, siblings, a main language other than German, discrepancies between social and personal values, and irregular physical activity) were associated with limited participation. These variables discriminated significantly between patients with and without participation barriers. CONCLUSION: Participation barriers in patients treated for pediatric PFT are frequent. In addition to pathobiological variables, environmental risk factors also play an important role in limiting school and social participation. This underlines the fact that a sole consideration of pathobiology is not sufficient when examining risk factors for the occurrence of late effects. The adoption of biopsychosocial perspectives in future studies is inevitable.

Perceptions and Beliefs of Memory Loss and Dementia Among Korean, Samoan, Cambodian, and Chinese Older Adults: A Cross-Cultural Qualitative Study.

Older adults who are Asian American and Pacific Islander (AAPI) represent one of the fastest growing populations in the United States and face a significant burden of Alzheimer's disease and related dementias (ADRD). Little is known about ADRD among AAPI subgroups. The current study aimed to: (a) explore perceptions and beliefs of memory loss and dementia among Korean, Samoan, Cambodian, and Chinese older adults in the United States; and (b) identify culturally relevant facilitators and barriers of participation in a brain health program among four AAPI subgroups. Seven focus groups comprising 14 Cambodian, 21 Chinese, 14 Korean, and 13 Samoan older adults were conducted. Data were analyzed using inductive and indigenous coding approaches. Similar and unique perceptions and experiences related to memory loss were identified. Future research could include developing and testing culturally tailored and language congruent strategies regarding ADRD education and resources to facilitate ADRD early detection among AAPI older adults. [Journal of Gerontological Nursing, 48(6), 40-48.].

The potential of timber-agroforestry to meet Sarawak’s forestry demand

Many forest communities in Sarawak, and globally, practise some form of smallholder management system including agroforestry. Yet, agroforestry practitioners predominantly focus on non-timber crops as the major source of income while the timber output remains underutilized and understudied. Smallholder timber agroforestry systems, therefore, have huge potential to equitably meet the increasing demand for both timber and food while reducing the pressure on natural forests. We investigate the readiness of agroforestry smallholders in Sarawak to supply timber commercially, and the opportunities and challenges they face. Semi-structured interviews were conducted with Sarawak forestry stakeholders including agroforestry farmers, timber industry actors, civil society organizations, academia, and government agencies. Descriptive statistics are used to analyse the data. Our results demonstrate that smallholders in Sarawak lack technical silvicultural and horticultural knowledge and formal timber market access, despite majority smallholders expressing interest in timber production. The underutilization of smallholder timber is linked with conservation and protection objectives. Legal constraints, limited capacity building and lack of market information were cited as major barriers for smallholders. Key recommendations to lower barriers for smallholder participation include provision of resources and an enabling legal framework that harmonizes agriculture and forestry demands while being inclusive of smallholders’ perspectives and realities.