Implementation Barriers Research Articles

Green supply chain management (GSCM): rethinking implementation barriers based on fuzzy dematel method in the textile industries of Bangladesh

Green supply chain management (GSCM): rethinking implementation barriers based on fuzzy dematel method in the textile industries of Bangladesh

Integrating a mental health intervention into PrEP services for South African young women: a human-centred implementation research approach to intervention development.

Adolescent girls and young women (AGYW) who may benefit from HIV pre-exposure prophylaxis (PrEP) face high levels of common mental disorders (e.g. depression, anxiety). Common mental disorders can reduce PrEP adherence and increase HIV risk, yet mental health interventions have not been well-integrated into PrEP delivery. We conducted a four-phase human-centred design process, from December 2020 to April 2022, to understand mental health challenges among AGYW in Johannesburg, South Africa and barriers to integrated mental health and PrEP services. In the "Discover" phase, we conducted in-depth interviews with AGYW and key informants (KIs) in Johannesburg. We conducted a rapid qualitative analysis, informed by the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers of integrated mental health and PrEP services and mapped barriers to potential implementation strategies. In the "Design" and "Build" phases, we conducted stakeholder workshops to iteratively adapt an evidence-based mental health intervention, the Friendship Bench, and refine implementation strategies for South African PrEP delivery settings. In the "Test" phase, we piloted our adapted Friendship Bench package. Interviews with 70 Discover phase participants (48 AGYW, 22 KIs) revealed the importance of integrated mental health and PrEP services for South African AGYW. Interviewees described barriers and implementation strategies for mental health and PrEP services around the CFIR domains: intervention characteristics (e.g. challenges with AGYW "opening up"); outer Johannesburg setting (e.g. community stigma); inner clinic setting (e.g. judgemental healthcare providers); characteristics of counsellors (e.g. training gaps); and the implementation process (e.g. need for demand creation). The Design and Build workshops included 13 AGYW and 15 KIs. Implementation barriers related to the quality and accessibility of public-sector clinic services, lay counsellor training, and community education and demand creation activities were prioritized. This led to 12 key Friendship Bench adaptations and the specification of 10 implementation strategies that were acceptable and feasible in initial pilot testing with three AGYW. Using a human-centred approach, we identified determinants and potential solutions for integrating mental health interventions within PrEP services for South African AGYW. This design process centred stakeholders' perspectives, enabling rapid development of an adapted Friendship Bench intervention implementation package.

INCLUSIVITY IN HIGHER EDUCATION: ANALYSING THE IMPLEMENTATION OF NEP 2020 FOR MARGINALIZED COMMUNITIES IN INDIA

This study examines the implementation of the National Education Policy (NEP) 2020 and its impact on inclusivity in higher education for marginalized communities in Punjab, India. The research employs a qualitative case study approach, focusing on three districts—Amritsar, Ferozepur, and Moga—through semi-structured interviews with 50 stakeholders, including students, educators, and local government officials. Key findings reveal significant challenges in access to higher education, including financial barriers, inadequate digital infrastructure, and limited language support, which continue to hinder the inclusivity goals of NEP 2020. While there is a positive perception of scholarship schemes, their availability and complexity of access remain concerns. The curriculum is still perceived as elitist, and the support for marginalized students is viewed as insufficient. Implementation barriers such as inadequate educator training, bureaucratic delays, and awareness gaps further complicate the policy's effectiveness. However, success factors like community engagement, proactive local governance, and the use of digital learning platforms demonstrate potential areas for improvement. The study underscores the need for targeted interventions, increased financial support, and enhanced training to address these challenges. The findings provide empirical evidence to inform policy adjustments, ensuring that NEP 2020 fulfills its promise of creating an inclusive and equitable education system for all.

Survey of clinician perspective on management of papillary thyroid microcarcinoma in Australia and New Zealand.

The incidence of thyroid cancer has been rapidly increasing in recent years largely due to improved diagnostic methods. There is evidence to suggest that in papillary thyroid microcarcinoma (PTMC), active surveillance (AS) is comparable in effectiveness compared to immediate surgery (IM). We conducted a survey of Clinicians and Surgeons from Australia and New Zealand to assess the role of AS in the management of PTMC. A short electronic survey was created on the platform Survey Monkey, separate links containing the survey were sent to various medical societies to be distributed to its members. The list of medical societies included: General Surgeons Australia, Endocrine Society of Australia, Australian and New Zealand Endocrine Surgeons, Australian and New Zealand Head and Neck Cancer Society and New Zealand Association of General Surgery. We received 110 complete responses, which demonstrated that 63% of clinicians will discuss AS with patients diagnosed with PTMC. Surgeons are more likely to discuss AS compared to endocrinologists (P=0.03). Forty-eight percent of respondents report managing patients with AS in the past year, those who are able to perform thyroid ultrasounds are more likely to utilise AS (P=0.03). Common perceived barriers to AS include patient anxiety, lack of access to regular follow-up and lack of patient compliance. Our survey shows that Australian and New Zealand clinicians are generally aware of AS as a treatment option for PTMC, but there remain considerable barriers for common implementation.

A novel framework for waste management in smart city transformation with industry 4.0 technologies

Most of the developed and developing nations focus on the transformation of city livelihood through the development of smart cities. Waste management in smart cities is a critical concern for policymakers and smart city administration. The fourth industrial transformation (hereafter Industry 4.0) helps to improve waste management practices in smart cities to improve the sustainability of the city. This paper tries to develop a roadmap for industry 4.0 technologies relevant to managing waste in smart cities. This paper proposes a novel framework for analyzing the deployment enablers of Industry 4.0 technologies, implementation barriers, current best practices, and opportunities for digital technologies (EBPO) for smart city transformation. The proposed EBPO conceptual framework is analyzed in the context of studies conducted in developed and developing countries. The EBPO presents the unique linkages among the technological advancements for managing waste in smart cities. The present research is an early attempt to explore the relevance of industry 4.0 technologies in the smart waste management context for improving environmental sustainability. The keyword and theme mapping analysis proposes three major waste management clusters in smart cities. This paper provides insight for improving EBPO elements for smart cities’ waste management. The policy and theoretical implications are presented for smart city stakeholders. The paper also highlights the different dimensions of the EBPO framework.

NAVIGATING BARRIERS: THE NEED FOR INTEGRATED HEALTH INFORMATION SYSTEM FOR TUBERCULOSIS-DIABETES CO-SCREENING

Background: Tuberculosis-diabetes mellitus (TB-DM) is a co-epidemic condition representing a double burden for high TB burden countries like Indonesia. Private primary care (PPC) in Indonesia was newly reintroduced to the TB program. Aims: This study explores the challenges PPC healthcare workers (HCWs) face in implementing TB-DM bi-directional screening and strategies to improve it. Methods: An explorative qualitative method was used by conducting two-round focus group discussions (FGDs) with HCWs (n=15) from five private clinics in Yogyakarta Special Region Province Indonesia and triangulated with 10 DM patients and the TB program manager from the provincial health office. The data were audio recorded, transcribed verbatim, and subjected to thematic analysis. Results: HCWs face complex barriers in TB-DM co-screening implementation from patients, HCWs, and health system aspects. An integrated system to remind, support decision-making, report, reduce documentation duplication, monitor, and evaluate co-screening implementation emerged as a potential strategy, although some challenges to deploy. Conclusion: Albeit HIS is promising in enhancing integrated TB-DM screening and management, a comprehensive approach and multisector roles are still needed to overcome impediments to TB-DM bidirectional screening in PPCs. Keywords: diabetes mellitus, health information system, screening, tuberculosis

Toward a better understanding of China's e-waste reverse logistics implementation barriers: A certified disassembler's perspective

E-waste, containing valuable materials and hazardous substances, poses a significant challenge to the environment and society. One approach to addressing this challenge is the implementation of a reverse logistics network to recover e-waste, which involves a disassembler connecting the upstream collector with the downstream recycler and disposer. In China, a certified disassembler in a subsidy scheme plays a crucial role in e-waste recycling effectiveness. However, a declining recycling rate and high idle capacity have led to a ‘certified disassembler dilemma’. This study uses stakeholder analysis processes to identify barriers to e-waste reverse logistics, and the grey-based decision-making trial and evaluation laboratory approach is utilized to explore their causal relationships. The results, supported by a sensitivity analysis, indicate that the certified disassemblers' internal capability deficiencies form the most significant causal barrier, with a net cause value of 2.74. In contrast, the increased number of illegal disassemblers is the primary determinant of all other barriers, with a prominence value of 19.5. Recommendations for improving certified disassemblers' internal capabilities are provided, including exploring the deep processing of waste materials, extending the residential collection network, and reassessing multiple e-waste recovery options.

State Implementation of Congregate Care Reforms for Children in Foster Care.

The Family First Prevention Services Act (FFPSA) allows states to use federal Title IV-E funds to provide time-limited, clinically appropriate use of congregate care, including Qualified Residential Treatment Programs (QRTPs), for youth in foster care. October 1, 2021 marked the deadline for states to begin implementing these FFPSA congregate care reforms. From June to September 2022, we conducted a mixed-methods study to obtain a baseline understanding of implementation barriers, successes, and recommendations to inform congregate care policy and practice. We fielded a national survey with state child welfare agency directors and conducted focus groups with youth with QRTP experiences, child welfare agency administrators, and QRTP executive leaders. We integrated a descriptive analysis of survey data with focus group themes to summarize state implementation progress. A total of 47 states (90%) responded to the survey. Most states reported ongoing congregate care reforms aligned with FFPSA, reducing the use of congregate care and increasing kinship foster care. QRTPs have become the primary congregate care setting. Top implementation barriers concerned workforce resource and capacity constraints, funding, and access to therapeutic foster care models and foster families. Focus group themes converged on the lack of tailored treatment, quality staff, coordinated aftercare, and a need for QRTP outcome evidence. Early implementation lessons of FFPSA congregate care reforms call for additional funding and technical assistance, oversight of congregate care, professionalization and investment in QRTP staff, youth advisory boards to promote youth-driven treatment, and performance- and outcome-based monitoring of QRTPs.

Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study

Purpose A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers. Methods We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC). Results Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow. Conclusions In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies.

Tariff option preferences for smart and bidirectional charging: Evidence from battery electric vehicle users in Germany

Smart charging of battery electric vehicles (BEVs) can contribute to flexibility in power grids and help integrate renewable electricity. Tapping into this potential requires high user acceptance for smart charging and corresponding tariffs. In this paper, we analyze the preferences of current BEV users, representing the potential near-term adopters of smart charging, for different smart charging tariff design elements by conducting a discrete choice experiment with 689 participants in Germany. In doing so, we (1) provide an overview of current BEV users' preferences, (2) identify and characterize BEV user groups with substantial differences in their preferences, and (3) identify barriers for smart charging implementation from the perspective of current BEV users. More specifically, we find that potential cost savings along with the pricing scheme and charging mode are the most important tariff elements, whereof a pre-defined price corridor with an emergency price for grid bottlenecks and charging a safety buffer before applying smart charging are most preferred. We identify three user groups, with a large share of innovative adopters. Moreover, driving range or reluctance regarding data sharing can represent barriers for smart charging adoption. Based on our findings, we derive implications for decision-makers in policy and industry.

Evaluating the Perceived Health-Related Effectiveness of 'The Daily Mile' Initiative in Irish Primary Schools.

Many Irish primary school children do not meet recommended physical activity (PA) guidelines. The Daily Mile (TDM) is a primary school initiative designed to increase children's PA output. This study evaluates TDM's perceived effect on Irish primary school children's health-related metrics. A mixed-methods study, comprising two data collection phases, used the RE-AIM framework to evaluate TDM. Phase One involved teachers, principals and classroom assistants (n = 191) from TDM-registered schools completing a questionnaire. Two TDM-registered schools participated in Phase Two, where (i) interviews were conducted with each principal, (ii) a teacher sub-sample (n = 4) participated in a focus group, and (iii) a child sub-sample (n = 14) participated in separate focus groups. TDM was perceived to positively impact the markers of children's health, including their PA behaviour, physical fitness and social well-being. Inclement weather (66.5%) and a lack of time (56.5%) were reported as the top-ranked implementation barriers. Moreover, TDM's repetitive nature often left children feeling disinterested and resulted in some teachers modifying the initiative to maintain engagement levels. Maintaining the long-term implementation of TDM and its health benefits in primary schools may require bespoke amendments to the original format to preserve children's engagement.

Circular economy integration in traditional business models: Strategies and outcomes

This study embarks on a critical examination of the integration of circular economy (CE) strategies into traditional business models, a pivotal transition in the quest for sustainable development. The purpose of the study is to elucidate the barriers hindering the effective adoption of CE principles and to propose actionable recommendations for overcoming these obstacles. Employing a comprehensive methodological framework, the study synthesizes findings from a broad array of literature, augmented by empirical data, to provide a nuanced understanding of the challenges and opportunities inherent in CE implementation. Key findings reveal that insufficient resources, resistance to change, and the complexity of integrating CE into existing business structures are major impediments. These barriers are dissected to uncover underlying causes, such as inadequate funding, stakeholder inertia, and logistical challenges in material recovery and recycling. The study concludes that addressing these issues requires a multifaceted approach, including the development of unified conceptual frameworks, increased financial and technical support, and enhanced stakeholder engagement. Furthermore, it emphasizes the role of consumer behavior in the success of CE initiatives, advocating for more research into consumer attitudes and the promotion of sustainable consumption practices. The recommendations presented aim to guide businesses and policymakers in fostering an environment conducive to CE, thereby accelerating the transition towards a sustainable and resilient economic model. Keywords: Circular Economy, Business Models, Sustainable Development, Resource Efficiency, Consumer Behavior, Implementation Barriers.

A Qualitative Evaluation of Smoke-Free Policy Implementation among the Hospitality Industry in Yogyakarta, Indonesia

Background: The Indonesian government has implemented various regulations, including smoke-free policies (SFPs) aimed at reducing exposure to second-hand smoke and improving public health. However, the implementation of these policies has encountered challenges. Objective: This study aimed to investigate the implementation of SFP in the hospitality industry in Yogyakarta, Indonesia. Methods: Three focus group discussions with the managers of hotels, restaurants, and coffee shops (n=19) were conducted in November 2021. Thematic analysis was used to analyse the data. Results: Three themes were identified: 1) Efforts to implement SFPs at hospitality premises; 2) Reasons for adopting SFPs; and 3) Challenges for policy implementation. Many hospitalities industry have undertaken efforts to implement SFPs, though they are not comprehensive. The reasons for implementing SFPs include protecting second-hand smokers, meeting guest preferences, and creating a fresher environment. Resistance from customers has become a significant challenge, as some view SFPs as an infringement on personal freedom. Furthermore, unclear sanctions and enforcement from the government also highlighted by participant as the main barriers of SFPs implementation. Conclusion: Overall, while there is significant effort to implement SFPs in hospitality venues, challenges such as customer resistance and unclear government guidance persist. This condition underscores the need for clearer policies and support mechanisms for successful implementation.

TrajVis: a visual clinical decision support system to translate artificial intelligence trajectory models in the precision management of chronic kidney disease.

Our objective is to develop and validate TrajVis, an interactive tool that assists clinicians in using artificial intelligence (AI) models to leverage patients' longitudinal electronic medical records (EMRs) for personalized precision management of chronic disease progression. We first perform requirement analysis with clinicians and data scientists to determine the visual analytics tasks of the TrajVis system as well as its design and functionalities. A graph AI model for chronic kidney disease (CKD) trajectory inference named DisEase PrOgression Trajectory (DEPOT) is used for system development and demonstration. TrajVis is implemented as a full-stack web application with synthetic EMR data derived from the Atrium Health Wake Forest Baptist Translational Data Warehouse and the Indiana Network for Patient Care research database. A case study with a nephrologist and a user experience survey of clinicians and data scientists are conducted to evaluate the TrajVis system. The TrajVis clinical information system is composed of 4 panels: the Patient View for demographic and clinical information, the Trajectory View to visualize the DEPOT-derived CKD trajectories in latent space, the Clinical Indicator View to elucidate longitudinal patterns of clinical features and interpret DEPOT predictions, and the Analysis View to demonstrate personal CKD progression trajectories. System evaluations suggest that TrajVis supports clinicians in summarizing clinical data, identifying individualized risk predictors, and visualizing patient disease progression trajectories, overcoming the barriers of AI implementation in healthcare. The TrajVis system provides a novel visualization solution which is complimentary to other risk estimators such as the Kidney Failure Risk Equations. TrajVis bridges the gap between the fast-growing AI/ML modeling and the clinical use of such models for personalized and precision management of chronic diseases.

Resident Care in the “In-Between Time”: Cross-Sector Perspectives on Enhancing Synergy Between Palliative Care and Permanent Supportive Housing

Despite established disparities in serious illness prevalence among formerly homeless people living in permanent supportive housing, there is a dearth of research aimed at promoting and enhancing palliative care service delivery in this setting. This paper describes current practices, perceived barriers, and recommendations in permanent supportive housing for residents living with serious illness through a thematic analysis of interviews with cross-sector stakeholders ( n = 30) from the Research and Supportive Care at Later-life for Unhoused People (RASCAL-UP) study. Themes identified across resident care, program collaboration, and policy and environment areas included: (1) unique resident care needs; (2) on-site relationships; (3) adaptation of aging, disability, and healthcare services for residents; (4) internal implementation barriers; (5) preparing the environment for serious illness; and (6) missing levels of care. From these results, we put forth recommendations for future collaborative care intervention development, supportive housing policy, and capacity-building efforts for healthcare and housing providers alike.

Providing EBP Training in Graduate School to Strengthen the School Mental Health Workforce: A Pilot

ABSTRACT Offering mental health (MH) care in schools may help youth overcome barriers to accessing services. However, the diverse school MH workforce receives disparate training in evidence-based practice (EBP) across disciplines. Many implementation efforts focus on training independently practicing providers; however, strengthening EBP training during graduate school may have wide-reaching benefits for graduate students and the students they will serve in schools. The TRAILS (Transforming Research into Action to Improve the Lives of Students) implementation program partnered with a school psychology graduate program for a quality improvement project to examine the feasibility and proximal, training-level outcomes of offering TRAILS EBP training to school MH graduate students. Specifically, a graduate instructor was trained to provide clinical and implementation support to graduate students (n = 12) in delivering transdiagnostic cognitive-behavioral therapy (CBT) skills to 3rd-12th grade students (n = 33). A mixed methods approach including interviews, focus groups, and surveys, revealed that those participating in this program (1 graduate instructor, 13 graduate students, and 4 supporting school-based MH professionals) found the training to be acceptable. Graduate student knowledge of and attitudes toward CBT improved significantly (p < .001) from pre-training to the end of the semester. Qualitative interviews revealed several graduate student-specific implementation barriers and facilitators, which should be considered when further developing TRAILS implementation support to graduate programs, and may be of interest to other implementation and training programs as well. This quality improvement project will inform the refinement of embedding TRAILS training during graduate school, supporting broader community access to EBP.

Yoga-based lifestyle intervention for antenatal depression (YOGA-D): study protocol for a pilot randomized controlled trial

Background Depression during pregnancy is associated with pre-term labor, low birthweight, post-partum depression and adverse child outcomes. There are concerns about the safety of anti-depressant medications during pregnancy. Many pregnant women with antenatal depression are neither aware about their depression nor do they have access to non-pharmacological interventions for depression. Evidence suggests that pre-natal yoga can improve antenatal depression. Yoga is native to the Indian culture and women can practice yoga as a ‘self-care’ intervention with minimal training. There is no study till date on the efficacy of yoga on antenatal depression in pregnant women in a low resource (rural) setting in India. This pilot randomized controlled trial aims to study the feasibility, acceptability, and preliminary efficacy of a YOGA -based lifestyle intervention for Antenatal D epression (YOGA-D) in Maharashtra, India. Methods We will undertake a single-blind individual randomized parallel group-controlled pilot trial with 1:1 allocation ratio. Adult women with 12–26 weeks of pregnancy, without any obstetric or medical complications will be randomly allocated to either the active intervention group (Yoga-Sanskar (YS)) or the Enhanced Usual Care (EUC) group. Trained yoga instructors will teach a pre-defined yoga sequence to the participants in the YS arm. In the EUC arm, participants will receive a single session of health education. We will assess trial feasibility using the recruitment, retention, and study completion rates. The primary outcome of depression will be measured using the translated Marathi version of the Patient Health Questionnaire-9. Assessments will be at the baseline, three-months post-randomization, and post-delivery. Discussion This study will help us to understand the barriers in implementation of a yoga-based intervention for antenatal depression in a low-resource/rural setting in Maharashtra, India. Based on the learnings of this pilot trial, we plan to undertake an explanatory randomized controlled trial in the next few months. Registration CTRI (CTRI/2024/05/067176; 10/05/2024).

Key informant perspectives on implementing genomic newborn screening: a qualitative study guided by the Action, Actor, Context, Target, Time framework.

Newborn screening (NBS) programmes are highly successful, trusted, public health interventions. Genomic sequencing offers the opportunity to increase the benefits of NBS by screening infants for a greater number and variety of childhood-onset conditions. This study aimed to describe who needs to do what, when, and for whom to deliver genomic newborn screening (gNBS) and capture perceived implementation barriers and enablers. 'Key informants' (individuals involved in the delivery of NBS) were interviewed. The Actor, Action, Context, Time and Target framework guided data collection and analysis. Participants (N = 20) identified new Actions required to deliver gNBS (educating healthcare providers, longitudinal psychosocial support), NBS Actions needing modification (obtaining consent) and NBS Actions that could be adopted for gNBS (prompt referral pathways). Obtaining consent in a prenatal Context was a source of some disagreement. The Time to disclose high chance results was raised as a key consideration in gNBS programme design. Genetic counsellors were identified as key Actors in results management, but workforce limitations may be a barrier. Online decision support tools were an enabler to offering gNBS. The implementation of gNBS will require behaviour changes from HCPs delivering NBS. Findings can inform how to deliver gNBS at population-scale.

Shifting From Best Practice to Standard Practice: Implementing Measurement-Based Care in Health Systems.

There is a high prevalence of untreated depression in adults and youth observed at the population level in the United States, and many who would benefit from treatment do not receive it. One proposed effort to increase access to care is the use of measurement-based care (MBC; repeated use of symptom measures for screening and treatment guidance) by primary care physicians to treat non-complex cases of depression. MBC has been shown to improve patient outcomes compared to care as usual, but there are barriers that need to be addressed at the health system level for effective implementation to occur. Herein we provide an overview of MBC and detail benefits and barriers of MBC implementation. Relevant considerations and guidance for implementing MBC are presented, and a case example of a health system implementing MBC is included. Though issues of reimbursement, limited human and technological resources, and resistance to systemic change are barriers to implementing MBC, effective strategies exist to overcome these barriers. In addition to helping health systems align with changes to value-based care models, effective implementation of MBC can likely improve patient outcomes and result in net financial benefits.

Perceived barriers and facilitators for model-informed dosing in pregnancy: a qualitative study across healthcare practitioners and pregnant women

BackgroundMost women use medication during pregnancy. Pregnancy-induced changes in physiology may require antenatal dose alterations. Yet, evidence-based doses in pregnancy are missing. Given historically limited data, pharmacokinetic models may inform pregnancy-adjusted doses. However, implementing model-informed doses in clinical practice requires support from relevant stakeholders.PurposeTo explore the perceived barriers and facilitators for model-informed antenatal doses among healthcare practitioners (HCPs) and pregnant women.MethodsOnline focus groups and interviews were held among healthcare practitioners (HCPs) and pregnant women from eight countries across Europe, Africa and Asia. Purposive sampling was used to identify pregnant women plus HCPs across various specialties prescribing or providing advice on medication to pregnant women. Perceived barriers and facilitators for implementing model-informed doses in pregnancy were identified and categorised using a hybrid thematic analysis.ResultsFifty HCPs and 11 pregnant women participated in 12 focus groups and 16 interviews between January 2022 and March 2023. HCPs worked in the Netherlands (n = 32), the UK (n = 7), South Africa (n = 5), Uganda (n = 4), Kenya, Cameroon, India and Vietnam (n = 1 each). All pregnant women resided in the Netherlands. Barriers and facilitators identified by HCPs spanned 14 categories across four domains whereas pregnant women described barriers and facilitators spanning nine categories within the same domains. Most participants found current antenatal dosing information inadequate and regarded model-informed doses in pregnancy as a valuable and for some, much-needed addition to antenatal care. Although willingness-to-follow model-informed antenatal doses was high across both groups, several barriers for implementation were identified. HCPs underlined the need for transparent model validation and endorsement of the methodology by recognised institutions. Foetal safety was deemed a critical knowledge gap by both groups. HCPs’ information needs and preferred features for model-informed doses in pregnancy varied. Several pregnant women expressed a desire to access information and partake in decisions on antenatal dosing.ConclusionsGiven the perceived limitations of current pharmacotherapy for pregnant women and foetuses, model-informed dosing in pregnancy was seen as a promising means to enhance antenatal care by pregnant women and healthcare practitioners.