Knowledge Barriers Research Articles

Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review.

Although the COVID-19 pandemic has caused the need for the largest mass vaccination campaign ever undertaken to date, African, Caribbean, and Black (ACB) populations have shown both a disproportionately high degree of negative impacts from the pandemic and the lowest willingness to become vaccinated. This scoping review aims to investigate low vaccine uptake in ACB populations relative to public health in high-income countries. A search was conducted in MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), APA PsycInfo (OvidSP), the Cochrane Central Register of Controlled Trials (OvidSP), the Cochrane Database of Systematic Reviews (OvidSP), the Allied and Complimentary Medicine Database (Ovid SP), and the Web of Science following the Joanna Briggs Institute (JBI) framework for scoping reviews, supplemented by PRISMA-ScR. Theoretical underpinnings of the intersectionality approach were also used to help interpret the complexities of health inequities in the ACB population. The eligibility criteria were based on the population, concept, context (PCC) framework, and publications from 2020-19 July 2022 which discussed vaccine uptake amongst ACB people in high-income countries were included. Analysis was carried out through thematic mapping and produced four main themes: (1) racism and inequities, (2) sentiments and behaviors, (3) knowledge and communication, and (4) engagement and influence. This study has contributed to the identification and definition of the issue of low vaccine uptake in ACB populations and has illustrated the complexity of the problems, as vaccine access is hampered by knowledge, psychological, socioeconomic, and organizational barriers at the individual, organizational, and systemic levels, leading to structural inequities that have manifested as low vaccine uptake.

The 2023 AO Spine-Praxis Guidelines in Acute Spinal Cord Injury: What Have We Learned? What Are the Critical Knowledge Gaps and Barriers to Implementation?

Narrative summary of the 2023 AO Spine-Praxis clinical practice guidelines for management in acute spinal cord injury (SCI). The objective of this article is to summarize the key findings of the clinical practice guidelines for the optimal management of traumatic and intraoperative SCI (ISCI). This article will also highlight potential knowledge translation opportunities for each recommendation and discuss important knowledge gaps and areas of future research. Systematic reviews were conducted according to accepted methodological standards to evaluate the current body of evidence and inform the guideline development process. The summarized evidence was reviewed by a multidisciplinary guidelines development group that consisted of international multidisciplinary stakeholders. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of the evidence for each critical outcome and the "evidence to recommendation" framework was used to formulate the final recommendations. The key recommendations regarding the timing of surgical decompression, hemodynamic management, and the prevention, diagnosis, and management of ISCI are summarized. While a strong recommendation was made for early surgery, further prospective research is required to define what constitutes sufficient surgical decompression, examine the role of ultra-early surgery, and assess the impact of early surgery in different SCI phenotypes, including central cord syndrome. Furthermore, additional investigation is required to evaluate the impact of mean arterial blood pressure targets on neurological recovery and to determine the utility of spinal cord perfusion pressure measurements. Finally, there is a need to examine the role of neuroprotective agents for the treatment of ISCI and to prospectively validate the new AO Spine-Praxis care pathway for the prevention, diagnosis, and management of ISCI. To optimize the translation of these guidelines into practice, important barriers to their implementation, particularly in underserved areas, need to be explored. Ultimately, these recommendations will help to establish more personalized approaches to care for SCI patients. The recommendations from the 2023 AO Spine-Praxis guidelines not only highlight the current best practice in the management of SCI, but reveal critical knowledge gaps and barriers to implementation that will help to guide further research efforts in SCI.

Pre-Existing Knowledge and Self-Reported Barriers to uptake Eye Care among Type-1 Diabetic Patients attending a City Diabetic Hospital at Southern Bangladesh

Purpose: To find out the knowledge about diabetic complication of eye & the barriers to uptake of diabetic eye care among Type-1 diabetic patients. Method: This is a hospital based observational case series of 100 cases of Type-1 Diabetes Mellitus (DM1). Demographic data, knowledge about diabetic complication of eye, self reported barriers to uptake diabetes eye health service were collected by face-to-face interview. Interview was done on a formulated questionnaire including pre-existing knowledge about diabetes related ocular problems and factors act as a barrier to receive eye care. All DM1 patients attending in a city diabetic hospital during one year (from October 2017 to September 2018) period were included. Written consent was taken. Patients refuse to give consent & aged more than 30 years were excluded. Results: The mean age of participants was (17.09 ± 3.92) years with range 6 to 23 years and 57% of them were female. About 59 % subjects were students. Around 50% of the respondent had knowledge about the adverse effect of diabetes on eyes, among them only 6% had knowledge about retina problems and 3% knew that blindness may happen. Only 32% of study population gave answer about the reason behind not seeking diabetic eye care and the most common (12%) answer was “not feeling necessity of eye care”. Conclusion: DM1 patients are more prone to systemic and ocular morbidity. The main reasons for not getting eye care services was lacks of awareness. Increase awareness building program can bring them to the eye health service which will very important to reduce diabetic ocular morbidity of young people who have long life in front of them.

Lean constructions barriers in Jordan's building sub-sector: A comprehensive knowledge framework

Lean Construction (LC) is a managerial approach to tackle productivity concerns. Minimize waste and address prevalent challenges in the construction industry. Despite that, this approach is still fresh in developing countries. This research aims to explore the barriers to LC implementation in the Jordanian building sub-sector, and develop a suggested framework that helps to connect these barriers. To achieve these objectives, 27 barriers were extracted from the literature review and modified based on academic professionals' opinions. The research methodology depends on the quantitative approach, where these barriers form the content of a questionnaire survey distributed to Jordanian building professionals; a total of 207 responses were returned and analyzed by different statistical analyses: Mann-Whitney U, Principal Component Analysis (PCA), and Linear Regression. The results indicated that the building professionals in Jordan needed a higher awareness and knowledge of the LC. Furthermore, the main finding of this research demonstrates that knowledge barriers are the ones preventing the implementation of LC in the Jordanian building sub-sector; these barriers are: lack of training in LC, lack of knowledge of LC concepts, and lack of knowledge about LC implementation. In addition, the remaining barriers were grouped into three groups based on PCA results: government, attitude, and resource. Moreover, the results include a suggested knowledge framework that helps overcome the knowledge barriers after studying the connection between them and the other groups of barriers.

Barriers to adopting evidence-based practice: A cross-sectional study among undergraduate nursing students in Vietnam

Background & Aim: As the future nursing workforce, evidence-based practice is one of the key competencies for undergraduate nursing students in delivering safe and quality care. While plenty of studies investigate nurses' evidence-based practice, understanding this topic is limited among nursing students. Thus, this study aimed to identify barriers and associated factors to adopting evidence-based practice among undergraduate nursing students in Vietnam.
 Methods & Materials: A cross-sectional descriptive study was conducted on 395 undergraduate nursing students who were conveniently selected at a public university in Central Vietnam from March to May 2022. A questionnaire was administered to collect information about general characteristics and barriers to implementing evidence-based practice regarding knowledge, practice, authority, setting, and research utilization. Data were analyzed using SPSS 20.0 with descriptive statistics, independent T-test, one-way analysis of variance, and Pearson's correlation coefficients.
 Results: Among 395 participants, most of them faced barriers regarding knowledge (91.9%), practice (96.2%), authority (89.1%), clinical setting (92.2%), and research utilization (96.2%). The most mentioned barriers were related to research utilization and clinical settings. Barriers to adopting evidence-based practice were significantly associated with a level of seeking information about research/scientific evidence and a level of participating in research/implementing evidence-based practice (p<.05). Moreover, knowledge barriers were related to age, school year, and sources of data for searching (p<.05).
 Conclusion: Undergraduate nursing students have faced many barriers when adopting scientific evidence into clinical practice. Supporting students in addressing these barriers is necessary to enhance their evidence-based practice competency.

The role of speech-language pathologists in frailty: An Australian qualitative study of perceptions, practices, and opportunities

Purpose Frailty is an important geriatric syndrome, yet the role of speech-language pathologists (SLPs) in identifying and managing frailty remains unclear. The purpose of this study was to explore the perspectives of SLPs regarding frailty, including enablers, barriers, and opportunities for multidisciplinary improvements to frailty prevention and management. Method In this exploratory qualitative study, data were collected from SLPs through online semi-structured interviews and analysed using a qualitative descriptive approach. Result Seven Australian SLPs from acute, rehabilitation, geriatric, and community settings were interviewed. Three overarching themes were created: (1) SLPs understand the clinical manifestation of frailty but do not use explicit language to describe it; (2) SLPs acknowledged the importance of addressing knowledge gaps and barriers in frailty management; and (3) SLPs do not currently have an established identity within the frailty field, but do have a role within the multidisciplinary team and the care of people living with frailty. Conclusion Participants’ understandings of frailty varied and highlighted the lack of education about frailty as barriers to effective service provision. Additional research is required to produce formal recommendations for SLPs regarding frailty management, which may include frailty education to SLPs and awareness of SLPs’ role within the multidisciplinary team.

Assessment of Parents' Knowledge, Attitudes, and Satisfaction of Childhood Immunization: A Cross-Sectional Survey from a Rural District of Sindh, Pakistan

Background: Immunization is a cornerstone of public health, preventing millions of deaths annually, especially among children. Despite global efforts to increase vaccination coverage, significant gaps remain, influenced by parental knowledge, attitudes, and satisfaction with immunization services. These gaps are particularly pronounced in rural and socio-economically disadvantaged regions. Objective: This study aimed to assess parents' knowledge, attitudes, and satisfaction regarding childhood immunization and to identify barriers to vaccination in a rural district of Sindh, Pakistan. Methods: A cross-sectional survey was conducted in two cities, Mirpurkhas and Digri, within the Mirpur Khas district. Using the Raosoft® Sample Size Calculator, a sample size of 382 participants was determined with a 95% confidence level and a 5% margin of error. Participants were selected through convenience sampling. Data collection involved a semi-structured questionnaire developed from extensive literature review and validated through expert focus group discussions. The questionnaire covered demographics, perceptions of immunization, knowledge of the Expanded Programme on Immunization (EPI) schedule, and satisfaction with immunization services. Data analysis employed SPSS version 25, utilizing descriptive statistics and Mann-Whitney tests to analyze differences between variables. Results: Among 382 respondents, 55.76% were male, and 44.24% were female. A significant proportion (43.45%) were aged between 21–30 years. The majority acknowledged the importance of immunization (96.85% agreement), yet knowledge gaps were evident, with only 10.98% correctly identifying vaccines given at birth. Satisfaction with immunization services was high (73.56% satisfied with hospital services), despite 88.46% reporting incorrect knowledge about the vaccine given at birth. Barriers identified included affordability, vaccine unavailability, and long waiting times. Conclusion: While parental attitudes towards immunization were largely positive, significant knowledge gaps and barriers to immunization persist. Efforts to improve immunization coverage in rural Pakistan must address these knowledge deficits and structural barriers, emphasizing the development of targeted awareness campaigns and enhancing the accessibility and quality of immunization services.

Knowledge, practice and communication barriers for oncology doctors in Chile when addressing the sexuality of their patients.

Communication in a doctor-patient relationship constitutes a crucial aspect in medicine, and its multiple dimensions encompass a wide variety of ethical issues. Communication is particularly relevant in oncology, because it requires continually dealing with sensitive topics in one of the most highly vulnerable situations as a human: illness and proximity to death. Sexuality is one of these topics because it constitutes an area that is frequently affected by cancer and cancer treatment, which may include causing significant distress, the reinforcement of a negative self-image, relationship conflicts and a permanent memory of having cancer. The objective of this research is to describe the perception of knowledge and communications practices used by oncology doctors with respect to sexual health in the care of their patients, as well as the barriers found when it comes to confronting the topic. An exploratory quantitative, descriptive and cross-sectional study was carried out, in which a self-administered questionnaire was given to oncology doctors who practise in Chile. This questionnaire had 41 closed questions with answers on a Likert scale and was previously validated by being reviewed and applied to a pilot group of five professionals (one medical bioethics expert and four doctors in the field of oncology). The data were analysed with the SPSS statistical program v. 20, using descriptive statistics. The main results show that the surveyed doctors consider sexuality to be an important part of patients' quality of life. However, this finding does not align with the practices given for including it as part of clinical care. The professionals refer as the main barriers those that are attributed to the structural functioning of the institution, giving little value to those barriers related to personal aspects or those associated with patient characteristics and/or behaviors. The results of this study show that, despite oncology doctors seeing sexuality as an important aspect of the quality of life of their patients, they do not include the topic in clinical care. Given that one of the main barriers is obstacles relating to the institution, it is necessary to create political institutions that create the conditions for including this area as a relevant part of cancer patient care.

Implementing decision aids for cardiovascular disease prevention: stakeholder interviews and case studies in Australian primary care.

Australian cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk assessment, but less than half of eligible patients have the required risk factors recorded due to fragmented implementation over the last decade. Co-designed decision aids for general practitioners (GPs) and consumers have been developed that improve knowledge barriers to guideline-recommended CVD risk assessment and management. This study used a stakeholder consultation process to identify and pilot test the feasibility of implementation strategies for these decision aids in Australian primary care. This mixed methods study included: (1) stakeholder consultation to map existing implementation strategies (2018-20); (2) interviews with 29 Primary Health Network (PHN) staff from all Australian states and territories to identify new implementation opportunities (2021); (3) pilot testing the feasibility of low, medium, and high resource implementation strategies (2019-21). Framework Analysis was used for qualitative data and Google analytics provided decision support usage data over time. Informal stakeholder discussions indicated a need to partner with existing programs delivered by the Heart Foundation and PHNs. PHN interviews identified the importance of linking decision aids with GP education resources, quality improvement activities, and consumer-focused prevention programs. Participants highlighted the importance of integration with general practice processes, such as business models, workflows, medical records and clinical audit software. Specific implementation strategies were identified as feasible to pilot during COVID-19: (1) low resource: adding website links to local health area guidelines for clinicians and a Heart Foundation toolkit for primary care providers; (2) medium resource: presenting at GP education conferences and integrating the resources into audit and feedback reports; (3) high resource: auto-populate the risk assessment and decision aids from patient records via clinical audit software. This research identified a wide range of feasible strategies to implement decision aids for CVD risk assessment and management. The findings will inform the translation of new CVD guidelines in primary care. Future research will use economic evaluation to explore the added value of higher versus lower resource implementation strategies.

The Barriers to Shared Decision-making in Exercise Prescription for Children With Asthma: A Qualitative Study From Parents’ Perspective

The knowledge of barriers from the parental perspective is essential for facilitating shared decision-making in the field of pediatric asthma. Participants who were parents of children with a diagnosis of asthma were recruited, and in-depth, semistructured interviews were conducted. The interview transcripts were analyzed thematically using framework methods. Seventeen participants undertook interviews. Three themes and nine subthemes emerged: (1) decision-making need level-limited understanding of decision-making knowledge, ambiguity regarding self-empowerment roles, and lack of family member support; (2) decision-making support level-insufficient ability to evaluate information, inefficient communication with health care professionals, and excessive use of professional terminology; and (3) decision-making outcome level-doubts about the final decision-making choices, time constraints on decision-making, and absence of mechanisms to track decisions made. The findings would serve as crucial foundations for the development of decision-aid programs within the context of pediatric asthma.

Mapping the evolution of university-industry collaboration: A systematic literature review from 2000 to 2022

This research aims to improve knowledge exchange and innovation through collaborations between universities and industries in South-East European Countries (SEECs). The region benefits from better collaboration, and understanding factors such as proximity, motivations, and challenges is crucial. The study begins by suggesting that geographical closeness may influence the strength of university-industry ties and that specific conditions in SEECs may either support or impede these relationships. The paper proposes a new University-Industry Collaboration (UIC) model tailored for SEECs, built upon a review of literature from 2000 to 2022. This review examines factors like location, organizational approaches, types of knowledge exchange, key motivators and barriers, and the evolving role of universities in the region. The study introduces a specialized UIC model that could enhance regional cooperation, emphasizing strategies to overcome barriers and align university and industry goals. By extensively reviewing existing research, the paper contributes valuable insights into UIC in SEECs, aiming to deepen the understanding of these collaborations in the region.

Cervical Cancer Awareness and Screening Practices Amongst Women in Ras Al-Khaimah, UAE and Migrant Women in Sydney, Australia

Cervical cancer is the fifth most common cancer in the UAE and the fourteenth most common cancer among women in Australia (Sung et al., 2021). Despite the introduction of vaccinations and cervical screening programs in both countries, Emirati and non-Emirati women living in Ras Al Khaimah and migrant women living in Sydney still face significant health disparities when accessing cervical cancer screening services. Currently, there is a lack of literature examining the obstacles to and facilitators of cervical screening among these groups of women. This study aimed to better understand the knowledge and awareness of cervical cancer and factors that hinder or promote access to cervical screening among these groups, which is crucial if healthcare professionals and policymakers are to deliver culturally sensitive services. This study was conducted in Ras Al Khaimah (RAK) and Sydney. The results identified several barriers to cervical cancer screening participation, including lack of knowledge, emotional, cultural, religious and psychological barriers, and organizational factors. The findings have implications for policies to address these barriers and encourage women to participate in health awareness initiatives and screening services.

Whole-Body Vibration in Oncology Rehabilitation: Perceived Benefits, Barriers, and Clinician Willingness

Background: Patients with active and prior cancer diagnoses suffer a sequela of physical effects that negatively impact quality of life. Improvements in commonly impacted physiological systems have been achieved with the use of whole-body vibration (WBV). Current usage, appropriate diagnoses, and clinician perceptions of WBV remain unknown despite an increasing body of literature. The purpose of this study was to examine current practices and understand perceived indications, benefits, and barriers for the use of WBV in patients with cancer, particularly of clinicians working with pediatric populations. Methods: A Web-based survey was distributed via e-mail and social media posts to clinicians across the United States serving patients with cancer diagnoses. Results: Of a total of 72 responses, less than 3% of clinicians are currently using WBV in clinical practice. Diagnoses perceived as most appropriate for the use of WBV included leukemia/lymphoma (63.6%), central nervous system cancers (49.4%), and neuroblastoma (46.8%). Bone cancers were reported as the most inappropriate diagnoses (49.4%). Perceived benefits of WBV include improvements in blood flow, muscular strength, and bone mineral density. Lack of training (82%) and access to equipment (75%) were the most commonly reported barriers to use. Conclusion: WBV is perceived to be useful, safe, and beneficial for targeting effects of antineoplastic treatment for patients with cancer diagnoses, though current use is limited because of barriers of cost, access, and clinician knowledge.

COLONTOWN Searching Safari: Education to remove barriers to pursue clinical trials for patients with metastatic colorectal cancer (mCRC).

82 Background: Clinical trials can expand otherwise limited treatment options for patients with metastatic cancer. Yet, the complexity of the trial landscape can prevent patients from pursuing trials. Even in mCRC patients motivated to participate in trials, 79% described trial search negatively, mainly ‘overwhelming.’ We hypothesized that “clinical trial-literacy” and familiarity with the tools/process of pursuing trials were critical precursors for patients to incorporate trials into their treatment plan. To test this, we, as managers of COLONTOWN, a large, online CRC patient/caregiver community, developed an interactive course. Methods: We reviewed many posts from the COLONTOWN clinical trial groups to identify gaps between the desire to participate in a trial and the knowledge/tools needed to do so. We then determined those most likely to benefit as mCRC MSS patients interested in, but not in urgent need of, trials. We developed a 4-week long course with 5 hours of live online sessions and 5 hours of homework. Participants built fluency in the language of clinical trials, learned about available tools, and identified and assessed trials in the context of their personal needs and disease dynamics. Unlike most other trial resources, the focus was on informed patient-centered decision-making, not on the science or mechanics of trials. The course was offered 3 times in 2022/23 with iterative improvements after each session. Participants (n=48) were assessed for their attitudes around trials before and after the course to measure impact. Results: We found that our repeatable, scalable course improves mCRC patient perceptions of and skills to pursue trials as evidenced by pre-course vs. post-course surveys. This included average response to “How prepared do you feel to find a clinical trial?” increasing from 2.1 to 3.8 on a 5-pt scale and positive sentiment about the process rising from 7% to 71% (table). Positive feedback on meeting course objectives and amount of coursework being ‘just right’ (96% and 92% of responses, respectively) support the material’s value for time invested. Conclusions: Through systematic skill building, self reflection, and practical tools, our guided course can build confidence and empower patients and caregivers to take the next step to pursue clinical trials. Patient education can indeed help overcome often-overlooked emotional and knowledge barriers to pursuing clinical trials present even in a motivated patient population. Next, we plan to create and assess the benefit of an additional on-demand e-learning course and to expand to other patient groups. [Table: see text]

Exploring pharmacovigilance practices and knowledge among healthcare professionals: A cross-sectional multicenter study.

Healthcare professionals' awareness of adverse drug reaction reporting and pharmacovigilance practices differ by country. The study assesses healthcare professionals' knowledge, practice, and potential barriers to pharmacovigilance-related practices and reporting adverse drug reaction. A cross-sectional investigation was conducted in government and private healthcare settings. The study included licensed physicians, pharmacists, and nurses. To examine knowledge, practice, and potential barriers to pharmacovigilance-related practices and adverse drug reaction reporting, a 22-item validated questionnaire was used. The final analysis included 311 healthcare professionals. Most healthcare professionals, 59% (N = 182), mentioned encountering patients with adverse drug reactions during the last year. On the other hand, most healthcare professionals, 54% (n = 167), mentioned that they had not reported adverse drug reactions. A good proportion of respondents mentioned that it is essential to report adverse drug reactions (N = 288, 92.6%), availability of adverse drug reactions reporting forms in practice sites (N = 216, 69.5%), had awareness regarding how to report adverse drug reactions (N = 221, 71.1%), the necessity of reporting minor/less important adverse drug reactions (N = 265, 85.2%), and were trained on how to report adverse drug reactions (N = 201, 64.6%). Adverse drug reaction reporting program in the United Arab Emirates (N = 148, 47.6) was known to many healthcare professionals. Lack of time was the major impediment to reporting adverse drug reactions at 42.7% (N = 133). The predictor variable work experience does add to the model (p < 0.05) concerning association with filling of adverse drug reaction forms (Estimate = 0.380; SE = 0.452; p = 0.400), professional role (Estimate = 0.454; SE = 0.673; p = 0.500). In addition, the predictor variable practice setting adds to the model (p < 0.05) concerning the knowledge regarding the availability of adverse drug reaction reporting forms (Estimate = -1.229; SE = 0.298; p = 0.000), training on how to report adverse drug reactions (Estimate = -0.660; SE = 0.294; p = 0.025), and awareness regarding the adverse drug reaction reporting program in the United Arab Emirates (Estimate = -1.032; SE = 0.280; p = 0.000). Pharmacists had the most knowledge regarding adverse drug reaction reporting and pharmacovigilance. The underreporting of adverse drug reactions was documented among physicians and nurses. Lack of time was the most significant barrier to reporting adverse drug reactions, followed by uncertainty and complicated adverse drug reaction documentation forms.

Зміна парадигми поведінкової економіки: усунення бар’єрів, що перешкоджають поведінковим змінам

Socioeconomic development of society takes place under the constant influence of changes caused by scientific and technological progress, mechanisms of economic laws, cooperation and integration, world globalization processes, marketing strategies. Economic development plans are closely related to the State policy, changing demand for certain types of goods, products and services; further, requirements for their quality and value, provide for constant and timely identification of the reasons for deviation from the planned programs and the search for ways to eliminate them or make certain adjustments to achieve the set goal. The behavioral doctrine helps to understand how the characteristics of the human cognitive-psychological system affect economic decisions, and explains economic, social, environmental and other motives, makes it possible to form general principles of behavior of economic agents in market conditions. The aim of the article is to identify tendencies in the changing paradigm of behavioral economics and ways to eliminate barriers that hinder behavioral changes. In the process of conducting the study and presenting its results, the following methods were used: analysis, synthesis, generalization, concretization. The influence of positive and negative reactions on human behavior is considered. The tendencies of transformation of behavioral economics (from the origins of the 1950s to the present) are analyzed. The change of clusters is displayed. Discoveries in psychology and economics have enabled behaviorist economists to identify the factors that drive human behavior, breaking the scientific consensus. The features of the approach called the «model of «pathology of supporters» are defined. The internal (attitudes and beliefs; motivation and willpower; self-efficacy) and the external (social and physical environment; support systems) barriers influencing behavioral changes have been identified. A questionnaire is proposed to identify barriers to behavior change in order to minimize or completely eliminate them. Barriers are systematized into three key groups: physical (economic); social (psychological); knowledge barriers. Prospective areas for further research are the approbation of the proposed questionnaire to identify barriers in terms of target audiences.

Green Finance Barriers and Solution Strategies for Emerging Economies: The Case of India

The need to increase green developers&#x2019; access to finance is critical and urgent for emerging economies that are currently facing an annual green financing gap of &#x0024;2.5&#x00A0;trillion. This article investigates barriers and strategies for promoting green finance (hereafter GF) in India which is one of the fastest emerging economies globally. The article uses a two-phase methodology. In the first phase, an exhaustive literature survey followed by a three-round modified Delphi method is used to extract significant barriers and solution strategies for GF adoption. In the second phase, the best worst method is used to rank the barriers using their relative weights, and the solution strategies by utilizing global weights as input. The article finds that policy, economic, and knowledge barriers are the top three barriers for GF adoption. Clear green policies and risk assessment frameworks; credit enhancement mechanisms for green developers; low-cost refinancing and securitization markets for green technology and products; and combining directed finance with incentivized finance, public finance with private finance, and financial markets with technology are some of the most important strategies obtained from this article for promoting GF adoption.

Perception and barriers to access Pre-exposure Prophylaxis for HIV/AIDS (PrEP) among the MSM (men who have sex with men) Brazilian Amazon: A qualitative study.

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that consists in the use of antiretroviral drugs by seronegative people at risk of HIV. Negative perceptions, inadequate understanding, and access barriers have been associated with decreased medication adherence. Manaus is the largest city in the Brazilian Amazon, where the incidence of HIV/AIDS is high, and the rates of adherence to the antiretroviral treatment for HIV and PrEP are low. In this qualitative study among PrEP users, mostly MSM, we explored perceptions, knowledge, and access barriers. We conducted 21 in-depth interviews with an intentionally sampled group of participants who had used PrEP at least once in their lifetime, selected through the snowball technique, between April and July 2022. A thematic analysis was conducted with a predominantly inductive approach. We highlight three relevant themes: (i) access to information about PrEP and its influences on users, (ii) access, monitoring, and barriers encountered, and (iii) facilitators for PrEP adherence and sexual behaviors. One of the negative perceptions identified in the study involves a misunderstanding of the association between PrEP users and the HIV/AIDS status. Participants revealed that some non-PrEP users suspect that individuals claiming PrEP usage are concealing an HIV-positive status to engage in unprotected sex. Lack of information by health professionals regarding HIV prevention methods poses significant barriers to PrEP access and adherence. Participants emphasized social media's crucial role in PrEP awareness. The results suggest a need to increase digital outreach regarding PrEP, decentralize PrEP services, and provide comprehensive healthcare training to improve the effectiveness of the preventive measure.

Prostate cancer knowledge and barriers to screening among men at risk in northern Tanzania: A community-based study

BackgroundAlthough prostate cancer (Pca) screening plays important role in early diagnosis and reduction of mortality, Tanzanian men are relatively unscreened. We aimed to investigate Pca knowledge level and barriers to screening among at-risk men in northern Tanzania. MethodsThis community-based survey was conducted in northern Tanzania from May to September 2022, involving men age ≥40 years. Participants were invited by announcing in local churches, mosques, brochures, and social media groups. Participants attended a nearby health facility where survey questionnaires were administered. Knowledge level was measured on the Likert scale and scored as poor (<50 %) or good (≥50 %). ResultsA total of 6205 men with a mean age of 60.23 ± 10.98 years were enrolled in the study. Of these, 586 (9.5 %) had ever been screened for Pca. Overall, 1263 men (20.4 %) had good knowledge of Pca. Having health insurance, knowing at least 1 risk factor or symptoms of Pca, and hospital as the source of Pca information were significantly associated with ever being screened. The most common reasons for not being screened were a belief that they are healthy (n = 2983; 53.1 %), that Pca is not a serious disease (n = 3908; 69.6 %), and that digital rectal examination (DRE) as an embarrassing (n = 3634; 64.7 %) or harmful (n = 3047; 54.3 %) procedure. ConclusionHaving Pca knowledge, health insurance and hospital source of information were correlated with increased screening. False beliefs about DRE and the seriousness of Pca had negative effects on screening. Increasing community knowledge and universal health coverage would improve uptake of Pca screening.

Prática baseada em evidências e atuação clínica em linguagem infantil: uma pesquisa online com fonoaudiólogos brasileiros

ABSTRACT Purpose To characterize the knowledge, skills, opinions, and main barriers perceived by speech-language pathologists, in child language in Brazil, regarding evidence-based practice (EBP). Methods The study was conducted between August 2021 and July 2022 using an online questionnaire. In addition to sociodemographic and field data, 22 items related to EBP were considered and subdivided into “knowledge”, “skills”, “opinion” and “barriers”. Each item had five response options (strongly disagree, disagree, not decided, agree, strongly agree). A total of 122 speech-language pathologists who work with child language answered the questionnaire. Their responses were described by the percentage of frequency distribution. The time since graduation and the level of proficiency in English were considered to compare the distribution pattern of the answers. Results Although most speech-language pathologists report having learned the basics of EBP in their academic training, there are weaknesses in their knowledge and lack of mastery of search strategies and critical evaluation of scientific articles. Although most agree that EBP’s use is necessary for speech-language practice and consider the need to increase the use of scientific evidence in their daily practice, the lack of articles, difficulties related to the practical application of scientific results and lack of collective support among colleagues are identified as barriers. Conclusion This study alerts the academic community to the urgency of considering EBP in the context of Brazilian Speech-Language Pathology.