Implementation Barriers Research Articles

Development of a Novel Shared Care Intervention to Address Obstructive Sleep Apnea in Rural West Virginia.

There is a critical need to create sustainable interventions for the nearly 80% of patients with undiagnosed obstructive sleep apnea (OSA), particularly in rural communities where notable health disparities exist. The objective of this study is to use implementation science and community engaged research methods to address OSA care disparity in West Virginia (WV) by designing an intervention to support primary care providers (PCPs) who treat patients in rural WV. Our overall project is grounded in context-sensitive approaches to address the unique challenges of OSA management in the rural primary care setting. Here we describe the pre-implementation work conducted to identify the determinants of implementation in rural settings and the selection of strategies that led to the initial program and will inform our prospective implementation effectiveness study. The Veterans Affairs Quality and Enhancement and Research Initiative (QUERI) Implementation Roadmap to inform program development. Barriers and facilitators were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR) to inform our implementation plan. We derived ERIC strategies from the CFIR mapping exercise to identify the strategies that would improve implementation outcomes in rural primary care. Themes identified from our previous mixed methods community engagement study with PCPs were reviewed and mapped to CFIR domains and coded as implementation barriers or facilitators. Facilitators included provider recognition of the relative importance of OSA management, provider knowledge about OSA, and perceived patient receptivity to having a PCP evaluate and treat OSA. Predominant barriers included: PCPs' relatively low self-reported confidence in their ability to identify or manage OSA, challenges with clinical process and workflow that facilitate program adoption, and a relative lack of community-based resources or networks to support patients in such a program. One major barrier mapped to the CFIR domain "inner setting" was lack of clinical processes to support OSA screening, testing and referrals. The implementation strategy category that was identified to be most important for the OSA care program implementation was "Develop stakeholder interrelationships." Other important strategy categories included "Provide interactive assistance" and "Support for clinicians" in the targeted rural communities. Leveraging a community-engaged approach and using implementation science informed the development and implementation of a novel OSA program to educate and support PCPs in OSA diagnosis and management that is tailored to the realities of rural primary care. This program, the West Virginia Obstructive Sleep Apnea Academic Mentoring Partnership, is well-positioned to address the care disparity for OSA in rural communities in a sustainable way.

A cross-sectional needs assessment for a trauma-informed care curriculum for multidisciplinary healthcare providers

BackgroundTrauma-informed care (TIC) is a framework that recognizes the pervasive impact of trauma, aiming to enhance both patient outcomes and provider well-being. Given the high prevalence of trauma among individuals seeking healthcare, it is essential for healthcare providers (HCPs) to be trauma informed. However, standardized TIC curricula for training healthcare staff are lacking. This study assessed perceptions towards TIC among multidisciplinary HCPs, patients, and leadership staff at two urban hospitals in Canada.MethodsThis mixed-methods prospective cross-sectional study employed Kern’s six-step approach for curriculum development. A needs assessment was conducted via an online questionnaire for HCPs and semi-structed interviews with individuals from the three participant groups: HCPs, patients, and leadership staff. The questionnaire assessed knowledge, skills, and attitudes regarding TIC. Semi-structured interviews explored perspectives on TIC, including curriculum priorities and potential implementation barriers. Findings informed the development of a virtual TIC curriculum, with iterative feedback collected to refine and assess its acceptability.ResultsAmong 106 HCP questionnaire respondents including Medical Doctors, Social Workers and Registered Nurses, 96 (90.6%) identified as women, and 97 (91.5%) as providers of direct patient care. Despite 93 (87.7%) having prior TIC education, 77 (72.6%) reported low confidence in applying TIC knowledge in clinical practice. Key perceived challenges to TIC training implementation included time constraints and lack of standardization across disciplines. A multimedia, self-paced course was the preferred solution. Thematic analysis of interviews with 28 participants (10 HCPs, 10 patients, 8 leadership staff) revealed six major themes: healthcare interactions, TIC implementation, training needs, system level barriers, curriculum preferences, and systems level improvements. Participants underscored the risk of re-traumatization to patients in healthcare settings without TIC and emphasized the need for universal TIC training for all staff.ConclusionThis study revealed a strong interest in a TIC course for multidisciplinary HCPs, supports the translation of knowledge into practice and incorporates a focus on cultural humility. Integrating insights from key stakeholders in this needs assessment phase resulted in the development of a TIC curriculum inclusive of diverse voices and viewpoints and strengthened the understanding of contextual factors that will support effective TIC implementation.

What hinders AI adoption in MSMEs of India? – Importance and interlinkages between the barriers

Purpose This study aims to help MSMEs in understanding the barriers to adoption of AI and how they are interlinked with each other. There is a general consensus amongst researchers and corporates that artificial intelligence (AI) can help in better and faster decision-making. However, many medium, small and micro enterprises (MSMEs) have not adopted AI in the context of automation. Design/methodology/approach The authors have assigned weights to the barriers of AI implementation by using Best Worst Method (BWM). In this study, the authors argue that the more alternatives there are, the greater the chances of making an error in judgment. This is a drawback of the traditional comparison matrices that are used for assigning weights to attributes/alternatives/factors. Subsequently, we have computed the influence of the barriers on each other using the DEMATEL method. This helped us understand what the drivers of the bottlenecks are and the interlinkages between them. Findings The barriers identified are top management support, change resistance from employees, lack of knowledge about AI in automation, Lack of resources to implement the solution, uncertainty regarding the future of benefits, perception of job loss and subsequent conflicts and lack of perseverance. Price of automation, uncertainty regarding future and top management support were identified as factors that drive other bottlenecks. Practical implications The study has theoretical implications, as it corroborates the technology organization environment (TOE) framework in the context of AI automation in MSMEs. This is the first study of this type, to the best of the authors’ knowledge, on MSMEs in India. Factors such as lack of top management support, change resistance, perseverance and price of the automation can be viewed as organizational blocks to AI implementation. Lack of knowledge about AI in automation and Lack of resources are technology-related barriers, whereas uncertainty regarding the future of technology and job loss are related to the environment. This has implications for the top management of MSMEs. The results did show that some bottlenecks act as drivers of other bottlenecks. Thus, the MSMEs, which inherently have limited resources, can prioritize their focus on the ones that have high driving power. Originality/value The authors have used the TOE framework to refer to the technological, organizational and environmental factors that affect the decisions to adopt a new technology. The decision of the business and government, to participate in the diffusion of AI, may be contingent upon monitoring the bottlenecks and designing mechanisms to enhance use of AI for automation by MSMEs across India. Thus, this study has wide policy implications.

Primary Care Providers' Perspectives on Receiving Opportunistic Genomic Results from a National Study - the Million Veteran Program Return Of Actionable Results (MVP-ROAR) Study.

Primary Care Providers' Perspectives on Receiving Opportunistic Genomic Results from a National Study - the Million Veteran Program Return Of Actionable Results (MVP-ROAR) Study.

Acceptability of digital health interventions in perioperative care: a systematic review and narrative synthesis of clinician perspectives

ObjectivesTo identify themes relating to clinician acceptability of digital health intervention (DHIs) in the perioperative setting.DesignSystematic review and narrative synthesis applying an inductive-deductive framework synthesis approach.Data sourcesMedline, Embase and Cumulative...

Quantum Machine Learning for Secure Financial Forecasting: Mitigating Data Breaches and Adversarial Exploits

Quantum Machine Learning (QML) offers a transformative approach to financial forecasting by enhancing predictive accuracy and cybersecurity resilience. This study evaluates QML’s effectiveness using financial market data from Yahoo Finance, comparing Quantum Long Short-Term Memory (QLSTM) to classical LSTM and ARIMA models. Security vulnerabilities were assessed using the IEEE DataPort adversarial attack dataset, while encryption performance was analyzed using Quantum Key Distribution (QKD) data from NIST. Experimental results demonstrate that QLSTM outperforms classical models, achieving lower RMSE (1.82), MAE (1.45), and MSE (3.31), indicating superior forecasting precision. Quantum Support Vector Machines (QSVM) exhibit increased adversarial robustness, limiting accuracy degradation to 11.67% under FGSM attacks and 15.60% under PGD attacks, whereas classical models suffer losses exceeding 24%. QKD provides a substantial security advantage over RSA-4096, achieving a 5.87 bps secure key rate and demonstrating over 100 years of resistance to quantum attacks, reinforcing its role as a next-generation cybersecurity mechanism for financial institutions. Despite these advantages, the adoption of QML in financial forecasting faces challenges related to high computational costs, hardware limitations, and integration complexities. Quantum security frameworks require significant infrastructure investments to ensure scalability and reliability. Financial institutions must prioritize QML investment, integrate quantum security mechanisms, and collaborate with regulatory bodies to establish standardized guidelines for secure financial applications. This study contributes to the growing field of quantum-enhanced financial analytics, highlighting its potential to mitigate cyber threats and improve financial forecasting reliability while addressing existing implementation barriers.

Evaluation of a Simulation Program for Providing Telenursing Training to Nursing Students: Cohort Study.

Telenursing has become prevalent in providing care to diverse populations experiencing different health conditions both in Israel and globally. The nurse-patient relationship aims to improve the condition of individuals requiring health services. This study aims to evaluate nursing graduates' skills and knowledge regarding remote nursing care prior to and following a simulation-based telenursing training program in an undergraduate nursing degree. A cohort study assessed 114 third-year nursing students using comprehensive evaluation measures of knowledge, skills, attitudes, self-efficacy, and clinical skills regarding remote nursing care. Assessments were conducted at 2 critical time points: prior to and following a structured simulation-based training intervention. Participant demographics revealed a predominantly female sample (101/114, 88.6%), aged 20-50 years (mean 25.68, SD 4.59 years), with moderate to advanced computer and internet proficiency. Notably, 91.2% (104/114) had no telenursing exposure, yet 75.4% (86/114) expressed training interest. Statistical analyses demonstrated significant improvements across all measured variables, characterized by moderate to high effect sizes. Key findings included substantial increases in telenursing awareness, knowledge, skills, attitudes and self-efficacy; significant reduction in perceived barriers to remote care delivery; and complex interrelation dynamics between variables. A multivariate analysis revealed nuanced correlations: higher awareness and knowledge were consistently associated with more positive attitudes and increased self-efficacy. Positive attitudes correlated with enhanced self-efficacy and reduced perceived barriers. Change score analyses further indicated that increased awareness and knowledge facilitated more positive attitudinal shifts, while heightened awareness and positive attitudes corresponded with decreased implementation barriers. The study underscores the critical importance of integrating targeted telenursing training into nursing education. By providing comprehensive preparation, educational programs can equip students to deliver optimal remote care services. The COVID-19 pandemic has definitively demonstrated that remote nursing will be central to future health care delivery, emphasizing the urgent need to prepare nursing students for this emerging health care paradigm.

Strategies for Effective Implementation of Balanced Housing Policy in Commercial Apartments: A Multi-Stakeholder Approach in Jakarta

ABSTRACT This study examines the implementation of Indonesia's Balanced Housing Policy (BHP) in Jakarta, aimed at integrating low-income communities into commercial apartment developments. Despite institutional support, challenges like high land costs, insufficient government incentives, and weak law enforcement hinder progress, perpetuating residential segregation. Using stakeholder analysis, descriptive statistics, and the Delphi methodology, this research identifies key stakeholders and factors affecting BHP success. The findings propose 17 consensus-based strategies, emphasizing the need for collaborative efforts to overcome implementation barriers. This study contributes actionable strategies for improving social mix objectives in Jakarta's housing policy.

Integrated Behavioral Health Care in Pediatric Practices: The Dollars Don’t Add Up

Abstract Given the prevalence of behavioral health disorders in children and adolescents, and ongoing access gaps, clinicians and policymakers have pushed to expand integrated care models in pediatric primary care settings. Despite the evidence surrounding the efficacy of integrated behavioral health models for pediatric populations, uptake has been slow. Practices report many implementation barriers, including stand-up costs, training needs, and inadequate administrative support. In this Commentary, we argue that perhaps even more fundamentally, ongoing financial challenges are restricting model adoption, scale, and sustainability, particularly for independent and smaller pediatric group practices. Two real-world case studies illustrate several key financial challenges and opportunity costs for such practices, including administrative barriers and lag times in contracting and credentialing behavioral health providers; reimbursement rates that fail to cover the costs of care delivery; opportunity costs for practice revenue; and persistent coding and billing restrictions. Policies aiming to fulfill the clinical promise of integrated behavioral health care must account for these fiscal realities, prioritizing billing and payment alignment with pediatric practices’ bottom dollar.

A Systematic Review on the Impact of Electronic Consultations on Diabetes Care.

A Systematic Review on the Impact of Electronic Consultations on Diabetes Care.

Impact of DRG policy on the performance of tertiary hospital inpatient services in Chongqing, China: an interrupted time series study, 2020-2023.

Implementing the diagnosis-related groups (DRG) payment policy in 2021 marked a significant step in increasing the capacity and efficiency of public hospital services in Chongqing, China. However, the adaptability and effectiveness of DRG policy in middle-income regions like Chongqing remain understudied. This study evaluates the impact of DRG on tertiary hospital inpatient services in Chongqing, focusing on challenges unique to resource-constrained settings. Using an interrupted time series design, we analyzed monthly data of 14 DRG performance measures obtained from the DRG comprehensive management system, covering two public hospitals in Chongqing from 2020 to 2023. To evaluate both immediate and long-term effects of the DRG policy, we employed an interrupted time series analysis model to analyze changes in indicator levels and trends pre- and post-intervention. We found significant changes in the following indicators since the implementation of the DRG policy: case-mix index (CMI) level increased by 0.0661 (p = 0.02), but the trend decreased by 0.0071 (p < 0.001). The time efficiency index (TEI) level decreased by 0.123 (p < 0.001), while the trend increased by 0.0106 (p < 0.001). The cost efficiency index (CEI) level decreased by 0.0633 (p = 0.003), with the trend rising by 0.0076 (p < 0.001). And average length of stay (ALOS) trend increased by 0.0609 (p = 0.002). Readmission rates (RR) exhibited an instantaneous increase of 0.5653% (p = 0.008) post-intervention, though the long-term trend remained stable (p = 0.598). No significant differences were observed in the changes in inpatient numbers, surgical proportion, bed turnover rate (BTR), mortality rates (DR), cost per hospitalization (CPH), drug cost per hospitalization (DCPH), consumable cost per hospitalization (CCPH), medical examination cost per hospitalization (MECPH), or medical service cost per hospitalization (MSCPH). The DRG policy in Chongqing led to unintended trade-offs: tertiary hospitals prioritized high-volume, low-complexity cases, eroding service capacity for severe conditions. Middle-income regions faced implementation barriers, including fragmented health IT systems and insufficient administrative capacity, which diminished policy effectiveness. Policymakers must tailor DRG implementation to local contexts, balancing efficiency with equity and quality.

Empirical investigation of barriers and benefits of smart farming

PurposeSmart farming (SF) holds immense potential in making farming viable and improving farmers' livelihoods. However, its adoption is still in the early stages, and the resulting impacts are underexplored. This study investigates the information systems/policy and implementation barriers to the adoption of SF and its implications for various socioeconomic aspects.Design/methodology/approachThis survey research used a structured questionnaire to collect data on farm details, farmer characteristics and usage of SF technologies from a sample of 197 farmers based in the State of Karnataka, India. Exploratory factor analysis with principal component extraction is used to validate the proposed questionnaire constructs. Results are analyzed using one-way and two-way ANOVAs and interaction plots.FindingsOur study throws light on the benefits and barriers of SF technologies. Advanced SF technologies displayed a significant positive effect on socioeconomic variables compared to startup SF technologies, which displayed no significant effect. Overcoming information systems/policy barriers for adopting startup and advanced SF technologies displayed significant positive effects on farmers' health and net income, whereas overcoming implementation barriers for adopting advanced SF technologies led to improvement in the farmers' gross income.Originality/valueAlthough the technical feasibility of SF has been explored in the literature, its adoption barriers and socioeconomic impacts have been underexplored. To the best of our knowledge, the interaction between different types of barriers and the level of SF adoption has not yet been investigated in the literature. Our study addresses those research gaps using data from a previously underexplored context, viz. developing nations.

Speech-Language Pathologists' Use of Patient-Reported Outcome Measures for Adult Patients With Cognitive-Communication Disorders: A Survey Study.

Speech-language pathologists (SLPs) primarily assess patients with cognitive-communication disorders using performance-based measures. Patient-reported outcome measures (PROMs) may also prove useful in clinical practice with these populations, as they can capture applied communication constructs with subjective or unobservable elements (e.g., cognitive fatigue). We conducted a survey to gain insight into SLPs' clinical use of PROMs with these populations. Ninety-five SLPs responded to 26 survey items that explored SLPs' (a) current use of PROMs in clinical care for adults with cognitive-communication disorders, (b) needs and barriers related to PROM use in clinical practice, and (c) gaps and needs with respect to the measurement of patient health-related quality of life. A convergent mixed-methods design was used to analyze qualitative and quantitative survey responses. Free-response questions were coded using a conventional content analysis. Forty percent of respondents reported using PROMs with their patients with cognitive-communication disorders, most often for goal setting, followed by assessing treatment effects. SLPs also reported barriers to PROM use with patients with cognitive-communication disorders, such as patient insight deficits and limited time. The identified barriers of poor implementation and dissemination have implications for future research directions. The survey findings suggest that many SLPs do not currently use PROMs with patients who have cognitive-communication disorders, but those who do find them useful for goal setting. Survey findings also indicate several barriers that limit broader adoption of PROMs for this clinical population, which should be addressed through future implementation research and clinical initiatives such as creating PROM education for SLPs.

Process evaluation of an intervention to reduce sleep problems in people living with dementia in nursing homes: a mixed-methods study.

People living with dementia often suffer from sleep disturbances. The MoNoPol-Sleep (multimodal, nonpharmacological intervention for sleep disturbances in people with dementia living in nursing homes) study aimed to develop and evaluate a multimodal, nonpharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes. To investigate implementation fidelity, adoption, barriers and facilitators of the multimodal, nonpharmacological intervention. Mixed-methods process evaluation alongside an exploratory cluster-randomised controlled trial. Twenty-two nursing homes in three regions in Germany. Nursing staff, nursing home managers, sleep nurses and other target groups of the intervention from the participating nursing homes. Questionnaires, qualitative interviews and documentation of the intervention's implementation. The intervention was predominately implemented as planned, but implementation fidelity varied between the clusters. The most frequently planned and implemented sleep-promoting interventions were daytime activities. There is some evidence that person-centredness slightly increased in the intervention group. The commitment of nursing home managers, the motivation of nurses and good cooperation with the main contact persons of the research team were identified as facilitating context factors. Identified barriers were financial and time resources and low motivation of the nurses. The results of the cRCT have been published elsewhere. For a successful implementation, involvement of nurses from day and night shifts and other stakeholders is crucial. Based on the results of this process evaluation conducted alongside an exploratory trial, the intervention can be adapted and further developed to evaluate its effectiveness in a future full trial. ISRCTN No ISRCTN36015309.

Text Messaging Interventions for Unhealthy Alcohol Use in Emergency Departments: Mixed Methods Assessment of Implementation Barriers and Facilitators.

Many patients with unhealthy alcohol use (UAU) access health care in emergency departments (EDs). Scalable supports, such as SMS text messaging interventions, are acceptable and feasible to enhance care delivery for many health issues, including substance use. Further, SMS text messaging interventions have been shown to improve patient outcomes related to alcohol consumption (eg, reduced consumption compared to no intervention, basic health information, or drink tracking), but they are rarely offered in clinical settings. This paper describes a mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The goal of this study was to use a stakeholder-engaged mixed methods design to assess barriers and facilitators to the implementation of SMS text messaging interventions for UAU in EDs with a focus on the recipient's characteristics, the innovation's degree of fit within the existing practice, and the unique nature of the inner and outer context. This study was conducted in a large health system in the northeastern United States. We examined electronic health record data on alcohol screening in 17 EDs; surveyed 26 ED physician chairpersons on implementation feasibility, acceptability, and appropriateness; and interviewed 18 ED staff and 21 patients to understand barriers and facilitators to implementation. Interviews were analyzed according to the i-PARIHS framework to assess recipient characteristics, innovation degree of fit, and inner and outer context. Electronic health record data revealed high variability in alcohol screening completion (mean 73%, range 35%-93%), indicating potential issues in identifying patients eligible to offer the intervention. The 26 ED chair surveys revealed a relatively high level of implementation confidence (mean 4, SD 0.81), acceptability (mean 4, SD 0.71), and appropriateness (mean 3.75, SD 0.69) regarding the UAU SMS text messaging intervention; feasibility (mean 3.5, SD 0.55) had the lowest mean, indicating concerns about integrating the text intervention in the busy ED workflow. Staff were concerned about staff buy-in and adding additional discussion points to already overwhelmed patients during their ED visit but saw the need for additional low-threshold services for UAU. Patients were interested in the intervention to address drinking and health-related goals. ED visits involving UAU have increased in the United States. The results of this formative study on barriers and facilitators to the implementation of UAU SMS text messaging interventions in EDs indicate both promise and caution. In general, we found that staff viewed offering such interventions as appropriate and acceptable; however, there were concerns with feasibility (eg, low alcohol risk screening rates). Patients also generally viewed the SMS text messaging intervention positively, with limited drawbacks (eg, slight concerns about having time to read messages). The results provide information that can be used to develop implementation strategies that can be tested in future studies.

Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis.

Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants' prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Many participants experienced that the ESM tool provided useful information about clients' mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Clinicians' and clients' choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters.

“We worked together to change things about our lives”: a longitudinal qualitative analysis exploring Hispanic/Latino and Somali immigrant health promoters’ perspectives on a social network intervention to address cardiovascular disease disparities

BackgroundEvidence-based health promotion programs are commonly assessed within research environments, yet there is a critical need to understand how to implement interventions across multiple settings, prioritizing populations who are underserved and under-resourced. A possible approach involves leveraging established social networks to enhance health outcomes. Within these networks, influential individuals, known as health promoters (HPs), play a key role in disseminating health information. The Rochester Healthy Community Partnership created a social network–based intervention called Healthy Immigrant Community (HIC), utilizing HPs to encourage healthy eating and physical activity to address cardiovascular disease outcomes among Hispanic/Latino and Somali immigrant populations. We conducted three focus groups pre-, mid-, and post intervention (nine groups total; n = 30) to understand HPs’ motivations for participating, implementation barriers and facilitators they faced, and suggestions for improvement.MethodsUsing the National Institute on Minority Health and Health Disparities Research Framework and Public Health Critical Race Praxis, we conducted a longitudinal trajectory analysis to explore themes and changes over time.ResultsParticipants reported that their motivations to be a HP in Healthy Immigrant Community were personal goals, such as health improvement and weight loss, as well as collective community benefits and personal gains like knowledge and leadership skills. Barriers included logistical challenges, navigating health-related differences between one’s country of origin and the US, and structural issues such as racism, high costs (e.g., food), and absence of an affordable gym. Facilitators included strong community ties, peer-to-peer support, and culturally relevant approaches, with participants recommending additional resources, tailored programming, and reframing the program’s focus on overall health rather than weight loss.ConclusionsOur study highlighted a shift in HPs’ motivations to participate in Healthy Immigrant Community from weight loss to holistic health promotion. The HPs’ reflections on their experience showcase the transformative impact of culturally tailored, equity-focused interventions while emphasizing the need to address systemic barriers and incorporate community feedback for sustainable change.

HIV pre-exposure prophylaxis (PrEP) use among PrEP-eligible men who have sex with men: a systematic review and meta-analysis.

HIV pre-exposure prophylaxis (PrEP) use among PrEP-eligible men who have sex with men: a systematic review and meta-analysis.

Understanding Barriers and Facilitators to Disability and Rehabilitation Policy Implementation in Gauteng, South Africa: A Qualitative CFIR-Informed Study.

The effective implementation of disability and rehabilitation frameworks is essential for the full participation and social integration of individuals with disabilities. In Gauteng, South Africa, significant challenges persist in the execution of the Framework and Strategy for Disability and Rehabilitation (FSDR). This study aimed to explore the barriers and facilitators to the implementation of the FSDR in Gauteng. We employed qualitative research methods, including semi-structured interviews and focus group discussions with stakeholders involved in the implementation process, from management to end users. Data were triangulated with a review of paper-based implementation reports from rehabilitation managers. The interview, focus group, and document review data were analyzed using inductive thematic analysis with MAXQDA qualitative data analysis software. Barriers to implementation included resource constraints, organizational inefficiencies, and socio-cultural attitudes toward disability. Facilitators identified included inter-sectoral collaboration, community engagement, and alignment of policies with international guidelines. Using the Consolidated Framework for Implementation Research (CFIR), barriers and facilitators were mapped to domains such as intervention characteristics, outer and inner setting factors, characteristics of individuals, and the implementation process. Key challenges included insufficient awareness and training among healthcare professionals, limited resources, safety concerns, and inconsistent policy implementation. Facilitators such as inter-sectoral collaboration, policy development, provincial training, and advocacy by persons with disabilities were crucial for overcoming these challenges. This study provides valuable insights into the contextual factors influencing disability and rehabilitation policy implementation in Gauteng. By addressing identified barriers and leveraging facilitators, evidence-based strategies can strengthen rehabilitation services, promote social inclusion, and enhance the rights of individuals with disabilities in South Africa and globally.

Understanding oral care in the intensive care unit: A qualitative study of nurse experiences and practices with mechanically ventilated patients.

Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in the intensive care unit (ICU), often linked to poor oral care. Despite its importance, oral care is frequently neglected in ICU settings, leading to increased morbidity and health care costs. To explore the challenges ICU nurses face in providing oral care to mechanically ventilated patients and identify their specific educational needs. This study employed a qualitative descriptive design to detail oral care experiences in the ICU. Standardized qualitative research reporting protocols ensured integrity. Data collection included observational methods using video and photographic records, followed by heuristic interviews. Three key themes were identified: logistical challenges in providing ICU oral care, the need for more education and better resource allocation and the importance of ethical communication in nursing. Differences in policy implementation, spatial constraints and communication barriers highlighted the need for improved education, better resource management and enhanced communication strategies while maintaining patient dignity. ICU nurses encounter challenges in oral care because of spatial constraints, technical difficulties and lack of knowledge. Targeted education, resource allocation and better communication can improve oral care quality, reduce VAP incidence and enhance patient outcomes. Comprehensive training programmes and addressing psychological barriers are critical to enhancing ICU nurses' effectiveness in oral care. Improved communication practices and balancing patient dignity with medical demands are essential for maintaining high standards of care.