Behavioral Barriers Research Articles

What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel

ObjectiveMajor trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DesignOnline survey informed by the TDF and BCW. SettingUK trauma rehabilitation pathway. PopulationRehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). AnalysisMean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. ResultsMost respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). ‘Social/professional role and identity’, 'knowledge’ and ‘emotion’ (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including ‘seen as tick-box exercise’,‘not a priority’, lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. ConclusionsAlthough rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.

Examining barriers to antiretroviral therapy initiation in infants living with HIV in sub-Saharan Africa despite the availability of point-of-care diagnostic testing: a narrative systematic review.

Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point-of-care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC. This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub-Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes. Of the 266 abstracts reviewed, 52 full-text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0-12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow-up). Maternal-related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential. We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants. This paper identifies barriers and proposes strategies for timely ART initiation in infants.

Determinants of Intention to Uptake COVID-19 Vaccination Among Saudi Adults: Application of the Health Belief Model.

The pandemic caused by COVID-19 has had a profound effect on global health. Due to its potential impact on the efficacy of pandemic control measures, vaccine hesitancy (VH) in relation to COVID-19 has emerged as a significant concern. The attainment of herd immunity is contingent on the rate of COVID-19 vaccine adoption. Despite this, there have been reports of reluctance toward the COVID-19 vaccine. This study seeks to investigate the effect of constructs that influence adults' intentions to receive COVID-19 vaccination using the Health Belief Model (HBM). A cross-sectional study was conducted by recruiting Saudi Arabian adults as participants. Using Structural Equation Modeling (SEM), the proposed HBM model was evaluated. A total of 505 individuals replied to the survey. The suggested HBM model explained 68% of the variation in intention to get COVID-19 immunization. I found all HBM variables namely perceived susceptibility, greater levels of perceived behavioral control, severity, benefits, and barriers to be significant predictors of vaccination intentions. Among demographic variables, only married status had a significant relationship with the intention to obtain COVID-19 immunization. The findings of this study indicate that the HBM can be utilized effectively to obtain insight into the factors that influence COVID-19 prevention measure adherence. Understanding and recognizing individuals' perceived health beliefs and practices is essential for the development of effective COVID-19 intervention strategies.

Factors influencing physical activity in individuals with head and neck cancer: a scoping review

ObjectivesHigher physical activity (PA) levels are associated with better quality of life in people with head and neck cancer (HNC). Despite this positive association, most individuals with these cancer types...

Assessing communication competencies of public servants in Kazakhstan: Current status and approaches for enhancement

Political crises, socio-economic issues, and industrial shocks in Kazakhstan highlight the need for prompt and proficient government responses to mitigate their consequences. Public managers must possess the capability to assume responsibility and communicate effectively. This study aims to analyze the level of communication competencies among civil servants in Kazakhstan to assess their status and propose approaches for enhancement. The study utilized a mixed-method approach, combining quantitative survey and qualitative interviews. The quantitative phase involved the distribution of structured questionnaires to civil servants across diverse departments (n = 4,790), aiming to evaluate existing communication competencies, identify strengths and weaknesses, and comprehend prevailing communication issues. The qualitative component included in-depth interviews with selected participants to better understand their experiences and views on communication in the public service sector (n = 27 experts). Research findings define the existing problems and barriers that hinder the development of the communicative competencies of civil servants. Most respondents (25%) believe that problems stem from a lack of understanding of information and citizens’ reluctance or inability to interact with government agencies, while 16% attribute issues to civil servants’ behavioral barriers. Smaller percentages point to language barriers (11%), emotional barriers (9%), cultural barriers (6%), and gender barriers (3%) as contributing factors. Additionally, the study revealed a lack of systematic training and support for developing effective communication skills among government employees. The study suggests several approaches to improve communication competencies, such as targeted training programs, cross-departmental collaboration, and organizational culture promotion. Acknowledgment The study was carried out within the framework of grant funding from the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan (IRN AP14872210).

Consumer Response to Novel Foods: A Review of Behavioral Barriers and Drivers.

There is a pressing need for a transition toward more sustainable diets, which has become a shared priority for both consumers and businesses. Innovation is becoming increasingly widespread across all facets of the food supply chain. This innovation spans various domains related to production, including sustainable cultivation methods as well as new food technologies like gene editing, new product development like functional foods, and revitalizing underutilized and genetically diverse varieties to preserve biodiversity. However, not all innovative efforts are accepted by consumers and survive in markets. The interwoven and long agri-food supply chains often obscure the feedback loop between production and consumption. Consequently, it is important to understand to what extent consumers embrace these food innovations and form new eating habits. This review aims to investigate the consumer response to novel foods, focusing on behavioral factors, which have yet to receive as much attention as sensory factors. Peer-reviewed empirical articles from the last decade are examined inductively to develop a bird's-eye view of the behavioral barriers to and drivers of consumer acceptance of novel foods. In addition, strategies to overcome the identified challenges associated with the behavioral barriers are reviewed and examined. Based on this, the study links cognitive biases with behavioral factors influencing consumer acceptance of novel foods. This study concludes that the inconvenience associated with abandoning established eating habits is typically perceived as a loss, and avoiding this inconvenience is deemed more worth the risk than the potential gains associated with novel food consumption. This study suggests that framing and placing pro-diversity labels could serve as effective behavioral interventions for marketing strategists and food policymakers.

Drivers and constraints of students’ entrepreneurial intentions across cultural contexts: A neo-configurational perspective

Even though there is evidence of interconnectedness among antecedents of entrepreneurial intentions, emphasizing the need for understanding their joint effects, cross-cultural studies focused on students' entrepreneurial intentions have primarily looked into the isolated effects of these factors, neglecting their complex interplay. Drawing upon complexity theory, we aim to fill this gap by exploring how various factors mutually influence students' entrepreneurial intentions across diverse cultural settings. We employ the fuzzy-set Qualitative Comparative Analysis on a sample of 144 students to generate novel insights about drivers and constraints of entrepreneurial intentions in two distant cultural clusters, i.e., Confucian Asia and Eastern Europe. Our findings shed light on how attitudes, subjective norms, perceived behavioural control and barriers intertwine to shape students' entrepreneurial intentions in different cultural settings, thereby affirming the principles of the neo-configurational perspective adopted in this study—multiple conjunctural causation, causal equifinality, and causal asymmetry. While enriching our understanding of the role of national culture in shaping entrepreneurial intentions, this study provides unique insights to management education scholars and practitioners about the need for tailoring entrepreneurial curricula based on the complexity and cultural sensitivity of antecedents of students’ entrepreneurial intentions.

Holistic citywide sanitation for an urban area in the Global South: A case study of the Noakhali Pourashava of Bangladesh

ABSTRACT Urban areas currently grapple with the consequences of poor sanitation systems and a burgeoning population. The issue remains acute for developing nations where financing and governance structures for urban sanitation remain inadequate. Using cutting-edge techniques such as shit flow diagrams (SFDs), city service delivery assessments (CSDAs), and SWOT analysis, this study provides an in-depth exploration of the sanitation scenario in the Noakhali Pourashava of Bangladesh. The study reveals a critical lack of sanitation infrastructure and inadequate fecal sludge management, with implications for public health and environmental sustainability. Findings indicate that only 3% of excreta enters the sewer system, while 88% is improperly disposed of through SFDs and CSDAs, highlighting areas for improvement. Recommendations include increased investment in sanitation infrastructure, public awareness campaigns, adoption of innovative technologies, improved stakeholder coordination, and addressing cultural and behavioral barriers. These insights aim to inform policy and decision-making processes to achieve sustainable and inclusive urban sanitation, ultimately improving public health and environmental outcomes in Noakhali and similar coastal urban areas.

Examining the unsustainable relationship between SDG performance, ecological footprint and international spillovers

For almost a decade, countries have been working to achieve the Sustainable Development Goals (SDGs). Yet progress on the SDGs across countries, as well as across the 17 goals, has proven frustratingly slow. Even countries that have performed relatively well on the SDGs may have done so by causing negative externalities, such as environmental degradation, in other parts of the world. To determine if this is the case empirically, we developed and tested hypotheses concerning how a country’s SDG performance is associated with such externalities. We then ran a regression to examine correlations between indices measuring SDG progress, ecological footprints and international spillovers. We found that SDG progress is positively correlated with increased ecological footprints and spillovers. The results indicate that SDG progress remains closely associated with conventional measures of economic growth, and that negative environmental and social impacts of internationally-sourced consumption represent behavioural and structural barriers to meaningful progress on sustainability.

Using Photovoice to Improve Engagement in Community Health Assessments Addressing Behavioral Health.

Behavioral health disorders are well-known to have close links with the social determinants of health, yet little is known about how impacted communities perceive these links. Qualitative participatory methods can not only provide insight into how communities conceptualize these relationships but also empower those with lived experience to contextualize their perspectives and formulate calls to action. This study used Photovoice as a participatory method to supplement the Clark County Health Department Community Health Assessment and determine priority facilitators and barriers contributing to the behavioral health of Clark County, KY, residents. A secondary aim was to gain a greater understanding of how the Photovoice methodology impacts community engagement efforts in Community Health Assessments. Twenty-three Clark County residents participated in four Photovoice groups involving five weekly sessions, which included photograph "show and tell," critical group dialogue, participatory analysis, and planning for dissemination. Secondary analysis of Photovoice focus group discussions revealed behavioral health facilitators and barriers were most influenced by (1) public sector unresponsiveness, (2) strong partnerships formed between community and grassroots organizations, and (3) the siloed division of responsibility between agencies and across sectors. The authors also found the Photovoice method successfully enhanced engagement and empowered those with lived experience to frame their perspectives of the behavioral health landscape. This project has implications for enhancing community engagement and empowerment in behavioral health-focused public health assessments and shaping policy to promote multi-sector collaboration.

Empowering people living with HIV (PLHIV): unveiling care gaps and identifying opportunities for improving care for PLHIV in Singapore and Hong Kong.

This study explored the behaviours of people living with HIV in Singapore and Hong Kong in terms of achieving and maintaining their physical and psychological wellbeing in relation to HIV, to identify the challenges and support needed in HIV care. This qualitative study involved 90-minute interviews among Singapore and Hong Kong people living with HIV aged ≥18 years to explore health-related quality of life perceptions and gaps in patient empowerment in HIV care during February-May 2022. The COM-B (C: Capability; O: Opportunity; M: Motivation; B: Behaviour) framework was used during data analysis to identify behaviour facilitators and barriers for people living with HIV to achieve and maintain their wellbeing. Detailed accounts of respondents' experience of living with and managing HIV, that is what worked well, unmet needs and perceived significance of wellbeing indicators, were analysed qualitatively via a combination of inductive content and deductive frameworks. A total of 30 and 28 respondents were recruited from Singapore (SG) and Hong Kong (HK), respectively. Most respondents were aged 20-49 years (SG: 83.3%; HK: 64.3%), males (SG: 96.7%; HK: 92.9%), men who have sex with men (SG: 93.3%; HK: 71.4%), had university or higher education (SG: 73.3%; HK: 50.0%) and were fully employed (SG: 73.3%; HK: 57.1%). In both Singapore and Hong Kong, physical health was considered a key focus of overall wellbeing, albeit attention to long-term health associated with cardiovascular and renal health was less salient. The impact of symptoms, side effects of treatment, mood and sleep were among the top wellbeing indicators of importance. Respondents felt that insufficient information was provided by physicians, citing consultation time and resource constraints impeding further expression of concerns to their physicians during consultation. Respondents prioritized functional wellness and delegated psychosocial health to supportive care professionals, patient groups, families and/or friends. There is a need in Singapore and Hong Kong to empower people living with HIV to establish better communications with their physicians and be more involved in their treatment journey and equally prioritize their psychosocial wellbeing.

Selective Timing of Maternal Immune Activation Alters Developmental Milestones, Behavior, and Blood-Brain Barrier Integrity

Background and Hypothesis: Maternal immune activation (MIA) has been associated with increased risk for neuropsychiatric disease. Fetal exposure to maternal infection activates different toll-like receptors (TLRs) to initiate innate inflammatory responses in mother and fetus. The goal of the current study is to determine sex-dependent aspects of MIA during mid-gestation on neurodevelopment. Methods: Timed-pregnant female mice were administered RQ (TLR7 agonist) or vehicle saline on embryonic day (E) 12.5. Maternal and fetal cytokines were measured to ensure infection of pregnant dam (E15). Offspring were assessed postnatally for developmental milestones and behavior. Adult offspring were perfused with fluorescein isothiocyanate (FITC; 100mg/mL) to visualize blood vessel integrity (FITC leakage; Frahm & Tobet, 2015). To determine neural molecular mechanisms for behavioral changes, sections through the paraventricular nucleus of the hypothalamus (PVN) of offspring were immunolabeled for Glial Fibrillary Acidic Protein (GFAP; astrocytic end feet), Desmin (pericytes) and IBA-1 (microglia). Results: Maternal cytokines IL-6 (p<0.05) and IL-10 (p<0.01) were higher while TNFα (p<0.01) and IL-17 were lower 3 days after RQ-exposure. In fetuses (E15), IL-6 (p<0.05) and IL-17 (p<0.0001) were greater, while IL-10 was higher only in males (p<0.001) exposed to maternal infection. RQ-exposed males also had reduced TNFα (p<0.05). Additionally, RQ-exposed offspring had lower body weights at birth and delayed eye openings. Females exposed to maternal RQ exhibited slower onset of puberty with delayed vaginal openings. On the behavioral side, juvenile and adult offspring of RQ injected moms exhibited less social-like behavior (p<0.001 for all groups) with lower hedonic-like behavior selectively in females (p<0.001). RQ-offspring further showed greater leakage in the PVN indicated by more FITC in the extravascular space (males p<0.001, females p<0.01). GFAP + (astrocytic end feet) coverage of FITC-labeled vessels was higher in the PVN selectively in RQ males (p<0.001). Desmin+ (pericyte) coverage was greater in the PVN of RQ males (p<0.01) and females (p<0.001). Finally, there was greater number of IBA-1+ cells in the adult offspring PVN of both sexes (p<0.01) after maternal injection of RQ. Conclusions: This study provides support for sex-dependent influences of fetal antecedents for altered brain development and behavioral outputs that could be indicative of increased susceptibility for adult disorders through immune mechanisms. Future studies will examine how timing of infection during gestation (mid vs. late) changes neurodevelopmental outputs in offspring. Supported by ORWH-NIMH U54 SCORE-MH118919. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Correction to: Behavioral barriers to the use of renewable and energy-efficient technologies in residential buildings in Iran

Correction to: Behavioral barriers to the use of renewable and energy-efficient technologies in residential buildings in Iran

Recurrent gene flow events occurred during the diversification of clownfishes of the skunk complex.

Clownfish (subfamily Amphiprioninae) are an iconic group of coral reef fish that evolved a mutualistic interaction with sea anemones, which triggered the adaptive radiation of the clade. Within clownfishes, the "skunk complex" is particularly interesting. Besides ecological speciation, interspecific gene flow and hybrid speciation are thought to have shaped the evolution of the group. We investigated the mechanisms characterizing the diversification of this complex. By taking advantage of their disjunct geographical distribution, we obtained whole-genome data of sympatric and allopatric populations of the three main species of the complex (Amphiprion akallopisos, A. perideraion and A. sandaracinos). We examined population structure, genomic divergence and introgression signals and performed demographic modelling to identify the most realistic diversification scenario. We excluded scenarios of strict isolation or hybrid origin of A. sandaracinos. We discovered moderate gene flow from A. perideraion to the ancestor of A. akallopisos + A. sandaracinos and weak gene flow between the species in the Indo-Australian Archipelago throughout the diversification of the group. We identified introgressed regions in A. sandaracinos and detected in A. perideraion two large regions of high divergence from the two other species. While we found that gene flow has occurred throughout the species' diversification, we also observed that recent admixture was less pervasive than initially thought, suggesting a role of host repartition or behavioural barriers in maintaining the genetic identity of the species in sympatry.

Barriers in Rubber Dam Isolation Behaviour of Dental Students During Adhesive Restorative Treatments: A Cross-Sectional Study.

There are unfavorable opinions connected with rubber dam isolation amongst dental students during adhesive restorative treatments. The aim of this study was to investigate the various barriers to practicing rubber dam isolation during dental procedures and provide necessary insight towards implementation of rubber dam among undergraduate dental students in Jazan. A pre-validated questionnaire in English entitled Rubber Dam Isolation Survey (E-RDIS) based on the Capability Opportunity Motivation-Behaviour (COM-B) model of behavioral change wheel was responded by 226 university dental students. The satisfaction of training was highest among sixth year students (Mean=3.57, p<0.001). Fourth year dental students scored higher in the capability (Mean=3.18) and were more highly motivated to use rubber dams (Mean=4.21). Third year students were more likely to use rubber dams in anterior teeth (Mean=3.52) whereas fourth year students use rubber dam in posterior teeth (Mean=3.74). Lack of motivation was found to be the significant barrier influencing rubber dam usage (odds ratio (OR)=12.1; 3.74, p<0.05). The satisfaction with training differed among the students of different years. The rubber dam technique might be used more frequently if it were made clear to students that mastering it would be necessary for them to receive good grades.

Challenges and way forward for implementation of sugar taxation in the Middle East and North Africa (MENA).

Over consumption of added sugar beyond the World Health Organization (WHO) recommended level of 10% of daily energy intake has well-established negative health consequences including oral diseases. However, the average consumption of added sugar in the Middle East and North Africa region (MENA-World Bank's regional classification) is 70% higher than the WHO recommended level. Imposing taxes on added sugar has been proposed by the WHO to decrease its consumption. Yet, only 21.6% of the total MENA population are covered by taxation policies targeting added sugar. Well-recognized challenges for the implementation of sugar taxation in MENA include the tactics used by the food and beverage industry to block these type of policies. However, there are also other unfamiliar hurdles specific to MENA. Historically, there have been incidents of protest and riots partially sparked by increased price of basic commodities, including sugar, in MENA countries. This may affect the readiness of policy makers in the region to impose added sugar taxes. In addition, there are also cultural, lifestyle and consumption behavioural barriers to implementing added sugar taxation. Ultra-processed foods and sugar-sweetened-beverages (SSBs) rich in added sugar are perceived by many in MENA as essential treats regardless of their health risks. Furthermore, some countries even provide subsidies for added sugar. Also, (oral) healthcare providers generally do not engage in policy advocacy mainly due to limited training on health policy. Here, we discuss these challenges and suggest some ways forward such as (1) support from a health-oriented political leadership, (2) raising public awareness about the health risks of over consumption of sugar, (3) transparency during the policy-cycle development process, (4) providing a free and safe environment for a community dialogue around the proposed policy, (5) training of (oral) healthcare professionals on science communication and policy advocacy in local lay language/dialect, ideally evidence informed from local/regional studies, (6) selecting the appropriate political window of opportunity to introduce a sugar tax policy, and (7) clear and strict conflict of interest regulations to limit the influence of commercial players on health policy.

Behavioral Patterns and Barriers to Medication Adherence in Older Adults with Diabetes

Behavioral Patterns and Barriers to Medication Adherence in Older Adults with Diabetes

Behavioural Factors Affecting Corporate Environmental Sustainability. Evidence From a Field Study Among Polish SMEs and Implications for the EU Environmental Policies

Considering climate change problems that European countries are currently struggling with, the aim of this paper is to examine the behavioural factors that affect corporate environmental sustainability (CES). Based on the relevant academic literature and reports behavioural barriers and enablers for corporate environmental sustainability are identified using the ABCD (attention-belief formation-choice-determination) framework. Selected issues are further investigated in a survey among a representative sample of 350 small and medium-sized Polish enterprises and discussed in a broader European context. Our research reveals what goals and motivations Polish SMEs employ to make green investments, how they asses their environmental efforts compared with peer companies, what sources of environmental information they consider as trustworthy, as well as what factors they believe most strengthen the firm’s determination for sustainable development. The contribution of this paper lies in shedding light on the starting dispositions of entrepreneurs as targets of public policies promoting environmental goals in the EU. Such insights are instrumental in designing and implementing effective policy interventions.

Stunting prevention behavior among children under two years based on integrated behavior: A model development

Introduction: Stunting, a form of chronic malnutrition, continues to increase annually in Indonesia, making it the third country with the highest prevalence of stunting in Southeast Asia. This study aimed to analyze what factors were most dominant that influenced family behavior toward stunting prevention in the Bangkalan Region. Methods: This research follows an analytical observational approach with a cross-sectional design. The study involved a sample size of 110 participants. Inclusion criteria for this study encompassed children aged 0-24 months residing with their mothers, mothers in good physical and mental health, and both children and mothers living in the Bangkalan district. The sampling technique involved multistage random sampling, followed by stratified sampling using a proportionate stratified random sampling method. Data collection was conducted using a questionnaire. Seven questionnaires are used: attitude, personal agency, knowledge, intention, behavior and environmental barrier. The distribution of questionnaires involved direct engagement with several field officers. The analysis technique employed in this study is partial least squares (PLS) using structural equation modeling (SEM).Results: We found three factors significantly influencing mothers' behavior in stunting prevention among habits (P-value 0.031; T 2.221), intentions and knowledge of mothers in stunting prevention (P-value &lt;0.001; T 5.744). The extent of the mother's intention to prevent stunting was influenced directly by the mother's agency (P-value 0.044; T 2.399) and attitude regarding stunting (P-value &lt;0.001; T 7.920).Conlusions: Intention is a direct influence driving factor for individuals to shape behavior, which is influenced by personal attitudes and beliefs. Effective stunting prevention strategy in children under two years is through the development of a stunting prevention behavior model for caregivers through improvements in attitudes, beliefs, norms, personal agencies, knowledge and skills to perform the behavior, intentions, and habits as a family empowerment effort to prevent stunting. Keywords: intentions; parenting; prevention; stunting

A Qualitative Study of Barriers to Medication-Taking Among People With Type 2 Diabetes Using the Theoretical Domains Framework.

We aimed to better understand the challenges related to type 2 diabetes medication-taking through Theoretical Domains Framework (TDF)-guided interviews with people with type 2 diabetes with varying degrees of medication-taking. One-on-one qualitative interviews following a semistructured discussion guide informed by the TDF were conducted. Thirty people with type 2 diabetes in Canada were interviewed, with representation from across the country, of both sexes (47% female), of people with various diabetes durations (mean 12.9 ± 7.9 years), with different types of medication plans (n = 15 on polypharmacy), and with various medication-taking levels (n = 10 each for low-, medium-, and high-engagement groups). Themes related to medication-taking from interviews mapped to 12 of the 14 TDF theme domains, with the exclusion of the knowledge and skills domains. The most prominent domains, as determined by high-frequency themes or themes for which people with low and high medication-taking had contrasting perspectives, were 1) emotion; 2) memory, attention, and decision processes; 3) behavioral regulation; 4) beliefs about consequences; 5) goals; and 6) environmental context and resources. Through our interviews, several areas of focus emerged that may help efforts to increase medication-taking. To validate these findings, future quantitative research is warranted to help support people with type 2 diabetes in overcoming psychological and behavioral barriers to medication-taking.