Complex Barriers Research Articles

Oral health promotion: a qualitative study to explore perspectives of kindergarten nurses at Qatar

BackgroundThe oral health of preschool children remains a concern globally. Kindergarten and school nurses can improve oral health by reducing the incidence of Early Childhood Caries (ECC) among children. This study aimed to explore the perceptions of kindergarten nurses about a proposed oral health promotion program to be implemented in primary health centres and kindergartens.MethodsThe qualitative research used in-depth interviews of 12 kindergarten nurses who were audio-recorded and transcribed verbatim. Qualitative data analysis software was used (NVivo9 MANUF). Four major themes emerged and were analysed to explore contextual patterns within the data.ResultsThe major themes included participants acknowledged the high prevalence of caries in children and identified several causes within the local context, including parental practices, poor dietary habits, the impact of cultural lack of oral health knowledge and limitations in the healthcare system. However, the study results’ themes also revealed complex barriers and enablers regarding the implementation of the program highlighting interpersonal, structural, systemic, and social elements.ConclusionKindergarten nurses maintained an affirmative attitude towards oral health promotion programs and were enthusiastic about initiating and supporting these programs. This qualitative study brought out critical socio-biological-cultural factors that influence the oral health promotion of preschool children.

Synthetic Biology‐Based Engineering Cells for Drug Delivery

ABSTRACTAlthough drug delivery technology has promoted the clinical translation of small molecule drugs, there is an urgent need for advanced delivery systems to overcome complex physiological barriers and the increasing development of biological drugs. This review overviews the emerging applications of synthetic biology‐based engineered cells for drug delivery. We first introduce synthetic biology strategies to engineer cells for biological drug delivery and discuss the benefits in terms of specificity, intelligence, and controllability. Furthermore, we highlight the cutting‐edge advancements at the convergence of synthetic biology and nanotechnology in drug delivery. Nanotechnology expands the engineering design and construction concepts of synthetic biology, and synthetic biology drives the development for biotechnology‐driven nanomaterial synthesis. In the future, synthetic biology‐based engineered cells may be developed to be more modular, standardized, and intelligent, leading to significant breakthroughs in the construction of advanced drug delivery systems.

A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives.

Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information. This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions to the TC3 phone-based intervention to text messaging, which addresses barriers among those referred for colposcopy after abnormal screening results. Semistructured depth qualitative interviews were conducted over Zoom [Zoom Communications, Inc] or telephone with a purposive sample of 22 clinic staff members (including clinicians and support staff members) and 34 patients referred for colposcopy from 3 academic obstetrics and gynecology (OB-GYN) clinics that serve predominantly low-income, minoritized patients in different urban locations in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes. Clinic staff members and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messages emphasizing that human papillomavirus is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff members was needed in certain instances; they proposed connecting patients experiencing complex psychosocial or structural barriers to staff members for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns. Clinic staff members and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multimodal interventions may be necessary for patients with complex barriers to colposcopy attendance, which we intend to evaluate in a subsequent trial.

Computational complexity as a potential limitation on brain-behaviour mapping.

Within the reductionist framework, researchers in the special sciences formulate key terms and concepts and try to explain them with lower-level science terms and concepts. For example, behavioural vision scientists describe contrast perception with a psychometric function, in which the perceived brightness increases logarithmically with the physical contrast of a light patch (the Weber-Fechner law). Visual neuroscientists describe the output of neural circuits with neurometric functions. Intuitively, the key terms from two adjacent scientific domains should map onto each other; for instance, psychometric and neurometric functions may map onto each other. Identifying such mappings has been the very goal of neuroscience for nearly two centuries. Yet mapping behaviour to brain measures has turned out to be difficult. Here, we provide various arguments as to why the conspicuous lack of robust brain-behaviour mappings is rather a rule than an exception. First, we provide an overview of methodological and conceptual issues that may stand in the way of successful brain-behaviour mapping. Second, extending previous theoretical work (Herzog, Doerig and Sachse, 2023), we show that brain-behaviour mapping may be limited by complexity barriers. In this case, reduction may be impossible.

Rapid, complex back barrier pedestal formation preconditions washover deposition on the southeast Indian coast

Rapid, complex back barrier pedestal formation preconditions washover deposition on the southeast Indian coast

Evaluating Digital Rehabilitation Outcomes in Chronic Musculoskeletal Conditions Across Non-Obesity, Obesity, and Severe Obesity.

Obesity is a known risk factor and aggravator of musculoskeletal (MSK) conditions. The rising prevalence of obesity calls for scalable solutions to address MSK conditions in this population, given their complex clinical profile and barriers to accessing care. To evaluate the engagement and clinical outcomes of a fully remote digital care program in patients with MSK conditions, focusing on those with and without comorbid obesity. A post-hoc analysis of a prospective, longitudinal, single-arm observational home-based study conducted between August, 2023, and August, 2024. Adults suffering from chronic MSK pain were categorized according to their body mass index (BMI) into non-obesity, obesity and severe obesity. Outcomes included completion rates, engagement, satisfaction, pain (minimal clinically important change: 30%), impairment in daily activities, and patient global impression of change (PGIC). Depending on the clinical outcomes, latent basis growth analysis and logistic regression were used. Completion rates were high across all groups (77.5-85.6%), although slightly lower in the obesity groups. Fairly similar engagement was observed with both exercise sessions and the educational content (1.9-2.2 exercise sessions per week; 8.10-9.31 educational content videos watched). Obesity groups interacted more with the physical therapists than the non-obesity group (severe obesity: 24.6 (SD 10.1); obesity: 23.2 (SD 10.46) vs non-obesity: 22.4 (SD 9.8), P < 0.001). Despite higher baseline risk and clinical impairment in the obesity groups, all groups showed significant pain reductions, with pain responder rates ranging from 56.6 to 63.6%, slightly lower in the severe obesity group. Improvements in daily activities were significant across groups, alongside a positive PGIC (50.4-53.6%). Satisfaction was very high (>9/10) in all BMI groups. Despite worse baseline clinical presentations, obesity groups achieved high completion rates, engagement, and significant clinical improvements comparable to the non-obesity group, highlighting the potential of a digital program for this population.

Predicting Magnetic Barriers in Lanthanide Complexes with Electrostatic Potential Charges.

Single-molecule magnets (SMMs) with slow relaxation of magnetization and blocking temperatures above that of liquid nitrogen are essential for practical applications in high-density data storage devices and quantum computers. A rapid and accurate prediction of the effective magnetic relaxation barrier (Ueff) is needed to accelerate the discovery of high-performance SMMs. Using density functional theory and multireference calculations, we explored correlations between Ueff, partial atomic charges, and the anisotropic barrier for a series of sandwich-type lanthanide complexes containing cyclooctatetraene, substituted cyclopentadiene, phospholyl, boratabenzene, or borane ligands. Our results show a correlation between the electrostatic potential charge of the lanthanide ion in the complex and Ueff. Systematic ligand modifications show that reducing ligand nucleophilicity and incorporating soft bases enhance magnetic anisotropy and Ueff values. This work identifies a correlation to predict Ueff values and optimization of ligand coordination environments in lanthanide-based SMMs.

Knowledge, Beliefs, and Experiences With Mental Health Services and Help-Seeking in People With Aphasia and Care Partners.

Supporting psychological well-being in persons with aphasia (PWA) can improve social and health outcomes; however, PWA and their care partners (CPs) are often not receiving mental health support. Previous research explores this from the perspective of health care professionals. The aim of this study was to examine knowledge, beliefs, and experiences related to mental health services directly from PWA and CPs. The study included 11 PWA and 11 CPs. Participants completed a guided survey (virtual) with opportunities for elaboration related to the knowledge, beliefs, and experiences of mental health. There was variability in personal preferences for referrals, types of coping strategies, and confidants for general thoughts and feelings and those specific to aphasia. PWA identified health care professionals as people to share thoughts and feelings, whereas CPs chose family and friends more often. Both CPs and PWA reported communication difficulty and finding a counselor as "sometimes" preventing access to services but cited fear and trust as "always" preventing access. Knowledge, beliefs, and experience with help-seeking and mental health services are personal and variable. Assessing barriers unique to living with aphasia, such as communication challenges and locating a suitable counselor, must also be considered within more complex and personal barriers of fear and trust that are consistently reported in the general public. Health professionals across the continuum of aphasia care need to understand the communication challenges of living with aphasia in tandem with understanding individual differences to personalize approaches to mental health services and help-seeking.

Automating Quality Control on a Shoestring, a Case Study

Dependence on manual inspections for quality control often results in errors, especially after prolonged periods of work that heighten the risk of missed defects. There is no shortage of expensive commercial inspection systems that can carry out the quality control work satisfactorily. However, small to medium-sized enterprises (SMEs) often face challenges in adopting these new systems for their production workflows because of the associated integration risks, high cost, and skill complexity. To address these issues, a portable, cost-effective, and automated quality inspection system was developed as an introductory tool for SMEs. Leveraging computer vision, 3D-printed mechanical parts, and accessible components, this system offers a 360-degree inspection of production line products, enabling SMEs to explore automation with minimal investment. It features a brief training phase using a few defect-free parts to reduce the skill barrier, thus helping SMEs to transition towards smart manufacturing. These help to address the main technology adoption barriers of cost, risk, and complexity. The system’s performance was validated through repeated testing on a large sheet metal chassis installed in uninterruptible power supplies (UPS), confirming its effectiveness as a steppingstone toward more advanced smart manufacturing solutions.

Indigenous youth involvement in land-based food systems in Fort Providence, Northwest Territories

Northern Indigenous communities in Canada face complex barriers rooted in ongoing colonial impositions to access the land and land-based food systems. They also continue to implement a variety of strategies to address these challenges and build more sustainable food systems. Youth are imperative to these processes because of their unique roles in the transmission of knowledge and culture. Our research examines the challenges to and opportunities for youth engagement in land-based food programming in the Dene and Métis community of Fort Providence, Northwest Territories, Canada. We also explore how participants viewed youth as important in land-based food systems and how their experiences support cultural continuities, self-determination, and adaptive capacity to socio-economic and environmental changes. Our work is informed by Indigenous methodologies and based on semi-structured interviews with Dene and Métis youth, community members, leaders, and non-Indigenous residents involved in local food initiatives. Our results demonstrate how youth participation in land-based food programming can respond to pressing colonial-imposed changes and foster food systems strategies in their communities and broader society.

Exploring Antimicrobial Compounds from Agri-Food Wastes for Sustainable Applications.

Transforming agri-food wastes into valuable products is crucial due to their significant environmental impact, when discarded, including energy consumption, water use, and carbon emissions. This review aims to explore the current research on the recovery of bioactive molecules with antimicrobial properties from agri-food waste and by-products, and discusses future opportunities for promoting a circular economy in its production and processing. Mainly, antibacterial molecules extracted from agri-food wastes are phenolic compounds, essential oils, and saponins. Their extraction and antimicrobial activity against a wide spectrum of bacteria is analyzed in depth. Also, their possible mechanisms of activity are described and classified based on their effect on bacteria, such as the (i) alteration of the cell membrane, (ii) inhibition of energy metabolism and DNA synthesis, and iii) disruption of quorum sensing and biofilm formation. These bioactive molecules have a wide range of possible applications ranging from cosmetics to food packaging. However, despite their potential, the amount of wastes transformed into valuable compounds is very low, due to the high costs relating to their extraction, technical challenges in managing supply chain complexity, limited infrastructure, policy and regulatory barriers, and public perception. For these reasons, further research is needed to develop cost-effective, scalable technologies for biomass valorization.

Nanomedicine in the treatment of Alzheimer's disease: bypassing the blood-brain barrier with cutting-edge nanotechnology.

Alzheimer's disease (AD) remains a formidable challenge in the field of neurodegenerative disorders, necessitating innovative therapeutic strategies. Nanomedicine, leveraging nanomaterials, has emerged as a promising avenue for AD treatment, with a key emphasis on overcoming the blood-brain barrier (BBB) to enhance drug delivery efficiency. This review provides a comprehensive analysis of recent advancements in the application of nanomaterials for AD therapy, highlighting their unique properties and functions. The blood-brain barrier, a complex physiological barrier, poses a significant hurdle for traditional drug delivery to the brain. Nanomedicine addresses this challenge by utilizing various nanomaterials such as liposomes, polymeric nanoparticles, and metal nanoparticles. These nanocarriers enable improved drug bioavailability, sustained release, and targeted delivery to specific brain regions affected by AD pathology. The review discusses the diverse range of nanomaterials employed in AD treatment, exploring their capacity to encapsulate therapeutic agents, modulate drug release kinetics, and enhance drug stability. Additionally, the multifunctionality of nanomaterials allows for simultaneous imaging and therapy, facilitating early diagnosis and intervention. Key aspects covered include the interaction of nanomaterials with Aβ aggregates, the role of antioxidants in mitigating oxidative stress, and the potential of nanomedicine in alleviating neuroinflammation associated with AD. Furthermore, the safety, biocompatibility, and toxicity profiles of various nanomaterials are scrutinized to ensure their clinical applicability. In conclusion, this review underscores the pivotal role of nanomedicine and nanomaterials in revolutionizing AD treatment strategies. By specifically addressing BBB challenges, these innovative approaches offer new avenues for targeted drug delivery and improved therapeutic outcomes in the complex landscape of Alzheimer's disease.

Declarative Approaches to Outcome Determination in Judgment Aggregation

Judgment aggregation (JA) offers a generic formal framework for modeling various settings involving information aggregation by social choice mechanisms. For many judgment aggregation rules, computing collective judgments is computationally notoriously hard. The central outcome determination problem, in particular, is often complete for higher levels of the polynomial hierarchy. This complexity barrier makes it challenging to develop practical exact algorithms to outcome determination. Taking on this challenge, in this work we develop practical exact algorithms for outcome determination under a range of the most central JA rules—namely Kemeny, Slater, MaxHamming, Young, Dodgson, Reversal scoring, Condorcet, Ranked agenda, and LexiMax—by harnessing the declarative approach, in particular, Boolean satisfiability (SAT) and integer programming techniques. For the Kemeny, Slater, MaxHamming, Young, and Dodgson rules, we detail direct approaches based on maximum satisfiability (MaxSAT) and integer programming. For the Reversal scoring, Condorcet, Ranked agenda, and LexiMax rules, we develop iterative algorithms, including algorithms based on the counterexample-guided abstraction refinement (CEGAR) paradigm, making use of recent advances in incremental MaxSAT solving and preferential SAT-based reasoning. We provide an open-source implementation of the algo- rithms, and empirically evaluate them using real-world preference data. We compare the performance of our implementation to a recent approach which makes use of declarative solver technology for answer set programming (ASP). The results demonstrate that our approaches scale significantly beyond the reach of the ASP-based algorithms for all of the judgment aggregation rules considered.

Tralokinumab Treatment of Atopic Dermatitis Induces a Progressive Transcriptomic Response.

Atopic dermatitis is characterized by a complex epidermal barrier deficiency and exaggerated immune responses dominated by type 2 mechanisms with variable contributions of additional immune axes. IL-13 is overexpressed in atopic dermatitis skin and a key driver of both barrier dysfunction and inflammation. In this study, we prospectively studied the effects of IL-13 inhibition with tralokinumab on cutaneous transcriptome profiles using RNA sequencing of biopsies from 16 patients with moderate-to-severe atopic dermatitis obtained at baseline, week 2, and week 16. Tralokinumab therapy induced early and delayed expression changes and progressively shifted the transcriptomic profile of lesional toward nonlesional skin by modulating both genes associated with keratinocyte proliferation and differentiation, itch signaling, and downstream inflammatory responses. At week 16, 751 genes were still significantly dysregulated compared with those in healthy control skin, reinforcing the need for long-term immunomodulatory therapy of moderate-to-severe atopic dermatitis to achieve deep responses. The study was registered with ClinicalTrials.gov (NCT04556461).

The new normal for children’s physical activity and screen viewing: a multi-perspective qualitative analysis of behaviours a year after the COVID-19 lockdowns in the UK

Abstract Background The COVID-19 pandemic significantly impacted children’s physical activity. Recent evidence indicated children’s accelerometer-measured physical activity levels have, on average, returned to near pre-pandemic levels in 2022, though sedentary behaviour remains higher. However, insufficient physical activity levels among children continues to be a critical public health issue in the UK, with only 41% meeting physical activity guidelines. This study aimed to provide in-depth analysis of how the pandemic has shaped children’s physical activity patterns beyond the short-term periods following lockdowns and identify the new challenges to engaging children in physical activity. Methods One-to-one interviews with parents (n = 22), school staff (n = 9), and six focus groups with children aged 10–11 years (n = 45) were conducted between February and July 2022. Topics explored changes to children’s physical activity and sedentary behaviour patterns, including screen-viewing, and factors influencing any changes. The framework method was used for analysis. Results Five themes were generated. Theme 1 described residual lockdown habits, including increased screen-viewing within the home, while activities outside the home continued to feel less spontaneous. Theme 2 highlighted an interrupted development of social, emotional, and physical skills among children compared to what would be expected pre-pandemic. This coincided with Theme 3 which reflected increased mental health challenges among families, creating complex barriers to children’s physical activity. A new normal for child physical activity was evoked and explored in Theme 4, with greater dependence on structured and organised activities. However, Theme 5 highlighted that girls and children with lower socio-economic position may be especially at risk of decreased physical activity. Conclusions There is a new normal for children’s physical activity that is characterised by increased dependence on structured and organised physical activities, such as active clubs, and less on unstructured and spontaneous physical activities, such as physical play. While this may suit many children, girls and children from lower socio-economic households face barriers to participating in the new normal. It is important that affordable and equitable opportunities are provided to all children to prevent physical activity and health inequalities.

Chitosan decoration enhanced the thermal and ultraviolet resistance of vitamin A-vitamin D coencapsulated in OSA starch-stabilized emulsion by regulating viscoelasticity, interfacial thickness and structure.

In this study, octenyl succinic acid sodium starch (OSAS) decorated with chitosan (CS) of different molecular weights (50-150kDa) and concentrations (10-30mg/mL) was used to stabilize an emulsion coencapsulating with vitamin A (VA) and vitamin D (VD). The effect of CS decoration on the thermal and UV stability of the emulsion, as well as the underlying mechanism, was elucidated. The incorporation of CS increased the retention rates of VA and VD by 11.36-25.52% and 3.65-20.54%, respectively, when exposed to 100°C for 30min, and by 13.35-33.05% and 15.97-37.49%, respectively, under ultraviolet (UV) exposure for 12h, respectively. The OSAS/CS complexes were absorbed at the oil-water interface through electrostatic interactions and hydrogen bonding, forming thick interfacial film barriers, and regulating emulsion viscoelasticity to achieve protection against thermal and UV damage. CS decoration increased the thickness, relative crystallinity, and thermal degradation resistance of the interfacial films to mitigate thermal interference with the emulsion. The OSAS/CS complex barriers shielded UV by forming longer molecular chains or ring structures at the interface, enhancing amide functionality, and promoting intermolecular hydrogen bonding. This research could provide a reference for designing practical delivery systems for heat-sensitive and UV-sensitive nutrients like VA and VD.

Defining barriers to food systems sustainability: a novel conceptual framework

The transformation of food systems emerges as a critical challenge necessitating a deep, holistic comprehension of the complex and multifaceted barriers that hinder progress towards sustainability. The existing literature is not consistent in identifying these barriers. Building upon existing work, this paper introduces a comprehensive, integrated, and interdisciplinary framework to dissect the nature and origins of the barriers to food system sustainability. Our framework categorizes these impediments into five domains: political economy, socio-technical, socio-cultural, biophysical, and socio-economic barriers, and highlights their intricate interplay and interconnected nature. We pinpoint the foundational role of political economy barriers as the cornerstone of a “system of barriers” that create or perpetuate unsustainability. This framework not only advances academic knowledge by providing a structured basis for analysing sustainability barriers but also serves as a practical tool for policymakers, researchers, and practitioners, to foster transdisciplinarity and develop targeted interventions. We call for further empirical research, emphasizing the need for comparative analyses, longitudinal studies, and the exploration of feedback loops and non-linear dynamics between barriers, to inform effective and sustainable food system transformation strategies.

The role of the mucosal barrier system in maintaining gut symbiosis to prevent intestinal inflammation.

In the intestinal tract, where numerous intestinal bacteria reside, intestinal epithelial cells produce and release various antimicrobial molecules that form a complex barrier on the mucosal surface. These barrier molecules can be classified into two groups based on their functions: those that exhibit bactericidal activity through chemical reactions, such as antimicrobial peptides, and those that physically hinder bacterial invasion, like mucins, which lack bactericidal properties. In the small intestine, where Paneth cells specialize in producing antimicrobial peptides, the chemical barrier molecules primarily inhibit bacterial growth. In contrast, in the large intestine, where Paneth cells are absent, allowing bacterial growth, the primary defense mechanism is the physical barrier, mainly composed of mucus, which controls bacterial movement and prevents their invasion of intestinal tissues. The expression of these barrier molecules is regulated by metabolites produced by bacteria in the intestinal lumen and cytokines produced by immune cells in the lamina propria. This regulation establishes a defense mechanism that adapts to changes in the intestinal environment, such as alterations in gut microbial composition and the presence of pathogenic bacterial infections. Consequently, when the integrity of the gut mucosal barrier is compromised, commensal bacteria and pathogenic microorganisms from outside the body can invade intestinal tissues, leading to conditions such as intestinal inflammation, as observed in cases of inflammatory bowel disease.

Unveiling barriers to reproductive health awareness among rural adolescents: a systematic review.

Sexual and reproductive health (SRH) among adolescents is a critical aspect of global health. Rural adolescents often encounter significant barriers to reproductive health awareness, elevating their risks for unintended pregnancies, sexually transmitted infections (STIs), and other reproductive health issues. This systematic review seeks to identify and analyze the barriers hindering reproductive health awareness among rural adolescents. This review followed PRISMA guidelines. Literature searches were conducted in PubMed, ScienceDirect, Google Scholar, and Taylor & Francis, focusing on studies published from 2019 to 2024. Keywords included "Adolescent," "Rural," "Reproductive Health," "Awareness," and "Barriers." Studies were screened based on eligibility criteria, and data were extracted and analyzed to identify key barriers at the individual, interpersonal, social/community, and health services levels. Out of 669 records, 20 studies met the inclusion criteria. Identified barriers at the individual level included lack of knowledge, myths, misconceptions, and feelings of shame and fear. Interpersonal barriers were related to poor communication between parents and adolescents and misinformation from peers. Social and community barriers encompassed rigid social norms, stigma, and discrimination. Health services barriers included limited access and negative experiences with reproductive health services. Rural adolescents face complex barriers to reproductive health awareness driven by factors at the individual, interpersonal, social, and health services levels. Comprehensive interventions, such as educational campaigns, training for healthcare providers, and improved access via mobile or online platforms, are essential to enhance reproductive health awareness and outcomes. https://www.crd.york.ac.uk/, PROSPERO (CRD42024554439).

Inclusive Public Toilets: A Universal Design Enquiry for Indian Context.

Public toilets fulfil an essential need for all human beings. In the context of India, the diversity of population implies a diverse set of complex barriers in the public toilet experience. Inclusion and the contextual translation of universal design becomes crucial, considering the distinct socio-cultural dimensions. This study intends to enquire the above-mentioned perspective and contribute towards an understanding of inclusion and universal design in public toilets. The methodology is a three-part process including literature review, experiential case reflections and ethnographic field perspectives. The gathered data is mapped thematically and assessed qualitatively, based on the existing principles of universal design. The insights from the assessment highlight the need for contextualization of existing universal design principles, bringing out a multi-dimensional complexity of inclusion across human needs, behaviour, physical, planning and service aspects. This study paves a way forward for evolving design directions by raising further questions through fresh perspectives on inclusion & accessibility in public toilets. The raised questions contribute to a dilemma of standardisation versus contextual customisation around the understanding of inclusion and universal design, focusing on the scenario of Indian public toilets.