External Barriers Research Articles

Compassion Without Fatigue. A Unitary Caring Science Approach: Part II—Essential Truths of Compassion Fatigue for Pediatric Nurses

This article shares the findings of a research study about the external and internal barriers and consequences nurses face as they try to ward off compassion fatigue. This qualitative research employs Relational Caring Inquiry, honoring unique narratives while gaining collective insight into the experiences of being a nurse. Participants for this study were nurses on inpatient units. Findings illustrate the tangible consequences nurses face from the complexities of working in today’s healthcare settings. The information shared reflects the profound purpose that nurses bring while shedding light on what keeps them from flourishing in their roles.

Investigating and prosecuting white-collar and corporate crime: Challenges and barriers for national police agencies

Many countries have established national authorities to investigate and prosecute serious and complex white-collar and corporate crime incidents. This article reviews research literature regarding external challenges and barriers for national agencies in Norway (Økokrim), New Zealand (SFO), the United Kingdom (SFO), and the Netherlands (OSF). The policing study in this article is important as it illustrates dilemmas that governments need to address when reviewing their national fraud offices and economic crime authorities. While Økokrim in Norway seems reluctant to prosecute too complex economic crime cases, the SFO in New Zealand attempts prevention of deinstitutionalization, the SFO in the UK might have deterrence effects, while the OSF in the Netherlands is challenged by the private industry of corporate investigators. These are some of the challenges and barriers facing national authorities that are charged with the tasks of investigating and prosecuting white-collar and corporate crime at the national level. The identified challenges and barriers especially related to the convenience theory perspective should enable future research to identify relevant actions.

Physical Activity Barriers Among Adolescents in Jordan: A Cross-Sectional Study.

Physical activity is critical for health promotion and the prevention of noncommunicable illnesses, especially among teenagers. However, teenagers' active participation in physical exercise may be hampered by perceived impediments to physical activity. This study aimed to identify the external and internal barriers to physical activities among adolescents, as well as any differences in these barriers between males and females. A cross-sectional study was carried out among 600 adolescent students (aged 11-16) from a public school in Jordan. A self-administered questionnaire with 12 items assessed barriers to physical activity. Internal and external barriers were identified, and statistical analyses were performed using SPSS. Male adolescents reported more perceived hurdles to physical exercise than female adolescents, with lack of time and lack of self-confidence being the most significant impediments. External impediments were more prominent than internal barriers, particularly a lack of resources. The total score for external barriers was significantly higher than that for internal barriers. "Lack of resources" was the most important external barrier (mean = 3.49), and "lack of self-confidence" was the most significant internal barrier (mean = 3.47). Male and female teenagers differed in the obstacles of "lack of self-confidence" (p = .045) and "lack of time" (p = .040). The most significant perceived hurdles included a lack of awareness of the health benefits of exercise, concerns about appearance while exercising, limited access to fitness centers, lack of exercise equipment at home, and insufficient spare time due to a packed class schedule. It is critical to implement interventions that address the identified barriers to physical activity, particularly among female adolescents, such as improving opportunities for physical activity and providing social support for participation.

Framework for Strategic Integration of Internationalization in Teacher Education Institutions

This study addresses the internal and external drivers and barriers to creating a tangible strategic integration of the internationalization framework for Teacher Education Institutions. The strategic alignment in the curricula, planning processes, and assessment of implementation were notably established as emerged from the data analysis. Though internationalization embraces numerous advantages or positives to higher education, crucial risks are connected with this complex and growing phenomenon, including some identified internal and external drivers and barriers in the conduct of internationalization of the Teacher Education Institution.

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

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

Barriers and enablers to engagement with a type 2 diabetes remission project in the North East of England: qualitative perspectives of patients

Abstract This qualitative research sought to identify factors influencing patient choice of, and patient-related internal and external enablers and barriers to engagement with, type 2 diabetes (T2D) remission strategies offered by the Remission in diabetes (REMI.D) project. Patients had a choice of three diets: Total Diet Replacement (TDR)-Formula Food Products, TDR-Food, and Healthy lifestyle approach; and three activity pathways: Everyday life, General Practitioner referral, and Social hub. Semi-structured interviews were recorded and transcribed. Thematic analysis used the Framework Method and NVivo 12 to assist with generation and organisation of codes, inductive and deductive (Theoretical Domains Framework). The REMI.D project was a place-based approach (place in this case being defined as two local authorities with significant rates of deprivation) situated in the North East of England. Twenty patients out of a possible 65 patients took part. Areas of interest included: patient choice, patient intention, patient adherence, patient non-adherence, and patient stigma. Addition of a more moderate dietary strategy (not dissimilar to the diet in the Healthier You NHS Diabetes Prevention Programme) to the existing NHS England T2D Path to Remission programme may enable more patients to achieve remission or delayed progression with deprescribing of diabetes medications. Embedding a tailored physical activity path within or as a bolt-on to the NHS programme requires consideration. Limited resources should be targeted towards patients who identify with more barriers or fewer opportunities for health behaviour modification. Further research on use of virtual programmes in deprived areas is warranted.

Трансформация делового климата российского бизнеса в условиях западных санкций

Modern trends and problems in the development of the global economy require a search for increasing the competitiveness of Russian companies in the global economic system. At the same time, one of the most important indicators assessing competitiveness opportunities is business activity and confidence in the future. The article presents an assessment of the business environment and analysis of the business climate of the Russian Federation in the period from 2014 to 2023, including in various sectors of the economy, taking into account positive, negative and restraining assessments given by the heads of large, small and medium-sized businesses. The main problems, internal and external barriers to the functioning of enterprises during the sanctions period under consideration are analyzed. Every year, more than half of entrepreneurs note the problem of rising prices and tariffs, high taxation, instability of the ruble exchange rate and a high key rate. One of the most important, and rightfully one of the three most negative barriers to doing business, is the lack of highly qualified personnel. Also relevant are the problems of unfair competition, difficulties in carrying out foreign economic transactions, underdeveloped infrastructure, insufficient protection of property rights and contract rights; remaining high administrative barriers, etc.

Analysing the Impact of Factors on Challenges and Barriers in Supply Chain Management Implementation in the Sri Lankan Retail Industry During Covid-19

The primary purpose of this research study is to analyse the impact of factors on challenges and barriers faced by the retail industry in Sri Lanka in implementing supply chain management (SCM) amidst the COVID-19 situation. Furthermore, this study attempts to examine the mitigating strategies of challenges and obstacles to implementing SCM under disaster situations. The study sample comprised 52 individuals (out of 208 individuals directly engaged with supply chain activities) from six selected supermarket chains operating within Sri Lanka, and the data was collected using a questionnaire. Descriptive statistics were used to measure the degree of internal and external challenges and barriers to implementing SCM. Correlation and regression analysis were performed to identify the relationship between selected independent variables and the challenges and barriers of implementing SCM. The findings indicated a positive relationship between selected independent variables and the challenges and barriers of implementing SCM within the Sri Lankan retail industry. The study recommends effective actions to successfully implement SCM within the retail industry in Sri Lanka amidst the COVID-19 situation.

Barreiers and opportunities of the Republic of Moldova as a future member of the European Union

Introduction. The article explores the challenges and prospects faced by the Republic of Moldova in its ambitions to become a member of the European Union. Moldova’s geopolitical location, situated between EU member states and Ukraine, makes it a significant participant in the Eastern Partnership program. The main barriers hindering Moldova’s path to EU membership, such as political instability, corruption, and economic disparities, have been analyzed. The impact of the Transnistria conflict on the country’s European integration ambitions has also been studied. Potential opportunities and advantages Moldova possesses, such as commitments to democratic reforms and association agreements with the EU, have been examined. The continuous support from the EU towards Moldova’s European integration through financial assistance and cooperation in political matters has been highlighted. A roadmap for realizing Moldova’s European ambitions has been proposed, and the consequences of its potential future membership in the European Union have been revealed.
 Purpose. The aim of the article is to analyze the economic, political, and geopolitical issues influencing the Eurointegration processes in the Republic of Moldova, particularly its status as a candidate for European Union membership.
 Methods. To achieve the stated goal of the article, several specialized research methods were employed, including analysis and synthesis, induction and deduction, abstraction and concretization, systematization, and elements of comparative analysis. The methodological foundation for the research included national normative legal acts of the EU member states and the Republic of Moldova, as well as joint documents regulating integration processes. Additionally, scholarly works of domestic and foreign researchers, statistical reports, and other sources of information were utilized. This comprehensive approach facilitated a profound analysis and substantiation of conclusions regarding Moldova’s Eurointegration prospects and the necessity for implementing reforms to ensure successful membership in the European Union.
 Conclusions. The Republic of Moldova faces significant barriers, such as political instability, impeding the adoption of long-term reforms; widespread corruption affecting the business climate and investment potential; and economic disparities hindering regional development. Several promising opportunities for Moldova were identified during the research. These include commitments to democratic reforms and cooperation with the European Union. The conclusion was drawn that successful EU membership would grant Moldova substantial benefits, such as enhanced economic development, foreign investment attraction, access to the European market, and the promotion of contemporary standards across various sectors. The importance of implementing necessary reforms and changes to achieve Moldova’s Eurointegration goals and EU support in this process were emphasized.
 Discussion. The research findings indicate that the Republic of Moldova encounters internal and external barriers complicating its path to becoming a future member of the European Union. Political instability, corruption, and economic disparities remain significant obstacles to European integration. However, Moldova possesses the potential and opportunities for reforms and cooperation with the EU, increasing its chances of obtaining membership. EU support and commitment to democracy and European standards open doors to realizing potential advantages of EU membership. To succeed in Eurointegration processes, Moldova must continue implementing reforms and maintaining cooperation with the EU.

Czech education system’s conditions for the implementation of GIS in the curriculum in an international context

The implementation of geospatial technologies in both primary and secondary education is more than desirable. However, many obstacles stand in the way. This paper reflects on the current state of geographic information systems (GIS) implementation in the educational curriculum in Czechia in comparison with an international context. The study aimed to analyse the anchoring of GIS in Czech curricula and identify the enablers and barriers to the use of GIS in education. It employed a questionnaire survey to capture a large number of responses (n = 94); following this, guided interviews were conducted with selected teachers (n = 9) to delve deeper into the selected topics. This research work shows that external barriers to the use of GIS in teaching are essentially non-existent; specifically, (the curriculum does not hinder GIS implementation, school management support is sufficient, and the material and technical facilities required are available in most schools). However, teachers’ non-/unpreparedness—their lack of motivation or experience in teaching with GIS—is a significant internal barrier.

Barriers to sustainable and circular product design – A theoretical and empirical prioritisation in the European automotive industry

Despite the increasing availability of tools and methods for sustainable and circular product design (DfS), their uptake in practice is slow. This is also true in the automotive industry, where DfS is an important measure for addressing the industry's negative environmental and social impacts. To facilitate DfS implementation, this paper uses an analytic hierarchy process (AHP) and offers, for the first time, a classification and prioritisation of the barriers that need to be overcome when implementing DfS into vehicle development processes. Based on a systematic literature review and on an expert workshop, the top 15 DfS barrier factors were derived and divided equally into five groups, following a multi-level structure. These factors and groups formed the input for a survey-based analytic hierarchy process with 38 European industry experts. The results show that strategic issues are the most important barriers, followed by the group of operational, personal, external, and tool-related barriers. Among the 15 barrier factors identified, the top five were (1) an unclear link to profitability, (2) lack of top management support, (3) difficulties in handling trade-offs, (4) high operational costs, and (5) a lack of integration of DfS into corporate strategy. The results indicate that while external constraints already exert pressure on automotive companies, they still face particular challenges when attempting to integrate sustainability into corporate strategies and in transferring such strategies to DfS activities at the operational level. The study results may be used to inform managerial policy and further research.

CONDITIONS FOR INTRODUCING INNOVATION ON AGRICULTURAL FARMS

Innovations are an integral element of the development of economic units, including farms. The main aim of the research was to identify and characterize the implemented innovations and methods of managing them on farms. The research was carried out on the basis of an original survey questionnaire addressed to 80 owners of farms from the Warmian-Masurian Voivodeship. The research was carried out between June and November 2020. Research results have shown that innovations in agriculture are implemented mainly for economic reasons. Important reasons for these activities are the desire to achieve higher income, farm development, increase in efficiency and decrease in labor intensity. The most frequently indicated external barriers when trying to implement innovations were difficulties in obtaining the necessary funds, and internal ones: fear of failure and insufficient level of own funds. After implementing the innovation, farmers observed an increase in production capacity and a decrease in labor intensity. Thanks to innovations, many respondents were able to expand the area of their operations and influence the development of their farms.

Social Entrepreunership In Fish Farming

Entrepreneurship plays an important role in the economy as it facilitates the production of goods and services and job creation. The agriculture sector including fish farming is one of the main livelihood sources for the community and has potential for growth through entrepreneurship programs. However, there are several obstacles in achieving this goal, such as the low level of community education and knowledge as well as limited social networking access. The fishing pond farmers in Kalanganyar Village, Sedati Sub-district, Sidoarjo Regency face similar challenges with additional complexity from external barriers such as fluctuating operational costs for fish farming. This economically causes fishing pond farmers to only be able to utilize their ponds for a single source of main income and have not been able to utilize it to find alternative income sources. These challenges hinder the development of programs to improve the economic conditions of fishing pond farmers. An approach that could address these problems is social entrepreneurship focusing on increasing collaboration between fishing pond farmers and the surrounding community. Cooperation plays an important role in economic growth by facilitating business expansion. Cooperation becomes a core component in the planning and implementation process by involving fishing pond farmers and the community as active participants. The fields of cooperation need to be developed to increase the welfare of the community.

To explore clinical pharmacists’ opinions, and their perceived barriers and facilitators, to supporting clinical research delivery in secondary care

Abstract Introduction The National Health Service (NHS) is confronted with significant challenges in facilitating clinical research delivery.1 Clinical pharmacists were instrumental in ensuring patient safety while conducting urgent public health studies, such as the RECOVERY trial, during the COVID-19 pandemic.2 Numerous studies have reported the positive impact of pharmacy workforce in supporting clinical research delivery3. However, it remains unclear whether pharmacists are willing to take on this extra responsibility. Aim To explore the opinions of UK clinical pharmacists towards facilitating the delivery of clinical research in secondary care. Objectives include understanding the level of knowledge of clinical research among clinical pharmacists; assessing levels of interest among clinical pharmacists towards supporting clinical research delivery; identifying clinical pharmacists’ perceived barriers and facilitators to supporting clinical research delivery; and developing recommendations to facilitate pharmacists’ engagement in research delivery. Methods This study employed a qualitative research approach and utilised convenience sampling based on the researcher’s professional network. Eight pharmacists from two secondary care NHS Trusts participated. Individual semi-structured interviews were conducted using questions adapted from the Research Capacity and Culture (RCC) tool which was validated by two clinical trial pharmacists. Keele University Research Ethics Committee provided a favourable ethical opinion. Interview transcripts were analysed to identify emerging themes by using framework analysis. Results The findings revealed that participants possessed limited knowledge of clinical research in general. The key themes identified were categorised into three domains: individual, professional, and organisational, which corresponded with the RCC tool. In the individual domain, pharmacists demonstrated interest in clinical research delivery but lacked confidence. They acknowledged clinical research as contributing to evidence-based practice and enhancing professional development. However, they expressed concerns about patient harm resulting from trial interventions and poorly designed studies generating misleading data. Within the professional domain, pharmacists' capability to support clinical research delivery was limited by inadequate training in clinical research, their clinical skills, and their disease knowledge. They perceived internal and external barriers to participation. It has been suggested to improve the research culture within the profession and promote the role pharmacists can play in delivering research among other healthcare professionals. In the organisational domain, the workplace environment was perceived to present obstacles due to competing priorities and clinical research not being seen to be a core duty by managers. Additionally, awareness of clinical research opportunities was limited and exposure to clinical research-related activities within the workplace was minimal. Discussion/Conclusion Recommendations to address these barriers include promoting clinical research training, developing mentorship programs, creating platforms to connect clinical pharmacists with research opportunities, and identifying roles that allow pharmacists to incorporate clinical research into their routine practice. This research project has several limitations, including the use of a convenience sampling method, a small sample size and potential interviewer bias due to research participants all being known to the researcher. In summary, the pharmacy workforce possesses the potential to support the challenges in clinical research delivery faced by the NHS. However, addressing the perceived barriers is critical to enhancing pharmacist involvement in this field.

Strengthening Primary Healthcare in Jordan for Achieving Universal Health Coverage: A Need for Family Health Team Approach.

Achieving Universal Health Coverage (UHC) is a strategic objective of the Jordanian government and has been prioritized in its strategies and plans. However, there are several challenges affecting primary healthcare in Jordan and the health system in general that prevent Jordan from achieving UHC. This paper highlights the importance of team-based care in the form of Family Health Teams (FHTs) to realize Jordan's goal of achieving UHC. FHTs are a team-based approach that brings together diverse professionals to provide a comprehensive, efficient, patient-centered primary care system that meets the changing needs of Jordan's population and refugees. However, the implementation of FHT may encounter obstacles, including individual, organizational, institutional, and external barriers. To overcome such obstacles, several actions and processes need to be taken, including political commitment and leadership, implementing good governance and policy frameworks, allocating resources and funding, multisectoral collaboration, and engagement of communities and stakeholders. The successful implementation of FHTs requires participation from government officials, parliamentarians, civil society, and influential community, religious, and business leaders. A strategic policy framework, effective oversight, coalition building, regulation, attention to system design, and accountability are also essential. In conclusion, adopting the FHT approach in Jordan's Primary Healthcare system offers a promising path towards achieving UHC, improving healthcare access, quality, and efficiency while addressing the unique challenges faced by the country's healthcare system.

Undergraduate students’ perceived mobile technology-learning barriers in their academic studies: a study in Greece

Mobile technology is used by undergraduate students for educational purposes, it supported students’ learning during the pandemic, while mobile learning may have potential benefits and barriers. This study investigates Greek undergraduate students’ perceptions on mobile technology-learning barriers in their academic studies. This topic is of international interest and still underexplored in Greece. An online questionnaire was completed by 212 students, and this study is descriptive-inferential. Students’ perceptions regarding major barriers, reveal both external (internet connectivity issues, high cost of mobile devices, outdated operating system) and internal (tutors’ negative attitudes and insufficient knowledge for mobile technology-learning integration) barriers. Other obstacles are associated with student concerns about distraction, and inadequate training opportunities to use mobile technology in their studies. Students’ confidence, attitudes and digital skills regarding mobile technology adoption/use are perceived as minor barriers (or no barriers). The findings have implications for students, university tutors and university stakeholders.

Keterlibatan Perempuan secara Formal dalam Pengelolaan Kegiatan Pariwisata di Desa Wisata Kebonagung, Bantul

The tourism industry is seeing rapid growth. Nevertheless, the involvement of women in the official administration of the tourism industry remains limited. The objective of this study was to examine the extent of women's formal involvement in the management of tourist operations in Kebonagung tourist Village, located in Imogiri, Bantul Regency, in the Daerah Istimewa Yogyakarta Province. The analysis was conducted using the MOA (Motivation, Opportunity, and Ability) participation model. This study employed a qualitative methodology, utilizing techniques such as observation, interviews, and documentation. Data collection spanned a duration of 20 days, commencing on April 1st and concluding on April 20th, 2022. The researcher conducted interviews with three managers and pioneers of the Kebonagung Tourism Village,three female members who hold formal positions in the administration structure of the village, and three female local residents who actively participate in tourism activities. The findings of this study indicate that the level of women's engagement in formal management, as measured by factors such as motivation, opportunity, and ability, was significantly low. Additionally, the participation of women in formal management positions was shown to be extremely limited. The low participation of women in formal management in Kebonagung Tourism Village can be attributed to various factors. These include a lack of motivation among women to engage in management roles, limited opportunities that are not effectively utilized, inadequate or insufficient capabilities, as well as internal and external barriers that hinder women from formally participating in managing tourism activities.

Drivers and barriers for implementing social sustainability in supply chains: a qualitative investigation of a developing country's multi-tier suppliers

PurposeThe purpose of this paper is to investigate why multi-tier apparel suppliers integrate social sustainability practices into their supply chains and what barriers these suppliers encounter while embedding social sustainability practices.Design/methodology/approachThis study employs a qualitative research design, drawing on data from semi-structured interviews with 46 owners and managers from 33 multi-tier apparel suppliers in Bangladesh, an important outsourcing hub for the global apparel industry. To corroborate research findings, the views of owners and managers were triangulated by further interviewing 11 key representatives of institutional actors such as third-party auditors, a donor agency, industry associations, regulatory agencies and a non-governmental organisation (NGO).FindingsThe authors' findings suggest a range of divergent institutional drivers and barriers – coercive, mimetic and normative – that determine the implementation of multi-tier suppliers' social sustainability practices. The key reported drivers were buyers' requirements, external stakeholders' expectations, top management commitment and competition. Conversely, cost and resource concerns and gaps in the regulatory framework were identified as key social sustainability implementation barriers. In particular, owners and managers of second-tier and third-tier supplier firms experienced more internal barriers such as cost and resource concerns than external barriers such as gaps in values, learning and commitment (i.e. compromise for mutual benefit and non-disclosure of non-compliance) that impeded effective social sustainability implementation.Research limitations/implicationsSocial sustainability in supply chain management has received significant attention from academics, business practitioners, governments, NGOs and supranational organisations. However, limited attention has been paid to investigating the drivers and barriers for social sustainability implementation from a developing country's multi-tier supplier perspective. The authors' research has addressed this knowledge gap.Practical implicationsThe evidence from the authors' study provides robust support for key assumptions of institutional theory and has useful implications for both managers and policy-makers.Originality/valueThe authors' study contributes to the embryonic research stream of socially sustainable multi-tier supply chain management by connecting it to the application of institutional theory in a challenging institutional context.

Acceptability, Usefulness, and Ease of Use of an Enhanced Video Directly Observed Treatment System for Supporting Patients With Tuberculosis in Kampala, Uganda: Explanatory Qualitative Study.

In tuberculosis (TB) control, nonadherence to treatment persists as a barrier. The traditional method of ensuring adherence, that is, directly observed therapy, faces significant challenges that hinder its widespread adoption. Digital adherence technologies such as video directly observed therapy (VDOT) are emerging as promising solutions. However, as these novel technologies gain momentum, a critical gap is the lack of comprehensive studies evaluating their efficacy and the unique experiences of patients in Africa. The aim of this study was to assess patients' experiences that affected acceptability, usefulness, and ease of use with an enhanced VDOT system during monitoring of TB treatment. We conducted individual open-ended interviews in a cross-sectional exit qualitative study in Kampala, Uganda. Thirty participants aged 18-65 years who had completed the VDOT randomized trial were purposively selected to represent variability in sex, adherence level, and HIV status. We used a hybrid process of deductive and inductive coding to identify content related to the experience of study participation with VDOT. Codes were organized into themes and subthemes, which were used to develop overarching categories guided by constructs adapted from the modified Technology Acceptance Model for Resource-Limited Settings. We explored participants' experiences regarding the ease of use and usefulness of VDOT, thereby identifying the facilitators and barriers to its acceptability. Perceived usefulness refers to the benefits users expect from the technology, while perceived ease of use refers to how easily users navigate its various features. We adapted by shifting from assessing perceived to experienced constructs. The participants' mean age was 35.3 (SD 12) years. Of the 30 participants, 15 (50%) were females, 13 (43%) had low education levels, and 22 (73%) owned cellphones, of which 10 (45%) had smartphones. Nine (28%) were TB/HIV-coinfected, receiving antiretroviral therapy. Emergent subthemes for facilitators of experienced usefulness and ease of VDOT use were SMS text message reminders, technology training support to patients by health care providers, timely patient-provider communication, family social support, and financial incentives. TB/HIV-coinfected patients reported the added benefit of adherence support for their antiretroviral medication. The external barriers to VDOT's usefulness and ease of use were unstable electricity, technological malfunctions in the app, and lack of cellular network coverage in rural areas. Concerns about stigma, disease disclosure, and fear of breach in privacy and confidentiality affected the ease of VDOT use. Overall, participants had positive experiences with the enhanced VDOT. They found the enhanced VDOT system user-friendly, beneficial, and acceptable, particularly due to the supportive features such as SMS text message reminders, incentives, technology training by health care providers, and family support. However, it is crucial to address the barriers related to technological infrastructure as well as the privacy, confidentiality, and stigma concerns related to VDOT.

Staff Perceptions on the Effectiveness of GRiP-S, a New Approach to Clinical Supervision Incorporating Safewards: An Interpretive Phenomenological Analysis

This study explored the impact of an innovative approach to clinical supervision for mental health nurses which integrates Safewards, named Group Reflective integrated Practice with Safewards – GRiP-S. Qualitative data was collected through 10 individual semi-structured interviews with nursing staff who had participated within the clinical supervision approach. Interviews provided insights into the nursing staff’s perception and experience of the clinical supervision approach. Through interpretive phenomenological analysis six themes emerged (i) illuminating embodied practice of Safewards, (ii) building confidence through empowering connections, (iii) creating a culture of positive change, (iv) identifying internal motivation for and external barriers to supervision engagement, (v) navigating a global pandemic, and (vi) the transformative role of reflection. Findings demonstrated that the GRiP-S approach assisted mental health nurses’ adoption of Safewards interventions in practice, while supporting the development of a cohesive staff team. The impact of COVID-19 within the study setting was addressed and nurses identified how the Safewards model assisted in navigating challenges during this time. Findings further supported prior research on the role of the supervisor and supervisee relationship. This study supports the integration of Safewards within reflective clinical supervision for mental health nursing staff to assist in Safewards fidelity and nursing staff personal and professional development.