Extrinsic Barriers Research Articles

An assessment of the factors affecting the commercialization of cell-based therapeutics: a systematic review protocol

BackgroundCellular-based therapies represent a platform technology within the rapidly expanding field of regenerative medicine and are distinct from conventional therapeutics—offering a unique approach to managing what were once considered untreatable diseases. Despite a significant increase in basic science activity within the cell therapy arena, alongside a growing portfolio of cell therapy trials and promising investment, the translation of cellular-based therapeutics from “bench to bedside” remains challenging, and the number of industry products available for widespread clinical use remains comparatively low. This systematic review identifies unique intrinsic and extrinsic barriers in the cell-based therapy domain.Methods/designEight electronic databases will be searched, specifically Medline, EMBASE (OvidSP), BIOSIS & Web of Science, Cochrane Library & HEED, EconLit (ProQuest), WHOLIS WHO Library Database, PAIS International (ProQuest), and Scopus. Addition to this gray literature was searched by manually reviewing relevant work. All identified articles will be subjected for review by two authors who will decide whether or not each article passes our inclusion/exclusion criteria. Eligible papers will subsequently be reviewed, and key data extracted into a pre-designed data extraction scorecard. An assessment of the perceived impact of broad commercial barriers to the adoption of cell-based therapies will be conducted. These broad categories will include manufacturing, regulation and intellectual property, reimbursement, clinical trials, clinical adoption, ethics, and business models. This will inform further discussion in the review. There is no PROSPERO registration number.DiscussionThrough a systematic search and appraisal of available literature, this review will identify key challenges in the commercialization pathway of cellular-based therapeutics and highlights significant barriers impeding successful clinical adoption. This will aid in creating an adaptable, acceptable, and harmonized approach supported by apposite regulatory frameworks and pertinent expertise throughout the respective stages of the adoption cycle to facilitate the adoption of new products and technologies in the industry.

Role of Cell-Intrinsic and Environmental Age-Related Changes in Altered Maintenance of Murine T Cells in Lymphoid Organs

Age-related changes in primary lymphoid organs are well described. Less is known about age-related changes affecting peripheral lymphoid organs, although defects in old peripheral lymph nodes (pLNs) were recently described in both steady state and during viral infection. To address whether such pLN defects were intrinsic to old T cells or extrinsic (due to aging microenvironment), we employed heterochronic parabiosis. We found no age-related intrinsic or extrinsic barriers to T cell circulation and seeding of pLN, spleen, and bone marrow. However, heterochronic parabiosis failed to improve cellularity of old pLN, suggesting an environment-based limit on pLN cellularity. Furthermore, upon parabiosis, pLN of the adult partner exhibited reduced, old-like stromal and T cell cellularity, which was restored following separation of parabionts. Decay measurement of adult and old T cell subsets following separation of heterochronic parabionts delineated both T cell-intrinsic and environmental changes in T cell maintenance. Moreover, parabiotic separation revealed differences between CD4 and CD8 T cell subset maintenance with aging, the basis of which will require further investigation. Reasons for this asymmetric and subset-specific pattern of differential maintenance are discussed in light of possible age-related changes in lymph nodes as the key sites for peripheral T cell maintenance.

High Self-Efficacy Correlates With Use of Long-Acting Reversible Contraceptives [20A

INTRODUCTION: The American College of Obstetrics and Gynecology recommends long-acting reversible contraceptives (LARCs) as the safest and most effective reversible contraceptives. In the US, only 7% of women use LARCs, and 45% of pregnancies continue to be unintended. Barriers to LARC use can be intrinsic or extrinsic. While previous studies focus on extrinsic barriers to LARC use, our study evaluates intrinsic barriers. We hypothesize that two psychological traits, locus of control (LOC) and contraceptive self-efficacy (SE), influence use of LARCs. METHODS: Data are from the baseline survey of an IRB-approved randomized control trial. The study population was 874 privately insured Pennsylvania residents aged 18-40, who were not intending pregnancy for 12 months. LOC (internal vs external) and contraceptive SE (high vs low) were measured using composite scores from 5 and 8-item scales respectively. The association of LOC and SE with LARC use was determined using multivariable logistic regression adjusting for future pregnancy intention, education, and history of unintended pregnancy. RESULTS: LARC use was predicted by high SE (Adjusted OR 1.90, 95% CI 1.13, 3.19), but not by internal LOC (Adjusted OR 0.86, 95% CI 0.53-1.42). LARC use was also predicted by ambivalence about future pregnancy and history of previous unintended pregnancy. CONCLUSION: Women with high SE had an increased use of LARCs. Efforts to identify patients with low self-efficacy may provide opportunity for increased counseling and interventions to promote use of LARCs.

Life on the rocks: Multilocus phylogeography of rock hyrax (Procavia capensis) from southern Africa

Understanding the role of geography and climatic cycles in determining patterns of biodiversity is important in comparative and evolutionary biology and conservation. We studied the phylogeographic pattern and historical demography of a rock-dwelling small mammal species from southern Africa, the rock hyrax Procavia capensis capensis. Using a multilocus coalescent approach, we assessed the influence of strong habitat dependence and fluctuating regional climates on genetic diversity. We sequenced a mitochondrial gene (cytochrome b) and two nuclear introns (AP5, PRKC1) supplemented with microsatellite genotyping, in order to assess evolutionary processes over multiple temporal scales. In addition, distribution modelling was used to investigate the current and predicted distribution of the species under different climatic scenarios. Collectively, the data reveal a complex history of isolation followed by secondary contact shaping the current intraspecific diversity. The cyt b sequences confirmed the presence of two previously proposed geographically and genetically distinct lineages distributed across the southern African Great Escarpment and north-western mountain ranges. Molecular dating suggests Miocene divergence of the lineages, yet there are no discernible extrinsic barriers to gene flow. The nuclear markers reveal incomplete lineage sorting or ongoing mixing of the two lineages. Although the microsatellite data lend some support to the presence of two subpopulations, there is weak structuring within and between lineages. These data indicate the presence of gene flow from the northern into the southern parts of the southern African sub-region likely following the secondary contact. The distribution modelling predictably reveal the species’ preference for rocky areas, with stable refugia through time in the northern mountain ranges, the Great Escarpment, as well as restricted areas of the Northern Cape Province and the Cape Fold Mountains of South Africa. Different microclimatic variables appear to determine the distributional range of the species. Despite strong habitat preference, the micro-habitat offered by rocky crevices and unique life history traits likely promoted the adaptability of P. capensis, resulting in the widespread distribution and persistence of the species over a long evolutionary period. Spatio-temporal comparison of the evolutionary histories of other co-distributed species across the rocky landscapes of southern Africa will improve our understanding of the regional patterns of biodiversity and local endemism.

Significant genetic differentiation among meroplanktonic barrel jellyfish Rhizostoma pulmo (Cnidaria: Scyphozoa) in the Mediterranean Sea

Molecular data have shown that jellyfishes are more geographically restricted and evolutionarily divergent than previously thought. We examined genetic variation and divergence within the meroplanktonic barrel jellyfish Rhizostoma pulmo in the Mediterranean Sea; specific sampling areas were the northern Adriatic, western Mediterranean and Tunisian coast. A total of 19 sampling sites and 68 sequences of the mtDNA cytochrome c oxidase subunit I (COI) gene were used. Of the 68 COI sequences, 45 were newly collected specimens which originated from nine sampling sites along the Tunisian coast. A total of 24 haplotypes were obtained and the specimens sampled were characterised by relatively high levels of haplotype diversity (h = 0.866) and low levels of nucleotide diversity (π = 0.004). Haplotype network analysis showed the presence of three distinct phylogenetic lineages (populations), with separate geographic ranges in the northern Adriatic, western Mediterranean and Tunisian coast. The observed genetic differentiation between these three lineages was supported by the presence of significant genetic differentiation between the 19 populations (FST = 0.757, p < 0.001). The high level of genetic differentiation detected in the barrel jellyfish investigated could be attributed to either intrinsic and/or extrinsic barriers to genetic exchange between different populations that may have adapted to different environmental conditions.

The Role of Occupational Therapy within the Federal Strategic Action Plan on Services for Victims of Human Trafficking in the United States

ABSTRACTThe occupational injustices experienced by human trafficking survivors lead to immediate occupational performance deficits and promote long-term instability. Experience and previous patterns of behavior contribute to the deficits and instability. The occupational manifestations of complex trauma are reflected in the inability to participate in meaningful and necessary occupations. Occupational therapy intervention can be a means of empowering victims of human trafficking by using the occupational therapy process, occupational therapy theories, and models of practice. Occupational therapy practitioners can enable survivors to address the intrinsic and extrinsic barriers to achieving increased overall well-being and occupational performance.

Race-Conscious Professionalism and African American Representation in Academic Medicine.

African Americans remain substantially less likely than other physicians to hold academic appointments. The roots of these disparities stem from different extrinsic and intrinsic forces that guide career development. Efforts to ameliorate African American underrepresentation in academic medicine have traditionally focused on modifying structural and extrinsic barriers through undergraduate and graduate outreach, diversity and inclusion initiatives at medical schools, and faculty development programs. Although essential, these initiatives fail to confront the unique intrinsic forces that shape career development. America's ignoble history of violence, racism, and exclusion exposes African American physicians to distinct personal pressures and motivations that shape professional development and career goals. This article explores these intrinsic pressures with a focus on their historical roots; reviews evidence of their effect on physician development; and considers the implications of these trends for improving African American representation in academic medicine. The paradigm of "race-conscious professionalism" is used to understand the dual obligation encountered by many minority physicians not only to pursue excellence in their field but also to leverage their professional stature to improve the well-being of their communities. Intrinsic motivations introduced by race-conscious professionalism complicate efforts to increase the representation of minorities in academic medicine. For many African American physicians, a desire to have their work focused on the community will be at odds with traditional paths to professional advancement. Specific policy options are discussed that would leverage race-conscious professionalism as a draw to a career in academic medicine, rather than a force that diverts commitment elsewhere.

Individuals with Chronic Conditions Want More Guidance from Health Professionals in Finding Quality Online Health Sources

Objective – To explore how and when individuals with chronic health conditions seek out health information online, and the challenges they encounter when doing so.&#x0D; &#x0D; Design – Qualitative study employing thematic analysis.&#x0D; &#x0D; Setting – Urban Western Australia.&#x0D; &#x0D; Subjects – 17 men and women between 19 and 85 years of age with at least 1 chronic health condition.&#x0D; &#x0D; Methods – Participants were recruited in late 2013 at nine local pharmacies, through local radio, media channels, and a university's social media channels. Participants were adult English speakers who had looked for information on their chronic health condition(s) using the Internet. Semi-structured face-to-face interviews were conducted with each participant, audio recorded, and transcribed. The transcripts were coded in QSR Nvivo using two different processes – an initial data-driven inductive approach to coding, followed by a theory driven analysis of the data. &#x0D; &#x0D; Main Results – Three major themes emerged: trust, patient activation, and relevance. Many of the participants expressed trust both in health professionals and in the efficacy of search engines like Google. However, there was uncertainty about the quality of some of the health information sources found. Searching for information online was seen by some participants as a way to feel more empowered about their condition(s) and treatment, but they reported frustration in finding information that was relevant to their specific condition(s) given the volume of information available. Low health literacy emerged in participant interviews as an intrinsic barrier to effective online searches for health information, along with low patient motivation and lack of time. The many extrinsic barriers identified included difficulty determining the quality of information found, the accessibility of the information (e.g., journal paywalls), and poor relationships with health care providers.&#x0D; &#x0D; Conclusion – Individuals look for online health information to help manage their chronic illnesses, but their ability to do so is influenced by their levels of health literacy and other external barriers to effective online navigation. Consumers may prefer to receive recommendations from health professionals for high quality health websites rather than training in how to navigate and identify these resources themselves.

Fishery composition and evidence of population structure and hybridization in the Atlantic bonefish species complex (Albula spp.)

The distributions, genetic structure, and occurrence of hybrids were explored among three Atlantic bonefishes (Albula spp.), to determine recreational fishery composition, using 19 microsatellite loci. Between 1977 and 2012, study specimens were obtained from 14 locations across the Caribbean Sea and western Atlantic Ocean, with an external collection from the eastern Atlantic. The species were broadly sympatric across the region, though occurrence at the local level was variable, likely due to habitat partitioning. Albula vulpes appeared to be the primary contributor to the recreational fishery, which occurs predominantly in coastal flats habitats. Unexpected, non-geographic population partitioning was identified within all three species. Robust evidence for two genetic populations of A. vulpes was further supported by hypothesis testing for migration patterns between them. The potential existence of two quasi-discrete spawning groups (fall and spring) within species may explain the observed partitions. Patterns of interspecific hybridization were explored to further inform management and conservation efforts. Hybrids were observed at low frequency (40 individuals, equaling a 1.5 % hybridization rate), and most were collected from Florida and The Bahamas. Our results suggest that a combination of intrinsic and extrinsic semipermeable barriers to gene flow exists among these divergent species. These findings are congruent with previous studies that revealed substantial genetic divergence among these secondarily sympatric bonefishes. Further, clarification is provided on regional distributions and the composition of the economically and culturally important recreational fishery. On first order, management efforts would have the greatest impact if focused on A. vulpes populations and their preferred habitat.

Immigrant inviability produces a strong barrier to gene flow between parapatric ecotypes of Senecio lautus.

Speciation proceeds when gene exchange is prevented between populations. Determining the different barriers preventing gene flow can therefore give insights into the factors driving and maintaining species boundaries. These reproductive barriers may result from intrinsic genetic incompatibilities between populations, from extrinsic environmental differences between populations, or a combination of both mechanisms. We investigated the potential barriers to gene exchange between three adjacent ecotypes of an Australian wildflower to determine the strength of individual barriers and the degree of overall isolation between populations. We found almost complete isolation between the three populations mainly due to premating extrinsic barriers. Intrinsic genetic barriers were weak and variable among populations. There were asymmetries in some intrinsic barriers due to the origin of cytoplasm in hybrids. Overall, these results suggest that reproductive isolation between these three populations is almost complete despite the absence of geographic barriers, and that the main drivers of this isolation are ecologically based, consistent with the mechanisms underlying ecological speciation.

718. Cell Therapy Commercialization: An Assessment of Translational Barriers

Cellular based therapies represent a platform technology within the rapidly expanding field of regenerative medicine and are distinct from conventional therapeutics - offering a unique approach to managing what were once considered untreatable diseases. Despite a significant increase in basic science activity within the cell therapy arena, alongside a growing portfolio of cell therapy trials and promising investment, the translation of cellular based therapeutics from “bench to bedside” remains challenging, and the number of industry products available for widespread clinical use remains comparatively low. This systematic review identifies unique intrinsic and extrinsic barriers in the cell based therapy domain. Key electronic databases were searched and manuscripts subjected to pre-defined inclusion and exclusion criteria. Two independent reviewers examined the retrieved publications, and performed data extraction. 3374 unique publications were identified. 138 of these qualified for full assessment and subsequent data extraction. A number of key themes were identified, enabling examination of current challenges and opportunities facing cell therapy development, including manufacturing, regulatory, reimbursement, ethical and clinical adoption issues. In addition to an up-to-date analysis of the current landscape, we discuss a number of pragmatic solutions to facilitate future development and translation.

Community Pharmacists' Perceptions about Pharmaceutical Care of Traditional Medicine Products: A Questionnaire-Based Cross-Sectional Study in Guangzhou, China.

This study aimed to investigate community pharmacists' perceived responsibility, practice behaviors, knowledge, perceived barriers, and improvement measures towards provision of pharmaceutical care in relation to traditional medicine (TM) products in Guangzhou, China. A self-completion questionnaire was used to survey licensed pharmacists working at community pharmacies. This study found that the community pharmacists in Guangzhou, China, were involved in the provision of TM products during their daily practice but only provided pharmaceutical care in this area with a passive attitude. Extrinsic barriers such as lack of scientific evidence for the safety and efficacy of TM products and unclear definition of their roles and responsibilities were highlighted while intrinsic factors such as insufficient TM knowledge were identified.

Reflections on a shared leadership approach to curriculum development in higher education

South African universities today must prepare teachers to meet the needs of diverse learners, including disabilities, linguistic differences, and extrinsic barriers to learning. This need was highlighted in the Education White Paper 6 which challenged South African schools to begin serving the needs of all learners, moving to an inclusive model and away from a segregated service model focused on deficits. This article was informed by a study in which we used a participatory action research model and an interpretative paradigm to analyse our learning about the challenges of effective leadership and about ourselves as co-leaders involved in curriculum development work. Based on the results, recommendations are made for faculty teams doing similar work in response to governmental policy initiatives. Keywords: leadership, teams, curriculum development, teacher education, inclusive education, Education White Paper

Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students

Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice. The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students. A qualitative study comprising five focus groups. Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University. Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input. In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills.

Knowledge, attitude, and practices with respect to disease surveillance among urban private practitioners in Pune, India

BackgroundParticipation of private practitioners in routine disease surveillance in India is minimal despite the fact that they account for over 70% of the primary healthcare provision. We aimed to investigate the knowledge, attitudes, and practices of private practitioners in the city of Pune toward disease surveillance. Our goal was to identify what barriers and facilitators determine their participation in current and future surveillance efforts.DesignA questionnaire-based survey was conducted among 258 practitioners (response rate 86%). Data were processed using SPSS™ Inc., Chicago, IL, USA, version 17.0.1.ResultsKnowledge regarding surveillance, although limited, was better among allopathy practitioners. Surveillance practices did not differ significantly between allopathy and alternate medicine practitioners. Multivariable logistic regression suggested practicing allopathy [odds ratio (OR) 3.125, 95% confidence interval (CI) 1.234–7.915, p=0.016] and availability of a computer (OR 3.670, 95% CI 1.237–10.889, p=0.019) as significant determinants and the presence of a laboratory (OR 3.792, 95% CI 0.998–14.557, p=0.052) as a marginal determinant of the practitioner's willingness to participate in routine disease surveillance systems. Lack of time (137, 55%) was identified as the main barrier at the individual level alongside inadequately trained subordinate staff (14, 6%). Main extrinsic barriers included lack of cooperation between government and the private sector (27, 11%) and legal issues involved in reporting data (15, 6%). There was a general agreement among respondents (239, 94%) that current surveillance efforts need strengthening. Over a third suggested that availability of detailed information and training about surveillance processes (70, 33%) would facilitate reporting.ConclusionsThe high response rate and the practitioners’ willingness to participate in a proposed pilot non-communicable disease surveillance system indicate that there is a general interest from the private sector in cooperating. Keeping reporting systems simple, preferably in electronic formats that minimize infrastructure and time requirements on behalf of the private practitioners, will go a long way in consolidating disease surveillance efforts in the state. Organizing training sessions, providing timely feedback, and awarding continuing medical education points for routine data reporting seem feasible options and should be piloted.

Adaptive radiation versus 'radiation' and 'explosive diversification': why conceptual distinctions are fundamental to understanding evolution.

Adaptive radiation is the rise of a diversity of ecological roles and role-specific adaptations within a lineage. Recently, some researchers have begun to use 'adaptive radiation' or 'radiation' as synonymous with 'explosive species diversification'. This essay aims to clarify distinctions between these concepts, and the related ideas of geographic speciation, sexual selection, key innovations, key landscapes and ecological keys. Several examples are given to demonstrate that adaptive radiation and explosive diversification are not the same phenomenon, and that focusing on explosive diversification and the analysis of phylogenetic topology ignores much of the rich biology associated with adaptive radiation, and risks generating confusion about the nature of the evolutionary forces driving species diversification. Some 'radiations' involve bursts of geographic speciation or sexual selection, rather than adaptive diversification; some adaptive radiations have little or no effect on speciation, or even a negative effect. Many classic examples of 'adaptive radiation' appear to involve effects driven partly by geographic speciation, species' dispersal abilities, and the nature of extrinsic dispersal barriers; partly by sexual selection; and partly by adaptive radiation in the classical sense, including the origin of traits and invasion of adaptive zones that result in decreased diversification rates but add to overall diversity.

Benefits and Barriers

Purpose – This study aims to describe the design of a provincial government ministry group mentoring program and examine mentees’ and mentors’ experiences in the program. Design/methodology/approach – A total of 151 mentees rated their satisfaction in a post-program survey. The survey was followed by in-depth, semi-structured interviews with 10 mentees and 11 mentors. Findings – In all, 87 per cent of mentees rated their learning as effective. Benefits to mentees were relevance of the learning, and senior leader/mentors use of current issues, events and personal stories. Delivery through a combination of Web conferencing and collaboration technologies was most effective. Mentors learned from mentees and other mentors. Regular and full mentee participation was an identified issue. In addition, not all mentoring teams worked well together. Research limitations/implications – The selection criteria favored participants who had a positive experience. Including more participants who were disengaged or less active may have revealed what inhibited full engagement. Complex underlying systemic and cultural issues negatively affected mentee participation and mentoring team effectiveness. It is unclear whether this was caused by intrinsic or extrinsic barriers. Further study could shed light on how to address participation issues. Practical implications – Selection criteria favored highly active participants who had a positive experience. Including more disengaged or less active participants may have revealed barriers to full engagement. Social implications – Despite a context of extreme organizational churn, this program delivered cost-effective and engaging learning to a large number of employees. Recommendations are made to further strengthen the program. Originality/value – This contextually grounded case study will be useful to those who plan to implement a group mentoring program.

The Recreation and Leisure Pursuits of Employed Adults with Visual Impairments in Nigeria: Part 1

Introduction This qualitative study explored the recreation and leisure activities of employed Nigerians with visual impairments. Methods A questionnaire was developed that examined the work, recreation, and leisure activities of adults with visual impairments. The sample included 172 adults with visual impairments living and working in Nigeria. Participant responses to the open-ended survey questions about recreation and leisure activities are presented in this article. Results Although most participants (89%) reported engagement in some sort of recreation or leisure activity on a regular basis, the vast majority of recreation and leisure activities reported were sedentary (69%) or solitary in nature such as listening to the radio, watching television, reading, or cooking. Participants identified the lack of personal funds or time, facilities, and adapted equipment as challenges to their recreation and leisure participation. Transportation issues and environmental barriers, discrimination, and inadequate assistance or training of human supports were also included in the challenges reported. Discussion Choices for recreation and leisure involvement were severely limited for participants. Active and community-based recreation and leisure offerings were virtually nonexistent. Although the respondents were employed, their economic status as workers was not adequate to support their engagement in a variety of recreation and leisure activities. The underlying turmoil of social, political, and economic issues described by participants was a highly restrictive obstacle. Implications for practitioners Practitioners and other stakeholders in developing countries are encouraged to intervene in the remediation of extrinsic and intrinsic barriers to recreation and leisure participation on behalf of their students and clients. Public awareness efforts, professional development courses, and disability-specific skill training programs are essential components in the improvement of the overall life satisfaction of people with visual impairments.

Central nervous system regenerative failure: role of oligodendrocytes, astrocytes, and microglia.

Animal studies are now showing the exciting potential to achieve significant functional recovery following central nervous system (CNS) injury by manipulating both the inefficient intracellular growth machinery in neurons, as well as the extracellular barriers, which further limit their regenerative potential. In this review, we have focused on the three major glial cell types: oligodendrocytes, astrocytes, and microglia/macrophages, in addition to some of their precursors, which form major extrinsic barriers to regrowth in the injured CNS. Although axotomized neurons in the CNS have, at best, a limited capacity to regenerate or sprout, there is accumulating evidence that even in the adult and, especially after boosting their growth motor, neurons possess the capacity for considerable circuit reorganization and even lengthy regeneration when these glial obstacles to neuronal regrowth are modified, eliminated, or overcome.

Dr Google and the consumer: a qualitative study exploring the navigational needs and online health information-seeking behaviors of consumers with chronic health conditions.

BackgroundThe abundance of health information available online provides consumers with greater access to information pertinent to the management of health conditions. This is particularly important given an increasing drive for consumer-focused health care models globally, especially in the management of chronic health conditions, and in recognition of challenges faced by lay consumers with finding, understanding, and acting on health information sourced online. There is a paucity of literature exploring the navigational needs of consumers with regards to accessing online health information. Further, existing interventions appear to be didactic in nature, and it is unclear whether such interventions appeal to consumers’ needs.ObjectiveOur goal was to explore the navigational needs of consumers with chronic health conditions in finding online health information within the broader context of consumers’ online health information-seeking behaviors. Potential barriers to online navigation were also identified.MethodsSemistructured interviews were conducted with adult consumers who reported using the Internet for health information and had at least one chronic health condition. Participants were recruited from nine metropolitan community pharmacies within Western Australia, as well as through various media channels. Interviews were audio-recorded, transcribed verbatim, and then imported into QSR NVivo 10. Two established approaches to thematic analysis were adopted. First, a data-driven approach was used to minimize potential bias in analysis and improve construct and criterion validity. A theory-driven approach was subsequently used to confirm themes identified by the former approach and to ensure identified themes were relevant to the objectives. Two levels of analysis were conducted for both data-driven and theory-driven approaches: manifest-level analysis, whereby face-value themes were identified, and latent-level analysis, whereby underlying concepts were identified.ResultsWe conducted 17 interviews, with data saturation achieved by the 14th interview. While we identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers we identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources. The navigational needs of our participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Our participants’ online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance.ConclusionsThis study suggests that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers’ online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted.