Identification Of Barriers Research Articles

Report of the First ONTOX Stakeholder Network Meeting: Digging Under the Surface of ONTOX Together With the Stakeholders.

The first Stakeholder Network Meeting of the EU Horizon 2020-funded ONTOX project was held on 13-14 March 2023, in Brussels, Belgium. The discussion centred around identifying specific challenges, barriers and drivers in relation to the implementation of non-animal new approach methodologies (NAMs) and probabilistic risk assessment (PRA), in order to help address the issues and rank them according to their associated level of difficulty. ONTOX aims to advance the assessment of chemical risk to humans, without the use of animal testing, by developing non-animal NAMs and PRA in line with 21st century toxicity testing principles. Stakeholder groups (regulatory authorities, companies, academia, non-governmental organisations) were identified and invited to participate in a meeting and a survey, by which their current position in relation to the implementation of NAMs and PRA was ascertained, as well as specific challenges and drivers highlighted. The survey analysis revealed areas of agreement and disagreement among stakeholders on topics such as capacity building, sustainability, regulatory acceptance, validation of adverse outcome pathways, acceptance of artificial intelligence (AI) in risk assessment, and guaranteeing consumer safety. The stakeholder network meeting resulted in the identification of barriers, drivers and specific challenges that need to be addressed. Breakout groups discussed topics such as hazard versus risk assessment, future reliance on AI and machine learning, regulatory requirements for industry and sustainability of the ONTOX Hub platform. The outputs from these discussions provided insights for overcoming barriers and leveraging drivers for implementing NAMs and PRA. It was concluded that there is a continued need for stakeholder engagement, including the organisation of a 'hackathon' to tackle challenges, to ensure the successful implementation of NAMs and PRA in chemical risk assessment.

Identification of Barriers for Active Disease Management and of Medication-Related Problems through Therapeutic Patient Education in Older Home-Care Patients.

Combining therapeutic patient education (TPE) with a medication review service could foster the adoption of appropriate lifestyles by patients and support care-providers in identifying strategies to improve the quality of prescribed care. This study aimed to identify barriers experienced by patients in managing their diseases and medication-related problems. This was a monocentric, case series, observational study involving home-care patients from the Local Health Authority ASL TO4. Patients were enrolled for a TPE intervention where drug therapies and patient habits were collected through narrative interviews. Medication review was performed to identify potentially inappropriate prescriptions (PIPs). Twenty patients (13 females) with a mean age of 74.7 years were enrolled. Patients had an average of 4.3 diseases and 80.0% of them were treated with ≥5 daily medications. The main PIPs involved ibuprofen, furosemide and pantoprazole. The qualitative analysis of the interviews identified seven macro-themes relating to different aspects of medication management: therapy; diseases; patient; patient journey; professionals; family and caregivers; drug information. The results of this study revealed some critical aspects related to the treatment path and healthcare professionals. These results will be used to plan educational interventions for polypharmacy patients to improve medication adherence and the understanding and management of diseases.

Implementing BIM and Lean Construction Methods for the Improved Performance of a Construction Project at the Disassembly and Reuse Stage: A Case Study in Dezhou, China

The construction industry is adopting a collaborative paradigm by combining Lean construction (LC) principles and BIM capabilities. Existing studies lack sufficient case studies and performance evaluations, especially for the disassembly and reconstruction stage, creating a gap in the practical application of BIM and Lean construction (BIM-LC) in China. To bridge this gap, this study quantitatively assessed the BIM-LC methodology in a relocation project in Dezhou, China. The project employed BIM-LC practices such as the Last-Planner System (LPS), Just-In-Time (JIT), Kanban, Value-Stream Mapping (VSM), and Continuous Improvement to enhance construction efficiency and minimize waste. Two main areas of the relocation process were investigated: (i) the identification of common barriers and on-site solutions to the implementation of BIM-LC; (ii) evaluation of the construction efficiency, construction and demolition waste (CDW), and carbon-emission performance. The results showed that the BIM-LC strategy improved labor efficiency and productivity by 3.4% and 12.9%, shortened the construction period by 11 days, reduced construction costs by 8.07% (i.e., USD 9093.8), and reduced transportation costs by 12.5% (i.e., USD 1875). The CDW generation rate ranged from 1–5%, which is comparable to the rates observed in residential construction across various countries. The total weight was 1903.8 kg (10.4 kg/m2). Moreover, the carbon emission during the relocation process was 15,288.4 kgCO2e, with a carbon intensity of 83.5 kg/m2. This study extends the knowledge systems on the application of the BIM-LC method in relocation projects and supports data-driven decision making. It also plays a crucial role in fostering new markets for recycled components, contributing to the realization of a sustainable built environment.

Direct-to-patient telemedicine: Expanding access to regional pediatric specialty care.

Telemedicine is seen as a useful tool in reducing gaps in health care but this technology-enabled care can also exacerbate health inequity if not implemented with a focus on inclusivity. Though many studies have reported improvements as well as exacerbation of disparities in access to care in their telehealth programs, there does not exist a common evaluation tool to assess these programs. To mitigate the impact of COVID-19 on health care workers and protect medically vulnerable children, in March 2020 we expanded our pre-established specialty and subspecialty direct-to-patient pediatric telemedicine program in a high volume urban pediatric health system. Our program aimed to prevent disparities in pediatric health care. In this study, using a "Pillars of Access" approach as a model to evaluate impact and access to care of our direct-to-patient telemedicine program, we analyzed the patients that were seen pre-COVID versus post-COVID. Our study demonstrated an increase in telemedicine visits for patients from diverse socioeconomic and racial backgrounds, and geographically underserved communities. We also observed an increase in telemedicine visits for mental health complaints and for certain categories of high-risk patients. This study was not designed to identify language and cultural barriers to telemedicine. Future identification of these specific barriers is needed. The tool to evaluate telehealth impact/access to care through a "Pillars of Access" approach presented here could serve as a model for implementation of telehealth programs. Our study highlights telemedicine programs as a mechanism to address healthcare inequity and overcome barriers to care.

Identification of Barriers and Facilitators towards Diabetic Peripheral Neuropathy Patients’ Experiences about Physiotherapy Intervention: A Stepwise Interview Guide Protocol

Introduction: Diabetic Peripheral Neuropathy (DPN) is the most common complication of diabetes. Qualitative study includes patients experiences in detail which are not covered under quantitative study. This interview guide will collect broad information about the facilitators and barriers of DPN patients about the physiotherapy intervention which is helpful for decision makers to solve the challenges experienced by the patients. Need of the study: The present study is based on the experiences of DPN patients to identify their facilitators and barriers for physiotherapy intervention. It will provide broad information about the facilitators and barriers for physiotherapy intervention and will be helpful for decision makers and policy formulators to plan and implement evidence-based strategies to solve the challenges experienced by DPN patients. Aim: To cater the experiences of the DPN patients to identify facilitators and barriers of the physiotherapy intervention through an interview guide to solve the treatment challenges experienced by them. Materials and Methods: This phenomenological study will recruit 5-25 DPN participants (Acc. to Polkinghorne, 1989) till data saturation. An interview guide is prepared through the Delphi method. In depth face to face semi-structured interview will be conducted after the physiotherapy intervention of 4 times/week for 6 weeks. All the interviews will be video recorded and transcripts will be prepared in English. After that interview, transcripts will be analysed through thematic analysis by the Qualitative Data Analysis (QDA) Miner-lite software. QDA Miner-lite software will be used to describe the results i.e., facilitators and barriers in the form of word-cloud, bar graph, pie-chart and code tree which will highlights the description of the patients’ experiences about the physiotherapy intervention.

SLOVENSKÉ STARTUPY A ICH VÝZVY V SÚČASNOM PODNIKATEĽSKOM PROSTREDÍ

The paper deals with the topic of Slovak startups and the challenges that these types of companies face in the current business environment. Startups are young innovative companies, and their entrepreneurial activities bring with them specificities that result primarily from increased uncertainty. This uncertainty is caused by the fact that startups usually create new products or services that have not yet been tested by the market. Statistics vary, with estimates suggesting that between 10% and 25% of startups do not survive the first 5 years of their existence. Startups focus on providing innovative solutions to existing problems and try to improve processes in different sectors. A country's startup ecosystem is an important element of economic development and an accelerator for new ideas that help to transform traditional industries. On the one hand, startups are more agile and flexible to respond to challenges and changes, on the other hand, they must deal with various existing barriers that complicate their entrepreneurship. The aim of this paper is to examine the attitudes of Slovak startups towards the entrepreneurial environment and to identify the challenges and barriers that directly affect their success. As a sample for this research, 5 Slovak startups were selected, which are operating in different industries and are in different stages of the life cycle. The main research method was a combination of a questionnaire survey, structured interviews, and subsequent thematic analysis, in which we systematically grouped the findings into selected categories. The result of the presented paper is the identification of key challenges and barriers faced by Slovak startups. These findings may be applicable to other startups as well as to economic policy makers responsible for regulating the Slovak business environment. The limitations of this paper are primarily related to the limited sample of respondents we worked with.

Barriers and facilitators to physical activity: A comparative analysis of transplant athletes competing in high intensity sporting events with other transplant recipients.

There is widespread recognition that many transplant recipients struggle to become and remain physically active. However, some transplant recipients do undertake strenuous training and significant physical activity (PA) and participate in intensive sports. This study sought to understand facilitators and barriers to be physically active for Transplant Athletes (TXA) compared to a group of Dutch transplantees. This explorative mixed methods study analysed race performance and interview data from TxA who participated in cycling and/or the sprint triathlon at the World Transplant Games 2023, and compared their lived experiences in terms of barriers and facilitators of PA with those of 16 transplantees in a study from the Netherlands previously published in this journal. Using Patient and Public Involvement and engagement (PPI), race data from World Transplant Games 2023 and subsequent in-depth interviews were used from 27 TxA. A visual artefact of barriers and facilitators from the previous Dutch study was used to prompt identification and discussion of barriers and facilitators of PA. Interview data were coded by three coders. Many of the barriers to PA previously reported by Dutch transplant recipients were not shared by the majority of TxA in this study. The TxA in this study reported significantly lower physical limitations, lower fear to undertake exercise, and no comorbidity issues for TxA. Furthermore, TxA perceived they received substantial social support, had the strength to do PA, and were in control of their weight. Several TxA reported a lack of understanding from medical and other professionals about the appropriate intensity of PA. An evidence-based framework of PA for transplant recipients and transplant athletes is needed for safe and appropriate PA.

Identification of the causal relationship between features and barriers of product–service systems based on Bayesian network model

Product-service systems (PSS) potentially offer a promising avenue for balancing resource efficiency improvement and economic growth to achieve sustainability. To successfully implement and operate PSS, early identification and mitigation of implementation barriers are required for enhanced social acceptability. To this end, determining the interrelationship between designing PSS features and potential barriers is crucial. Existing research focused on the PSS attributes and its barriers in isolation, falling short of a holistic understanding of their causal relationships. This paper aims to fill this gap by amalgamating case study data from literature survey and subsequently constructing a Bayesian network model. By establishing a graphical model and probability table, this study identified the stochastic dependencies between PSS features and barriers. This approach not only captures their relationship but also assists in predicting potential barriers based on PSS characteristics during the design phase. The results of this study are expected to furnish PSS designers with a tool for anticipating and addressing implementation barriers, thereby facilitating the successful implementation of PSS.

Characterization, identification and quantification of barriers to access to diagnosis in the Colombian pig sector

La detección y el diagnóstico tempranos de enfermedades porcinas son fundamentales para una intervención sanitaria oportuna. Por ejemplo, puede ayudar a reducir la resistencia antimicrobiana (RAM), la cual se produce cuando los microorganismos sufren cambios al verse expuestos a antimicrobianos; y esta aumenta el riesgo de propagación de enfermedades, por lo que es considerada un problema de salud pública a nivel mundial. El diagnóstico inadecuado de las enfermedades en animales de granja es una de las principales causas de la aparición de la RAM. Por esta razón, el diagnóstico oportuno y adecuado de las enfermedades es una de las principales estrategias para su prevención. Evidencia reciente sugiere que en Colombia los productores porcinos no acceden a la infraestructura ni los servicios diagnósticos disponibles en el país. Este artículo caracteriza e identifica las principales barreras de acceso a la red de servicios diagnósticos y cuantifica su importancia. Para esto, primero se caracterizaron cualitativamente los conocimientos, las actitudes, las percepciones, los comportamientos y las prácticas asociadas con el diagnóstico de enfermedades y el uso de antibióticos en las granjas porcinas del país. Seguidamente, se realizó un análisis del lenguaje natural complementario, cuyo objetivo fue proveer evidencia cuantitativa complementaria para la definición de las barreras. Finalmente, se cuantificó la importancia de cada una de estas necesidades. El estudio identificó 11 grupos de barreras de acceso en categorías relacionadas con falta de conocimiento, aspectos económicos, accesibilidad, entre otros. Los resultados sugieren que las barreras relacionadas con la capacitación tienen la importancia más alta para los productores. Asimismo, dichas barreras pueden apoyar la formulación de políticas públicas a nivel local e interinstitucional para la adopción de los servicios diagnósticos disponibles.

DRIVE for Health Equity: Tailoring Quality Improvement, Clinical Education, and Community Engagement to Improve Type 2 Diabetes (T2DM) Outcomes for Minoritized Communities in Oakland, California

Background: Type 2 Diabetes Mellitus (T2DM) is influenced by various factors, with racial and ethnic minorities experiencing higher prevalence. Existing diabetes management programs focus on primary prevention, often neglecting optimal hemoglobin A1C (HbA1c) management for individuals with prediabetes. Consistent HbA1c monitoring is crucial for comprehensive care. This study highlighted the need for secondary prevention and community collaboration to enhance health equity for individuals with T2DM. The DRIVE program, conducted by the National Minority Quality Forum's (NMQF) Center for Sustainable Health Care Quality and Equity (SHC), aimed to improve health outcomes for individuals with Type 2 Diabetes Mellitus (T2DM) in Oakland, CA. Building on prior successes in New Orleans, Los Angeles, and Queens, NY, DRIVE employs a flexible and sustainable approach that integrates quality improvement strategies at clinic sites, focusing on patient and community engagement. The study addressed barriers to medication adherence, provided Diabetes Self-Management Education and Support (DSMES), fostered community partnerships, and utilized culturally appropriate resources. The program's impact was evaluated through changes in HbA1c levels and community participation. Methods: A pre-and post-test design was used, targeting patients of Baywell Health, Oakland, CA, aged 18 and older with initial HbA1c levels greater than 9%. The intervention, developed using SHC’s DRIVE program, included components such as food distribution events, workflow enhancements, identification and mitigation of medication adherence barriers, rapid cycle improvement processes, community educational sessions, and the creation of patient resources. This two-year study implemented four Plan-Do-Study-Act (PDSA) cycles, each lasting 2-4 months, following a three-month planning phase. HbA1c levels were measured at baseline, six months after implementation, and again at 18-month follow-up. Statistical Analysis Univariate analyses described demographic data, while paired sample t-tests assessed changes in HbA1c levels. Independent sample t-tests and ANOVA with pairwise comparisons were used to determine group differences. Results: Among the 255 participants, 58% identified as female and 42% as male. The majority were Black/African American (64%) and 73% were Non-Hispanic/Latino/a, with a mean age of 55.4 years. HbA1c levels were significantly reduced from an average of 10.3±1.4 to 9.4±2.1 at follow-up. Participants who enrolled the longest showed greater reductions. Community initiatives reached over 600 individuals, demonstrating the program's effectiveness in building partnerships and sustainability. Conclusion: SHC’s DRIVE program improved T2DM outcomes through community involvement, quality improvement, and culturally tailored education. This initiative highlighted the importance of addressing health inequities and barriers in diabetes care through culturally sensitive techniques and sustained interventions. DRIVE effectively reduced disparities and promoted sustainable health outcomes among minority groups. Collaborative efforts enhanced trust and demonstrated the advancement of health equity through tailored interventions, with DRIVE providing a flexible and sustainable framework for tailoring interventions to community needs. These findings underscored the need for individualized, culturally competent diabetes care, continuous education, community engagement, and equitable resource access to support communities of color and ethnic minorities in managing T2DM effectively.

Obstacles in Obtaining Optimal Physiotherapy Services for Musculoskeletal Conditions in Rural Communities of Goa: A Cross-sectional Study

Background: Musculoskeletal disorders are the leading cause of disability worldwide and occur across all age groups. The treatment of choice for this remains nonsteroidal anti-inflammatory drugs despite evidence showing exercises reduce pain and also improve quality of life. In India, the majority of the population belongs to rural areas where access to physiotherapy can be difficult. Greater dependence on traditional medicine is also seen in these areas. This research aims to identify obstacles faced by the rural communities in Goa in obtaining physiotherapy services. Objectives: The objective of this study was to identify barriers to physiotherapy services for musculoskeletal problems in rural sectors and reliance on traditional medicine for movement-related problems. Materials and Methods: This was a descriptive study involving 200 participants and 27 health workers. The questionnaire was administered by the investigator. Data were analyzed manually as well as using SPSS (version 26). Results: Movement-/function-related pain in daily life was reported by 63.5%. Awareness of physiotherapy was present in 74% and 12% had a clinic in their community. Only 18% relied on traditional medicine. Out of the health workers/professionals interviewed, 96% were aware of physiotherapy. The most common reason was the lack of resources for the absence of physiotherapy services. Conclusion: The obstacles identified were lack of clinics, poor referrals, and lack of resources for physiotherapy equipment. Clinical Implications: Identification of barriers to physiotherapy in rural sectors will help to improve services in the area.

Stakeholder Engagement to Identify Implementation Strategies to Overcome Barriers to Delivering Chronic Pain Treatments: A NIDILRR and VA TBI Model Systems Collaborative Project.

The purpose of this article is to illustrate the process of stakeholder-engaged intervention mapping approach to identify implementation strategies to overcome data-driven prioritized barriers to receiving chronic pain services for persons with traumatic brain injury (TBI). Community. Healthcare providers (n = 63) with 2 or more years' experience treating persons with TBI, interviewed between October 2020 and November 2021 provided data for identification of barriers. TBI, chronic pain, and qualitative research subject matter experts (SMEs) participated in the mapping approach. Participatory-based research design, using descriptive and intervention mapping approaches. Four barriers to accessing chronic pain treatment by persons with TBI which emerged from provider interviews were prioritized for intervention mapping: cognitive deficits of patients (67%); patient comorbidities (63%); mental health and/or substance abuse issues (59%); and patient participation (62%). SMEs used prioritized barriers to develop 4 primary objectives and implementation strategies designed to: (1) engage consumers to validate and identify strategies; (2) tailor pain treatment and delivery to overcome barriers; (3) develop and disseminate guidelines and best practices when delivering care to persons with TBI to support spread; and (4) increase awareness, skills, and readiness of workforce to deliver pain treatment to persons with TBI. SMEs used an evidence-based approach to develop a mapping matrix of the prioritized barriers, implementation objectives, and aligned implementation strategies to impact change. Implementation science is needed to facilitate knowledge translation into practice for this complex population to overcome barriers to care. Implementation strategies to address barriers to accessing chronic pain care for individuals with TBI were chosen through a participatory approach to engaging SMEs to support these rehabilitation implementation efforts. Future work includes gathering input from individuals with TBI and chronic pain and to move the intervention (implementation) mapping matrix forward to inform future implementation research, policy, and practice.

Barriers to inclusion of Muslim migrant students in western schools. A systematic review

At present, there has been a gradual increase in the number of migrant students in schools in Western societies, in which Muslim students are one of the largest groups. Their inclusion has become the main goal for governments and schools. However, this group sometimes face different barriers to their inclusion, which limit their educational experiences, and prevent or hinder their access and participation, promoting their marginalisation. Research on migration and education generally focuses on specific cases or communities, so it is interesting to analyse from a broader perspective what recurrent forms of inclusion and exclusion occur at the global level in schools. This systematic review aims to determine the barriers to inclusion faced by first and second generation Muslim migrant students at different stages of their formal education. It followed PRISMA guidelines and a PEO research strategy, conducted in two databases, Boolean as well as truncators were used for specific terms. It included assessments of methodological quality and validity. A total of 24 articles met the selection criteria. The study finds socio-cultural, linguistic and discrimination barriers as well as barriers produced by educational policy and the availability of resources and training. There are barriers in the pedagogical practice too. Furthermore, those barriers had a greater or lesser impact according to the generation or the educational stage the students are in. This not only favours the identification of barriers, but also the search for measures and solutions to reduce or eradicate them at both the micro and macro levels, by promoting the development of policies, the provision of resources and the creation of working networks in interculturality.

Barreiras para a prática de atividade física e fatores associados em pacientes com hipertensão arterial

Abstract The identification of barriers to regular physical activity (PA) is a form of an initial and effective strategy to encourage behavior modification and adherence to a more active lifestyle in hypertensive patients. This cross-sectional study aimed to identify the barriers to PA practice in patients with hypertension classified as physically inactive and to analyze the association of the number of these barriers with sociodemographic factors and health indicators. Two hundred one hypertensive patients of both sexes (61.7±12.7 years) answered an anamnesis with health information and sociodemographic data, a PA level questionnaire, and a barrier questionnaire for the practice of PA. Regarding the level of PA of the participants, 48.8% were classified as physically inactive and reported, on average, 6.1 (±3.8) barriers to PA practice, with the barrier “fear of falling or getting hurt” the most commonly reported. Furthermore, women and patients with low education, negative perception of health, and a greater presence of comorbidities reported a greater number of barriers to PA practice. PA practice as a non-pharmacological tool for the treatment of hypertension should focus on women and patients with low education, negative perception of health, and a greater presence of associated comorbidities.

Empowering Special Minds: A Systematic Review of Government Support for Students with Disabilities in Tanzania

The scope of the study includes an analysis of the implementation of inclusive education policies for students with disabilities in Tanzania as well as the identification of barriers that affect their effectiveness. This study aims to explore the conditions of implementation of inclusive education policies and identify challenges in achieving sustainable education inclusion for students with disabilities in Tanzania. The methodical strategy used to find relevant documents published between 2004 and 2022 was powered by the publish or perish domain across many electronic databases, namely Google Scholar, Institutional Repositories, and ERIC. Nine documents out of 41 were selected for data mining and analysis after meeting inclusion and exclusion criteria. The results show that the government has implemented several policies and strategies, like the Education and Training Policy, the Persons with Disabilities Act, the Inclusive Education Strategy, and educational regulations and circulars reinforcing inclusive education and children with disabilities' rights to access education. In addition, the government has established inclusive schools and special needs education departments at the ministerial level to address the several needs of students with disabilities. The review also highlights several impediments to implementing inclusiveness in education by government initiatives. These impediments include insufficient funds, dilapidated and inaccessible infrastructure, the community stigma related to disability, inadequate specialised experts, and a lack of assistive technology in many conventional schools. The implication of this research is to provide a better understanding of the effectiveness of inclusive education policy implementation in Tanzania and highlight the barriers that need to be overcome to achieve sustainable education inclusion for students with disabilities.

Психологические барьеры принятия цифровой образовательной среды студентами российских университетов

The implementation of digital educational environment (DEE) in higher education is a complex and multifaceted process, often accompanied by opposition. The opposition may be due to various reasons, among which psychological barriers can be mentioned, for example, negative experiences in educational activity, personality traits that prevent DEE acceptance, an insufficient level of behavioral self-regulation. The identification of such barriers by university students was the main aim of present research. Using a sample of students from various universities (N=1059, age 22.3 ± 7.1 years), the following indicators were measured: attitude towards educational activity (Activity-Related Experiences Assessment technique); the resources of self-regulation (Self-Activation and the Style of Behavior Self-regulation questionnaires); personality traits (Big Five Inventory-2), and the attitude towards learning in DEE (AUDEE Scale). Cluster analysis (k-means method) allowed to identify two contrasting groups of students, differing in their assessments of the university DEE: acceptance group and resistance group. The selected groups differ in agreeableness and conscientiousness, and both of these qualities are higher in the group that has positive attitude towards learning in DEE. Acceptance group also has a higher level of self-activation and self-regulation: its members better plan goals, program their actions and model significant conditions for achieving goals. Students from resistance group make more efforts in learning activities with less pleasure, they are characterized by such experiences as meaninglessness and emptiness (void). At the same time, psychological barriers are of transient nature, and students are able to overcome them over time with appropriate support.

Systematic Review of Sustainable Development Goals in Higher Education Institutions: First Five Years of Agenda 2030

This paper presents a systematic review of the scientific evidence regarding the Sustainable Development Goals (SDGs) in universities at the international level in the first 5-year period since the 2030 Agenda (2015–2020). The search comprises a selection of 63 articles published in Web of Science, Scopus, and Google Academic. This study analyses the main research trends, objectives, methodologies, and research tools. The paper concludes with the identification of barriers and limitations.

A rigorous, stepwise procedure for multi-stakeholder design of implementation actions

Implementation of evidence-based practice necessitates identification of barriers and facilitators as well as using effective implementation strategies tailored to these barriers and facilitators. Collaboration with stakeholders is an essential aspect of implementation, but there is limited guidance on how to combine input from stakeholders with other sources of information when designing implementation actions. In this study, we adapt and evaluate a novel stepwise procedure (based on Knapp et al, 2022) to combine multi-stakeholder input with best available evidence on matching barriers to implementation strategies.
 In the context of an implementation project for physiotherapist led Cognitive Behavior therapy for Insomnia (CBT-I) in patients with Knee Osteoarthritis (OA), stakeholders (physiotherapists (PTs), patients with OA and comorbid insomnia, general practitioners (GPs), orthopedic surgeons (OS), rheumatologists, and psychologists with expertise in CBT-I) participate in a rigorous, iterative process of identifying and prioritizing barriers, followed by a selection of implementation strategies to address identified barriers. In this process, stakeholder discussion or survey input is alternated with feedback from the research team, who are providing a summary of stakeholder perspectives and provide input based on findings from the implementation science literature. The process integrates aspects of user-centered design (Dopp et al., 2018; Dopp et al., 2020), a modified version of Delphi approach (Hasson et al., 2000), a participatory approach (Jagosh et al., 2012), and the Expert Recommendations for Implementing Change (ERIC) protocol (Powell et al., 2015; Waltz et al., 2015).
 Compared to Knapp et al. (2022) we have streamlined the development process into a six-step alternating procedure. Furthermore, we have broadened the categories of stakeholders participating in the stakeholder discussions, including patients and health care providers of different disciplines. In order to facilitate representation of patients and different disciplines of health care providers, we are conducting the first step stakeholder discussions in two parallel teams: (1) a team focusing on the determinants related to patient-PT interactions, the process of implementation, and the intervention itself; and (2) a team focusing on the determinants related to interactions between different health care providers, the referral patterns, and the structural aspects of healthcare. The first team consists of patients, psychologists, and physiotherapists. The second team involves various healthcare providers involved in the treatment of osteoarthritis, both first and second line. That is physiotherapists, GPs, orthopedic surgeons, and rheumatologists.
 The study is currently ongoing, and we will be discussing preliminary outcomes related to the methodology and design process, including evaluations at each stage of the project. The project can serve as a template for structured, multidisciplinary stakeholder engagement in the design of implementation actions. This work is integrated into a clinical trial that was funded by the Applied Biomedical Research Program, Research Foundation Flanders (Fonds voor Wetenschappelijk Onderzoek Vlaanderen), Belgium (FWO-TBM project no. TBM2021 - T000521N - 54252, “Towards PREcision MEdicine for Osteoarthritis: Added value of cognitive behavioural therapy for insomnia (the PREMEO trial).

Presenting a Wind Turbine Model for Climate Change Education and Action

This article introduces and evaluates a climate change education model - the wind turbine model. Developed through an extensive review of technical literature, this model extracts essential facets of climate change education. The wind turbine model serves as a comprehensive educational tool for addressing climate change, highlighting the significance of various elements: knowledge acquisition, critical thinking abilities, awareness of values, identity formation, worldview, practical actions, motivation, participation, future orientation, hope, emotions, and identification of operational barriers. In this study, wind is conceptualized as one of the manifestations of climate change, and the turbine is portrayed not as a tool for production but as a mechanism to combat climate change. Each component of the turbine, including the generator, gearbox, and transformer, is integral to this system aiming to augment knowledge, foster environmental perspectives, and influence family behavior. Lastly, this model is proposed for implementation in environmental education via social networks within families. Following the presentation of the aforementioned action plan to address climate change, prioritization is conducted. Ultimately, this article delves into prospects for the future development of this model.

The place of the higher education system in the innovation sphere in solving the problem of staffing the innovative economy. Part II

This article continues the study of the Innovation sphere role in the higher education system for innovative economy personnel training. It is devoted to the problem of the network project-based learning development within the framework of the entrepreneurial university model implementation. The core of the problem is development of entrepreneurial competencies in technical universities to promote technological startups through usage of expertise acquired by the Innovation students. The following article, as well as the previous one, is based on Basadur simplex method to find a range of factors which contribute to the solution of non-standard management problems. Identification of barriers to interaction is the most important factor in the development of a successful collaboration. Barriers of insufficient acquaintance with a partner, or low innovation susceptibility to the collaboration, are considered serious. The purpose of the study is to determine the external factors of innovative susceptibility to network interaction by universities that provide innovations. Low demand in the labour market is said to be the main barrier to the innovative susceptibility towards an innovation manager. There is no standardisation of his activity under the conditions of a high role of the Russian labour market regulation aspect. As a result, the author’s vision of key requirements set for the development of professional innovation standards is proposed to promote the innovation manager and increase innovative susceptibility of the market to his qualification level.