Importance Of Different Barriers Research Articles

Measuring the importance of different barriers to opioid agonist treatment using best-worst scaling in an Australian setting

ObjectiveOpioid agonist treatment (OAT) is an effective treatment for opioid use disorder (OUD), however several client barriers to OAT are reported. Client importance of these barriers using economic preference elicitation measures have not been identified. This paper determines the most important OAT barriers using best-worst scaling (BWS) and compares the results of BWS to Likert scale. MethodsCross-sectional self-completed survey with 191 opioid dependent clients who attended Australian needle and syringe sites. Participants were presented 15 Likert scale barriers and 15 BWS barrier scenarios. The BWS data was presented using count analysis, multinomial logit and mixed logit models. The ranking of barrier items was completed using three BWS methods and one Likert scale method, with share preference results (BWS) or mean scores (Likert) used to rank the 15 barriers. ResultsThe most important client barriers were ‘enjoy using opioids’, ‘lack of support services’ and ‘hard to access’. The four ranking methods produced different barrier rankings for the most important barriers, but similar results for the least important barriers. ConclusionPolicies around OAT as a harm reduction approach, increased support services and increased availability of OAT services would be beneficial in improving OAT uptake. Comparing BWS and Likert methods produced different highest ranked barriers, indicating the method used to identify preferences has significant implications on the type of intervention prioritised.

“This is where public transport falls down”: Place based perspectives of multimodal travel

No single transport mode can replace the private car in terms of its support for flexible mobility. Combinations of multiple transport modes are required. If we are to contribute to reduced car dependency it is crucial that we understand what makes such multi-modal journeys difficult. Despite large bodies of literature on mode choice and on perceptions and experiences of various travel modes, few scholars have looked specifically at journeys that combine more than one transport mode. This research fills that gap, taking a qualitative approach to explore end-user perspectives of the challenges therein. Specifically, it focusses on the barriers people in urban, peri-urban, and rural areas perceive when thinking about combining two or more transport modes in a single journey. Thematic analysis of the responses of 146 participants of a series of asynchronous online focus groups revealed an overall picture of challenges shared, with some differences in the relative importance of different barriers for those in different locations. The time incurred, the difficulties in synchronising timetables, and the criticality of each leg’s reliability are core barriers for all, while those in rural areas are more affected by basic service provision and the physical linking of different modes. Of greater significance for urban and peri-urban residents were the complexities around planning a multi-modal journey where there are multiple options available, as well as the facilities available at stations and stops. Results are discussed in terms of interventions that could help people in different residential settings use their car less.

Navigating COVID-19: unraveling supply chain disruptions through best-worst method and fuzzy TOPSIS

PurposeThe COVID-19 pandemic has caused significant disruptions to global supply chains (SCs), affecting the production, distribution, and transportation of goods and services. To mitigate these disruptions, it is essential to identify the barriers that have impeded the seamless operation of SCs. This study identifies these barriers and assesses their impact on supply chain network (SCN).Design/methodology/approachTo determine the relative importance of different barriers and rank the affected industries, a hybrid approach was employed, combining the best-worst method (BWM) and the technique for order preference by similarity to an ideal solution (TOPSIS). To accommodate the inherent uncertainties associated with the pandemic, a triangular fuzzy TOPSIS was used to represent the linguistic variable ratings provided by decision-makers.FindingsThe study found that the airlines and hospitality industry was the most affected by the barriers, accounting for 46% of the total, followed by the healthcare industry (23%), the manufacturing industry (19%), and finally the consumer and retail industry (17%).Research limitations/implicationsThis study is limited to the four critical industries and nine identified barriers. Other industries and barriers may have different weights and rankings. Nevertheless, the findings offer valuable insights for decision-makers in SC management, aiding them in mitigating the impact of COVID-19 on their operations and enhancing their resilience against future disruptions.Originality/valueThis study enhances understanding of COVID-19’s impact on SCN and provides a framework for assessing disruptions using multi-criteria decision-making processes. The hybrid approach of BWM and TOPSIS in a fuzzy environment is unique and offers potential applicability in various evaluation contexts.

Barriers to and Facilitators of the Implementation of Digital Mental Health Interventions as Perceived by Primary Care Decision Makers: Content Analysis of Structured Open-Ended Survey Data.

Digital mental health represents a way to increase access to evidence-based psychological support. However, the implementation of digital mental health in routine health care practice is limited, with few studies focusing on implementation. Accordingly, there is a need to better understand the barriers to and facilitators of implementing digital mental health. Existing studies have mainly focused on the viewpoints of patients and health professionals. Currently, there are few studies about barriers and facilitators from the perspective of primary care decision makers, that is, the persons responsible for deciding whether a given digital mental health intervention should be implemented in a primary care organization. The objectives were to identify and describe barriers to and facilitators of the implementation of digital mental health as perceived by primary care decision makers, evaluate the relative importance of different barriers and facilitators, and compare barriers and facilitators reported by primary care decision makers who have versus have not implemented digital mental health interventions. A web-based self-report survey was conducted with primary care decision makers responsible for the implementation of digital mental health in primary care organizations in Sweden. Answers to 2 open-ended questions about barriers and facilitators were analyzed through summative and deductive content analysis. The survey was completed by 284 primary care decision makers-59 (20.8%) decision makers representing implementers (ie, organizations that offered digital mental health interventions) and 225 (79.2%) respondents representing nonimplementers (ie, organizations that did not offer digital mental health interventions). Overall, 90% (53/59) of the implementers and 98.7% (222/225) of the nonimplementers identified barriers, and 97% (57/59) of the implementers and 93.3% (210/225) of the nonimplementers identified facilitators. Altogether, 29 barriers and 20 facilitators of implementation were identified related to guidelines; patients; health professionals; incentives and resources; capacity for organizational change; and social, political, and legal factors. The most prevalent barriers were related to incentives and resources, whereas the most prevalent facilitators were related to the capacity for organizational change. A number of barriers and facilitators were identified that could influence the implementation of digital mental health from the perspective of primary care decision makers. Implementers and nonimplementers identified many common barriers and facilitators, but they differ in terms of certain barriers and facilitators. Common and differing barriers and facilitators identified by implementers and nonimplementers may be important to address when planning for the implementation of digital mental health interventions. For instance, financial incentives and disincentives (eg, increased costs) are the most frequently mentioned barrier and facilitator, respectively, by nonimplementers, but not by implementers. One way to facilitate implementation could be to provide more information to nonimplementers about the actual costs related to the implementation of digital mental health.

Extending the theory of planned behaviour to understand the effects of barriers towards sustainable fashion consumption

PurposeExtending the theory of planned behaviour (TPB), this paper aims to measure the relative importance of different barriers to sustainable fashion consumption (SFC).Design/methodology/approachExisting studies have mainly adopted a qualitative methodology for identifying barriers to uptake of SFC, this study uses six of the main identified barriers: environmental apparel knowledge, perceived value, price sensitivity, product attributes and variety, availability and scepticism into the TPB framework to test and reveal which barriers have the greater impact on the TPB cognitions and consequently on building intention towards SFC. To test this model a survey study among 669 consumers from Europe, Asian and North America was conducted, structural equation modelling is used to test the research hypotheses.FindingsFindings confirm the role of TPB cognitions on predicting intention and show that the proposed barriers provide a satisfactory explanation of the TPB model. Furthermore, results show that product attributes and variety and environmental apparel knowledge have the greatest impact on the TPB cognitions and on building intention towards SFC. Differences were found between the impacts of the price for the three continents.Originality/valueThis research contributes to the emerging sustainable fashion literature by examining the impact of different barriers to SFC in an extended TPB framework. To the best of our knowledge price sensitivity, availability and scepticism have never been studied in the context of sustainable fashion. It also provides a multifactor group analysis which uncovers differences among consumers from different continents.

Barriers of implementing sustainable housing in Malaysian residential property sector

Designing and constructing sustainable housing by changing its design, construction and operation could help in reducing resource consumption and mitigate climate change. However, it is found that there are barriers impeding the implementation of sustainable housing. This research aims to determine such barriers in Malaysian residential property sector. A questionnaire was designed and distributed to the key stakeholders (i.e. engineers, real estate agents, contractors and home buyers) in Malaysia. This questionnaire asked the respondents to rate the relative importance of 21 barriers which were categorized into four key categories (i.e. design and technical barrier, economic barrier, institutional barrier and socio-culture barrier). The results showed that economic barrier is the most critical category among the four categories of barriers. Out of the 21 barriers, the top critical barrier is high capital/investment cost. This research identified the importance of different barriers based on the perceptions of and experiences of the respondents. While most studies focused on the professional stakeholders or home buyers, there are only few studies dedicated to the combination of the perceptions for both professional stakeholders and homebuyers in Malaysia. This research could contribute to both the knowledge and practices of sustainable housing implementation in Malaysia.

The contribution of multiple barriers to reproduction between edaphically divergent lineages in the Amazonian tree Protium subserratum (Burseraceae).

Disentangling the strength and importance of barriers to reproduction that arise between diverging lineages is central to our understanding of species origin and maintenance. To date, the vast majority of studies investigating the importance of different barriers to reproduction in plants have focused on short‐lived temperate taxa while studies of reproductive isolation in trees and tropical taxa are rare. Here, we systematically examine multiple barriers to reproduction in an Amazonian tree, Protium subserratum (Burseraceae) with diverging lineages of soil specialist ecotypes. Using observational, molecular, distributional, and experimental data, we aimed to quantify the contributions of individual prezygotic and postzygotic barriers including ecogeographic isolation, flowering phenology, pollinator assemblage, pollen adhesion, pollen germination, pollen tube growth, seed development, and hybrid fitness to total reproductive isolation between the ecotypes. We were able to identify five potential barriers to reproduction including ecogeographic isolation, phenological differences, differences in pollinator assemblages, differential pollen adhesion, and low levels of hybrid seed development. We demonstrate that ecogeographic isolation is a strong and that a combination of intrinsic and extrinsic prezygotic and postzygotic barriers may be acting to maintain near complete reproductive isolation between edaphically divergent populations of the tropical tree, P. subserratum.

Prepreke s kojima se mala i srednja preduzeća u regionu Zapadnog Balkana suočavaju u pristupanju lancima dobavljača - pristup zasnovan na binarnoj logističkoj regresiji

The inclusion of small and medium-sized enterprises (SMEs) in the supply chains is broadly used to leverage the internationalisation of operations of the companies. SMEs in the Western Balkans make up for a vast majority of the companies and tend to be better integrated into the EU and global market. The supply chains enable SMEs to raise their innovativeness and performance. However, large corporations also find mutual benefits in the integration of SMEs into their supply chains. Large supply chains have recently introduced a new approach towards the inclusion of SMEs as a part of their CSR and sustainability strategy. In this paper, we observe the state of play in accessing the supply chains in three non-EU Western Balkan countries, namely Serbia, Bosnia and Herzegovina and Montenegro, as well as in Croatia as the only EU member state from the observed region. It seems that, regardless of the current status of the EU accession process, the observed SMEs are facing the same challenges in accessing the supply chains. Therefore, our research has two goals: 1) to determine whether and in what way the perception of the importance of different barriers affects inclusion in the supply chains, and 2) to determine whether the different-sized companies perceive differently the importance of individual barriers to inclusion in the supply chains. The results have shown that there are no significant differences in the perception of the importance of barriers to inclusion in the supply chains between companies of different sizes. Also, the length of receivables collection period and inadequate and incomplete information on the requirements for participation negatively affect the inclusion of SMEs in the supply chains.

Barriers to Small and Medium Entrepreneurship in Kazakhstan: Qualitative and Quantitative Observations

Small and medium entrepreneurship is one of the determinants of the innovation economy, as well as the most important strategic resource for national development. The assessment of the efficiency and activity of small and medium entrepreneurship is carried out in a variety of ways. One of the tools that allows to position business entities in the system of integral economic coordinates is survey and ranks. A survey conducted by Kazakhstan Ministry of Economy, and National Economic Research Institute was evaluated by using SPSS software package (Statistical Package for the Social Sciences) to examine the relative importance of different barriers that affect the growth and operational effectiveness of SMEs in the developing countries with transition economies like Kazakhstan. The SPSS analysis indicated that a lack of awareness about laws and programmes, a lack of easy access to financial resources, level of corruption in public administration institutions, and poor access to and the quality of human resources are found to be the most important barriers, which have reduced the development of entrepreneurship in Kazakhstan. The findings of this study will assist the policy makers in the economy to create an environment conducive to the growth and consistent outstanding performance of SMEs in any economy.

Prioritizing the barriers of TQM implementation from the perspective of garment sector in developing countries

PurposeThe purpose of this paper is to investigate the relative importance of different total quality management (TQM) implementation barriers in the context of Readymade Garment (RMG) industries in Bangladesh. Present study has developed a hierarchical framework of several TQM barriers to assess their importance. Expert opinions from RMG industries have been taken to evaluate the importance of one barrier over another.Design/methodology/approachMethodology adopted in this study to find out the rank of different TQM barriers is fuzzy analytic hierarchy process.FindingsThe study shows that, according to order, inappropriate planning of TQM implementation program, lack of financial support, lack of employee training, lack of empowerment of employees, lack of sufficient physical resources, etc. are critical barriers and hampering the successful implementation of TQM program in this sector.Research limitations/implicationsThis study has both theoretical and practical implications. It has found out strong and weak contribution of different barriers during TQM implementation. Therefore, this finding will strengthen the knowledge of successful implementation of TQM and will further enrich the existing literature in the context of manufacturing industries in developing countries. Moreover, this finding will also help the decision makers in preparing an effective plan for successful implementation of TQM by utilizing limited resources.Practical implicationsMoreover, our results will aid the managers of RMG sector to find the weight of importance of different barriers. Accordingly, they will make a plan to overcome the major TQM barriers which will increase the success rate of TQM implementation. Every Successful program will bring business excellence. These findings could be a guideline for TQM implementation program in developing countries.Originality/valuePresent study possesses some significant values. First, so far our knowledge go, no other study has developed a hierarchical structure of TQM barrier on the basis of overall change needed within the organization for TQM implementation. Second, this study could be a good guideline for TQM implementation program in RMG sector in developing countries.

Barriers to and Drivers for Improved Energy Efficiency in the Swedish Aluminium Industry and Aluminium Casting Foundries

Industrial energy efficiency is important for reducing CO2 emissions and could be a competitive advantage for companies because it can reduce costs. However, cost-effective energy efficiency measures are not always implemented because there are barriers inhibiting their implementation. Drivers for energy efficiency could provide means for overcoming these barriers. The aim of this article was to study the importance of different barriers to and drivers for improved energy efficiency in the Swedish aluminium industry and foundries that cast aluminium. Additionally, the perceived usefulness of different information sources on energy efficiency measures was studied. The data were collected through a questionnaire covering 39 barriers and 48 drivers, divided into different categories. Both the aluminium and foundry industries considered technological and economic barriers as the most important categories. The most important category of drivers for the aluminium industry was organisational drivers, while the foundries rated economic drivers as the most important. Colleagues within the company, the company group and sector, and the trade organisation were considered the most useful information sources. Important factors for driving work with improved energy efficiency included access to knowledge within the company, having a culture within the company promoting energy efficiency, and networking within the sector. The policy implications identified included energy labelling of production equipment, the law on energy audit in large companies and subsidy for energy audits in small- and medium-sized companies, voluntary agreements that included long-term energy strategies, increased taxes to improve the cost-effectiveness of energy efficiency measures, and EUs Emission Trading System.

Barriers to Using a Nationwide Skin Cancer Screening Program: Findings from Germany

Background: In 2008, a nationwide standardized and systematic skin cancer screening (SCS) service, which is globally unique, was implemented in Germany. We aimed to provide current data on SCS use, to explore barriers to SCS usage, and to identify population groups with lower rates of SCS use. Methods: We analyzed data from 2,635 participants (18-45 years) in the National Cancer Aid Monitoring on Sunbed Use. Data on SCS use, barriers to SCS, and sociodemographic characteristics were obtained. Chi-square tests and logistic regression analyses were performed to analyze the data. Data was weighted by age, sex, educational level, and federal state. Results: In total, 39.0% of participants reported having been screened for skin cancer at least once in their lifetime. The subjective importance of different barriers varied depending on the participants' educational level. SCS use was negatively associated with male sex (odds ratio (OR) = 0.63, p < 0.001), low level of education (OR = 0.83, not significant), immigrant background (OR = 0.63; p < 0.001), and having no employment. Conclusion: Although the SCS is part of the regular healthcare services offered in Germany, our data showed lower usage among certain population groups. Barriers relevant for these groups should be considered when developing measures to increase SCS use.

Patient-Reported Barriers to Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis.

BackgroundMaintaining high levels of adherence to antiretroviral therapy (ART) is a challenge across settings and populations. Understanding the relative importance of different barriers to adherence will help inform the targeting of different interventions and future research priorities.Methods and FindingsWe searched MEDLINE via PubMed, Embase, Web of Science, and PsychINFO from 01 January 1997 to 31 March 2016 for studies reporting barriers to adherence to ART. We calculated pooled proportions of reported barriers to adherence per age group (adults, adolescents, and children). We included data from 125 studies that provided information about adherence barriers for 17,061 adults, 1,099 children, and 856 adolescents. We assessed differences according to geographical location and level of economic development. The most frequently reported individual barriers included forgetting (adults 41.4%, 95% CI 37.3%–45.4%; adolescents 63.1%, 95% CI 46.3%–80.0%; children/caregivers 29.2%, 95% CI 20.1%–38.4%), being away from home (adults 30.4%, 95% CI 25.5%–35.2%; adolescents 40.7%, 95% CI 25.7%–55.6%; children/caregivers 18.5%, 95% CI 10.3%–26.8%), and a change to daily routine (adults 28.0%, 95% CI 20.9%–35.0%; adolescents 32.4%, 95% CI 0%–75.0%; children/caregivers 26.3%, 95% CI 15.3%–37.4%). Depression was reported as a barrier to adherence by more than 15% of patients across all age categories (adults 15.5%, 95% CI 12.8%–18.3%; adolescents 25.7%, 95% CI 17.7%–33.6%; children 15.1%, 95% CI 3.9%–26.3%), while alcohol/substance misuse was commonly reported by adults (12.9%, 95% CI 9.7%–16.1%) and adolescents (28.8%, 95% CI 11.8%–45.8%). Secrecy/stigma was a commonly cited barrier to adherence, reported by more than 10% of adults and children across all regions (adults 13.6%, 95% CI 11.9%–15.3%; children/caregivers 22.3%, 95% CI 10.2%–34.5%). Among adults, feeling sick (15.9%, 95% CI 13.0%–18.8%) was a more commonly cited barrier to adherence than feeling well (9.3%, 95% CI 7.2%–11.4%). Health service–related barriers, including distance to clinic (adults 17.5%, 95% CI 13.0%–21.9%) and stock outs (adults 16.1%, 95% CI 11.7%–20.4%), were also frequently reported. Limitations of this review relate to the fact that included studies differed in approaches to assessing adherence barriers and included variable durations of follow up. Studies that report self-reported adherence will likely underestimate the frequency of non-adherence. For children, barriers were mainly reported by caregivers, which may not correspond to the most important barriers faced by children.ConclusionsPatients on ART face multiple barriers to adherence, and no single intervention will be sufficient to ensure that high levels of adherence to treatment and virological suppression are sustained. For maximum efficacy, health providers should consider a more triaged approach that first identifies patients at risk of poor adherence and then seeks to establish the support that is needed to overcome the most important barriers to adherence.

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire.

AimsGood end‐of‐life communication and decision‐making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision‐making about goals of care for hospitalized patients with advanced HF.MethodsWe distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.ResultsOf 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7‐point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.ConclusionsIn this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi‐centre study of end‐of‐life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision‐making about goals of care with HF patients.

Ranking and Rating Analyses of Barriers to Surgical Care for Children in Guatemala

Background: Barriers to surgical care for children in low and middle income countries (LMICs) remain poorly defined. In this study, we used two consumer decision analysis tools to measure how families view the importance of different barriers to pediatric surgical care in Guatemala. Methods: Our subject population was a convenience sample of parents or guardians of children receiving surgical care at a single non-governmental organization in Guatemala City. Respondents performed rating and ranking surveys to determine the relative importance of eight barriers to surgical care using a structured questionnaire. Results: We included 46 respondents in this study. By rating analysis, the most significant barriers to care were the cost of surgery, perceived quality of care, and transportation issues. By ranking analysis, the most significant barriers to care were the cost of surgery, waiting time for surgery, and perceived quality of care. Conclusions: Based on rating and ranking analyses, the cost of care is the most significant barrier to pediatric surgical care in Guatemala, although perceived quality of care is also important for families. Using complementary analysis tools provided enhanced insight into how families view the importance of different barriers to care, and should help policy makers develop programs to enhance surgical access for children.

The tempo and modes of evolution of reproductive isolation in fungi

Reproductive isolation is an essential ingredient of speciation, and much has been learned in recent years about the evolution of reproductive isolation and the genetics of reproductive barriers in animals and plants. Fungi have been neglected on these aspects, despite being tractable model eukaryotes. Here, we used a model fitting approach to look at the importance of different barriers to gene flow to explain the decrease of reproductive compatibility with genetic distance in fungi. We found support for the occurrence of reinforcement in the presyngamy compatibility among basidiomycetes. In contrast, no evidence for reinforcement was detected in ascomycetes, concurring with the idea that host/habitat adaptation in this group can pleiotropically cause reproductive isolation. We found no evidence of a snowballing accumulation of postsyngamic reproductive incompatibilities in either ascomycetes or the complex of anther smut fungi. Together with previous studies, our results suggest that ecologically based barriers to gene flow and karyotypic differences may have an important role in hybrid inviability and sterility in fungi. Interestingly, hybrid sterility appeared to evolve faster than hybrid inviability in fungi.

Barriers to Entry and Growth of Private Companies in Poland, the Czech Republic, Hungary, Albania and Lithuania (Part II)

Free 'Entry' and free 'Exit' are fundamental mechanisms of the competitive market economy operation. Free entry ensures that potential entrepreneurs will take advantage of profitable opportunities and enter profitable segments of the market, increasing competitive pressure on the incumbent firms, lowering output prices and improving the overall allocation of resources. Both free entry and free exit guarantee that more efficient firms and those producing in accordance with the market demand, survive and prosper while inefficient units and those whose production is not geared to the market will contract and eventually embark on exit. Barriers to entry and exit influence the development of competitive conditions in established market economies, however, for economies in transition the freedom of entry and exit has an even more significant dimension. The reason for that are particular 'initial conditions' which the economies inherited from their communist past: massive distortions of the economic structure, highly monopolistic and oligopolistic markets, and a large average firm size. With a collapse of the old regime, transformation of the old economic structure had to take place through the entry of new, market-oriented firms particularly in the undeveloped sectors of the economy and the exit of inefficient and uncompetitive enterprises especially from the over-grown industrial sector. This report presents some outputs of the research project 'The Impact of Barriers to Entry on the Speed of Transition: A Comparative Study of Countries in Different Stages of Transition' (PHARE ACE project No. P95-2047-R), coordinated by Leszek Balcerowicz and done by an international team which included: Ewa Balcerowicz (Poland), Andrzej Bratkowski, (Poland); Irena Grosfeld (France); Iraj Hashi (U.K); Jan Mladek (the Czech Republic); Gediminas Rainys (Lithuania); Jacek Rostowski (Hungary); Miklos Szanyi (Hungary); and Lindita Xhillari (Albania). The main aim of the project was to investigate nature and impact of barriers to entry in five countries at different stages of transition with various development backgrounds and traditions. The study has been based on the experience of new firms in Poland, Hungary, the Czech Republic, Lithuania and Albania - the first three having reached an advanced stage of transition and the latter two having embarked on the transition process later, thus lagging behind the front-runners. The study has focussed on the legal, fiscal and institutional factors which impede new entries and slow down the expansion of new firms in each country. The report consists of two parts. In Part I, Chapter 2 we discuss the interaction between the government's regulatory activity and the entry of new firms into the formal or informal sectors of the economy. Here we highlight the necessity of this important function of the government as well as its undesirable implications such as rent seeking and corruption. In Chapter 3 we consider a framework for the analysis of barriers to entry and growth of new firms, highlighting the main constraints to entry and growth considered by this report. Chapter 4 is devoted to the review of an actual pattern of new firms' entry in the early transition period in the five countries under consideration. Part II reports on the results of our enterprise survey; it is a detailed study of 400 firms in five transition economies. Here we first discuss (Chapter 5) the composition of the sample on which the study is based and then (Chapters 6,7,8,9 and 10) summarize main findings of the study in terms of the relative importance of different barriers facing new firms in each country. Chapter 11 discusses the main policy recommendations of this study.

Assessing access barriers to maternal health care: measuring bypassing to identify health centre needs in rural Uganda

In low income countries, several barriers exist to the use of health services for child delivery, including distance, transportation, informal costs or low perceived quality. Yet there is rarely information about which barriers are more or less important to the use of a given health facility. This study assessed the relative importance of different barriers to maternal health facility use in rural Uganda through the use of simple indicators based on locally available data. Data from public health facilities performing deliveries in a rural district were used along with census information to construct a set of indicators useful for diagnosing barriers to delivery service use. Indicators included the number of facility-based deliveries per 1000 women served, the proportion of users from a facility's local area, and a new indicator, the 'bypassing ratio', defined as the number of women from a facility's local area who delivered in other facilities, divided by the number of local women using the facility itself. Numbers of deliveries varied greatly between facilities of the same level. A few very low use facilities saw over 75% of women come from the local area, while other facilities services attracted a large majority of women from other areas. The phenomenon of bypassing provides additional insight into the relative importance of distance or transport as opposed to internal facility factors preventing use. Simple and easily replicable tools are essential to assist health managers to identify communities and facilities needing improvements in access to delivery care. The methods developed in this paper could be utilized by local officials in other areas to assist planning and improvement of both maternal care and other health services.

Discordance in Perceptions of Barriers to Diabetes Care Between Patients and Primary Care and Secondary Care

We sought to compare perceived barriers to diabetes care between people with diabetes and different health professional groups. This was a cross-sectional, postal, open-questionnaire survey conducted in the Waikato district, New Zealand. A total of 3,890 individuals with diabetes participated, as well as 436 primary and secondary health professionals. Barriers were reported in 69.7% of patients. Psychological barriers were most important (55.5%), followed by systems barriers (25.7%), and then knowledge as least important (15.3%). Psychological barriers were ranked first among general practitioners (91.0%), but systems barriers were ranked first by other health professionals (38.8-100%). General practitioner and patient barrier group rankings were similar (r(T) = 0.976, P < 0.05). Of specific barriers among individuals with diabetes, strictness of treatment regimen was the most frequently reported (42.3 vs. 0.1-16.8%) (P < 0.001) and 2.5 (95% CI 2.4-2.7)- to 3.4 (3.2-3.7)-fold more than the 2nd through 4th ranked barriers. Motivation was the most common specific barrier reported by general practitioners (86%), practice nurses (31.5%), and the diabetes team (85.7%). Practice and hospital nurse/dietitian rankings were most comparable with patients (r(T) = 0.457 and 0.466, respectively, both P < 0.05). A major area of patient-health professional discordance was the influence of other health problems, which was ranked 2nd among patients but 10th-18th among health professionals. The most important barriers to diabetes care perceived by patients are psychological and particularly relate to the strictness of the regimen. Discordance between patients and different health professionals exists in the perception of the importance of different barriers to diabetes care.

REPRODUCTIVE ISOLATION BETWEEN TWO CLOSELY RELATED HUMMINGBIRD POLLINATED NEOTROPICAL GINGERS

Empirical estimates of the relative importance of different barriers to gene flow between recently diverged species are important for understanding processes of speciation. I investigated the factors contributing to reproductive isolation between Costus pulverulentus and C. scaber (Costaceae), two closely related hummingbird-pollinated understory Neotropical herbs. I studied broad-scale geographic isolation, microhabitat isolation, flowering phenology, overlap in pollinator assemblages, floral constancy by pollinators, mechanical floral isolation, pollen-pistil interactions, seed set in interspecific crosses, and postzygotic isolation (hybrid seed germination, greenhouse survival to flowering, and pollen fertility). Aside from substantial geographic isolation, I found evidence for several factors contributing to reproductive isolation in the sympatric portion of their geographic ranges, but the identity and relative strength of these factors varied depending on the direction of potential gene flow. For C. pulverulentus as the maternal parent, mechanical floral isolation was the most important factor, acting as a complete block to interspecific pollen deposition. For C. scaber as the maternal parent, microhabitat isolation, pollinator assemblage, mechanical floral isolation, and postpollination pollen-pistil incompatibility were important. Overall, prezygotic barriers were found to be strong, resulting in 100% reproductive isolation for C. pulverulentus as the maternal parent and 99.0% reproductive isolation for C. scaber as the maternal parent. Some postzygotic isolation also was identified in the F1 generation, increasing total isolation for C. scaber to 99.4%. The results suggest that ecological factors, including habitat use and plant-pollinator interactions, contributed to speciation in this system and evolved before extensive intrinsic postzygotic isolation.