Important Facilitators Research Articles

Approaches to deliver depression care and understanding barriers and facilitators to implementation in people with tuberculosis in LMICs: a systematic review

Background Depression is a common comorbidity in people with tuberculosis. Various approaches to delivering depression care for people with tuberculosis have been implemented in low- and middle-income countries. To date, there are no comprehensive reviews that summarise and explore the implementation of these approaches to delivering depression care for people with tuberculosis. Objectives To identify the various interventions and approaches to delivering depression care as part of routine tuberculosis care in low- and middle-income countries, and to summarise the barriers and facilitators to their implementation. Review methods We conducted a systematic review to identify the relevant evidence. We conducted searches in June and July 2020 in the following databases, from inception: MEDLINE, Scopus, PsycINFO, Web of Science, PubMed, EMBASE, Cochrane Library, SciELO and LILACS, Health Management Information Consortium. We also hand-searched the reference lists of the included studies. Two reviewers independently screened the titles and abstracts of all records. Two reviewers independently screened the full texts. We used the Mixed Methods Appraisal Tool for quality appraisal. We coded and synthesised the findings using the constructs of the Consolidated Framework for Implementation Research as an a priori guide to analyse the barriers and facilitators. Results The search retrieved 10,982 records, 39 studies were selected for full-text screening and 10 studies were included in the analysis. We categorised the interventions as psychological, combined (pharmacological and psychological), combined with socioeconomic support and screening-only approaches. The most commonly implemented types of intervention were psychological interventions, on their own or combined with pharmacological interventions or socioeconomic support. The most common barrier to implementation was the costs associated with the intervention and its implementation. There were multiple facilitators for implementation for all types of interventions in different Consolidated Framework for Implementation Research domains. Facilitators were related to the characteristics of the intervention (relative advantage), the inner setting (compatibility of the intervention with existing workflows) and the process of implementation (the positive attitudes of innovation participants). Limitations This study relied on published information; thus, it is possible that important barriers and facilitators were not reported in the published studies and were, therefore, absent from this evidence synthesis. Conclusion We identified psychological interventions as the most commonly implemented approach to the delivery of depression care for people with tuberculosis, alone or in combination with other approaches. We identified the increase in costs as a barrier experienced for all intervention types. We identified the relative advantage of the intervention, its compatibility and the beliefs and attitudes of people with tuberculosis, their families and communities as facilitators that were reported in all intervention types. The integration of depression care for people with tuberculosis in existing tuberculosis services is possible but will require the barrier of the costs associated with delivery and implementation to be addressed. This review was carried out during the COVID-19 pandemic, when the effects of the pandemic on tuberculosis and mental health services were yet to be seen. Future research should focus on the impact of the pandemic on tuberculosis and mental health services, and on people with tuberculosis and their mental health. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/130. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/GRWH1425.

Affect-based dimensions of trust: a study of buyer-supplier relationships in Thai manufacturing

PurposeTrust is an important facilitator of successful B2B relationships. The purpose of this study is to investigate affect-based antecedents of both interpersonal and interorganizational trust, and their impact on the performance of buyer–supplier relationships. The authors ask two research questions: (1) What are affect-based dimensions of interpersonal and interorganizational trust? (2) How do interpersonal and interorganizational trust influence buyers’ operational performance?Design/methodology/approachThe authors use data from an original survey of 156 buyer–supplier relationships between multinational enterprise subsidiaries and local suppliers in the Thai manufacturing sector to develop a structural model in which the authors test the hypotheses.FindingsConsistent with social exchange theory and social psychology, the empirical analysis shows that affect-based dimensions at the individual level, namely, likeability, similarity and frequent social contact, and at the organizational level, namely, supplier firm willingness to customize and institutionalization of cooperation, are important for establishing trust. In addition, interpersonal trust enhances buyers’ operational performance indirectly via interorganizational trust.Practical implicationsBuying and selling firms may develop organizational trust by developing processes that enhance organizational trust. Individuals with purchasing or sales responsibilities may enhance trust in their personal relationship. However, such interpersonal trust needs to be translated to the organizational level to benefit organizational performance.Originality/valueThe findings contribute to the literature on affect-based antecedents and outcomes of trust. Specifically, the authors offer theory and empirical evidence regarding the contribution of salespersons toward affect-based dimensions of trust and its impact on buyer’s operational performance.

Hanging up the car keys: Exploring factors that influence older drivers planning for driving retirement in Australia

IntroductionOlder driver safety is of increasing interest for policy makers and practitioners as the population of Australia continues to grow and age because capacity to drive safely may be affected by age-related physical and cognitive declines. Additionally, older drivers are at increased risk of serious injury or death if involved in a crash. Evidence suggests that only a small percent of drivers plan for driving retirement and there is limited understanding of the factors that influence this behaviour. Ultimately, the transition to driving retirement may be facilitated by actively planning for the day when an older driver hangs up the keys. MethodsThis qualitative study aimed to explore factors that influenced older adults planning for driving retirement through semi-structured in-depth interviews with 12 Sunshine Coast residents aged 65 and older who have retired from driving. The research was underpinned by the Social Ecological Model (SEM). ResultsThe data analysis identified that 1) individual factors are generally the stimulus for an older driver to begin thinking about retiring from driving; 2) interpersonal feedback did not play a large role in influencing planning driving retirement; 3) having available social support was an important facilitator of planning for driving retirement; 4) neighbourhood accessibility, infrastructure, and available alternative transport was a significant factor that influenced planning for driving retirement; and 5) at a policy level there is a need for coordinated and comprehensive resources to aid older drivers planning for driving retirement. ConclusionsThis study identified factors at all four levels of the SEM that influence planning for driving retirement, which provides support for addressing all levels of the SEM in future interventions, policy changes, and research. This knowledge can be valuable for future policy and intervention development.

Health challenges and facilitators of arbaeen pilgrimage: a scoping review

BackgroundThe Arbaeen Pilgrimage, a momentous religious journey drawing millions of participants annually, presents a profound spiritual experience. However, amidst its significance lie various health challenges that pilgrims encounter along the way. Addressing these challenges is vital to ensure the well-being of participants and the success of this extraordinary event. In light of this, the aim of this study is to examine the health challenges of the Arbaeen Pilgrimage, identify facilitators for solving these challenges, and propose effective solutions to enhance the overall pilgrimage experience for all involved.MethodsThe scoping review was performed by searching databases such as Web of Science, PubMed, Scopus, and Google Scholar search engine with a focus on the keywords “Arbaeen”, “Arbaeen walk” and “Arbaeen pilgrimage”. The search was not constrained by a specific time limitation in the databases. Data from studies were extracted using a data extraction form consisting of 9 fields. The selection of articles and data extraction were carried out by two researchers, adhering to predefined inclusion and exclusion criteria. Any disagreements were resolved through consultation with a third researcher. The study was reported following the PRISMA checklist.ResultsOut of 1619 retrieved articles, 9 were finally included in this study. All these studies were published since 2017 and conducted in Iraq and Iran. In total, 101 health challenges and facilitators were identified, comprising 61 challenges and 40 facilitators. The challenges with the highest frequency included “infectious disease outbreaks” (n = 7), “Poor management of Iraq’s health system in waste collection and disposal” (n = 4), “Rising incidence of walking injuries among pilgrims (e.g., burns, fractures, lacerations, wounds, and blisters)” (n = 4), and “Insufficient knowledge about personal and public health“(n = 4). The most important facilitators to solving the challenges were: “Customized pilgrim training and addressing their issues, with a focus on vital practices” (n = 6), “Coordinating mass gathering stakeholders, including health ministries and organizations” (n = 4), and “Implementing an agile syndromic system for rapid surveillance and identification of contagious illnesses” (n = 4).ConclusionThe article discusses health challenges faced during the Arbaeen Pilgrimage and proposes facilitative measures for participants’ well-being. It emphasizes the significance of addressing health risks in large gatherings and suggests incorporating measures for a safer and enjoyable pilgrimage experience. Overall, understanding and managing these health factors can lead to a successful execution of the Arbaeen Pilgrimage, benefiting the physical and spiritual well-being of all involved.

A scoping review to identify barriers and facilitators of research participation among chiropractic faculty.

To describe peer-reviewed literature on chiropractic faculty participation in research and identify important barriers and facilitators. We conducted a scoping review using comprehensive searches of relevant databases from inception through November 2022. English language publications of any design were included, with search terms consisting of subject headings specific to each database and free text words related to chiropractic, faculty, and research. Primary and secondary reviewer teams performed article screening and data abstraction using Covidence software, with primary reviewers responsible for consensus. Data were entered into evidence tables and analyzed descriptively. A total of 330 articles were screened, with 14 deemed eligible including 8 cross-sectional/correlational studies and 6 narrative reviews/editorials. Article publication dates ranged from 1987 to 2017. No intervention studies were identified. Facilitators of chiropractic faculty research included research assignment as primary role, institutional culture promoting research, and dedicated release time. Barriers included teaching/clinic assignments, lack of incentives and mentorship, and teaching load. Qualitative results identified 5 domains impacting faculty research: demographics/professional roles; personal empowerment; research culture; institutional setting/policies; and research training. Our scoping review found a paucity of recently published articles on chiropractic faculty participation in research. Educational institutions building research capacity among chiropractic faculty must establish cultural environments where scholarship is expected, rewarded, and valued. Tangible support, such as research policies, resources, and space, advanced training, funding, and release time, must be available. Faculty are encouraged to build upon key facilitators, evaluate interventions to address barriers to chiropractic faculty research, and publish their results.

To capture the child’s interest - nurses experiences of ‘Saga stories in health talks’

BackgroundAs unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. ‘Saga Stories in health talks’ is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the ‘Saga Stories in health talks’ material.MethodsThis study used a qualitative design. The material ‘Saga Stories in health talks’ was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis.ResultsThree categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children’s interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks’ was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child’s interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts.ConclusionsThis pilot study show that the material ‘Saga Stories in health talks’ was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.

Assessing the Impacts and Challenges of Deployed Community Development Workers: The Case of Bishoftu Community Development Workers Training College Graduates

Community development is about placing individuals at the centre of the development process and helping them realize their potential. Community Development Workers (CDWs) are community-based resource persons who collaborate with other community activists to help fellow community members. The objective of this study is to assess factors that challenge the roles of CDWs. The study used both quantitative and qualitative study designs. Data were gathered through questionnaires, in-depth interviews and personal observation. The collected data was analyzed using mixed method of analysis of both quantitative and qualitative data. The study revealed that CDWs have proved to be key and important local actors and facilitators in bringing about attitudinal change among the communities they work with, are attracting the trust and confidence of the people they work with, have revitalized local social organizations as instruments of development, have tabled the agendas of the socially marginalized community groups, working on the principle of matching community inputs with resources, and their role approved to be well aligned with Development Policy as it fosters ‘community participation, promotes self-reliance, and is strategically fasten at the grass roots level. The study concludes that CDWs are facing challenges in contextualizing their role and institutional factors are discovered to be impeding the roles of CDWs. The study recommends a multi-disciplinary research involving educationalists, and social anthropologists could perhaps develop a more thorough of investigation and be more conclusive on the factors that influence CDWs performance initiated by this research.

Risk Stratification and Treatment of Obesity for Primary and Secondary Prevention of Cardiovascular Disease.

In this review, we discuss contemporary and emerging approaches for risk stratification and management of excess adiposity for the primary and secondary prevention of cardiovascular disease. Obesity is simultaneously a pandemic-scale disease and major risk factor for the incidence and progression of a wide range of cardiometabolic conditions, but risk stratification and treatment remain clinically challenging. However, sex-, race-, and ethnicity-sensitive anthropometric measures, body composition-focused imaging, and health burden-centric staging systems have emerged as important facilitators of holistic risk prediction. Further, expanding therapeutic approaches, including comprehensive lifestyle programs, anti-obesity pharmacotherapies, device/endoscopy-based interventions, metabolic surgery, and novel healthcare delivery resources offer new empowerment for cardiovascular risk reduction in individuals with obesity. Personalized risk stratification and weight management are central to reducing the lifetime prevalence and impact of cardiovascular disease. Further evidence informing long-term safety, efficacy, and cost-effectiveness of novel approaches targeting obesity are critically needed.

Use of Epic Electronic Health Record System for Health Care Research: Scoping Review.

Electronic health records (EHRs) enable health data exchange across interconnected systems from varied settings. Epic is among the 5 leading EHR providers and is the most adopted EHR system across the globe. Despite its global reach, there is a gap in the literature detailing how EHR systems such as Epic have been used for health care research. The objective of this scoping review is to synthesize the available literature on use cases of the Epic EHR for research in various areas of clinical and health sciences. We used established scoping review methods and searched 9 major information repositories, including databases and gray literature sources. To categorize the research data, we developed detailed criteria for 5 major research domains to present the results. We present a comprehensive picture of the method types in 5 research domains. A total of 4669 articles were screened by 2 independent reviewers at each stage, while 206 articles were abstracted. Most studies were from the United States, with a sharp increase in volume from the year 2015 onwards. Most articles focused on clinical care, health services research and clinical decision support. Among research designs, most studies used longitudinal designs, followed by interventional studies implemented at single sites in adult populations. Important facilitators and barriers to the use of Epic and EHRs in general were identified. Important lessons to the use of Epic and other EHRs for research purposes were also synthesized. The Epic EHR provides a wide variety of functions that are helpful toward research in several domains, including clinical and population health, quality improvement, and the development of clinical decision support tools. As Epic is reported to be the most globally adopted EHR, researchers can take advantage of its various system features, including pooled data, integration of modules and developing decision support tools. Such research opportunities afforded by the system can contribute to improving quality of care, building health system efficiencies, and conducting population-level studies. Although this review is limited to the Epic EHR system, the larger lessons are generalizable to other EHRs.

Bridging capital after civil war? Protest, acts of citizenship and public space in Beirut

While research has indicated a significant role for social capital in building resilience to disaster, this relationship is more problematic in the aftermath of civil war. Social capital in such contexts risks being utilized ‘bonding capital’, which is designed to strengthen ethnic communities rather than act as an integrative agent to bring communities together. In response, policymakers and researchers have advanced the case for bridging social capital, the form of social capital needed to link communities across a cleavage that divides society. In the context of societies that have experienced protracted political violence along sectarian lines, bridging capital is seen as having the potential to peacefully bind communities together through everyday relations. To explore this, this article examines the role of protest in public spaces as way to engender bridging capital in divided cities. While existing research argues that protest can only sustain moderate forms of bridging capital, this paper suggests that protest in postwar divided urban contexts can be important facilitators of unity. To explore these issues, the article draws on data from two waves of protest in Beirut, the capital of Lebanon.

Barriers and facilitators to national guideline implementation for palliative cancer care in a Danish cross-sectoral healthcare setting: A qualitative study of healthcare professionals' experiences.

Patients with incurable cancer should receive general palliative care according to their needs, as provided through collaboration between hospital departments, municipalities, and general practices and as outlined in national guidelines. However, the implementation of general palliative care in Denmark has been inadequate. This study aimed to investigate the healthcare professionals' (HCPs') perceptions on barriers to and facilitators of the implementation of the Danish National Guideline (NG) for general palliative care. This descriptive, qualitative study was guided by the Consolidated Framework for Implementation Research (CFIR). Qualitative focus group and individual interviews were conducted with 23 HCPs. The interview guide, coding, analysis, and reporting of findings were developed within the CFIR framework. The main barriers to implementing NG were as follows: lack of knowledge about the NG, lack of an implementation plan, and insufficient communication and collaboration across sectors. Important facilitators were as follows: HCP motivation to meet palliative care needs, HCPs with special functions taking responsibility for incorporating NG into local guidelines, and the role of district nurses specialised in palliative care as opinion leaders providing security and continuity for the HCPs working in palliative care. To address the needs of patients with incurable cancer, greater efforts are required on implementing general palliative care. Although HCPs in our setting were motivated to improve NG implementation, financial resources and strategies are necessary to ensure sufficient knowledge uptake and accommodate identified barriers in order to translate the NG into practice.

How young adults with sickle cell disease define "being a good patient" in the adult healthcare system.

Young adulthood brings new challenges for managing sickle cell disease. There are fewer adult specialists, sickle cell disease morbidities accumulate, and mortality increases. Developmental changes in roles and responsibilities also affect management. This study explores how young adults with sickle cell disease experience their role as a patient. In this mixed-methods study at a sickle cell center, young adult participants completed the Sickle Cell Self Efficacy Survey, the Measures of Sickle Cell Stigma, and the Adult Sickle Cell Quality of Life Measurement Short-Forms. Semi-structured interviews on the patient role were conducted, transcribed, and then analyzed using thematic analysis. Twenty-four participants aged 19-25years defined expectations of being a "good patient." Five definitional themes emerged: health maintenance, emotion regulation, self-advocacy, honest communication, and empathy for clinicians. Participants identified support from families and clinicians are important facilitators of role fulfillment. How young adult patients with sickle cell disease define being a "good patient" has implications for the transition of care for both pediatric and adult medicine practices. This understanding can inform healthcare system designs and programs aimed at supporting patients and families.

Perspectives of General Practitioners on signaling and diagnosing dementia

AbstractBackgroundAlthough a timely diagnosis of dementia is beneficial for patients, their relatives, and society, people with dementia often remain undiagnosed or receive a diagnosis at a relatively late stage (Lang 2017). General practitioners (GPs) have a prominent role in the detection of dementia, yet GPs experience several barriers in diagnosing dementia in primary care (Koch 2010). This study aims to explore the experiences and perspectives of GPs in diagnosing dementia in primary care.MethodA qualitative study was conducted consisting of semi‐structured interviews with 10 Dutch GPs purposively selected using maximum variation sampling. The study was an initiative of Alzheimer Center Groningen as part of ABOARD (A Personalized Medicine Approach for Alzheimer’s Disease). Overall topics included: experiences in signaling dementia; thoughts about the decision to wait in diagnosing dementia, to perform diagnostics, or to refer to a medical specialist for diagnosing dementia; and the needs of GPs in the diagnostic process of dementia. Interview transcripts were analyzed in multiple rounds by a multidisciplinary research team using thematic analysis with a phenomenological approach.ResultOverarching themes were ‘initiation of the diagnostic trajectory’, ‘timing of diagnosis’, ‘relevance of a formal diagnosis’, ‘division of roles and responsibilities, ‘patient denial’, ‘patient‐physician relationship’, ‘crisis’, and ‘arranging care after diagnosis’. Key findings within the ‘initiation of the diagnostic trajectory’ theme were that observations from people around patients (family, community nurse, practice nurse, pharmacist, or medical specialist) were often signals for GPs to start a conversation about dementia and diagnostic possibilities. The diagnostic trajectory rarely started with a request for help from the patient. Patient denial was described as a major obstacle in diagnosing dementia and arranging appropriate care subsequently. A proactive practice policy to detect and monitor cognitive impairment was a key facilitator to achieve a timely diagnosis and prevent crises in dementia. For example, GPs favored regular home visits by a practice nurse and low‐threshold cognitive examination; a long‐term physician‐patient relationship; and successful interdisciplinary collaboration with local care providers, especially consultation of an elderly care physician.ConclusionPatient denial and surrounding people are important barriers and facilitators, respectively, to the diagnostic process of dementia.

Barriers and facilitators to self-measured blood pressure monitoring among US-resettled Arab refugees with hypertension: a qualitative study

BackgroundMinoritized communities including refugees are at an increased risk of poorly controlled hypertension. Evidence indicates that self-measured blood pressure monitoring (SMBP) is an effective method to improve blood pressure control in patients with hypertension. However, it has not been studied among refugee populations. The objective of this study is to examine barriers and facilitators to SMBP among Arab refugees resettled in the United States (US) with diagnosed hypertension.MethodsA total of 109 participants were recruited through a Federally Qualified Health Center system that is a major provider of healthcare to refugees in San Diego, California. Participants completed a questionnaire and were interviewed using in-depth, semi-structured interviews. Interviews were transcribed and translated, and data were coded using inductive thematic analysis and organized based on the theory of care-seeking behavior.ResultsSeveral barriers to engaging in effective SMBP monitoring were identified. Clinical and sociodemographic barriers included reliance on public monitors and poor hypertension literacy. Psychosocial barriers of affect, norms, and habits included fear and anxiety from hypertension, cultural stigma of illness, and conditional SMBP with symptoms, respectively. Utility psychosocial barriers included lack of SMBP prioritization in treatment and perceived inaccuracy of home monitors. Family members’ support with home monitoring served as an important facilitator to SMBP.ConclusionsThere are several barriers to effective SMBP among the US-resettled Arab refugee population that may reflect unique cultural and care-seeking behaviors. Tailored public health and clinical interventions are needed to support refugee patients and providers to improve hypertension self-management behaviors for this unique population.

Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study.

Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors. In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals. A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals. This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Experiences of living with binge eating disorder and facilitators of recovery processes: a qualitative study

BackgroundBinge eating disorder (BED) is the most prevalent eating disorder worldwide. BED is often associated with low quality of life and mental health problems. Given the complexity of the disorder, recovery may be challenging. Since BED was only recently specified as a diagnostic category by the World Health Organization (2021), little is known about how patients experience living with BED in everyday life. This study aimed to explore how patients experience living with BED and to investigate factors perceived as facilitating recovery.MethodIndividual interviews were conducted with six patients in a rehabilitation programme for recovery from BED. Interviews were conducted digitally and verbally transcribed between December 2020 and January 2021. The analysis was based on Malterud’s systematic text condensation.ResultsBeing diagnosed with BED could be experienced as a relief. The participants perceived living with BED as a challenging addiction. They struggled with a low self-image and experienced a lack of understanding from others, resulting in shame. Self-compassion and social support from friends and family and through participation in a rehabilitation programme were important facilitators of recovery.ConclusionParticipants perceived living with BED as a challenging addiction. They struggled with low self-esteem and experienced a lack of understanding from others, resulting in shame. Being diagnosed with BED was perceived as a relief. They appreciated that issues related to mental health were addressed during rehabilitation to better understand the complexity of BED. Knowledge about BED, as well as the difficulties of living with BED among family members and friends might help patients with BED feel less ashamed of their disorder and could thus contribute to increased self-compassion.

Implementation of structured feedback in a psychiatry residency program in Canada: a qualitative analysis study

IntroductionStructured feedback is important to support learner progression in competency-based medical education (CBME). R2C2 is an evidence-based four-phased feedback model that has been studied in a range of learner contexts; however, data on factors influencing implementation of this model are lacking. This pilot study describes implementation of the R2C2 model in a psychiatry CBME residency program, using the Consolidated Framework for Implementation Research (CFIR).MethodsThe study was carried out in three phases: planning, implementation and evaluation. After receiving training, 15 supervisors used the R2C2 feedback model with residents. Semi-structured interviews explored (n = 10) supervisors’ experience of the model. CFIR was used to identify factors that influence implementation of the R2C2 model when providing feedback to residents.ResultsQualitative data analysis revealed four key themes: Perceptions about the R2C2 model, Facilitators and barriers to its implementation, Fidelity to R2C2 model and Intersectionality related to the feedback. The CFIR implementation domains provided structure to the themes and subthemes.ConclusionThe R2C2 model is a helpful tool to provide structured feedback. Structure of the model, self-efficacy, in-house educational expertise, learning culture, organizational readiness, and training support are important facilitators of implementation. Further studies are needed to explore the learner’s perspective and fidelity of this model.

Implementation and effectiveness of a physician-focused peer support program.

The practice of medicine faces a mounting burnout crisis. Physician burnout leads to worse mental health outcomes, provider turnover, and decreased quality of care. Peer support, a viable strategy to combat burnout, has been shown to be well received by physicians. This study evaluates the Peer Outreach Support Team (POST) program, a physician-focused peer support initiative established in a 2-hospital system, using descriptive statistical methodologies. We evaluate the POST program using the Practical Robust Implementation and Sustainability Model (PRISM) framework to describe important contextual factors including characteristics of the intervention, recipients, implementation and sustainability infrastructure, and external environment, and to assess RE-AIM outcomes including reach, effectiveness, adoption, implementation, and maintenance. This program successfully trained 59 peer supporters across 11 departments in a 2-hospital system over a 3-year period. Trained supporters unanimously felt the training was useful and aided in general departmental culture shift (100% of respondents). After 3 years, 48.5% of physician survey respondents across 5 active departments had had a peer support interaction, with 306 successful interactions recorded. The rate of interactions increased over the 3-year study period, and the program was adopted by 11 departments, representing approximately 60% of all physicians in the 2-hospital system. Important implementation barriers and facilitators were identified. Physician recipients of peer support reported improved well-being, decreased negative emotions and stigma, and perceived positive cultural changes within their departments. We found that POST, a physician-focused peer support program, had widespread reach and a positive effect on perceived physician well-being and departmental culture. This analysis outlines a viable approach to support physicians and suggests future studies considering direct effectiveness measures and programmatic adaptations. Our findings can inform and guide other healthcare systems striving to establish peer support initiatives to improve physician well-being.

Therapeutic drug monitoring to personalize dosing of imatinib, sunitinib, and pazopanib: A mixed methods study on barriers and facilitators.

Personalized dosing based on measurement of individual drug levels and adjusting the dose accordingly can improve efficacy and decrease unnecessary toxicity of oncological treatment. For imatinib, sunitinib, and pazopanib, this therapeutic drug monitoring (TDM)-guided dosing is, however, not routinely used, despite accumulating evidence favoring individualized dosing. Therefore, we aimed to identify and quantify (potential) barriers and facilitators in TDM-guided dosing for imatinib, sunitinib, and pazopanib. We performed a mixed methods study among all stakeholders involved: patients, healthcare professionals (HCPs), pharmaceutical companies, and health insurance companies. During the first qualitative part of this study, we performed semi-structured individual interviews and one focus group interview to identify all (potential) barriers and facilitators, and during the second quantitative part of this study, we used a web-based survey to quantify these findings. The interviews addressed the six domains of the implementation of change model of Grol and Wensing: (1) the innovation itself; (2) the HCP; (3) the patient; (4) social context; (5) organizational context; and (6) finances, law, and governance. In the qualitative study, we interviewed 20 patients, 18 HCPs and 10 representatives of pharmaceutical and health insurance companies and identified 72 barriers and 90 facilitators. In the quantitative study, the survey was responded by 66 HCPs and 58 patients. Important barriers were on the domain of the HCP, such as a lack of experience with TDM (36.4%), on the domain of the patient, such as lack of awareness of TDM (39.7%), and the processing time for measurement and interpretation of the TDM result (40.9%) (organizational domain). Important facilitators were education of HCPs (95.5%), education of patients (87.9%) and facilitating an overview of when and where TDM measurements are being performed (86.4%). We identified and quantified important barriers and facilitators for the implementation of TDM-guided dosing for imatinib, sunitinib, and pazopanib. Based on our results, the implementation strategy should mainly focus on educating both HCPs and patients and on the organizational aspect of TDM.

From the lab to the field: acceptability of using electroencephalography with Indian preschool children.

Background: Measurement of social and cognitive brain development using electroencephalography (EEG) offers the potential for early identification of children with elevated risk of developmental delay. However, there have been no published reports of how acceptable EEG technology is to parents and children within communities, especially in low-resource contexts such as in low and middle income countries (LMICs), which is an important question for the potential scalability of these assessments. We use a mixed-methods approach to examine whether EEG assessments are acceptable to children and their caregivers in a low resource community setting in India. Methods: We assessed the acceptability of neurophysiology research and Braintools (a novel neurodevelopmental assessment toolkit using concurrent EEG and eye-tracking technology) using: 1) a child engagement measure, 2) interviews with caregivers (n=8); 3) survey about caregiver's experience (n=36). Framework analysis was used to analyse interview data. Results: A high level of child engagement in EEG tasks was demonstrated, with children's gaze at the screen during the task averaging at 85.4% (±12.06%) of the task time. External distractions and noise during the tasks were measured, but not found to significantly effect child's attention to the screen during EEG tasks. Key topics were examined using the framework analysis: 1) parental experience of the assessment; and 2) the acceptability of research. From topic 1, four sub-themes were identified: i) caregivers' experience of the assessment, ii) caregivers' perception of child's experience of assessment, iii) logistical barriers and facilitators to participation, and iv) recommendations for improvement. Results from interviews and the survey indicated acceptability for gaze-controlled EEG research for parents and children. From topic 2, three themes were identified: i) caregivers' understanding of the research, ii) barriers to participation, and iii) facilitators to participation. Barriers to participation mainly included logistical challenges, such as geographic location and time, whereas involvement of the wider family in decision making was highlighted as an important facilitator to partake in the research. Conclusions: We demonstrate for the first time the acceptability of conducting neurodevelopmental assessments using concurrent EEG and eye-tracking in preschool children in uncontrolled community LMIC settings. This kind of research appears to be acceptable to the community and we identify potential barriers and facilitators of this research, thus allowing for future large scale research projects to be conducted investigating neurodevelopment and risk factors for suboptimal development in LMICs.