Main Facilitators Research Articles

Cancer prevention in people experiencing homelessness: feasibility of the Health Navigator Model

Abstract Background The Health Navigator Model (HNM) is a newly developed skill-mixed model that may improve access to cancer prevention services for over 895,000 People who are currently Experiencing Homelessness (PEH) in Europe. The aim of this study was to assess the feasibility and implementation of the model in European settings. Methods A co-designed pilot implementation study was undertaken in Austria, Spain, Greece and the United Kingdom. A total of 20 trained health navigators were appointed at support centres for PEH and facilitated PEH’s access to cancer prevention activities based on a comprehensive and tailored needs assessment. The study duration was 19 months, with two follow-ups. Feasibility data (recruitment/retention/participation rates, barriers, facilitators) were monitored throughout the study. Results More than 1,981 PEH were informed about the study and 652 of them participated. Most participants were male (64%), with low or no income (42%) and had previously experienced homelessness (51.7%). The mean age of participants was 47.4 years old. Overall, 69% of participants completed the first, and 42.5% completed the second follow-up. Main dropout reasons were loss of contact, loss of interest or having other priorities. Participants undertook a range of cancer prevention activities, including education (n = 494), workshops (n = 280), health consultations (n = 251), referrals for specialist care (n = 212) and cancer screening tests (n = 169). Difficulties in accessing the healthcare system, de-prioritising cancer and PEH’s complex needs were identified as the main barriers. Building trusting relationships with PEH, increasing cancer awareness and coordinating social and health services were identified as the main facilitators. Conclusions Implementing the Health Navigator Model was a feasible and dynamic process leading to improved equity and inclusion of people experiencing homelessness in cancer preventive services. Key messages • The Health Navigator Model is a feasible model to enhance cancer prevention among people experiencing homelessness following a person-centred, destigmatising approach. • Effective liaison between health and social services under the Health Navigator Model plays a critical role in facilitating access to cancer preventive care among people experiencing homelessness.

Facilitators and barriers to improving beverage consumption among primary school children in Belgium

Abstract Background School is seen as a relevant setting to intervene in children’s health behaviour, including their beverage consumption. A randomized controlled trial (DRINK) has been implemented to compare nutrition and sustainability-based interventions to reduce sugary beverages and to increase tap water consumptions among primary school children in French-speaking Belgium. The aim of this qualitative study was to describe the context before the intervention implementation and to identify the facilitators and barriers to implementing the project. Methods In 2021, the 48 schools included in the trial responded to a semi-structured interview prior to the intervention, and 30 were interviewed one year later. School characteristics (including socioeconomic index, SEI) and contextual components were summarised. The qualitative corpus was analysed using thematic content methods to identify emerging themes, then classified into obstacles and facilitators. Results Of the 48 schools, 70.8% were Walloon, 76.6% had a medium or high SEI, and 41.7% included less than 90 pupils. The majority had already implemented nutrition and sustainable development initiatives before the trial. While taps were available in classrooms and reusable bottles were used, the initiatives could be extended, e.g. to increasing the number of water points. The main facilitators were the interest to receive additional support by the schools already involved in other projects, and the flexibility of the intervention. The main barriers were related to lack of access to tap water; insufficient support for the implementation of the intervention; and poor availability of school staff to get involved in such a project. Conclusions Alongside the main trial findings, understanding the facilitators and barriers will enable the intervention to be further adapted and extended. Considering the school context and perceptions is essential to ensure effective and durable school health initiatives. Key messages • Largely involved in promoting nutrition and sustainability, the schools were keen to receive support to continue. • Strengthening access to water, communication and support for schools are essential.

Mobile street clinics and harm reduction: pathways to provide care to homeless people in Brazil

Abstract Homeless people (HP) are defined as a heterogeneous group that lives in extreme poverty, with weakened or severed family ties, lacking access to conventional housing, and using public spaces as residence. In terms of health, mental health conditions are prominent as a primary treatment demand, with care aimed at addressing needs arising from the use of alcohol and other drugs being a priority in serving HP. In this context, mobile street clinics (MSC) provide health services directly in street environments, focusing on individuals who use alcohol and other substances through harm reduction approaches. Harm reduction is defined as a set of practices aimed at minimizing the adverse health effects of alcohol and drug use without necessarily eliminating usage. Moreover, it represents an ethical and political direction in care, confronting the logic of criminalization and compulsory abstinence, enhancing access to health care for alcohol and other drug users through strategies that foster autonomy development. In the current study, we conducted an integrative review assessing the facilitators and barriers for HP access to mental health services. Preliminary results indicated that MSC, the connection between healthcare workers and the HP they serve, and the implementation of local street-based actions were the main facilitators of access for individuals who engage in harmful use of alcohol and other drugs to mental health services. Conversely, stigma, services’ lack of adjustment to the lifestyles of homeless people, and excessive bureaucracy were identified as the principal barriers of access. MSC, through their harm reduction activities, have emerged as a potential care technology to facilitate access to health services for homeless people. This research aims to present harm reduction as an ethical and political direction of care through the actions of mobile street clinics, as a way to facilitate access to health services for the homeless people. Key messages • Homeless people require mental health care tailored to the use of alcohol and other drugs, and harm reduction strategies implemented through mobile street clinics prove to be an effective form of care. • Mobile street clinics and harm reduction are important care technologies that enhance access to health services for the homeless population.

Young Flexitarians: An Insight into Barriers and Facilitators Related to Capability, Opportunity, and Motivation for Meat Reduction

In recent decades, meat consumption has faced growing scrutiny from an environmental, health, and animal welfare perspective. As a result, reducing meat consumption has emerged as an important strategy to mitigate its negative effects. Flexitarians, a growing group of meat reducers, have attracted attention for potentially shaping future dietary trends. This study uses a qualitative approach and draws on 15 in-depth interviews with young flexitarians in Slovenia (YFS) to identify the main facilitators and barriers to meat reduction by exploring their motivations, capabilities, and opportunities as described in the COM-B behavioral model. This study fills the gap in studies on flexitarians using the COM-B model by looking at capabilities and opportunities, not solely motives. In addition, it fills the gap in qualitative in-depth studies on all three COM-B categories, as well as a gap in studies conducted outside northwest Europe and other primarily western geographical contexts. This study highlights important findings for the central and eastern European context that industry and governments should consider when developing behavior change strategies for healthy, sustainable diets. This study shows that strong rural family ties and limited access to meat alternatives are the major barriers to meat reduction in Slovenia. The YFS preferred whole, unprocessed foods (legumes, vegetables, grains) over processed meat alternatives and reduced their meat consumption primarily for health and environmental reasons, relying on social support from peers and information from popular documentaries and social media influencers.

Exploration of barriers to treatment for patients with eating disorders in Chile

BackgroundEating disorders (EDs) are associated with high morbidity and mortality, affecting predominantly young people and women. A delay in starting treatment is associated with chronic and more severe clinical courses; however, evidence on barriers and facilitators of access to care in Latin America is scarce. We aimed to identify barriers and facilitators of ED treatment in Chile from the perspective of patients, relatives, and health professionals.MethodsQualitative approach through semi-structured interviews with patients, their relatives, and health professionals. Participants were recruited from two ED centers in Santiago, Chile (one public and one private). Analysis was mainly based on Grounded Theory, using MAXQDA software.Results40 interviews were conducted (n = 22 patients, 10 relatives, and 8 health professionals). The mean age of patients was 21.8 years, while the mean duration of untreated ED was 91.4 months (median 70 months). Five categories emerged with intersections between them: patient (P), family and social environment (FSE), health professionals (HP), healthcare system (HCS), and social and cultural context (SCC). Relevant barriers appeared within these categories and their intersections, highlighting a lack of professional knowledge or expertise, cultural ignorance or misinformation regarding EDs, and patient’s ego-syntonic behaviors. The main facilitators were patients’ and relatives’ psychoeducation, recognition of symptoms by family members, and parents taking the initiative to seek treatment.ConclusionsThis study provides information regarding access to treatment for patients living with EDs in Chile. A practical public health approach should consider the multi-causality of delay in treatment and promoting early interventions.Plain English SummaryEating disorders (EDs) may severely affect the daily functioning of people enduring them. A delay in starting treatment is associated with a disease that is more difficult to treat. To our knowledge, there are no published studies carried out in Latin America exploring factors influencing treatment initiation in EDs patients. This study aimed to identify facilitators of and barriers to treating patients with EDs in Chile. We interviewed patients (n = 22), their relatives (n = 10), and health professionals (n = 8) from a private and a public center in Santiago, Chile. Our analysis showed that the main barriers to starting treatment were the lack of professional knowledge in ED, the monetary cost of illness, and cultural misinformation. Facilitators were related to the role of the family in recognizing and addressing the disease while being educated in EDs by professionals. This study helps to provide data about treatment access in developing countries. While facilitators and barriers were similar to others reported in the literature, the untreated ED’s duration was longer. It is essential to address these barriers to provide access to treatment more efficiently and prevent severe and enduring forms of disease.

Facilitators and barriers of adherence to rectal interventions by parents of young children with functional constipation: a qualitative study.

Functional constipation in children is a worldwide problem that impacts both children's gastrointestinal function and the quality of family life. The treatment of this condition often depends on parental involvement to administer rectal interventions to their children to stimulate defecation. However, adherence to rectal interventions is currently suboptimal. We sought to explore the factors that facilitate and hinder parents from adherence to rectal interventions. A descriptive qualitative study was conducted involving semi-structured interviews with parents of infants and young children with functional constipation requiring rectal interventions from March to May 2023. The data were analyzed using content analysis. Fourteen parents participated in the study. Parents reported the main facilitators of adherence to prescribed rectal interventions as recognition of illness severity, support from family and friends, and medical resource support and e-health literacy. Parents reported the primary barriers as information barriers, family conflict, cognitive misalignment, and difficulties in accessing healthcare services. Rectal interventions are often essential in managing constipation in young children, with parental compliance being crucial for effective treatment. Healthcare providers must consider the psychosocial aspects of parents' perceptions, adhere to guidelines to standardize communication, and ensure comprehensive education to improve medication literacy.

Barriers and Facilitators to the Applicability of Adult Daycare Centers in Saudi Arabia: A Qualitative Study.

Adult daycare centers (ADCs) enable older adults to socialize and enjoy planned group activities while receiving healthcare services. These centers also assist caregivers by empowering them to remain in the workforce. This study aims to explore the challenges in establishing ADCs in Saudi Arabia (SA) from the perspectives of healthcare professionals, healthcare policymakers, older adults, and caregivers. Additionally, this study's objective is to identify the barriers, facilitators, and applicability of ADCs in SA. A qualitative study was conducted using semi-structured individual interviews. Inductive and deductive thematic analyses were employed to identify common themes regarding the barriers and facilitators to the applicability of ADCs in SA. Five researchers independently examined the transcripts using inductive analysis. Deductive analysis mapped the themes to Campinha-Bacote's cultural competence model. Data were collected from 46 participants, including caregivers, older adults, healthcare professionals, and healthcare policymakers. The findings highlight that the main facilitators to establishing ADCs in SA are the expected positive impact on the psychological and physical well-being of older adults and their caregivers. Conversely, cost and transportation, in addition to cultural considerations are possible barriers. This study identified the perceived benefits of ADCs for older adults and caregivers from a Saudi societal perspective. Thematic analysis showed that ADC's applicability in SA is possible, with some modifications to fit within the Saudi context. Additional efforts are necessary to promote the concepts and services that ADCs provide for older adults and to encourage support for these centers by non-profit organizations and the government.

The COM-B model: a cross-sectional survey assessing capability, opportunities, and motivation to follow the MIND diet among informal female caregivers of people with Alzheimer's disease and related dementias.

Caring for a person with Alzheimer's disease or dementia has been correlated with poor dietary patterns in caregivers. Dietary patterns like The Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet have the potential to reduce the negative health outcomes associated with caregiving. Our objective was to assess capabilities, opportunities, and motivation of caregivers to follow the MIND diet using the COM-B model approach. Female caregivers (n = 299, m age = 37.7 ± 13.7) participated in an online survey. Majority were White (72%) and cared for someone with Alzheimer's disease (42.6%). The survey included at least one question for each of the 6 COM-B subcomponents: psychological capability, physical capability, social opportunity, physical opportunity, reflective motivation, and automatic motivation. Most caregivers were not consuming the MIND diet as only 8.4% reported normally eating the MIND diet items. Caregivers (36.5%) were slightly confident or not confident at all in cooking and eating the MIND diet. Participants (67.1%) reported that consuming the MIND diet would somewhat to very much be supported by friends and family. Budget, time, and transportation were selected as the main barriers. Budget, cooking skills, access to food and stores, and family support were the main facilitators. Strategies to increase capability, opportunities, and motivation for the MIND diet are needed to improve caregivers' health. Future MIND diet interventions should improve budget planning and cooking skills of caregivers (capabilities), make MIND diet food items accessible to them (opportunity) and incorporate social support from family and friends (motivation).

Healthcare providers' expected barriers and facilitators to the implementation of person-centered long-term follow-up care for childhood cancer survivors: A PanCareFollowUp study.

Childhood cancer survivors face high risks of adverse late health effects. Long-term follow-up care for childhood cancer survivors is crucial to improve their health and quality of life. However, implementation remains a challenge. To support implementation of high-quality long-term follow-up care, we explored expected barriers and facilitators for establishing this follow-up care among healthcare providers from four European clinics. A qualitative study was conducted using four focus groups comprising 30 healthcare providers in total. The semi-structured interview guide was developed based on the Grol and Wensing framework. Data was analyzed following a thematic analysis, combining both inductive and deductive approaches to identify barriers and facilitators across the six levels of Grol and Wensing: innovation, professional, patient, social, organizational and economic and political. Most barriers were identified on the organizational level, including insufficient staff, time, capacity and psychosocial support. Other main barriers included limited knowledge of late effects among healthcare providers outside the long-term follow-up care team, inability of some survivors to complete the survivor questionnaire and financial resources. Main facilitators included motivated healthcare providers and survivors, a skilled hospital team, collaborations with important stakeholders like general practitioners, and psychosocial care facilities, utilization of the international collaboration and reporting long-term follow-up care results to convince hospital managers. This study identified several factors for successful implementation of long-term follow-up care for childhood cancer survivors. Our findings showed that specific attention should be given to knowledge, capacity, and financial issues, along with addressing psychosocial issues of survivors.

Healthcare professionals’ perspectives on the barriers and facilitators of integrated childhood obesity care

BackgroundBoth the causes and consequences of childhood obesity can be complex. To provide healthcare that is suitably tailored to the specific needs of children with obesity integrated care is required. The objective of this study was to explore the perceived barriers and facilitators of healthcare professionals (HCPs) in providing integrated care for children with obesity, to support them in tailoring the healthcare approach.MethodsIn this qualitative study, semi-structured in-depth interviews were conducted with 18 healthcare professionals with experience in childhood obesity care; pediatricians, youth healthcare nurses and a youth healthcare physician. A two-phased thematic content analysis was performed: an inductive analysis with open and selective coding and a deductive analysis with axial coding using the patient-centered care model by Stewart.ResultsOverall, the healthcare professionals defined the etiology of obesity as complex, and experienced the integrated care as complicated. The results fit into the four theme-structure of the patient-centered care model, with the integrated care system as an additional fifth theme. The main barriers were perceived within the sub-themes of illness and healthcare experiences, and sensitivity over talking about weight-related issues. The main facilitators were perceived within the sub-themes of conducting a biomedical, psychosocial and lifestyle assessment, tailoring the approach to families’ situation and investing in a family-professional relationship. Weight stigma appeared to be an underlying barrier for healthcare professionals that impacted, both explicitly and implicitly, upon all themes.ConclusionsHealthcare professionals providing integrated care for children with obesity, experience this type of care as complicated and comprising many barriers and facilitators regarding the four themes of the patient-centered care model and the fifth theme of the integrated care system. This paper demonstrates the patient-centered care model could prove helpful structuring a tailored approach within integrated care. This approach supports healthcare professionals in adopting a broad perspective towards individual and environmental factors and investing in the relationship, with respect to the sensitivity and complexity of childhood obesity.

Exploring the effectiveness of eHealth interventions in treating Post Intensive Care Syndrome (PICS) outcomes: a systematic review

BackgroundIt remains unclear how to optimise critical care rehabilitation to reduce the constellation of long-term physical, psychological and cognitive impairments known as Post Intensive Care Syndrome (PICS). Possible reasons for poor recovery include access to care and delayed treatment. eHealth could potentially aid in increasing access and providing consistent care remotely. Our review aimed to evaluate the effectiveness of eHealth interventions on PICS outcomes.MethodsStudies reporting eHealth interventions targeting Post Intensive Care Syndrome outcomes, published in Medline, CINAHL, PsycINFO, Embase, and Scopus from 30th January 2010 to 12th February 2024, were included in the review. Study eligibility was assessed by two reviewers with any disagreements discussed between them or resolved by a third reviewer. Study quality and risk of bias were assessed using the Mixed Method Appraisal Tool. Further to the identification of effective strategies, our review also aimed to clarify the timeline of recovery considered and the outcomes or domains targeted by the interventions.ResultsThirteen studies were included in our review. Study duration, eHealth intervention delivery format, and outcome measures varied considerably. No studies reported a theory of behavioural change and only one study was co-produced with patients or carers. Most studies were conducted in the early post-discharge phase (i.e., < 3 months) and had feasibility as a primary outcome. The cognitive domain was the least targeted and no intervention targeted all three domains. Interventions targeting the psychological domain suggest generally positive effects. However, results were underpowered and preliminary. Though all studies were concluded to be feasible, most studies did not assess acceptability. In studies that did assess acceptability, the main facilitators of acceptability were usability and perceived usefulness, and the main barrier was sensitivity to mental health and cognitive issues.ConclusionOur systematic review highlighted the promising contributions of eHealth with preliminary support for the feasibility of interventions in the early stages of post-critical care rehabilitation. Future research should focus on demonstrating effectiveness, acceptability, the cognitive domain, and multi-component interventions.

Usage, Attitudes, Facilitators, and Barriers Toward Digital Health Technologies in Musculoskeletal Care: Survey Among Primary Care Physiotherapists in Norway.

Work burden increases for physiotherapists in the primary health care sector as the prevalence of musculoskeletal disorders (MSDs) increases. Digital health technologies (DHTs) are proposed as a viable solution to secure the sustainability of the health care system and have shown promising results in a range of conditions. However, little is known about use of DHTs among physiotherapists in the primary health care sector in Norway. This study aimed to investigate the use of and attitudes toward DHTs among physiotherapists treating patients with MSDs in primary care, and potential facilitators or barriers for adopting DHTs in clinical practice. An author-developed web-based questionnaire was distributed to physiotherapists in all Norwegian municipalities in March 2023. The questionnaire included items regarding use of technologies, attitudes, suitability, and factors influencing adoption of DHT. Suitability and agreement on statements were scored on an 11-point numeric rating scale (0=very unsuitable or strongly disagree, 10=very suitable or strongly agree). Differences across employment sites and users versus nonusers of DHT were analyzed using the χ2 test, Fisher exact test, Student t test, and Mann-Whitney U test. Approximately 5000 physiotherapists were invited to participate, of which 6.8% (338) completed the questionnaire. A total of 46.2% (156/338) offered DHTs in their practice, of which 53.2% (83/156) used it on a weekly basis, mostly telephone consultations (105/156, 67.3%). A higher proportion of physiotherapists in private practice offered DHT compared with those employed by municipalities (95/170, 55.9% vs 61/168, 36.3%; P<.001). A majority (272/335, 81.2%) were positive about recommending DHTs to their patients. Suitability of DHTs in physiotherapy was rated an average of 6 (SD 2.1). Apps for smartphones or tablets were rated most suitable (mean rating 6.8, SD 2.4). The most frequently reported advantages were flexibility in how physiotherapy is offered (278/338, 82.3%) and reduced travel time for the patient (235/338, 70%). The highest rated disadvantages were limited scope for physical examination (252/338, 74.6%) and difficulty in building rapport with the patient (227/338, 67.2%). The main facilitators and barriers included a functioning (median rating 10, IQR 8-10) or lack of functioning (median rating 9, IQR 8-10) internet connection, respectively. Lack of training in DHTs was prominent regarding evaluation, diagnosing, and treatment (median rating 0, IQR 0-2), with minor, but significant, differences between nonusers and users (median rating 0, IQR 0-1 vs median rating 1, IQR 0-4); P<.001). Physiotherapists in Norwegian primary care treating patients with MSDs are positive about using DHTs, and almost 50% (156/338) have adopted them in clinical practice. Concerns are related to lack of a physical examination and technical aspects. Training in the use of DHTs should be addressed in implementation processes.

Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model.

The importance and effectiveness of palliative care (PC) in intensive care units (ICU)are known. Less is known about the implementation and integration of ICU-based PC interventions. This systematic review aims to use a modified implementation research logic model (IRLM) to identify, map, and synthesise evidence on implementation of ICU-PC (primary and/or specialist) interventions. This systematic review used an adapted Smith's IRLM to understand relationships between implementation factors-determinants (barriers and facilitators), strategies, and mechanisms-and report intervention characteristics and outcomes. Searches up to 2nd December 2023, of MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO, combined PC, intensive care, and implementation terms. 84 studies (8 process evaluations, 76 effectiveness studies) were included. Published evidence on ICU-PC interventions issubstantial, but reporting on implementation factors is variable and often lacking, especially for patient and family-related determinants and for all aspects of mechanisms. Main facilitators forimplementation are adequate resources and collaborationbetween PC and ICU teams. Main barriers to implementation are lack of resources, negative perceptions of PC, and high ICU acuity.Implementation strategies include auditing resources, building stakeholder collaboratives, creating adaptable interventions, utilising champions, and supporting education. Mechanisms most commonly worked by facilitating collaborative working. This review provides recommendations for ICUs when designing (stakeholder involvement, ICU-PC collaboration, assessment of culture and resources); implementing (targeted and adapted strategies, champions, and education); and evaluating/reporting (collect effectiveness and implementation data, including mechanisms) ICU-PC interventions. Use of implementation structures and patient/family involvement are both needed and important to be included.

Peripheral intravenous catheter clinical care standard adherence in emergency departments: A qualitative study underpinned by the behaviour change wheel.

To explore the barriers and facilitators influencing emergency department clinicians' adherence to the Australian Peripheral Intravenous Catheter (PIVC) Clinical Care Standard, using the Behaviour Change Wheel (BCW). Suboptimal PIVC practices are frequently linked to a range of patient-important adverse outcomes. The first Australian Peripheral Intravenous Catheter Clinical Care Standard was introduced in 2021, aiming to standardize practice. However, a recent national survey revealed a lack of adherence to the Standard among emergency department clinicians. A qualitative descriptive study. The study was conducted across two Australian emergency departments in 2023. Utilizing purposive sampling, semi-structured interviews were conducted. The analysis incorporated both deductive and inductive approaches, mapping the findings to the BCW. Interviews with 25 nurses and doctors revealed nine key subthemes. The main barriers were the stressful environment, insufficient education and training, and the absence of a feedback mechanism. The main facilitators were recognition of suboptimal practice, belief in the importance of patient engagement, and the desire to improve practice. Multiple complex factors have an impact on clinicians' adherence to the Standard. The identified interventions will serve as a guide for future implementation of the Standard. The findings inform healthcare organizations of the significance of implementing strategies to enhance clinicians' acceptance of the Standard. Clinicians should consider incorporating the multifaceted interventions developed in accordance with the BCW for future implementation projects. Promoting adherence to standards opens avenues to challenge suboptimal practice and has the potential to instigate a culture shift in the fundamental skills of frontline clinicians. The study is designed and reported according to the Consolidated Criteria for Reporting Qualitative Research checklist. No patient or public contribution.

Evaluating cancer rehabilitation services: Insight from Australia and New Zealand

Background: Despite evidence supporting the benefits of rehabilitation for cancer survivors, the nature of cancer rehabilitation programs is inadequately described in Australia and New Zealand. This study provides insight into current service delivery and challenges for healthcare systems in implementation of cancer rehabilitation programs. Methods: A cross-sectional survey of directors of public and private rehabilitation services in hospital and ambulatory settings across Australia and New Zealand using the Australasian Rehabilitation Outcomes Centre (AROC) registry evaluated the current delivery of cancer rehabilitation programs, health professional workforce, core care components delivered, barriers and facilitators to service delivery, and unit/organisation-wide cancer rehabilitation activities. Descriptive statistics analyzed quantitative data, and qualitative analyses interpreted item responses. Results: Of the 300 services, 102 (34%) participants completed the survey. Most services provide non-dedicated cancer rehabilitation programs (n=63), led by rehabilitation physicians, followed by allied health. The common tumour streams referred included central nervous system (67%, n=56), haematological (59%, n=49), prostate (58%, n=48), and lung cancers (58%, n=48). Patients were frequently referred during post-treatment (87%, n=72) and treatment phases (66%, n=55). Core program components were multimodal exercises, fatigue management strategies, and management of medical complications and medications. The main barriers and facilitators toward the uptake of cancer rehabilitation programs were identified. Key activities in education, research, advocacy, and clinical practice improvement were also highlighted. Conclusions: The survey identified key barriers and facilitators for the implementation of cancer rehabilitation programs. Collaborative efforts of relevant stakeholders, clinicians, consumers, and policymakers need to address barriers to broader implementation of cancer rehabilitation services.

Barriers and facilitators to using a clinical decision support tool for the management of osteoarthritis pain in patients undergoing hemodialysis: a qualitative study

BackgroundWhile osteoarthritis is a significant issue within the hemodialysis population and contributes to reduced quality of life, pain related to osteoarthritis is poorly managed by healthcare professionals (HCPs) in hemodialysis settings due to the absence of clinical guidance applicable to this population. The purpose of this study was to explore the perceptions of HCPs on the barriers and facilitators to using a clinical decision support tool for osteoarthritis pain management in the hemodialysis setting.MethodsA qualitative descriptive study was conducted. Purposeful and snowball sampling techniques were used to recruit hemodialysis clinicians from academic and community settings across multiple Canadian provinces. One-to-one interviews were conducted with clinicians using a semi-structured, open ended interview guide informed by the Theoretical Domains Framework, a behavior change framework. A general inductive approach was applied to identify the main themes of barriers and facilitators.ResultsA total of 11 interviews were completed with 3 nephrologists, 2 nurse practitioners and 6 pharmacists. Findings revealed 6 main barriers and facilitators related to the use of the clinical decision support tool. Alignment of the tool with practice roles emerged as a key barrier and facilitator. Other barriers included challenges related to the dialysis environment, varying levels of clinician comfort with pain medications, and limited applicability of the tool due to patient factors. An important facilitator was the intrinsic motivation among clinicians to use the tool.ConclusionsMost participants across the included hemodialysis settings expressed satisfaction with the clinical decision support tool and acknowledged its overall potential for improving osteoarthritis pain management among patients on hemodialysis. Future implementation of the tool may be limited by existing roles and practices at different institutions. Increased collaboration among hemodialysis and primary care teams may promote uptake of the tool.

Barriers and facilitators to accessing oral healthcare for older people in the UK: a scoping review.

Introduction Access to dental services is a growing problem for older people in the UK. The aim of this scoping review is to identify the barriers and facilitators influencing older people's ability to access oral healthcare in the UK based on the existing literature.Methods The scoping review followed the framework proposed by Levac and colleagues (2010). Peer-reviewed literature was retrieved in April 2023 from Web of Science, Medline, PsycInfo and CINAHL for the period 1973-2023. After screening, data were extracted to identify barriers and facilitators mapped to individual, organisational and policy-level factors. The themes generated were used to identify gaps in the literature and policy recommendations.Results Overall, 27 studies fulfilled the inclusion criteria. Most studies published were from England; there was a large representation of opinion pieces. The main barriers and facilitators related to cost of services, perceptions of dentistry, availability of services and both the dental and social care workforce.Conclusion Multiple barriers exist surrounding access to dental care for older people. Various facilitators exist but not all are successful. More research needs to be carried out on older people's access to dental services in the community, particularly for the 'oldest old' and minority groups.

Barriers and Facilitators to the Use of Wearable Robots as Assistive Devices: Qualitative Study With Older Adults and Physiotherapists.

Light wearable robots have the potential to assist older adults with mobility impairments in daily life by compensating for age-related decline in lower extremity strength. Physiotherapists may be the first point of contact for older adults with these devices. The aims of this study were to explore views of older adults and physiotherapists on wearable robots as assistive devices for daily living and to identify the barriers and facilitators to their use. Six older adults (aged 72-88 years) tested a wearable robot (Myosuit) and participated in semistructured interviews. A focus group with 6 physiotherapists who had a minimum of 5 years of professional experience and specialized in geriatrics was conducted. Data were analyzed using thematic qualitative text analysis. Older adults perceived benefits and had positive use experiences, yet many saw no need to use the technology for themselves. Main barriers and facilitators to its use were the perception of usefulness, attitudes toward technology, ease of use, and environmental factors such as the support received. Physiotherapists named costs, reimbursement schemes, and complexity of the technology as limiting factors. A light wearable robot-the Myosuit-was found to be acceptable to study participants as an assistive device. Although characteristics of the technology are important, the use and acceptance by older adults heavily depend on perceived usefulness and need.

Physics-Informed Machine Learning for Battery Capacity Forecasting

Batteries, recognized as effective energy storage solutions, are considered the main facilitators of the world-wide transition towards clean and renewable energy sources. Among different types of batteries, lithium-ion (Li-ion) variants offer higher energy densities and relatively longer life spans when compared to other types. Nonetheless, a primary concern with these batteries is their lifetime. Batteries undergo various degradation mechanisms under storage and use, significantly impacting their lifespan. To this end, it is crucial to predict the degradation and lifetime of Li-ion batteries under given conditions.Researchers use three main methodologies to perform battery health diagnostics and to predict the lifetime of batteries. One approach revolves around using mechanistic, first-principle electrochemical models, also known as physics-based models. If equipped with proper thermodynamic theories, such models can show promising capabilities; however, holistic degradation prediction with these models is still challenging due to the computational complexities and the multitude of parameters that need to be fine-tuned in this approach. The other common strategy is to use empirical models to predict battery degradation. These models generally entail fewer parameters to be identified and are computationally less intensive to solve. Nonetheless, empirical models can suffer from the accuracy point-of-view as they are constrained to predict degradation trends introduced by certain degradation modes. Another common technique in battery life prediction is to utilize purely data-driven methods, such as machine learning (ML) algorithms, which also have shown promising results in the literature on rapid health predictions. However, these methods require large volumes of experimental data for training and testing ML models to ensure accuracy. In addition, data-driven methods are likely to extrapolate poorly to conditions beyond their training data and are indifferent towards the underlying degradation mechanisms. Recently, physics-informed machine learning (PI-ML) methods have garnered significant attention. They integrate physics-based or empirical models (developed based on physics) with a data-driven approach and allow one to train ML models on a smaller set of experimental data.To the best of the authors’ knowledge, the performance comparison between first-principle and empirical models when integrated within PI-ML remains unclear. Therefore, in this work, we aim to compare these two models when applied to prognostics (capacity forecasting and remaining useful life prediction) of a set of Li-ion batteries. To perform this study, we generate aging data for 40 Li-ion coin cells cycled under randomized conditions. Each cell undergoes a three-step charging stage followed by a two-step discharge stage. After obtaining the aging data, we will develop two PI-ML models, one equipped with a physics-based model and another with a set of empirical models. Both PI-ML models in this work will follow the sequential integration approach, where the training data for the final PI-ML model come from both experimental and computational data, the latter of which are obtained from the physics-based or empirical models. The parameters for the physics-based and empirical models are identified from another set of experimental data. Finally, the PI-ML models will be tested with experimental data obtained at different cycling conditions. The data flow for the sequential architecture of PI-ML is shown in the attached figure. This comparative study will help identify the performance of physics-based and empirical models when integrated into PI-ML. The main performance metric considered in this work is each model’s ability to extrapolate beyond the experimental training data set, hence aiding the final PI-ML model in generalizing to conditions not covered by its experimental training data set. Figure 1

Implementation of evidence-based practice in paediatric nursing care: Facilitators and barriers

BackgroundEvidence-based practice (EBP) is widely recognised in healthcare as a means of improving patient outcomes by incorporating patient preferences, clinical experience, and rigorous research. Although it has demonstrated potential in promoting healthcare, increasing patient safety, and reducing costs, there are still challenges in implementing and applying EBP in practice. The aim of this study was to explore the barriers and facilitators identified by nurses concerning the implementation of EBP in the care provided to children and their families. MethodsTwo focus groups were held with a total of 32 nurses from a paediatric unit of a university hospital. The qualitative data were organised using NVivo, and thematic analysis was undertaken following Bardin’s three-phase process. FindingsThree categories emerged: Facilitators for the Implementation of EBP, Barriers to the Implementation of EBP, and Family and Child-Centred Care in Clinical Practice. The main facilitators are the presence of mentors, institutional recognition, an environment that promotes EBPs, and the interest and motivation of the team. The main barriers highlighted were unassertive intradisciplinary and interdisciplinary communication, time management, tradition, and inexperience in research. Organisations must implement policies that promote environments conducive to EBP. ConclusionIt is crucial to prioritise ongoing professional development, integrate this practice into nursing education, promote innovative organisational cultures, and embrace the principles of Family-Centred Care. Nurses recognise the importance of mentors as key to implementing this practice.