Major Facilitators Research Articles

Circular Economy Practices in Biomass-Fired Power Plants in Brazil: An Assessment Using the ReSOLVE Framework

This study aimed to identify the adoption of circular economy (CE) practices at thermoelectric power plants (TPPs) fueled by forest biomass in Brazil and determine the degree of implementation; social, environmental, and economic impacts; motivations; challenges; and facilitating factors for the adoption of such practices. Data were collected through a questionnaire applied to a sample of 32 TPPs in Brazil employing the ReSOLVE framework from October 2023 to January 2024. The data were analyzed using descriptive statistics, with the assignment of scores, and principal component analysis. The results indicate that optimization practices are the most widespread (6.7) and sharing practices were the least adopted (4.0). The greatest motivators for adopting CE practices are promoting sustainability (9.5) and enhancing corporate image (9.5). One of the most relevant positive impacts of such practices is the improvement in social relations between companies and the community (9.1). A major challenge to CE adoption is government neglect, whereas certification systems constitute one of the major facilitators (with 20 indications). This study provides indicators for decision-makers in the private sector and public managers interested in promoting sustainable practices in the renewable energy industry.

Using Implementation Science in Surgical Care: A Scoping Review.

Improvement of surgical care is dependent upon evidence-based practices (EBPs), policies, procedures, and innovations. The objective of this study was to understand and synthesize the use of implementation science (IS) in surgical care. This article summarizes the existing literature to identify the frequency and types of EBPs selected for surgical care, IS frameworks that guided the published research, and prominent facilitators and barriers. A modified version of the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews Checklist were used to provide the guidance and standards to conduct this scoping review. We queried: Ovid MEDLINE; American Psychological Association PsycINFO; Embase; Cumulated Index to Nursing and Allied Health Literature; Web of Science; and Google Scholar for manuscripts published January 2001 - June 2023. The initial search found 3,674 citations of which 129 met inclusion criteria. The heterogeneity and volume of innovations within the surgical IS field were vast. The most frequent innovations were in peri-operative care, safety in surgery, and Enhanced Recovery After Surgery. Six constructs were identified as both major facilitators and barriers: support from leadership; surgeon and staff knowledge regarding EBPs; relationship/team building; environmental context; data; and resources. Identifying these implementation factors used in the surgical field enables us to determine variables that support and inhibit the adoption and implementation of new practices, support practice change, enhance quality and equity of surgical care, and identify research gaps for future IS in surgical care.

Facilitators and barriers to initiating and completing tuberculosis preventive treatment among children and adolescents living with HIV in Uganda: a qualitative study of adolescents, caretakers and health workers

IntroductionPeople living with HIV (PLHIV) have a 20-fold risk of tuberculosis (TB) disease compared to HIV-negative people. In 2021, the uptake of TB preventive treatment among the children and adolescents living with HIV at the Baylor-Uganda HIV clinic was 45%, which was below the national target of 90%. Minimal evidence documents the enablers and barriers to TB preventive treatment (TPT) initiation and completion among children and adolescents living with HIV(CALHIV). We explored the facilitators and barriers to TPT initiation and completion among CALHIV among adolescents aged 10-19years and caretakers of children below 18years.MethodsWe conducted a qualitative study from February 2022 to March 2023, at three paediatric and adolescent HIV treatment centers in Uganda. In-depth interviews were conducted at TPT initiation and after completion for purposively selected health workers, adolescents aged 10–19 years living with HIV, and caretakers of children aged below 18years.ResultsThe desire to avoid TB disease, previous TB treatment, encouragement from family members, and ministry of health policies emerged as key facilitators for the children and adolescents to initiate TPT. Barriers to TPT initiation included; TB and HIV-related stigma, busy carer and adolescent work schedules, reduced social support from parents and family, history of drug side effects, high pill burden and fatigue, and perception of not being ill. TPT completion was enabled by combined TPT and ART refill visits, delivery of ART and TPT within the community, and continuous education and counseling from health workers. Reported barriers to TPT completion included TB and HIV-related stigma, long waiting time. Non-disclosure of HIV status by caretakers to CALHIV and fear of side effects was cited by health workers as a barrier to starting TPT. Facilitators of TPT initiation and completion reported by healthcare workers included patient and caretaker health education, counselling about benefits of TPT and risk of TB disease, having same appointment for TPT and ART refill to reduce patient waiting time, adolescent-friendly services, and appointment reminder phone calls.ConclusionThe facilitators and barriers of TPT initiation and completion among CALHIV span from individual, to health system and structural factors. Health education about benefits of TPT and risk of TB, social support, adolescent-friendly services, and joint appointments for TPT and ART refill are major facilitators of TPT initiation and completion among CALHIV in Uganda.

Knowledge, attitudes, awareness and factors associated with the uptake of influenza vaccine among pregnant women in urban Pune

: This cross-sectional study was aimed to assess the knowledge, attitudes, awareness, facilitators, and barriers associated with the uptake of influenza vaccination during pregnancy in the urban area of Pune. : The study was conducted with 500 participants: 62 pregnant women and 438 postpartum women (total 524 were approached) attending Obstetrics and Gynaecology outpatient department (OPD) in a tertiary-care municipal hospital in Pune. The study-questionnaire collected data regarding socio-demographics general knowledge about influenza, attitude towards influenza vaccination, vaccine risk awareness, and its potential risk and benefits during pregnancy. The log-binomial regression models were used to examine the factors associated with influenza vaccination. : A good uptake of the vaccine (223/500, 44.6%) was found during current pregnancy of the participant; however, only 2.7% of study-participants vaccinated with influenza vaccine in their previous pregnancies. Also, there was poor awareness among all the participants regarding the safety of the seasonal influenza vaccine during pregnancy (19%, n=95/500). 11.2% (n=31/277) study-participants were found to be against the maternal influenza vaccination. Women receiving the vaccine against influenza were more likely to be previously informed of the recommendations from health-care providers about maternal influenza vaccination with odds ratio of 0.18 (95% CI, 0.04 to 0.8; p<0.00001), received the influenza vaccine in the past OR 8.27 (95% CI, 0.94 to 72.0), Z 1.09, p=0.05 and of having knowledge on influenza and its complications has more impact on influenza vaccination during pregnancy OR 14.4 (95% CI, 5.68 to 36.53), Z 5.6, p<0.0001 respectively.: This study concludes the vital causative factors for non-vaccination were provision of incomplete information or poor awareness about influenza vaccination (68.6%). There was poor knowledge among the pregnant women regarding the safety of maternal influenza vaccines. The recommendation from healthcare professionals is the major facilitators of decision-making by pregnant women for influenza vaccination during pregnancy.

Healthcare workers' experiences protecting themselves and their families during the COVID-19 pandemic in 2020-2021.

We characterized experiences and strategies used by frontline healthcare workers to prevent severe-acute-respiratory-syndrome-related coronavirus transmission at work and to household members during the coronavirus disease pandemic. Alongside an online questionnaire (n = 234), remote semi-structured interviews (n = 23: 15 clinicians, 8 non-clinicians) were conducted in 2021. Mitigation challenges and facilitators were identified from data to represent experiences as a process considering the before, during, and after work shifts. Journey mapping was utilized to visually describe how healthcare workers experienced the stages of the work environment, leaving work, commuting home, and the home environment, and strategies implemented to stay safe. Major facilitators included the uptake of coronavirus disease vaccines and testing, information regarding virus transmission, and adequate personal protective equipment. The most critical challenges identified included a lack of designated areas for end-of-day disinfection, changing rooms, showers, and lockers in the leaving work stage. Psychosocial and environmental factors must be considered in future hospital pandemic preparations.

Approaches towards pragmatic language assessment in Indian pre-schoolers: A survey among speech-language pathologists.

Pragmatic language assessment in children is performed in line with standard protocols, guidelines, and best practices. The absence of these aspects in the Indian context has resulted in the quest to explore the approaches used by speech-language pathologists (SLPs) to assess pragmatic language impairments. This survey explored the current practices of SLPs towards the assessment of pragmatic language among preschool children in India. It also aimed to identify the barriers, facilitators and identify the level of knowledge, skill and overall practice of SLPs towards their practices using self-appraisal. A total of 100 SLPs(94 females and 6 males) working with preschool aged children (three-to-six-year-olds) from across different Indian states participated in the survey. Participants were enquired about the aspects of pragmatic language assessed, methods used for assessment, awareness and use of Indian tools, the settings, members, and language used for the assessment. Additionally, they were asked to mention the specific tools used, informal methods used, barriers and facilitators, and self-appraise their knowledge, skill and overall practice. Majority of participants assessed multiple aspects of pragmatic language. All used a combination of different assessment methods, with the participants commonly using informal compared to formal approaches. Preschoolers were assessed at multiple settings, along with different communication partners. Lack of awareness on assessment tools developed in India was the major barrier, while the use of informal tasks or activities were the major facilitators influencing pragmatic language assessment to a greater extent. The knowledge and skills for the assessment of pragmatic language obtained poorer scores compared to practices. The assessment practices of the SLPs were largely influenced by the unavailability of developed or adapted tools for Indian preschoolers, leading to the need to develop indigenous assessment tools. Certain considerations for further assessment practices have been identified and discussed.

The Nigerian Dietary Screening Tool: A Step toward Improved Patient-Clinician Communication in Nigerian Hospitals: A Pilot Implementation Study.

Implementing dietary screening tools into clinical practice has been challenging, including in Nigeria. This study evaluated the impact of the Nigerian dietary screening tool (NiDST) on patient-clinician communication and barriers to and facilitators of implementation. A mixed methods approach was used to collect data from patients (n = 151) and clinicians (n = 20) from outpatient clinics in Nigeria. Patients completed the validated 25-item NiDST prior to outpatient consultations. Both patients and clinicians completed the Measurement Instrument for Determinants of Innovations (MIDI) questionnaire to assess implementation determinants post-consultation. Semi-structured interviews were conducted for in-depth feedback. The fidelity of implementation was 92% for NiDST-reported dietary discussion, with a mean completion time of <6 min and an accepted marginal increase in consultation time (<10 min). For clinicians, 25% reported time constraints and their additional nutritional knowledge as barriers, while facilitators of NiDST implementation were the clarity and completeness of the NiDST, clinical relevance and improved patient-clinician communication, as reported by all the clinicians. Over 96% of patients reported the NiDST as quick to complete, with 90.7% reporting self-reflection on dietary intake. This study demonstrated the NiDST's potential to enhance patient-clinician communication and highlighted major facilitators of implementation in clinical practice to improve dietary discussion in Nigeria.

Review of the Knowledge, Barriers, and Facilitators of HPV Vaccination among Latino Migrant and Seasonal Farmworkers in the United States.

One subgroup of Latinos whose healthcare needs must be more thoroughly addressed is the roughly three million farmworkers pursuing seasonal agricultural work within the United States (U.S.). Latino migrant and seasonal farmworkers (MSFW) face compounded political, social, and personal contexts that complicate healthcare access. Although the human papillomavirus (HPV) vaccine prevents HPV infections and cancers, uptake among Hispanic adolescents remains suboptimal. Therefore, it is important to understand Latino MSFW's HPV knowledge, as well as barriers to and facilitators of vaccination so culturally appropriate measures can bolster vaccination. An integrative review was conducted in PubMed, Scopus, and Web of Science using key search terms. Results were evaluated for compatibility with inclusion/exclusion criteria, and selected articles were coded and evaluated via thematic analysis. Six studies of various designs were ultimately included in the review. While some Latino MSFW have baseline knowledge about HPV and the vaccine, knowledge gaps remain. Participants expressed curiosity about how the vaccine works, contents, side effects, dosing, recommended age, and information about prevented diseases. Although additional education and MSFW's receptiveness to provider's recommendations were cited as major facilitators, many barriers also need addressed. Providers must leverage MSFW's existing knowledge, provide education, and facilitate vaccination to protect farmworker families from HPV and related cancers. It must become standard practice for providers to recommend the HPV vaccine to MSFW, who are receptive to this conversation. Increasing vaccination can decrease the disproportionate burden of HPV-related cancers on patients and facilitate access to healthcare services.

Defying the odds: Facilitating integration of abortion care into clinical practice in the United States

ObjectivesWe sought to describe the experiences of physicians who successfully incorporated abortion care into their practices in the United States. We explored facilitators of and barriers to abortion provision. Study designIn this qualitative study, we conducted semistructured interviews with a national sample of obstetrician–gynecologists and family medicine physicians providing abortion care. Interviews addressed facilitators of and barriers to abortion provision, lessons learned and recommendations for future providers. We analyzed data using a content analysis approach. ResultsWe interviewed 14 obstetrician–gynecologists and 11 family medicine physicians providing abortion care as part of their practices. We identified four categories of facilitators and barriers: personal, community, training, and workplace factors. Major facilitators included supportive leadership and professional mentorship. Major barriers included antagonistic colleagues and leadership. Lessons learned included proactively assessing leadership support, identifying institutional allies, actively minimizing workplace conflict and being perceived as a team player. Recommended resources to increase abortion provision included clinical support, mentorship, funding, negotiation coaching, and access to clinical policies. ConclusionsInstitutional leadership support emerged as a critical facilitator for initiating and continuing to offer abortion care. Efforts to expand abortion access should include investments in supportive leadership, both in academic and community practices. ImplicationsMaximizing abortion access is essential to counteract the legislative and political restrictions imposed on abortion care. Institutional support is a critical facilitator of abortion provision, and efforts to expand abortion access should include investments in supportive leadership and health care administration.

Sustainable Implementation of Physician-Pharmacist Collaborative Clinics for Diabetes Management in Primary Healthcare Centers: A Qualitative Study

BackgroundAlthough physician-pharmacist collaborative clinics for diabetes management have been shown to be effective and cost-effective worldwide, there is limited understanding of the factors that influence their sustainable implementation. This study aims to identify the associated factors and provide sustainability strategy to better implement physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers in China.MethodsA sample of 43 participants were participated in face-to-face, in-depth, semi-structured interviews. Consolidated Framework for Implementation Research was used to identify facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers, and to explore discriminating factors between low and high implementation units. A sustainable strategy repository based on dynamic sustainability framework was established to inform further implementation.ResultsThis study demonstrated that clear recognition of intervention benefits, urgent needs of patients, adaptive and tailored plan, highly collaborative teamwork and leadership support were the major facilitators, while the major barriers included process complexity, large number and poor health literacy of patients in primary areas, inappropriate staffing arrangements, weak financial incentives and inadequate staff competencies. Six constructs were identified to distinguish between high and low implementation units. Sixteen strategies were developed to foster the implementation of physician-pharmacist collaborative clinics, targeting Intervention, Practice setting, and Ecological system.ConclusionThis qualitative study demonstrated facilitators and barriers to implementing physician-pharmacist collaborative clinics for diabetes management in primary healthcare centers and developed theory-based strategies for further promotion, which has the potential to improve the management of diabetes and other chronic diseases in under-resourced areas.

An empirical assessment of seaports as facilitators of FOC-flagged transshipment landings

Transshipment is one of the most common activities occurring between carriers and fishing vessels to exchange fish, as well as fuel, crew, and gear at sea or at port. While transshipment reduces the need for the fishing vessels to visit ports to offload their catches, thus increasing their efficiency, research has shown that this activity is also one of the major facilitators of IUU fishing. Research on transshipments is limited, and the few studies that are available on the subject focus on identifying hotspots of transshipment, and networks of actors involved. No study to date has examined the role ports play in facilitating transshipment activities, nor are there any studies that examine whether ports that are affiliated with China (the country with the highest IUU Fishing Index Score and 38% of the global share of distant-water fleets) are more likely to experience disproportionately higher volumes of FOC-flagged carrier vessel visits. Therefore, using the carrier vessel portal database from Global Fishing Watch, which contains information on the origin and destination ports of the carrier vessels involved in transshipment activities between 2015 and 2022, this research aims to (a) understand hot spots of FOC-flagged carrier vessel activity in the high seas and where such vessels offload their catches around the world; and (b) empirically test the characteristics of the ports (and the countries where these ports are located) used by these vessels to offload their catches. Findings suggest that ports that experience higher volumes of fishing vessel traffic, are in close proximity to high-seas transshipment activities involving FOC-flagged carriers, are designated ports of entry for foreign vessels, are Chinese-affiliated, as well as have low monitoring, control, and surveillance capacity are significantly more likely to be visited by FOC-flagged high-risk carrier vessels. This research proposes policy recommendations deriving from the findings of this research.

Examining the Use and Application of the WHO Integrated People-Centred Health Services Framework in Research Globally - a Systematic Scoping Review.

The World Health Organisation (WHO) accepted the Integrated People-centred Health Services (IPCHS) framework in 2016 as an essential component for achieving universal health coverage in fragmented health systems. We aimed to examine the empirical applications of the WHO IPCHS framework to guide its use in strengthening health-service research. Academic databases and the IPCHS website were searched for relevant articles published between 2016 and July 2023. Two reviewers independently screened and extracted data on the study design, setting, IPCHS framework components, and facilitators and barriers to implementing the IPCHS strategies. Descriptive and content analyses were conducted. Six studies were identified using the IPCHS framework. Studies have examined a combination of the five IPCHS strategies. All studies reported building strong primary care-based systems and coordinating care for individuals. Continued relationships and trust, co-production of health programmes, diversity of health care team, and technology were major facilitators, while low health literacy, lack of primary setting capacity and healthcare workforce were principal barriers to IPCHS implementation. This scoping review offers an overview of IPCHS strategies employed in healthcare research. Generally, the IPCHS framework remains underutilised in primary research. These results offer guidance for future research to support effective healthcare delivery.

IJCM_204A: A qualitative research to identify the barriers and facilitating factors in the utilization of healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi District

Background: Udupi district hosts two major Particularly Vulnerable Tribal Groups (PVTG) namely Malaikudiya and Koraga. Koraga tribes are declining in number and deprived of availability of healthcare services and accessibility to healthcare facilities. There are a lot of barriers such as lack of awareness and social stigma amalgamate the existing conditions of Koraga tribes in Udupi district. Research studies pertaining to this problem has been seldom done. Objective: We aim to explore the barriers and facilitating factors in accessing healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi district. Methodology: We conducted qualitative research through 8 in-depth interviews with AMOs from PHC and CHC, ITDP staff and NGO workers, and 3 focus group discussions with community health nurses, ASHA workers, and Koraga community leaders from Udupi district. We explored the major facilitators and barriers that influence the utilization of health care services by the PVTG. Results: On the beneficiaries’ point of view, lack of awareness, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, lack of infrastructure, unwelcoming neighbourhood approaches, and economic instability were the main barriers to utilizing healthcare facilities. On the stakeholders (providers) point of view, availability of healthcare facilities, government policies and schemes and NGO activities are the facilitating factors. Conclusion: Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the PVTG members’ socio- economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that there are a number of barriers which lessens the effectiveness of the programs to enhance the utilization of healthcare facilities by the PVTG in the study area.

Health professionals' experience on District Health Information System (DHIS2) and its utilization at local levels in Gandaki province, Nepal: A qualitative study.

DHIS2 is a web-based platform primarily used in developing countries, ensuring reliable data and aiding decentralized decision-making. The Ministry of Health and Population has greatly emphasized using DHIS2 for data entry and reporting. However, studies regarding health workers' experiences on DHIS2 and the utilization of data at the local level remain limited. Therefore, this study aims to investigate the usage and practical experience of DHIS2 at the local levels of Gandaki province, Nepal. An exploratory qualitative study was conducted in the Gandaki province from February to August 2023. We conducted twenty in-depth interviews among the DHIS2 users at local levels, health posts, and provincial health directorate using in-depth interview guidelines. The study participants were selected purposively. Thematic analysis was conducted to analyze the data, and NVivo was used to facilitate data analysis. Health professionals demonstrated dedication and commitment to use DHIS2 for reporting. DHIS2 has facilitated timely reporting, data storage, data analysis and visualization, feedback and communication mechanisms, and service delivery. Users' self-motivation and support from the local and provincial levels and regular review and program-specific review meetings were major facilitators for DHIS2 use. Similarly, technical issues, poor internet connectivity, power outages, and inexperienced health professionals were the significant challenges to using DHIS2. The basic and refresher training needed improvement at all levels, and learning materials were unavailable in health facilities. In addition, the data utilization at the local level in various actions was unsatisfactory despite sufficient data. Health professionals have been facilitated by DHIS2 in various actions. Capacity building of health professionals on data analysis and interpretations, continued onsite coaching, reliable internet connectivity, availability of learning materials, and improved server capacity are needed to enhance the performance of DHIS2 at the local level.

Barriers and facilitators of severe acute malnutrition management at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, North West Ethiopia, descriptive phenomenological study.

Malnutrition is a clinical condition that affects all age groups, and it remains a major public health threat in Sub-Saharan Africa. As a result, this research aimed to investigate the barriers and facilitators of treating severe acute malnutrition at Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar City, North West Ethiopia. A descriptive phenomenological study was conducted from February to April 2021. The final sample size taken was fifteen based on data saturation. In-depth and key informant interviews were conducted with nine caregivers, three healthcare workers, and three healthcare managers supported by observation. A criterion-based, heterogeneous purposive sampling technique was used to select the study participants. Each interview was audio-taped to ensure data quality. Thematic analysis was done to analyze the data using Atlas. ti version 7 software. Two major themes and six sub-themes emerged. Barriers related to severe acute malnutrition management include subthemes on socio-economic and socio-cultural conditions, perceived causes of severe acute malnutrition and its management, and the healthcare context. Facilitators of severe acute malnutrition management include severe acute malnutrition identification, service delivery, and being a member of community-based health insurance. Effective management of severe acute malnutrition was affected by a multiplicity of factors. The results reaffirm how socioeconomic and sociocultural conditions, perceived causes of severe acute malnutrition (SAM) and its management and the health care context were the major barriers, while able to identifying severe acute malnutrition, service delivery, and is a member of community-based health insurance were the major facilitators for SAM management. Therefore, special attention shall be given to SAM management.

Exploring Facilitators and Barriers to Physical Activity for Families of Rural Preschoolers Participating in a Motor Skill Program.

While schools provide one opportunity to encourage physical activity, caregivers play an exceedingly important role in creating an environment conducive to preschool children's physical activity. Yet, little is known regarding the perceptions of caregivers, important choice agents for young children's physical activity behavior after participating in a motor skill program. The purpose of this study was to examine caregivers' perceptions of facilitators and barriers to children's physical activity at home among rural, low-income families who participated in a school-based early childhood physical activity program, SKIPping with PALS, designed to increase physical activity and improve motor development. Eleven caregivers consented to participate in a semi-structured interview regarding their perceptions of physical activity and their experience after six months of participation in the program. An inductive, naturalistic evaluation approach was utilized for qualitative data analysis, following the six recursive phases of thematic analysis. A review of the interview transcripts revealed that all caregivers valued physical activity and encouraged their children to be active. Four major facilitators, four major barriers, and an overarching theme of parental support for childhood physical activity were identified. These factors are largely circumstantial and attitudinal and, thus, are difficult to modify but are important to be cognizant of when designing interventions.

Exploring therapeutic communication in managing chronic non-communicable diseases: a mixed-method study in Ghana

BackgroundGlobally, the burden of chronic non-communicable diseases is increasing rapidly and approximately one in three of all adults suffer from multiple chronic conditions. Therapeutic communication plays a crucial role in achieving curative, preventive, and promotive goals regarding chronic disease management. We examined therapeutic communication between health professionals and patients with chronic non-communicable diseases at the Ho Teaching Hospital.MethodsWe adopted a concurrent mixed-methods approach. The quantitative aspect of the study was descriptive while the qualitative was explanatory. The quantitative study was conducted among 250 patients. The qualitative data was collected among eight health professionals. A stratified sampling and simple random sampling methods were used to recruit patients for the quantitative survey while purposive and convenient sampling was used for the qualitative aspect of the study. The quantitative data was collected using a semi-structured questionnaire while the qualitative data was collected using an in-depth interview guide. The quantitative data were analyzed using STATA v17 and the qualitative data were analyzed thematically using Atlas ti. The major themes that emerged were, therapeutic communication practices, barriers to therapeutic communication and possible solutions to good therapeutic communication.ResultsWe found that 37% patients were 60 years and above with 53.2% being females. It was noted that 36.4% of patients have had tertiary-level education. We found that 59.2% of patients reported having good therapeutic communication with health professionals. We, however, noted that male participants were 92% less likely to practice good therapeutic communication compared with females (aOR = 0.92,95% Cl = 0.46–1.84). Health professionals’ activities to ensure good therapeutic practices included their capacity to listen, build rapport with their patients, and clarify information. We found that the major facilitators of good therapeutic communication included trust in the health professionals (90.4%), conducive environment (93.2%), using simple and plain language by health professionals (92.0%) We found that there are myriad of barriers that impede communication process. This included language, health professionals’ inability to break terminologies, and the unconscious state of patients.ConclusionsThe study revealed that there was good therapeutic communication between health professionals and patients with CNCDs. Nevertheless, it was also identified that ineffective therapeutic communication between health professionals and their patients due to barriers like language could lead to dissatisfaction with care, misdiagnosis, and noncompliance to treatment regimen. For Ghana as a country to achieve SDG target 3.4 by reducing mortality due to NCDs and improve wellbeing of patients by 2030, it will be imperative on Ghana Health Service to design communication strategy training for health professionals that could help improve therapeutic communication between patients and health professionals.

Effects of integrating motivational instructional strategies into a process-genre writing instructional approach on students’ engagement and argumentative writing

This study advances the strand of research on motivational instructional strategies, the process-genre writing instructional approach, as well as student engagement and writing achievements. To this end, motivational writing instructional strategies were integrated into the process-genre argumentative writing instructional approach and the impacts on students' writing engagement and achievements were assessed at a university in China. Quantitative data were gathered from 142 undergraduate students employing a pretest-posttest control group design. Additionally, self-report data regarding students' writing engagement and perceptions were collected from experimental groups to examine the contribution of students' perceptions of the motivational process-genre writing instructional approach to their engagement. Moreover, focus-group data were gathered from four highly-engaged and high-achieving students to identify the factors facilitating their engagement. The results showed that the experimental groups wrote significantly better argumentative essays than did the control group, and regression analyses indicated that motivational instructional strategies contributed to students' engagement significantly. Further, the thematic analysis of focus group data suggested that the three major facilitators of students’ engagement were collaborative motivational writing learning strategies, competence-boosting experiences, and active participation in creating learning opportunities. These findings show the paramount significance of incorporating the motivational strategies into the process-genre writing instructional approach. Other pedagogical implications and recommendations for further research are also discussed.

Validation of the Comprehensive ICF Core Set for Multiple Sclerosis: A Turkish clinical perspective.

The aim of this study was to evaluate the results of the construct validity of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Multiple Sclerosis (MS) and to identify the impact of MS on specific health domains according to the ICF categories in Turkish individuals. Between December 2011 and December 2012, a total of 150 individuals with MS (69 males, 81 females; mean age: 39.8±8.0 years; range, 19 to 52 years) who were diagnosed by a neurologist at least six months previously were included. The Comprehensive ICF Core Set for MS was used to assess functioning, disability, and environmental factors in all participants. The Spearman correlation coefficient was used to determine construct validity of the ICF Core Set between the ICF components and disease-specific and general measurements. The most frequently coded impairments in the body functions component were b280 sensation of pain, b134 sleep functions, b1301 motivations, and b740 muscle endurance functions. The most frequently coded impairments in the body structures component were s110 structure of brain, s120 spinal cord and related structures and s750 structure of lower extremity. A significant problem was documented in 47 of the 53 categories of the activities and participation. Of the 38 categories in the environmental factors, 23 were identified as a facilitator, while 12 categories were identified as a barrier. All body function, structure, activities and participation and environmental factors categories showed a significant correlation with disease-specific and generic measures. Based on these results, the ICF Core Set may help to determine major facilitators or barriers to functioning and disability and a targeted rehabilitation approach in patients with MS.

Integrating clinical pharmacists into transitions of care: A qualitative study of barriers and facilitators among federally qualified health centers

AbstractBackgroundComprehensive medication management (CMM) is a service provided by clinical pharmacists. CMM aims to optimize pharmacotherapy outcomes by ensuring patients' medications are indicated, effective, safe, and patients are able to adhere to the prescribed medication regimen and take the medications as intended. The goal of CMM is to optimize patients' medications to ensure they are meeting their medication and health‐related goals.ObjectiveThe objective of this project is to evaluate facilitators and barriers to integrating CMM during transitions of care (ToC) at Federally Qualified Health Centers (FQHCs).DesignSemistructured qualitative interviews were conducted with 22 key informants identified through purposive sampling at three FQHCs. Interviews were coded and analyzed deductively using a modified Consolidated Framework for Implementation Research (CFIR) adapted for ToC.Key ResultsThirty‐nine codes were identified across all CFIR constructs, including the addition of a new construct, “Patient characteristics.” Major facilitators included the perceived advantage and feasibility of the intervention, standardization of ToC processes, and organizational buy‐in. Major barriers included health information technology system limitations, communication barriers with discharge facilities, technical and staffing challenges in applying criteria to identify patients for CMM, and low patient throughput.ConclusionsIdentifying early‐stage barriers and facilitators are key to maximize facilitators and address barriers to support successful implementation. The findings of this work are being used to guide project adaptations to better integrate CMM into the ToC processes.