Organizational Barriers Research Articles

Recommended summary plan for emergency care and treatment: ReSPECT a mixed-methods study

Background Do not attempt cardiopulmonary resuscitation decisions have been widely criticised. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process was developed to facilitate shared decisions between patients and clinicians in relation to emergency treatments, including cardiopulmonary resuscitation. Objective To explore how, when and why ReSPECT plans are made and what effects the plans have on patient outcomes. Design A mixed-methods evaluation, comprising (1) a qualitative study of ReSPECT decision-making processes, (2) an interrupted time series examining process and survival outcomes following in-hospital cardiac arrest and (3) a retrospective observational study examining factors associated with ReSPECT recommendations and patient outcomes. Setting NHS acute hospitals and primary care and community services in England (2017–2020). Participants Hospital doctors, general practitioners, nurses, patients and families. Data sources The following sources were used: (1) observations of ReSPECT conversations at six hospitals and conversations with clinicians, patient, families and general practitioners, (2) survey and freedom of information data from hospitals participating in the National Cardiac Arrest Audit and (3) a review of inpatient medical records, ReSPECT forms and NHS Safety Thermometer data. Results By December 2019, the ReSPECT process was being used in 40 of 186 (22%) acute hospitals. In total, 792 of 3439 (23%) inpatients, usually those identified at risk of deterioration, had a ReSPECT form. Involvement of the patient and/or family was recorded on 513 of 706 (73%) ReSPECT forms reviewed. Clinicians said that lack of time prevented more conversations. Observed conversations focused on resuscitation, but also included other treatments and the patient’s values and preferences. Conversation types included open-ended conversations, with clinicians actively eliciting the patients’ wishes and preferences, a persuasive approach, swaying the conversation towards a decision aligned with medical opinion, and simply informing the patient/relative about a medical decision that had already been made. The frequency of harms reported on the NHS Safety Thermometer was similar among patients with or without a ReSPECT form. Hospital doctors and general practitioners gave different views on the purpose of the ReSPECT process and the type of recommendations they would record. Limitations The research was undertaken within the first 2 years following the implementation of ReSPECT. Local policies meant that doctors led these conversations. Most patients were seriously ill, which limited opportunities for interviews. Incomplete adoption of the ReSPECT process and problems associated with the NHS Safety Thermometer tool affected the evaluation on clinical outcomes. Conclusions Patients and families were involved in most ReSPECT conversations. Conversations focused on resuscitation, but also included other emergency treatments. Respect for patient autonomy and duty to protect from harm informed clinicians’ approach to varying degrees, depending on the clinical situation and their views of ReSPECT as a shared decision-making process. The complexity of these conversations and the clinical, emotional and organisational barriers observed suggest that a nuanced and multifaceted approach will be necessary to support good ReSPECT processes. Future work Further research is needed to understand the advantages and disadvantages to the adoption of a national emergency care and treatment plan system, the most effective national and local implementation approaches, and whether or not shared decision-making approaches in the context of emergency care and treatment plans could further enhance patient and family engagement. Study registration This study is registered as ISRCTN11112933. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 40. See the NIHR Journals Library website for further project information.

Barriers and facilitators to pharmacy professionals’ specialist public health roles: a mixed methods UK-wide pharmaceutical public health evidence review

Abstract Introduction Pharmaceutical Public Health (PPH) is defined as “the application of pharmaceutical knowledge, skills and resources to the science and art of preventing disease, prolonging life, promoting, protecting and improving health for all through organised efforts of society”.1 In the UK (and globally) pharmacy professionals (PPs) contribute to the delivery of local and national public/population health (PH) interventions.2,3 However, little is known to what extent PPs have specialist/advanced roles within PH practice. Aim The mixed methods review, commissioned by the UK Chief Pharmaceutical Officers in 2020, aimed to explore PPs’ specialist PH contributions including barriers and opportunities. Methods Databases available through PubMed were searched to retrieve articles published in English (2011- 2021) on seven topics including: emergency preparedness resilience and response (EPRR); integrating pharmacy to better support public health protection and improvement goals; public health skills and mitigating health inequalities. Two independent electronic surveys were developed, piloted and deployed for pharmacy and public health specialists via email cascade and social media. The surveys explored the extent to which PPs are involved in PH roles including the barriers and opportunities. Descriptive statistics summarised the data, and open-ended responses were themed. The NHS Health Research Authority tool identified this project did not require ethical approval as the surveys were service evaluation. Results Rapid Evidence reviews: Following assessment of 2,542 articles, 448 evidence statements were extracted from 135 relevant articles. They were predominantly from USA (39%) and UK (29%), with fewer high-quality reviews (17) or guidance (12), than moderate/low-quality reviews (42), single studies (33), or quantitative research (33). Common themes of PPs’ contributions included: surveillance and intelligence gathering; advocacy for their communities; signposting; delivery of health improvement and protection services; supporting people with long-term-conditions; and EPRR. Barriers identified included: limited public and professional awareness of pharmacy’s contribution to public health and under-resourced PH training. Pharmacy and PH professionals Surveys: There were UK-wide responses from 128 PPs and 37 PH specialists. Opportunities identified by PPs included: PH areas they directly contribute to (45%); qualifications, knowledge and skills (27%); strategic position in the community (19%), recent changing health landscape (4%). Barriers included lack of defined career pathway (20%); poor professional recognition (18%); limited resources (16%); lack of training and support (15%) and organisational and structural barriers (10%). PH specialists identified at least 12 areas from the Faculty of PH’s functions and standards, they believed additional benefits would be realised by PPs working directly within PH teams. Although only 40% PH specialists had PPs working within their teams, 83% stated that it would be beneficial or very beneficial to have PPs specialising in PH. Discussion/Conclusion Dedicated PPH training and system-wide leadership are required to fully realise population-level benefits. Low responses to the surveys present a study limitation, however, there was consensus from the themes emerging from both surveys and rapid evidence reviews findings. Pharmacy professionals make specialist contributions to PH despite barriers. Further investigation is required to identify how best to deploy advanced PPH resources. Future qualitative studies should be considered.

Assessment of symmetries and asymmetries on barriers to circular economy adoption in the construction industry towards zero waste: A survey of international experts

This study evaluates simultaneously the symmetries and asymmetries on the classification of barriers to circular economy (CE) adoption in the building construction industry (BCI) of developing and developed economies. This is crucial because the vagueness of the impacts of CE barriers in extant studies affects encyclopaedic and specific CE policy formulation. Consequently, feedbacks from 140 CE experts across 39 developing and developed economies were analysed. Fuzzy synthetic evaluation (FSE) method was deployed to objectively determine the significant impacts of the barriers, whereas the Mann-Whitney U test was applied to identify significant differences in experts' opinions between the two economies. The FSE results indicated that organizational, information technology, and infrastructure and logistics barriers are the most critical to global CE adoption. The Mann-Whitney U test reveals a significant difference in the experts’ perspectives between developing and developed economies on regulatory, information technology, and economic and market barriers. Therefore, they are perceived as specific barriers as they impact CE adoption in BCI differently across the two economies. However, infrastructure and logistics, and organizational barriers are classified as general barriers. The findings of this study underscored the contextuality of barriers to CE adoption in BCI and demonstrated the need for generic and specific policy development. Also, the significance indices of the classification of the barriers using FSE method serve as an allocative function that will help policymakers and stakeholders allocate requisite resources to the most profound barriers towards achieving global systemic circularity and zero construction waste.

Supply Chain Link Prediction on Uncertain Knowledge Graph

With manufacturing companies outsourcing to each other, multi-echelon supply chain networks emerge in which risks can propagate over multiple entities. Considerable structural and organizational barriers hamper obtaining the supply chain visibility that would be required for a company to monitor and mitigate these risks. Our work proposes to combine the automated extraction of supply chain relations from web data using NLP with augmenting the results using link prediction. For this, the first graph neural network based approach to model uncertainty in supply chain knowledge graph reasoning is shown. We illustrate our approach on a novel dataset and manage to improve the state-of-the-art performance by 60% in uncertainty link prediction. Generated confidence scores support real-world decision-making.

Russian and foreign students’ involvement in the educational process in the context of the digital distance educational technologies use in the Russian universities

In the context of global changes in the world socio-economic system, the formation of an international educational research space, in the technological platform of the education system, the widespread use of distance learning technologies it is extremely relevant to conduct a comparative analysis of the involvement of Russian and foreign students in the educational process in Russian universities. The article provides the results of an electronic questionnaire survey of 760 foreign and 2,280 Russian students at universities located in 38 regions of the Russian Federation in all federal districts. Russian and foreign students assessed their level of involvement in the educational process in distance and face-to-face learning according to the parameters of four types of involvement: emotional (affective), behavioral, cognitive and academic. Involvement in the educational process during the distance learning decreases among all students, while for foreign students it is to a greater extent than for Russian students, which is due to the linguistic, cultural, mental characteristics of this category of students. Organizational, technical, psychological and emotional barriers were identified as problems that reduce the involvement in the educational process in the distance learning format of Russian and foreign students.

Outcomes management practices in tiered school-based speech-language therapy: A Canadian example.

Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended. What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.

Healthcare providers’ and policymakers’ experiences and perspectives on barriers and facilitators to chronic disease self-management for people living with hypertension and diabetes in Cameroon

BackgroundHypertension and diabetes are chronic noncommunicable diseases ranked among the leading causes of morbidity and mortality in resource-limited settings. Interventions based on patient empowerment (PE) have been shown to be effective in the management of these diseases by improving a variety of important health outcomes. This study aims to examine from the healthcare providers’ and policymakers’ experiences and perspectives, the facilitators and barriers in the management of hypertension and diabetes for patient empowerment to achieve better health outcomes in the context of the healthcare system in Cameroon.MethodsWe carried out a qualitative study involving three levels of embedded analysis in a public primary healthcare delivery system in Cameroon, through 22 semi-structural interviews with healthcare providers and policymakers and 36 observations of physicians’ consultations. We combined thematic and lexicometric analyses to identify robust patterns of differences and similarities in the experiences and perspectives of healthcare providers and policymakers about direct and indirect factors associated with patients’ self-management of disease.ResultsWe identified 89 barriers and 42 facilitators at the central, organizational, and individual levels; they were preponderant at the organizational level. Factors identified by healthcare providers mainly related to self-management of the disease at the organizational and individual levels, whereas policymakers reported factors chiefly at the central and organizational levels. Healthcare providers involved in the decision-making process for the delivery of healthcare tended to have a sense of ownership and responsibility over what they were doing to help patients develop self-management abilities to control their disease.ConclusionWhile interventions focused on improving patient-level factors are essential to PE, there is a need for interventions paying more attention to organizational and political barriers to PE than so far. Interventions targeting simultaneously these multilevel factors may be more effective than single-level interventions.

Multidisciplinary team healthcare professionals' perceptions of current and optimal acute rehabilitation, a hip fracture example A UK qualitative interview study informed by the Theoretical Domains Framework.

To understand multidisciplinary team healthcare professionals' perceptions of current and optimal provision of acute rehabilitation, perceived facilitators and barriers to implementation, and their implications for patient recovery, using hip fracture as an example. A qualitative design was adopted using semi-structured telephone interviews with 20 members of the acute multidisciplinary healthcare team (occupational therapists, physiotherapists, physicians, nurses) working on orthopaedic wards at 15 different hospitals across the UK. Interviews were audio-recorded, transcribed verbatim, anonymised, and then thematically analysed drawing on the Theoretical Domains Framework to enhance our understanding of the findings. We identified four themes: conceptualising a model of rehabilitative practice, which reflected the perceived variability of rehabilitation models, along with facilitators and common patient and organisational barriers for optimal rehabilitation; competing professional and organisational goals, which highlighted the reported incompatibility between organisational goals and person-centred care shaping rehabilitation practices, particularly for more vulnerable patients; engaging teams in collaborative practice, which related to the expressed need to work well with all members of the multidisciplinary team to achieve the same person-centred goals and share rehabilitation practices; and engaging patients and their carers, highlighting the importance of their involvement to achieve a holistic and collaborative approach to rehabilitation in the acute setting. Barriers and facilitators within themes were underpinned by the lack or presence of adequate ways of communicating with patients, carers, and multidisciplinary team members; resources (e.g. equipment, staffing, group classes), and support from people in leadership positions such as management and senior staff. Cornerstones of optimal acute rehabilitation are effective communication and collaborative practices between the multidisciplinary team, patients and carers. Supportive management and leadership are central to optimise these processes. Organisational constraints are the most commonly perceived barrier to delivering effective rehabilitation in hospital settings, which exacerbate silo working and limited patient engagement.

The “Boys’ Club”, sexual harassment, and discriminatory resourcing: An exploration of the barriers faced by women sport officials in Australian basketball

Sport official's experience of abuse in their role is well documented, but the additional gendered barriers that women officials face are not. This study used Concept Mapping to explore the most important and frequent barriers that women referees and officials in Australian basketball face. Results were analyzed according to the Socio-Ecological Framework with a feminist lens, which demonstrated the complexity and interconnectedness of barriers between different levels. While participants were not specifically asked about gendered experiences, the results indicated that barriers were overwhelmingly gendered at every level, including discriminatory resourcing, lack of senior women, and concerningly, incidents of sexual harassment. This research sheds new light on the experience of women officials and the organizational and societal barriers that limit their careers and make their workplace unsafe. Finally, it discusses where the locus of responsibility lies in addressing these issues for women sport officials, placing emphasis on the role of organizations.

ORGANIZATIONAL COMMUNICATION AUDIT OF CLEAN INDONESIA GENBI PROGRAM IN NORTH SUMATERA REGION

The purpose of this study is to find out whether the new Indonesian Generation (GenBI) in North Sumatera Province already has an organizational communication barrier in the implementation of the Clean Indonesia Program which is carried out simultaneously by GenBI throughout Indonesia. The theory used in this research is Organizational Communication Theory proposed by Pace and Faules. The object studied in this research is the Clean Indonesia GenBI Program for the North Sumatera Region. The Method used in this study is the qualitative method. The results show that GenBI has implemented an organizational communication model, although there are still many obstacles.

“International humanitarian organizations’ perspectives on localization efforts”

The humanitarian sector has formulated a collective strategic intent to localize. This involves delegating responsibilities and transferring capacities and resources to national and local actors. However, progress is slower than expected. Strategy execution is hard, and translating a general strategic intent to the actual way humanitarian organizations operate is not obvious. To suggest remedies for the slow progress, this paper investigates drivers and barriers for international humanitarian organizations (IHOs) to localize their logistics preparedness capacities. It is essential to understand IHOs' perspectives as they are global and powerful actors in the humanitarian sector and by far represent the largest recipients of donor funds. We focus on logistics since it constitutes key activities of strong local contextual character, such as procurement, warehousing, and transport. By interviewing practitioners from a representative set of large IHOs, and connecting the empirical insights with relevant theory, we unravel reasons that hinder localization. These include IHOs' strategic choices due to context-sensitive benefits of localization, mandated expectations on IHOs, the lack of internal drivers for IHOs to localize, and resistance to localize due to IHOs’ desire and motives for continued engagement in humanitarian aid. Based on these insights, actionable propositions are developed to help accelerate progress toward localization.

Conceptual and organizationalbarriers to quantitative systems pharmacology modeling of pathophysiological systemic drug hypotheses.

Conceptual and organizationalbarriers to quantitative systems pharmacology modeling of pathophysiological systemic drug hypotheses.

Influence of Palliative Care Qualifications on the Job Stress Factors of General Practitioners in Palliative Care: A Survey Study.

Due to demographic change, the number of patients in palliative care (PC) is increasing. General Practitioners (GPs) are important PC providers who often have known their patients for a long time. PC can be demanding for GPs. However, there are few studies on the job stress factors of GPs performing PC and the potential influence of their PC training. To get more insights, a postal survey was performed with GPs in North Rhine, Germany. The questionnaire was based on a literature search, qualitative pre-studies, and the Hospital Consultants' Job Stress & Satisfaction Questionnaire (HCJSSQ). Participants state that a high level of responsibility, conflicting demands, and bureaucracy are the most important stressors they experienced in PC. The influence of PC qualification level on their perceived job stress factors is low. Only advanced but not specialist qualification shows a correlation with renumeration-related stress. Gender and work experience are more dominant influences. In our study, female GPs and physicians with more work experience tend to be more stressed. In conclusion, organisational barriers, such as administration, should be reduced and renumeration should be increased to facilitate the daily work of GPs.

Developing A Framework of Effective Risk Communication for Crisis Management in The Abu Dhabi Police Department

chapter one provides a clear outline of different engaging steps in current research. This chapter includes the background of the study, research objectives, problem statements, and operational definitions used in the research study. This chapter gives a comprehensive study of how the research is going to be conducted and it will engage the reader to move to the next chapter. chapter two has reviewed the previous literature on the importance of effective communication in crisis management. Also, the communication approach is used to deal with crises. Next, reviewed Important Constructs in Effective Communication for the team. The theoretical review looks at attribution, situational and image repair theory. The empirical review has considered the objectives of the study. On the role of channels of communication in crisis management, the study has considered a review of literature in the role of traditional and social media during crisis management. Considering barriers to effective communication in crisis management, the literature review considers technological, organizational, and social barriers to effective communication in crisis management. The last objective presents a new model that should be considered by organizations for effective communication in crisis management. From the review of the literature, no research has already been done on the role of effective communication during crisis management specifically. This creates a research gap that needs to be considered. Therefore, there is a need for this research study to identify the importance of effective communication during crisis management in the Police Department of Abu Dhabi. The methodology chapter has provided a clear breakdown of various steps in which the researcher engages in conducting the interview. The aspects of sampling, data collection methods, research design, data analysis, instruments, and ethical considerations have been well discussed in this chapter.

Lessons and Implementation Challenges of Community Health Information System in LMICs: A Scoping Review of Literature.

Accurate and timely information on health intervention coverage, quality, and equity is the foundation of public health practice. To achieve this, countries have made efforts to improve the quality and availability of community health data by implementing the community health information system that is used to collect data in the field generated by community health workers and other community-facing providers. Despite all the efforts, evidence on the current state is scant in Low Middle Income Countries (LMICs). To summarize the available evidence on the current implementation status, lessons learned and implementation challenges of community health information system (CHIS) in LMICs. We conducted a scoping review that included studies searched using electronic databases like Pubmed/Medline, World Health Organization (WHO) Library, Science Direct, Cochrane Library. We also searched Google and Google Scholar using different combinations of search strategies. Studies that applied any study design, data collection and analysis methods related to CHIS were included. The review included all studies published until February 30, 2022. Two authors extracted the data and resolved disagreements by discussion consulting a third author. A total of 1,552 potentially relevant articles/reports were generated from the initial search, of which 21 were considered for the final review. The review found that CHIS is implemented in various structures using various tools across different LMICs. For the CHIS implementation majority used registers, family folder/card, mobile technologies and chalk/white board. Community level information was fragmented, incomplete and in most cases flowed only one way, with a bottom-up approach. The review also indicated that, technology particularly Electronic Community Health Information System (eCHIS) and mobile applications plays a role in strengthening CHIS implementation in most LMICs. Many challenges remain for effective implementation of CHIS with unintegrated systems including existence of parallel recording & reporting tools. Besides, lack of resources, low technical capacity, shortage of human resource and poor Information Communication Technology (ICT) infrastructure were reported as barriers for effective implementation of CHIS in LMICs. Generally, community health information system implementation in LMICs is in its early stage. There was not a universal or standard CHIS design and implementation modality across countries. There are also promising practices on digitalizing the community health information systems. Different organizational, technical, behavioural and economic barriers exist for effective implementation of CHIS. Hence, greater collaboration, coordination, and joint action are needed to address these challenges. Strong leadership, motivation, capacity building and regular feedback are also important to strengthen the CHIS in LMICs. Moreover, CHIS should be transformed in to eCHIS with integration of different technology solutions. Local ownership is also critical to the long-term sustainability of CHIS implementation.

Implementing the Bloom Trial: Community health nurses’ perceptions of potential barriers

Abstract Background The overall aim of the Bloom Trial is to develop and test a program promoting healthy weight development during infancy within the community health nurse setting in Denmark. Many interventions are poorly implemented, and to ensure adequate implementation support, previous studies have suggested to assess barriers and organizational readiness before intervention start. The aim of the present study is to assess barriers for implementing and sustaining the Bloom Trial among program adopters and implementers. Methods Telephone interviews with managing health nurses (adopters) and health nurses (implementors) from twenty Danish municipalities were carried out (n = 22) in 2017. Moreover, two workshops with health nurses, and continuously meetings with implementation science experts were conducted in 2021-2022. Results Barriers were identified on different levels. Organizational barriers within the work of health nurses included lack of time, economic resources, project fatigue, and political priority. Furthermore, health nurses lacked relevant tools to guide parents about promoting healthy weight development. Interpersonal barriers between health nurses and parents were identified as the difficulties of having conversations about healthy weight development, especially if the parents or health nurses were overweight themselves. Cultural differences including language barriers and different perceptions of for example healthy food choices were also found. Conclusions The findings are central for ensuring that the Bloom Trial is relevant and applicable to the setting of health nurses in Danish municipalities. This is crucial for ensuring successful adoption, implementation, and prolonged sustainability. Key messages • The study pinpoints key barriers (e.g. lack of time, project fatigue and cultural factors) of implementing an intervention promoting healthy weight in the community health nurse setting in Denmark. • Involving community health nurses’ perceptions aim at increasing the chances of producing a relevant and successful implementation strategy.

Health system barriers to HPV vaccination in marginalized Roma communities in Slovakia

Abstract Background People from marginalized Roma communities often experience poverty, limited access to education, employment, housing, and health care (HC). The aim of the study was to explore the perceptions of people from marginalized Roma communities and health professionals regarding health system (HS) barriers to HPV vaccination. Methods A qualitative study was conducted in the Kosice region as a part of the RIVER-EU project. Semi-structured interviews with marginalized Roma parents (N = 18), children (N = 15), and health professionals (N = 18) were audio-recorded and thematic analysis of the transcripts was performed in MAXQDA. Findings Four main themes were identified regarding HS barriers: 1. Lack of information (lack of culturally and linguistically appropriate information, lack of information provision from HC providers, unreliable and conflicting information on the internet), 2. Restricted access to HC providers (lack of capacities, work overload, long wait in the waiting room, distance, traffic connection), 3. Financial and organizational barriers (limited coverage of vaccination expenses from health insurance, picking up prescribed vaccines in a pharmacy by parents, parental consent), 4. Attitudes and behaviours of HC providers (neglect of care, double standard, inappropriate behaviour and communication, prejudices, racism). Conclusions The reasoning and perception of several barriers to HPV vaccination differ among groups of respondents. Nevertheless, HPV is not viewed as a priority by both - marginalized Roma and health professionals. HS fails to reach marginalized Roma with appropriate information about HPV and HPV vaccination. Moreover, the lack of capacities and motivation of HC providers to address these topics lead to a lack of awareness. Organization and health insurance coverage of vaccination pose additional barriers to HPV vaccination.

Barriers and facilitators to healthcare access for homeless people in four European countries

Abstract Background People experiencing homelessness (PEH) have higher prevalence of adverse health outcomes and premature mortality compared to the general population, and often experience significant barriers in accessing healthcare services. This study aimed to better understand the health needs of PEH, as well as to identify the barriers and facilitators to their timely and equitable access to health services from the perspective of PEH and relevant health professionals and social care workers. Methods During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project. Semi-structured interviews were conducted across four European settings (Austria, Greece, Spain and the UK). Interviews were audio-recorded, transcribed verbatim and analyzed according to the inductive thematic approach set out by Saldaña (2021). Results In total, 69 interviews were completed with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Three overarching themes relating to the research question were identified: (a) Health needs of people experiencing homelessness; (b) Barriers to access healthcare services and (c) Facilitators to access healthcare services. Overall, the general health of PEH was depicted as extremely poor and mainstream health services were portrayed as ill-equipped to respond to the needs of this population, with many organizational and system-level barriers noted. Tailored approaches to care, and in particular involving trusted professionals in the delivery of care, were identified as a key strategy for overcoming existing barriers. Conclusions While a number of context-specific findings were identified, results indicated there to be a high degree of overlap and consistency in the health needs of PEH, and in the barriers and facilitators that exist when accessing healthcare across four different healthcare systems. Key messages • Homelessness is a determinant of health that is linked to poor health outcomes. Tailored approaches that draw upon trusting relationships have the potential to overcome this problem. • The array of identified barriers indicates that general healthcare services are not currently structured in a way that facilitates timely and equitable access and appropriate care for PEH.

Influence of occupation on the subjective health of forced migrant doctors-a qualitative study

Abstract Background With the refugee movement in 2015, also forced migrated female and male medical professionals have arrived in Germany. The effect of occupation on the subjective health status of these physicians working in the German health care system was investigated on the basis of Antonovsky's sense of coherence (SOC) and the occupational science models of Siegrist and Karasek&Theorell. Methods Using a semi-structured interview guide, nine forced migrated physicians were interviewed before and nine forced migrated physicians were interviewed during their professional medical activity. Both interview groups had an Arabic cultural background. The transcribed interviews were analyzed according to Kuckartz's content structuring qualitative content analysis using the MAXQDA 2020 software tool. Results The SOC of migrated physicians is favorably influenced by meaningful occupational activity and the newly gained manageability of life. Positive influences are seen in professional appreciation and collegial support at all hierarchical levels. Negative effects are perceived in experiences of discrimination, insecurity and experienced injustice in the recognition of foreign qualifications. Physical stress results from occupational overload, unfamiliar work and time pressure. Conclusions The salutogenic effect of the work, the recognition in the profession and the collegial support are essential contributions to the promotion of especially mental health among forced migrated doctors. This speaks in favor of rapid and stringent integration into professional life. However, organizational barriers inherent in the German health care system should not be disregarded, which is why both legal and structural improvements should be made to the existing integration procedure before and during professional activity. Key messages

The role of sports clubs to integrate people with disabilities

ABSTRACT Purpose Since the 2000s the French government has been pursuing a policy of inclusion with regard to people with disabilities (PWDs) in every sector of society. The hosting of the Olympic and Paralympic Games in France in 2024 will accelerate political measures to develop the practice of sports for PWDs. The aim of this article is to evaluate the capacity of sports clubs to welcome PWDs. Methodology This survey was conducted in partnership with the Organising Committee of the 2024 Olympic and Paralympic Games. We used a quantitative and qualitative approach. A questionnaire for sports clubs (n = 1042) and another for members with disabilities (n = 1752) circulated in October and November 2019. The findings were discussed during semi-structured interviews with PWDs (n = 64). Findings While the survey revealed an effective and progressive inclusion in clubs, there are still structural, organisational and human barriers to overcome before being able to move from a segregated to an inclusive model. Practical implications This research contributes to better understanding organisations (sports clubs) and how they can host PWDs. Research contribution This article provides knowledge about the limitations of integration (and inclusion) of PWDs in sports clubs.