Organizational Barriers Research Articles

Development of a tool to assess financial advocacy service delivery.

21 Background: In 2023, the Association of Cancer Care Centers (ACCC) Financial Advocacy Network published Financial Advocacy Services Guidelines developed through an expert-led, consensus-driven process (1). The Guidelines provide a framework for equitable delivery of financial advocacy (FA) services to address patients’ financial concerns. The Guidelines cover 3 domains: financial advocacy services and functions, program management functions, and partner engagement functions. ACCC adapted the Guidelines into a Financial Advocacy Services Assessment Tool to help cancer care organizations assess and improve service delivery and to advance research of organization-level FA practices across the U.S. Methods: ACCC convened an expert task force to guide this work. ACCC conducted a scan of implementation science literature and health care organizational assessments to inform the development of a rating system for each of the 43 guidelines. Four service delivery levels were identified, and a score was assigned to each level (Table). The tool was programmed in Qualtrics to provide a total score and average score per guideline for each FA domain and sub-domain. The task force added unscored questions about organizational demographics, barriers, and readiness to enable aggregate research and sub-group analysis. ACCC invited members of the Financial Advocacy Network to participate in a pilot via email invitation and provided opportunities for open-ended feedback. Results: 20 cancer centers participated in the pilot between March-May 2024. 15% were academic institutions and 85% were community-based programs (18% of which are directly affiliated with an academic institution). Respondents reported the tool was easy to use and informative for quality improvement efforts. See Table 1 for total scores for initial pilot. Conclusions: Pilot results reflect that all participating cancer centers are already engaged in some level of FA services. Broader dissemination and analysis is ongoing. The assessment provides centers with a practical resource to assess alignment to guidelines and identify opportunities for quality improvement. Regular review of aggregate results will help ACCC provide benchmarks for areas of service delivery, identify barriers to implementation, and monitor trends in FA staffing. 1. Kajdic Hodzic R, Liang MI, et al. Developing consensus-based oncology financial advocacy services guidelines. JCO Oncol Pract. 2023;19(suppl 11):38. Levels of FA service delivery and pilot total scores. Level Description % of pilot cancer centers Level 1 Not performing financial advocacy services. 0% Level 2 Making progress with financial advocacy services, but it is done informally or inconsistently. 35% Level 3 Performing financial advocacy services consistently in at least one key area of the organization. 60% Level 4 Reliably performing financial advocacy services across all key areas of the organization. 5%

Metabolic Monitoring for Children and Adolescents Prescribed Second-Generation Antipsychotics: A Qualitative Study with Child Psychiatrists.

Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.

KAZAKHSTAN'S HEALTHCARE SYSTEM IN THE CONTEXT OF THE INTRODUCTION OF COMPULSORY SOCIAL HEALTH INSURANCE

This article is devoted to the analysis of the Kazakhstani healthcare system in the context of the implementation of the compulsory social health insurance system. It will examine issues related to healthcare costs, the degree of satisfaction of the population with health insurance, the quality of medical services, etc. Since its introduction in 2020, the healthcare insurance system in Kazakhstan has encountered significant challenges. These include public dissatisfaction with the quality of medical services, inadequate coverage of the population with health insurance, vulnerabilities in the insurance information system, the existence of medical supplements, underdeveloped infrastructure in rural areas, and information asymmetry in the health insurance sector. President of Kazakhstan, Kassym-Jomart Tokayev, criticized the reform process of the health insurance system and addressed these issues during a meeting with the Government on February 7, 2024. This article delves into the evolution of the Kazakhstan health insurance system by analyzing financial indicators and monitoring data. Through this analysis, problematic areas were identified, and practical recommendations were developed to optimize the compulsory social health insurance system. Various scientific methods were employed in this study, including institutional analysis, synthesis, literature review, comparative and contrastive, and sociological methods. The goal of this study is to provide recommendations for enhancing the healthcare system in Kazakhstan during the implementation of compulsory social health insurance. The empirical foundation of this study consists of legislative documents in the healthcare sector, official publications, and analytical and statistical reports from the Ministry of Health of the Republic of Kazakhstan. The hypothesis of the study is that the introduction of compulsory social health insurance in Kazakhstan is intended to promote positive changes in the healthcare system, but due to existing organizational and financial barriers does not improve the availability and quality of medical services. Keywords: health, health insurance, health care system, public administration, health care costs.

ETHICS OF BUSINESS RELATIONS AS THE BASIS OF CORPORATE CULTURE

The article is devoted to the study of modern trends in management changes in business, due to the rapid development of market relations, new technologies and globalization. Special attention is paid to the role of the ethics of business relations in corporate culture, management processes and interaction between participants in business activities. The causes and nature of conflicts in the business environment are determined, offering effective methods of their resolution, including negotiations, mediation and analysis of the causes of conflicts. The barriers preventing effective communication in business, such as communication, psychological and organizational barriers, as well as trust barriers, are substantiated. The role of ethics in the processes of management and responsible decision-making, which contributes to increasing the efficiency of enterprises in modern conditions, is highlighted. Emphasis is placed on the need to develop ethical literacy of managerial staff through education, training, corporate codes and self-improvement. The development of such skills allows specialists not only to increase personal responsibility and efficiency, but also to strengthen the ethical basis of the entire enterprise. An important role in this is played by methods of increasing knowledge in the field of business ethics and compliance with ethical standards in business. Ethical standards are an integral part of successful management activities and contribute to the formation of a sustainable corporate culture. The development of moral consciousness and the introduction of ethical principles into daily activities help to minimize conflicts, strengthen trust between participants in business processes and enhance the company's reputation in the market

Codifying transformative learnings: Examining the codified boundary object characteristics that afford project-to-project learning between sustainability demonstrations

Sustainability demonstration projects, which bring emerging technologies closer to large-scale adoption through public-private collaborations, are critical for sustainable development and climate change response. These projects are motivated by knowledge development however immature practices are resulting in missed opportunities for project-to-project learning. This challenge is consistent with cross-domain findings that effective project learning is complex and rare, constrained by temporal, geographical and organisational barriers. A key approach to spanning scale-barriers and community-of-practice boundaries is the externalised sharing of codified learnings within boundary objects, where these objects require structural characteristics that afford project-to-project learning. To date, these characteristics have not been studied in sustainability demonstration contexts, forming a significant research gap. We conduct an integrative review of the cross-domain literature and, as a new contribution to knowledge, propose a reconceptualised 13-characteristic schema for codified boundary objects affording project-to-project learning between sustainability demonstrations. The study advances the theory of knowledge sharing from projects for sustainability by putting boundary object characteristics into context providing insight into enabling and restricting potential along with identifying key research gaps for future research.

Decisional needs for older adults, home health care nurses and dental hygienists during team-based oral health assessments in ordinary home settings – a qualitative study

BackgroundParticipation by all actors involved in health planning is a prerequisite for person-centred care and healthy ageing. Understanding the multiple knowledge needs and the values that shape oral health assessments in home settings is important both to enable participation in oral health planning and to contribute to healthy ageing.ObjectiveThe aim of this study was to investigate decisional needs during oral health assessments in ordinary home settings from the perspectives of older adults, home health care nurses and dental hygienists.MethodsData was collected in ordinary home settings through 24 team-based oral assessments and 39 brief, semi-structured interviews including older adults (n = 24), home health care nurses (n = 8) and dental hygienists (n = 7). Data was analysed using content analysis with a deductive approach. The analysis was guided by the Ottawa Decision Support Guide.ResultsThe analysis revealed that all participants considered participation in decision-making important but until now, older adults might not have participated in making decisions regarding oral health issues. The older adults considered participation important because the decisions had a strong impact on their lives, affecting their health. The professionals considered decision-making important for knowing what step to take next and to be able to follow up and evaluate previous goals and treatments. Organizational and personal barriers for shared decision-making among home health care nurses and dental hygienists were identified. Of the 24 older adults, 20 had different oral health conditions that objectively indicated the need for treatment. An initial important decision concerned whether the older adult wanted to make an appointment for dental care, and if so, how. Another decisional conflict concerned whether and how assisted oral care should be carried out.ConclusionIt is important for key participants in ordinary home settings to participate in interprofessional teams in home health care. To further anchor this in theory, conceptual models for professionals from different care organizations (municipal care, dental care) need to be developed that also involve older adults as participants. Future research could bridge theory and practice by including theories of learning while exploring interorganizational oral health planning in home settings.

Navigating the Glass Ceiling: Women's Career Challenges in Nepal's Banking Sector

Background: Glass ceiling factors, such as organizational, social, and psychological barriers, continue to hinder women's career advancement, particularly in managerial roles. Despite increasing efforts to promote gender equality in the workplace, these factors still limit opportunities for women’s development, especially in traditionally male-dominated industries like banking in Nepal. This study investigates how these factors influence women’s perceptions of career development and whether they significantly impact their progress. Methods: The research employed a quantitative approach using a structured questionnaire distributed to 51 respondents in the banking sector. The survey measured perceptions of organizational, social, and psychological factors impacting women’s career development. Multiple regression analysis was used to assess the impact of these factors on personal factors related to career growth. Descriptive statistics and correlation analyses were also performed. Results: The findings indicate that social factors significantly influence personal factors (B = 0.257, p = 0.035), suggesting that social barriers are key determinants of women's career development. Organizational and psychological factors, while positively related to personal factors, did not show statistically significant effects (OFFF: B = 0.159, p = 0.164; PSFFF: B = 0.144, p = 0.275). The model explained 29.5% of the variance in personal factors, highlighting that additional unexamined factors may influence women’s career perceptions. Conclusion: Social factors have a significant impact on women's perceptions of career barriers, underscoring the need to address societal norms and biases that prevent women from advancing. Organizational and psychological factors, although relevant, were not statistically significant in this context. The study contributes to understanding the dynamics of the glass ceiling, particularly within Nepal’s banking sector, and provides insights for policy and organizational change. Novelty: This study offers a unique perspective on the glass ceiling in the Nepalese banking sector, providing empirical evidence of how social factors predominantly influence women's career progression. The findings suggest targeted interventions to address these barriers and promote more equitable career advancement opportunities for women in managerial roles.

Abstract C007: Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention

Abstract Background. Tobacco use remains a significant public health issue, particularly among the LGBTQ+ community. Los Angeles County, which is home to the second-largest LGBTQ+ population in the US, has notably higher prevalence of tobacco use compared to the general population, partly due to targeted marketing by the tobacco industry, social stressors, and discrimination. These factors contribute to higher rates of smoking and tobacco-related health disparities; however, little is known about the capacity of community-based organizations, clinical providers, support staff, and other personnel that work closely with the LGBTQ+ community to provide smoking cessation services. Methods. Cedars Sinai Cancer Center Community Outreach and Engagement (COE) assisted in the facilitation of conducting a needs assessment, Clinical Provider and Staff Survey, to assess the opinions of clinical providers and community leaders about tobacco cessation-related topics related to 1) Building culturally competent tobacco cessation services; 2) Reducing health disparities in tobacco cessation services; 3) Improving access to care (Medicaid/Medi-Cal access and uptake) for diverse populations that are affected by tobacco-related disparities; 4) Improving the utilization of tobacco cessation services. The survey was administered online from December 2022 to April 2023 with providers throughout Los Angeles County. Results. A total of 261 surveys were collected which revealed several key issues at the organization level: they do not prioritize tobacco screening, treatment, or referrals; there is no standardized process for client management; staff have limited knowledge on tobacco prevention and patient navigation; and there is limited staff capacity and funding. To address organizational-focused barriers, COE trained 147 clinical providers and staff from 4 local health clinics and organizations and on capacity building, including the basics of tobacco, evidence-based interventions like "Ask, Advice, Refer," and lung cancer screening. Additionally, to address Client/Patient-Focused Barriers for Organizations, such as: lack of motivation to quit, low perception of the severity of smoking, and a lack of culturally competent or targeted cessation resources, COE staff assisted in navigating resources, ensuring both providers and clients were aware of and could access relevant support services. This involved sharing LGBTQ+ affirming resources, including medical care, behavioral health, and housing, and referred smokers to gender-affirming cessation support groups. Conclusion. The survey highlighted the need to enhance service delivery and support for the LGBTQ+ community. With these findings, our COE staff were able to increase organizational capacity through training and education for clinical providers and staff to enhance their knowledge and skills in tobacco cessation and share gender-affirming resources and navigation, which are crucial towards improving the overall effectiveness of tobacco cessation services for LGBTQ+ populations. Citation Format: Victor Cristanto, Alexandra Caro, Reener Balingit, Zul Surani. Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C007.

Barriers to health visitors identifying child neglect

Child neglect poses a significant issue in the UK with enduring repercussions for the health and wellbeing of children. Health visitors are responsible for safeguarding and promoting child welfare and play a pivotal role in identifying and addressing neglect, but a multitude of barriers can hinder this. This article explores the complex landscape of health visitors identifying child neglect, outlining the significance of early intervention, with a particular focus on health visiting in Scotland. Challenges faced by health visitors are examined, including organisational barriers, family/carer disguised compliance, and varying professional thresholds for when to intervene. The importance of leadership support, enhanced training and clear thresholds in safeguarding work are highlighted. The concept of ‘respectful uncertainty’ is advocated as an approach for health visitors to navigate the challenges they encounter when protecting and promoting the wellbeing and safety of children in the UK.

Innovative Approach: Leveraging Design Thinking for Enhancing Knowledge Sharing in Knowledge Intensive Firms

Purpose: This research delves into the intricate challenges of knowledge management (KM) within technical departments of knowledge-intensive firms (KIFs), with a specific focus on preserving critical knowledge amidst employee turnover. Recognizing the four main components of KM—people, process, content/IT, and strategy—and emphasizing the paramount importance of individuals in KM alongside the human-centric approach of design thinking (DT), the study aims to enhance KM processes, particularly knowledge sharing (KS), utilizing DT to fortify organizational success. Methodology: This study utilizes mixed method action research, which includes in-depth interviews and observations, immersion and questionnaire to collect employee insights. Thematic analysis is utilized to identify key challenges. Employing the DT framework, the research progresses through problem definition, ideation, prototyping, testing, and iterative refinement stages, following the structured steps of DT. Findings: Thematic analysis identifies persistent KM challenges, encompassing individual, organizational, and technology barriers. These challenges are effectively addressed through innovative solutions developed with DT principles, leading to tangible enhancements in KM processes. Iterative cycles of prototyping and testing further refine these solutions, particularly in facilitating KS among employees. Originality: This research demonstrates the efficacy of DT in addressing KM challenges within KIFs. Through prioritizing human-centric problem-solving, DT's iterative and learning-oriented nature boosts organizational efficiency and stimulates innovation. The direct engagement of end-users in solution design further highlights the cost-effectiveness of this approach, ultimately enhancing KM outcomes. Contribution: The study presents solutions tailored to the unique challenges of KM, transferable not only within the technical department but also across KIFs. Given the prevalence of unsuccessful KM implementations, the human-centric ethos of DT emerges as a pragmatic and economical approach for diagnosing and mitigating KM obstacles. Nonetheless, the study highlights the adaptability of DT in addressing specific KM issues, offering a pathway for other departments to tackle their KM challenges effectively.

From ideal to reality: governance of AMR in a multi-level setting

ABSTRACT This paper asks whether, and if so how, it is possible to design a system characterised by coordination across sectors and levels of governance aimed at governing AMR. The ambition is, firstly, to analyse how coordination problems materialise in the governing of the AMR problem, and secondly, with an emphasis on the structure of decision-making and communication processes, to probe into how coordination of AMR governance is achieved. The paper’s focus is on Norway, which stands out as one of the better performing countries for AMR governance. Drawing on literature on coordination and governance, the paper argues that effective coordination of AMR governance is more likely to follow a ‘bottom-up’ sequencing pattern. It thus provides a study of the systems for governing AMR in a multi-level setting. Through public documents, literature and interviews with key officials involved in AMR management, the paper illustrates the importance of – and organisational barriers to – inter-sectoral cooperation and coordinated strategies and actions at different levels of governance.

Enhanced train-the-trainer program for registered nurses and social workers to apply the founding principles of primary care in their practice: a pre-post study

BackgroundA train-the-trainer approach can effectively support the integration of new practice standards for health and social services professionals. This study describes the effects of an enhanced train-the-trainer program to support registered nurses and social workers working in primary care clinics in their understanding of the fundamental principles of primary care.MethodsWe implemented an enhanced train-the-trainer program for registered nurses and social workers in six primary care clinics. We conducted a pre-post study using quantitative and qualitative data to assess trainers’ and trainees’ intention, commitment, and confidence in applying acquired knowledge.ResultsWe trained 11 trainers and 33 trainees. All the trainers and trainees were satisfied with the program. Trainers were less confident in their abilities as trainers following the training, especially regarding tailored coaching (p = 0.03). Trainees’ commitment to becoming familiar with the functioning of their clinic (p = 0.05) and becoming part of the team increased significantly (p = 0.01); however, their intention to use their knowledge decreased (p = 0.02). Trainers and trainees identified organizational and professional barriers that may explain the observed decrease.ConclusionAn enhanced train-the-trainer program positively impacted registered nurses’ and social workers’ assimilation of the fundamental principles of primary care. Further research is needed to understand the long-term effects of train-the-trainer programs on primary care trainees and how these effects translate into patient care.

Abstract P319: Organizational Determinants to Hypertension Management: A Qualitative Examination at Two Academic Learning Health Systems

Background: Hypertension management is a national priority. However, hypertension control rates are suboptimal and vary across clinics, even among those in the same health system and geographic region. Objective: To identify organizational barriers and facilitators that impact hypertension management at the provider- and clinic-level. Design: Semi-structured interviews were conducted with primary care providers (N=25) and patients with uncontrolled hypertension (N=22). Participants were recruited from thirteen family and internal medicine clinics across two academic learning health systems. Participants: Twenty-five providers and twenty-two patients were recruited from clinics across North Carolina and Kansas. Approach: Interviews were analyzed using both inductive and deductive coding methodologies. A health equity framework scaffolded interview guide design and codebook development, with thematic analysis employed to categorize emergent themes across the four framework domains. Key Results: Participants discussed organizational and clinic-level barriers and facilitators that impact hypertension management, with health systems’ resource centralization being frequently mentioned. Some participants lauded centralized interventions for improving patient access and increasing touchpoints, while others lamented reductions in their clinic’s staffing to accommodate centralized workflows. Insufficient in-clinic staffing and blood pressure (BP) measurement equipment, limited exam rooms, short appointment duration, and hurried clinic environments were all mentioned as challenges to hypertension management, particularly as they hindered adherence to BP recheck policies. Appointment availability was mentioned as a barrier, however providers referenced clinics’ use of virtual and/or nurse-specific visits as a mechanism to increase patient access. Multiple providers noted that tasks central to hypertension management, like BP telemonitoring and MyChart correspondence, go unaccounted for on their schedules and can lead to unpaid work, which they linked with increased stress and burnout. Conclusions: Primary care clinics experience multiple interrelated organizational barriers to effective hypertension management. Future studies should examine the impact of different clinic staffing models, including multidisciplinary care teams, telemedicine, and remote BP monitoring, on BP outcomes in diverse primary care settings.

S06-2: Moving Cancer Care: The importance of exercise during and after a cancer treatment

Abstract Purpose Literature is recognizing exercise in cancer as a promising therapeutic tool. Authors have shown that exercise could prevent health deterioration, reduce the risk of comorbidities, and improve overall quality of life. Despite this, few cancer patients participate in exercise programs. In this study, we identify barriers and solutions for cancer patients and professionals in promoting exercise. We investigate patient motivations, enhance professional roles (assess, motivate, refer) and identify optimal exercise programs. Methods We used a human-centred design research, an iterative approach that focuses on understanding and addressing the needs of the field. For this, we first reviewed the international literature and specifically mapped the situation in Flanders (Belgium). We used qualitative (face-to-face interviews, focus groups, online survey) and quantitative (parameter registration) methods among cancer patients (39) and health/exercise professionals (36). In the second phase, our goal was to address the issue through collaborative feedback and partnership with the professional field. This resulted in the creation of practical tools, allowing professionals to assist cancer patients more effectively in their exercise routines. Results Patients and professionals commonly face barriers related to exercise resistance (e.g. lack of motivation) and limited referral pathways. Patients also express concerns about the location of exercise programs and susceptibility to external factors (e.g. weather conditions). While health and exercise professionals contend with challenges such as limited professional knowledge and organizational barriers, including an overloaded workload. When developing exercise programs, it is important to incorporate proven design criteria from previous research. These include the use of behaviour change models, adherence to evidence-based exercise standards, and the provision of guidance and follow-up throughout the program. Conclusions This research highlights the urgent need for a paradigm shift in cancer care, advocating not only more appropriate exercise programs, but also the integration of exercise coaching into the standard care pathway for all cancer patients. The inspirational book and practical guidelines elaborated serves as valuable resources for health and exercise professionals and aims to promote physical activity during cancer treatment. This project aims to contribute to the future of care, envisioning sustainable physical rehabilitation beyond the traditional hospital setting

Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review.

Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women.

Optimizing intervention dissemination at scale: A qualitative study of multi-sector partner organization experiences.

For population-wide impact of interventions, evidence-based programs must be successfully disseminated and adopted at scale. Research-practice partnerships can legitimize programs and support organizational adoption, however, ways of leveraging the contributions of partners during dissemination processes are less clear. TransformUs is a school-based physical activity and sedentary behaviour program, and since 2018, has been disseminated at scale to all primary schools in Victoria, Australia, in partnership with 16 state and national organizations. The study objective was to investigate the experiences of partner organizations disseminating TransformUs within their networks, and factors associated with awareness and adoption of the program in schools, from the perspective of partner organizations. Semi-structured interviews with representatives from 15 (out of 16) partner organizations in 2019 involved in disseminating TransformUs state-wide. An interview guide was informed by the RE-AIM framework. Interviews were audio-recorded, transcribed, and coded anonymously. Data were analysed thematically. Four themes (and 13 sub-themes) were identified: (i) organizational barriers and facilitators to dissemination; (ii) implementation support for partners; (iii) overall research experience; and (iv) dissemination strategy. Partners used multiple dissemination channels to increase adoption, and strong alignment between TransformUs and the partner organization's goals appeared to enable dissemination. Partners outlined several local, regional, and state organizations to partner with, and offered suggestions regarding preferred content and timing of dissemination activities for their networks. Researchers planning research-practice partnerships should proactively consider organizational barriers partners may face during dissemination. Regular communication and feedback on dissemination outcomes may contribute to positive research-practice experiences and allow for tailored dissemination strategies.

Applying Experienced-Based Co-Design principles to improve digital health demand management processes in a large metropolitan multi-hospital health system

ObjectiveThis study describes the application of Experienced-Based Co-Design (EBCD) principles with an embedded implementation technology framework for improving digital health and informatics demand management processes in a multi-hospital healthcare system. The study identified barriers and enablers within the existing demand management system, proposed interventions to address these challenges and engaged in collaborative co-design with stakeholders. MethodsA multi-method qualitative approach aligning with EBCD principles was used. Framework mapping (Non-adoption, Abandonment, Scale-up, Spread, Sustainability) was applied to barriers and enablers associated with baseline practices. Reflexive thematic mapping and process charts were used to inform stakeholder priorities and co-design. Prototyping was iterative using feedback for continuous improvement with ongoing monitoring. ResultsFragmentation of information was a technological barrier, decentralized processes and service duplication were organizational barriers, and opportunities to improve clarity of governance policies were identified. Solutions were co-generated and prioritised by stakeholders. The co-design and prototyping phase followed an iterative approach which generated two interventions. For centralizing intake and management, a new workflow process was devised. For improving project portfolio visibility and developing a weighted scoring criterion, a single tool to track projects across the lifecycle and a scoring model based on prioritization techniques were created. ConclusionA novel application of an EBCD approach was used to improve demand management processes in a digital health and informatics service context in a large health system. It highlights the value and agility of EBCD to generate flexible and modular solutions for this digital health context and compares favorably to analogous approaches. Public interest summaryIn today's fast-paced digital age, it is vital for hospitals to manage health information innovation efficiently. This study used an Experienced-Based Co-Design design (EBCD) approach to improve how a multi-hospital health system handles and prioritizes digital health projects. We listened to stakeholders, identified challenges, including fragmented information and unclear processes, then co-created solutions. The EBCD produced an implementable streamlined method for managing digital health project requests, including prioritizing and tracking projects from start to finish. This outcome of the exemplar EBCD process is likely to ensure that the most critical health projects are prioritized. For the public, this means better, faster, and more efficient digital health services in the future.

Factors Affecting Health Research Utilization Among Health Professionals in Nigeria

The utilization of health research in clinical practice is hindered by individual, organizational, and systemic barriers, including insufficient research literacy and unsupportive organizational cultures. Enhancing research literacy, fostering supportive environments, and implementing evidence-based policies are crucial for bridging the gap between research and practice, ultimately improving patient outcomes. This study investigates the factors affecting health research utilization among health professionals in Nigeria, an essential aspect for advancing healthcare systems and patient outcomes. Utilizing a cross-sectional descriptive design, data were collected via an online survey distributed to public health professionals and policymakers. The survey explored demographics, research utilization, dissemination effectiveness, barriers, and recommendations for improvement. Key findings indicate significant demographic disparities, with a higher proportion of younger and non-public health degree holders reporting unused research findings. The study identified major barriers, including inadequate communication, poor dissemination practices, and lack of access to research findings. Despite 87.6% of respondents conducting potentially impactful research, only 13.6% reported actual utilization of their findings. The recommendations for improvement emphasized the role of knowledge brokers, fostering research-attuned and decision-relevant cultures, enhancing communication and interaction between researchers and users, and building capacity among all stakeholders. Additionally, establishing effective dissemination systems, securing funding, and promoting international collaboration were highlighted as critical strategies. The study underscores the necessity of addressing structural, cultural, and communicative barriers to improve the practical application of health research in Nigeria, aligning with global trends and literature advocating for a multifaceted approach to enhance health outcomes.

A Qualitative Study on the Transition from Pediatric to Adult Care in Oncology: How Health Care Professionals Can Adapt Their Practice?

Purpose: The main objective of this study was to identify the facilitators of and barriers to the transition from pediatric to adult care for adolescents and young adults (AYAs) with cancer according to physicians and nurses working in oncology. The secondary objectives were (1) to explore the viewpoints of health care professionals (HCPs) on this transition and (2) to discover HCP's needs and the needs they perceive among AYAs and their parents. Methods: Semistructured interviews were conducted with 19 HCPs to discover their experiences with pediatric to adult care transitions. Thematic analysis was then conducted. Results: Participants reported that transitioning is a complex process influenced by numerous barriers and facilitators, which can be classified into four themes: (1) balancing the needs and relationships of the three actors involved in the transition process, (2) factors that enable HCPs to determine the ideal time for transitions, (3) institutional and organizational barriers and facilitators that challenge HCPs, and (4) HCPs' reflections on defining and improving the transition process. Conclusion: Beyond the lack of human and financial resources, which hinders the structuring of transitions, our results suggest the need for a paradigm shift. That is, the position given to AYAs in pediatrics before the transition needs to evolve so that they are gradually positioned at the center of the relationship with HCPs and, therefore, are the focus of care and the transition process. This will enable them to acquire the skills, knowledge, and autonomy needed for a successful transition to adult care.

Integrating traditional practitioners within primary healthcare teams: Development of an accreditation framework.

While the work of Traditional Healing and its practice is centuries old, many mainstream healthcare providers do not recognize its value. A priority for the Indigenous Primary Health Care Council (IPHCC) is to support Indigenous people, communities, and partners in the work of reclaiming safe spaces for Traditional Healing within primary healthcare settings. The primary goal of this IPHCC-led initiative was to understand barriers for organizations to integrate Traditional Healing and cultural services and from this information design an accreditation model for Traditional Healing Practitioners. This included the protection and maintenance of the experiences and knowledge of our Traditional Healing Practitioners through promoting and delivering Traditional Healing training and mentorship opportunities for the next seven generations of practitioners; and the creation of curriculum that will embed the concept of Two-Eyed Seeing as it relates to integrated Traditional Healing within mainstream practice.