Practice Partners Research Articles

Uncovering effects of supply chain distance on sustainability adoption: empirical evidence from a multi-stakeholder partnership

Purpose To investigate the effects of supply chain (SC) distance on sustainability adoption, this study aims to advance the way prior studies on SC sustainability presume that SC structures are well-developed and stable. Since SC members face structural voids in different regions, we recognize that the information flow is impacted as SC partners often have limited knowledge of their direct partners. Thus, by studying a multi-stakeholder partnership, this article sheds light on the institutional foundation of sustainability adoption issues largely neglected to date. Design/methodology/approach A qualitative case study was used with members of an MSP (i.e. a roundtable), to understand the beef SC located in Brazil. Overall, 18 h of interview recordings and notes from 18 h of meeting observations were gathered, equaling 36 h of primary data. Findings Four dimensions of SC distance (physical, organizational, cultural and institutional) were identified, generating three driving effects on symbolic sustainability adoption and, consequently, a degree of invisibility for beef SC members. The results explain the process of sustainability adoption and highlight that smaller and more upstream suppliers show lower degrees of substantive adoption of SC sustainability practices. Originality/value This study investigates how SC distance affects the alignment of SC members in terms of sustainability adoption. By providing reflections on how institutional distance can hinder suppliers from adopting sustainability requirements they received from the SC, this research contributes to shifting from sustainability discourse to real practice and proactive partner engagement.

Co-designing a Children’s Cabinet: a school district–university partnership for youth well-being post-pandemic

PurposeThis paper presents a case study of a school district–university partnership to co-design a Children’s Cabinet, a cross-sector initiative bringing together institutional and community leaders to address youth well-being in the aftermath of the COVID-19 pandemic. In a vibrant, immigrant-serving community in the Northeast United States, the partnership was initiated by district leaders in Spring 2021 after pandemic disruptions led to a youth mental health crisis.Design/methodology/approachOur descriptive, qualitative case study focuses on the structure and emerging design principles of the research–practice partnership, which established a Children’s Cabinet comprised of educational, government and community leaders along with researchers. From Spring 2021 through Spring 2024, we collected and analyzed member and youth interviews, ethnographic observations and artifacts from all meetings and process interviews with key partners.FindingsWe describe the structure of the partnership, including how researchers and district leaders collaborated on meeting facilitation and how researchers conducted and shared applied research. We then discuss three design principles that guided the work, including centering relationships, sustaining focus on key goals and embedding applied research.Originality/valueAs embedded research partners, our team is uniquely situated to narrate the nature and structure of the partnership and reflect on the design of our cross-sector initiative. Increasingly, universities are partnering directly with districts on school improvement initiatives. Our work shows how engaging in RPPs to bring together school, community and research partners can facilitate local leadership and collaboration to address complex, cross-sector goals such as increasing youth well-being.

How do communities define “work precarity” and “labour exploitation”? Lessons for research from participatory research in high economic hardship communities in Chicago, Illinois/USA

Abstract Labour migration has both social and economic drivers that channel workers into jobs that are less desirable to citizens of the receiving countries. Immigrant workers find jobs through contacts from their home countries, including temporary staffing companies. These workers tend to co-locate in segregated communities and coalesce in jobs that entail hard work, low wages, and limited social benefits. As such, labour migration adds a dimension to the structural and social determinants of health (SDOH) that can broaden our understanding of health inequities, and that can point us toward policies and practices to enhance the health and wellbeing of migrant workforces. However, to generate evidence, align interventions with workers’ needs and priorities, and move evidence to action, it is crucial to engage communities. This presentation describes a community-university research partnership that co-investigates the relationship between work and health as experienced at the community level in two high-economic-hardship neighbourhoods in Chicago, Illinois/USA. The academic and practice partners co-developed and tested a conceptual model of the interrelations among migration, work and health, conducted an inventory of local employers, and executed a street-level survey of 497 workers in these two communities. The research findings helped enhance existing models of the structural/social determinants of health and of work precarity, thus informing methodological approaches to measure work precarity, labour exploitation, and their health effects. The community-based participatory research further led to several action-research projects that are ongoing. This presentation will describe the development of the community-university research partnership and its work, the subsequent enhancements made to the worker precarity and SDOH models, and preliminary findings of the partnership’s current action-research projects.

The Impact of Allyship on Minoritized Patients and Providers in Palliative Practice

Many minoritized patients experience discrimination in health care. The same is true for minoritized health care clinicians, including the advanced practice registered nurse (APRN). Specifically, Black Americans have historically and disproportionally been privy to both structural racism and interpersonal racial discrimination (J Subst Abuse Treat 2022;133:108551). For patients, such exposure is associated with physical and mental health consequences, including hypertension, obesity, depression, anxiety, psychological distress, and mortality (Health Serv Res 2019;54 suppl 2(suppl 2):1399–1408). For minoritized clinicians, the subsequent result of discrimination additionally includes poor job satisfaction, decreased productivity, and high turnover (JAMA Health Forum 2023;4(12):e235249). Allyship, the act of supporting minoritized individuals while not being a member of that group, is potentially useful in improving the practice experience of minoritized APRNs, as well as positively impacting minoritized patients’ outcomes. This article aims to provide actionable and practical skills for the APRN to create safe spaces for minoritized patients and partners in palliative practice. Explicitly, the role of the palliative care APRN as an ally will be reviewed as well as guidance on how to implement changes that will affect the health care experience for both patients and clinicians.

Experiences of Newly Qualified Nurses' Engagement with Quality Improvement in Practice: A Qualitative Follow-Up Study.

Nurse education plays an essential role in preparing future nurses to engage with quality improvement (QI) initiatives in their organisations and improve patient care. However, frontline nurses continue to report that a lack of QI knowledge hinders their abilities to engage in improvement work. In the UK, student nurses are now trained in QI within their degree to enable them to contribute to improvements once qualified. This qualitative follow-up study investigated the sustainability of QI engagement in nurses who undertook QI training and a QI project during their degree and explored the factors influencing their engagement in QI once qualified. This paper followed the COREQ criteria to report upon 10 semi-structured interviews undertaken with registered nurses and focuses on their experiences of QI engagement post-registration. The data were investigated using an inductive thematic analysis and Nvivo 14. Five themes emerged: transition to a newly qualified nurse, QI knowledge decline, influencing factors (hierarchy, leadership, COVID-19 pandemic, data access and location), and skill transferability. This study showed that qualified nurses can sustain their QI knowledge and remain engaged with QI where they experience positive QI leadership and were exposed to ongoing QI activity in their preceptorship year. However, a lack of QI opportunities and a culture which does not consider QI a responsibility of new nurses is seen to hinder engagement. Educational institutions and practice partners require careful collaboration to assess and develop ongoing QI learning activities that support new nurses to engage in QI.

Implementation of research, education and leadership placements into Operating Department Practitioner training: A 4-pillar practice-based learning approach.

Practice-based learning has traditionally focused on clinical practice in pre-registration courses. However, recent national strategies emphasise the importance of incorporation of all four pillars, clinical, education, leadership and research, into practice-based learning (placements). This article details the introduction of practice-based learning in research, education and leadership alongside clinical placements for BSc Operating Department Practice students at Sheffield Hallam University. It provides insights into the benefits of this approach, outlines the components of each placement with examples of completed projects, shares feedback from students and practice partners and addresses challenges. The authors advocate for adoption of this approach across all pre-registration Operating Department Practice courses, to ensure a workforce capable of meeting evolving health care needs and driving the Operating Department Practice profession forwards.

National implementation trial of BeUpstanding™: an online initiative for workers to sit less and move more.

The online BeUpstanding™ program is an eight-week workplace-delivered intervention for desk-based workers to raise awareness of the benefits of sitting less and moving more and build a supportive culture for change. A workplace representative (the "champion") delivers the program, which includes a workshop where teams collectively choose their sit less/move more strategies. A toolkit provides the champion with a step-by-step guide and associated resources to support program uptake, delivery, and evaluation. Here we report on the main findings from the Australian national implementation trial of BeUpstanding. Recruitment (12/06/2019 to 30/09/2021) was supported by five policy and practice partners, with desk-based work teams from across Australia targeted. Effectiveness was measured via a single arm, repeated-measures trial. Data were collected via online surveys, toolkit analytics, and telephone calls with champions. The RE-AIM framework guided evaluation, with adoption/reach (number and characteristics); effectiveness (primary: self-reported workplace sitting time); implementation (completion of core components; costs); and, maintenance intentions reported here. Linear mixed models, correcting for cluster, were used for effectiveness, with reach, adoption, implementation, and maintenance outcomes described. Of the 1640 website users who signed-up to BeUpstanding during the recruitment period, 233 were eligible, 198 (85%) provided preliminary consent, and 118 (50.6%) champions consented and started the trial, with 94% (n = 111 champions) completing. Trial participation was from across Australia and across industries, and reached 2,761 staff, with 2,248 participating in the staff survey(s): 65% female; 64% university educated; 17% from a non-English speaking background. The program effectively changed workplace sitting (-38.5 [95%CI -46.0 to -28.7] minutes/8-hour workday) and all outcomes targeted by BeUpstanding (behaviours and culture), with small-to-moderate statistically-significant effects observed. All participating teams (n = 94) completed at least 5/7 core steps; 72.4% completed all seven. Most champions spent $0 (72%) or >$0-$5 (10%) per team member; most (67/70 96%) intended to continue or repeat the program. BeUpstanding can be adopted and successfully implemented by a range of workplaces, reach a diversity of staff, and be effective at creating a supportive culture for teams of desk-based workers to sit less and move more. Learnings will inform optimisation of the program for longer-term sustainability. ACTRN12617000682347.

Exploring the role of healthcare partners in referrals to a community-based exercise program with a healthcare-community partnership designed for people with balance and mobility limitations

Purpose To explore how healthcare partners in community-based exercise programs for people with balance and mobility limitations perceive and enact referral in the context of their role. Materials and methods We conducted a descriptive, qualitative study involving semi-structured interviews and reflexive thematic analysis. Results Twelve healthcare partners from the Together In Movement and Exercise (TIMETM) program completed interviews. Seven (58%) participants were clinicians and 5 (42%) held non-clinical roles. The most common professional background of participants was physical therapy (n = 9, 75%). Clinicians made direct referrals while non-clinical participants facilitated referral by promoting the program. The main theme was healthcare partners perceive their role in referrals as secondary to their role as educators and trainers. Subthemes were: (1) healthcare partners fulfill educator and trainer roles when conducting formal training of instructors, educating instructors during program visits, and fielding questions; (2) almost all healthcare partners facilitate referral by sharing program information formally and informally; and (3) healthcare partners in clinical practice make direct referrals depending on the clientele. Conclusions Healthcare partners perceive their roles as educators and trainers as taking precedence over their role in referrals. Findings can be used to guide selection and training of healthcare partners, design of clinical education programs, and research on competencies.

You can travel AND have a career as a practice partner. And don't forget being a mum too!

Embracing whatever was thrown her way, Laura Bowen proved that a successful career and travel were good partners; not stopping there she sold the practice and went on to win the Clipper Round the World yacht race.

Freire, Critical Pedagogy, and Culture Circles

In celebration of our 20th Anniversary as a journal, the InterActions: UCLA Journal of Education and Information Studies editorial team opted to put forth a call on the work of Paulo Freire, critical pedagogy, and culture circles. It’s hard not to continue to see why critical pedagogy, a praxis of nurturing critical consciousness toward humanization and society towards justice, continues to be an essential aspect of education in P-20 settings in a healthy democracy. This issue was an opportunity to showcase contemporary work and research inspired by the legacy of Paulo Freire. Humanizing education is a collective practice in partnership with students and communities, redresses structures that maintain social inequalities and hierarchies of human life, and repairs the harm they have inflicted (Freire, 1970; Paris & Alim, 2017). The call to humanize education is especially urgent given our ongoing crises in education: unceasing youth gun violence and school shootings (Schildkraut & Muschert, 2019); the defunding divestment of public instruction and closures of public schools (George, 2024); the varied emergences COVID-19 variants and other looming pandemics (Pokhrel & Chhetri, 2021); corresponding deterioration of working conditions and livable wages for those working for our nation’s education systems (Schmitt & deCourcy, 2022; Souto-Manning & Melvin, 2021); book bans and bans misconstruing interpretations of Critical Race Theory, and acceptance and kindness towards LGBTQIA students, teachers, and their families (Morgan, 2022); proposed and implemented legislation to dehumanize queer, trans, nonbinary, and intersex children and parents (Goldberg & Abreu, 2024); and ongoing racialized hate and terror harming Black, Asian, and other nonwhite students, teachers, and their families, among others (Gillborn, 2006; Gover et al., 2020 ; Tuchinda, 2023; Wun, 2014). The urgency of critical pedagogy remains as relevant as ever.

Linguistically responsive teacher identity construction through reflections on sociocultural pedagogical practices: Collaborating with secondary content area teachers of emergent bilinguals

AbstractThis article shares findings from the implementation of an ongoing National Professional Development (NPD) project that advances second language literacy and biliteracy in secondary content areas. The project is part of a research–practice partnership between a large public university and two school districts in south Texas that engages in‐service secondary school teachers seeking additional certification in English as a Second Language or Bilingual Education. Project activities adapt linguistically responsive theoretical and research perspectives to impact secondary teachers' knowledge, dispositions/beliefs, and practices. Analysis examines how secondary in‐service content‐area teachers reflect, narrate, and enact their professional identities as linguistically responsive teachers of emergent bilinguals (EBs) through professional learning activities. Findings describe how participants negotiated their identities as teachers of linguistically responsive instruction for EBs, as demonstrated through their engagement of reflective practices, digital language stories, and enactments of sociocultural pedagogical practices.

An Applied Research Partnership to Improve The Children’s Behavioral Health System Of Care

Objective and ApproachThis session describes a doctoral student-led process to align research, policy, and practice partners around the use of integrated data to address a policy priority—the mounting youth mental health crisis. The project partners engaged in a five-year governance process to leverage integrated administrative data from a large health and human service agency in one U.S. state. Qualitative field notes—collected while conducting quantitative analyses and engaging partners—were analyzed to document a realistic timeline and process for ethical, actionable research using cross-sector data. ResultsFive key lessons for partnership-engaged research emerged, emphasizing the importance of adapting to changes in project themes, leveraging strong partnership to address data quality concerns, nurturing existing and new relationships, balancing data access and data privacy, and supplementing administrative data with contextual data. ConclusionsThough engaging deeply with partners takes substantial time and energy, there are benefits to researchers, policymakers, practitioners, and most importantly, residents whose data are represented. Furthermore, building pathways to legally and ethically access integrated data can promote the efficient, strategic use of data for social policy research, and ultimately, be leveraged to support evidence-based policymaking in an ever-changing world. ImplicationsThis session underscores the value of forming applied research partnerships and building legal and ethical pathways to access integrated data when tackling complex social policy issues.

Using System Dynamics for Local Authority Public Health practice in England

A key function of local authority public health teams in England is to undertake a regular health needs assessment of their population. This involves forecasting, among other things, prevalence and incidence of long term conditions and health care service demand. Over the last few years, Kent County Council Public Health has adopted the use of system dynamics modelling (SDM) to not only do this but generate scenarios to simulate the impact of different interventions across different cohorts defined by age groups and diagnosable conditions. These include “no conditions” as well as understand the combined effects of different interventions, demographic changes and wider health determinants. Risk factors, such as smoking, diet and physical activity, were calculated using local linked data for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty. These were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy was significant. SDM heavily influenced local authority commissioning decisions for health improvement services redesign such as smoking cessation, weight management as well as other secondary prevention measures such as hypertension management and cardiovascular disease screening delivered by General Practice and other health service partners.

Collaborating for Social Change: Promising Practices for Effective Youth-Adult Partnerships

Collaborating for Social Change: Promising Practices for Effective Youth-Adult Partnerships

Stronger Together: A Successful Model of Health System-Community Collective Action During the COVID-19 Pandemic

Abstract: Background: Discontinuity between health care delivery systems and community-based organizations is a significant barrier to improving population health. Objective: To describe the facilitators and barriers experienced by a health system–community partnership 15 months after implementation. Methods: Coalition members who led committees within the coalition or had active, sustained participation in coalition activities were invited to participate. Qualitative interviews used a semi-structured interview guide that elicited information on coalition functioning. A content analysis used inductive and deductive codes which were reviewed using a consensus process. Final themes centered on factors that facilitated or impeded the coalition’s success in supporting community needs during the COVID-19 pandemic. Lessons Learned: Coalition stakeholder perspectives identified several critical factors: defined governance, a culture of trust that accelerates learning, reliable resources, and a health-care anchor organization committed to shared investment. Conclusions: Lessons from this endeavor contribute to a deeper understanding of successful practices for health system-community partnerships.

General practice variation in peptic ulcer prophylaxis: a nationwide register-based study

Background Incidence of peptic ulcer bleeding can be substantially reduced by prophylactic use of proton pump inhibitors (PPIs) in patients at risk, but use of PPI varies among risk patients, and substantial under-prescribing may exist. The variation in prophylactic prescribing among general practices remains unknown. Methods A nationwide register-based cross-sectional study analyzing the proportion of patients at risk of ulcer bleeding receiving PPI treatment within Danish general practices. Using logistic regression, we analyze associations between general practice characteristics and prophylactic treatment among patients at risk of ulcer bleeding listed with the general practice. Results In most general practices, less than 40% of the patients at increased risk of ulcer bleeding were covered by PPI. Geographical variation was present, where practice location outside the capital area was associated with higher odds of PPI coverage among their risk patients. Partnership practices with GPs with a mean age ≥65 years or with only female GPs were associated with higher odds of providing prophylaxis among their risk patients compared to practices with a mean GP age <45 years or with only male GPs. Similar associations were not found for single-handed practices. Conclusions A significant under-prescribing of ulcer prophylaxis is common across all general practice characteristics, and only few associations with practice characteristics were present. Most efforts to rationalize PPI prescribing have aimed at reducing overprescribing but the findings point to under-prescribing as a problem as well. Development of new methods to assist GPs in identifying individuals at risk of ulcer complications is needed.

Model of partnership in sustainable palm oil: efforts to increase partnerships in the palm oil business in Indonesia

Purpose A partnership model is necessary for palm oil plantations’ sustainability. The developed model does not identify the optimal technique for smallholder palm oil because it faces complex challenges. This study aims to determine a partnership model for sustainable palm oil plantation business in Indonesia. Design/methodology/approach Qualitative research methods were used, and data analysis was performed using NVivo 12 Plus software, which helps improve the accuracy of qualitative studies and provides implications for evidence-based studies. All respondents, whether through surveys, interviews or focus group discussions, understood their contributions to this research and provided consent. Findings The results indicate that the core–plasma partnership pattern implemented by companies needs to be considered a relevant model for partnerships in the Indonesian palm oil industry. Social networks play a role in implementing this partnership pattern, which is influenced by the diversity of the actors involved. However, complexity arises from the dynamics of power and position among these actors, which demands increased interaction and mutual trust. Therefore, various dimensions must be considered, including plantation management, product marketing, cultivation techniques and sustainable development. Research limitations/implications The research results have limitations, particularly regarding access to information for company policymakers, because there remains complexity related to the position and dominance of power between actors, which influences the achievement of common goals. A more complex analysis is needed to produce complete research. Further studies are required to provide a more comprehensive explanation of the humanist approach in the context of palm plantations. Originality/value This study provides an important theoretical implementation: a more humane approach through a partnership model that adds value and is based on aspects of morality in implementing partnerships in the palm oil plantation sector. It also provides new and substantial insights regarding practical implementation for policymakers and practitioners who want to improve partnership practices in sustainable palm oil businesses by implementing value-added and morality-based partnership models in Indonesia as well as other developing countries.

An innovative Doctor of Nursing Practice scholarly project curriculum model: Strategies for supporting learners at various entry levels

The Doctor of Nursing Practice (DNP) Program curriculum must address the challenge of developing Competency Based Education (CBE) curriculum for DNP Scholarly Projects tailored to meet variations in nursing learner preparation and practice, from novice bachelor's entry level and master's advanced nurse practice expert entry level pathways. The recent Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity report by the National Academy of Medicine advocates that competency-based education (CBE) approaches in nursing schools should focus upon the advanced practice nursing population within collaborative academic practice partnerships. This article describes an innovative DNP Scholarly Project Curriculum model at an academic health science center that integrates academic partnerships and CBE strategies that have been developed for second degree Bachelor's direct entry to nursing (direct entry), post BS in nursing to DNP (BS to DNP), Post Master's to DNP (PM DNP) entry levels of preparation. The DNP Scholarly Project Curriculum utilizes an innovative, scaffolded approach to fostering CBE for the assessment of learning activities at the doctoral level. The DNP Scholarly Project Curriculum includes domains of quality improvement, critical appraisal of the literature, evidence-based practice models, implementation practice models, policy analysis, and process/outcome evaluations. Preliminary alumni and stakeholder feedback suggests that these projects are not only impacting practice but improving learner competency in quality improvement science. Implementation of this model has led to enhanced CBE-driven curriculum teaching and learning strategies, and sustainable collaborative academic partnerships.

Collaborating for co-researching: A multi-stakeholder case narrative of student nurses co-researching technology-supported care

AimEvaluate the impact of LS@H project participation on stakeholders. BackgroundAs populations age and workforces decline, care technology in nursing is becoming increasingly commonplace. Collaboration between nurse academia, education and practice can result in practice-based research and meaningful learning for nursing students and staff. However, little is known about the factors influencing effective collaboration. Based on the knowledge that narratives can be an effective vehicle for healthcare practice change, a Dutch school of nursing and its practice partners collaborated on the Living Longer and Safe at Home! (LS@H) project. This project aimed to explore a more person-centred approach to the use of technology in nursing care. Having gathered data from multiple sources to construct case narratives on the use of technology in older persons care, students nurses were able to contribute to practice development as their narratives were fed back to local and regional teams. DesignTo evaluate the impact of the LS@H project, we employed the same methodology used in the project: mixed data gathering methods to construct a case narrative. LS@H project students, supervisors, mentors and higher management shared their experiences and the research team constructed the case narrative. MethodsQualitative data were gathered via individual, duo and group interviews and supplemented with a survey among students. Transcription and thematic analysis followed, with multiple rounds of critical peer review before the thematic framework was agreed, survey results integrated and the case narrative constructed. ResultsAccording to stakeholder participants, the LS@H project led to an unfreezing of the status quo in both education and practice. The approach was new and guidelines with community support was needed to allay fears. The project design enabled a sense of shared ownership, across individuals and organisations for improving practice. Perspectives on the use of technology and older persons nursing were transformed. Critically dialoguing case narratives encouraged purposeful action to improve practice and fostered reflective practice among students and teams. ConclusionsCollaborative practice-based research can be a valuable learning experience for student nurses, positively influencing their view of nursing practice as well as enabling them to actively contribute to practice development. Adequate preparation, supervision and practice mentorship is vital, alongside practice (leader) commitment to ensure continued student assignments with subsequent critical dialogue of the multi-stakeholder case narratives produced. Registration numberAt point of submission put this on title page

Degenerative Cervical Myelopathy Awareness in Primary Care: UK National Cross-Sectional Survey of General Practitioners.

Degenerative cervical myelopathy (DCM) is a progressive neurological condition, characterized by spinal cord injury secondary to degenerative changes in the spine. Misdiagnosis in primary care forms part of a complex picture leading to an average diagnostic delay of 2 years. This leads to potentially preventable and permanent disability. A lack of awareness secondary to deficits in postgraduate education may contribute to these delays. This study aims to assess the awareness of DCM in the setting of general practice. General practitioners completed a quantitative web-based cross-sectional questionnaire. The 17-item questionnaire captured data regarding demographics, subjective awareness, and objective knowledge. The questionnaire was disseminated via professional networks, including via practice managers and senior practice partners. Incentivization was provided via a bespoke DCM fact sheet for those that completed the survey. A total of 54 general practitioners representing all 4 UK nations responded to the survey. General practitioners most commonly self-assessed that they had "limited awareness" of DCM (n=24, 51%). General practitioners felt most commonly "moderately able" to recognize a case of DCM (n=21, 46%). In total, 13% (n=6) of respondents reported that they would not be at all able to recognize a patient with DCM. Respondents most commonly reported that they were "moderately confident" in their ability to triage a patient with DCM (n=19, 41%). A quarter of respondents reported no prior introduction to DCM throughout their medical training (n=13, 25%). The mean score for knowledge-based questions was 42.6% (SD 3.96%) with the lowest performance observed in patient demographic and clinical recognition items. General practitioners lack confidence in the recognition and management of DCM. These findings are consistent with the diagnostic delays previously described in the literature at the primary care level. Further work to develop and implement educational interventions to general practitioner practices is a crucial step to improving patient outcomes in DCM.