Perceptions Of Barriers Research Articles

Інституціональні засади формування та розвитку стійкого ринку електронної комерції

This research examines the institutional aspects of developing a resilient e-commerce market in Ukraine. The institutional approach allows us to consider various aspects of formation, functioning, and changes within the social institutions and their influence of e-commerce solutions on individuals’ activities and social interaction. During the literature review, the various approaches to the essence of the institution as an economic category were considered. The author proposed considering the e-commerce institution as a socially formed system that structures interaction within the e-commerce market by implementing formal and informal rules that influence subjects’ activities by establishing restrictions and organizing motivational mechanisms that support the desired behavior to maximize the aggregate economic impact. The roles and functions of the leading institutional players, particularly state institutions, market institutions, research institutions, and public and non-profit institutions, are defined. The literature review determined that e-commerce adoption is significantly determined by the response to pressure from external agents (consumers and competitors) and internal agents (employees). The model of the institutional environment of the e-commerce system is presented. The proposed model is based on the interaction of e-commerce institutions that contribute to institutionalizing e-commerce technologies within the Ukrainian business environment. The institutional influence is being implemented by utilizing the interaction of the ‘business-government-society’ triad. Among the expected institutional effects of the general modernization of the socio-economic system, the harmonization of relationships between individual participants and the reduction of resource asymmetry can be highlighted. Three types of institutional pressures that influence the enterprises’ decisions to adopt and develop e-commerce systems are discussed, particularly coercive, regulatory, and mimetic types of pressure. The interaction of these types of institutional pressure thereby influences the enterprises’ perception of barriers and opportunities for adopting and utilizing e-commerce. Keywords: e-commerce, institutionalization, resilience.

Exploring barriers to mental health service access: a preliminary study among the general Paraguayan population

This study aimed to explore the perception of barriers to accessing mental health services within the general population of Paraguay using the Barriers to Access to Care Evaluation (BACE) scale. The barriers were categorized into three types: attitudinal, instrumental, and stigma-related. The sample comprised 321 participants, the majority of whom were women (82.9%). Among the participants, 62.9% reported experiencing mental ill-health, with the most common disorders being anxiety (37.4%), depression (30.5%), and sleep disorders (20.6%). Of the participants, 157 (48.9%) reported significant attitudinal barriers, which include beliefs and perceptions about mental health treatment, among others; 87 (27.1%) reported significant stigma-related barriers, which involve prejudices and stereotypes associated with mental disorders; and 189 (58.9%) experienced significant instrumental barriers, including financial constraints and limited availability of services. Mental ill-health was significantly associated with all types of barriers. In conclusion, significant barriers to accessing mental health services persist among the Paraguayan population. These barriers must be addressed through evidence-based public policies to improve the quality-of-life of both individuals with mental ill-health and the broader general population.

A Mixed Methods Study of Barriers to Help-Seeking for Intimate Partner Aggression in the LGBTQIA+ Community.

People in the LGBTQIA+ community (i.e., lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other gender/sexual minorities) experience greater rates of intimate partner aggression (IPA) than the general population and have fewer help-seeking pathways available. The current research examined the extent to which LGBTQIA+ people's perceptions of barriers to help-seeking were associated with perceptions of societal heteronormativity-the belief that being cisgender and heterosexual is the norm-and whether the source of support was formal (e.g., police, counselors) versus informal (e.g., friends, family). The current research was conducted in two parts. In the first part of the study (Study 1a), structural equation modeling indicated a significant positive association between perceived societal heteronormativity and self-focused barriers (e.g., feeling too ashamed or guilty to seek help) but not with other-focused barriers (e.g., expecting unfair treatment). Instead, LGBTQIA+ people perceived greater other-focused barriers when considering formal compared to informal sources of support. In the second part of the study (Study 1b), we interviewed 10 LGBTQIA+ people about barriers to help-seeking for IPA. A reflexive thematic analysis identified four themes: (1) Who can hold the status of being a "victim"?; (2) The heightened importance of autonomy; (3) Formal supports need LGBTQIA+ competency; and (4) Judged by the outside in. The themes illustrated unique barriers experienced by LGBTQIA+ people when judging possible harm, choosing whether to seek help, and actual help-seeking. Altogether, current help-seeking pathways for IPA are generally inaccessible to people in the LGBTQIA+ community. IPA interventions for the LGBTQIA+ community require awareness of stigma, improved education for informal and formal support pathways, and the development of community-led interventions.

The relationship between men's health literacy levels and their health beliefs and attitudes towards prostate cancer screening: A case study in a rural area.

This study aimed to examine the relationship between health literacy level and health beliefs and attitudes regarding prostate cancer screening in males aged 40-70 who lived in rural areas and had not been diagnosed with prostate cancer. The sample of the study consisted of 379 men. The data were collected between January and December 2022 using the "Participant Information Form," the "Turkey Health Literacy-32 Scale," and the "Prostate Cancer Screening Health Belief Model Scale." 58% of the participants are between the ages of 40-55. It was determined that 61.2% defined cancer as a fatal disease, only 14.2% had PSA in their blood and 21.6% had DRE. The average health literacy scale total score of the participants is 33.76 ± 11.55. The health literacy level of men was found to be limited in 14.8%. There was a negative relationship between the total scores of the health literacy scale and the susceptibility perception, seriousness perception, and barriers perception sub-dimensions of the Health Belief Model Scale of Cancer Screenings and a positive relationship between the total scores of the Health Literacy Scale and health motivation and benefits perception subdimensions (p < .001). As a result, men living in rural areas should be given individual counseling by health professionals to use screening tests for cancer symptoms and early diagnosis. In addition, men's health literacy levels should be increased by providing planned and regular health education in order to create positive attitudes and perceptions regarding cancer screenings, especially prostate cancer.

Individualized activity recommendation based on a physical fitness assessment increases short- and long-term regular physical activity in people with multiple sclerosis in a retrospective cohort study.

Despite the evidence of beneficial effects of physical activity (PA), people with multiple sclerosis (pwMS) are less physically active than the general population. To increase PA in pwMS, we developed a structured individually tailored PA promotion program which is conducted within clinical practice in a university-based outpatient clinic since 2016. This study serves as retrospective quality control of this program. In a retrospective cohort study, we assessed the physical fitness of pwMS and the impact of the program on short- and long-term PA changes and behavioral determinants. The program consisted of four appointments each 2-4 weeks apart. Spiroergometric test results of female pwMS were compared to female non-MS controls who underwent a voluntary physical fitness analysis. The short version of the Freiburger questionnaire, self-developed questions and the modified Physical activity screening questionnaire (PASQ) were sent to all participants assessing the PA levels before the program, 3 months after the program (short-term), and at the time of the survey (long-term). Additionally, established questionnaires assessed behavioral determinants before the program and long-term. A total of 166 participants [mean age 38.32 (± 10.61 SD), mean EDSS 2.30 (±1.29 SD)] and mostly females (63.3%, n = 105) were included in the study and started the program. A total of 136 participants completed the program. Out of these 63.9% (n = 87) answered the questionnaires in 12.38 (±11.34 SD) months after finishing the program. At baseline female pwMS (n = 100) showed a lower physical fitness in comparison to non-MS controls (n = 26) (maximal workload (Watts): 138.86 ± 37.85 vs. 191.73 ± 45.25, p < 0.001; peak oxygen consumption (ml min-1 kg-1): 26.40 ± 7.23 vs. 31.56 ± 10.10, p = 0.020). pwMS were more regularly active in short- (62.1%) and long-term (55.2%) compared to baseline (24.2%, p < 0.001). Among the activated participants, we observed improved internal motivation (p = 0.002) and decreased perception of barriers (p = 0.006) compared to baseline. PwMS showed a lower physical fitness in comparison to non-MS controls. An individually tailored PA promotion program might improve behavioral determinants and thereby increase short- and long-term PA levels of pwMS.

Effects of coping mechanisms on nurses' practices and psychological well-being

Lockdown procedures brought on by the COVID-19 outbreak have severely limited athletes' possibilities to exercise, creating both physical and psychological difficulties. This study looked into how lockdowns affected people who participated in adventure sports, including cycling, swimming, and running. Examining the effect of lockdown on athletes' perceptions of instruction barriers. The study's specific goal was to look into the relationships between instruction volume, lockdown-specific resilience, perceptions of movement limitations, and instruction hurdles. The study also sought to examine the relationship between athletes' personal dedication to their sports and lockdown resilience, coping mechanisms, and perceived instruction constraints. An online survey was used to collect participant information. The survey was used to examine variables such as age, gender, country of residence, personal involvement in endurance sports, resilience, emotion regulation mechanisms, mobility limits, instruction regimens, and mental health. To find participants on pertinent internet sites, convenience sampling techniques were used. The data were examined statistically using multiple regression analysis and nonparametric testing. According to the study's findings, poorer instruction volume, a lower level of lockdown-specific resilience, and more unfavorable views of lockdown mobility limits were all linked to higher levels of perceived instruction barriers during the lockdown. According to the data, athletes that had a strong personal commitment to their sport showed stronger mental resilience. COVID-19 pandemic lockdown had an effect on athletes' preparation and mental health. Reduced instruction, a lack of resilience, and unfavorable opinions all increased hurdles. Strongly devoted athletes showed resilience, adaptive coping, and less burdens. Personal dedication and coping skills are essential for athletes' wellbeing through trying circumstances.

Formal help-seeking in intimate partner violence among Spanish-born and immigrant women in Spain: A focus group study.

Intimate partner violence (IPV) is a public health problem. In Spain, although the prevalence of IPV is greater in immigrant women than in Spanish-born women, immigrant women seem to access services to a lesser extent. This study aimed to explore and compare perceptions of barriers to and strategies for seeking formal help among Spanish-born and immigrant women IPV survivors. A qualitative study was conducted based on three focus groups with women of Spanish (n = 9), Romanian (n = 4), and Latin American (n = 4) origin. The thematic analysis was supported by Atlas.ti. Three categories and 12 subcategories were identified: general characteristics of help-seeking behavior (e.g., children as the main motivating factor), barriers (e.g., immigrant status, fear of the perpetrator), and strategies for accessing services (e.g., increasing education). Differences in help-seeking behavior were found between groups. Relevant information for professionals to improve women's access to IPV support services is provided.

Role of COVID-19 Caller Tune and Intention to Get Vaccinated: An Application of the Health Belief Model

This study examined the persuasive healthcare communication of COVID-19 vaccination using mobile phone caller tunes as cues to action in intention to get vaccinated. Results indicate that caller tunes have a significant impact on only two constructs of the health belief model (HBM)—perceived benefits and self-efficacy—which can lead to getting vaccinated. However, the individual’s perception of barriers, severity and susceptibility was not found to be influenced by the caller tunes. The study was conducted with a sample of 334 drawn from India who were in the process of getting vaccinated at the time of the data collection. Our analysis reveals that a well-designed caller tune message by incorporating aspects of all constructs of HBM may have a bigger impact in such an unprecedented crisis. There is a dearth of research focussing on the relevance of cues to action in public health communication, and our study is an attempt to address this gap.

Adult perceptions of mental health access barriers facing youth in rural Washington State: A group concept mapping study.

To explore adult community members' perspectives concerning barriers to mental health care that confront rural-dwelling youth. Group concept mapping, a participatory community-engaged research method, was used. Adult community members brainstormed and sorted statements describing barriers rural youth encounter in accessing mental health services. Point and cluster maps were created to visualize conceptual similarities between statements. Statements were rated according to their commonness and importance (1: low commonness/importance, 5: high commonness/importance). Thirty-five adults sorted and/or rated 71 barriers facing rural youth in accessing mental health services. Seven conceptual clusters were identified: system-level barriers, knowledge and communication, youth concerns, parent/guardian concerns, parent/guardian barriers, costs and convenience, and school-level barriers. Within youth concerns, community members also identified a subcluster focused on stigma. Common and important statements related to limited after-school programs and community mental health support initiatives. Group concept mapping methodology provides structure for conceptualizing challenges facing rural youth in accessing mental health services. Policies should be informed by rural community concerns and priorities. After-school and support programs may align with mental health needs identified by rural communities.

Pain, inconvenience and blame: defining work-related injuries in the veterinary workplace.

The veterinary workplace carries a high risk of staff accidents and injuries, yet there is scant research exploring it in comparison with other comparable fields, such as human medicine. To understand how veterinary professionals define injuries and to understand what injuries they do, or do not, deem reportable. A cross-sectional survey comprising demographic questions and open-text questions was shared with veterinary practice staff across the UK. Data were analysed descriptively and using an inductive content analysis. There were 740 respondents, who were broadly representative of the veterinary profession. There were differences in how injuries were defined; for example, small animal veterinarians expected injuries to involve blood, while equine and production animal veterinarians were more likely to expect injuries to reduce their ability to perform work and require medical treatment. Many suggested that 'all' workplace injuries should be reported; however, 'minor' injuries were often overlooked, for example, needlestick injuries did not always meet the criteria of being an 'injury'. Injuries caused by staff themselves (e.g. trips) were less likely to be reported than injuries that could be blamed on an external factor (e.g. dog bite). Collectively, the data suggest a wide-ranging perception of risk of injury in practice, with some harms seen as 'everyday norms'. Veterinary practices should interpret their injury statistics with a high degree of caution. They should explore the microcultures within their practices relating to worker perception of risk, injury and barriers to reporting.

Advancing minimally invasive hepato-pancreato-biliary surgery: barriers to adoption and equitable access.

Despite a growing body of literature supporting the safety of robotic hepatopancreatobiliary (HPB) procedures, the adoption of minimally invasive techniques in HPB surgery has been slow compared to other specialties. We aimed to identify barriers to implementing robotic assisted surgery (RAS) in HPB and present a framework that highlights opportunities to improve adoption. A modified nominal group technique guided by a 13-question framework was utilized. The meeting session was guided by senior authors, and field notes were also collected. Results were reviewed and free text responses were analyzed for major themes. A follow-up priority setting survey was distributed to all participants based on meeting results. Twenty three surgeons with varying robotic HPB experience from different practice settings participated in the discussion. The majority of surgeons identified operating room efficiency, having a dedicated operating room team, and the overall hospital culture and openness to innovation as important facilitators of implementing a RAS program. In contrast, cost, capacity building, disparities/risk of regionalization, lack of evidence, and time/effort were identified as the most significant barriers. When asked to prioritize the most important issues to be addressed, participants noted access and availability of the robot as the most important issue, followed by institutional support, cost, quality of supporting evidence, and need for robotic training. This study reports surgeons' perceptions of major barriers to equitable access and increased implementation of robotic HPB surgery. To overcome such barriers, defining key resources, adopting innovative solutions, and developing better methods of collecting long term data should be the top priorities.

A human resource professional perspective of strategies to accommodate employees with mental health conditions in the workplace in South Africa.

The South African Labour Relations Act, specifically the Code of Good Practice (CGP) advocates against the discrimination and unfair dismissal of individuals with mental health conditions in the workplace. However, little is known about the implementation of these national policies within the workplace, especially from the perspective of the employer rather than the employee. The aim of this study was to explore the experiences and perceptions of how human resource practitioners accommodate and support individuals with mental health conditions in the workplace. Eleven participants (Human Resource Professionals) participated in the study. The researchers utilized semi-structured interviews where the data was analysed by means of thematic analysis to formulate themes. Three themes emerged depicting the participants' experiences and perceptions of barriers and facilitators which influenced their return to work: The themes that emerged through thematic analysis consisted of 1) Challenges perceived by Human Resource personnel that influences work participation; 2) The influence that workplace accommodations and support structures have on the work participation; 3) The prevalence of policies and laws that are available in theworkplace. The study highlighted that Human Resource Professionals struggle to interpret and implement labor related polices that aid in employing individuals with mental health conditions in the workplace. It is important to implement strategies that will assist Human Resource practitioners in understanding how to implement such policies to successfully accommodate individuals with mental health conditions in the workplace.

Research on the psychoanalytic intervention of user reactive habits and avoidance

Lockdown procedures brought on by the COVID-19 outbreak have severely limited athletes' possibilities to exercise, creating both physical and psychological difficulties. This study looked into how lockdowns affected people who participated in adventure sports, including cycling, swimming, and running. Examining the effect of lockdown on athletes' perceptions of instruction barriers. The study's specific goal was to look into the relationships between instruction volume, lockdown-specific resilience, perceptions of movement limitations, and instruction hurdles. The study also sought to examine the relationship between athletes' personal dedication to their sports and lockdown resilience, coping mechanisms, and perceived instruction constraints. An online survey was used to collect participant information. The survey was used to examine variables such as age, gender, country of residence, personal involvement in endurance sports, resilience, emotion regulation mechanisms, mobility limits, instruction regimens, and mental health. To find participants on pertinent internet sites, convenience sampling techniques were used. The data were examined statistically using multiple regression analysis and nonparametric testing. According to the study's findings, poorer instruction volume, a lower level of lockdown-specific resilience, and more unfavorable views of lockdown mobility limits were all linked to higher levels of perceived instruction barriers during the lockdown. According to the data, athletes that had a strong personal commitment to their sport showed stronger mental resilience. COVID-19 pandemic lockdown had an effect on athletes' preparation and mental health. Reduced instruction, a lack of resilience, and unfavorable opinions all increased hurdles. Strongly devoted athletes showed resilience, adaptive coping, and fewer burdens. Personal dedication and coping skills are essential for athletes' wellbeing through trying circumstances.

Development of a COVID-19 pandemic psychological endurance and coping efficiency model

Lockdown procedures brought on by the COVID-19 outbreak have severely limited athletes' possibilities to exercise, creating both physical and psychological difficulties. This study looked into how lockdowns affected people who participated in adventure sports, including cycling, swimming, and running. Examining the effect of lockdown on athletes' perceptions of instruction barriers. The study's specific goal was to look into the relationships between instruction volume, lockdown-specific resilience, perceptions of movement limitations, and instruction hurdles. The study also sought to examine the relationship between athletes' personal dedication to their sports and lockdown resilience, coping mechanisms, and perceived instruction constraints. An online survey was used to collect participant information. The survey was used to examine variables such as age, gender, country of residence, personal involvement in endurance sports, resilience, emotion regulation mechanisms, mobility limits, instruction regimens, and mental health. To find participants on pertinent internet sites, convenience sampling techniques were used. The data were examined statistically using multiple regression analysis and nonparametric testing. According to the study's findings, poorer instruction volume, a lower level of lockdown-specific resilience, and more unfavorable views of lockdown mobility limits were all linked to higher levels of perceived instruction barriers during the lockdown. According to the data, athletes that had a strong personal commitment to their sport showed stronger mental resilience. COVID-19 pandemic lockdown had an effect on athletes' preparation and mental health. Reduced instruction, a lack of resilience, and unfavorable opinions all increased hurdles. Strongly devoted athletes showed resilience, adaptive coping, and less burdens. Personal dedication and coping skills are essential for athletes' wellbeing through trying circumstances.

Persepsi Orang Tua dan Pengasuh terhadap Pemberian Imunisasi Rutin pada Balita Pasca Pandemi Covid-19

Immunization is an effective strategy of the government to reduce morbidity and mortality from Preventable Diseases by Immunization (PD3I). During the Covid-19 pandemic, this situation had a significant impact on the health sector, reducing immunization coverage rates. Currently, Indonesia is in the post-Covid-19 pandemic phase characterized by positive trends in pandemic control. This study aims to understand the perceptions of parents or caregivers regarding the provision of routine immunization to children in the post-Covid-19 pandemic era. The research method used a cross-sectional design with sampling using the quota sampling method, with a total of 100 respondents. Data were collected through a questionnaire adopting the health belief model theory to parents or caregivers who brought their children to the Posyandu for immunization. The results showed that perceptions of vulnerability (p value = 0,071), seriousness (p value = 0,121), and cues to action (p value = 0,731) had an insignificant effect on immunization for toddlers, while perceptions of benefits (p value = 0,008), barriers (p value = 0,000), and self-efficacy (p value = 0,000) had a significant effect on immunization for toddlers in the post-Covid-19 pandemic era (p value &lt; 0.05). The components of the health belief model that form the perceptions of parents or caregivers towards immunization are interconnected, although not all are statistically significant. Therefore, perceptions of vulnerability, seriousness, and cues to action need to be improved to form a good perception of immunization after the Covid-19 pandemic

Professional perceptions of barriers and facilitators from the implementation of a neonatal early supported transfer to home intervention for late preterm infants: a qualitative study.

Professional perceptions of barriers and facilitators from the implementation of a neonatal early supported transfer to home intervention for late preterm infants: a qualitative study.

Digitalising Specialist Smoking Cessation Support in Pregnancy: Views of Pregnant Smokers.

Unsupported attempts to quit smoking during pregnancy have a low success rate. Chances of quitting successfully are higher with an interpersonal treatment programme but there is low uptake of this in the United Kingdom (UK). Delivering a pregnancy-specific treatment programme digitally may provide an alternative treatment route. This study explored pregnant smokers' perceptions of barriers and facilitators to using digital cessation support, along with identifying modes of delivery and engagement enhancers. Semi-structured interviews were carried out with an ethnically and socioeconomically diverse sample of 25 participants with recent experience of attempting to quit smoking in pregnancy, aged 20 - 40, from the UK. An inductive thematic analysis approach was used. Digital smoking cessation support, particularly a smartphone app, for pregnancy was felt to overcome many barriers to engaging with interpersonal support, being viewed as more convenient and non-judgemental, providing better consistency of advice, and enhancing privacy and autonomy. However, some participants felt that removing access to a human could undermine a digital support package and reduce engagement. Popular engagement enhancers included self-monitoring (e.g. digital recording of smoking; smartphone-linked carbon monoxide monitoring), online communities, and remote access to nicotine substitution options. Digital support was viewed as having potential as a stand-alone intervention or working in conjunction with standard interpersonal treatment. The findings support the investigation of a digital support package as both a stand-alone and adjunct to standard interpersonal cessation support in pregnancy to increase the proportion of pregnant smokers who make a supported quit attempt. In many countries like the UK, there are few smoking cessation options routinely available that provide effective support for smoking cessation in pregnancy. To maximise impact, health services need an effective range of strategies to engage with and support quit attempts made by all pregnant smokers, particularly as interpersonal support options are not often well engaged with. Development of a pregnancy-specific digital support package for smoking cessation in pregnancy may represent a means to help address this gap.

Investigation on pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China

ObjectiveThis study aimed to understand the current status of pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China, and to provide a reference for further improving the quality of pharmaceutical care and perfecting the construction of pharmaceutical care system in China. MethodsThe PCBS-CH scale (Pharmaceutical Care Barriers Scale in Chinese Hospitals) was used to measure the perceived pharmaceutical care barriers of clinical pharmacists, and descriptive statistical analysis was used to identify the main barriers faced by clinical pharmacists. The different barriers perceived by clinical pharmacists with various characteristics was investigated by subgroup analysis. ResultsA total of 1266 clinical pharmacists from 31 provinces were finally included. The results revealed that the main barriers faced by clinical pharmacists in the process of implementing pharmaceutical care included lack of additional staffing, lack of time for pharmaceutical care provision and continuing education, and lack of an electronic information system and prescription evaluation system for pharmaceutical care. Subgroup analysis found that clinical pharmacists who are without training (P < 0.001), worked in tertiary hospitals (P = 0.036), and had other training certificates (P < 0.001) perceived higher pharmaceutical care barriers. ConclusionClinical pharmacists in secondary and tertiary hospitals in China have a low perception of overall pharmaceutical care barriers, but still face some important barriers. In order to promote the development of pharmaceutical care in China, the quality of clinical pharmacists should be improved, strict entry criteria should be established, clear responsibilities should be defined, the rights of female clinical pharmacists should be protected, and hospital facilities should be upgraded.

Influential Factors Affecting the Intention to Utilize Advance Care Plans (ACPs) in Thailand and Indonesia

Demographic shifts resulting from population aging are evident globally, including in Southeast Asia, Thailand, and Indonesia. The relevance of advance care plans is becoming increasingly apparent as the worldwide demographic transforms due to aging. This study sought to investigate the factors influencing the use and implementation of advance care plans (ACPs) using the health belief model (HBM) and technology acceptance model (TAM). This study selected a sample of individuals aged 30–60 in Indonesia and Thailand based on established inclusion and exclusion criteria. The study utilized the purposive random sampling method, integrating aspects of purposive and random selection. A total of 532 questionnaires were distributed via an online form, and 472 were obtained after data cleaning. Most respondents to this survey came from Indonesia, comprising 238 out of 472 respondents (50.4%), and from Thailand, comprising 49.5%; most respondents were women who were between 36 and 40 years old, and most reported graduating with a bachelor’s degree. A significant construct influences the use of advance care plans, i.e., perceived barriers. The perceived barrier (PBA) construct included data security, accessibility, and language barriers. In summary, overcoming existing barriers can indirectly increase the benefits of advance care plans. The results show that perceived usefulness (β = 0.189, p &lt; 0.001), perceived ease of use (β = 0.150, p &lt; 0.01), perceived susceptibility (β = 0.153, p &lt; 0.01), perceived severity (β = 0.105, p &lt; 0.05), and perceived benefits (β = 0.241, p &lt; 0.001) all had significant positive effects on behavioral intention. In contrast, health motivation (β = 0.073, p = 0.100) and perceived barriers (β = 0.034, p = 0.134) did not show significant relationships with behavioral intention in Indonesia and Thailand, offering insights into both countries’ development strategies and the promotion of advance care plans with media as the technology.

Effective Use of Interpreter Services for Diverse Patients in a Safety-Net Hospital: Provider Perceptions of Barriers and Solutions

Culturally and linguistically diverse (CALD) patients should but do not routinely receive professional interpretation. The authors examined provider perceptions of barriers and solutions to interpreter services (IS) in a safety-net hospital to inform quality improvement (QI). A 13-item survey was distributed to 750 clinicians representing 10 services across professional roles, including social workers. Closed- and open-ended questions addressed accessing IS, IS value, and care for CALD patients. Respondents ranked eight barriers to routine IS use and provided ideas for improvement. Descriptive statistics characterized survey results in aggregate and by professional role and care team. Quantitative and qualitative results were triangulated for agreement between survey domains and coded free-text response themes. A total of 221 responses were analyzed (29.5% response rate). Cost was the lowest-ranked barrier across roles. Leading barriers were efficiency pressures and cumbersome access. Free-text responses agreed with these findings. CALD patients were perceived to have higher complication risk by 87.5% of social workers but by 56.8% of other roles. Recommendations to increase IS varied by team: streamlined access process (46.2% emergency, 37.8% inpatient respondents), expanded in-person interpretation (55.6% inpatient, 45.8% perioperative respondents), and better equipment (44.4% outpatient, 35.9% emergency, 25.0% perioperative respondents). Provider experiences vary by care team and interpretation modality. Interpretation services are cumbersome to access and compete with efficiency pressures, leading to shortcuts that fail to provide adequate language access. Three initial QI efforts resulted: increased video interpretation equipment, a new language access committee, and a new language access leadership role.