Positive Staff Attitudes Research Articles

Barriers and facilitators of access to maternity care for African-born women living in Australia: a meta-synthesis of qualitative evidence

BackgroundAdverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women’s access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia.MethodsThe search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque’s framework of healthcare access.ResultsOut of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted.ConclusionsThis review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women’s unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women’s engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population.Systematic review registrationPROSPERO CRD42023405458.

Determinants of Bluetooth-Enabled Self-Measured Blood Pressure Monitoring in Federally Qualified Health Centers.

In 2021, the Health Resources and Services Administration (HRSA) launched the National Hypertension Control Initiative (HTN Initiative) with the goal to enhance HTN control through Bluetooth-enabled self-measured blood pressure (BT-SMBP) monitoring and use this data to inform clinical decisions in Federally Qualified Health Centers (FQHCs) with a large proportion of their population with uncontrolled blood pressure (BP). We sought to understand the experience of Michigan-based FQHCs in implementing the HTN initiative. Staff from three Michigan-based FQHCs were invited to participate in semi-structured interviews from September to November 2022. Interviews were conducted in-person and were based on the Tailored Implementation in Chronic Diseases framework. Content analysis was performed by three coders. Ten staff participated in interviews (FQHC 1: n = 6, FQHC 2: n = 1, FQHC 3: n = 3). The FQHCs differed in their stage of implementation and their approach. FQHC 1 created a large-scale, community health worker driven program, FQHC 2 created a small-scale, short term, BP device loan program, and FQHC 3 created a primarily outsourced, large-scale program through a contracted partner. Positive staff attitudes and outcome expectations, previous experience with SMBP grants, supportive clinic leadership, social support, and free BP cuff resources were identified as facilitators to implementation. Patients' high social needs, SMBP-related Technology, and insufficient workforce and staff capacity were identified as barriers. BT-SMBP among FQHC patients is promising but challenges in integrating SMBP data into clinic workflow, workforce capacity to support the high social needs of participants, and to assist in reacting to the more frequent BP data remain to be overcome.

How employees perceive and (dis)engage with ‘green’ practices in luxury hotels

The success of implementation of ‘green’ practices in hotels depends on employees. Many studies assume that hotel employees perceive ‘green’ practices positively and, therefore, engage with environmental conservation. Employees can, however, feel negative towards ‘green’ practices and disengage with their implementation. By interviewing 28 frontline employees in luxury hotels in China, this study explores their perceptions of ‘green’ practices and related behavioural response. The study finds that employee perceptions can be categorised as positive, neutral, and negative falling into four types: value creation; image building; control system; formalism. These perceptions trigger five patterns of behavioural response ranging from positive (pro-active support), via neutral (passive compliance; indifference) to negative (informal protest; avoidance). The study enables preliminary conceptualisation of complex employee response to environmental sustainability interventions in luxury hotels in China and beyond. The study outlines measures for hotel administrations to facilitate positive staff attitudes to environmental conservation.

Digital health and technologies

Digital health was given impetus by the COVID-19 pandemic and demonstrated its potential for the delivery of safe care in the community. Remote monitoring and virtual wards are becoming mainstreamed across the UK. Artificial intelligence (AI) software has the potential to transform healthcare delivery but its trustworthiness is a key challenge. Positive staff attitudes towards digital health and new ways of working require staff education and engagement. Continued attention is required to meet the needs of those without access to digital technology and its use.

Navigating the application of new innovations: Establishing an indocyanine green lymphography clinic in Australia.

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long-term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi-structured interviews of key staff participants from a quaternary public hospital sixmonths after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N= 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice.

Access to health care for people with stroke in South Africa: a qualitative study of community perspectives

BackgroundIncidence of stroke is increasing in sub-Saharan Africa. People who survive stroke experience disability and require long-term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures.MethodsIn-depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non-government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as proposed by Levesque et al. to map and inform barriers to accessing health care from the user perspective.ResultsPWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS.ConclusionsStrategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services.

Perspectives on linkage to care for patients diagnosed with HIV: A qualitative study at a rural health center in South Western Uganda.

Linkage to care for newly diagnosed human immunodeficiency virus (HIV) patients is important to ensure that patients have good access to care. However, there is little information about factors influencing linkage to care for HIV patients. We aimed to identify existing measures in place that promote linkage to care and to explore facilitators and barriers to linkage to care for clients diagnosed with HIV/acquired immune deficiency syndrome at a rural health center in Uganda. This descriptive qualitative study enrolled 33 purposively selected participants who included expert clients, linkage facilitators, heads of families with people living with HIV, and health workers. Data were collected using in-depth interviews that were audio-recorded, transcribed, and translated. The data were manually analyzed to generate themes. The following four themes were generated: 1) availability of services that include counseling, testing, treatment, follow-up, referral, outreach activities, and support systems. 2) Barriers to linkage to care were at the individual, health facility, and community levels. Individual-level barriers were socioeconomic status, high transport costs, fear of adverse drug effects, fear of broken relationships, and denial of positive results or treatment, while health facility barriers were reported to be long waiting time, negative staff attitude, and drug stock outs. Community barriers were mostly due to stigma experienced by HIV clients, resulting in discrimination by community members. 3) Facilitators to linkage to care were positive staff attitudes, access to information, fear of death, and support from others. 4) Suggestions for improving service delivery were shortening waiting time, integrating HIV services, increasing staff numbers, and intensifying outreaches. Our findings highlight the importance of stakeholder involvement in linkage to care. Access and linkage to care are positively and negatively influenced at the individual, community, and health facility levels. However, integration of HIV services and intensifying outreaches are key to improving linkage to care.

Towards universal health coverage for people with stroke in South Africa: a scoping review

ObjectivesTo explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA).SettingSA.DesignScoping review.Search methodsWe...

Identifying positive change within the NHS as a result of the COVID–19 pandemic

We aimed to identify positive change within the NHS as a result of the COVID-19 pandemic by assessing staff views on re-deployment, wellbeing and workplace satisfaction. An anonymous questionnaire was sent out to medical staff working across four major NHS trusts using SurveyMonkey. We surveyed staff working in NHS trusts across London and the surrounding areas. We used a randomly selected range of medical, nursing and dental staff across multiple specialties, including those who were redeployed and those who were not. We reviewed positive and negative responses to binary questions.Staff surveyed felt a greater sense of workplace camaraderie and fellowship, and generally more appreciated as NHS caregivers than they had prior to the COVID-19 pandemic. It is clear that the pandemic has been a catalyst for reflection, as a majority of staff (71.43%) felt there was more mental health and wellbeing support accessible in their workplace now than there was a year ago, and 75.63% felt that COVID-19 had influenced their perspective on work-life balance. The first wave of the pandemic engendered positive change, and positive staff attitudes persisted in the face of a second wave due to ascribed support, appreciation, and co-worker camaraderie and fellowship.

Perspectives of Adolescent Girls and Young Women on Optimizing Youth-Friendly HIV and Sexual and Reproductive Health Care in Zambia.

Youth-friendly health care delivery models are needed to address the complex health care needs of adolescent girls and young women (AGYW). The aim of this study is to explore the lived experiences of AGYW seeking comprehensive HIV and sexual and reproductive health (SRH) care and to elicit their preferences for integrated health care services. We conducted in-depth interviews and focus group discussions in Lusaka, Zambia among 69 AGYW aged 10-20 who were HIV-negative or of unknown status and 40 AGYW aged 16-24 living with HIV. The data were coded through deductive and inductive processes and analyzed thematically using modified World Health Organization (WHO) dimensions of quality for youth-friendly services. AGYW expressed preference for one-stop clinics with integrated services that could provide HIV services along with other services such as pregnancy testing and family planning. AGYW also wanted information on staying healthy and approaches to prevent disease which could be delivered in the community setting such as youth clubs. An integrated clinic should address important attributes to AGYW including short wait time, flexible opening hours, assurance of confidentiality and positive staff attitudes. Youth-friendly, integrated care delivery models that incorporate AGYW preferences may foster linkages to care and improve outcomes among vulnerable AGYW.

Oral health perceptions and client satisfaction among homeless adults attending a community-centred dental clinic.

The homeless face significant barriers accessing dental care. Community-centred dental clinics might provide more accessible care to this group. This descriptive epidemiological study aimed to measure oral health perceptions and client satisfaction among homeless and similarly disadvantaged adults receiving community-centred dental care. A sample of 79 clients attending St Patrick's Oral Health Clinic completed Locker's Global Oral Health Item, the Oral Health Impact Profile 14 and the Client Satisfaction Questionnaire 4. High levels of satisfaction with St Patrick's Oral Health Clinic were based on positive staff attitudes, low cost, time effectiveness and staff sensitivity to anxiety. Ideas for improvement included shorter treatment waiting lists, offering additional treatment types and better communication and advertisement of the service. Compared to the general Australian population, participants reported a relatively poor self-perception of oral health and a high prevalence and severity of oral health impacts. Participants experienced significant personal and social impacts due to their oral conditions. High levels of client satisfaction reflect the value of community-centred dental care for this group. An understanding of factors influencing satisfaction might be useful for similar services providing oral care to homeless and similarly disadvantaged groups.

"It Depends on What They Experience in Each Health Facility. Some Are Satisfied, Others Are Not." A MixedMethods Exploration of Health Workers' Attitudes Towards Performance-Based Financing in Burkina Faso.

Background: Evidence emerging from qualitative studies suggests the existence of substantial variation in how health workers experience performance-based financing (PBF) within the same setting. To date, however, no study has quantified or systematically explored this within-setting heterogeneity. Considering that differences in health workers’ affective reactions to PBF likely constitute an important element mediating the effectiveness of PBF in improving health service delivery, systematic and tangible information will be highly valuable to policy-makers and program managers who aim to maximize positive impacts of PBF. Our study aimed at contributing to filling this gap in knowledge by quantifying health workers’ knowledge of, satisfaction with, and perceptions of PBF in Burkina Faso, and exploring factors associated with heterogeneity therein. Methods: The study employed a post-intervention cross-sectional explanatory mixed methods study design with a dominant quantitative component – a structured survey to a total of 1314 health workers from 396 intervention health facilities – and a small and focused qualitative component – key informant interviews with 5 program managers – to triangulate and further elucidate the quantitative findings. Quantitative data were analyzed descriptively as well as using 3-level mixed-effects models. Qualitative data were analyzed in a largely deductive process along the quantitative variables and results. Results: Health workers were on average moderately satisfied with PBF overall, with a slight tendency towards the positive and large variation between individuals. Two-thirds of health workers did not have adequate basic knowledge of key PBF elements. Perceived fairness of the performance evaluation process, of the bonus distribution process, and satisfaction with the individual financial bonuses varied dramatically between respondents. Factors associated with heterogeneity in knowledge, satisfaction, and fairness perceptions included responsibility at the facility, general work attitudes, management factors, and training in and length of exposure to PBF. Conclusion: Findings imply that investments into staff training on PBF and manager training on organizational change processes might be beneficial to positive staff attitudes towards PBF, which in turn would likely contribute to improving the effectiveness of PBF.

Implementation of supported employment in the context of a national Canadian program: Facilitators, barriers and strategies.

To describe facilitators, barriers, and strategies to implementation of the Canadian national At Work/Au travail program. This program funded supported employment services, following some of the principles of the Individual Placement and Support (IPS) model, in 12 sites across Canada. We conducted on-site individual interviews (12) and focus groups (15) with 35 employment support workers, 12 team supervisors or managers, and 10 directors or CEOs. Interview summaries were created and coded using thematic analysis techniques. Codes were then distilled into themes grouping prominent barriers and facilitators to implementation. Four themes emerged: (i) national program structure: Flexible eligibility criteria and flexibility in use of subsidy funds were perceived as generally helpful, although there were difficulties associated with communication around noneligibility decisions and outcome targets; (ii) training and reinforcement: The support provided to sites was generally thought to be an important facilitator, especially when more intensive. Several participants viewed the online IPS training as a facilitator; (iii) external factors: Rules concerning impacts of employment earnings on benefits could be viewed as a barrier; and (iv) internal factors: Facilitators included strong leadership, positive staff attitudes, and larger program size. Several participants reported staff resistance as a barrier. Several features of the national program structure and leadership emerged that could be maintained if the program were extended elsewhere. The flexibility allowed for spending of wage subsidy funds, as well as the provision of more intensive training, were both perceived as potential enhancements to an eventual expansion of the program. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Perceived barriers and enablers to conducting nursing assessments in residential aged care facilities in Victoria, Australia

Objective: Nurses working in aged care facilities need to be adequately prepared to manage the increasingly complex care needs of older people. This paper reports on the views of nurses on the barriers and enablers to conducting nursing assessments with older people in residential aged care, six weeks after attending a four day education and training workshop on this topic. Design: Descriptive evaluation. Setting: Data were collected in a range of venues in which the education was delivered. Subjects: Registered (RNs) and enrolled (ENs) nurses (n= 345) working in residential aged care facilities in Victoria, Australia. Findings: Fourteen barriers and eight enablers, which affect the capacity of nurses to conduct assessments with older people, were identified. The most common cited barriers included lack of time (78%), residents’ poor state of health (41%) and the absence of equipment (33%). Common enablers were organisational support (38%); staff education and training (29%); having the appropriate equipment (22%); positive staff attitudes (17%) and the resident’s condition and cooperation (16%). Conclusion: Nursing assessments are vital to the delivery of quality and evidence based aged care. The issues identified provide aged care services and managers with a basis for ensuring that nurses have the necessary preparation, training and ongoing support to perform the appropriate and required assessments to provide the best possible care.

Enablers of adherence to clinic appointments for children attending an antiretroviral clinic in Northern Nigeria: Perspectives of caregivers and care providers.

Nigeria has the highest burden of paediatric HIV infection, and the success of control efforts in the country is crucial to the global control of the HIV epidemic. However, defaults from schedules of care pose a threat to paediatric HIV control in Nigeria. This study was conducted in a pioneer facility for the implementation of the National HIV Prevention and Treatment Programmes. The objective of this study was to explore factors that facilitate adherence to clinic appointments from perspectives of child caregivers and service providers. This is a qualitative study using in-depth, face-to-face interviews conducted in 2016. Thirty-five participants were purposely sampled to comprise types of caregivers of HIV-exposed/infected children receiving care and from categories of service providers. The interviews were audio recorded, transcribed, thematically analysed and presented using a socioecological model. The themes that emerged from participants' narratives included advanced education, affluence and residing close to the clinic at the intrapersonal level. Stable family dynamics and support, HIV status disclosure and being a biologic parent or grandparent as caregiver emerged at the interpersonal level. At the community level, disclosure and support were identified, while at the health facility level, positive staff attitude, quality of healthcare and peer support group influence were factors identified to facilitate regular clinic attendance. The factors that enable retention of children in care are multidimensional and intricately connected. Programme improvement initiatives should include regular assessment of clients' perspectives to inform implementation of strategies that could reinforce caregiver confidence in the health system.

Breast cancer screening in women with cerebral palsy: Could care delivery be improved?

BackgroundWomen with disabilities (WWD) have reported lower mammography rates than the general population, however rates for women with cerebral palsy (CP) have not been specifically studied. ObjectiveTo evaluate mammography rates in women with CP and to identify strengths and barriers with their screening experience. MethodsWomen with CP 40 years or older (n = 118) participating in a prospective cross-sectional survey were queried regarding screening status, imaging modality, and accommodation needs and availability. Categorical variables were summarized and Chi-square testing used to assess factors contributing to screening compliance. The effect of functional factors on screening was evaluated using logistic regression. Results77 women (65.3%) had mammograms within the past two years; 56 (47.5%) were screening mammograms. Severity of fine motor deficits was associated with lack of screening (OR 0.559, p = 0.019). 85 (72.0%) experienced positive staff attitudes. Facilities most often met needs for ramps, elevators, and/or wide doorways (92.9%), exam explanations (84.4%), and accessible parking (82.5%). Needs least often met included accommodations for standing (59.3%) or for difficulties with arm/shoulder positioning (57.1%), and wheelchair-accessible mammogram machines (59.1%). ConclusionsThe screening compliance rate for women with CP is low, although the 2-year mammography rate is comparable to that reported for WWD and the general female U.S. population. Women were usually offered respectful care. Adequate physical accommodations during the procedure were reported less often than overall facility environmental accommodations. These findings demonstrate the need for improved screening rates in women with CP, and highlight areas for improving their screening experience.

Employee involvement climate and climate strength

PurposeAddressing the continuing productivity challenge, the purpose of this paper is to analyze data from the National Health Service on employee involvement (EI) in order to gain critical insights into how employees’ shared perception of EI in organizational decision making (i.e. EI climate) might address two persistent issues: how to enhance positive staff attitudes and improve organizational performance. In doing so, the authors respond to recent calls for more multilevel research and extend previous research on EI climate by attending to both EI climate level and EI climate strength.Design/methodology/approachData from 4,702 employees nested in 33 UK hospitals were used to test the moderating role of EI climate strength in the cross-level EI climate level employee level-attitudes relationship and in the organizational-level EI climate-organizational effectiveness relationship.FindingsThe results of the multilevel analyses showed that EI climate level was positively associated with individual-level employee attitudes (i.e. job satisfaction, organizational commitment). Further the results of the hierarchical regression analysis and the ordinal logistic regression analysis showed that EI climate level was also related to organizational effectiveness (i.e. lower outpatient waiting times, higher performance quality). In addition, both analyses demonstrated the moderating role of EI climate strength, in that the positive impact of EI climate level on employee attitudes and organizational effectiveness was more marked in the presence of a strong climate compared to a weak EI climate.Practical implicationsBy creating and maintaining a positive and strong climate for involvement, hospital managers can tackle the productivity challenge that UK hospitals and health care institutions more generally are currently facing while improving the attitudes of their employees who are critical in the transformative process and ultimately underpin the organizational success.Originality/valueThis is the first study which provides evidence that favorable and consistent collective recognition of EI opportunities by staff contributes to enhance both employee attitudes and hospital performance. Results highlight the role of EI climate strength and underscore its importance in future research and practice.

Ottawa Model of Implementation Leadership and Implementation Leadership Scale: mapping concepts for developing and evaluating theory-based leadership interventions.

PurposeLeadership in health care is instrumental to creating a supportive organizational environment and positive staff attitudes for implementing evidence-based practices to improve patient care and outcomes. The purpose of this study is to demonstrate the alignment of the Ottawa Model of Implementation Leadership (O-MILe), a theoretical model for developing implementation leadership, with the Implementation Leadership Scale (ILS), an empirically validated tool for measuring implementation leadership. A secondary objective is to describe the methodological process for aligning concepts of a theoretical model with an independently established measurement tool for evaluating theory-based interventions.MethodsModified template analysis was conducted to deductively map items of the ILS onto concepts of the O-MILe. An iterative process was used in which the model and scale developers (n=5) appraised the relevance, conceptual clarity, and fit of each ILS items with the O-MILe concepts through individual feedback and group discussions until consensus was reached.ResultsAll 12 items of the ILS correspond to at least one O-MILe concept, demonstrating compatibility of the ILS as a measurement tool for the O-MILe theoretical constructs.ConclusionThe O-MILe provides a theoretical basis for developing implementation leadership, and the ILS is a compatible tool for measuring leadership based on the O-MILe. Used together, the O-MILe and ILS provide an evidence- and theory-based approach for developing and measuring leadership for implementing evidence-based practices in health care. Template analysis offers a convenient approach for determining the compatibility of independently developed evaluation tools to test theoretical models.

Organizational Capacity Building for Sexual Health Promotion

ABSTRACTWe present an organizational capacity building program that is a systemic approach to training professionals, creating organizational policies and practices, and enhancing the physical environment with materials about sexual and reproductive health. The evaluation of four different organizations showed increases over six months in: staff reports of administrative support for providing materials and referrals to clients, as well as having sexual health conversations with clients; positive staff attitudes about, and preparedness for, providing sexual health information; and knowledge about sexual health. All were sustained at twelve months. Environmental enhancement with educational materials and condom distribution also increased.

Staff perspectives regarding the implementation of a yoga intervention with chronic pain self-management in a clinical setting

Chronic pain affects millions of Americans and can be addressed through multiple modalities, interventions, and strategies. Yoga and self-management have been proven effective in treating chronic pain, but little research has been conducted on the feasibility and implementation barriers related to these alternative intervention forms. In our qualitative study, we examined staff perceptions regarding the feasibility of implementing yoga along with established self-management at a pain management clinic in Colorado. We utilized the Implementation Drivers of Competency, Organizational, and Leadership, and our added Hypothetical Driver to explore barriers and facilitators related to project implementation. Our findings suggest that positive staff and patient attitudes were crucial for successful implementation. We also identified physical space, transportation, and supportive leadership as necessary components of project implementation. Further research is needed to examine barriers such as funding to ensure intervention sustainability and the need for adequate staffing.