Practical Hurdles Research Articles

Locked-down learning amid COVID-19: young refugees in Greece and their supporters co-navigating a new crisis

ABSTRACT Greece, and the hundreds of thousands of refugees currently trapped in the country, are no strangers to ‘crisis’. Financial collapse and migration mismanagement were already severely impacting newcomers’ ability to participate in education before COVID-19 lockdowns made the situation even more dire. Based on interviews from a study on young refugees’ (aged 15–25) engagement with education in Greece, this paper explores how exactly lockdowns impacted learning and compounded pre-existing issues. It details how crisis was felt at the micro level as lost and disrupted learning opportunities, and as uncertainty and immobility – demonstrating the social, material and affective impacts of crises in the everyday. The paper also shows how youth expressed their relational agency by navigating constraints with the support of peers, educators and non-governmental organisations, even as technological and family-related issues came into play and supporters (or ‘co-navigators’) faced their own bureaucratic and practical hurdles. It concludes by arguing for sustained financial and political support for refugee-serving organisations, alongside greater flexibility and accessibility in the public education system.

A Tetrazine Amplification System for Visual Detection of Trace Analytes via Click‐Release Reactions

Achieving visual detection of analytes at ultra‐low concentrations in complex mixtures remains a persistent challenge. While sophisticated techniques offer single‐molecule sensitivity, practical hurdles remain, necessitating tailored signal amplification systems for direct visual detection. In this study, we develop a strategy for the visualized detection of tetrazine through a "click‐release‐oxidation‐cycle" (CROC) cascade amplification process. We systematically describe the construction and synthesis of this system, the kinetic process of click release, the kinetics of oxidation to tetrazine and its cascade amplification effect in trace amounts of tetrazine. This system is capable of amplifying the signal of tetrazine at a concentration as low as 2 nM by 105‐fold, thereby providing a clearly visible purple signal. Finally, as proof of concept, we successfully apply this method to visually detect trace β‐galactosidase (β‐gal) and Pd2+.

A Tetrazine Amplification System for Visual Detection of Trace Analytes via Click-Release Reactions.

Achieving visual detection of analytes at ultra-low concentrations in complex mixtures remains a persistent challenge. While sophisticated techniques offer single-molecule sensitivity, practical hurdles remain, necessitating tailored signal amplification systems for direct visual detection. In this study, we develop a strategy for the visualized detection of tetrazine through a "click-release-oxidation-cycle" (CROC) cascade amplification process. We systematically describe the construction and synthesis of this system, the kinetic process of click release, the kinetics of oxidation to tetrazine and its cascade amplification effect in trace amounts of tetrazine. This system is capable of amplifying the signal of tetrazine at a concentration as low as 2 nM by 105-fold, thereby providing a clearly visible purple signal. Finally, as proof of concept, we successfully apply this method to visually detect trace β-galactosidase (β-gal) and Pd2+.

From alcohol detoxification to treatment: A qualitative interview study on perceived barriers and assessed potential of mHealth among individuals postdetoxification.

Most individuals attending detoxification clinics do not pursue subsequent treatment. Earlier research has suggested that emerging technologies like mHealth interventions could address the postdetoxification treatment gap, yet it remains unclear whether patients themselves endorse such approaches. Our study aimed to qualitatively explore perceived treatment barriers and assessed potential of mHealth among individuals who have undergone alcohol detoxification. We conducted a single-interview-per-participant qualitative study, sampling participants (n = 23) that had visited the Stockholm substance use disorder emergency department for alcohol-related reasons, of whom n = 8 were purposively included due to having missed their scheduled follow-up outpatient appointment. Semistructured telephone interviews were conducted (2021-2022) and then systematically analyzed using reflexive thematic analysis. Across both areas of analysis, we identified six themes in total. We clustered barriers to postdetoxification treatment into three themes (10 subthemes) that may offer a nuancing perspective on previous research: "Misalignment between the treatment system and the individual," "Practical hurdles" and "Between reaching out and retreating." We identified three themes in participants' perspectives on mHealth as aftercare support, revealing expectations that such an approach may promote "self-awareness on own terms," assist in "navigating from solitary substance use struggles to supportive connections," and "offer a lifeline when needed most," thereby potentially resolving several barriers to treatment. This first qualitative study on barriers to alcohol treatment and mHealth potential postdetoxification offered various insights that may be translated into effective, real-world solutions to bridge the postdetoxification treatment gap. A natural next step for future research is to evaluate the impact of mHealth postdetoxification. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Theoretical and Practical Challenges in Assessing Intercultural Competence

Assessing intercultural competence is crucial in today's globalized business landscape. This study delves into the challenges of evaluating intercultural competence, focusing on dimensions like cultural understanding, adaptability, sensitivity, and intercultural interaction. By exploring theoretical frameworks and practical hurdles in assessing intercultural competence, the research aims to illuminate its evaluation across disciplinary contexts. Additionally, the study aims to elevate understanding of cultural differences, trust-building, effective communication, efficiency enhancement, and innovation fostering. It also seeks to offer comparative methods for evaluating dynamic intercultural competences at different learning stages and provide insights to enhance professional communication in diverse business settings. The study underscores the significance of creating inclusive assessment tools adaptable to diverse disciplinary contexts, with findings expected to provide valuable guidance for individuals navigating cultural differences in diverse and multicultural business settings.

Navigating identity shifts and well-being in the entrepreneurial exit process: A comparative study of entrepreneurs nearing retirement

Entrepreneurs in their 50s and beyond face significant identity shifts and well-being challenges as they transition out of the businesses they have built. Grounded in Super’s career-development framework and utilizing the Eisenhardt Method for case study analysis, this research explores the entrepreneurial exit process during the maturity and decline stages. With an average business tenure of 11 years, these entrepreneurs encounter emotional and practical hurdles, such as health concerns, financial pressures, and shifting priorities. The study highlights valuing identity diversification and social support in easing the transition, revealing that financial success alone does not guarantee positive post-exit well-being. Gender differences show women prioritize sustainability and family, while men focus on growth and professional identity. These insights underscore the need for early exit planning and holistic support for successful entrepreneurial succession and retirement strategies. JEL CLASSIFICATION: L26: Entrepreneurship; D91: Intertemporal Household Choice; Life Cycle Models and Saving; M14: Corporate Culture; Diversity; Social Responsibility; J14: Economics of the Elderly; Economics of the Handicapped; Non-labor Market Discrimination; I31: General Welfare, Well-being

Perspectives of psychiatrists on Mental Health Care Act, 2017: An in-depth pilot survey

ABSTRACT Background: The Mental Health Care Act, 2017 (MHCA, 17) was passed through both houses of the parliament. The Indian Psychiatric Society through its Patient’s Rights Task Force committee has been deliberating various rounds of discussion at levels of stakeholders, mental health professionals, and patients’ perspective. However, a scarce budget for mental health services, lack of trained mental health professionals, and poor infrastructure and logistics pose a challenge for this new act as still there is a lack of awareness of different provisions of MHCA at the administrative, judiciary, and public levels. Aim: The present study was undertaken to address the perspectives of psychiatrists related to MHCA,2017 its provisions. Materials and Methods: A self-administered questionnaire was designed to gather information on awareness about MHCA, 2017. The responses were collected from the member psychiatrists of Indian Psychiatric Society in a google form including the suggestions regarding amendments in MHCA, 2017. Results: 22.6% of participants were using MHCA in clinical practice completely, and 20.2% did not use it all. 52.4% stated that they are using it partly. Capacity assessment of the person suffering from mental illness was done by 52.4% of participants in day-to-day clinical practice. 35.7% denied assessing it. With respect to section 309 IPC, 31% were registering and managing suicide attempts as medico legal cases and 63.1% as non-MLC cases. 54.2% of the participants were not aware about medical insurance for mental health. The qualitative data suggest the act should be simplified including relaxation in provisions of minor, capacity assessment and ensure active functioning of various authorities. Conclusions: Amendments are required in MHCA, 2017 taking into cognizance the opinions from various practicing psychiatrists who are facing hurdles in routine clinical practice.

Leveraging Artificial Intelligence to enhance the Quality of Life for patients with Autism Spectrum Disorder: A Comprehensive Review

Integrating Artificial Intelligence (AI) into healthcare, specifically for managing autism spectrum disorder (ASD), offers transformative potential to enhance diagnostic accuracy, personalize treatment, and improve patient outcomes. This review explores the application of various AI programs in ASD management, discussing their functionalities, ethical considerations, implementation challenges, and the need for comprehensive regulatory frameworks. Critical AI applications such as AI-driven diagnostic imaging, predictive analytics, assisted therapy robots, remote monitoring, treatment personalization, decision support systems, and therapeutic chatbots are examined. Each technology is analyzed for its ability to improve the quality of life for individuals with ASD by offering more personalized, efficient, and effective care and support. Ethical issues, particularly concerning data bias and privacy, are highlighted as significant challenges that need addressing to maximize AI’s benefits while minimizing risks. Practical hurdles like integration with existing healthcare systems, the need for scalable solutions across diverse geographic and socio-economic contexts, and the high costs associated with AI development are also discussed. Furthermore, the review underscores the necessity for robust regulatory policies that ensure patient safety, protect data privacy and maintain high ethical standards in AI deployment. The paper concludes that while AI presents substantial opportunities for advancing ASD management, achieving these benefits requires a concerted effort from technologists, clinicians, ethicists, and policymakers to develop AI tools that are not only innovative but also ethical, equitable, and universally beneficial.

Social inclusion practices in the upstream supply chain: a systematic literature review

PurposeThis study conducts a systematic literature review (SLR) on social inclusion within upstream supply chains, targeting a notable literature gap in modern SCM discourse. By delving into this critical, yet underexamined, domain, this study spotlights the pressing need to incorporate social inclusion practices, particularly as global supply chains face increased scrutiny over their social ramifications. It examines social inclusion’s intricacies, offering practical insights for industry professionals to adopt, so that trustworthy social inclusion practices can proliferate across their upstream supply chains, thereby making a substantial contribution to both theoretical understanding and practical application.Design/methodology/approachEmploying five search queries across two leading academic databases, this investigation reviewed 86 articles that examined social issues related to social inclusion in the upstream supply chain. Via content analysis, this study aims to answer essential research questions and employs statistical bibliometric analyses to investigate the collected data further.FindingsThis study’s findings establish a definition of social inclusion within the upstream supply chain and present a conceptual framework delineating levers and indicators for evaluating such practices. Through rigorous analysis, it becomes apparent that mechanisms such as supplier compliance, collaboration and development are crucial for promoting social inclusion; however, their importance differs at various levels of suppliers in multi-tiered supply chains. Furthermore, a methodological matrix is introduced for assessing social inclusion practices’ efficacy, equipping practitioners with a roadmap for developing and executing strategies that extend social inclusion efforts throughout the supply chain, as well as emphasising these levers through monitoring, assessment and application of six specified indicators.Originality/valueThis study contributes to the dialogue surrounding upstream supply chain management by spotlighting social inclusion practices, addressing the literature gap in comprehending how social inclusion dynamics operate within upstream supply chains and outlining a distinct direction for forthcoming research. By highlighting the pressing importance of enhancing social inclusion practices, this study not only enriches the theoretical landscape but also lays the groundwork for subsequent empirical studies aimed at deciphering the complexities and practical hurdles associated with the efficient execution of these practices.

Education for deliberative democracy through the long-term view

This article argues that conceptualization through the long-term view strengthens the case for education for deliberative democracy. This is due to two key factors. First, education for deliberative democracy has novel potential in helping curb the negative effects of political polarization, which, when analyzed through longtermism, can be identified as an important existential risk factor. Second, education for deliberative democracy enables societies to defuse the threat of a value lock-in, and in doing so to keep their cognitive space open to enable increased flexibility in dealing with new challenges that will arise in the future. Consequently, this article further argues that education for deliberative democracy as an education initiative can be normatively justified but acknowledges that there are still theoretical and practical hurdles to overcome, and thus calls for more research into developing a mature, pedagogically sound program of education for deliberative democracy.

A holistic framework to model student's cognitive process in mathematics education through fuzzy cognitive maps

This study introduces a pioneering framework for modeling students' cognitive processes in mathematics education through Fuzzy Cognitive Maps (FCMs). By integrating key educational theories—Duval's Semiotic Representation Theory, Niss's Mathematical Competencies, Marton's Variation Theory, and the broad Engagement, Motivation, and Participation framework— the model offers a comprehensive and holistic understanding of students' cognitive landscapes. This research underscores the necessity of a multidimensional approach to capturing the intricate interplay of cognitive, affective, and behavioral factors in students' mathematical learning experiences. The novelty lies in its methodological innovation, employing FCMs to transcend traditional qualitative analyzes and facilitate quantitative insights into students' cognitive processes. This approach is particularly relevant in the current era dominated by digital learning environments and artificial intelligence, where real-time, automated analysis of student interactions is increasingly vital. The proposed FCM has been developed over the years with a data-driven approach; the concepts and relationships in it have been derived from the literature and refined by the author's experience in the field. Illustrated through case studies, the framework's utility is demonstrated in diverse contexts, highlighting how the quantitative data obtained are confirmed by qualitative approach: analyzing the impact of remote learning during the Covid-19 pandemic on student engagement and exploring Augmented Reality's role in enhancing mathematical conceptualization. These applications show the framework's adaptability and its potential to integrate new technologies in educational practices. However, the transition from qualitative to quantitative methodologies poses a challenge, given the prevalent use of qualitative approaches in mathematics education research. Additionally, the technological implementation of the FCM model in educational software presents practical hurdles, necessitating further development to ensure ease of integration and use in real-time educational settings. Future work will focus on bridging these methodological gaps and overcoming technological challenges to broaden the FCM model's applicability and enhance its contribution to advancing mathematics education.

Challenges and Prospects of Establishing Accounting Treatment Standards for Digital Currency

Digital Currency have emerged as a disruptive force in the financial world, challenging traditional accounting practices and regulatory frameworks. This study examines the challenges and prospects for establishing accounting standards for Digital Currency. Initially conceived as a secure medium of exchange, Digital Currency have evolved into assets that can be exchanged for goods or services. However, their dual role as currencies and commodities presents a classification dilemma. Current accounting standards primarily classify Digital Currency as intangible assets, but their rapid appreciation renders historical cost measurement ineffective. Adopting fair value measurement emerges as an optimal solution, but practical hurdles remain. Through insights from existing literature and analysis, this study optimizes accounting approaches for Digital Currency, addressing challenges such as asset valuation, regulatory inconsistencies, diverse investor perspectives, and legal uncertainties. Establishing standardized and transparent accounting practices tailored to Digital Currency is critical to ensuring transparency, consistency, and reliability in financial reporting.

Progress and Outlook on Electrochemical Sensing of Lung Cancer Biomarkers.

Electrochemical biosensors have emerged as powerful tools for the ultrasensitive detection of lung cancer biomarkers like carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and alpha fetoprotein (AFP). This review comprehensively discusses the progress and potential of nanocomposite-based electrochemical biosensors for early lung cancer diagnosis and prognosis. By integrating nanomaterials like graphene, metal nanoparticles, and conducting polymers, these sensors have achieved clinically relevant detection limits in the fg/mL to pg/mL range. We highlight the key role of nanomaterial functionalization in enhancing sensitivity, specificity, and antifouling properties. This review also examines challenges related to reproducibility and clinical translation, emphasizing the need for standardization of fabrication protocols and robust validation studies. With the rapid growth in understanding lung cancer biomarkers and innovations in sensor design, nanocomposite electrochemical biosensors hold immense potential for point-of-care lung cancer screening and personalized therapy guidance. Realizing this goal will require strategic collaboration among material scientists, engineers, and clinicians to address technical and practical hurdles. Overall, this work provides valuable insight for developing next-generation smart diagnostic devices to combat the high mortality of lung cancer.

Harnessing artificial intelligence for predicting and managing postoperative pain: a narrative literature review.

This review examines recent research on artificial intelligence focusing on machine learning (ML) models for predicting postoperative pain outcomes. We also identify technical, ethical, and practical hurdles that demand continued investigation and research. Current ML models leverage diverse datasets, algorithmic techniques, and validation methods to identify predictive biomarkers, risk factors, and phenotypic signatures associated with increased acute and chronic postoperative pain and persistent opioid use. ML models demonstrate satisfactory performance to predict pain outcomes and their prognostic trajectories, identify modifiable risk factors and at-risk patients who benefit from targeted pain management strategies, and show promise in pain prevention applications. However, further evidence is needed to evaluate the reliability, generalizability, effectiveness, and safety of ML-driven approaches before their integration into perioperative pain management practices. Artificial intelligence (AI) has the potential to enhance perioperative pain management by providing more accurate predictive models and personalized interventions. By leveraging ML algorithms, clinicians can better identify at-risk patients and tailor treatment strategies accordingly. However, successful implementation needs to address challenges in data quality, algorithmic complexity, and ethical and practical considerations. Future research should focus on validating AI-driven interventions in clinical practice and fostering interdisciplinary collaboration to advance perioperative care.

Half a step behind – bulk disclosure of confidential data in third-party GenAI solutions under the Swedish Public Access to Information and Secrecy Act

Technological progress poses unique challenges for the public sector. New technology should be adopted, but it must always be done within the framework of good administration. It follows laws governing public administration must be continuously adapted. Sweden recently amended its secrecy legislation to facilitate the use of third-party cloud solutions by public authorities. When the amendment was enacted, most public sector organisations had already been using external cloud solutions for a long time. Today, there is as much pressure on authorities to implement AI technology as there ever was to move administration into the cloud. This paper uses traditional legal methodology to investigate if the Swedish secrecy legislation adequately enables the use of cloud-based GenAI solutions. Findings indicate that the recent amendment is likely insufficient and that there are significant practical hurdles for the application of the law, particularly with services from global cloud providers. The paper contributes to the understanding of Swedish law, and of the difficulties that can occur anywhere when policy makers and legislators do not move in tandem.

Mapping Blockchain Adoption Challenges

The evolution of the Internet has shifted from centralised to decentralised systems, particularly after the financial crisis in 2008. The Internet disrupts traditional financial systems and the consequent shift towards Blockchain Technology (BCT) for more transparent and accountable business practices. It outlines BCT’s origins and transformative potential in various domains. Thus, this study aims to investigate challenges in BCT adoption in various domains. This study adopted a bibliometric analysis based on the data obtained from the Scopus database. Based on the keywords used, which are related to BCT adoption in the article title, the study obtains 229 documents for further analysis. Various tools have been employed, such as Microsoft Excel to conduct the frequency analysis and VOSviewer for data visualisation analysis. This study reports the results using standard bibliometric indicators such as publication year, document type, source type, source title, languages, subject area, keywords analysis, geographical distribution, authorship, active institutions, and citation analysis. The analysis reveals that studies on BCT integration with the Internet of Things (IoT) suggest the highest cites followed by BCT adoption challenges. Since 2021, there has been a rapid accumulation of citations, highlighting the ongoing relevance and interest in BCT across diverse fields. Indonesia leads in academic contributions to BCT, while the United States excels in citation impact. Notably, China, Australia, Jordan, and Malaysia are interested in adopting BCT in Asia. In Europe, the United Kingdom stands out alongside Romania and Belgium for their commitment to the study as well. Prominent authors and keywords highlight BCT’s integration with IoT and supply chain. Findings underscore global academic engagement with BCT challenges and applications, offering a foundation for future research on practical hurdles, regulations, and technological intersections. Blockchain is just one of many IR4.0 technologies that will enhance governance when coupled with Artificial Intelligence (AI) and Big Data Analytics. Future research should focus deeper on practical challenges, regulations, and intersections of BCT with other technologies, building upon the findings of this analysis.

A D-VUCAD Transitioning Analysis on Romanian Higher Education System in the Context of Artificial Intelligence. Challenges, Opportunities and Perspectives

Abstract The significant global transformations in recent years have led to widespread disruption across numerous facets of society. Events such as the COVID-19 pandemic and other concurrent realities have had a tremendous impact on the global order, resulting in profound effects across various crucial dimensions in a D-VUCAD context. Relevant studies highlight the fact that technology has redefined global higher education offering personalized learning but raising ethical concerns. Leadership must adapt to digital disruptions while addressing conflicts between traditional and modern approaches. In this context, the education system is rapidly changing due to technology and societal shifts, posing complex challenges for leaders. Enrollment fluctuations and workforce demands add to the volatility, requiring flexible responses. Furthermore, at EU level, European initiatives aim to improve education, but face practical hurdles in diverse contexts. Despite research common efforts, there's a need to bridge educational insights with real-world applications, navigating from uncertainty to clarity in an evolving digital era. This paper aims to provide through the case study method, an original and unique D-VUCAD analysis on Romanian higher education system in the context of artificial intelligence to understand, on one hand, the realities, and the challenges it faces and on the other hand, to adapt the educational system to the new matrix, transitioning from old dimensions to the new ones: volatility to vision, uncertainty to unity, complexity to clarity, ambiguity to alignment, disruption to digitalization. While the first part of the case study identifies and illustrates with concrete examples and numbers the challenges Romanian higher education system is facing with, the second section of the research analyze the transition from traditional environment to the reinvented one, adding concrete initiatives, programs, and projects as examples to enrich the understanding of these manifests in the realm of higher leadership education perspectives. Paper findings show that multiple initiatives and endeavors are ongoing to modernize the vocational education and training (VET) system, reforms and investments backed by the RRF are geared towards reducing the school dropout rates, enhancing the population’s digital skills and creating lifelong learning opportunities. However, ensuring high-quality, skills-oriented education and alignment with the labor market, policy coordination, efficient legislative initiatives and a comprehensive strategic framework delineating the vision and targets for education remain significant challenges.

PQCAIE: Post quantum cryptographic authentication scheme for IoT-based e-health systems

The increasing integration of Internet of Things (IoT) technologies in consumer electronics has revolutionized various sectors, including healthcare. This evolution has led to the development of IoT-enabled consumer health devices and systems, offering benefits such as enhanced remote health monitoring and more efficient health data management. However, these advancements also pose significant security challenges, especially regarding data privacy and secure access. A critical concern is the vulnerability of current cryptographic methods to potential future quantum computing capabilities. This paper focuses on addressing these challenges by exploring the implementation of Post-Quantum Cryptography (PQC) in IoT-based consumer health electronics. Specifically, it evaluates the application of PQC methods in conjunction with Transport Layer Security 1.3 (TLS 1.3) for robust authentication in these systems. The study analyzes the performance and security efficacy of these schemes, comparing them to existing cryptographic approaches. Additionally, it delves into the practical hurdles and prospective solutions related to the deployment of post-quantum cryptographic techniques in the context of consumer health electronics, paving the way for more secure and reliable healthcare technology in the era of advanced consumer electronics.

Supporting Doctoral Candidates through Completion and Final Examination

Completion and final examination comprise the final stages of a doctoral program and represent the culmination of the doctoral candidates’ years of research. In this entry, completion is defined as the writing and submission of a doctoral thesis, and final examination is defined as the viva voce. Over the years, the format and scope of doctoral degrees has expanded and a variety of formats are now offered. In addition to the traditional research-only doctoral degree, professional, practice-based, and new route programs also contain a taught element alongside research. However, the creation of a substantive thesis or practice-based alternative addressing a novel research question is common to all. In contrast, processes and formats of viva voces vary across the globe. These range from private, closed-door defenses to assessed or ritualistic public defense presentations. For both completion and final examination, there are many practical and psychological hurdles that need to be navigated in order for the candidate to attain their doctoral degree. This entry will highlight these aspects as well as provide evidence-based guidance for supervisors in supporting their doctoral candidates through these daunting final stages.

Codesigning Online Continuing Medical Education on Social Health Integration and Social Risk-Informed Care for Primary Care Providers.

Adapting clinical care decisions for patient-reported social risks is essential to social health integration and patient-centered care. Most research in this area focuses on awareness and assistance (social-needs-targeted care), such as screening and referral to food, financial, and other resources. Limited evidence for adjustment strategies (social risk-informed care) or adapting care for social risks made it difficult for Kaiser Permanente to implement new initiatives. This article describes a codesign process to build a novel, adjustment-focused continuing medical education course. The authors codeveloped the online continuing medical education course with patients and clinicians using user-centered design. Transcripts from codesign activities were coded and analyzed by thematic analysis to identify major themes, including perceptions of social risk-informed care and barriers to care adjustment. Practical hurdles for implementing social risk-informed care emerged, including clinicians' concerns about the ethics of adjustment as substandard care, particularly without robust assistance activities. However, patients expressed a desire for their care to be adapted to their social circumstances, to allow for more realistic care plans. Implementation barriers identified from the codesign were addressed through an interactive, case-study approach. Existing evidence on contextualized care and shared decision making informed a general framework for primary care providers to engage in awareness and adjustment activities, paired with 3 interactive case studies based on real-world, clinician-supplied scenarios. The authors recommend that multiple stakeholder perspectives be incorporated during the development of social health integration initiatives, particularly adjustment. Education complemented by active, nuanced, flexible implementation strategies may be necessary for the successful uptake of care-delivery-based social health integration activities.