Practitioner Perspectives Research Articles

India’s emerging trends and meanings in healthy human-nature relationships: Indian outdoor education practitioner perspectives

ABSTRACT Using a descriptive, exploratory study of recent developments in outdoor adventure education (OAE) fields in India, the authors report on the significant contributions of Indian OAE practitioners in promoting healthy human-nature relationships. Semi-structured interviews with Indian OAE practitioners revealed an underlying interconnectedness between OAE, environmental education, and experiential education. Findings show that OAE practitioners in India represent new genres of practice diversifying into nature-based sports, therapeutic adventure, experiential activities, and more to help individuals develop positive relationships with nature, emphasising reciprocity and mutual respect. Drawing from the historical, spiritual, and cultural aspects of nature-relatedness in Indian culture, OAE practitioners bridge the gap between traditional knowledge and contemporary practices to foster deeper connections with the natural worlds. This study postulates that Indian OAE practitioners, with their understanding of nature’s therapeutic effects, play vital roles in guiding people towards a holistic and sustainable relationship with nature that contributes to individual well-being and environmental preservation.

How the Metaverse can add new layers of hospitality services: a perspective of senior industry practitioners

How the Metaverse can add new layers of hospitality services: a perspective of senior industry practitioners

Perspectives on telehealth implementation in Australia: An exploratory qualitative study with practice managers and general practitioners

BackgroundThere is a lack of understanding regarding the impact of telehealth on clinical delivery and the feasibility of sustained implementation by health services. The COVID-19 pandemic provided an ideal opportunity to identify factors related to the implementation of telehealth. This study assessed factors that influenced telehealth implementation during COVID-19 in the Western region of Victoria, Australia, from the perspectives of practice managers and general practitioners (GPs). MethodsEmploying a qualitative approach, we conducted semi-structured interviews with 14 GPs and 11 practice managers across metropolitan and rural settings in the Western region of Victoria, Australia. Interviews were conducted between December 2021 to June 2022, which included periods during and beyond the peak of the COVID-19 pandemic. Themes were synthesised using the Consolidated Framework for Implementation Research, which comprised five domains: innovation, inner setting, outer setting, individuals and implementation process. An additional domain related to billing and finances was added. ResultsThe innovation domain revealed that telehealth was identified by both stakeholder groups as a critical tool for improving healthcare access for vulnerable patients. GPs highlighted the role of telehealth in follow-up care and the need for extended telephone consultation services. For the implementation process, both stakeholder groups identified a shift in attitudes among GPs from reluctance to acceptance of telehealth. In terms of outer setting, constant changes in regulations posed challenges to administrative staff. Practice managers faced difficulties in acquiring information on changes, but those with robust professional networks were well supported. Initial loss of incentive funding and government-imposed billing methods posed hurdles for clinics. Both stakeholder groups highlighted the need for education around videoconference and a standardised telehealth platform. ConclusionEvolving telehealth regulations during the emergence of COVID-19 posed financial, operational and administrative challenges to primary care clinics. To ensure sustainability, policymakers should improve stakeholder communication, set interoperability standards, and ensure sustainable funding for telehealth.

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners’ and people living with Long COVID: a qualitative study

ObjectivesTo explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).DesignQualitative descriptive study employing one-to-one semistructured virtual interviews analysed...

Brief Report: Updated Data From IMscin001 Part 2, a Randomized Phase III Study of Subcutaneous Versus Intravenous Atezolizumab in Patients With Locally Advanced or Metastatic NSCLC

IntroductionSubcutaneous atezolizumab is approved for the treatment of various solid tumors. Previous results from the IMscin001 study (NCT03735121) revealed that the pharmacokinetics, efficacy, immunogenicity, and safety of subcutaneous and intravenous atezolizumab were consistent (data cutoff: April 26, 2022). We present updated data from this trial (data cutoff: January 16, 2023). MethodsEligible patients aged above or equal to 18 years with locally advanced or metastatic NSCLC were randomized (2:1) to receive atezolizumab subcutaneously (1875 mg, n = 247) or intravenously (1200 mg, n = 124) every 3 weeks. Here, we present updated efficacy (overall survival [OS]; progression-free survival; objective response rate; duration of response), safety, and immunogenicity end points, alongside patient-reported outcomes and health care practitioner (HCP) perspectives. ResultsIn this updated analysis, the median survival follow-up was 9.5 months. Median subcutaneous injection time was 7.1 minutes, with an average subcutaneous injection time of 4 to 8 minutes in most patients (75.7%). OS data were mature: median OS was similar between treatment arms, at 10.7 and 10.1 months in the subcutaneous and intravenous arms, respectively (hazard ratio: 0.88; 95% confidence interval: 0.67–1.16). Other efficacy end points, as well as immunogenicity, patient-reported outcomes, and safety, were similar between arms. Most HCPs found subcutaneous administration convenient (79.5%), easy to administer (89.7%), and were satisfied with the treatment (84.6%); 75.0% of HCPs agreed that administering atezolizumab subcutaneously compared with intravenously could save time. ConclusionsIn this analysis, mature OS data were similar between treatments. The updated efficacy and safety profile of subcutaneous atezolizumab is consistent with previous findings and equivalent to intravenous atezolizumab.

Do it yourself or send for help? Considering specialty referral from a general practitioner perspective.

General practice veterinarians (GPs) are often faced with the question of which services they should provide themselves and which are more appropriately the province of board-certified specialists. The growing availability of specialty care, the expectations of many pet owners for advanced care resembling that which they receive, the expanding availability of new and more technologically sophisticated interventions, and many less easily defined shifts in the economic and cultural context of veterinary medicine all add to the pressure to limit services in general practice and refer more patients to specialists. However, the criteria for making decisions about referral are often ill-defined and controversial. Furthermore, most GPs are trained by specialists in secondary or tertiary care institutions, providing them with a perspective that may not reflect the realities of the general practice environment.While each referral decision for a specific patient must be made in the unique context of that case, reflection and discussion concerning relevant general principles can help GPs build a rational foundation for making such decisions. The principles and methods of evidence-based medicine and the expanding concept of a spectrum of care can usefully inform decision-making about referral. It is also critical that all stakeholders contribute to discussion of these questions and to the training of veterinarians so that the next generation will be prepared to shape and embody the role of GP in a manner that best meets the needs of patients, pet owners, and veterinarians themselves.

Enhancing compliance assessment through regenerative transformations – A food waste perspective

Addressing food waste is a growing priority for hotel groups. However, aligning corporate sustainability goals with the practicalities of individual hotels is challenging. While hotels increasingly adopt certification programs to enable transparency on sustainability performance, there is a risk that compliance-based assessment systems may not fully capture the nuances of each hotel’s local context. The notion of regeneration, emphasizing reinvestment in people, place and the natural world, offers the potential to bridge the gap between corporate waste targets, hotel operations and local outcomes. Food waste, recoverable through a biological cycle, aligns with the principles of regeneration. This study explores the perspectives of practitioners involved in certification and benchmarking and those advocating for regeneration in the tourism sector. This study explores whether compliance assessment systems are sufficient to account for the challenges associated with hotel food waste and whether regenerative enhancements could be conceptualised. Through in-depth interviews, the research reveals a divide between compliance assessment and regeneration across key areas. A conceptual framework is introduced, highlighting areas of convergence that could enhance existing certification programs – with the ultimate aim of helping hotels reconsider their relationship with food waste and their local ecological system.

Understanding exercise referrals in primary care: a qualitative study of General Practitioners and Physiotherapists

BackgroundPhysical inactivity is estimated to cost the UK National Health Service over £7.4 billion per year. Healthcare practitioners have a key role in supporting increases in physical activity (PA) levels, including referring to exercise referral schemes. To date, there has been little research into practitioner perspectives on referrals to exercise schemes. ObjectivesTo explore the views and experiences of General Practitioners (GPs) and physiotherapists in relation to factors which influence referral and adherence to exercise referral schemes. Design setting and participantsQualitative study of primary care-based practitioners in Glasgow, UK. MethodsSemi-structured interviews were conducted with 14 practitioners (seven GPs and seven physiotherapists). Interviews were recorded and analysed thematically. ResultsFour themes are presented. Firstly, all people, including healthcare practitioners, bring inherent biases which are influenced by their background, experiences and worldviews to a consultation which impact their approach to PA promotion. Secondly, clinical time pressures are a major barrier to effective PA promotion. Thirdly, patient-led, compassionate care which seeks to fully understand a patient is the most vital component of behaviour change, with suggestions that promoting peer support and the use of personal anecdotes to normalise vulnerabilities might be helpful. Lastly, providing ongoing support for change was felt to be beneficial to PA promotion. This is often accessed through exercise referral schemes and improved by better collaboration between exercise providers and referring practitioners. ConclusionPractitioners believed exercise referrals could be improved with more targeted training in behaviour change facilitation, support for multidisciplinary working, and enhanced communication between the programmes and referrers. Additionally, supporting behaviour change requires time for compassionate care and fully understanding patients’ motivations and beliefs. Lack of time was felt to be the greatest current barrier to effective PA promotion. Contribution of the Paper•Previous physical activity promotion research has focussed on overcoming barriers to physical activity.•Few studies have considered the effect of the therapeutic interaction on successful exercise referrals.•In this qualitative study, primary care-based practitioners (GPs and physiotherapists) reported inherent biases which affected referrals, as well as time pressures.•Targeted training, support for multidisciplinary working, and enhanced communication between the programmes and referrers, would improve referrals.

Integrating traditional and allopathic child health: A healthcare transformation opportunity.

Numerous forums both domestically and internationally have discussed integration of allopathic and traditional healthcare. In South Africa, using traditional child healthcare is popular practice. If properly controlled, integrating this aspect of traditional child-health with allopathic healthcare may be advantageous to communities that use both healthcare systems. Allopathic and traditional healthcare remain separate organisations in South Africa despite efforts and discussions to integrate them. The study sought to explore the integration of traditional and allopathic child healthcare from the perspectives of children's caregivers and traditional healthcare practitioners. The study was conducted in a semi-urban area in the city of Tshwane. An exploratory qualitative research study was conducted using semi-structured interviews to collect data from 11 traditional healthcare practitioners and 15 children's caregivers who were sampled using snowball and convenient sampling respectively. The participants expressed their understanding of the usage of traditional healthcare practitioners in the care of children as well as their support for integration, and further indicated its necessity. Religion and its effects in health-seeking behaviour were cited as a factor in why there has not been greater integration between the two healthcare systems. The undocumented and undisclosed use of traditional healthcare potentially hinders the delivery of therapeutic healthcare. As such, integrating the two systems is essential to ensure patients' safety. This article highlights understanding of culture congruence and safe child healthcare that may be brought forward by the integration of the two healthcare systems.

Where Does Hope Lie? The Dialectical Tensions Between Hopes and Expectations of Vocational Transition Planning from the Perspectives of Autistic Young Adults, Parents, and Practitioners.

The post-secondary transition for autistic youth is a complex process, with hopes and expectations serving as malleable mediators often overlooked in research and practice. Career awareness, exploration, and counseling services play a critical role in facilitating vocational transition, but the vocational hopes and expectations of autistic youth and their parents are often disregarded. This study aims to explore these aspirations and their impact on the vocational transition process, seeking to harmonize elements to better align with the needs of autistic youth and their families. This study used a focus group design involving group interviews with three participant groups: autistic transition-aged youth, parents, and practitioners. The findings reveal five key themes: 1) Accepting Disability or Constrained by Ableism: Resisting Marginalization, 2) Finding the Sweet Spot: Are Parents and Youth's Expectations Too High or Too Low, 3) Market Forces at Work-Finding a Meaningful Vocational Path in a Capitalist Society, 4) Despite Meticulous Planning, there is a Disconnect Between Needs and Resources, and 5) The Hills and Valleys of Finding Resilience. Navigating the multifaceted landscape of vocational transition planning for autistic youth necessitates a collaborative and flexible approach. Identified tensions serve as opportunities for growth and transformation. Recognizing and addressing system shortcomings is crucial for informed decision-making. Challenges extend beyond individual circumstances, reflecting broader systemic issues, and identifying these gaps allows for a comprehensive understanding of available resources, cultivating a basis of hope as uncertainties are addressed.

Assessing the Adoption of Blockchain Technology in Smart Sustainable Cities: Insights from Construction Practitioners in Malaysia

ABSTRACT In response to rapid urbanization and associated challenges, city planners worldwide are increasingly turning to the development of smart sustainable cities (SSC). Blockchain technology has emerged as a disruptive force with the potential to facilitate this transformation. While existing research has explored the concept, features, and applications of blockchain within SSC, limited attention has been given to the perspectives of construction practitioners regarding its adoption. This study seeks to address this gap by assessing the acceptance level of construction practitioners toward blockchain technology in SSC. Through the distribution of questionnaires to construction practitioners, comprising 153 responses, this research reveals a generally high level of acceptability toward blockchain technology in SSC, with notable exceptions in property or asset transactions and data management. Furthermore, significant disparities in acceptance were observed across different age groups and educational backgrounds, with older generations and those with lower levels of education demonstrating lower levels of acceptance. These findings provide valuable insights for city planners and relevant authorities, enabling them to design informed strategies and roadmaps to ensure the successful integration of blockchain technology in SSC by considering the acceptance levels of construction practitioners.

DemStepCare: Risk-stratified support for primary care-based dementia care - evaluation from general practitioner's view

The innovation fund project DemStepCare aimed to optimize multi-professional care through case management, risk stratification, and crisis outpatient clinic. Here, the evaluation results from the perspective of the general practitioners are presented. A quantitative survey was carried out at three time points regarding acceptance, benefit assessment and sensitivity to dementia of the general practitioners. In addition, qualitative interviews were conducted. Satisfaction with the overall project was high. Added value and relief factors were perceived and more effective and stable dementia care was achieved through collaboration with case management. Physicians reported increased subjective competence in diagnostics and disease management. The results confirm the benefit and effectiveness of DemStepCare from general practitioner's perspective.

Students’ Perceptions of English Medium Instruction (EMI) in Secondary School Bilingual Classes: A Case Study

In contemporary international secondary education in Indonesia, English-Medium Instruction (EMI) has gained popularity and expanded into a rising global phenomenon. Recognizing this phenomenon and the importance of English language skills for students from an early age, this study aims to investigate the perceptions of junior high school students in bilingual classes on the use of EMI in schools. A qualitative research design in the form of a case study was adopted in this study. It involved thirteen (13) junior high school students (2 males, 11 females) of two bilingual class programs at a private junior high school in Bandung, West Java, Indonesia. Data were collected through questionnaires, semi-structured interviews, and an FGD (forum group discussion) session. The findings indicate that all participants show positive perceptions of the EMI implementation in terms of the importance of EMI for Learning, the importance of EMI for career, and the use of EMI associated with the preservation of tradition issue. This study also reveals the obstacles that are often faced in the use of EMI such as a lack of understanding of technical terms in the content course and teachers' low proficiency in English. Therefore, it is expected that this study will offer recommendations from the perspectives of EFL practitioners in order to optimize the advantages of the EMI policy in an EFL context.

Exploring patient referral practices of traditional healthcare practitioners in Soshanguve, Gauteng Province, South Africa.

It may be necessary for healthcare professionals to refer patients to other professionals and institutions that are able to provide the care needed by patients, depending on the severity each case presents, healthcare requirements, and resources available to offer care. In healthcare generally, patient referral is standard procedure; however, in South Africa, referral patterns between allopathic and traditional healthcare practitioners are unknown, and this is a problem yet to be addressed. The study objective was to explore patient referral practices from the perspectives of traditional healthcare practitioners of South Africa. A qualitative, exploratory and descriptive design was employed to collect data from 11 traditional healthcare practitioners who were sampled using snowball sampling. An individual semi structured interview schedule was used to collect data. Content analysis was used to analyze the data. Patient referral was common practice in traditional health practices, however not reciprocal between the traditional and allopathic healthcare. Several indications for patient referral to allopathic healthcare practitioners included management of chronic conditions amongst others. Patient referral being an important part of healthcare practices should be promoted and regulation and traditional health practices improved to promote safe referral practices and curb unsafe self-referrals by patients.

Clinicians' Experiences and Perspectives about a New Lung Cancer Referral Pathway in a Regional Health Service.

Development and implementation of the Townsville Lung Cancer Referral Pathway [TLCRP] aims to reduce delays and improve referral patterns of people with suspected lung cancer in north Queensland, Australia. Reported in this paper is the experiences and perspectives of general practitioners [GPs] and specialists of the TLCRP. This was a descriptive qualitative study nested within a larger project evaluating TLCRP, utilising a broader implementation science framework. In-depth, semi-structured interviews with GPs and specialists were conducted. An iterative, inductive thematic analysis of interview transcripts was used to derive key codes, then grouped into themes regarding participant experiences and perceptions. Data analysis identified two major themes and several sub-themes. The major themes were variation in the uptake of TLCRP and enhancing coordinated care and communication. Several enablers and barriers to implementing TLCRP were identified. Barriers to adaptation of TLCRP included lack of clinical time, resistance to changing referral patterns, lack of familiarity or experience with HealthPathways and technology issues. Emerging themes from this study may be used to reduce the barriers and improve uptake of TLCRP and other health care pathways in the local health service and may have wider relevance in other settings.

Examining advanced clinical practice from the perspective of a trainee advanced clinical practitioner

This article discusses advanced clinical practice from the perspective of a trainee advanced clinical practitioner (ACP). The commentary explores the four pillars of advanced practice with respect to the frailty specialty, taking both the author and a trainee ACP into account. The evaluation analyses the historical development of advanced clinical practice and the knowledge, skills and competencies expected at the advanced level. It highlights how support, colleague networking and supervision remain vital to the journey of trainee ACP, and influences the overall wellbeing of, and care given to, the patient.

Exploring blockchain technology acceptance among non-managerial construction practitioners in Shenzhen, China

PurposeProblems such as information asymmetry and a lack of trust among construction practitioners damage the quality and progress of construction projects. The decentralization, transparency, traceability and temper-proof nature of blockchain technology (BCT) can provide solutions and facilitate multiparty cooperation. However, BCT acceptance in the construction industry is relatively low, and there are few pilot projects adopting BCT. Most relevant literature focuses on BCT acceptance at the industry and organizational levels, but the impact of non-managerial practitioners executing BCT or the traditional approach in day-to-day work tends to be disregarded. This study aims to establish a theoretical model of BCT acceptance, identify key influencing factors and paths of behavioral intention to adopt BCT and promote strategies to enhance BCT adoption.Design/methodology/approachA new BCT acceptance model for construction practitioners was proposed. A survey was performed with 203 construction practitioners in Shenzhen, China and post-survey interviews were conducted with four BCT experts for validation. Covariance-based structural equation modeling was used to examine the influence paths and moderating effect analysis was performed to check practitioners’ differential perceptions.FindingsPerformance expectancy, social influence, facilitating conditions and perceived behavioral control significantly and positively influence behavioral intention to accept BCT, while impacts from effort performance and risk are negative. Overcoming obstacles related to the effort required for BCT adoption and effective risk management will be essential to unlocking BCT’s transformative potential. Then, the moderating effects of respondents’ gender, degree and BCT knowledge as well as the project type involved were analyzed. Continued adoption of BCT in the construction industry has the potential to revolutionize project management, transparency and trust among stakeholders.Research limitations/implicationsThe findings of this research can help practitioners and government agencies understand crucial influencing factors and pathways of BCT acceptance. Targeted measures, such as increasing practitioners’ benefits and sense of BCT usefulness, conducting pilot projects and increasing publicity, were proposed for project leadership teams to enhance BCT adoption. This may lead to increased efficiency, reduced disputes and more streamlined and secure construction processes, ultimately enhancing the industry’s overall performance.Originality/valueFew studies have explored BCT acceptance from the perspective of non-managerial construction practitioners. The BCT acceptance model proposed in this study is a novel adaptation of previous technology acceptance models, with new factors (risk and perceived behavioral control) and moderating variables (degree, BCT knowledge and project type) added for better understanding of non-managerial practitioners’ perceptions and differences.

Practitioner Perspectives on the Implementation of the Lee Silverman Voice Treatment-BIG® Program

Practitioner Perspectives on the Implementation of the Lee Silverman Voice Treatment-BIG® Program

Promoting Older Adults’ Engagement in Disaster Recovery Through Supportive Relationships, Partnerships, and Collaboration: Perspectives of Social Work Practitioners and Human Service Professionals

Shifting demographics—that is, the growing number of older adults in Canada and internationally—and intersecting climatic risks create a complex landscape of aging in place in disaster contexts. Some older adults are vulnerable due to their underlying health conditions and limited physical mobility. Yet they also exhibit resilience in a distinct manner, owing to their wealth of knowledge, wisdom, and ability to navigate adversities. This article elucidates potential avenues for promoting the involvement of older adults in disaster recovery efforts. Our intention is to recognize and foster older adult resilience and mitigate vulnerability by drawing upon insights from the study titled “In the Aftermath of the 2016 Alberta Wildfires: The Role of Social Work Practitioners and Human Service Professionals in Long-Term Disaster Recovery.” Employing a qualitative research approach, that study recruited 51 participants for semistructured interviews and focus groups. A thematic analysis of the collected data unveiled the pivotal roles played by social workers and human service practitioners in facilitating recovery from the 2016 wildfires in the research. Notably, three overarching themes emerged concerning the promotion of older adults’ involvement in disaster recovery: fostering supportive relationships, building partnerships and enhancing collaboration, and addressing ongoing challenges. These findings offer valuable insights into how social work practitioners and human service professionals can effectively facilitate the engagement of older adults in disaster recovery initiatives. This article emphasizes the significance of actively promoting the participation of older adults in disaster mitigation efforts, thereby fostering greater resilience within communities.

Empathy in Nutrition and Dietetics: A Scoping Review

BackgroundEmpathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care. ObjectiveThis scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics. MethodsUsing the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table. ResultsTwenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies. ConclusionsThis review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.