Professional Barriers Research Articles

Factors influencing the decision to become a supervisor: A qualitative study of early-career general practitioners and rural generalists.

General practitioner (GP) training in Australia relies on accredited GP supervisors facilitating workplace-based training for GP registrars. There is a shortage of supervisors that is likely to worsen. This research aimed to elucidate the perspectives of early-career GPs and ruralgeneralists (RGs) about the barriers, motivators andenablers to becoming a GP supervisor. Qualitative descriptive methodology was used in the study. Transcripts from three focus groups and six semistructured interviews with 11 RGs (four registrars andseven new Fellows) and 13 GPs (all new Fellows) were analysed thematically. The following key themes were identified: being a good supervisor; motivated by past experiences of supervision; financial implications of being a supervisor; factors unique to rural settings; new models of supervision; and becoming a supervisor - how and when? The findings highlighted personal and professional barriers to becoming a GP supervisor and some enabling strategies to mitigate these barriers.

Determinants of adherence towards tuberculosis guidelines among Indonesian private practitioners: a qualitative study

IntroductionIn high tuberculosis (TB) burden countries, the private sector manages a large proportion of initial visits by presumptive patients with TB. In Indonesia, the second largest contributor of TB cases...

Anaerobic rhetoric

ABSTRACT This essay locates breath in a rhetorical taxonomy of anti-Black/LGBTQIA+ phobogenesis that dehumanizes the academic pulse of queer and racialized learning environments. It names and specifies a discursive-material arrangement of public address called anaerobic rhetoric (i.e., rhetoric without oxygen) that circulates in the hypoxic ontologies (i.e., hematic vessels with reduced blood flow and oxygen-compromised tissues) of U.S. higher education. Rhetorical breath work is a paraontological praxis of breathing otherwise and alongside structural-experiential hypoxias of U.S. higher education. Through such fugitive breathing maneuvers, I invite a similarly dispossessed audience of queer and faculty of color in U.S. academia, experiencing professional barriers to educational care, to re-group as a noisy gaggle of the gagged and aspire to re-possessions of otherwise air. The key locational texts for examining these civic hypoxias resulting from anaerobic rhetoric include (a) U.S. legislative discourses of higher education, specifically, Florida state’s house bills—“The Stop WOKE Act” (HB 7) and “Don’t Say Gay” law (HB 1557)—that take the speech-restricting shape of educational “gag” orders to intensify a white supremacist climate of anti-Blackness/LGBTQIA+ness in 2022–23, and (b) Diversity, Equity, and Inclusion (DEI) based discourses operationalized through white timekeeping techniques of regimenting breath/ing in Predominantly White Institutions (PWI).

Nova Scotia's Deemed Consent for Deceased Organ Donation: Family Member Perspectives and Experiences in the ICU Setting.

The purpose of this study was to explore the experience of family members of potential organ donors in the intensive care unit following the change to deemed consent legislation in Nova Scotia. This was a qualitative study with semistructured, in-depth interviews with 17 family members who were asked to make an organ donation decision on behalf of patients admitted to the intensive care unit in Nova Scotia. We analyzed themes using a descriptive approach. Participants were recruited from the organ donation organization in Nova Scotia, Canada. Participant awareness and knowledge of the Human Organ and Tissue Donation Act legislation varied from individuals having no awareness and knowledge of the bill to those who had awareness and optimism that the legislation would be beneficial for increasing organ donation rates in the province. Other themes emerging from the interviews included (1) COVID context, (2) quality of healthcare professional care, (3) family support, and (4) barriers to donation (waiting, consent questionnaire, and patient transfers). The Human Organ and Tissue Donation Act legislation included enhanced support, which was viewed positively by family members. There is a need for continued evaluation as most participants felt it was too early to see the tangible impacts of the newly implemented legislation.

Indie economics: social purpose, lay expertise and the unusual rise of modern monetary theory

ABSTRACT We argue that the IPE literature on economic expertise has been characterised by ‘methodological elitism’ that makes it ill equipped to account for the influence of heterodox and grassroots forms of expertise. To remedy this, we posit a theoretical framework that emphasises the tensions between two forms of professional legitimacy. One is internal legitimacy and it is rooted in appeals to scientific objectivity, political neutrality and high professional barriers of entry. However, internal legitimacy may clash with external legitimacy, which is a function of a clear articulation of social purpose. Taking the surprising rise of Modern Monetary Theory as a case study, the paper makes two claims. First, its ideas did not coalesce into a distinctive heterodox brand of economics through traditional mechanisms like academic peer-review and citation networks, but through intense online activity. Second, the messaging that spurred MMT consistently combined constitutive claims with explicit declarations of social purpose. The result was an open project with a broad normative appeal, which successfully enrolled a large group of passionate followers and co-creators. To date, IPE scholars have been blind to such alternative forms of knowledge production.

Domiciliary Care Service at a Tertiary Centre

Background: The domiciliary service comprises of medical and rehabilitation services done at the home of patients to ensure uninterrupted care upon early discharge, render support to the family members in training the caregiver and to reduce readmission by providing quality care. Objective: To explore the facilitators and barriers of domiciliary services at Hospital Seberang Jaya (HSJ), Penang. Methods: A total of 53 respondents (34 trained nurses, 8 sisters, 5 matrons, 4 occupational therapists and 2 physiotherapists) involved in domiciliary care from the medical, surgical, orthopedics and pediatrics wards were interviewed using a semi-structured questionnaire as homogenous focus groups or as individuals, audio recorded, transcribed and thematically analyzed. Results: 3 domains were identified as facilitators and barriers; Health System factors, Health professional and Patient and Caregiver factors. In facilitators, health system factors (ongoing measures in domiciliary updates, having a reference file in ward, cluster hospital concept and a dedicated person in charge). Health professional factors (teamwork, synchronized explanation and pre planned discharge), patient and caregiver factors (suitable caregiver, locale convenience of health facility) and finally the proactiveness, motivating and supportive factors that encompasses all 3. The Health System barriers were (inadequacy in; man power, public information and ineffective domiciliary team). Health Professionals Barriers were (bias selection of cases and default in responsibilities). Patient and Caregiver Barriers (unsuitable caregiver, misconception on nursing role, lacking confidence to learn and financial issues). Encompassing all were lack in continual monitoring, communication and supervision. Conclusions: For a successful domiciliary care, health system factor, health professional factors, patient and caregiver factors need to be addressed. Its Implementation will involve all stakeholders to work for a common goal for an effective delivery of domiciliary services at HSJ.

Banging My Head Against a Brick Wall! Enablers and Barriers to Nurse Practitioners Delivering Opioid Agonist Treatments in Regional/Rural Victoria, Australia.

The Victorian government's Alcohol and other drugs (AOD) workforce policy calls for greater recruitment of alcohol and other drugs nurse practitioners (AODNPs). However, frontline organisations in Victoria report several systemic barriers to their recruitment and retention. Additionally, there is scant Australian literature that examines the experiences of AODNP in opioid agonist treatment (OAT) provision in regional/rural areas. This research aims to address this gap by examining the AODNP workforce issues in delivering pharmacotherapy treatments in regional/rural areas of Victoria. Using an interpretative phenomenological approach, we conducted qualitative, in-depth interviews with 11 OAT prescribing AODNP's working in regional or rural Victoria. We analysed transcripts using reflective thematic analysis and generated three themes: (1) Professional motivations and values, (2) Enablers to professional role and (3) Barriers to professional role. The findings suggest that AODNPs in regional/rural areas are a dedicated workforce who provide holistic and integrated care for OAT clients. AODNPs play an important role in reducing and providing timely and subsidised health care for OAT clients living in regional/rural locations. AODNPs face many systemic and organisational barriers. These include inadequate funding for AODNP positions to prescribe pharmacotherapy treatments, lack of understanding of the AODNP professional role at the executive/management level within organisations and irregular access to supervision, mentoring, training and education. Also, endemic stigma in the health system acts as a barrier in recruiting and supporting AODNP positions that focus on care for OAT clients.

A study of professional practices, attitudes and barriers to blended tube feeding in Australia and New Zealand.

This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement. A cross-sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35-questions including multiple choice, Likert scales and open-ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi-squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open-ended text responses to the survey questions which were then categorised and further synthesised into overarching themes. Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice. This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence-based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations.

A novel approach to the cause of death identification—multi-strategy integration of multi-organ FTIR spectroscopy information using machine learning

Identifying the cause of death has always been a major focus and challenge in forensic practice and research. Traditional techniques for determining the causes of death are time-consuming, labor-intensive, have high professional barriers, and are vulnerable to significant subjective bias. Additionally, most current studies on causes of death are limited to specific organs and single causes. To overcome these challenges, this study utilized simple and rapid fourier transform infrared spectroscopy (FTIR) detection technology, integrating data from six organs—heart, liver, spleen, lung, kidney, and brain. The optimum model for identifying seven different causes of death was determined by evaluating the performance of models developed using the model efficiencies of single-organ (SO), single-organ model fusion (SOMF), multi-organ data fusion (MODF), and multi-organ data model fusion (MODMF) modeling methods. Considering factors such as operational costs, model performance, and model complexity, the MODF artificial neural network (ANN) model was found to be the most suitable choice for constructing a cause of death identification model, with a cross-validation mean accuracy of 0.960 and a test set accuracy of 0.952. The heart and kidney contributed more spectral features to the construction of the cause of death identification model compared to other organs. This study not only demonstrated that data fusion and model fusion are effective strategies for improving model performance but also provided a comprehensive data analysis framework and process for modeling with small sample multi-modal data (multiple organ data). In conclusion, by exploring various approaches, this study offers new solutions for identifying the cause of death.

A program evaluation of the new choices workforce development program: An appreciative inquiry approach

A significant amount of money ($1.76B annually in the United States) is spent on workforce development programs, while there is limited research on the effectiveness of workforce development programs in meeting their program objectives and assisting program participants in attaining employment. This study evaluated the New Choices Program, a workforce development program offered by PA Women Work, to help its clients obtain employment and overcome personal and professional barriers. The program has historically been offered in a 30-hour in person format but was forced to be modified to a 10-hour virtual program when the COVID-19 pandemic restrictions began. This program evaluation included a comparative analysis of the perceptions of participants in the 30-hour in person program and the 10-hour virtual program. It was found that participants in both the 30-hour in person program and 10-hour virtual program perceived the program positively, experienced an increase in self-confidence and belonging, which led to either obtaining employment or being better prepared for the job search process. The data will help inform the New Choices program stakeholders on programmatic improvements and how best to structure the program in the post-pandemic employment world.

Commemoration of Seven Accomplished Jewish Women in Dermatology from Europe and Canada

We commemorate and celebrate the historic careers and the medical and dermatologic contributions of seven distinguished European and Canadian Jewish women who were pioneers in dermatology. Although there may be other notable women, we have selected these dermatologists as examples of courage and determination. Each struggled to overcome professional barriers to women in medicine, and all had experienced antisemitism, especially those who fell under Nazi rule. We honor their achievements: Lili Farkas (1899-1992), Vera Shukhman (1900-1987), Stefania Jablonska (1920-2017), Halina Szenicer-Rotstein (1907-1942), Fanny Cohn (1899-1990), Marie Caroline Kaufmann-Wolf (1877-1922), and Rickey Kanee Schachter (1918-2007).

Barriers to Empowerment: Examining the Transition of Pakistani Women from Higher Education (HE) to Professional Life

Gender equality is essential for economic and societal advancement, as outlined in the United Nations’ Sustainable Development Goal 5. This research examines the obstacles that hinder women’s progression from higher education to empowerment in Pakistan. Using a comprehensive descriptive survey questionnaire, we collected quantitative data to gain insights from a diverse sample of various provinces. The survey consisted of two sections: background information and 25 constructs of barriers from the existing literature. Data analysis involving 399 respondents included descriptive and inferential statistics, cross-tabulation, and significance testing using non-parametric tests. The findings highlighted significant sociocultural, familial, and professional barriers, with regional disparities underscoring the need for targeted interventions. Women respondents consistently perceived barriers more keenly than men, underscoring the gender-specific nature of these challenges. This study emphasizes the need for focused policies and educational initiatives to address barriers and promote gender equality in Pakistan’s higher education and professional spheres.

Enhanced train-the-trainer program for registered nurses and social workers to apply the founding principles of primary care in their practice: a pre-post study

BackgroundA train-the-trainer approach can effectively support the integration of new practice standards for health and social services professionals. This study describes the effects of an enhanced train-the-trainer program to support registered nurses and social workers working in primary care clinics in their understanding of the fundamental principles of primary care.MethodsWe implemented an enhanced train-the-trainer program for registered nurses and social workers in six primary care clinics. We conducted a pre-post study using quantitative and qualitative data to assess trainers’ and trainees’ intention, commitment, and confidence in applying acquired knowledge.ResultsWe trained 11 trainers and 33 trainees. All the trainers and trainees were satisfied with the program. Trainers were less confident in their abilities as trainers following the training, especially regarding tailored coaching (p = 0.03). Trainees’ commitment to becoming familiar with the functioning of their clinic (p = 0.05) and becoming part of the team increased significantly (p = 0.01); however, their intention to use their knowledge decreased (p = 0.02). Trainers and trainees identified organizational and professional barriers that may explain the observed decrease.ConclusionAn enhanced train-the-trainer program positively impacted registered nurses’ and social workers’ assimilation of the fundamental principles of primary care. Further research is needed to understand the long-term effects of train-the-trainer programs on primary care trainees and how these effects translate into patient care.

Pressure ulcer prevention for people with long-term neurological conditions (LTNCs) who self-manage care and live at home

AimTo develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. MethodsA participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP):•WP1 – Development of two co-operative Inquiry Groups (CIGs)•WP2 - Semi-structured interviews and/or app participation•WP3– Professional and strategic stakeholder engagement•WP4–Systems mapping and Theory of Change (ToC pathway developmentIterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FindingsOverall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. ConclusionsThe study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.

S06-2: Moving Cancer Care: The importance of exercise during and after a cancer treatment

Abstract Purpose Literature is recognizing exercise in cancer as a promising therapeutic tool. Authors have shown that exercise could prevent health deterioration, reduce the risk of comorbidities, and improve overall quality of life. Despite this, few cancer patients participate in exercise programs. In this study, we identify barriers and solutions for cancer patients and professionals in promoting exercise. We investigate patient motivations, enhance professional roles (assess, motivate, refer) and identify optimal exercise programs. Methods We used a human-centred design research, an iterative approach that focuses on understanding and addressing the needs of the field. For this, we first reviewed the international literature and specifically mapped the situation in Flanders (Belgium). We used qualitative (face-to-face interviews, focus groups, online survey) and quantitative (parameter registration) methods among cancer patients (39) and health/exercise professionals (36). In the second phase, our goal was to address the issue through collaborative feedback and partnership with the professional field. This resulted in the creation of practical tools, allowing professionals to assist cancer patients more effectively in their exercise routines. Results Patients and professionals commonly face barriers related to exercise resistance (e.g. lack of motivation) and limited referral pathways. Patients also express concerns about the location of exercise programs and susceptibility to external factors (e.g. weather conditions). While health and exercise professionals contend with challenges such as limited professional knowledge and organizational barriers, including an overloaded workload. When developing exercise programs, it is important to incorporate proven design criteria from previous research. These include the use of behaviour change models, adherence to evidence-based exercise standards, and the provision of guidance and follow-up throughout the program. Conclusions This research highlights the urgent need for a paradigm shift in cancer care, advocating not only more appropriate exercise programs, but also the integration of exercise coaching into the standard care pathway for all cancer patients. The inspirational book and practical guidelines elaborated serves as valuable resources for health and exercise professionals and aims to promote physical activity during cancer treatment. This project aims to contribute to the future of care, envisioning sustainable physical rehabilitation beyond the traditional hospital setting

Jewish women in dermatology

We highlight the contribution of notable Jewish women in American dermatology. Although not intended to be a thorough listing, we selected nine representatives as examples of early pioneer women in American dermatology and research and those who were political leaders, authors and journal editors, and teachers and role models. All struggled to overcome professional barriers to women in medicine; many experienced antisemitism, especially those who were forced to flee Nazi Germany. Despite persecution and upending their lives, they rebuilt their careers and made outstanding contributions to the field of dermatology.

Barriers to postgraduate education in primary dental care: a qualitative study

ObjectivesPostgraduate education for primary care dentists offers numerous benefits in terms of advancing clinical skills and career opportunities, culminating in improved treatment and patient outcomes. There is a strong desire amongst primary care dentists to enhance skills and provide contemporaneous evidence-based dentistry, accredited by higher educational qualifications. However, significant barriers hinder their pursuit of further training and career advancement. The aim of this study is to explore the barriers to undertaking formal postgraduate education for dental practitioners working in primary dental care. Exploration of these perceptions should help to identify further areas of study to help alleviate some of these obstacles, enabling more primary care dentists to access postgraduate education and improve patient care. MethodA qualitative study was undertaken through individual narrative interviews with primary care dental practitioners (n = 20) with varying levels of experience and located across the UK. All interviews were conducted using a study guide, transcribed and analysed thematically. ResultsThe participants indicated that there is a strong desire to undertake postgraduate study amongst primary care dental practitioners. Significant barriers were identified, with three major themes emerging:1.Personal Cost: Time constraints and accessibility, Financial Burden, Family Commitments.2.Business Viability: Business time constraints, Inability to use Enhanced Skills, Remuneration systems.3.Business Culture and Team Dynamics: Stage of Career, Current Practice Business Model, Leadership and Vision.These barriers appear to be multifaceted and interconnected, however participants also identified significant opportunities to address them. ConclusionStudy participants identified a range of personal and professional barriers to undertaking postgraduate dental education whilst working in primary dental care. Practitioners working within predominately NHS orientated practices perceived more professional barriers than those in private practice. The majority of participants indicated their preference for hybrid models of education which would work around clinical commitments. Further research and engagement with stakeholders should be undertaken to help reduce these barriers.

Continuing professional development barriers and recommendations: Perspectives of audiologists.

Continuing professional development (CPD), a compulsory requirement of the Health Professions Council of South Africa (HPCSA), is undertaken by healthcare professionals (HCPs), including audiologists, to remain up-to-date with the latest developments, technology and best practices within their discipline. However, the low compliance rates of audiologists engaging in CPD need to be investigated to establish the barriers that audiologists encounter as well as possible interventions to improve their participation. This study aimed to explore the barriers that audiologists encounter when participating in CPD activities and to highlight their suggestions for improving its uptake. The descriptive qualitative research design entailed the use of semi-structured online interviews with 11 audiologists practising within the private sector in the province of KwaZulu-Natal, South Africa, their responses being thematically analysed. Three barriers were identified, namely: (1) personal, (2) financial and (3) structural barriers, with eight subthemes and nine recommendations provided by participants. It is anticipated that implementing the proposed strategies will address the barriers and allow active engagement of audiologists in their continued education.Contribution:Limited literature has been documented on the barriers that young, private sector audiologists encounter within the South African context while also providing suggestions to address these barriers.

A physics-guided automated machine learning approach for obtaining surface radiometric temperatures on sunny days based on UAV-derived images

Urban surface radiometric temperatures, approximate to the surface kinetic temperatures, are predominantly retrieved using satellites or unmanned aerial vehicles (UAVs) and exhibit pronounced spatiotemporal variations. Despite numerous methods ranging from empirical to physical models for obtaining urban microscale surface radiometric temperatures via UAVs, challenges remain given the limited physical significance and substantial professional barriers to method application. Against this background, this study introduces a novel and straightforward approach for acquiring spatially distributed radiometric temperatures on sunny days without understanding the complex radiative transfer process as well as acquiring low-altitude atmospheric parameters. An automated machine learning was employed to train a model capable of efficiently estimating radiometric temperatures. Training and testing datasets were created based on the urban radiative transfer equation, incorporating three independent variables: UAV-measured surface brightness temperature, broadband emissivity, and sky view factor, which collectively represent the diverse thermal environments across different surface characteristics and urban layouts during sunny transitional and summer seasons. The model's accuracy was subsequently confirmed through direct comparisons with radiometric temperatures retrieved from UAV-collected multimodal images and kinetic temperatures synchronously collected on the ground across four periods. The results indicate that AutoGluon achieved high accuracy (MAE: 0.04 K; RMSE: 0.06 K; R2: 0.99). Additional ground measurement validations further demonstrated the model's reliability, with absolute biases on sunlit surfaces maintained within 1.25 K. Given its capability for real-time, high-spatial-resolution mapping of radiometric temperatures (April test: 8.70 cm, July test: 6.89 cm) in urban microscales with considerable heterogeneity, such a method is envisioned to be an effective tool for the dynamic monitoring and management of thermal environments at the microscale level in urban settings.

Revitalising traditional Indian games: inclusive game adaptations for children with cerebral palsy

Background Children with cerebral palsy (CP) present unique challenges to physical activity due to various factors. Despite the benefits of inclusive approaches and adapted physical education, low- and middle-income countries face specific barriers including environmental, equipment, personal, policy, social and professional barriers. Traditional Indian games, with their cultural significance and potential therapeutic benefits, offer a promising avenue for inclusive adaptations. At present we couldn’t find any studies that explore’s the method of adaptation of traditional Indian games for children with cerebral palsy of varying functional levels. Purpose The aim of the study was to explore the adaptation of traditional Indian games for children with CP of varying functional levels. Methods Traditional Indian games were identified through ethnographic qualitative research, and adapted using the Delphi process involving experts from various fields. A total of 10 traditional games were selected based on their health benefits using an operationalised conceptual model. The CHANGE IT model of adapted physical activity was used to systematically adapt each game. Validation of the model was then performed on children with CP [a smaller sample size, n = 10] with different levels of functioning. Results The games varied in playing positions, surfaces and phases. Modifications included changes in game rules, play environment, equipment and time duration. The study validation through informal interview among the parents of CP children revealed that adapted traditional game protocol shown improvements in their children’s activity levels and participation. Conclusions While this is a preliminary exploration, no firm conclusion can be drawn. The model presented in this study lays the foundation for future randomised controlled trials to validate the effects of adapted traditional Indian games on children with cerebral palsy of different functional levels.