Readiness Assessment Research Articles

E73 Resilience and transition readiness for adolescents living with rheumatic diseases: a narrative review of literature and a plea for action

Abstract Introduction Rheumatic diseases are among common chronic health conditions affecting the pediatric population and persist through adolescence to adulthood. Adolescence is a complex period of development, growth and vulnerability, especially for those living with chronic illnesses. Socio-emotional, physical and cognitive growth spurt, quest for independence and peer pressure affect coping with rheumatic disorders and adherence to management. Dealing with rheumatic diseases may be associated with disruption of school routine, relationships and friendships, body image and overall quality of life, and may be devastating to affected adolescents. An additional toll on mental health is exerted by dealing with loss of fellow patients who succumb from the diseases like their own. A comprehensive mode of care that foster resilience and well-being of adolescents beyond disease control, and ensuring successful transition to adult care is of paramount importance. The objective of this review was to synthesize evidence on resilience programs and transition services offered to adolescents living with rheumatic diseases. Adolescents living with rheumatic diseases are of two classes; those growing into adolescence with child-onset rheumatic diseases and those who are newly diagnosed during adolescence. This review included both populations. We also aimed to specifically document such services existing in the Sub-Saharan Africa (SSA) context. Methods We conducted a narrative review of literature from publicly available databases including google scholar and PubMed. PICO aspect of this review was as follows; P: Adolescents living with rheumatic diseases, I: Transition and resilience programs to foster their well-being during and beyond adolescence C: there was no comparator group assessed and O: successful transition to adult care. Results Challenge on comprehensive care for adolescents living with rheumatic diseases and successful transition of adolescents from child-oriented care to independent adult care exist globally. Lack of adolescent oriented care, teaching aids and poor knowledge of providers on the importance of offering adolescent-oriented care rather than dealing with the disease alone have been implicated. Further to that, shortage of resources such as space, finances and personnel have been documented to hinder implementation of adolescent friendly services. Lack of integrated multidisciplinary coordination involving clinicians, sociologists, psychologist and community workers has also been shown to hamper wholistic care approach for adolescents growing up with rheumatic diseases. Various clinic models, transition programs, transition readiness assessment tools (TRAT) and transition readiness assessment questionnaires (TRAQ) have been proposed, most of which are from high income settings. Of importance to note, there is an alarming scarcity of literature from SSA context despite a growing population of children and adolescents diagnosed with rheumatic diseases. Questions remain; what are the needs to be addressed to enhance resilience of adolescents living with rheumatic diseases in SSA context? What are the acceptable methods to assess transition readiness, foster adolescents’ treatment responsibility and good treatment outcomes? Conclusion Due to complexity of adolescence time period, there is an urgent need for context specific models that may help adolescents living with rheumatic diseases navigate through adolescence and successfully transit to independent adult care. Multiple clinical care and transition models have been proposed to enhance successful transition of adolescents living with rheumatoid diseases to adulthood. However, adolescents from SSA may have unique challenges compared with those from developed countries where most of the studies have been done. There is an urgent need to address this gap. Ethics This work encompasses synthesis of evidence already published material containing de-identified information. Ethical approval was not deemed pertinent.

Association of Transport Time, Proximity, and Emergency Department Pediatric Readiness With Pediatric Survival at US Trauma Centers.

Emergency department (ED) pediatric readiness is associated with improved survival among children. However, the association between geographic access to high-readiness EDs in US trauma centers and mortality is unclear. To evaluate the association between the proximity of injury location to receiving trauma centers, including the level of ED pediatric readiness, and mortality among injured children. This retrospective cohort study used a standardized risk-adjustment model to evaluate the association between trauma center proximity, ED pediatric readiness, and in-hospital survival. There were 765 trauma centers (level I-V, adult and pediatric) that contributed data to the National Trauma Data Bank (January 1, 2012, through December 31, 2017) and completed the 2013 National Pediatric Readiness Assessment (conducted from January 1 through August 31, 2013). The study comprised children aged younger than 18 years who were transported by ground to the included trauma centers. Data analysis was performed between January 1 and March 31, 2022. Trauma center proximity within 30 minutes by ground transport and ED pediatric readiness, as measured by weighted pediatric readiness score (wPRS; range, 0-100; quartiles 1 [low readiness] to 4 [high readiness]). In-hospital mortality. We used a patient-level mixed-effects logistic regression model to evaluate the association of transport time, proximity, and ED pediatric readiness on mortality. This study included 212 689 injured children seen at 765 trauma centers. The median patient age was 10 (IQR, 4-15) years, 136 538 (64.2%) were male, and 127 885 (60.1%) were White. A total of 4156 children (2.0%) died during their hospital stay. The median wPRS at these hospitals was 79.1 (IQR, 62.9-92.7). A total of 105 871 children (49.8%) were transported to trauma centers with high-readiness EDs (wPRS quartile 4) and another 36 330 children (33.7%) were injured within 30 minutes of a quartile 4 ED. After adjustment for confounders, proximity, and transport time, high ED pediatric readiness was associated with lower mortality (highest-readiness vs lowest-readiness EDs by wPRS quartiles: adjusted odds ratio, 0.65 [95% CI, 0.47-0.89]). The survival benefit of high-readiness EDs persisted for transport times up to 45 minutes. The findings suggest that matching children to trauma centers with high-readiness EDs within 30 minutes of the injury location may have potentially saved 468 lives (95% CI, 460-476 lives), but increasing all trauma centers to high ED pediatric readiness may have potentially saved 1655 lives (95% CI, 1647-1664 lives). These findings suggest that trauma centers with high ED pediatric readiness had lower mortality after considering transport time and proximity. Improving ED pediatric readiness among all trauma centers, rather than selective transport to trauma centers with high ED readiness, had the largest association with pediatric survival. Thus, increased pediatric readiness at all US trauma centers may substantially improve patient outcomes after trauma.

Health facility availability and readiness for family planning and maternity and neonatal care services in Nepal: Analysis of cross-sectional survey data.

To determine the availability and readiness of health facilities to provide family planning, antenatal care and basic emergency obstetric and newborn care in Nepal in 2021. Secondary objectives were to identify progress since 2015 and factors associated with readiness. This is a secondary analysis of cross-sectional Nepal Health Facility Survey (NHFS) data collected in 2015 and 2021. The main outcome measures were availability and readiness of family planning, antenatal care, and basic emergency obstetric and newborn care services. Readiness indices were calculated using WHO-recommended service availability and readiness assessment (SARA) methods (score range 0 to 100%, with 100% indicating facilities are fully prepared to provide a specific service). We used independent t-tests to compare readiness indices in 2015 and 2021. Factors potentially associated with readiness (rurality setting, ecological region, managing authority, management meeting, quality assurance activities, and external supervision) were explored using multivariable linear regression. There were 940 and 1565 eligible health facilities in the 2015 and 2021 surveys, respectively. Nearly all health facilities provided family planning (2015: n = 919 (97.8%); 2021: n = 1530 (97.8%)) and antenatal care services (2015: n = 920 (97.8%); 2021: n = 1538 (98.3%)) in both years, but only half provided delivery services (2015: n = 457 (48.6%); 2021: n = 804 (51.4%)). There were suboptimal improvements in readiness indices over time: (2015-21: family planning 68.0% to 70.9%, p<0.001, antenatal care 49.5% to 54.1%, p<0.001 and basic emergency obstetric and newborn care 56.7% to 58.0%, p = 0.115). The regression model comprising combined datasets of both NHFSs indicates facilities with regular management meetings and/or quality assurance activities had significantly greater readiness for all three indices. Similarly, public facilities had greater readiness for family planning and basic emergency obstetric and newborn care while they had lower readiness for antenatal care. Readiness to deliver family planning, antenatal care and basic emergency obstetric and newborn care services in Nepal remains inadequate, with little improvement observed over six years.

Organizational readiness for smart working: a model and assessment tool

PurposeThis paper aims to provide an easy-to-use yet powerful tool to assess the organizational readiness to adopt effective Smart Working (SW). In light of this main objective, based on the current state of research, the study develops a maturity model to assess the SW organizational readiness (SWOR). The SWOR maturity model consists of three dimensions, each of them further detailed into two sub-dimensions. A tool was developed to make use of the model.Design/methodology/approachThe SWOR maturity model was converted into a Web-based questionnaire that includes 54 questions based on 44 items to operationalize the model sub-dimensions. The questionnaire was used in a survey conducted at the Local Health Authority (ASL) of the province of Bari (Italy).FindingsSeveral implications derive from the present study. From a managerial perspective, the SWOR maturity model supports companies in the as-is analysis of processes, technologies and human resources, which are the enablers of an effective SW, and in the development of a roadmap to achieve a desired “to-be” situation.Originality/valueDespite recent studies on SW have identified the key drivers that affect the success of SW implementation, there is a lack of models and tools that help companies become aware of the actions and investments to be taken to move towards an effective SW adoption. Even the analysis of the literature on maturity models reveals a gap in the research related to the assessment of SW organizational readiness. The present paper tries to overcome these limitations.

Sustainable Industrial Revolution Competency Framework for 5G Technology Applications using TRIZ

The Malaysian industrial revolution strategy, also known as Industry4WRD, has been the driving force behind the transformation of the industrial sectors by accepting and implementing modern technology. The initial phase of the Industry4WRD initiative focuses on the readiness assessment of industrial businesses to determine their level of adoption of Industry 4.0. However, the second phase challenges firms to advance and increase their readiness index. According to data collected from 473 firms, the 'People' shift element has the most significant obstacle for companies to overcome, particularly for small and medium-sized businesses (SMEs). In the 'people' dimensions of Industry4WRD, the research emphasised the importance of competency in developing human capital for 5G technology applications. The benchmarking technique revealed five skill levels, the competency unit and work activities associated with 5G telecommunications and system networks. The theory of creative problem solving (TRIZ) was applied to a system-based idea to develop a conceptual competence framework. Twenty-five firms were selected and contributed to this research by designing and verifying a conceptual competence framework for 5G technology implementation. With a 0.81 concordance coefficient, the study's objective has been accomplished by obtaining a high level of unanimity across 25 organisations in three rounds of the Delphi poll. As a guideline, the conceptual competency framework may be utilised to create other technology competencies, such as automation and artificial intelligence workforce. It would benefit the country to conduct more research on the specifics of competence units depending on the needs of industrial sectors.

Outcomes of a Structured Ambulatory Care Health Care Transition Approach in a Large Children's Hospital

PurposeWithout a structured health-care transition (HCT) process, youths with chronic conditions face increased morbidity, care gaps, and dissatisfaction. This article documents the process and outcomes of implementing a standardized approach in a large children's hospital. MethodsChildren's Mercy Kansas City adopted Got Transition's Six Core Elements of Health Care Transition and established a system-wide implementation plan, between 2015 and 2019, involving leadership buy-in, consumer engagement, infrastructure improvements, and quality improvement efforts. Outcomes measured included the number of youths aged 12–21 years receiving transition readiness assessments and participating in goal setting, receiving counseling, and receiving a transfer order, if appropriate. Also, Division-specific process outcome surveys were conducted annually using Got Transition's Current Assessment of HCT Activities. ResultsA total of 8,099 unique patients received a structured HCT intervention using the Six Core Element approach over the 5-year period. From 2015 to 2019 the average annual growth was: 207% for completion of transition readiness and goals assessments, 243% for charting of HCT discussions, and 105% for transfer orders. In 2015, 3/20 (15%) divisions were implementing this HCT intervention; in 2019, 17/20 (85%) divisions were implementing it, representing a 467% growth. Division participation in measuring HCT implementation also increased by 89% from 9/20 in 2016 to 17/20 in 2019. The average Current Assessment of HCT Activities scores increased by 35% from 14.55/32 to 19.67/32 during that time. DiscussionThis hospital-wide program demonstrates that a standardized HCT process can be successfully implemented in a diverse group of outpatient pediatric primary and subspecialty care settings.

Transition Readiness Assessment Questionnaire: Skill gaps and psychosocial predictors of transition readiness among adolescents and young adults with chronic medical conditions.

Transferring from paediatric to adult care can be challenging. Adolescents and young adults (AYAs) with chronic health conditions need to develop a specific set of skills to ensure lifelong medical follow-up due to the chronicity of their condition. The Transition Readiness Assessment Questionnaire-French version (TRAQ-FR) is a 19-item questionnaire measuring such skills. The aims of the study were to (1) describe participant characteristics and (2) identify constructs related to, and predictors of, having learned domain-specific transition readiness skills. Participants included 216 AYAs aged 14-20 years (M = 15.93; SD = 1.35; 54.1% male) recruited from five outpatient clinics in a Canadian tertiary hospital. AYAs completed the TRAQ-FR, the Pediatric Quality of Life Inventory 4.0 (PedsQL) and a sociodemographic questionnaire. Descriptive, bivariate and binary logistic regression analyses were conducted. Overall, participants reported significantly higher scores on the Talking with Providers, Managing Daily Activities and Managing Medications subscales than on the Appointment Keeping and Tracking Health Issues subscales (F[41075] = 168.970, p < .001). At the item level, median scores (on a 5-point Likert scale) suggest that AYAs had begun practising five of the 19 skills (median scores ≥4; 'Yes, I have started doing this'), while a median score of 1 ('No, I don't know how') was found for one item ('Do you get financial help with school or work?'). At the subscale level, TRAQ-FR skills and skill gaps were related to AYAs' age, sex and PedsQL scores (ps < .05). Older and female AYAs were more likely to have begun practising specific TRAQ-FR subscale skills. Better psychosocial functioning was also related to having learned specific transition readiness skills. AYAs show several gaps in transition readiness. Targeted intervention in transition readiness skill development could take into account AYAs' age, sex and psychosocial functioning for a successful transfer to adult care.

Analysis of public health-care facilities in rural India

PurposeThis paper aims to analyze the status of infrastructure, workforce and basic amenities at public health-care facilities in rural India and draw a comparison with its urban counterparts.Design/methodology/approachRural Health Statistics data and National Sample Survey Office Report for the period 2019–10 were used to analyze lower-level public health facilities, namely, subcenters, primary health centers and community health centers (CHCs). Selected tracer indicators under World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) mechanism such as health center density, core health workforce density and basic amenities were used to carry out the analysis. The extent of facility coverage was measured using the National Rural Health Mission (NRHM) guidelines and the proportion of facilities satisfying the Indian Public Health Standards (IPHS) was measured to assess the service provision quality in rural public health-care facilities.FindingsResults indicated that the density of public health centers is higher in rural areas than in urban areas. Almost all public health-care facilities lack basic amenities in rural areas. Working positions for health specialists in CHCs barely meet the total requirement. Almost all of the public health facilities functioning in rural areas do not meet the IPHS norms.Originality/valueTo the best of the authors’ knowledge, the present paper is the first initiative to assess the status of rural public health-care facilities on the national level using WHO’s SARA indicators as well as NRHM and IPHS guidelines. The study is significant in terms of policy input for achieving universal health coverage in India.

Weaning assessment of veno-arteriovenous (V-AV) extracorporeal membrane oxygenation (ECMO)

Currently, there is a lack of methods for simultaneous assessment of readiness for decannulation of the veno-venous (V-V) and veno-arterial (V-A) components during veno-arteriovenous (V-AV) extracorporal membrane oxygenation (ECMO) support. We describe a novel approach using a simultaneous off-sweep and controlled backflow test to assess readiness for decannulation from V-AV ECMO. This method needs testing in future clinical trials.

A Patient Portal Intervention to Promote Adolescent and Young Adult Self-Management Skills.

Failure to transfer care to adult medicine is associated with gaps in health care access and poor health outcomes among young adults. We examined whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care. We conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) portal user experience was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic. Descriptive statistics were used to describe participant characteristics, paired t tests, or Wilcoxon signed-rank tests to assess outcomes of survey response changes pre- versus postintervention. Sixty percent of enrolled participants (N=78) completed the surveys. Following the educational intervention, we observed an increase in participants self-reporting knowing how to access their protected health information P < .0001, (95%, confidence interval [CI], 1-2) and in the proportion of participants self-reporting to strongly agree to know their medication P=.025 (95%, CI 0-1). We also observed an increase in portal user access at 3 weeks; the median number of logins was 2 per participant (range 1-36, P < .0001). The Portal user experience was strongly positive. Our patient portal educational intervention suggests that AYAs welcome a patient portal to access protected health information and is associated with an increase in the proportion of participants self-reporting to strongly agree with knowing their medication. While these results are encouraging, this is a quasiexperimental study designed on the frame of feasibility. Our study was not adequately powered, limiting our findings' significance. Future interventions would benefit from a larger sample size with a comparison group to ascertain the effect of a patient portal on self-management skills in a diverse AYA population and inform best practices.

Use of a Pre-class iRAT to Increase Accessibility in TBL Readiness Assessment

Use of a Pre-class iRAT to Increase Accessibility in TBL Readiness Assessment

Stages of choosing a project for the diversification of production and business

Subject. The article considers the process of selecting a project for diversification of production and business at machine-building enterprises. Objectives. The purpose is to develop elements of a logical model of the diversification process, i.e. determination of the type of production, assessment of enterprise's readiness for diversification, assessment of resources of the diversified enterprise and expectations from the diversification project, formation of indicators to evaluate the diversified business. Methods. I employ a consistent comparative analysis of diversification projects at machine-building enterprises, which are the necessary basis for the study. The tools of the analysis rest on in-depth review of various theories of diversification and enable to visualize the results of the data obtained. Results. I compared different theories and classifications, determined the main metrics and sequence of their application when making a decision on diversification, defined objectives of diversification and ways to achieve cost-effectiveness of the project. The paper offers an approach to ensure the consistency of evaluation process and to analyze prospects for production diversification. It also formulates the necessary parameters of products selected by the enterprise for diversification, identifies and evaluates indicators for rapid assessment of diversification project, specifies the order of stages of selecting the diversification project. Conclusions. Enterprises with more than a quarter of the range of civilian products, qualified personnel, elaborated system of resource supply relying on flexible production, a high level of automation, and a technological platform have high chances to successfully implement a diversification project.

Parasympathetic Nervous System Activity During Measures of Volitional Self‐regulation Predicts School Readiness

ABSTRACTSelf‐regulation is an essential component of school readiness. Although in educational contexts self‐regulation is typically defined in terms of volitional processes, it also encompasses the activity of neurophysiological systems, including the parasympathetic nervous system (PNS). In a prospective longitudinal study, 102 preschoolers (Mage = 4.82 years; 52% female) completed two measures of volitional self‐regulation (the gift‐wrap task and a battery of EF tasks) at the beginning of their final preschool year, and then completed the Bracken School Readiness Assessment (BSRA) at year's end. Larger increases in parasympathetic function (indexed by respiratory sinus arrythmia, or RSA) during both the gift‐wrap and EF tasks were correlated with better performance on the BSRA at levels approaching significance, and subsequent regression models that controlled for relevant covariates revealed robust associations between increases in RSA and improved BSRA performance (gift wrap: B = 5.49, p = .012; EF: B = 7.77, p = .001). We interpret these results in light of polyvagal theory and discuss their implications for incorporating measures of parasympathetic activity into future educational neuroscience research.

Transition readiness of adolescents to adult health care.

Transition in health care is a process wherein adolescents gradually prepare for and shift towards care in the adult system. An initial assessment of the readiness of these adolescents is fundamental in providing appropriate health services for them. This paper aims to determine the readiness of adolescent patients towards transitioning to adult care. This is a prospective cross-sectional study utilizing an interviewer-guided modified Transition Readiness Assessment Questionnaire (TRAQ). Sixty-three adolescents ages 15 to 18 years seen in the Pediatric Outpatient Department (OPD) of a tertiary hospital in Baguio City from July 1 to October 31, 2020 were enrolled. Frequency and percentages were used to describe the demographic data; while mean score and standard deviation determined readiness based on a Likert scale. One-way ANOVA was utilized to determine association between factors and readiness to transition. For all domains of TRAQ, the mean score was 3.64, implying that they are not yet ready to transition. 49.2% belong to General Pediatrics. 44.4% belong to the Igorot ethnic groups. Most are still in High school, and majority of their parents finished High School level. Furthermore, the P-values were more than 0.05 for all variables suggesting no association between readiness to transition and the identified factors in this study. This study showed that adolescents who had both acute and chronic illnesses, were not yet ready to transition. Provision of a platform for assisting the adolescents in their assumption of bigger roles/responsibilities for their own health care is necessary to ensure proper transitioning to adult health care.

Covid-19 pandemic: A necessary catalyst for e-learning adoption and application

The Covid-19 pandemic brought the world to a grinding halt, adversely affecting almost every sector including the post school education and training (PSET) sector. The South African PSET sector is no exception. The academic enterprise was abruptly disrupted and led to a serious loss of teaching and learning time as the government passed new regulations discouraging movement and physical meetings of people. The state of disaster regulations and lockdown directives pronounced during March 2020 by the South African government presented an unprecedented way of operating since the formation of many higher education institutions (HEIs). This study assesses the state of e-learning before and after the first six weeks of lockdown regulations in two HEIs, using a theoretical framework of e-learning system readiness assessment and a participatory research approach. The study reveals a state of under-preparedness by HEIs to operate under the lockdown regulations, due to the adopted blended learning policy implementation gap. Based on these findings, the study concludes with an argument that the Covid-19 pandemic presented a great opportunity for HEIs not only to adopt e-learning at the policy level but also to adapt to the new e-learning methods and practices and thus prepare universities for times of uncertainty.

A small area model to assess temporal trends and sub-national disparities in healthcare quality

Monitoring subnational healthcare quality is important for identifying and addressing geographic inequities. Yet, health facility surveys are rarely powered to support the generation of estimates at more local levels. With this study, we propose an analytical approach for estimating both temporal and subnational patterns of healthcare quality indicators from health facility survey data. This method uses random effects to account for differences between survey instruments; space-time processes to leverage correlations in space and time; and covariates to incorporate auxiliary information. We applied this method for three countries in which at least four health facility surveys had been conducted since 1999 – Kenya, Senegal, and Tanzania – and estimated measures of sick-child care quality per WHO Service Availability and Readiness Assessment (SARA) guidelines at programmatic subnational level, between 1999 and 2020. Model performance metrics indicated good out-of-sample predictive validity, illustrating the potential utility of geospatial statistical models for health facility data. This method offers a way to jointly estimate indicators of healthcare quality over space and time, which could then provide insights to decision-makers and health service program managers.

Enhancing corporate readiness for and resilience to future public health threats, development and deployment of the public health readiness and resilience (PHRR) assessment tool.

As the world suffered through the COVID-19 pandemic, it is increasingly clear that the health of populations is foundational to a high-functioning economy, corporate well-being, and a core driver of social justice. Thus, companies need to understand how to become more resilient to current and future threats. This study (1) explored dimensions of resilience from a public health risk-specific lens and reviewed existing evaluation tools and frameworks to develop a methodology and framework (Public Health Readiness and Resilience-PHRR Assessment Tool) for organizations; and (2) leveraged the framework to evaluate a sample of large corporations to validate the insights the tool can provide, confirm functionality, and evaluate the ability to leverage publicly available vs. propriety data to complete the assessment. We conducted a non-exhaustive search for relevant indices using key word searches and cascade sampling. For the initial review of indices (n = 24), the team evaluated each document based on predefined criteria. Gaps identified in the available indices informed the development of the PHRR assessment tool. The tool was then used to examine real-world companies (n = 22) from eight different industries. Findings from the PHRR tool illustrated variation in readiness and resilience as well as the availability of data. Approximately half of the companies analyzed (n = 11) indicated high levels of potential resilience and readiness with significant data available. Leveraging the PHRR Assessment Tool can inform investments and cross-sector partnerships that enhance companies' readiness and resilience to a variety of public health threats. Additional research is needed to further validate this tool.

Organizational cybersecurity readiness in the ICT sector: a quanti-qualitative assessment

PurposeCyberattacks are becoming increasingly widespread, and cybersecurity is therefore increasingly important. Although the technological aspects of cybersecurity are its best-known characteristics, the cybersecurity phenomenon goes beyond the detection of technological impacts, and encompasses all the dimensions of an organization. This study thus focusses on an additional set of organizational elements. The key elements of cybersecurity organizational readiness depicted here are cybersecurity awareness, cybersecurity culture and cybersecurity organizational resilience (OR). This study aims to qualitatively assess small and medium enterprises’ (SMEs) overall level of organizational cybersecurity readiness.Design/methodology/approachThis study focused on conducting a cybersecurity organizational readiness assessment using a sample of 53 Italian SMEs from the information and communication technology sector. Informed mixed method research, this study was conducted consistent with the principles of the explanatory sequential mixed method design, and adopting a quanti-qualitative methodology. The quantitative data were collected through a questionnaire. Qualitative data were subsequently collected through semi-structured interviews.FindingsAlthough many elements of the technical aspects of cybersecurity OR have yielded very encouraging results, there are still some areas that require improvement. These include those facets that constitute the foundation of cybersecurity awareness, and, thus, a cybersecurity culture. This result highlights that the areas in need of improvement are exactly those that are most important in fighting against cyber threats via organizational cybersecurity readiness.Originality/valueAlthough the importance of SMEs is obvious, evidence of such organizations’ attitudes to cybersecurity are still limited. This research is an attempt to depict the organizational issue related to cybersecurity, i.e. overall cybersecurity organizational readiness.

Availability and readiness of the health facilities to provide HIV counseling and testing and prevention of mother-to-child transmission services in Burkina Faso: a trend analysis from 2012 to 2018

BackgroundProvider-Initiated HIV Testing and Counseling (PITC) and Prevention of Mother-To-Child Transmission (PMTCT) are key services for achieving the goal of complete elimination of HIV. However, there is limited evidence on the ability of health facilities to provide these services in Burkina Faso. Therefore, we aimed to assess the trends and disparities in the availability and readiness of health facilities to provide PITC and PMTCT services in Burkina Faso between 2012 and 2018.MethodsWe performed a secondary analysis of facility-level data from the World Health Organization’s Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016, and 2018 in Burkina Faso. The availability and readiness of health facilities were assessed using SARA’s manual, and linear regressions were used to examine trends.ResultsBetween 2012 and 2018, the mean proportion of health facilities providing PITC services increased, but not significantly, from 82.9% to 83.4% (p = 0.11), with the mean readiness index significantly decreasing from 71.5% to 65.4% (p < 0.001). This decrease concerned the staff and guidelines (73.8% to 50.5%; p < 0.001), equipment (79.0% to 77.4%; p < 0.001), and medicines and commodities (54.2% to 45.2%; p < 0.001) domains. Regarding the PMTCT services, the mean proportion of health facilities globally providing the service significantly decreased from 83.7% in 2012 to 67.7% (p = 0.030) in 2018, and the mean readiness significantly decreased from 53.2% in 2012 to 50.9% in 2018 (p = 0.004). This decreasing trend was related to the staff and training (80.3% to 57.6%; p < 0.001) and medicines and commodities (9.2% to 6.5%; p < 0.001) domains. The global significant negative trend of readiness was mainly observed at the primary level of healthcare (52.7% to 49.4%; p = 0.030). Four regions experienced a significant decrease in the readiness index of health facilities to provide PMTCT services: Cascades, Centre, Centre-Sud, and Sud-Ouest, while Haut-Bassins and Nord regions showed increasing trends.ConclusionAvailability and readiness of health facilities to provide PITC and PMTCT remain suboptimal in Burkina Faso. Actions to strengthen the skills of professionals and enhance the availability of medicines and commodities while focusing more on health regions with significant decreasing trends are urgently needed to improve the quality of services for HIV.

Transition readiness of youth with co-occurring chronic health and mental health conditions: A mixed methods study.

A large proportion of youth with chronic conditions have mental health comorbidities. However, the effect of these comorbidities on paediatric-adult transition readiness, and the relevance of widely used tools for measuring transition readiness, are unknown. The objectives of this study were to describe and explore the transition readiness of youth with co-occurring chronic health and mental health conditions using a combination of quantitative data obtained from participants completing the Transition Readiness Assessment Questionnaire (TRAQ) and qualitative data. A three-phase sequential explanatory mixed methods design was employed, with the qualitative strand taking priority. First, the TRAQ scores (range 1-5) of youth with co-occurring conditions (n = 61) enroled in a multisite randomized controlled trial were measured, followed by qualitative interviews with a sample of youth (n = 9) to explain the quantitative results. Results from both strands were then integrated, yielding comprehensive insights. Median TRAQ scores ranged from 2.86 on the appointment keeping subscale to 5.00 on the talking with providers subscale. The qualitative results uncovered the complexities faced by this group concerning the impact of a mental health comorbidity on transition readiness and self-management skills across TRAQ domains. The integrated findings identified a diverse and highly individualized set of strengths and challenges amongst this group that did not align with overarching patterns as measured by the TRAQ. This mixed methods study generated novel understandings about how youth with co-occurring conditions develop competencies related to self-care, self-advocacy and self-management in preparation for paediatric-adult service transitions. Results demonstrated the assessment of transition readiness using a generic scale does not address the nuanced and complex needs of youth with co-occurring chronic health and mental health conditions. Our findings suggest tailoring transition readiness practices for this group based on youths' own goals, symptoms, coping mechanisms and resources. This study was conducted in collaboration with five young adult research partners (YARP) with lived experience transitioning from paediatric to adult health/mental health services. The YARP's contributions across study phases ensured the perspectives of young people were centred throughout data collection, analysis, interpretation and presentation of findings. All five YARP co-authored this manuscript.