Relevant Barriers Research Articles

The transition towards a healthy and sustainable food system at local level: the Brussels City case

Abstract Despite the European Union’s political efforts to promote healthier and more sustainable food systems, challenges persist, with these systems not yet achieving sustainability and still exacerbating health inequalities. The EU-funded FEAST project aims to catalyse this transition through different actions including by focusing on mapping factors shaping food environments in five European cities, including Brussels. This study focuses on mapping existing policies and initiatives by the city government supporting healthier and more sustainable food systems in Brussels City. Policies were then categorized based on Food-EPI domains, types of policies (i.e. financial incentive) and role of the government (i.e. policy development). Results indicated that while Brussels City has a clear strategy (Good Food Strategy) and objectives (Climate Action Plan) to support the transition, there is a notable emphasis on sustainability over health which could be explained by the absence of a dedicated public health expert in the local government. While there are numerous policies focused on improving the school environment (i.e. healthy and sustainable canteens, banned sodas and snack provision, forbidden advertising inside and nearby of unhealthy foods), there is a lack of corresponding measures for public spaces. Furthermore legislative policies are practically inexistent possibly due to jurisdictional barriers from higher governmental levels. Stakeholder interviews will be conducted in the next phase to delve deeper into these issues and to explore potential facilitators and barriers faced in the development and implementation process of these policies. Overall, this research sheds light on the policy landscape in Brussels City, highlighting both progress, areas for improvement and policy gaps in advancing towards healthier and more sustainable food systems. Key messages • Despite EU political efforts to prioritise more sustainable food systems, relevant barriers are still present at local level in Brussels City, hampering the development and implementation of policies. • In Brussels relevant policies for healthier and more sustainable food systems have been implemented, especially in the school environment, but health seems to be overshadowed by sustainability.

Non-Pharmacological Exercise Randomized Controlled Trials in Alzheimer's Disease.

This narrative review aimed to summarize evidence on responses to exercise in pre-clinical Alzheimer's disease (AD) and on how long-term exercise programs work to improve neuropsychiatric symptoms and cognitive performance. We conducted a narrative review of the body of research on the benefits of long-term exercise programs in improving cognitive performance and reducing neuropsychiatric scores in patients with AD. Long-term exercise therapy appears to improve blood flow, increase hippocampal volume, and promote neurogenesis in patients with AD. Higher levels of physical activity are associated with a lower chance of developing the disease, and most prospective studies have shown that physical inactivity is one of the most prevalent modifiable risk factors for the development of AD. Exercise appears to be beneficial in improving cognitive function, a neuropsychiatric symptom of AD. Exercise has been shown to have fewer side effects, such as non-pharmacological effects and better adherence than medication. In this review, experts provided a snapshot and authoritative summary of evidence for non-pharmacological exercise in patients with AD based on the best synthesis efforts, identified the main knowledge gaps and relevant barriers, and provided directions for future research. Furthermore, experts in randomized trial designs provided practical details and recommendations for researchers working in this area, underscoring the importance of relevant topics.

Exploration of barriers to treatment for patients with eating disorders in Chile

BackgroundEating disorders (EDs) are associated with high morbidity and mortality, affecting predominantly young people and women. A delay in starting treatment is associated with chronic and more severe clinical courses; however, evidence on barriers and facilitators of access to care in Latin America is scarce. We aimed to identify barriers and facilitators of ED treatment in Chile from the perspective of patients, relatives, and health professionals.MethodsQualitative approach through semi-structured interviews with patients, their relatives, and health professionals. Participants were recruited from two ED centers in Santiago, Chile (one public and one private). Analysis was mainly based on Grounded Theory, using MAXQDA software.Results40 interviews were conducted (n = 22 patients, 10 relatives, and 8 health professionals). The mean age of patients was 21.8 years, while the mean duration of untreated ED was 91.4 months (median 70 months). Five categories emerged with intersections between them: patient (P), family and social environment (FSE), health professionals (HP), healthcare system (HCS), and social and cultural context (SCC). Relevant barriers appeared within these categories and their intersections, highlighting a lack of professional knowledge or expertise, cultural ignorance or misinformation regarding EDs, and patient’s ego-syntonic behaviors. The main facilitators were patients’ and relatives’ psychoeducation, recognition of symptoms by family members, and parents taking the initiative to seek treatment.ConclusionsThis study provides information regarding access to treatment for patients living with EDs in Chile. A practical public health approach should consider the multi-causality of delay in treatment and promoting early interventions.Plain English SummaryEating disorders (EDs) may severely affect the daily functioning of people enduring them. A delay in starting treatment is associated with a disease that is more difficult to treat. To our knowledge, there are no published studies carried out in Latin America exploring factors influencing treatment initiation in EDs patients. This study aimed to identify facilitators of and barriers to treating patients with EDs in Chile. We interviewed patients (n = 22), their relatives (n = 10), and health professionals (n = 8) from a private and a public center in Santiago, Chile. Our analysis showed that the main barriers to starting treatment were the lack of professional knowledge in ED, the monetary cost of illness, and cultural misinformation. Facilitators were related to the role of the family in recognizing and addressing the disease while being educated in EDs by professionals. This study helps to provide data about treatment access in developing countries. While facilitators and barriers were similar to others reported in the literature, the untreated ED’s duration was longer. It is essential to address these barriers to provide access to treatment more efficiently and prevent severe and enduring forms of disease.

Urologist communication is a primary factor leading to erectile dysfunction treatment postprostatectomy.

Studies have shown insufficient utilization of care for patients with erectile dysfunction (ED) after radical prostatectomy (RP). The aim of this study was to evaluate variables associated with barriers to seeking and receiving ED treatment. In this multicenter prospective cross-sectional study, the functional outcomes of 936 patients were assessed 10 to 15years after RP. A total of 525 patients with ED or incontinence were asked about their treatment experiences or lack thereof. The data were analyzed using the chi-square test, t test, and multivariate logistic analyses. Patients answered validated questionnaires regarding information sources, communication with their partner and urologist, and barriers to ED treatment. Of the 525 patients, 80 were not available to survey. A total of 304 patients answered the survey (response: 68.0%). A total of 246 patients had ED and were included in this study. The mean age at surgery was 64.4 ± 6.1years, and the mean age at the time of this survey was 77.1 ± 6.2years. The mean follow-up duration was 12.7 ± 1.5years. Forty-six percent (n = 114 of 246) of the patients had never received ED treatment. The most important conversation partners regarding the ED were the partner (69% [n = 169 of 246]) and the urologist (48% [n = 118 of 246]). Patients who never received ED treatment were less likely to have conversations with their urologist (34% vs 60%; P < .001), had less support (51% vs 68%; P = .01), and had less interest in sex from their partner (20% vs 40%; P = .001). Communication with other groups (general practitioners, other physicians, family, friends, and the Internet) had no influence on ED treatment utilization. The most relevant barrier to receiving ED treatment was the belief that treatment would not help (65%). No interest in sex from their partner (odds ratio, 3.9) and no conversation with their urologist about ED (odds ratio, 2.9) were found to be independent predictors of not receiving ED treatment. Urologists should have enhanced awareness of how to approach patients directly about their ED and actively offer them treatment options. These results should be further validated in a multicenter, prospective study. Response bias may have affected the results. Furthermore, the current cohort was relatively old. This study revealed that no interest in sex from one's partner and insufficient communication with a urologist were relevant barriers to insufficient utilization of ED treatment after RP.

Abstract B123: Multilevel influences on Black and Hispanic/Latine patient participation in early phase cancer clinical trials

Abstract Black and Hispanic/Latine patients are disproportionately burdened by cancer yet underrepresented in cancer clinical trials. Diverse participation in cancer clinical trials is essential to identify potential group differences in risks and benefits and to ensure equitable access to cutting-edge therapeutics. Prior research has focused on barriers to representation in later phase trials with less focus on early phase cancer clinical trials (EPCCTs). EPCCTs may include unique barriers to representation based on safety focus and intensive monitoring. We investigate multi-level influences on EPCCT participation for Black and Hispanic/Latine patients through in-depth qualitative interviews with (n=30) Black or Hispanic/Latine metastatic cancer patients and (n=30) oncology providers/staff from two community practices. Using the Ecological Model as a guiding framework, we explored facilitators and barriers to diverse EPCCT participation at the patient level, provider level, health system/policy level, and community level. We utilized Rapid Qualitative Inquiry to gain pragmatic, accurate understanding. At the patient level, we identified informational (e.g., understanding of cancer), emotional (e.g., trust), and instrumental (e.g., transportation) influences on Black and Hispanic/Latine participation. The most pervasive barrier to EPCCT inclusion was lack of invitation for Black and Hispanic/Latine patients. At the provider/staff level, key barriers to representation included low EPCCT knowledge among providers, preconceptions about barriers for Black and Hispanic/Latine patients, and perceived loss of control/relationship with patients/caregivers. At the health system/policy level, critical barriers included insufficient time to discuss EPCCTs, concerns about impact of trials on systems (e.g., wait-time for scans), and provider discomfort with referral process (sending patients to Phase I team without specific trial knowledge). At the community level, salient influences on patient decision-making were identified (e.g., peers, youtube). We conducted a systemwide survey of (n=81) oncology providers and their attitudes, beliefs, and behaviors regarding EPCCTs; we determined how attitudes and beliefs related to EPCCT referral behaviors. We have planned interventions to mitigate each barrier and leverage each facilitator to increase representation. It is critical to identify and address relevant local barriers to ensure equitable access to novel therapeutics and generalizability of scientific discoveries. Citation Format: Jessica Lewis, Amy Smoyer, Erin Singleton, Marcella Nunez-Smith, Imran Saeed, Patricia LoRusso. Multilevel influences on Black and Hispanic/Latine patient participation in early phase cancer clinical trials [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B123.

Empathy development through game-based learning: An investigative study on nursing professionals

BackgroundEmpathy is at the core of patient-centred care. Evidence has continually found that empathy helps foster therapeutic relationships and is essential in the delivery of quality healthcare. In India, many factors are barriers to empathy for nursing professionals. Objectives1.To design and test a game for Indian nurses to practice empathy.2.To develop and test reliability of a learner feedback form3.To test the impact of the game on the empathy of nurses Design and methodsThe IDEO design thinking process was followed to design the game. A focus group discussion with 18 nurses helped identify relevant scenarios and barriers to empathy. A scenario of an interaction between a nurse and a cancer patient was identified to create the game. The game mechanics, rubrics, and scenarios were built based on feedback from diverse professionals consisting of doctors, nurses, and UX designers. A learner feedback form assessing usability, contextual specificity, engagement, and perceived learnability was created and its reliability was tested. The game was tested on 60 nurses, followed by administration of the learner feedback form. To assess changes in empathy, an empathy scale was administered before the intervention and seven days after the intervention on 20 nurses. ResultsThe learner feedback form was found to have Cronbach's Alpha >0.70, and therefore reliable. The responses to the learner feedback form were analysed using the Chi Square test and were found to be positive and statistically significant (p-value<0.001).The differences in pretest and posttest empathy scores were analysed using the Wilcoxon Signed Ranks test and were found to be statistically significant as well (p-value<0.001). ConclusionsThe positive response to the learner feedback form, and the improvement in empathy scores after the intervention, indicates that games have a potential role in teaching empathy to Nursing Professionals.

Multilevel barriers to guideline implementation: a nationwide multi-professional cross-sectional study within child and adolescent psychiatry

BackgroundDespite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study.Methods440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated.ResultsOverall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption ability. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness.ConclusionThis large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research.

Facilitators and barriers to interprofessional collaboration among health professionals in primary healthcare centers in Qatar: a qualitative exploration using the “Gears” model

BackgroundThe number of patients seeking medical care is increasing, necessitating more access to primary healthcare services. As several of these patients usually present with complex medical conditions, the need for interprofessional collaboration (IPC) among health professionals in primary care is necessary. IPC is essential for facing the increasing and challenging healthcare demands. Therefore, the facilitators of and the barriers to IPC should be studied in the hope that the results will be used to promote such endeavors.ObjectivesThis study aimed to explore the perspectives of different health professionals regarding the facilitators of and the barriers to IPC in the primary healthcare settings in Qatar.MethodsA qualitative study using focus groups was conducted within the Primary Health Care Corporation (PHCC) in Qatar. Several health professionals were invited to participate in the focus groups. The focus groups were uniprofessional for general practitioners (GPs), nurses, and dentists, while they were interprofessional for the other health professionals. Focus groups were audio-recorded and transcribed verbatim and validated by the research team. The data were analyzed by deductive thematic analysis using the “Gears” Conceptual Model as a coding framework.ResultsFourteen focus groups were conducted involving 58 participants (including 17 GPs, 12 nurses, 15 pharmacists, 3 dentists, and 11 allied health professionals) working in PHCC in Qatar. The findings revealed a spectrum of factors influencing IPC, categorized into four main domains: Macro, Meso, Micro, and individual levels, with each accompanied by relevant barriers and facilitators. Key challenges identified included a lack of communication skills, insufficient professional competencies, and power imbalances, among others. To address these challenges, recommendations were made to implement dedicated training sessions on IPC, reduce hierarchical barriers among different health professionals, and enhance the effectiveness of existing systems. Conversely, it was emphasized that projects and campaigns focused on IPC, alongside the development of enhanced communication skills and the presence of supportive leadership, as essential for facilitating effective IPC in PHCCs.ConclusionThe interplay between the meso, macro, micro, and individual levels highlight the significance of a multifaceted approach to interventions, aiming to enhance the successes of IPC. While initiatives like interprofessional education training are underway, numerous challenges persist before achieving improved collaboration and more efficient integration of IPC in the PHCC setting.

Continuities and discontinuities in pharmaceutical treatment and medication use among older chronically ill patients of Turkish descent in Germany: a qualitative structuring content analysis.

Polypharmacy occurs frequently among older adults and is associated with an increased risk of falls and medication-related adverse events. In particular, people with a history of migration may receive inappropriate medication due to language barriers or discrimination in healthcare. This study aims to assess the continuities, discontinuities and barriers to drug therapy in older migrants of Turkish descent in Berlin, Germany. Eleven problem-centered qualitative interviews with chronically ill older persons of Turkish descent and family caregivers were conducted and analyzed qualitatively by means of structuring content analysis. The chronically ill participants of Turkish descent predominantly take more than 5 types of medication per day and aim to take them regularly. Discontinuities emerge when medication is forgotten or intentionally omitted due to side effects. Frequent changes in medication and physicians' lack of time are relevant barriers to drug treatment plans. To avoid language barriers and disinterest on the part of professionals, respondents prefer Turkish-speaking physicians.

Real-Time KMC Simulation of Vacancy-Mediated Intermixing in Au@Ag Octahedral Core-Cubic Shell Nanocrystals with Ab Initio-Guided Kinetics.

Utilization of core-shell rather than monometallic nanocrystals (NCs) facilitates fine-tuning of NC properties for applications. However, compositional evolution via intermixing can degrade these properties prompting recent experimental studies. We develop an atomistic-level stochastic model for vacancy-mediated intermixing exploiting a formalism which allows incorporation at an ab initio density functional theory level of not just the thermodynamics of vacancy formation, but also relevant diffusion barriers for a vast number of possible local environments (in the core and in the shell, at the interface, and in the intermixed phase). This facilitates a predictive treatment and comprehensive understanding of intermixing on the relevant time scale (e.g., 101-103 s). In contrast, previous modeling at the atomistic level utilized only unrealistic generic prescriptions of barriers or employed simplified continuum treatments. For Au@Ag octahedral core-cubic shell NCs, our modeling not only captures the experimentally observed rate or time scale for intermixing of ∼100 s at 450 °C for 60 nm NCs, but also elucidates the underlying rate controlling processes and the effective intermixing barrier.

Telehealth development in the WHO European region: Results from a quantitative survey and insights from Norway

BackgroundThe COVID-19 pandemic sent shock waves through societies, economies, and health systems of Member States in the WHO European Region and beyond. During the pandemic, most countries transitioned from a slow to a rapid adoption of telehealth solutions, to accommodate the public health and social measures introduced to mitigate the spread of the disease. As countries shift to a post-pandemic world, the question remains whether telehealth’s importance as a mode of care provision in Europe continues to be significant. ObjectiveThis paper aims to present, synthesize, and interpret results from the Telehealth Programmes section of the 2022 WHO Survey on Digital Health (2022 WHO/Europe DH Survey). We specifically analyze the implementation and use of teleradiology, telemedicine, and telepsychiatry. Norwegian telehealth experiences will be used to illustrate survey findings, and we discuss some of the relevant barriers and facilitators that impact the use of telehealth services. MethodsThe survey tool was revised from the 2015 WHO Global Survey on eHealth, updated to reflect recent progress and policy priorities.The 2022 WHO/Europe DH Survey was conducted by WHO and circulated to Member States in its European Region from April to October 2022. ResultsThe data analysis revealed that teleradiology, telemedicine, and telepsychiatry are the telehealth services most commonly used in the WHO European Region in 2022. Funding remains the most significant barrier to the implementation of telehealth in the Region, followed by infrastructure and capacity/human resources. The survey results highlighted in this study are presented in the following sections: (1) telehealth strategies and financing, (2) telehealth programmes and services offered by Member States of the WHO European Region, (3) barriers to implementing telehealth services, and (4) monitoring and evaluation of telehealth. ConclusionBased on WHO’s 2022 survey, the use of telehealth in the WHO European Region is on the rise. However, merely having telehealth in place is not sufficient for its successful and sustained use for care provision. Responses also uncovered regional differences and barriers that need to be overcome. Successful implementation and scaling of telehealth requires rethinking the design of health and social care systems to create robust, trustworthy, and person-centred digital health and care services.

Experimental study on the dynamic behavior of pile-anchor structures under impact loading of debris flow and rockfall

The pile-anchor structure is widely used in slope/landslide reinforcement, and is also applicable to debris flow and rockfall barriers in mountainous areas. However, the impact behavior of this structure has not been studied. To promote the use of this retaining structure in the prevention of slope geological disasters, this study investigated the dynamic responses and impact behavior of pile-anchor structures through a set of impact experiments, wherein dry granular materials with different particle size and sliding blocks with different masses were adopted to simulate different impact loading scenarios of granular flow and rockfall. The impact pressure on the pile-anchor structure, the seismic signals induced inside the slope during the sliding and impact processes, and the deformation characteristics and failure modes of the piles and anchors were systematically investigated. The results indicate that the peak impact force and intensity of the seismic signal are affected by the particle size of the impact granular materials. As the impact loading of sliding blocks increased, the tensile force of the anchor increased nonlinearly, the distribution pattern of the pile's impact dynamic moment changed, and anchor prestress loss was observed. The preliminary results obtained by this study are expected to provide the theoretical basis for designing relevant barriers in areas prone to debris flow and rockfall, and promote the inclusivity of the impact behavior of slope retaining structures in existing design codes pertaining to retaining structures.

Service providers’ Perception of Black Immigrant Domestic Violence Survivors’ Use of Support Services

ABSTRACT The accessibility, acceptance, and effectiveness of domestic violence (DV) services and resources are crucial for survivors, but previous research indicates that Black immigrant survivors face barriers in receiving and using support from formal services. The purpose of this study was to investigate how service providers perceive the available services and resources for survivors of domestic violence, particularly for Black immigrant survivors, and assess the adequacy of these services. This study aims to explore the following questions: 1. How do service providers perceive the adequacy and accessibility of support resources and services for Black immigrant survivors of DV in Calgary? 2. To what extent do existing services and supports meet the needs of Black immigrant survivors of DV, as perceived by service providers? A hermeneutic phenomenological study was conducted with 10 domestic violence service providers in Calgary who were interviewed in-depth to address these questions. The findings revealed that while numerous services and support are available for domestic violence survivors, Black immigrant survivors face barriers in accessing these services due to limited culturally relevant services, language barriers, transportation issues, financial issues, and lack of training among professionals. This research significantly contributed to the body of knowledge and recommendations to facilitate positive experiences for Black immigrant survivors receiving formal services. Overall, the study highlights the need for culturally sensitive services and training for professionals to support Black immigrant survivors of domestic violence better. The implications for research, practice, and policy are discussed in the study.

Silver diamine fluoride for the management of dental caries in children in primary dental care: protocol for a feasibility study

BackgroundDental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need.The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible.MethodsThis mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1–8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination.DiscussionThe ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators.Trial registrationClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.

System-Based Interventions to Address Physician Burnout: A Qualitative Study of Canadian Family Physicians' Experiences During the COVID-19 Pandemic.

Medical professionals experienced high rates of burnout and moral distress during the COVID-19 pandemic. In Canada, burnout has been linked to a growing number of family physicians (FPs) leaving the workforce, increasing the number of patients without access to a regular doctor. This study explores the different factors that impacted FPs' experience with burnout and moral distress during the pandemic, with the goal of identifying system-based interventions aimed at supporting FP well-being and improving retention. We conducted semi-structured qualitative interviews with FPs across four health regions in Canada. Participants were asked about the roles they assumed during different stages of the pandemic, and they were also encouraged to describe their well-being, including relevant supports and barriers. We used thematic analysis to examine themes relating to FP mental health and well-being. We interviewed 68 FPs across the four health regions. We identified two overarching themes related to moral distress and burnout: (1) inability to provide appropriate care, and (2) system-related stressors and buffers of burnout. FPs expressed concern about the quality of care their patients were able to receive during the pandemic, citing instances where pandemic restrictions limited their ability to access critical preventative and diagnostic services. Participants also described four factors that alleviated or exacerbated feelings of burnout, including: (1) workload, (2) payment model, (3) locum coverage, and (4) team and peer support. The COVID-19 pandemic limited FPs' ability to provide quality care to patients, and contributed to increased moral distress and burnout. These findings highlight the importance of implementing system-wide interventions to improve FP well-being during public health emergencies. These could include the expansion of interprofessional team-based models of care, alternate remuneration models for primary care (ie, non-fee-for-service), organized locum programs, and the availability of short-term insurance programs to cover fixed practice operating costs.

Evaluating the delivery of physical activity for people with developmental disabilities using an online knowledge translation approach: part 2 – content quality

Objective Web-based platforms for delivering physical activity (PA) to people with developmental disabilities have a great potential to improve the lives of many. However, their design, including the content design, lacks sufficient investigation. This study aims to evaluate three online platforms for delivering PA to people with developmental disabilities in terms of content quality and identify relevant barriers and facilitators of PA delivery. Methods The study used a methodological triangulation approach which involved quantitative evaluations by experts using an evaluation rubric, on-site observations and in-depth interviews with recruited participants. The participants consisted of 15 pairs of individuals, each consisting of a person with developmental disabilities and their primary caregiver. They were instructed to watch and follow five PA video content from each of the three platforms. The on-site observations and interviews were conducted in a large computer-equipped meeting room setting. Results The quantitative and qualitative analysis identified a set of barriers and facilitators of PA delivery related to content quality. Key barriers identified include a lack of content diversity, insufficient understanding of developmental disabilities among content creators, inappropriate language usage, and resistance to engaging in physical activities in home settings. Significant facilitators were pinpointed, such as incorporating engaging elements for individuals with developmental disabilities, utilising easy-read language, and ensuring sufficient repetition for effective learning. The results from the triangulation showed that the multiple methods were complementary and converged on the same outcome. Discussion The study findings could contribute to the development of adequately adapted PA content to distribute knowledge to populations with developmental disabilities.

Barriers, facilitators, and other factors associated with health behaviors in childhood, adolescent, and young adult cancer survivors: A systematic review.

Healthy behaviors are paramount in preventing long-term adverse health outcomes in childhood, adolescent, and young adult (CAYA) cancer survivors. We systematically reviewed and synthesized existing literature on barriers, facilitators, and other factors associated with health behaviors in this population. MEDLINE and PsycInfo were searched for qualitative and quantitative studies including survivors aged 16-50 years at study, a cancer diagnosis ≤25 years and ≥2 years post diagnosis. Health behaviors included physical activity, smoking, diet, alcohol consumption, sun exposure, and a combination of these behaviors (defined as health behaviors in general). Barriers, facilitators, and other factors reported in ≥2 two studies were considered relevant. Out of 4529 studies, 27 were included (n = 31,905 participants). Physical activity was the most frequently examined behavior (n = 12 studies), followed by smoking (n = 7), diet (n = 7), alcohol (n = 4), sun exposure (n = 4), and health behavior in general (n = 4). Relevant barriers to physical activity were fatigue, lack of motivation, time constraints, and current smoking. Relevant facilitators were perceived health benefits and motivation. Influence of the social environment and poor mental health were associated with more smoking, while increased energy was associated with less smoking. No relevant barriers and facilitators were identified for diet, alcohol consumption, and sun exposure. Barriers to healthy behavior in general were unmet information needs and time constraints whereas lifestyle advice, information, and discussions with a healthcare professional facilitated healthy behavior in general. Concerning other factors, women were more likely to be physically inactive, but less likely to drink alcohol and more likely to comply with sun protection recommendations than men. Higher education was associated with more physical activity, and lower education with more smoking. This knowledge can be used as a starting point to develop health behavior interventions, inform lifestyle coaches, and increase awareness among healthcare providers regarding which survivors are most at risk of unhealthy behaviors.

The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada

BackgroundPerson-centred planning refers to a model of care in which programs and services are developed in collaboration with persons receiving care (i.e., persons-supported) and tailored to their unique needs and goals. In recent decades, governments around the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery. Although regional mandates provide a framework for directing care, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. This study aims to address a gap in the literature by describing how person-centred care plans are implemented in community-care organizations.MethodsWe conducted semi-structured interviews with administrators from community-care organizations in Ontario, Canada. We asked participants about their organization’s approach to developing and updating person-centred care plans, including relevant supports and barriers. We analyzed the data thematically using a pragmatic, qualitative, descriptive approach.ResultsWe interviewed administrators from 12 community-care organizations. We identified three overarching categories or processes related to organizational characteristics and person-centred planning: (1) organizational context, (2) organizational culture, and (3) the design and delivery of person-centred care plans. The context of care and the types of services offered by the organization were directly informed by the needs and characteristics of the population served. The culture of the organization (e.g., their values, attitudes and beliefs surrounding persons-supported) was a key influence in the development and implementation of person-centred care plans. Participants described the person-centred planning process as being iterative and collaborative, involving initial and continued consultations with persons-supported and their close family and friends, while also citing implementation challenges in cases where persons had difficulty communicating, and in cases where they preferred not to have a formal plan in place.ConclusionsThe person-centred planning process is largely informed by organizational context and culture. There are ongoing challenges in the implementation of person-centred care plans, highlighting a gap between policy and practice and suggesting a need for comprehensive guidance and enhanced adaptability in current regulations. Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

A qualitative interview study to determine barriers and facilitators of implementing automated decision support tools for genomic data access

Data access committees (DAC) gatekeep access to secured genomic and related health datasets yet are challenged to keep pace with the rising volume and complexity of data generation. Automated decision support (ADS) systems have been shown to support consistency, compliance, and coordination of data access review decisions. However, we lack understanding of how DAC members perceive the value add of ADS, if any, on the quality and effectiveness of their reviews. In this qualitative study, we report findings from 13 semi-structured interviews with DAC members from around the world to identify relevant barriers and facilitators to implementing ADS for genomic data access management. Participants generally supported pilot studies that test ADS performance, for example in cataloging data types, verifying user credentials and tagging datasets for use terms. Concerns related to over-automation, lack of human oversight, low prioritization, and misalignment with institutional missions tempered enthusiasm for ADS among the DAC members we engaged. Tensions for change in institutional settings within which DACs operated was a powerful motivator for why DAC members considered the implementation of ADS into their access workflows, as well as perceptions of the relative advantage of ADS over the status quo. Future research is needed to build the evidence base around the comparative effectiveness and decisional outcomes of institutions that do/not use ADS into their workflows.

Revolutionizing Moroccan Education with AI: A Path to Customized Learning

This integrative literature review analyzes how AI, specifically Machine Learning (ML) and Large Language Models (LLMs), is used in Moroccan education. The study emphasizes the significance of modernizing traditional educational techniques. It investigates how artificial intelligence may personalize learning experiences, minimize educational disparities, and foster a culturally diverse and technologically sophisticated learning environment. The ILR uses a conceptual framework that highlights customized learning, equitable education, technological innovation, and a systematic methodology that incorporates extensive literature synthesis. The research process thoroughly examines multiple academic sources, including peer-reviewed articles, books, conference papers, and reports. The ILR identifies relevant patterns, barriers, and opportunities associated with integrating AI in Moroccan education by carefully studying and synthesizing data. The findings demonstrate the enormous potential of ML and LLMs in revolutionizing teaching methods, encouraging active student participation, and closing educational inequalities across Morocco. The paper finishes by underlining the need to incorporate AI into educational practice and identifying areas for future research. It emphasizes investigating how AI may help Morocco and other countries modernize their education systems.