Resource Barriers Research Articles

The Necessity and Importance of Research and its Role in Afghan Society

This research examines the necessity and importance of scientific research in Afghan society and its role in the economic, social, and cultural development of the country. Given the numerous challenges faced by Afghanistan, including war, poverty, and political instability, research is recognized as a vital tool for identifying and analyzing problems and providing data-driven and evidence-based solutions. The research employs a qualitative methodology based on semi-structured interviews with researchers, university professors, and policymakers. Findings indicate that scientific research can contribute to economic development by enhancing educational quality, improving infrastructure, and increasing innovation. Additionally, the results suggest that institutional, cultural, and financial resource barriers are among the main challenges to advancing research in Afghanistan. Ultimately, this study emphasizes the need for investment in research and the creation of suitable infrastructures to achieve sustainable development and improve the quality of life in Afghanistan.

A study of the Dynamic Relationship Between Optimal Global Population and Technological Progress

It is the quantity that depends on the interconnection between population and technology, the latter being capable of advancing to support the growth of the population. Taking into consideration the findings of Malthus, Harding, and other authors, this paper elaborates on the multifaceted and developmental connection between population growth and technological advancement within the context of the optimal population. It critiques the fallacy that population growth will always result in the depletion of resources. This paper seeks to establish the fact that a large enough optimal population can foster the generation of a positive feedback loop of technological advancement and population expansion but, at the same time, results in vices such as pollution of the environment and depletion of resources. In contrast, the population can increase the market needs, encourage the advancement of renewable energy sources, and decrease the energy depletion rate. Technological advancements, boosted by population pressure, have let human beings overcome perceived environmental and resource barriers. Thus, the optimal population is not the specific number but the goal that is set to change depending on the level of technology development. Lastly, this paper stresses the importance of technological equity on the international level.

"Who You Are and Where You Live Matters": Hospice Care in New York City During COVID-19 Perspectives on Hospice and Social Determinants: A Rapid Qualitative Analysis.

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals' perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

Barriers to Implementing a Quality Improvement Program in Low- and Middle-Income Countries: Adequacy of Resources.

Low- and middle-income countries (LMICs) report disproportionally worse cancer mortality. Current global cancer control efforts focus predominantly on expanding access to multimodality treatment for patients, whereas less attention has been spent on implementing strategies to ensure sustained quality assessment and improvement across the cancer care continuum. The goal of this focused review was to examine specific resource barriers to the development and implementation of quality improvement programs in LMICs. In this article, we use a nonsystematic review process to discuss the existing literature on four resource barriers within the context of cancer care delivery in LMICs, focusing on staff, time allocated for quality improvement work, research infrastructure, and funding. We provide possible solutions to address these barriers and share examples of specific quality improvement initiatives implemented across different world regions. Possible solutions to address these resource barriers include investment in human resources by increasing recruitment and training of the workforce, engagement of medical trainees and patients in quality improvement work, establishment of cancer registries and electronic medical records, and prioritization by large international funding agencies to invest in quality improvement research in LMICs. This review highlights four prevalent resources barriers to quality improvement in LMICs. Using examples from Botswana, Colombia, India, and Rwanda, we demonstrate solutions that may help overcome these barriers.

Improving patient outcomes in acute and subacute stroke using a wearable device-assisted rehabilitation system: a randomized controlled trial.

Multidisciplinary rehabilitation facilitates post-stroke functional recovery, but is associated with resource and accessibility barriers. This study evaluated the combination of a wearable device-assisted system (WEAR) and conventional therapy for post-stroke rehabilitation. This randomized, controlled, parallel group, clinical trial was conducted at two rehabilitation centers. A WEAR system was developed featuring sensors and application program-embedded smartphones. Stroke patients within 12 weeks of onset and modified Rankin Scale (mRS) scores of 2 to 4 were randomized into a wearable group (WG, WEAR + conventional rehabilitation) or control group (CG, conventional rehabilitation) for 90 days. The primary outcome was mRS score changes within 90 days. Among 127 stroke patients enrolled (76 men [59.8%]; mean age: 57.5 years), 63 and 64 patients were randomized to WG and CG, respectively. Both groups showed significant improvements in mRS scores. Between-group repeated measures analysis adjusted for sex, age and number of rehabilitation sessions showed greater improvement in mRS scores within 90 days in the WG than in the CG (estimate: 0.73). This combined WEAR and conventional rehabilitation approach may improve post-stroke functional recovery compared with conventional rehabilitation alone. The WEAR system permits remote monitoring and recording of rehabilitation in various settings.This clinical trial was retrospectively registered at www.clinicaltrials.gov with the Unique Identifier NCT04997408.

Fertility preservation in Malaysian pediatric cohort: a survey of healthcare providers' knowledge, practice, attitude, perceptions and barriers.

Impaired future fertility potential secondary to gonadotoxic therapies for childhood cancer is a shattering aftermath faced by childhood cancer survivors. Fertility preservation (FP) has emerged as a key to mitigate this unwelcomed sequelae. FP services catering to the needs of children and adolescents (C&A) population in developing countries are limited. Malaysia recently launched its pioneering pediatrics FP services. To evaluate healthcare providers' (HCPs) FP knowledge, practice behaviors, attitudes, perceptions, and barriers towards FP counseling/services (C/S) for the C&A cohort. A questionnaire-based study was conducted utilizing a questionnaire consisting of 51 items which was adapted from G.Quinn et al. The questionnaire was distributed both online and physically amongst HCPs in a tertiary center. Ethical committee approval was granted by the Research Ethical Committee, Universiti Kebangsaan Malaysia. A total of 102 HCPs completed the questionnaires. The majority of respondents were Malays (74.5%), females (80.4%), gynecology/pediatrics specialty (76.5%), and had children (88.2%). Nearly 72% of HCPs demonstrated good knowledge of FP. Almost 73% of HCPs consulted reproductive specialists (RES) on potential fertility issues and over 80% of HCPs referred patients who enquired on fertility issues to RES. Only 17% of HCPs practiced FP discussion, 12% reported no available person to discuss FP, and 10% of HCPs were unaware of who to discuss FP with. Patients' inability to afford FP (30.4%) tops the list of barriers to FP C/S, followed by limited available information on FP for patients (17.6%) and patients too ill to delay treatment (12.7%). Most HCPs (88.2%) demonstrated unfavorable attitudes towards FP C/S. In general, the majority of our HCP respondents demonstrated good current FP knowledge and practice behaviors. Mitigating several controversial issues in FP would improve HCPs' attitude towards FP. Main barriers to the uptake of FP C/S for C&A were patient and resource barriers. Addressing these issues by funding aid for FP procedures, increasing FP knowledge dispersion, as well as developing age-appropriate FP-related educational materials would improve FP service provision for C&A in the future. In conclusion, successful corrective action combined with strategic planning points to a promising future for Malaysia's FP services provision for C&A.

Toward a personalized autonomous transportation system: Vision, challenges, and solutions

The fragmented design of Intelligent Transportation Systems creates isolated intelligent systems. Resource competition and information gaps are fierce and widespread, worsening traffic issues and degrading overall service levels. Therefore, empowered by advanced technologies, an evolution towards Autonomous Transportation System (ATS) is observed. This evolution aims to develop a collaborative and sustainable ecosystem, prompting interoperability within the cloud-edge-device continuum. It can, accordingly, dismantle internal resource barriers and achieve a systematic balance between demand and supply with less human intervention. Despite the promising vision of ATS, it encounters three key challenges: disparate data, deficient models, and conflicting interests in supporting autonomous and personalized mobility. Hence, as an innovative solution, a trustworthy, private, and equal-serving framework called TPE is designed. It seamlessly integrates Blockchain, Federated Learning, and Large-scale Model to deploy a trustworthy operating environment, process private data for globally shareable knowledge, and develop a foundation model for personalized adaptation, respectively. Consequently, ATS empowered by TPE can serve diverse user groups both privately and equally.

Cascade of care for substance use and mental health disorders for justice-involved populations

IntroductionJustice-involved populations have dramatically higher rates of substance use disorders (SUD) and mental health disorders (MHD) compared to the general population. Despite high rates of SUD and MHD, treatment for this population is often limited and not evidence-based. The cascade of care model estimates drop-offs in the continuum of care from screening to identification of need, referral, care initiation, care engagement, and care completion. Recently, healthcare providers have utilized the cascade of care to improve the continuity of care for people with SUD and MHD in justice settings. The purpose of the current study is to 1) identify typologies that explain the proportion of new intakes that pass through each level of the cascade of care for SUD and MHD, and 2) describe agency-level factors that predict typology assignments and agency ability to assess client flow through the levels of the care cascade. MethodUsing Latent Class Analysis, we classify 791 agencies serving justice-involved individuals into typologies according to utilization of each stage in the mental health and substance cascades of care. Then, we examined county and agency characteristics that affect three stages of the cascade process: identification of need for behavioral health services, referrals to appropriate services, and treatment initiation. We build on previous work by exploring these patterns for both SUD and MHD treatment. ResultsThe study identified four SUD/MHD treatment patterns: Low Access, SUD-Focused, High Need-High Access, and Lower Need-High Access classes. Factors influencing typology alignment include location, specialized staff availability, warm hand-off coordination, Medicaid reimbursement, and performance measure tracking. Thirty-nine percent (39 %) of agencies could not be classified because they were unable to report their rate of care along the cascade measures. ConclusionFocusing on factors influencing typology assignment can help counties in assessing service delivery, identifying barriers, and targeting areas for improvements in policies and practices, potentially facilitating long-term changes and overall improvement in the care of individuals with mental health and substance use disorders. Identification of these factors and typologies can improve mental health treatment and access in counties and agencies with large resource barriers or limited attention to mental health treatment.

Identifying personalized barriers for hypertension self-management from TASKS framework

ObjectiveEffective management of hypertension requires not only medical intervention but also significant patient self-management. The challenge, however, lies in the diversity of patients' personal barriers to managing their condition. The objective of this research is to identify and categorize personalized barriers to hypertension self-management using the TASKS framework (Task, Affect, Skills, Knowledge, Stress). This study aims to enhance patient-centered strategies by aligning support with each patient's specific needs, recognizing the diversity in their unique circumstances, beliefs, emotional states, knowledge levels, and access to resources. This research is based on observations from a single study focused on eight patients, which may have been a part of a larger project.ResultsThe analysis of transcripts from eight patients and the Global Hypertension Practice Guidelines revealed 69 personalized barriers. These barriers were distributed as follows: emotional barriers (49%), knowledge barriers (24%), logical barriers (17%), and resource barriers (10%). The findings highlight the significant impact of emotional and knowledge-related challenges on hypertension self-management, including difficulties in home blood pressure monitoring and the use of monitoring tools. This study emphasizes the need for tailored interventions to address these prevalent barriers and improve hypertension management outcomes.

Factors Affecting Colorectal Cancer Screening in Primary Care Physician Practices in Ukraine.

This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs). A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics. The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals. The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.

Telephone hotlines for infectious disease outbreaks in Africa: A review and qualitative study.

Mobile health interventions like telephone hotlines face challenges that may threaten their use, adoption and sustainability in Africa. We sought to understand the barriers and facilitators for sustainability of telephone hotlines used in infectious disease outbreaks in Africa using a scoping review and a qualitative study. Participants form 12 African countries and Database searches. Databases were searched for articles on the barriers and/or facilitators in operating telephone hotlines for outbreaks in Africa. One-on-one interviews and focus group discussions with 30 participants from 12 African countries were also conducted. Emerging themes from the review and interviews were identified and synthesised to focus on barriers and facilitators for the sustainability of the hotlines. The search identified 1153 citations, and 25 studies were finally included. The articles were from 20 African countries. The government was the main source of funding in four countries. Barriers with calls and data management were the most frequent. Human resource barriers such as limited staff, high staff turnover, a lack of incentives and motivation were also significant. Financial barriers were the high cost of operation and huge dependence on external funders. Technological and infrastructural hurdles included limited Internet and phone coverage, malfunction and a lack of interoperability of software. Transitioning to either complete or shared government ownership with diversification and integration of the hotline into routine use was the main facilitator for sustainability. Strengthening technical capacity in telephone hotlines and ensuring financial sustainability are critical. Increased government support is needed. More studies on costing will help in developing financial sustainability models for Africa.

Embracing drones and the Internet of drones systems in manufacturing – An exploration of obstacles

The manufacturing sector attributes the growing prominence of Drones and the Internet of Drones (IoD) systems to their multifaceted utility in delivery, process monitoring, infrastructure inspection, inventory management, predictive maintenance, and safety inspections. Despite their potential benefits, adopting these technologies faces significant obstacles that need systematic identification and resolution. The current literature inadequately addresses the barriers impeding the adoption of Drones and IoD systems in manufacturing, indicating a research gap. This study bridges this gap by providing comprehensive insights and facilitating the organisational transition towards embracing Drone and IoD technologies. This research identifies 20 critical barriers to deploying Drones and IoD in manufacturing. These barriers are validated through a global quantitative survey of 120 Drone experts and analyzed via Exploratory Factor Analysis (EFA). EFA categorises these challenges into six distinct dimensions. Utilizing the Analytical Hierarchy Process (AHP), these dimensions and individual barriers are ranked, incorporating feedback from five Drone specialists. The study highlights ‘Safety and Human Resource Barriers’ and ‘Payload Capacity and Battery Barriers’ as the most predominant obstacles. Key concerns include limited battery life, explosion risks, and potential damage to assets and individuals. This research significantly advances the existing literature by presenting a practical methodology for categorising and prioritising Drone and IoD adoption barriers. Employing EFA and AHP offers a globally relevant framework for stakeholders to strategically address these challenges, advancing the integration of drones and IoD systems in the manufacturing domain.

IMPLEMENTATION OF PUBLIC SERVICE REFORM IN ENHANCING THE WELFARE OF BIMA DISTRICT COMMUNITY: CHALLENGES AND OPPORTUNITIES

This study examines the implementation of public service reforms in Bima District with the goal of enhancing community welfare. Utilizing a qualitative and descriptive approach, primary data were gathered through in-depth interviews with local stakeholders, while secondary data were sourced from policy documents and statistical reports. Thematic analysis was employed to categorize findings based on research objectives. Results show positive changes like improved health service accessibility and quality. However, challenges persist in management, service standards compliance, and policy alignment with community needs due to bureaucratic rigidity and lacking leadership. The research concludes that while reforms have benefits, there's substantial room for improvement, particularly in management, transparency, and service delivery innovation. It emphasizes the need for strong commitment across government levels to drive innovation, address infrastructure and human resource barriers, and enhance institutional coordination, thereby directly impacting community welfare in Bima District.

Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review

BackgroundThe preservation and promotion of maternal health (MH) emerge as vital global health objectives. Despite the considerable emphasis on MH, there are still serious challenges to equitable access to MH services in many countries. This review aimed to determine key barriers to the provision and utilization of MH services in low- and lower-middle-income countries (LLMICs).MethodsIn this scoping review, we comprehensively searched four online databases from January 2000 to September 2022. In this study, the approach proposed by Arksey and O’Malley was used to perform the review. Consequently, 117 studies were selected for final analysis. To determine eligibility, three criteria of scoping reviews (population, concept, and context) were assessed alongside the fulfillment of the STROBE and CASP checklist criteria. To synthesize and analyze the extracted data we used the qualitative content analysis method.ResultsThe main challenges in the utilization of MH services in LLMICs are explained under four main themes including, knowledge barriers, barriers related to beliefs, attitudes and preferences, access barriers, and barriers related to family structure and power. Furthermore, the main barriers to the provision of MH services in these countries have been categorized into three main themes including, resource, equipment, and capital constraints, human resource barriers, and process defects in the provision of services.ConclusionsThe evidence from this study suggests that many of the barriers to the provision and utilization of MH services in LLMICs are interrelated. Therefore, in the first step, it is necessary to prioritize these factors by determining their relative importance according to the specific conditions of each country. Consequently, comprehensive policies should be developed using system modeling approaches.

Supporting First-Generation Student Experiences in Programs and Advising: Lessons from a Pandemic

The COVID-19 pandemic exacerbated inequities within higher education. This study examined how first-generation students, compared to their continuing-generation peers, navigated institutional resources such as programs and academic advising during the pandemic. To examine institutional resource barriers, usage, and helpfulness for students, the study analyzed survey data of 524 students at a four-year private university in the United States. Results showed that lack of time, awareness, and access to institutional resources were barriers for first-generation students in using institutional resources. Furthermore, qualitative findings reveal factors that first-generation students found helpful in their college career: transparency of institutional resources on campus, initiative from institutional figures in reaching out to students, and holistic support for academic, personal, and professional development.

Development of an online teaching platform to improve access to postgraduate pathology training in sub-Saharan Africa.

Resource barriers to the provision of accessible training in cancer diagnosis in lower- and middle-income countries (LMICs) limit the potential of African health systems. Long-term provision via teaching visits from senior pathologists and trainee foreign placements is unsustainable due to the prohibitive costs of travel and subsistence. Emerging eLearning methods would allow pathologists to be trained by experts in a cheaper, more efficient, and more scalable way. This study aimed to develop an online teaching platform, starting with hematopathology, for trainee pathologists in sub-Saharan Africa, initially in Nairobi, Kenya, and Lusaka, Zambia. Course materials were prepared for both Canvas and the Zoom eLearning platforms using digitally scanned slides of lymph nodes and bone marrow trephines. Initial in-person visits were made to each site to establish trainee rapport and maximize engagement, evaluate different methods and course content, and obtain feedback to develop the project. The knowledge of trainees before and after course completion was used to measure initial effectiveness. Online teaching with the preferred platform is to be continued for 1 year before re-evaluation for long-term effectiveness. Canvas was selected as the preferred delivery platform as it is freely available and has good functionality to support all required tasks. Face-to-face teaching was considered optimal to establish the initial rapport necessary to maximize subsequent engagement with online teaching. Challenges have included sub-optimal internet speeds and connections and scheduling issues. Weekly online hematopathology teaching sessions using live image capture microscope sessions, Zoom, and Canvas have been delivered to students in Kenya and Zambia, with good attendance and interaction in case discussions. Our team has successfully designed and delivered an online training program in hematopathology to trainee pathologists in Kenya and Zambia, which has been ongoing for over a year. This project is now being scaled to other sub-Saharan countries and other sub-specialties.

Implementation of a Global Pediatric Trauma Course in an Upper Middle–Income Country: A Pilot Study

IntroductionOver 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. MethodsA 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants’ performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal–Wallis tests, and Wilcoxon rank-sum tests. ResultsTwenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. ConclusionsCompletion of global TRIK improved surgeons’ confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.

Future Fertility Among Pediatric Cancer Patients: Experiences and Perspectives of Health Workers in a Low-Resource Setting.

Purpose:Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Methods: Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Results: Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Conclusion: Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.

Evaluation of an HIV homecare program for lost-to-follow-up populations: a mixed methods study in Detroit, Michigan

BackgroundMaintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare’s impact on participants’ ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers.MethodsWe used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare’s success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests.ResultsIn the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare.ConclusionHomecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.

An assessment of barriers to digital transformation in circular Construction: An application of stakeholder theory

The construction industry faces the rising challenge of circularity, and digital transformation emerges as a pivotal solution. However, limited stakeholder involvement impedes the adoption of digital transformation. The existing literature does not analyze stakeholders' perceptions of digitalization adoption barriers. Therefore, this study investigates the barriers hindering digital transformation in circular construction by examining the varied perceptions of key stakeholders. The study contributes to aligning stakeholders' interests and leads to targeted and effective interventions, enhancing the likelihood of successful adoption. Using the Stakeholder Theory, the study identified contractors, investors, clients, waste managers and government as the most influential stakeholders in circular construction. This study explores skill and knowledge barriers, market barriers, regulatory barriers, organizational and cultural barriers, and financial and resource barriers as key dimensions hindering digital circular practices. The study integrates the fuzzy Delphi method, fuzzy decision-making trial and evaluation laboratory, and analytical network processing to address uncertainties and interrelationships among barriers. The findings indicate that stakeholders hold differing perceptions regarding the most critical barriers; however, there is a consensus that critical aspects are skill and knowledge, organizational and cultural, and regulatory barriers. Practical barriers include lack of government support, resistance to change, lack of feasibility information, lack of training capabilities, and poor digital literacy. The study provides theoretical and practical implications, informing future research and interventions to develop targeted strategies and initiatives.