Amid competing priorities, dementia must not be forgotten

AbstractCities around the world are confronted with the need to put in place climate adaptation policies to protect citizens and properties from climate change impacts. This article applies components of the framework developed by Moser and Ekström (2010) onto empirical qualitative data to diagnose institutional barriers to climate change adaptation in the Municipality of Beirut, Lebanon. Our approach reveals the presence of two vicious cycles influencing each other. In the first cycle, the root cause barrier is major political interference generating competing priorities and poor individual interest in climate change. A second vicious cycle is derived from feedbacks caused by the first and leading to the absence of a dedicated department where sector specific climate risk information is gathered and shared with other departments, limited knowledge and scientific understanding, as well as a distorted framing or vision, where climate change is considered unrelated to other issues and is to be dealt with at higher levels of government. The article also highlights the need to analyze interlinkages between barriers in order to suggest how to overcome them. The most common way to overcome barriers according to interviewees is through national and international support followed by the creation of a data bank. These opportunities could be explored by national and international policy-makers to break the deadlock in Beirut.

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“PrEP”ing for a PrEP demonstration project: understanding PrEP knowledge and attitudes among cisgender women

BMC Women s Health ◽

10.1186/s12905-021-01348-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elizabeth C. Pasipanodya ◽

Jamila Stockman ◽

Thupten Phuntsog ◽

Sheldon Morris ◽

Christina Psaros ◽

...

Keyword(s):

Los Angeles ◽

Focus Groups ◽

Knowledge And Attitudes ◽

Women Living With Hiv ◽

Effective Interventions ◽

Hiv Serostatus ◽

Prep Awareness ◽

Exposure Prophylaxis ◽

Competing Priorities ◽

And Control

Abstract Background Prior to implementing a pre-exposure prophylaxis (PrEP) demonstration study, we sought to explore cisgender women’s experiences with HIV prevention, PrEP knowledge and attitudes, and anticipated barriers and facilitators for PrEP uptake and adherence in Southern California. Methods Three focus groups were held with cisgender women of mixed HIV serostatus in San Diego and Los Angeles between November 2015 and January 2016. Women were recruited through local testing sites, community-based organizations, and social media. Focus groups were audio-recorded and transcripts were analyzed using thematic analysis. Results Twenty-two women participated in focus groups, with median age 44 (IQR 30–53) and 6 identifying as non-Hispanic Black, 7 non-Hispanic White, 8 Latina and 1 mixed race. Despite limited prior PrEP knowledge and no PrEP experience, participants expressed interest in taking PrEP. Anticipated benefits were freedom from worry about HIV and control over sexual health; however, these were tempered by concerns including the possibility of increased HIV risk behaviors and potential side effects. Cisgender women reported potential barriers to PrEP uptake and adherence barriers, like competing priorities and poor PrEP access. Conversely, PrEP facilitators included utilizing practical tools such as phone apps and pill boxes as well as receiving encouragement from loved ones and support from other cisgender women on PrEP, women living with HIV and their medical providers. Conclusions Although PrEP awareness was low, participants recognized the importance of PrEP and ways to facilitate adherence. Exploring perspectives of cisgender women is integral to developing effective interventions to support PrEP uptake and adherence for women at elevated risk for HIV.

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Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

Current Oncology ◽

10.3390/curroncol28020140 ◽

2021 ◽

Vol 28 (2) ◽

pp. 1483-1494

Author(s):

Sharlette Dunn ◽

Madelene A. Earp ◽

Patricia Biondo ◽

Winson Y. Cheung ◽

Marc Kerba ◽

...

Keyword(s):

Online Survey ◽

Social Issues ◽

Theoretical Domains Framework ◽

Advanced Cancer Patients ◽

Behaviour Change Wheel ◽

Negative Perceptions ◽

Cancer Types ◽

Multifaceted Interventions ◽

Competing Priorities ◽

Pan Cancer

Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was emailed to all oncology clinicians working with all cancer types in Alberta, Canada, from November 2017 to January 2018. Questions were informed by Michie’s Theoretical Domains Framework and Behaviour Change Wheel (BCW) and queried (a) PC provision in oncology clinics, (b) specialist PC consultation referrals, and (c) working with PC consultants and home care. Respondents (n = 263) were nurses (41%), physicians (25%), and allied healthcare professionals (18%). Barriers most frequently identified were “clinicians’ limited time/competing priorities” (64%), “patients’ negative perceptions of PC” (63%), and clinicians’ capability to manage patients’ social issues (63%). These factors mapped to all three BCW domains: motivation, opportunity, and capability. In contrast, the least frequently identified barriers were clinician motivation and perceived PC benefits. Oncology clinicians’ perceptions of barriers to early PC were comparable across tumour types and specialties but varied by professional role. The main challenges to early integrated PC include all three BCW domains. Notably, motivation is not a barrier for oncology clinicians; however, opportunity and capability barriers were identified. Multifaceted interventions using these findings have been developed, such as tip sheets to enhance capability, reframing PC with patients, and earlier specialist PC nursing access, to enhance clinicians’ use of and patients’ benefits from an early PC approach.

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Perception of and Motivation for Physical Activity among Women with a History of Gestational Diabetes

Women ◽

10.3390/women1020010 ◽

2021 ◽

Vol 1 (2) ◽

pp. 109-119

Author(s):

Julie Breinholm Svarrer Jakobsen ◽

Josefine Stæhr Brodersen ◽

Zainab Afshan Sheikh ◽

Karoline Kragelund Nielsen

Keyword(s):

Physical Activity ◽

Gestational Diabetes ◽

Social Relations ◽

Phenomenological Approach ◽

Physically Active ◽

Individual Interviews ◽

Women’S Perceptions ◽

History Of ◽

Competing Priorities

(1) Background: Women with a history of gestational diabetes mellitus (GDM) have a high risk of developing type 2 diabetes (T2DM). This risk can be reduced with lifestyle interventions, including physical activity. However, studies have shown that many women with prior GDM are not physically active. The aim of this study was to investigate the motivation for physical activity among women with prior GDM. (2) Methods: A qualitative study was carried out based on a phenomenological approach using semi-structured individual interviews with nine Danish women between 29 and 36 years of age with a minimum of one earlier GDM-affected pregnancy. (3) Results: Five themes were identified; perception of physical activity, risk perception, emotional distress, competing priorities and social support. The perception of physical activity varied among the women. The GDM diagnosis or the awareness of elevated risk for T2DM did not seem to be a decisive factor for the women’s motivation to be active. Competing priorities, including being in control of everyday life choices and support from social relations, were found to be important motivational factors. (4) Conclusion: Future interventions for women with prior GDM to increase motivation for physical activity should be compatible with and take into account the women’s perceptions, earlier lived experiences, possible competing priorities and support systems.

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Physical Activity Among Somali Men in Minnesota

American Journal of Men s Health ◽

10.1177/1557988313489132 ◽

2013 ◽

Vol 8 (1) ◽

pp. 35-44 ◽

Cited By ~ 23

Author(s):

Ahmed A. Mohamed ◽

Abdullahi M. Hassan ◽

Jennifer A. Weis ◽

Irene G. Sia ◽

Mark L. Wieland

Keyword(s):

Physical Activity ◽

United States ◽

Community Based Participatory Research ◽

The United States ◽

Success Stories ◽

Semistructured Interviews ◽

High Knowledge ◽

African Refugee ◽

Competing Priorities ◽

Exercise Equipment

Immigrants and refugees arrive to the United States healthier than the general population, but this advantage declines with increasing duration of residence. One factor contributing to this decline is suboptimal physical activity, but reasons for this are poorly understood. Persons from Somalia represent the largest African refugee population to the United States, yet little is known about perceptions of physical activity among Somali men. Somali members of a community-based participatory research partnership implemented three age-stratified focus groups and three semistructured interviews among 20 Somali men in Rochester, Minnesota. Team-based inductive analysis generated themes for barriers and facilitators to physical activity. Barriers to physical activity included less walking opportunities in the United States, embarrassment about exercise clothing and lack of familiarity with exercise equipment/modalities, fear of harassment, competing priorities, facility costs, transportation, and winter weather. Facilitators to physical activity included high knowledge about how to be active, success stories from others in their community as inspiration, and community cohesion. Findings may be used to derive interventions aimed to promote physical activity among Somali men in the United States.

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Nation Building, Democratization and Globalization as Competing Priorities in Ukraine's Education System*

Nationalities Papers ◽

10.1080/00905990701848317 ◽

2008 ◽

Vol 36 (1) ◽

pp. 1-23 ◽

Cited By ~ 9

Author(s):

Jan Germen Janmaat

Keyword(s):

Eastern Europe ◽

Educational Reform ◽

Education System ◽

Central And Eastern Europe ◽

Nation Building ◽

Modern System ◽

New States ◽

Consumer Demands ◽

Competing Priorities ◽

Individual Talent

One of the greatest challenges currently facing the new states in Central and Eastern Europe is educational reform. After obtaining independence in the early 1990s, these states were confronted with the immense task of transforming an outdated centralized education system, which was aimed at delivering a loyal communist workforce, into a modern system that would be much more responsive to consumer demands and would recognize and further individual talent. The immensity of the undertaking lies in the fact that three discourses make simultaneous demands on the education system: nation building, democratization and globalization.

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When colocation is not enough: a case study of General Practitioner Super Clinics in Australia

Australian Journal of Primary Health ◽

10.1071/py16039 ◽

2017 ◽

Vol 23 (2) ◽

pp. 107 ◽

Cited By ~ 6

Author(s):

Riki Lane ◽

Grant Russell ◽

Elizabeth A. Bardoel ◽

Jenny Advocat ◽

Nicholas Zwar ◽

...

Keyword(s):

Primary Care ◽

Social Scientist ◽

Multidisciplinary Care ◽

Multidisciplinary Teams ◽

Fee For Service ◽

Study Approach ◽

Organisational Routines ◽

Developed Nations ◽

Competing Priorities

Developed nations are implementing initiatives to transform the delivery of primary care. New models have been built around multidisciplinary teams, information technology and systematic approaches for chronic disease management (CDM). In Australia, the General Practice Super Clinic (GPSC) model was introduced in 2010. A case study approach was used to illustrate the development of inter-disciplinary CDM over 12 months in two new, outer urban GPSCs. A social scientist visited each practice for two 3–4-day periods. Data, including practice documents, observations and in-depth interviews (n=31) with patients, clinicians and staff, were analysed using the concept of organisational routines. Findings revealed slow, incremental evolution of inter-disciplinary care in both sites. Clinic managers found the facilitation of inter-disciplinary routines for CDM difficult in light of competing priorities within program objectives and the demands of clinic construction. Constraints inherent within the GPSC program, a lack of meaningful support for transformation of the model of care and the lack of effective incentives for collaborative care in fee-for-service billing arrangements, meant that program objectives for integrated multidisciplinary care were largely unattainable. Findings suggest that the GPSC initiative should be considered a program for infrastructure support rather than one of primary care transformation.

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Class Placements and Competing Priorities

Journal of Cases in Educational Leadership ◽

10.1177/1555458917751569 ◽

2018 ◽

Vol 21 (4) ◽

pp. 25-33

Author(s):

Julie D. Hasson

Keyword(s):

Charter School ◽

The State ◽

Achievement Scores ◽

New Model ◽

New Principal ◽

State Accountability ◽

Accountability System ◽

Competing Priorities ◽

Teacher Placement

Justine Finley, newly appointed principal of Northside Elementary, had been tasked with increasing her school’s grade under the state accountability system and keeping neighborhood families from choosing to enroll in the charter school down the street. The superintendent made these priorities very clear. After spending the first 3 months observing and analyzing data, Justine realized that a new model for placing students in classes could be a lever for increasing achievement scores. What Justine failed to realize was the conflict that the new model would generate among parents and teachers. This case highlights the challenges a new principal encountered when attempting to implement a change in student and teacher placement procedures amid competing priorities.

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Adolescent Girls’ Perceptions of Physical Activity: A Systematic Review of Qualitative Studies

American Journal of Health Promotion ◽

10.1177/0890117118818747 ◽

2018 ◽

Vol 33 (5) ◽

pp. 806-819 ◽

Cited By ~ 12

Author(s):

Méabh Corr ◽

Jennifer McSharry ◽

Elaine M. Murtagh

Keyword(s):

Physical Activity ◽

Adolescent Girls ◽

Qualitative Studies ◽

Future Research ◽

Qualitative Synthesis ◽

Prisma Statement ◽

Study Characteristics ◽

Critical Appraisal Skills ◽

Societal Expectations ◽

Competing Priorities

Objective: To synthesize evidence from qualitative studies relating to adolescent girls’ perceptions of physical activity participation. The protocol for this review is registered with PROSPERO (ID no. CRD42017054944). Data Source: PubMed, Sports Discus, Academic Search Complete, and Education Resources Information Centre. Inclusion and Exclusion Criteria: Studies reporting qualitative data that explored the views/opinions/perceptions of adolescent girls (>12 and <18 years old) published between 2001 and 2016 were included. Studies not in English, those focusing on school physical education or specific sports, and those including special populations were excluded. Extraction: Study characteristics and results were extracted to a form developed by the authors and managed using NVivo 10 (QSR International’s NVivo 10 software). Data were extracted by 1 reviewer, and a sample (25%) was checked by a second reviewer. Synthesis: Data were synthesized using a thematic network and managed using NVivo 10. The validity of the included studies was assessed using the “Critical Appraisal Skills Programme (2018)” checklist. The ENTREQ and PRISMA statement was followed when reporting this qualitative synthesis. Results: Of the 1818 studies identified in the search strategy, 24 met the inclusion criteria and were included in the analysis. Global themes were identified using a thematic network. These themes were “Gender Bias in Sport,” “Motivation and Perceived Competence,” “Competing Priorities during Adolescence,” and “Meeting Societal Expectations.” Conclusions: The results of this review provide insights into adolescent girls’ views on physical activity. Future research is needed to investigate the potential impact of alternative activity programs on adolescent girls with appropriate follow-up. Researchers and individuals working with young girls must consider the role of perceived motor competence in participation and how this can impact their perceptions.

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