scholarly journals Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Umedjon Ibragimov ◽  
Katherine E. Cooper ◽  
Evan Batty ◽  
April M. Ballard ◽  
Monica Fadanelli ◽  
...  
Keyword(s):  
Grounded Theory ◽  
Rural Areas ◽  
Healthcare Providers ◽  
Individual Characteristics ◽  
Barriers And Facilitators ◽  
Risk Environment ◽  
Structured Interviews ◽  
Meso Level ◽  
Appalachian Kentucky ◽  
Low Threshold

Abstract Background Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study’s purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. Methods We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017–2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. Results Stigma, a feature of IREF’s meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID’s individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. Conclusions Features of the social and healthcare environments operating at the meso-level, as well as PWID’s individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.

scholarly journals Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
John A. Batsis ◽  
Auden C. McClure ◽  
Aaron B. Weintraub ◽  
Diane Sette ◽  
Sivan Rotenberg ◽  
...  
Keyword(s):  
Weight Loss ◽  
Healthy Lifestyle ◽  
Video Conferencing ◽  
Tertiary Care ◽  
Physical Space ◽  
Individual Characteristics ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Intervention Delivery ◽  
Link Type

Abstract Purpose Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. Methods A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation and exploratory measures of program adoption and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interviews. We evaluated elements of the RE-AIM model (reach, adoption) to assess staff barriers to success for future scalability. Findings There were 27 patients and 8 staff completing measures. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. Conclusions The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity. Trial registration Clinicaltrials.gov NCT03309787. Registered on 16 October 2017.

scholarly journals Barriers and facilitators to adherence to anti-diabetic medications: Ethiopian patients’ perspectives

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Bruck M. Habte ◽  
Tedla Kebede ◽  
Teferi G. Fenta ◽  
Heather Boon
Keyword(s):  
Diabetes Education ◽  
Healthcare Providers ◽  
Common Factors ◽  
Public Hospitals ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Religious Healing ◽  
Number Of Factors ◽  
Open Coding

Background: Little is known about the experiences of Ethiopian patients with type 2 diabetes related to adherence to their anti-diabetic medications. This may limit attempts to develop and implement patient-centred approaches that consider Ethiopian contexts.Objectives: To conduct an exploratory study with a focus on identifying barriers and facilitators to anti-diabetic medications adherence in Ethiopian patients with type 2 diabetes.Methods: Qualitative methods were used to conduct semi-structured interviews with 39 purposively selected participants attending clinic in three public hospitals in central Ethiopia. Open coding was used to analyse the data to identify key themes.Results: A number of factors were identified as barriers and facilitators to participants’ adherence to their anti-diabetic medications. The most common factors were perceptions related to their illness including symptoms, consequences and curability; perceptions of medications including safety concerns, convenience and their necessity; religious healing practices and beliefs; perceptions about and experiences with their healthcare providers and the healthcare system including the availability of medications and diabetes education; and finally perceived self-efficacy and social support.Conclusions: The findings of this study provide guidance to strengthen diabetes education programmes so that they reflect local patient contexts focusing among other things on the illness itself and the anti-diabetic medications.

scholarly journals Healthcare providers’ perspectives on perceived barriers and facilitators of compassion: Results from a grounded theory study

2018 ◽  
Vol 27 (9-10) ◽  
pp. 2083-2097 ◽  
Author(s):  
Pavneet Singh ◽  
Shelley Raffin-Bouchal ◽  
Susan McClement ◽  
Thomas F Hack ◽  
Kelli Stajduhar ◽  
...  
Keyword(s):  
Grounded Theory ◽  
Healthcare Providers ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Grounded Theory Study

scholarly journals Implementing a Canadian Shared-care ADHD Program in Beijing: Barriers and Facilitators to Consider Prior to Start-up

2021 ◽  
Author(s):  
Sayna Bahraini ◽  
Alexander Maisonneuve ◽  
Yirong Liu ◽  
André Samson ◽  
Qian Ying ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Shared Care ◽  
Stepped Care ◽  
Barriers And Facilitators ◽  
Service Development ◽  
Care Pathways ◽  
Theory Approach ◽  
Structural Level ◽  
Structured Interviews ◽  
Intervention Level

Abstract Background: The ADHD Shared Care Pathways is a program that has been developed in Canada with two main strategies: (a) to implement shared care between general practitioners (GPs) and specialists, and (b) to implement stepped care in which the patient is treated at the most appropriate level of care, depending on complexity or outcome of their illness. The current study aims to identify challenges and facilitators in implementing this program in a Chinese context. Methods: Two focus groups were conducted using semi-structured interviews with a total of 7 healthcare providers in Beijing. A grounded theory approach using open, axial and selective coding provided three main themes pertaining to the barriers and facilitators faced at: (1) a social-level from of the perspectives of patients and healthcare providers; (2) at a structural-level related to both internal and external organizational environments; (3) and at the intervention-level. Results: Results reveal multilayered challenges in implementing an ADHD Shared Care Pathways program for children in China. Conclusion: Our study highlights the importance of consultation in a new implementation context in order to get a “lay of the land”. By extension, our results demonstrate areas for service development and further research.

scholarly journals Implementing a Canadian Shared-Care ADHD Program in Beijing: Barriers and Facilitators To Consider Prior To Start-Up.

2021 ◽  
Author(s):  
Sayna Bahraini ◽  
Alexander Maisonneuve ◽  
Yirong Liu ◽  
André Samson ◽  
Qian Ying ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Shared Care ◽  
Stepped Care ◽  
Barriers And Facilitators ◽  
Service Development ◽  
Care Pathways ◽  
Theory Approach ◽  
Structural Level ◽  
Structured Interviews ◽  
Intervention Level

Abstract Background The ADHD Shared Care Pathways is a program that has been developed in Canada with two main strategies: (a) to implement shared care between general practitioners (GPs) and specialists, and (b) to implement stepped care in which the patient is treated at the most appropriate level of care, depending on complexity or outcome of their illness. The current study aims to identify challenges and facilitators in implementing this program in a Chinese context. Methods Two focus groups were conducted using semi-structured interviews with a total of 7 healthcare providers in Beijing. A grounded theory approach using open, axial and selective coding provided three main themes pertaining to the barriers and facilitators faced at: (1) a Social-level from of the perspectives of patients and healthcare providers; (2) at a structural-level related to both internal and external organizational environments; (3) and at the intervention-level. Results Results reveal multilayered challenges in implementing an ADHD Shared Care Pathways program for children in China. Conclusion Our study highlights the importance of consultation in a new implementation context in order to get a “lay of the land”. By extension, our results demonstrate areas for service development and further research.

Barriers and facilitators of geriatric assessment implementation in daily oncology practice: A qualitative study applying a theoretical implementation framework.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12012-12012
Author(s):  
Ayumu Matsuoka ◽  
Tomonori Mizutani ◽  
Yuki Kaji ◽  
Akiko Yaguchi-Saito ◽  
Miyuki Odawara ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Healthcare Providers ◽  
Individual Characteristics ◽  
Barriers And Facilitators ◽  
Multiple Stakeholders ◽  
Implementation Framework ◽  
Multi Level ◽  
Oncology Practice ◽  
Inner Setting

12012 Background: Geriatric assessment (GA) is recommended in various guidelines for older adults with cancer, but is not widely used in daily practice. This study aims to identify multi-level barriers and facilitators of GA implementation in daily oncology practice, based on a theoretical implementation framework. Methods: We conducted 20 semi-structured interviews with healthcare providers and managers in 14 hospitals treating older adults with cancer in Japan. The Consolidated Framework for Implementation Research (CFIR) was used to guide the collection and analysis of interview data using a deductive approach. CFIR consists of 5 major domains (I. intervention characteristics, II. outer setting, inner setting,. individual characteristics, and V. process), including 39 constructs. Differences in the constructs influencing GA implementation between hospitals where GA is routinely performed (high implementation, HI) and hospitals where GA is not performed or performed only in clinical trials (low implementation, LI) were explored. Results: Among constructs identified as barriers or facilitators of GA implementation, 15 multi-level constructs greatly differed between 5HI and 5LI, including 4 constructs from intervention characteristics, 6 from inner setting, 1 from individual characteristics, and 4 from process. In HI, GA was self-administered (I. adaptability), or administered on a mobile app with interpretation (I. design quality and packaging). In HI, healthcare providers strongly perceived the need to change the practice for older adults (III. tension for change), and recognized GA as fitting in with existing workflow as part of their jobs (III. compatibility). In LI, they did not realize the need to change practice, and rejected GA as an extra burden on their heavy workload. In HI, the usefulness of GA was widely recognized by healthcare providers (IV. knowledge and beliefs about the intervention), GA was given high priority (III. relative priority), had strong support from hospital directors and nursing chiefs (V. leadership engagement), and multiple stakeholders were successfully engaged, such as healthcare providers, especially nurses (V. key stakeholders), directors and nursing chiefs (V. opinion leaders), and those who dedicated themselves to implementing GA (champions). Conclusions: This is the first study to reveal the multi-level barriers and facilitators of GA implementation in daily oncology practice. The findings highlight the need to focus not only on individual or intervention characteristics, but also on the inner setting and the process of implementing GA. Our findings suggest future strategies, such as devising the administration of GA using technology, conducting local needs assessment and consensus discussions about the usefulness and priority of GA, and engaging multiple stakeholders.

scholarly journals Parents’ Perceptions on Barriers and Facilitators of Physical Activity among Schoolchildren: A Qualitative Study

2021 ◽  
Vol 18 (6) ◽  
pp. 3086
Author(s):  
Vanesa Alcántara-Porcuna ◽  
Mairena Sánchez-López ◽  
Vicente Martínez-Vizcaíno ◽  
María Martínez-Andrés ◽  
Abel Ruiz-Hermosa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Early Childhood ◽  
Grounded Theory ◽  
Qualitative Study ◽  
Rural Areas ◽  
Barriers And Facilitators ◽  
Individual Factors ◽  
Activity Levels ◽  
Adiposity Rebound ◽  
La Mancha

Given that physical activity (PA) plays an important role in early childhood, understanding the factors that affect the practice of PA at an early age could help develop effective strategies for overcoming barriers and increasing activity levels in this age group. A qualitative study was conducted based on grounded theory aimed at exploring the perceptions of mothers and fathers from Cuenca and Ciudad Real (Castilla La Mancha, Spain) regarding barriers and facilitators of physical activity of their children during the adiposity rebound period. Data were collected using focus groups involving 46 parents of children in the 3rd grade of pre-school and 1st grade of elementary school. During the analysis, the socio-ecological model and grounded theory were used. The barriers encountered were the preferences of children for sedentary activities (individual factors), academic tasks as a main priority of parents, the influence of older siblings and the unfavorable school environment (microsystem), the lack of family conciliation (mesosystem), and barriers related to the built environment or lack of facilities for physical activity (exosystem). Facilitators were the preferences for active games (individual factors), parental models including the co-participation of parents in activities, the influence of friends, living in large homes, the support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities, favorable weather conditions (exosystem), and the existence of free or subsidized activities (macro system). Programs aimed at promoting PA in early childhood should include strategies that address contextual factors and not only focus on individual factors related to the child.

scholarly journals Organizational and individual barriers and facilitators to the integration of pediatric palliative care for children: A grounded theory study

2021 ◽  
pp. 026921632110261
Author(s):  
Anat Laronne ◽  
Leeat Granek ◽  
Lori Wiener ◽  
Paula Feder-Bubis ◽  
Hana Golan
Keyword(s):  
Palliative Care ◽  
Grounded Theory ◽  
Healthcare Provider ◽  
Care Center ◽  
Healthcare Providers ◽  
Pediatric Palliative Care ◽  
Structured Interviews ◽  
Grounded Theory Method ◽  
Organizational Barriers ◽  
Provider Barriers

Background: Pediatric palliative care has established benefits for children with cancer and their families. Overcoming organizational and healthcare provider barriers have been demonstrated as central for the provision of palliative care in pediatric oncology. A deeper understanding is needed of the influence of these barriers and the interactions between them, specifically in primary palliative care in hospital settings. Aim: To identify the organizational and healthcare provider barriers to the provision of primary pediatric palliative care. Design: This study utilized the grounded theory method. Semi-structured interviews were conducted and analyzed line by line, using NVivo software. Setting/participants: Forty-six pediatric oncologists, nurses, psychosocial team members, and other healthcare providers from six academic hospital centers participated in the research. Results: Organizational and healthcare provider factors were identified, each of which acted as both a barrier and facilitator to the provision of pediatric palliative care. Organizational barriers included lack of resources and management. Facilitators included external resources, resource management, and a palliative care center within the hospital. Individual barriers included attitudes toward palliative care among pediatric oncologists, pediatric oncologists’ personalities, and the emotional burden of providing palliative care. Facilitators include dedication and commitment, initiative, and sense of meaning. Provider facilitators for palliative care had a buffering effect on organizational barriers. Conclusion: Organizational and healthcare provider factors influence the quality and quantity of palliative care given to children and their families. This finding has implications on interventions structured to promote primary palliative care for children, especially in healthcare systems and situations where resources are limited.

scholarly journals Psychosocial Issues ‌of Retirement in Iran: ‌A Qualitative Study

Salmand ◽  
2021 ◽  
Vol 15 (4) ◽  
pp. 396-409
Author(s):  
Zohreh Alavi ◽  
◽  
Fardin Alipour ◽  
Hassan Rafiey ◽  
◽  
...  
Keyword(s):  
Elderly Care ◽  
Sampling Strategy ◽  
Well Being ◽  
Individual Characteristics ◽  
Barriers And Facilitators ◽  
Psychological Resilience ◽  
Care Providers ◽  
Structured Interviews ◽  
Emotional Deprivation ◽  
Psychosocial Challenges

Objectives: Retirement is a potentially challenging event in old age that has different‏ effects on older people’s lives. This study aims to identify the psychosocial consequences, barriers, and facilitators of adaption to retirement in Iran. Methods & Materials: In this study, we used conventional content analysis. The samples consisted of 22 people with experience or expertise in the field of retirement, who were selected by maximum diversity and purposeful sampling strategy Data were collected through semi-structured interviews from February 2019 to September 2019. Graneheim and Lundman's approach was used for data analysis. Results: Of 22 participants, 59% were male and 41% were female. Four main categories and 13 sub-categories were extracted covering different psychosocial aspects of adaption to retirement Including: Psychosocial challenges (emotional deprivation, reduced psychological resilience, role loss, social isolation, and family challenges), post-retirement development (developing interests and activities, and feeling of being free), barriers to retirement adaptation (health problems, lack of a retirement plan, and macro-structural deficiencies), and contextual/supportive facilitators (individual characteristics, job characteristics, and social support systems). Conclusion: After retirement, people face psychosocial challenges or opportunities for development. In the meantime, some barriers and facilitators can affect adaption to retirement. Therefore, preparation for retirement is an important issue in the field of gerontology services. Elderly care providers and health professionals can benefit from the finding of this study in their interventions to promote the psychosocial well-being of retirees and their families.‎

scholarly journals Barriers and Facilitators to Kangaroo Mother Care Implementation in Côte D’Ivoire: A Qualitative Study

2021 ◽  
Author(s):  
Kadidiatou Raissa Kourouma ◽  
Marie Laurette Agbré Yacé ◽  
Daouda Doukouré ◽  
Lassina Cissé ◽  
Chantière Somé-Meazieu ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cote D'ivoire ◽  
Côte D’Ivoire ◽  
Healthcare Providers ◽  
Kangaroo Mother Care ◽  
Decision Makers ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Cote D’Ivoire ◽  
Côte D'ivoire

Abstract BackgroundKangaroo Mother Care (KMC) is a key high impact intervention, low technology and cost-effective for the care of preterm and low birth weight newborn. Côte d’Ivoire has adopted the intervention and opened the first KMC unit in 2019. After one year of functioning, we aimed to assess barriers and facilitators of KMC implementation as well as proposed solutions to improve KMC implementation in Côte d’Ivoire.MethodThis was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using Nvivo 12.ResultsA total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, partner resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, leadership, the cost of the intervention, the value of the intervention for healthcare providers, mothers −healthcare providers relationship, mothers’ adherence to KMC.The proposed solution to improve KMC implementation were volunteer staff motivation, intensifying mothers and families education and counselling, the recruitment of a psychologist and the involvement of all stakeholders.ConclusionsOur study highlighted the challenges to implement KMC in Côte d’Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solution for a better implementation and scaling up of KMC intervention.

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