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

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.

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

10.21203/rs.3.rs-420636/v1 ◽

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.

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

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v9i1.1411 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 7

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.

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

Harm Reduction Journal ◽

10.1186/s12954-021-00518-z ◽

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.

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Survival in the gap: experiences of health management among people at high risk of stroke in China: A qualitative study (Preprint)

10.2196/preprints.17035 ◽

2019 ◽

Author(s):

Lina Guo ◽

Lin Wang ◽

Jo Booth ◽

Yanjin Liu ◽

Yiru Zhu ◽

...

Keyword(s):

Social Support ◽

High Risk ◽

Family Income ◽

Health Management ◽

Healthcare Providers ◽

Service Development ◽

System Reform ◽

Management Service ◽

Structured Interviews ◽

Step Method

BACKGROUND Effective health management of people at high risk of stroke is challenging. OBJECTIVE To identify and explore the experiences of health management among people at high risk of stroke in order to inform ideas for health management service development for this population. METHODS Semi-structured interviews were conducted with 31stroke people at high risk of stroke. The interviews were collated and analyzed using Colaizzi’s 7-step method. RESULTS The experiences of health management in people at high risk of stroke were described as ‘Survival in the gap’. Themes identified limited knowledge of health management, lack of confidence in health management and poor adherence with health management. The value of health management experience was highlighted and included: becoming active learners, promoting social interaction and enhancing self-health management. Health management was seen to be sensitive to multiple influencing factors including: The severity and complexity of diseases, family income and social support. CONCLUSIONS Health management of people at high risk of stroke is challenging and they ‘survive in the gap’. They learn to manage their ongoing health based mainly on their own experiences. Government and healthcare providers should pay attention to the situation for this special population and be devoted to health system reform, financial support and social support to manage the condition in the longer term.

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Medical Care-Related Decisions among Patients Diagnosed with Early Stage Malignant Brain Tumor: A Qualitative Study

Global Qualitative Nursing Research ◽

10.1177/2333393620960059 ◽

2020 ◽

Vol 7 ◽

pp. 233339362096005

Author(s):

Hanako Numata ◽

Maiko Noguchi-Watanabe ◽

Akitake Mukasa ◽

Shota Tanaka ◽

Shunsaku Takayanagi ◽

...

Keyword(s):

Decision Making ◽

Medical Care ◽

Early Stage ◽

Healthcare Providers ◽

Decision Making Process ◽

Theory Approach ◽

Structured Interviews ◽

Fear And Anxiety ◽

Grounded Theory Approach ◽

Insight Into

Medical care-related decision-making among patients with malignant brain tumors has not been sufficiently discussed. This study aimed to develop a framework for understanding patients’ experiences in the decision-making process. Semi-structured interviews with 14 patients were analyzed using a grounded theory approach, focusing on their 48 decision-making points. Additionally, interviews with two family members and seven healthcare providers, and participant observations were used to gain contextual insight into patients’ experiences. Patients faced decisions while they struggled in vulnerability under shock, fear, and anxiety while hoping. Under this context, they showed four decision-making patterns: (1) led by the situation, (2) controlled by others, (3) entrusted someone with the decision, and (4) myself as a decision-making agent. Across these patterns, the patients were generally satisfied with their decisions even when they did not actively participate in the process. Healthcare providers need to understand patients’ contexts and their attitudes toward yielding decision-making to others.

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

10.21203/rs.3.rs-477073/v1 ◽

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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Identified barriers and facilitators to stroke risk screening in children with sickle cell anemia: results from the DISPLACE consortium

Implementation Science Communications ◽

10.1186/s43058-021-00192-z ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Shannon M. Phillips ◽

Alyssa M. Schlenz ◽

Martina Mueller ◽

Cathy L. Melvin ◽

Robert J. Adams ◽

...

Keyword(s):

Sickle Cell ◽

Sickle Cell Anemia ◽

Transcranial Doppler ◽

Stroke Risk ◽

Ecological Model ◽

Healthcare Providers ◽

Transcranial Doppler Ultrasound ◽

The United States ◽

Barriers And Facilitators ◽

Structured Interviews

Abstract Background Children with sickle cell anemia are at risk for stroke. Ischemic stroke risk can be identified among children ages 2–16 years with sickle cell anemia using transcranial Doppler ultrasound. Despite strong recommendations for transcranial Doppler screening in guidelines released by the National Heart, Lung, and Blood Institute, implementation of transcranial Doppler screening in sickle cell anemia remains suboptimal. The purpose of this study was to identify barriers and facilitators to transcranial Doppler screening in a large national consortium to inform subsequent implementation interventions. Methods A qualitative descriptive approach was used to conduct 52 semi-structured interviews with a sample of patients with sickle cell anemia, their parents or primary caregivers, and healthcare providers dispersed across the United States. Interviews took place from September 2018 through March 2019. Directed content analysis was conducted with an adapted version of the Multilevel Ecological Model of Health as an initial coding framework, completed July 2019. Frequency analysis was conducted to determine predominant barrier and facilitator themes. Results Fourteen barrier themes and 12 facilitator themes emerged representing all levels of the ecological framework. Two barrier themes (Logistical Difficulties and Competing Life Demands and Gaps in Scheduling and Coordination), and 5 facilitator themes (Coordination, Scheduling and Reminders; Education and Information; Provider and Staff Investment and Assistance; Positive Patient Experience; and Convenient Location) were predominant. Conclusions Barriers and facilitators to transcranial Doppler screening in children with sickle cell anemia are complex and occur across multiple ecological levels. One barrier theme and 3 facilitator themes were found to be optimal to address in subsequent implementation interventions.

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Barriers and facilitators to kangaroo mother care implementation in Cote d’Ivoire: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-07086-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kadidiatou Raïssa Kourouma ◽

Marie Laurette Agbré-Yacé ◽

Daouda Doukouré ◽

Lassina Cissé ◽

Chantière Some-Méazieu ◽

...

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 Background Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d’Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d’Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country. Method This 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 both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding. Results A 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, father’s resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers’ perceived value of KMC, mothers−healthcare providers’ relationship, mothers’ adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders. Conclusion Our study highlighted the challenges to implement KMC in Cote 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 solutions for a better implementation and scaling up of KMC.

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The Other Entrepreneurs - Migrant Economies as Spaces for Social Innovation?

MIGRATION LETTERS ◽

10.33182//ml.v16i2.742 ◽

2019 ◽

Vol 16 (2) ◽

pp. 265-271

Author(s):

Claudia Lintner

Keyword(s):

Social Innovation ◽

Close Relation ◽

The Other ◽

Structural Level ◽

Structured Interviews ◽

Economic Activities ◽

Migrant Entrepreneurship ◽

False Dichotomy ◽

Migrant Entrepreneurs ◽

The One

This article analyses the relationship between migrant entrepreneurship, marginalisation and social innovation. It does so, by looking how their ‘otherness’ is used on the one hand to reproduce their marginalised situation in society and on the other to develop new living and working arrangements promoting social innovation in society. The paper is based on a qualitative study, which was carried out from March 2014- 2016. In this period, twenty semi-structured interviews were conducted with migrant entrepreneurs and experts. As the results show, migrant entrepreneurs are characterised by a false dichotomy of “native weakness” in economic self-organisation against the “classical strength” of majority entrepreneurs. It is shown that new possibilities of acting in the context of migrant entrepreneurship are mostly organised in close relation to the lifeworlds and specific needs deriving from this sphere. Social innovation processes initiated by migrant entrepreneurs through their economic activities thus develop on a micro level and are hence less apparent. Supportive networks are missing on a structural level, so it becomes difficult for single innovative initiatives to be long-lasting.

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Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211012605 ◽

2021 ◽

pp. 104990912110126

Author(s):

Valeria Cardenas ◽

Anna Rahman ◽

Yujun Zhu ◽

Susan Enguidanos

Keyword(s):

Palliative Care ◽

Controlled Trial ◽

Insurance Coverage ◽

Healthcare Providers ◽

Health Condition ◽

Insurance Companies ◽

Structured Interviews ◽

Care Services ◽

Home Based ◽

Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

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