Factors influencing physical distancing compliance among young adults during COVID-19 pandemic in Indonesia: A photovoice mixed methods study

The spreading of the coronavirus disease (COVID-19) is growing out of control in Indonesia since the first two confirmed cases were announced in March 2020. Physical distancing measures are key to slowing down COVID-19 transmission. This study investigated factors associated with physical distancing compliance among young adults in the Jakarta Metropolitan Area, Indonesia. A convergent photovoice mixed methods design was used. Quantitatively, using data from 330 young adults in Jakarta Metropolitan Area, Indonesia, physical distancing compliance scores and its associated factors were analyzed with hierarchical linear regression. Responses from 18 young adults in online focus group discussions and 29 young adults in photovoice were analyzed with thematic analysis. Then, the findings were integrated using joint displays. The mean compliance score of young adults was 23.2 out of 27.0. The physical distancing compliance score was higher among those who worked or studied from home (β = 0.14, p <0.05), compared with those who resumed work at an office or study at school. Celebrating religious days (β = −0.15, p <0.05) and having hometown in the Jakarta Metropolitan Area (β = −0.12, p <0.05) were negatively associated with higher physical distancing compliance scores. Joint displays expanded the reasons for workplace policy, awareness, and social pressure as facilitators and barriers to compliance. Young adults’ physical distancing compliance scores were high, but they are at risk of not complying due to religious events and changes in workplace policies. Beyond individual efforts, external factors, such as workplace policies and social pressure, play a major role to influence their physical distancing compliance.

Early fluid bolus in adults with sepsis in the emergency department: a systematic review, meta-analysis and narrative synthesis

Background Early intravenous fluids for patients with sepsis presenting with hypoperfusion or shock in the emergency department remains one of the key recommendations of the Surviving Sepsis Campaign guidelines to reduce mortality. However, compliance with the recommendation remains poor. While several interventions have been implemented to improve early fluid administration as part of sepsis protocols, the extent to which they have improved compliance with fluid resuscitation is unknown. The factors associated with the lack of compliance are also poorly understood. Methods We conducted a systematic review, meta-analysis and narrative review to investigate the effectiveness of interventions in emergency departments in improving compliance with early fluid administration and examine the non-interventional facilitators and barriers that may influence appropriate fluid administration in adults with sepsis. We searched MEDLINE Ovid/PubMed, Ovid EMBASE, CINAHL, and SCOPUS databases for studies of any design to April 2021. We synthesised results from the studies reporting effectiveness of interventions in a meta-analysis and conducted a narrative synthesis of studies reporting non-interventional factors. Results We included 31 studies out of the 825 unique articles identified in the systematic review of which 21 were included in the meta-analysis and 11 in the narrative synthesis. In meta-analysis, interventions were associated with a 47% improvement in the rate of compliance [(Random Effects (RE) Relative Risk (RR) = 1.47, 95% Confidence Interval (CI), 1.25–1.74, p-value < 0.01)]; an average 24 min reduction in the time to fluids [RE mean difference = − 24.11(95% CI − 14.09 to − 34.14 min, p value < 0.01)], and patients receiving an additional 575 mL fluids [RE mean difference = 575.40 (95% CI 202.28–1353.08, p value < 0.01)]. The compliance rate of early fluid administration reported in the studies included in the narrative synthesis is 48% [RR = 0.48 (95% CI 0.24–0.72)]. Conclusion Performance improvement interventions improve compliance and time and volume of fluids administered to patients with sepsis in the emergency department. While patient-related factors such as advanced age, co-morbidities, cryptic shock were associated with poor compliance, important organisational factors such as inexperience of clinicians, overcrowding and inter-hospital transfers were also identified. A comprehensive understanding of the facilitators and barriers to early fluid administration is essential to design quality improvement projects. PROSPERO Registration ID CRD42021225417.

Physical Activity Experiences of People with Multiple Sclerosis during the COVID-19 Pandemic

During the COVID-19 pandemic, government and health officials introduced measures such as social distancing and facility closures that amplified barriers to physical activity. Certain groups, including people with multiple sclerosis (MS), have been underserved during the pandemic. In this qualitative study we aimed to: (1) explore the physical activity experiences of people with MS during the COVID-19 pandemic; (2) identify the facilitators and barriers to physical activity during COVID-19 for people with MS; and (3) make recommendations for inclusive physical activity policy and programming. We conducted semi-structured interviews with 11 adults (9 women) with MS during January and February 2021. Following an inductive thematic analysis, three themes were developed: (1) changing opportunities and adapting to new opportunities; (2) social isolation and physical activity; and (3) adapting physical activity to stay safe from COVID-19. Common facilitators identified included having knowledge and resources to adapt activities, social connections, and access to outdoor recreation opportunities. Identified barriers included fear and anxiety related to the spread of the virus, a loss of in-person activity options, and the closure of physical activity spaces. Online and at-home opportunities for physical activity were a valued and accessible way to address barriers to physical activity for people with MS, and should be maintained post-pandemic while considering flexibility to accommodate variable support needs.

Point-of-Care Testing in Community Pharmacies: A Mixed-Methods Study on Users and Pharmacists’ Facilitators and Barriers

Background Point-of-care tests can contribute to earlier diagnosis and treatment of infectious diseases with the potential to prevent chronic stages. As part of the Fast-Track Cities initiative, a pilot was initiated in community pharmacies in Portugal. Aim To characterize the individuals using point-of-care screening tests for human immunodeficiency virus, hepatitis C and hepatitis B virus infections in community pharmacies, their behaviours and motivations to perform the tests, as well as understand the facilitators and barriers from the perspectives of pharmacists. Method A mixed-methods study was conducted. A survey was applied to test users in pharmacies between May and December 2019, and three focus groups were conducted with pharmacists involved in the initiative. Qualitative data were analysed according to thematic content analysis. Results A total of 210 questionnaires were collected. Point-of-care tests users were predominantly male, mean age of 35 years, the majority were foreign-born and had higher education level. Almost half of the users were first time tested and the main reason for screening was unprotected intercourse. Pharmacists identified speed, confidentiality, counselling provided to users, pharmacists’ initial training to perform the tests and trust in the pharmacist as facilitators of these tests. Stigma associated with infections, the procedure, logistical conditions and the referral process were considered as barriers. Conclusion Pharmacies are an effective screening site, with particular relevance for individuals who are first tested, heterosexuals and some migrants. Nevertheless, it is necessary to understand and reduce barriers and increase the support of specific groups.

Facilitators and barriers to compliance with COVID-19 guidelines: a structural topic modelling analysis of free-text data from 17,500 UK adults

Background During the COVID-19 pandemic, the UK government implemented a series of guidelines, rules, and restrictions to change citizens’ behaviour to tackle the spread of the virus, such as the promotion of face masks and the imposition of lockdown stay-at-home orders. The success of such measures requires active co-operation on the part of citizens, but compliance was not complete. Detailed research is required on the factors that aided or hindered compliance with these measures. Methods To understand the facilitators and barriers to compliance with COVID-19 guidelines, we used structural topic modelling, a text mining technique, to extract themes from over 26,000 free-text survey responses from 17,500 UK adults, collected between 17 November and 23 December 2020. Results The main factors facilitating compliance were desires to reduce risk to oneself and one’s family and friends and to, a lesser extent, the general public. Also of importance were a desire to return to normality, the availability of activities and technological means to contact family and friends, and the ability to work from home. Identified barriers were difficulties maintaining social distancing in public (due to the actions of other people or environmental constraints), the need to provide or receive support from family and friends, social isolation, missing loved ones, and mental health impacts, perceiving the risks as low, social pressure to not comply, and difficulties understanding and keep abreast of changing rules. Several of the barriers and facilitators raised were related to participant characteristics. Notably, women were more likely to discuss needing to provide or receive mental health support from friends and family. Conclusion The results demonstrated an array of factors contributed to compliance with guidelines. Of particular policy importance, the results suggest that government communication that emphasizes the potential risks of the virus and provides simple, consistent guidance on how to reduce the spread of the virus would improve compliance with preventive behaviours as COVID-19 continues and for future pandemics.

Implementation of a multi-family autism transition program in the high school setting

Transitioning Together is a multi-family intervention designed to support families of adolescents on the autism spectrum as they prepare for the transition to adulthood. Questions remain regarding its wide-scale adoption and implementation in real-world settings such as high schools. We examined student, teacher, and school-level facilitators and barriers to adopting and implementing Transitioning Together at 30 public high schools across three US states that were participating in the intervention arm of a larger randomized trial, which provided training and coaching for implementation of comprehensive evidence-based autism programming. Seventeen of the 30 schools adopted Transitioning Together. Community socioeconomic status and pre-existing quality of programming for family involvement and transition planning significantly predicted intervention adoption. Thirteen of the 17 schools that adopted Transitioning Together did so with a high level of fidelity (>90%). The areas of fidelity that schools struggled with most related to session structure, facilitating problem-solving and dialogue, and collecting feedback from families. Findings highlight struggles and successes with real-world adoption of the intervention in its current form. Future research is needed to further examine how to facilitate adoption across public high schools and/or other service systems, while maximizing effectiveness, as well as reach to historically underserved autism spectrum populations. Lay abstract Transitioning Together is an intervention that supports families of adolescents on the autism spectrum as they prepare for the transition to adulthood. While it has been delivered successfully and shown to result in positive outcomes for families in the university setting, questions remain about whether and how well it can be widely provided to families in real-world settings such as high schools. In this study, we analyzed predictors, facilitators, and barriers to providing Transitioning Together to families at 30 high schools across three US states, all of which received training from a team of researchers to deliver this intervention. Our findings highlight struggles and successes with real-world use of the intervention. Seventeen of the 30 schools were successful in providing Transitioning Together to families. Schools who had higher community socioeconomic status, higher quality family involvement, and higher quality transition planning programming before changing anything for this study were much more likely to provide this new intervention to families. Schools who used the intervention were mostly able to deliver it as designed and received positive feedback from families who participated. Common parts of the intervention that schools struggled with most included following the structure of the sessions, including group problem-solving and dialogue in the sessions, and collecting feedback from families. Future research is needed to learn how to make it even easier for public high schools and other service systems to provide this intervention to families, in a way that also maximizes its effectiveness and accessibility for historically underserved autism spectrum populations.

“I’m Going to be Successful Someday”: Women’s Personal Projects to Improve Their Lives, and Implications for Clarifying the Nature of Agency in Criminological Theories of Desistance

Women’s agency to construct prosocial lives remains understudied in criminology. This qualitative inquiry explores the nature and outcomes of women’s personal projects, which reflect their agency. In up to five interviews, 401 women on probation and parole explained efforts to improve their lives. Psychological theory on personal projects guided analysis that revealed information on project meaning and facilitators and barriers to project pursuit. Women shared a motivation to avoid trouble and establish prosocial lives. Outcomes were improved by social support and prosocial opportunities. Findings have implications for defining and analyzing agency in desistance research and for correctional responses to women.

Facilitators and Barriers of Mother Engagement in a Home-based Parenting Program Following Concerns of Child Maltreatment

The current study aimed to explore mothers’ perceptions of facilitators and barriers to engagement in the HoPES program, an intensive home-visiting intervention for families with young children identified as having child maltreatment concerns. Seven mothers who had participated in the program participated in semi-structured interviews about their experiences. Thematic analysis was conducted using NVivo Version 12. Themes relating to facilitators of engagement included the following: (1) clinician behaviours; (2) treatment relevance/acceptability; (3) strong therapeutic relationship; (4) mothers’ cognitions and beliefs about treatment and (5) program delivery. Themes relating to barriers to engagement included the following: (1) contextual/external barriers to treatment; (2) treatment relevance/acceptability; (3) mothers’ cognitions and beliefs about treatment and (4) program processes. This study highlights the important role which services and clinicians have in engaging parents at risk of child maltreatment. Specifically, the prioritisation of the therapeutic relationship through all intervention processes, and the utilisation of strength-based approaches, may facilitate engagement.