Barriers to Evaluation

ERIC Educational Resources Information Center

Charley, Lois

2007-01-01

According to the Department of Health and Human Services, "good program evaluations assess programs performance, measure impacts on families and communities, and document program successes." With this information, programs are able to direct limited resources to where they are most needed and most effective in their communities. This article is…

Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review.

PubMed

Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

2016-02-01

Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.

Enablers and barriers in delivery of a cancer exercise program: the Canadian experience

PubMed Central

Mina, D. Santa; Petrella, A.; Currie, K.L.; Bietola, K.; Alibhai, S.M.H.; Trachtenberg, J.; Ritvo, P.; Matthew, A.G.

2015-01-01

Background Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. Methods Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. Results Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. Conclusions Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada. PMID:26715869

A Pilot Study of Determinants of Ongoing Participation in EnhanceFitness: A Community-Based Group Exercise Program for Older Adults.

PubMed

Gillette, David B; Petrescu-Prahova, Miruna; Herting, Jerald R; Belza, Basia

2015-01-01

Physical activity has many benefits for older adults, but adherence is often low. The purposes of this study were to (1) identify motivators and barriers for participation in EnhanceFitness (EF), a group-based exercise program; and (2) quantitatively examine the association between motivators, barriers and individual characteristics, and ongoing participation in the program. This was a prospective, cross-sectional study. We mailed a pilot, investigator-developed survey to assess motivators and barriers to exercising to 340 adults who started a new EF class, regardless of their attendance rate. We precoded surveys on the basis of class attendance, with former participants defined as having no attendance a month or more before a 4-month fitness check. Of the 241 respondents (71% response rate), 61 (25%) were precoded as former participants and 180 (75%) as current participants. The mean age of respondents was 71 years and they were predominately female (89%). More than half of respondents were whites (58%), and almost half were married (46%). Former participants reported lower total motivation scores than current participants (P < .01) and had a significantly higher mean total barrier score (P < .001). The effects of 5 barriers ("Class was too hard," "Class was too easy," "I don't like to exercise," "Personal illness," and "Exercise caused pain") and 2 motivators ("I want to exercise" and "I plan exercise as part of my day") were significantly different between current and former participants. Discrete event history models show that dropout was related positively to ethnicity (whites were more likely to drop out) and health-related barriers. In newly formed EF classes, participants who drop out report more program, psychosocial, and health barriers, and fewer program and psychosocial motivators. Total barrier score and health barriers significantly predict a participant's dropping out, and white ethnicity is associated with a higher likelihood of dropping out. Employing strategies that address health barriers to participation could improve attendance rates for group-based exercise programs.

Perceived barriers, benefits, and motives for physical activity: two primary-care physical activity prescription programs.

PubMed

Patel, Asmita; Schofield, Grant M; Kolt, Gregory S; Keogh J, W L

2013-01-01

This study examined whether perceived barriers, benefits, and motives for physical activity differed based on allocation to 2 different types of primary-care activity-prescription programs (pedometer-based vs. time-based Green Prescription). Eighty participants from the Healthy Steps study completed a questionnaire that assessed their perceived barriers, benefits, and motives for physical activity. Factor analysis was carried out to identify common themes of barriers, benefits, and motives for physical activity. Factor scores were then used to explore between-groups differences for perceived barriers, benefits, and motives based on group allocation and demographic variables. No significant differences were found in factor scores based on allocation. Demographic variables relating to the existence of chronic health conditions, weight status, and older age were found to significantly influence perceived barriers, benefits, and motives for physical activity. Findings suggest that the addition of a pedometer to the standard Green Prescription does not appear to increase perceived motives or benefits or decrease perceived barriers for physical activity in low-active older adults.

Media campaign effectiveness in promoting a smoking-cessation program.

PubMed

Czarnecki, Karen Davis; Vichinsky, Laura E; Ellis, Jennifer A; Perl, Sarah B

2010-03-01

Little is known about the perceived barriers among smokers who do not utilize phone-based, population-level smoking-cessation services. The purpose of this study was to improve understanding of a media campaign's impact in promoting a phone-based, time-limited smoking-cessation program as measured by smoker awareness of the program, untapped interest in the program, perceived barriers to use of the program, and suggested methods for enhanced outreach. A random telephone survey of New York City smokers (n=1000) was conducted in 2006 in order to assess awareness of, interest in, and barriers to using the 2006 Nicotine Patch Program. Analyses were conducted in 2006 and 2007. The level of program awareness was high (60% overall), although it varied by demographic subgroup. The level of program interest among smokers unaware of the program was also encouragingly high (54%). Analysis of barriers to program use indicates that enrollment may be increased by addressing hesitance about using patches, developing messages for smokers who do not self-identify as smokers, and clarifying application procedures. Specific outreach strategies suggested by smokers include promotion through direct mail and advertising on public transportation. These data suggest that the use of mass media is an effective method for informing smokers about cessation services and that enrollment could be improved by modifying public messages to address barriers as well as expanding outreach to specific demographic groups. Improved outreach to smokers may be feasible using the strategies suggested by smokers in this survey. These findings can aid smoking-cessation services in expanding their reach and impact. Published by Elsevier Inc.

Barriers and facilitators to implementing continuous quality improvement programs in colonoscopy services: a mixed methods systematic review

PubMed Central

Candas, Bernard; Jobin, Gilles; Dubé, Catherine; Tousignant, Mario; Abdeljelil, Anis Ben; Grenier, Sonya; Gagnon, Marie-Pierre

2016-01-01

Background and aim: Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients. Methods: We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process. Results: We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists’ perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources. Conclusion: Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers. PMID:26878037

Pancreatic cancer survivors' preferences, barriers, and facilitators related to physical activity and diet interventions.

PubMed

Arthur, Anna E; Delk, Ashley; Demark-Wahnefried, Wendy; Christein, John D; Contreras, Carlo; Posey, James A; Vickers, Selwyn; Oster, Robert; Rogers, Laura Q

2016-12-01

To conduct a telephone survey establishing pancreatic cancer survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in exercise and diet intervention programming. These data will inform the development of such interventions for newly-diagnosed patients. Seventy-one survivors treated for resectable pancreatic adenocarcinoma from October 2011 to August 2014 were identified through an institutional cancer registry and contacted via telephone. A telephone survey was conducted to query survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in an exercise and dietary intervention program shortly after disease diagnosis. Acceptability of a technology-based visual communication (e.g., Skype™, FaceTime®) intervention was also assessed. Fifty participants completed the survey (response rate 71.8 %). Over two-thirds of participants reported interest in exercise and diet intervention programming. Over half reported comfort with a technology-delivered visual communication intervention. Barriers to participation included older age and physical, personal, and emotional problems. The most common facilitator was program awareness. Outcomes for future research important to participants were supportive care and quality of life. Most pancreatic cancer patients are interested in exercise and diet interventions shortly after diagnosis; however, some barriers to program participation exist. Future research and intervention planning for pancreatic cancer survivors should focus on developing messaging and strategies that provide support for survivorship outcomes, increase survivor awareness, address lack of familiarity with technology, reduce fears about potential barriers, and help survivors overcome these barriers. In so doing, survivorship needs can be better met and quality of life improved in this understudied population.

Evaluation of Athletic Training Students' Clinical Proficiencies

PubMed Central

Walker, Stacy E; Weidner, Thomas G; Armstrong, Kirk J

2008-01-01

Context: Appropriate methods for evaluating clinical proficiencies are essential in ensuring entry-level competence. Objective: To investigate the common methods athletic training education programs use to evaluate student performance of clinical proficiencies. Design: Cross-sectional design. Setting: Public and private institutions nationwide. Patients or Other Participants: All program directors of athletic training education programs accredited by the Commission on Accreditation of Allied Health Education Programs as of January 2006 (n  =  337); 201 (59.6%) program directors responded. Data Collection and Analysis: The institutional survey consisted of 11 items regarding institutional and program demographics. The 14-item Methods of Clinical Proficiency Evaluation in Athletic Training survey consisted of respondents' demographic characteristics and Likert-scale items regarding clinical proficiency evaluation methods and barriers, educational content areas, and clinical experience settings. We used analyses of variance and independent t tests to assess differences among athletic training education program characteristics and the barriers, methods, content areas, and settings regarding clinical proficiency evaluation. Results: Of the 3 methods investigated, simulations (n  =  191, 95.0%) were the most prevalent method of clinical proficiency evaluation. An independent-samples t test revealed that more opportunities existed for real-time evaluations in the college or high school athletic training room (t189  =  2.866, P  =  .037) than in other settings. Orthopaedic clinical examination and diagnosis (4.37 ± 0.826) and therapeutic modalities (4.36 ± 0.738) content areas were scored the highest in sufficient opportunities for real-time clinical proficiency evaluations. An inadequate volume of injuries or conditions (3.99 ± 1.033) and injury/condition occurrence not coinciding with the clinical proficiency assessment timetable (4.06 ± 0.995) were barriers to real-time evaluation. One-way analyses of variance revealed no difference between athletic training education program characteristics and the opportunities for and barriers to real-time evaluations among the various clinical experience settings. Conclusions: No one primary barrier hindered real-time clinical proficiency evaluation. To determine athletic training students' clinical proficiency for entry-level employment, athletic training education programs must incorporate standardized patients or take a disciplined approach to using simulation for instruction and evaluation. PMID:18668172

Concerns and Structural Barriers Associated with WIC Participation among WIC-Eligible Women.

PubMed

Liu, Cindy H; Liu, Heidi

2016-09-01

To examine sociodemographic status, psychosocial concerns, and structural barriers associated with women's participation in the USDA's Women, Infants, and Children (WIC) program among those eligible for the program. A total of 1,634 White, African-American, Hispanic, and Asian/Pacific Islander (A/PI) women from the New York City area completed the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2004 to 2007, a population-based survey. Data on WIC eligibility and participation, sociodemographic details, unintended pregnancy, social support, and structural barriers were evaluated. Hispanics and Blacks were 4.1 and 2.4 times more likely to participate, respectively, in the WIC program relative to Whites. Mothers reporting unplanned pregnancies, fewer social supports, and more structural barriers (e.g., transportation) were less likely to participate in WIC. Race-stratified analyses revealed race/ethnic differences in the pattern of barriers; unintended pregnancy and structural problems were barriers associated with WIC participation particularly for A/PI. WIC-eligible women with unintended pregnancies and fewer social supports tend to participate in WIC, but those who experience more structural barriers are less likely to participate. A/PI women may face specific challenges to WIC participation. Careful attention is needed to understand the unique attitudes and behaviors in the process of participating in WIC. © 2016 Wiley Periodicals, Inc.

At Risk on the Border: Assessment of Student Learning at an Hispanic Serving Institution

ERIC Educational Resources Information Center

Davila, Mario A.; Lovett, Steve; Hartley, Deborah J.

2018-01-01

Hispanics face multiple barriers to academic achievement. This study measured learning in an undergraduate criminal justice program at an Hispanic Serving Institution bordering Mexico. We estimated the average gains students achieved across core content areas using a technique that can be used by other faculty as part of program assessment. The…

Overview of ORNL/NRC programs addressing durability of concrete structures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Naus, D.J.; Oland, C.B.

1994-06-01

The role of reinforced concrete relative to its applications as either safety-related structures in nuclear power or engineered barriers of low-level radioactive waste disposal facilities is described. Factors that can affect the long-term durability of reinforced concrete are identified. Overviews are presented of the Structural Aging Program, which is addressing the aging management of safety-related concrete structures in nuclear power plants, and the Permeability Test Methods and Data Program, which is identifying pertinent data and information for use in performance assessments of engineered barriers for low-level radioactive waste disposal.

Convalescence care for seniors of lower Manhattan: an interdisciplinary outreach, rehabilitation, and education model.

PubMed

Moroz, Alex; Schoeb, Veronika; Fan, Grace; Vitale, Kenneth; Lee, Mathew

2004-03-01

The purpose of this study was to test the efficacy of an interdisciplinary geriatric outreach, rehabilitation, and education program for seniors. Community-dwelling Chinese seniors in lower Manhattan were recruited through outreach activities (17 educational workshops, three community health fairs, media interviews) and community physician referrals to offer rehabilitation services. The instrument administered at entry and exit included questions about pain intensity, quality of life, activities of daily living (ADLs), and an assessment of a variety of intrinsic and extrinsic barriers to life participation. The sample included 70 seniors (53 women) with a mean age of 70.5 +/- 7.48 years (range 60-93 years old) of whom 86% were Cantonese-speaking Chinese. The barriers-to-life participation assessment revealed cultural, communication, transportation, and physical environmental barriers as well as insufficient financial resources. Thirty-four patients who completed the program showed a significant improvement in quality of life. Patients' reports reflected a high degree of satisfaction with the program. Interdisciplinary team-oriented patient care, including a physiatrist, social worker, and rehabilitation staff, may result in good outcomes and high patient satisfaction in ambulatory community seniors.

College Success of Students with Psychiatric Disabilities: Barriers of Access and Distraction

ERIC Educational Resources Information Center

McEwan, Robert C.; Downie, Robert

2013-01-01

This study explored the barriers to success experienced by students with psychiatric disabilities (PD) enrolled in college programs. The students in the PD group were compared to a matched group of students with learning disabilities (LD) on graduation rates, endurance levels, grade point averages, self-assessment of cognitive, academic, and…

Life after the ban: an assessment of US syringe exchange programs' attitudes about and early experiences with federal funding.

PubMed

Green, Traci C; Martin, Erika G; Bowman, Sarah E; Mann, Marita R; Beletsky, Leo

2012-05-01

We aimed to determine whether syringe exchange programs (SEPs) currently receive or anticipate pursuing federal funding and barriers to funding applications following the recent removal of the long-standing ban on using federal funds for SEPs. We conducted a telephone-administered cross-sectional survey of US SEPs. Descriptive statistics summarized responses; bivariate analyses examined differences in pursuing funding and experiencing barriers by program characteristics. Of the 187 SEPs (92.1%) that responded, 90.9% were legally authorized. Three received federal funds and 116 intended to pursue federal funding. Perceived federal funding barriers were common and included availability and accessibility of funds, legal requirements such as written police support, resource capacity to apply and comply with funding regulations, local political and structural organization, and concern around altering program culture. Programs without legal authorization, health department affiliation, large distribution, or comprehensive planning reported more federal funding barriers. Policy implementation gaps appear to render federal support primarily symbolic. In practice, funding opportunities may not be available to all SEPs. Increased technical assistance and legal reform could improve access to federal funds, especially for SEPs with smaller capacity and tenuous local support.

Assessing systemic barriers to permanency achievement for children in out-of-home care: development of the child permanency barriers scale.

PubMed

Murphy, April L; Van Zyl, Riaan; Collins-Camargo, Crystal; Sullivan, Dana

2012-01-01

State and local child welfare agencies are engaged in multiple efforts to enact systems change to improve outcomes, particularly in regard to achievement of child permanency. The Child and Family Services Review process, conducted by the Administration Children and Families, requires states to implement program improvement plans designed to improve outcomes for which they are not meeting national standards. However, a tool has not been demonstrated as useful in assessing the barriers to achievement of permanency across the out-of-home service continuum, from recruitment of families to placement stability. This article reports on the development and refinement of such a tool in one Midwestern state. The Child Permanency Barriers Scale has four factors: kinship, placement and matching, adequate services and resources, and communication and collaboration. Implications for use in state-specific and multisystem assessment and system reform are discussed.

Global health training in ophthalmology residency programs.

PubMed

Coombs, Peter G; Feldman, Brad H; Lauer, Andreas K; Paul Chan, Robison V; Sun, Grace

2015-01-01

To assess current global health education and international electives in ophthalmology residency programs and barriers to global health implementation in ophthalmology resident education. A web-based survey regarding participation in global health and international electives was emailed to residency program directors at 116 accredited ophthalmology residency programs via an Association of University Professors in Ophthalmology (AUPO) residency program director listserv. Fifty-nine (51%) ophthalmology residency program directors responded. Thirty-seven program directors (63%) said global health was important to medical students when evaluating residency programs. Thirty-two program directors (55%) reported developing international electives. Reported barriers to resident participation in international electives were: 1) insufficient financial support, 2) inadequate resident coverage at home, and 3) lack of ACGME approval for international electives. Program directors requested more information about resident international electives, funding, and global ophthalmology educational resources. They requested ACGME recognition of international electives to facilitate resident participation. More than half (54%) of program directors supported international electives for residents. This survey demonstrates that program directors believe global health is an important consideration when medical students evaluate training programs. Despite perceived barriers to incorporating global health opportunities into residency training, program directors are interested in development of global health resources and plan to further develop global health opportunities. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Women’s Health Training in Gastroenterology Fellowship: A National Survey of Fellows and Program Directors

PubMed Central

Roberson, Erica; Richie, Kelly; Lindstrom, Mary J.; Esposti, Silvia Degli; Wald, Arnold

2013-01-01

Background and Aims The Gastroenterology Core Curriculum requires training in women’s digestive disorders; however, requirements do not necessarily produce knowledge and competence. Our study goals were: (1) to compare perceptions of education, fellow-reported levels of competence, and attitudes towards training in women’s gastrointestinal (GI) health issues during fellowship between gastroenterology fellows and program directors, and (2) to determine the barriers for meeting training requirements. Methods A national survey assessing four domains of training was conducted. All GI program directors in the United States (n = 153) and a random sample of gastroenterology fellows (n = 769) were mailed surveys. Mixed effects linear modeling was used to estimate all mean scores and to assess differences between the groups. Cronbach’s alpha was used to assess the consistency of the measures which make up the means. Results Responses were received from 61% of program directors and 31% of fellows. Mean scores in perceived didactic education, clinical experiences, and competence in women’s GI health were low and significantly differed between the groups (P < 0.0001). Fellows’ attitudes towards women’s GI health issues were more positive compared to program directors’ (P = 0.004). Barriers to training were: continuity clinic at a Veteran’s Administration hospital, low number of pregnant patients treated, low number of referrals from obstetrics and gynecology, and lack of faculty interest in women’s health. Conclusions (1) Fellows more so than program directors perceive training in women’s GI health issues to be low. (2) Program directors more so than fellows rate fellows to be competent in women’s GI health. (3) Multiple barriers to women’s health training exist. PMID:21267780

Food Safety Programs Based on HACCP Principles in School Nutrition Programs: Implementation Status and Factors Related to Implementation

ERIC Educational Resources Information Center

Stinson, Wendy Bounds; Carr, Deborah; Nettles, Mary Frances; Johnson, James T.

2011-01-01

Purpose/Objectives: The objectives of this study were to assess the extent to which school nutrition (SN) programs have implemented food safety programs based on Hazard Analysis and Critical Control Point (HACCP) principles, as well as factors, barriers, and practices related to implementation of these programs. Methods: An online survey was…

[Care Plan for Resuming the Physical Activity of Patients With Pancreatic Cancer and Diabetes After Surgery].

PubMed

Yang, Hui-Ting; Wu, Mei-Chih; Shun, Shiow-Ching

2018-02-01

Many barriers influence the ability of postoperative cancer patients to reengage in normal physical activities. Training programs have been shown to be effective in helping restore physical activity in patients and in reducing the care burdens of family members. Nurses cannot use physical activity guidelines in their care plan to assess individual needs. The clinical practice guidelines for physical activity in survivorship were published by the National Comprehensive Cancer Network (NCCN) in 2016. These guidelines are used to assess patients' physical status, curable factors, physical barriers, and risk of postoperative pancreatic cancer and diabetes. In line with this assessment tool, the physical activity guidelines, and the recommendations for cancer patients, the authors planned a physical activity training program that addressed the actual needs of patients under their care. Further, the authors provided special notes for a diabetic diet that helped reduce the barriers to resuming physical activity and enhanced independent care efficacy. Meanwhile, the authors encouraged family members to participate in patient-care activities and family mental-health support and to promote patient participation in the training program in order to increase quality of life. The present project demonstrates that this care plan may provide an effective guide for nurses to help other cancer patients resume physical activity.

Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study.

PubMed

Cameron, Kenzie A; Cohen, Elaine R; Hertz, Joelle R; Wayne, Diane B; Mitra, Debi; Barsuk, Jeffrey H

2018-03-14

The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas. We conducted semistructured interviews to assess perceptions of barriers and facilitators to CVC insertion. Deidentified transcripts were analyzed using a grounded theory approach and the constant comparative method. We subsequently mapped identified barriers and facilitators to our SBML curriculum to determine whether or not the curriculum addresses these factors. We interviewed 28 providers at six Veterans Administration Medical Centers, identifying the following five overarching factors of perceived barriers to CVC insertion: (1) equipment, (2) personnel/staff, (3) setting or organizational context, (4) patient or provider, and (5) time-related barriers. Three overarching factors of facilitators emerged: (1) equipment, (2) personnel, and (3) setting or organizational context facilitators. The SBML curriculum seems to address most identified barriers, while leveraging many facilitators; building on the commonly identified facilitator of nursing staff contribution by expanding the curriculum to explicitly include nurse involvement could improve team efficiency and organizational culture of safety. Many identified facilitators (e.g., ability to use ultrasound, personnel confidence/competence) were also identified as barriers. Evidence-based SBML programs have the potential to amplify these facilitators while addressing the barriers by providing an opportunity to practice and master CVC insertion skills.

Pancreatic cancer survivors’ preferences, barriers, and facilitators related to physical activity and diet interventions

PubMed Central

Arthur, Anna E.; Delk, Ashley; Demark-Wahnefried, Wendy; Christein, Johnf D.; Contreras, Carlo; Posey, James A.; Vickers, Selwyn; Oster, Robert; Rogers, Laura Q.

2016-01-01

Purpose To conduct a telephone survey establishing pancreatic cancer survivors’ level of interest in, preferences for and perceived barriers and facilitators to participating in exercise and diet intervention programming. These data will inform the development of such interventions for newly-diagnosed patients. Methods Seventy-one survivors treated for resectable pancreatic adenocarcinoma from October 2011 – August 2014 were identified through an institutional cancer registry and contacted via telephone. A telephone survey was conducted to query survivors’ level of interest in, preferences for, and perceived barriers and facilitators to participating in an exercise and dietary intervention program shortly after disease diagnosis. Acceptability of a technology-based visual communication (e.g. Skype™, FaceTime®) intervention was also assessed. Results Fifty participants completed the survey (response rate 71.8%). Over two-thirds of participants reported interest in exercise and diet intervention programming. Over half reported comfort with a technology-delivered visual communication intervention. Barriers to participation included older age and physical, personal and emotional problems. The most common facilitator was program awareness. Outcomes for future research important to participants were supportive care and quality of life. Conclusions Most pancreatic cancer patients are interested in exercise and diet interventions shortly after diagnosis; however, some barriers to program participation exist. Implications for Cancer Survivors Future research and intervention planning for pancreatic cancer survivors should focus on developing messaging and strategies that provide support for survivorship outcomes, increase survivor awareness, address lack of familiarity with technology, reduce fears about potential barriers and help survivors overcome these barriers. In so doing, survivorship needs can be better met and quality of life improved in this understudied population. PMID:27138993

Research on Physical Activity in the Elderly: Practical Implications for Program Planning.

ERIC Educational Resources Information Center

Myers, Anita M.; Gonda, Gail

1986-01-01

The authors critically examine the research on physical activity in the elderly to assess the elderly's capacity for exercise and the benefits accruing from exercise. Lower-intensity exercise programs attract a more representative group of senior participants and overcome many barriers. Implications for program planning and efforts are discussed.…

Coalition building by drug user and sex worker community-based organizations in Vietnam can lead to improved interactions with government agencies: a qualitative study.

PubMed

Le, Leah T; Grau, Lauretta E; Nguyen, Huong H; Khuat, Oanh Hai T; Heimer, Robert

2015-10-16

Drug users and female sex workers are among the groups most vulnerable to HIV infection in Vietnam. To address the HIV epidemic within these communities, former drug users and sex workers established the first community-based organizations (CBOs) in 2009. The study provides a focused assessment of CBOs' expanding efforts to advocate for their members that identifies existing collaborations with Vietnamese government programs. This assessment explores the barriers to and facilitators of expansion in order to propose recommendations to improve the working relationship between CBOs and government programs. Thirty-two individuals from drug user and sex worker CBOs (n = 24) and relevant government programs (n = 8) participated in face-to-face interviews in Hanoi, Ho Chi Minh City, and Hai Phong. Coded interview transcripts were analyzed qualitatively concerning the purpose of CBOs, the interactions between CBOs and government programs, and the perceived barriers, facilitators, and feasibility of future CBO-government program collaborations. Services provided by the CBOs were considered to improve members' quality of life. The formation of coalitions among CBOs increased efficiency in meeting members' specific service needs, in addition to internal capacity building. Government field staff interacted with CBOs by providing CBOs with technical and legal support. CBOs and methadone maintenance treatment (MMT) clinics collaborated to help the clinics meet patient enrollment quotas and facilitate entry into treatment for CBO members. Barriers to CBO-government program collaboration included perceived conflicting missions on how to address drug use and sex work in the community, limited CBO-government program communication, CBO mistrust of the MMT system, and lack of legal status for CBOs. To reduce these barriers, we recommend (1) introduction of CBO consultative services at government healthcare centers, (2) enlistment of CBO outreach to ensure full access to the imminent scaled-up MMT program, and (3) establishment of standards by which CBOs can obtain legal status.

Perceived Barriers and Facilitators of Farm-to-Consumer Retail Outlet Use Among Participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Alabama

PubMed Central

Singleton, Chelsea R.; Baskin, Monica; Levitan, Emily B.; Sen, Bisakha; Affuso, Ermanno; Affuso, Olivia

2018-01-01

This research aimed to identify perceived barriers and facilitators of farm-to-consumer (FTC) retail outlet (eg, farmers’ markets, farm/roadside stands) usage among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants residing in Birmingham, Alabama. Additionally, associations between barriers and facilitators reported and daily fruit and vegetable (F&V) intake were examined. A sample of 312 lower income women (mean age = 27.6; 67.0% non-Hispanic black; 45.3% obese) who participate in the Birmingham WIC program were surveyed between October 2014 and January 2015. Fischer’s exact test was used to assess associations between barriers (eg, outlet location, price, transportation), facilitators (eg, produce quality, produce variety), and high F&V intake (ie, consuming ≥ 5 servings per day). Approximately 81 (26.1%) participants reported using an FTC outlet to purchase produce in 2014. Lack of awareness (39.3%), outlet location (32.8%), and lack of interest (28.4%) were the barriers most often reported. Produce quality (69.1%), produce variety (49.4%), and price (39.5%) were the facilitators most often reported. Barriers and facilitators mentioned were not associated with high F&V intake. Lack of awareness and lack of interest are key barriers to FTC outlet usage among Birmingham WIC recipients. Interventions aiming to promote use of FTC outlets should consider the perceived barriers and facilitators to usage. PMID:29430270

Role of physical barriers in the control of sea lamprey (Petromyzon marinus)

USGS Publications Warehouse

Hunn, J.B.; Youngs, W.D.

1980-01-01

Mechanical and electromechanical barriers played a significant role in the initial attempts to control sea lamprey (Petromyzon marinus) populations in the upper Great Lakes. More recently electromechanical weirs have been used to assess the relative abundance of spawning-run sea lampreys in Lake Superior. Development of an integrated control approach to sea lamprey control has stimulated an ongoing research program to define structural and/or velocity criteria that can be used to design barrier dams that block spawning runs of sea lamprey

Implications for sexual assault prevention: college students as prosocial bystanders.

PubMed

Exner, Deinera; Cummings, Nina

2011-01-01

Prosocial bystander interventions are promising approaches to sexual assault prevention on college campuses. To assess bystander attitudes among undergraduate students at a northeastern university. A convenience sample of 188 students from 4 undergraduate classes was surveyed during regularly scheduled class sessions. Participants completed a short survey on bystander efficacy, readiness to change, and barriers to intervention prior to the start of class. The majority of students were not involved in activities or programs focused on sexual assault prevention. Although students agreed that violence could be prevented, they perceived many barriers to their own participation in intervention. There is a need for gender-targeted prevention programming that introduces the idea of prosocial bystander intervention, with a focus on increasing self-efficacy and lowering barriers.

Life After the Ban: An Assessment of US Syringe Exchange Programs’ Attitudes About and Early Experiences With Federal Funding

PubMed Central

Martin, Erika G.; Bowman, Sarah E.; Mann, Marita R.; Beletsky, Leo

2012-01-01

Objectives. We aimed to determine whether syringe exchange programs (SEPs) currently receive or anticipate pursuing federal funding and barriers to funding applications following the recent removal of the long-standing ban on using federal funds for SEPs. Methods. We conducted a telephone-administered cross-sectional survey of US SEPs. Descriptive statistics summarized responses; bivariate analyses examined differences in pursuing funding and experiencing barriers by program characteristics. Results. Of the 187 SEPs (92.1%) that responded, 90.9% were legally authorized. Three received federal funds and 116 intended to pursue federal funding. Perceived federal funding barriers were common and included availability and accessibility of funds, legal requirements such as written police support, resource capacity to apply and comply with funding regulations, local political and structural organization, and concern around altering program culture. Programs without legal authorization, health department affiliation, large distribution, or comprehensive planning reported more federal funding barriers. Conclusions. Policy implementation gaps appear to render federal support primarily symbolic. In practice, funding opportunities may not be available to all SEPs. Increased technical assistance and legal reform could improve access to federal funds, especially for SEPs with smaller capacity and tenuous local support. PMID:22420810

Obesity Prevention in Early Child Care Settings: A Bistate (Minnesota and Wisconsin) Assessment of Best Practices, Implementation Difficulty, and Barriers

ERIC Educational Resources Information Center

Nanney, Marilyn S.; LaRowe, Tara L.; Davey, Cynthia; Frost, Natasha; Arcan, Chrisa; O'Meara, Joyce

2017-01-01

Background: Long-term evaluation studies reveal that high-quality early care and education (ECE) programs that include a lifestyle component predict later adult health outcomes. The purpose of this article is to characterize the nutrition and physical activity (PA) practices, including implementation difficulty and barriers, of licensed center-…

Regional Issue Identification and Assessment (RIIA). Volume III. Institutional barriers to developing power generation facilities in the Pacific Northwest

DOE Office of Scientific and Technical Information (OSTI.GOV)

Morris, F. A.; Sawyer, C. H.; Maxwell, J. H.

1979-10-01

The Regional Assessments Division in the US Department of Energy (DOE) has undertaken a program to assess the probable consequences of various national energy policies in regions of the United States and to evaluate the constraints on national energy policy imposed by conditions in these regions. The program is referred to as the Regional Issues Identification and Assessment (RIIA) Program. Currently the RIIA Program is evaluating the Trendlong Mid-Mid scenario, a pattern of energy development for 1985 and 1990 derived from the Project Independence Evaluation System (PIES) model. This scenario assumes a medium annual growth rate in both the nationalmore » demand for and national supply of energy. It has been disaggregated to specify the generating capacity to be supplied by each energy source in each state. Pacific Northwest Laboratory (PNL) has the responsibility for evaluating the scenario for the Federal Region 10, consisting of Alaska, Idaho, Oregon, and Washington. PNL is identifying impacts and constraints associated with realizing the scenario in a variety of categories, including air and water quality impacts, health and safety effects, and socioeconomic impacts. This report summarizes the analysis of one such category: institutional constraints - defined to include legal, organizational, and political barriers to the achievement of the scenario in the Northwest.« less

Simulation in Canadian postgraduate emergency medicine training - a national survey.

PubMed

Russell, Evan; Hall, Andrew Koch; Hagel, Carly; Petrosoniak, Andrew; Dagnone, Jeffrey Damon; Howes, Daniel

2018-01-01

Simulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada. A national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE. Resident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0-150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs. SBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.

Project ADAPT: A Program to Assess Depression and Provide Proactive Treatment in Rural Areas

ERIC Educational Resources Information Center

Luptak, Marilyn; Kaas, Merrie J.; Artz, Margaret; McCarthy, Teresa

2008-01-01

Purpose: We describe and evaluate a project designed to pilot test an evidence-based clinical intervention for assessing and treating depression in older adults in rural primary care clinics. Project ADAPT--Assuring Depression Assessment and Proactive Treatment--utilized existing primary care resources to overcome barriers to sustainability…

Outcomes assessment of dental hygiene clinical teaching workshops.

PubMed

Wallace, Juanita S; Infante, Taline D

2008-10-01

Faculty development courses related to acquiring clinical teaching skills in the health professions are limited. Consequently, the Department of Dental Hygiene at the University of Texas Health Science Center at San Antonio conducted a series of clinical teaching workshops to address clinical teaching methodology. The goal of these workshops was to promote a problem-solving learning atmosphere for dental hygiene faculty to acquire and share sound clinical teaching strategies. To determine the value of the annual workshops on clinical teaching and evaluation, a web-based qualitative program assessment was developed using software by Survey Tracker. Four open-ended questions were designed to elicit perceptions regarding what significant changes in teaching strategies were achieved, what barriers or challenges were encountered in making these changes, and what strategies were used to overcome the barriers. The assessment was sent to dental hygiene educators representing thirty-eight dental hygiene programs who had participated in two or more of these workshops. Twenty-eight programs provided collective responses to the questions, and the narrative data were analyzed, using a qualitative methodology. Responses revealed that programs had made productive changes to their clinical education curricula and the information gained from the workshops had a positive effect on clinical teaching.

The "Total Worker Health" Concept: A Case Study in a Rural Workplace.

PubMed

Watkins, Cecilia; Macy, Gretchen; Golla, Vijay; Lartey, Grace; Basham, Jacqueline

2018-05-01

This case study was conducted to identify barriers of integration of health protection and health promotion in rural workplaces with tailored interventions that address the identified barriers. Data on a workplace's ability to integrate wellness programs and health protection programs were collected through a questionnaire along with a seven-question interview. Descriptive statistics were used to analyze the quantitative data. Qualitative measures were assessed using thematic analysis. Based off the results of the assessments, the company received tailored training sessions. The largest hindrance to organizational support was time. However, improved knowledge about the need and importance of integration helped the participants to conceptualize and plan for more collaboration between departments. New ways to increase integration at workplaces, especially rural workplaces are needed. More comprehensive interventions that include management are also needed.

School Nutrition Directors' Perceptions of Technology Use in School Nutrition Programs

ERIC Educational Resources Information Center

Pratt, Peggy; Bednar, Carolyn; Kwon, Junehee

2012-01-01

Purpose/Objectives: This study investigated the types of technology/software currently used by Southwest Region school nutrition directors (SNDs) and assessed their perceptions of barriers to purchasing new technology/software. In addition, the importance of future technology/software acquisitions in meeting school nutrition program (SNP) goals…

Identifying the Strengths, Needs, and Barriers to Student Success for First Generation, Low-Income, First Year College Students

ERIC Educational Resources Information Center

Hayes, Linda A.

2013-01-01

This participatory action research needs assessment was to empower the students in a large urban research university to explore and to identify the strengths of the program, to identify the needs, and to identify the barriers to student success during their first year of college. Using qualitative methods of Group Level Interviews (GLA) and…

Perceived barriers to completing an e-learning program on evidence-based medicine.

PubMed

Gagnon, Marie-Pierre; Légaré, France; Labrecque, Michel; Frémont, Pierre; Cauchon, Michel; Desmartis, Marie

2007-01-01

The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program. Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs. A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers. This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation.

Year-End Clinic Handoffs: A National Survey of Academic Internal Medicine Programs.

PubMed

Phillips, Erica; Harris, Christina; Lee, Wei Wei; Pincavage, Amber T; Ouchida, Karin; Miller, Rachel K; Chaudhry, Saima; Arora, Vineet M

2017-06-01

While there has been increasing emphasis and innovation nationwide in training residents in inpatient handoffs, very little is known about the practice and preparation for year-end clinic handoffs of residency outpatient continuity practices. Thus, the latter remains an identified, yet nationally unaddressed, patient safety concern. The 2014 annual Association of Program Directors in Internal Medicine (APDIM) survey included seven items for assessing the current year-end clinic handoff practices of internal medicine residency programs throughout the country. Nationwide survey. All internal medicine program directors registered with APDIM. Descriptive statistics of programs and tools used to formulate a year-end handoff in the ambulatory setting, methods for evaluating the process, patient safety and quality measures incorporated within the process, and barriers to conducting year-end handoffs. Of the 361 APDIM member programs, 214 (59%) completed the Transitions of Care Year-End Clinic Handoffs section of the survey. Only 34% of respondent programs reported having a year-end ambulatory handoff system, and 4% reported assessing residents for competency in this area. The top three barriers to developing a year-end handoff system were insufficient overlap between graduating and incoming residents, inability to schedule patients with new residents in advance, and time constraints for residents, attendings, and support staff. Most internal medicine programs do not have a year-end clinic handoff system in place. Greater attention to clinic handoffs and resident assessment of this care transition is needed.

Barriers to Neurosurgical Training in Sub-Saharan Africa: The Need for a Phased Approach to Global Surgery Efforts to Improve Neurosurgical Care.

PubMed

Sader, Elie; Yee, Philip; Hodaie, Mojgan

2017-02-01

Neurosurgery in low-income countries is faced with multiple challenges. Although the most common challenges include infrastructure and physical resource deficits, an underemphasized barrier relates to the methods and components of surgical training. The role of important aspects, including didactic surgical training, surgical decision-making, workshops, conferences, and assessment methods, has not been duly studied. Knowledge of these issues is a crucial step to move closer to strengthening surgical capacity in low-income countries. We designed an online survey to assess self-perceived and objectively measured barriers to neurosurgical training in various Sub-Saharan African countries. Key outcomes included perception toward adequacy of neurosurgery training and barriers to neurosurgical training at each individual site. Only 37% of responders felt that their training program adequately prepared them for handling incoming neurosurgical cases. Top perceived limitations of neurosurgery training included lack of physical resources (25% of all responses), lack of practical workshops (22%), lack of program structure (18%), and lack of topic-specific lectures (10%). Our results show that most responders believe their training program is inadequate and are interested in improving it through international collaborations. This implies that activities directed at strengthening surgical capacity must address this important necessity. One important strategy is the use of online educational tools. In consideration of the observed limitations in care, resources, and training, we recommend a phased approach to neurosurgical growth in low-income settings. Copyright © 2016. Published by Elsevier Inc.

Test Design Considerations for Students with Significant Cognitive Disabilities

ERIC Educational Resources Information Center

Anderson, Daniel; Farley, Dan; Tindal, Gerald

2015-01-01

Students with significant cognitive disabilities present an assessment dilemma that centers on access and validity in large-scale testing programs. Typically, access is improved by eliminating construct-irrelevant barriers, while validity is improved, in part, through test standardization. In this article, one state's alternate assessment data…

Screening for Learning Disabilities in Adult Basic Education Students

ERIC Educational Resources Information Center

Reynolds, Sharon L.; Johnson, Jerry D.; Salzman, James A.

2012-01-01

The extant literature offers little to describe the processes for screening students in adult basic education (ABE) programs for potential learning disabilities, referring adult students for diagnostic assessment, or barriers to obtaining diagnostic assessment for a learning disability. Without current documentation of a learning disability, ABE…

Dedicated training in adult education among otolaryngology faculty.

PubMed

McMains, Kevin C; Peel, Jennifer

2014-12-01

Most faculty members undergo ad hoc training in education. This survey was developed to assess the prevalence and type of dedicated training in education received by academic otolaryngology-head and neck surgery (OTO-HNS) faculty in the United States. Survey. An 11-item survey was developed to assess the prevalence of dedicated instruction in education theory and practice, the types of instruction received, and the barriers to receiving instruction. The survey was sent to all OTO-HNS program directors for distribution among their respective faculty. A total of 216 responses were received. Seventy respondents (32.7%) serve as program director, associate program director, or assistant program director in their respective programs. Forty-six respondents (21.8%) had received dedicated training in education. Of the respondents who described the type of education training received, 48.7% participated in didactics/seminar, 35.9% in degree/certificate programs, 10.3% in multimodality training, and 5.1% online training. Among the barriers encountered to participation in instruction in education, time/productivity pressures was the most commonly cited reason (60.2%), followed by not knowing about the opportunity to receive training (36.4%), lack of departmental support (26.2%), lack of available training (22.3%), and the perception that such training would not be useful (7.8%). Presently, only a minority of surveyed academic otolaryngologists in the United States have received any dedicated instruction in the theory and practice of education. Personal, departmental, and institutional barriers exist in many practice environments that hinder otolaryngology faculty from participating in education training. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Physical Activity and Fitness of First Nations Youth in a Remote and Isolated Northern Ontario Community: A Needs Assessment.

PubMed

Gates, Michelle; Hanning, Rhona; Gates, Allison; Stephen, Judy; Fehst, Andrew; Tsuji, Leonard

2016-02-01

Among a group of First Nations youth, this research aimed to obtain objective measures of anthropometry, physical activity (PA) and fitness; to identify any group-level differences by sex, body mass index, waist circumference and body fat categories; to assess the barriers and supports to PA. Youth participated in anthropometric measures (BMI, waist circumference, body fat percentage), PA assessment (3 days of accelerometry) and fitness testing (guided by the Canadian Physical Activity, Fitness and Lifestyle Approach). Barriers and supports were assessed via environmental scan and focus groups. Descriptive statistics were compared to reference data. Group differences by sex, BMI status, waist circumference and body fat categories were tested using Mann-Whitney U and Chi square tests (p ≤ 0.05). Qualitative data were assembled into one file and coded manually for categories and themes. Seventy-two youth (12.1 ± 1.1 years, 61.1% male) participated in at least one measure; 36 completed the accelerometry. Sixty-three percent were overweight or obese, 51% were abdominally obese and 21% had excess body fat. Most (86.1%) met Canada's PA guidelines. Boys were more active than girls (p = 0.025) and had greater cardiorespiratory endurance (p = 0.003). Overweight, obese, or abdominally obese youth had lower cardiorespiratory endurance than normal weight youth (p < 0.001). Barriers and supports fell under the main themes: motivation, role models, personnel and facilities, environment and programs. Based on this assessment, youth in this community are active, but not sufficiently physically fit, especially among those affected by obesity and abdominal obesity. The findings, in addition to the numerous barriers to PA, support the community's desire for school-based PA programming.

Ethics education in family medicine training in the United States: a national survey.

PubMed

Manson, Helen M; Satin, David; Nelson, Valerie; Vadiveloo, Thenmalar

2014-01-01

Although professional organizations endorse ethics education in family medicine training, there is little published evidence that ethics teaching occurs. This survey collated data on the aims, content, pedagogical methods, assessment, and barriers relating to formal ethics education in family medicine residency programs in the United States. A questionnaire surveyed all 445 family medicine residency programs in the United States. Forty percent of programs responded (178/445). Of these, 95% formally teach at least one ethics topic, 68.2% teach six or more topics, and 7.1% teach all 13 core topics specified in the questionnaire. Programs show variation, providing between zero to 100 hours' ethics education over the 3 years of residency training. Of the responding programs, 3.5% specify well-defined aims for ethics teaching, 25.9% designate overall responsibility for the ethics curriculum to one individual, and 33.5% formally assess ethics competencies. The most frequent barriers to ethics education are finding time in residents' schedules (59.4%) and educator expertise (21.8%). Considerable variation in ethics education is apparent in both curricular content and delivery among family medicine residency programs in the United States. Additional findings included a lack of specification of explicit curricular aims for ethics teaching allied to ACGME or AAFP competencies, a tendency not to designate one faculty member with lead responsibility for ethics teaching in the residency program, and a lack of formal assessment of ethics competencies. This has occurred in the context of an absence of robust assessment of ethics competencies at board certification level.

Evaluation of ethics education in obstetrics and gynecology residency programs.

PubMed

Byrne, John; Straub, Heather; DiGiovanni, Laura; Chor, Julie

2015-03-01

The objective of the study was to assess the current status of ethics education in obstetrics-gynecology residency programs. A cross-sectional, web-based survey was designed in conjunction with a professional survey laboratory at the University of Chicago. The survey was piloted with a convenience sample of clinical medical ethics fellows to assess question content and clarity. The survey was deployed by e-mail to all obstetrics-gynecology residency program directors. Descriptive statistics were used to analyze participant responses. The University of Chicago's Institutional Review Board deemed this study exempt from institutional review board formal review. Of 242 eligible obstetrics-gynecology residency program directors, 118 (49%) completed the survey. Most respondents were from university-based programs (n = 78, 66%) that were not religiously affiliated (n = 98, 83%) and trained 4-6 residents per postgraduate year (n = 64, 70%). Although 50% of program directors (n = 60) reported having ethics as part of their core curriculum, most programs teach ethics in an unstructured manner. Fifty-seven percent of respondents (n = 66) stated their program dedicated 5 or fewer hours per year to ethics. The majority of program directors (n = 80, 73%) responded they would like more to a lot more ethics education and believed that ethics education should be required (n = 93, 85%) for residents to complete their training. Respondents identified that crowding in the curriculum was a significant barrier to increased ethics training (n = 50, 45%) and two-thirds (n = 74, 67%) reported a lack of faculty expertise as a moderate barrier to providing ethics education in the residency curriculum. This study found that a lack of structured curricula, inadequate faculty expertise, and limited time were important barriers for ethics education in obstetrics-gynecology programs across the nation. Despite these existing challenges, program directors have a strong interest in increasing ethics education in residency training. Therefore, additional resources are needed to assist program directors in enhancing resident ethics education. Copyright © 2015 Elsevier Inc. All rights reserved.

Post-Graduation Effects of an Advocacy Engagement Project on Alumni of a Dental Hygiene Program.

PubMed

Bono, Leciel K; Rogo, Ellen J; Hodges, Kathleen; Frantz, Alan C

2018-02-01

The aim of this study was to investigate advocacy actions of dental hygiene program alumni who had completed a Legislative Advocacy Project (LAP) when they were students in the undergraduate or graduate program. Five variables were assessed: participation, frequency, perceived barriers, engagement, and mentorship. Alumni of the undergraduate and graduate programs were compared regarding frequency of and barriers encountered to legislative advocacy actions. A descriptive-comparative research design was used with quantitative and qualitative analysis. A convenience sample of 157 alumni who had completed a seven-week LAP at Idaho State University between 2008 and 2013 were invited to complete a 52-item author-designed online questionnaire in 2015. The response rate was 41.4%. The results showed a significant difference for participation prior to and after the LAP (df=12, X 2 =28.28, p=0.005). Most respondents, however, did not participate in legislative actions. There was a significant difference between the two groups for two frequency items: subscribing to online listservs (p=0.001) and contacting political representatives or staff (p=0.003). The three greatest barriers were time, financial resources, and testifying. The analysis found a significant difference between the two groups for the barrier of interest in advocating (p=0.05). In the qualitative analysis, themes emerged about engagement factors (collective efforts and advocacy commitment) and mentorship (mentoring experiences). Advocacy actions after graduation improved, but implementation of actions was challenging due to competing barriers. The results of this study may be useful in identifying key components of advocacy education that should be part of training programs.

FROM NEEDS ASSESSMENT TO PARTICIPATORY RESEARCH: A COMMUNITY VISION OF HEALTH PROMOTION PROGRAMS IN ONE NATIVE AMERICAN COMMUNITY

USDA-ARS?s Scientific Manuscript database

OBJECTIVE: Identify unique cultural needs, priorities, program delivery preferences and barriers to achieving a healthy diet and lifestyle in one Native American community. DESIGN: A novel modified nominal group technique (NGT) conducted in four districts and three age groups (Elders, adults and...

Growing the IBCLC Workforce: A Florida Needs Assessment.

PubMed

Eden, Aimee R; Anstey, Erica H; Orriola, Deidre

2018-02-01

Florida has fewer International Board Certified Lactation Consultants (IBCLCs) per 1,000 live births than the national average. An important strategy to support breastfeeding entails creating opportunities to prepare and train IBCLCs from underrepresented groups. However, it can be difficult for individuals to access lactation education and gain clinical experience necessary to become an IBCLC. Research aim: The Building a Better Breastfeeding Network project was a needs assessment designed to assess the interest in an IBCLC training program in Florida and perceived barriers and facilitators to completing such a program. An online survey was distributed via email to non-IBCLC students and maternal and child healthcare workers in Florida. Microsoft Excel was used to complete descriptive analyses. Surveys were initiated by 1,939 eligible individuals from diverse racial and ethnic backgrounds across the state, 86% of whom responded that they would be possibly to very interested in an IBCLC training program. For those interested, cost was perceived as a potential barrier to enrolling in a program, but flexible course schedules and scholarship or financial aid availability would further attract participants. More than half were interested in working with underserved populations or in low-resource settings, but Black and Hispanic participants were significantly more likely to express interest in working in those settings. Due to the high level of interest in an IBCLC training program in Florida, a formal lactation training program may be successful in attracting diverse students, particularly if funding and program flexibility needs are met.

Afghan Women: Comprehensive Assessments Needed to Determine and Measure DOD, State, and USAID Progress

DTIC Science & Technology

2014-12-18

Security Forces (ANSF). These barriers include a lack of programs and facilities, such as child care, latrines, and dormitories, to support women in the...Article 26 would negatively affect the prosecution of domestic violence and child abuse cases by restricting relatives of abusers from appearing as...disaggregate program beneficiaries of GE/WE secondary, or gender-mainstreamed, programs by sex to make sure those programs reach females; however

Decontamination systems information and research program. Quarterly report, April--June 1996

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This report contains separate reports on the following subtasks: analysis of the Vortec cyclone melting system for remediation of PCB contaminated soils using CFD; drain enhanced soil flushing using prefabricated vertical drains; performance and characteristics evaluation of acrylates as grout barriers; development of standard test protocol barrier design models for desiccation barriers, and for in-situ formed barriers; in-situ bioremediation of chlorinated solvents at Portsmouth Gaseous Diffusion Plant; development of a decision support system and a prototype database for management of the EM50 technology development program; GIS-based infrastructure for site characterization and remediation; treatment of mixed wastes via fluidized bed steammore » reforming; use of centrifugal membrane technology to treat hazardous/radioactive waste; environmental pollution control devices based on novel forms of carbon; development of instrumental methods for analysis of nuclear wastes and environmental materials; production and testing of biosorbents and cleaning solutions for D and D; use of SpinTek centrifugal membrane and sorbents/cleaning solutions for D and D; West Virginia High Tech Consortium Foundation--Environmental support program; small business interaction opportunities; and approach for assessing potential voluntary environmental protection.« less

Coastal Environment, Bathymetry and Physical Oceanography along the Beaufort, Chukchi and Bering Seas.

DTIC Science & Technology

1980-01-01

Unit No. 347 , Vol. III, Chukchi-Beaufort Sea, 409 pp. 3. Hopkins, D.M. and R.W. Hartz, 1978, Coastal morphology, coastal erosion, and barrier islands of...U.S. Department of Commerce, Alaska Outer Continental Shelf Environmental Assessment Program Final Report, Research Unit No. 347 , vol. III, Chukchi...Assessment Program Final Report, Research Univ No. 347 , vol. II, Bering Sea, 443 pp. 3. U.S. Department of Commerce, 1964, Pacific and Arctic Coasts

Management of Sodium-reduced Meals at Worksite Cafeterias: Perceptions, Practices, Barriers, and Needs among Food Service Personnel.

PubMed

Lee, Jounghee; Park, Sohyun

2016-04-01

The sodium content of meals provided at worksite cafeterias is greater than the sodium content of restaurant meals and home meals. The objective of this study was to assess the relationships between sodium-reduction practices, barriers, and perceptions among food service personnel. We implemented a cross-sectional study by collecting data on perceptions, practices, barriers, and needs regarding sodium-reduced meals at 17 worksite cafeterias in South Korea. We implemented Chi-square tests and analysis of variance for statistical analysis. For post hoc testing, we used Bonferroni tests; when variances were unequal, we used Dunnett T3 tests. This study involved 104 individuals employed at the worksite cafeterias, comprised of 35 men and 69 women. Most of the participants had relatively high levels of perception regarding the importance of sodium reduction (very important, 51.0%; moderately important, 27.9%). Sodium reduction practices were higher, but perceived barriers appeared to be lower in participants with high-level perception of sodium-reduced meal provision. The results of the needs assessment revealed that the participants wanted to have more active education programs targeting the general population. The biggest barriers to providing sodium-reduced meals were use of processed foods and limited methods of sodium-reduced cooking in worksite cafeterias. To make the provision of sodium-reduced meals at worksite cafeterias more successful and sustainable, we suggest implementing more active education programs targeting the general population, developing sodium-reduced cooking methods, and developing sodium-reduced processed foods.

Refining the Patient Navigation Role in a Colorectal Cancer Screening Program: Results From an Intervention Study.

PubMed

Rohan, Elizabeth A; Slotman, Beth; DeGroff, Amy; Morrissey, Kerry Grace; Murillo, Jennifer; Schroy, Paul

2016-11-01

Oncology patient navigators help individuals overcome barriers to increase access to cancer screening, diagnosis, and timely treatment. This study, part of a randomized intervention trial investigating the efficacy of patient navigation in increasing colonoscopy completion, examined navigators' activities to ameliorate barriers to colonoscopy screening in a medically disadvantaged population. This study was conducted from 2012 through 2014 at Boston Medical Center. We analyzed navigator service delivery and survey data collected on 420 participants who were navigated for colonoscopy screening after randomization to this intervention. Key variables under investigation included barriers to colonoscopy, activities navigators undertook to reduce barriers, time navigators spent on each activity and per contact, and patient satisfaction with navigation services. Descriptive analysis assessed how navigators spent their time and examined what aspects of patient navigation were most valued by patients. Navigators spent the most time assessing patient barriers/needs; facilitating appointment scheduling; reminding patients of appointments; educating patients about colorectal cancer, the importance of screening, and the colonoscopy preparation and procedures; and arranging transportation. Navigators spent an average of 44 minutes per patient. Patients valued the navigators, especially for providing emotional/peer support and explaining screening procedures and bowel preparation clearly. Our findings help clarify the role of the navigator in colonoscopy screening within a medically disadvantaged community. These findings may help further refine the navigator role in cancer screening and treatment programs as facilities strive to effectively and efficiently integrate navigation into their services. Copyright © 2016 by the National Comprehensive Cancer Network.

Refining the Patient Navigation Role in a Colorectal Cancer Screening Program: Results From an Intervention Study

PubMed Central

Rohan, Elizabeth A.; Slotman, Beth; DeGroff, Amy; Morrissey, Kerry Grace; Murillo, Jennifer; Schroy, Paul

2017-01-01

Background Oncology patient navigators help individuals overcome barriers to increase access to cancer screening, diagnosis, and timely treatment. This study, part of a randomized intervention trial investigating the efficacy of patient navigation in increasing colonoscopy completion, examined navigators' activities to ameliorate barriers to colonoscopy screening in a medically disadvantaged population. Methods This study was conducted from 2012 through 2014 at Boston Medical Center. We analyzed navigator service delivery and survey data collected on 420 participants who were navigated for colonoscopy screening after randomization to this intervention. Key variables under investigation included barriers to colonoscopy, activities navigators undertook to reduce barriers, time navigators spent on each activity and per contact, and patient satisfaction with navigation services. Descriptive analysis assessed how navigators spent their time and examined what aspects of patient navigation were most valued by patients. Results Navigators spent the most time assessing patient barriers/needs; facilitating appointment scheduling; reminding patients of appointments; educating patients about colorectal cancer, the importance of screening, and the colonoscopy preparation and procedures; and arranging transportation. Navigators spent an average of 44 minutes per patient. Patients valued the navigators, especially for providing emotional/peer support and explaining screening procedures and bowel preparation clearly. Conclusions Our findings help clarify the role of the navigator in colonoscopy screening within a medically disadvantaged community. These findings may help further refine the navigator role in cancer screening and treatment programs as facilities strive to effectively and efficiently integrate navigation into their services. PMID:27799508

Students' benefits and barriers to mental health help-seeking

PubMed Central

Vidourek, Rebecca A.; King, Keith A.; Nabors, Laura A.; Merianos, Ashley L.

2014-01-01

Stigma is recognized as a potential barrier to seeking help for a mental health disorder. The present study assessed college students' perceived benefits and barriers to obtaining mental health treatment and stigma-related attitudes via a four-page survey. A total of 682 students at one Midwestern university participated in the study. Findings indicated that females perceived a greater number of benefits to having participated in mental health services and held significantly lower stigma-related attitudes than did males. Students who had ever received mental health services reported significantly more barriers to treatment than did students who had never received services. Health professionals should target students with educational programs about positive outcomes related to receiving mental health services and work with treatment centers to reduce barriers for receiving services. PMID:25750831

The development and implementation of a theory-informed, integrated mother-child intervention in rural Uganda.

PubMed

Singla, Daisy R; Kumbakumba, Elias

2015-12-01

A randomised cluster effectiveness trial of a parenting intervention in rural Uganda found benefits to child development among children 12-36 months, relevant parenting practices related to stimulation, hygiene and diet, and prevented the worsening of mothers' depressive symptoms. An examination of underlying implementation processes allows researchers and program developers to determine whether the program was implemented as intended and highlight barriers and facilitators that may influence replication and scale-up. The objectives of this study were to describe and critically examine (a) perceived barriers and facilitators related to implementation processes of intervention content, training and supervision and delivery from the perspectives of delivery agents and supervisors; (b) perceived barriers and facilitators related to enactment of practices from the perspective of intervention mothers participating in the parenting program; and c) whether the program was implemented as intended. Semi-structured interviews were conducted at midline with peer delivery agents (n = 12) and intervention mothers (n = 31) and at endline with supervisors (n = 4). Content analysis was used to analyze qualitative data in terms of barriers and facilitators of intervention content, training and supervision, delivery and enactment. Additionally, mothers' recall and enactment of practices were coded and analyzed statistically. Monitoring of group sessions and home visits were examined to reveal whether the program was implemented as intended. Among the program's five key messages, 'love and respect' targeting maternal psychological well-being was the most practiced by mothers, easiest to implement by delivery agents, and mothers reported the most internal facilitators for this message. A detailed manual and structured monitoring forms were perceived to facilitate training, intervention delivery, and supervision. Interactive and active strategies based on social-cognitive learning theory were reported as facilitators to intervention delivery. Only program attendance, but not barriers, facilitators or message recall, was significantly positively related to message enactment. Monitoring of group sessions and home visits showed that the program was largely implemented as intended. This implementation assessment revealed a number of important barriers and facilitators from the perspectives of delivery agents, supervisors and program participants. The methods and results are useful to examining and informing the content, delivery, and scaling up of the current program as well as future mother-child interventions in LMIC settings. Copyright © 2015 Elsevier Ltd. All rights reserved.

Utilization of oral health care services among adults attending community outreach programs.

PubMed

Kadaluru, Umashankar Gangadhariah; Kempraj, Vanishree Mysore; Muddaiah, Pramila

2012-01-01

Good oral health is a mirror of overall health and well-being. Oral health is determined by diet, oral hygiene practices, and the pattern of dental visits. Poor oral health has significant social and economic consequences. Outreach programs conducted by dental schools offer an opportunity for early diagnosis and treatment, dental health education, and institution of preventive measures. To assess the utilization of oral healthcare services among adults attending outreach programs. This study included 246 adults aged 18-55 years attending community outreach programs in and around Bangalore. Using a questionnaire we collected data on dental visits, perceived oral health status, reasons for seeking care, and barriers in seeking care. Statistical significance was assessed using the Chi-square test. In this sample, 28% had visited the dentist in the last 12 months. Males visited dentist more frequently than females. The main reason for a dental visit was for tooth extraction (11%), followed by restorative and endodontic treatment 6%. The main barriers to utilization of dental services were high cost (22%), inability to take time off from child care duties (19.5%), and fear of the dentist or dental tools (8.5%). The utilization of dental services in this population was poor. The majority of the dental visits were for treatment of acute symptoms rather than for preventive care. High cost was the main barrier to the utilization of dental services. Policies and programs should focus on these factors to decrease the burden of oral diseases and to improve quality of life among the socioeconomically disadvantaged.

Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers.

PubMed

Zegeye, Elias Asfaw; Mbonigaba, Josue; Kaye, Sylvia Blanche; Wilkinson, Thomas

2017-02-01

Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE. This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia. In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas. A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting. The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.

Identifying Multilevel Barriers to Tobacco Intervention in Postdoctoral Dental Education.

PubMed

Albert, David A; Bruzelius, Emilie; Ward, Angela; Gordon, Judith S

2016-04-01

The aims of this mixed-methods study were to assess tobacco treatment behaviors among residents and faculty in dental specialty postdoctoral programs and to explore factors in training and practice related to tobacco treatment education. Surveys and focus groups were conducted with a convenience sample of participants at three postdoctoral residency programs in New York City. Surveys assessed tobacco cessation training and behaviors. Focus groups explored barriers to implementing tobacco cessation treatment in educational settings. Data were collected between May and December 2013. Among the 160 faculty and residents identified as potentially eligible for the study, 60 were invited by program directors to participate, and 50 subsequently completed the survey and participated in a focus group (response rate of 31.3%). Survey results indicated high levels of asking patients about tobacco use and advising patients to quit. In contrast, specific tobacco cessation assistance and follow-up care occurred less frequently. There were statistically significant differences in tobacco cessation intervention across the specialties surveyed, but not between residents and faculty. Focus group comments were grouped into three broad areas: clinician factors, organizational support, and structural and contextual factors. Focus group results indicated that participants experienced significant organizational and structural barriers to learning about and providing tobacco treatment. Participants from each specialty indicated that multi-level barriers impeded their provision of evidence-based tobacco cessation interventions in postdoctoral educational settings. They suggested that didactic education should be reinforced by organizational- and systems-level changes to facilitate comprehensive tobacco education and effective cessation treatment in future dental practice.

A Hybrid Effectiveness-Implementation Trial of an Evidence-Based Exercise Intervention for Breast Cancer Survivors

PubMed Central

Beidas, Rinad S.; Paciotti, Breah; Barg, Fran; Branas, Andrea R.; Brown, Justin C.; Glanz, Karen; DeMichele, Angela; DiGiovanni, Laura; Salvatore, Domenick

2014-01-01

Background The primary aims of this hybrid Type 1 effectiveness-implementation trial were to quantitatively assess whether an evidence-based exercise intervention for breast cancer survivors, Strength After Breast Cancer, was safe and effective in a new setting and to qualitatively assess barriers to implementation. Methods A cohort of 84 survivors completed measurements related to limb volume, muscle strength, and body image at baseline, 67 survivors completed measurements 12 months later. Qualitative methods were used to understand barriers to implementation experienced by referring oncology clinicians and physical therapists who delivered the program. Results Similar to the efficacy trial, the revised intervention demonstrated safety with regard to lymphedema, and led to improvements in lymphedema symptoms, muscular strength, and body image. Comparison of effects in the effectiveness trial to effects in the efficacy trial revealed larger strength increases in the efficacy trial than in the effectiveness trial (P < .04), but few other differences were found. Qualitative implementation data suggested significant barriers around intervention characteristics, payment, eligibility criteria, the referral process, the need for champions (ie, advocates), and the need to adapt during implementation of the intervention, which should be considered in future dissemination and implementation efforts. Conclusions This trial successfully demonstrated that a physical therapy led strength training program for breast cancer survivors can be implemented in a community setting while retaining the effectiveness and safety of the clinical trial. However, during the translation process, strategies to reduce barriers to implementation are required. This new program can inform larger scale dissemination and implementation efforts. PMID:25749601

Perspectives and Future Directions Concerning Fresh, Whole Foods in Montana School Nutrition Programs

ERIC Educational Resources Information Center

Stephens, Lacy; Byker Shanks, Carmen J.; Roth, Aubree; Bark, Katie

2015-01-01

Purpose/Objectives: To meet new USDA school meal standards, school nutrition programs may need to transition from a "heat and serve" meal preparation approach to increased scratch cooking and use of fresh, whole foods. This study aims to assess the attitudes, motivations, and barriers for Montana school nutrition professionals and key…

A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

PubMed

Martin, Shelly D; Bush, Anneke C; Lynch, Julia A

2006-09-01

Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

Perceptions of practicing pharmacists in Idaho about a potential behind-the-counter drug program.

PubMed

Hunt, Timothy L; Culbertson, Vaughn L; Erramouspe, John; Casperson, Kerry

2010-09-01

In late 2007, the Food and Drug Administration (FDA) held public hearings exploring the establishment of a new behind-the-counter (BTC) drug program. However, little is known about the views of pharmacists regarding such a program. To assess the overall perceptions of Idaho's practicing pharmacists about the creation of a formal BTC drug program, the appropriateness of including certain drug categories, specific barriers to its adoption, and the impact of the new program on access to medicines. A survey of practicing pharmacists in Idaho was conducted by mail, utilizing anonymous responses. Key questions exploring the views of pharmacists about the new BTC drug program utilized 5-point Likert scales. Data were also collected on respondent characteristics. A total of 357 practicing pharmacists in Idaho (31% response rate) returned the mail survey; 84% of pharmacists agreed that the FDA should be exploring an expanded BTC program, and 88% of pharmacists agreed that this program would improve access to some prescription-only products and convenience for patients. Almost 71% of pharmacists reported a personal willingness to both initiate and monitor certain BTC drug therapies. When focusing on specific drug categories for BTC status, the highest support was for selected agents within smoking cessation therapies (85%), nasal corticosteroids for allergies (81%), and vaccines (75%). Pharmacists who reported low barriers to the adoption of a new BTC program were significantly more likely to support this program than were those reporting high barriers. Only 39% of pharmacists agreed that adequate facilities were currently available for private evaluation and counseling of BTC patients. Pharmacists in a statewide survey of perceptions regarding a new BTC drug program overwhelmingly believe that patients would benefit. Pharmacists strongly support the development of the new program, and more than two thirds indicate that they would likely participate, given the necessary supporting institutional framework. Perceived barriers are related to willingness to participate and likely can be minimized through education and provision of private consulting areas.

Facilitators and barriers to exercise adherence in patients with osteopenia and osteoporosis: a systematic review.

PubMed

Rodrigues, I B; Armstrong, J J; Adachi, J D; MacDermid, J C

2017-03-01

The aim of this study was to categorize the facilitators and barriers of exercise and identify methods to promote exercise adherence in the osteoporosis population. Despite the fair methodological quality of included randomized controlled trials (RCTs), less than 75 % identified facilitators and barriers to exercise. Methods to promote and measure exercise adherence were poorly reported. Several studies have shown exercise to be successful in maintaining or increasing BMD in individuals with low bone mass. Yet, adherence to exercise is poor, with 50 % of those registered in an exercise program dropping out within the first 6 months, lack of time being the number one barrier in many populations. However, in the osteoporosis population, the main facilitator and barrier to exercise is still unclear. The aim of this study is to examine the extent to which RCTs reported the facilitators and the barriers to exercise and identified methods to promote adherence to an exercise program. PubMed, CINHAL, EMBASE, and the Cochrane Review were queried using a predefined search criterion, and the resulting citations were imported into DistillerSR. Screening was carried out by two independent reviewers, and articles were included in the analysis by consensus. The methodological quality of included studies was assessed using the PEDro scale. Fifty-four RCTs examining exercise interventions in patients with osteopenia or osteoporosis were included. A spectrum of facilitators and barriers to exercise for osteoporotic patients were identified; however, no one facilitator was more frequently reported than the other. The most commonly reported barriers were lack of time and transportation. In most RCTs, methods to promote and measure exercise adherence were unsatisfactory. Of the 54 papers, 72 % reported an adherence rate to an exercise program; the lowest reported rate was 51.7 %, and the highest 100 %. Most RCTs found were of fair quality; however, less than three quarters identified facilitators and barriers to exercise. Reporting of methods to promote and measure exercise adherence were low. Future work should be directed toward identifying major facilitators and barriers to exercise adherence within RCTs. Only then can methods be identified to leverage facilitators and overcome barriers, thus strengthening the evidence for efficacy of optimal interventional exercise programs. This review has been registered in PROSPERO under registration number CRD42016039941.

Increase the success of weight loss programs by creating an environment for change.

PubMed

Churchill, Julie

2010-12-01

Veterinary professionals frequently recommend weight loss programs for pets, but success is often elusive. By learning techniques to assess clients' readiness for change, the veterinary team can apply communication tools and strategies to help clients overcome obstacles and barriers to sustainable change. With a better assessment of a client's ability to change, a weight loss plan can be implemented at the right time in the right way to achieve better adherence to the agreed-upon plan and improve patient health.

Barriers to Physical Activity in Children With Autism Spectrum Disorders: Relationship to Physical Activity and Screen Time.

PubMed

Must, Aviva; Phillips, Sarah; Curtin, Carol; Bandini, Linda G

2015-04-01

Individual, social, and community barriers to physical activity (PA) experienced by children with autism spectrum disorder (ASD) make PA participation more difficult and may contribute to increased screen time. We compared the prevalence of parent-reported barriers to PA among 58 typically developing (TD) children and 53 children with an ASD, 3 to 11 years, and assessed the association between barriers and PA participation and screen time among children with ASD. Parents of children with ASD reported significantly more barriers than parents of TD children. Based on parent-report, 60% of children with ASD required too much supervision compared with no TD children (P < .001). Parents of children with ASD were more likely to report that adults lack skills needed to include their child (58%), that their child has few friends (45%), and that other children exclude their child (23%). The number of parent-reported barriers to PA was inversely correlated with the hours spent in PA per year (r = -0.27, P = .05) and positively related to total screen time (r = .32, P < .03). These findings underscore the need for community-based PA programs designed to meet the special requirements of this population and policies that compel schools and other government-supported organizations for inclusion and/or targeted programming.

Availability and characteristics of cardiac rehabilitation programs in one Brazilian state: a cross-sectional study.

PubMed

Sérvio, Thaianne Cavalcante; Ghisi, Gabriela Lima de Melo; Silva, Lilian Pinto da; Silva, Luciana Duarte Novais; Lima, Marcia Maria Oliveira; Pereira, Danielle Aparecida Gomes; Grace, Sherry L; Britto, Raquel Rodrigues

2018-03-22

Cardiac rehabilitation (CR) is a recommended model of care for cardiovascular diseases; however, is not widely available and is underutilized, especially in low- and middle-income countries. To identify the CR programs available in one Brazilian state (Minas Gerais; MG) and describe their characteristics by funding type. In this multi-center descriptive study, CR programs were identified in four MG regions and 41 CR coordinators were sent a survey to report the characteristics of their programs, including CR components described in guidelines and barriers to patients' participation. Descriptive and comparative analysis between public and private programs were carried out. Forty-one CR programs were identified, only 21.9% public. Nineteen completed the survey. The majority of CR programs offered initial assessment and physical training. Components of comprehensive CR programs that were rarely offered included treatment of tobacco dependence, psychological support and lipid control. Physical therapists were present in all CR programs. The six-minute walk test was used in most programs to assess functional capacity. Programs were located intra-hospital only in public hospitals. Phase 2 (initial outpatient) and phase 4 (maintenance) were offered significantly more in private programs when compared to public ones. The main barrier for CR participation was the lack of referral. The availability of CR programs in MG state is low, especially public programs. Most programs do not offer all core components of CR. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Telehealth: An Assessment of Growth and Distribution.

ERIC Educational Resources Information Center

Grigsby, William J.

2002-01-01

National surveys of telehealth networks, 1994-99, examined program characteristics; clinical activities (telemedicine); nonclinical activities related to continuing medical education, paraprofessional training, health promotion, administration, and research; technology; and barriers to growth and sustainability. Despite growing utilization,…

Implementation evaluation of steering teens safe: engaging parents to deliver a new parent-based teen driving intervention to their teens.

PubMed

Ramirez, Marizen; Yang, Jingzhen; Young, Tracy; Roth, Lisa; Garinger, Anne; Snetselaar, Linda; Peek-Asa, Corinne

2013-08-01

Parents play a fundamental role in teaching their children safe driving skills to reduce risk of motor vehicle crashes, the leading cause of death for teens. Steering Teens Safe is a new parent-based intervention that equips parents with communication skills to talk about, demonstrate, and practice safe driving behaviors and skills with their teens. This implementation evaluation focuses on a sample of 83 parents who delivered Steering Teens Safe to their teens. One-, 2- and 3-month follow-up assessments were conducted with intervention parents to evaluate the self-reported quantity and quality of talking about, demonstrating, and practicing safe driving goals with teens; perceived success and benefit of the program; and barriers to implementation. Over 3 months of follow-up, parents discussed driving goals with their teens for a median of 101.5 minutes. The most frequently addressed topics were general safety principles, including distracted driving, driving in bad weather, wearing a seat belt, and being a safe passenger. Parents spent a median of 30 minutes practicing safe driving skills such as changing lanes. Sixty-seven percent of parents talked to their children about rural road safety, but just 36% demonstrated and half practiced these skills with their teens. Barriers to implementation include time and opportunity barriers and resistant attitudes of their teens. However, barriers neither affected frequency of engagement nor parents' perceived benefit and comfort in delivering the program. Parents with time/opportunity barriers also had higher practice and demonstration times than parents without these barriers. Findings indicate high acceptability among parent implementers and promise for real-world delivery. Future studies are needed to assess intervention impact.

Barriers and Facilitators of HPV Vaccination in the VFC Program.

PubMed

Fleming, Wayne S; Sznajder, Kristin K; Nepps, Margaret; Boktor, Sameh W

2018-06-01

This study determined facilitators and barriers to human papillomavirus (HPV) vaccination perceived by providers of healthcare in the federally funded Pennsylvania Vaccines for Children (PA VFC) program. The cross-sectional study gathered descriptive data through a survey research design. Providers of healthcare were recruited through an email containing a link to an 18-question online survey. The survey was divided into four main sections which assessed the perceived facilitators and barriers to HPV vaccination of PA VFC program-eligibles. Survey respondents represented 65 of 66 Pennsylvania counties covered by the PA VFC Program. The study recruited 772 PA VFC participating healthcare facilities for a response rate of 52%. Ninety eight percent of the responding facilities reported that they offered the HPV vaccine. The most common barriers to vaccine administration were the parental belief that HPV vaccination is associated with sexual activity and parent/patient refusal of the HPV vaccination which together accounted for (44%) of responses. The majority of respondents (75.6%) indicated counseling parents and adolescents on the benefits of HPV vaccination was a very important factor in HPV vaccination uptake. Healthcare provider facility based training (32%) and web-based training for healthcare providers (22%) were the most recommended avenues for HPV training. The most common barrier to HPV vaccination was identified as the parental misconception that HPV vaccination is associated with sexual activity. Providers believed that the best way to increase HPV vaccination is through counseling parents and adolescents on the benefits of HPV vaccination and to correct misconceptions and change attitudes. Providers are desirous of receiving HPV web-based or workplace training.

Creation and validation of the barriers to alcohol reduction (BAR) scale using classical test theory and item response theory.

PubMed

Kunicki, Zachary J; Schick, Melissa R; Spillane, Nichea S; Harlow, Lisa L

2018-06-01

Those who binge drink are at increased risk for alcohol-related consequences when compared to non-binge drinkers. Research shows individuals may face barriers to reducing their drinking behavior, but few measures exist to assess these barriers. This study created and validated the Barriers to Alcohol Reduction (BAR) scale. Participants were college students ( n  = 230) who endorsed at least one instance of past-month binge drinking (4+ drinks for women or 5+ drinks for men). Using classical test theory, exploratory structural equation modeling found a two-factor structure of personal/psychosocial barriers and perceived program barriers. The sub-factors, and full scale had reasonable internal consistency (i.e., coefficient omega = 0.78 (personal/psychosocial), 0.82 (program barriers), and 0.83 (full measure)). The BAR also showed evidence for convergent validity with the Brief Young Adult Alcohol Consequences Questionnaire ( r  = 0.39, p  < .001) and discriminant validity with Barriers to Physical Activity ( r  = -0.02, p  = .81). Item Response Theory (IRT) analysis showed the two factors separately met the unidimensionality assumption, and provided further evidence for severity of the items on the two factors. Results suggest that the BAR measure appears reliable and valid for use in an undergraduate student population of binge drinkers. Future studies may want to re-examine this measure in a more diverse sample.

Barriers for identification and treatment of problem drinkers in primary care.

PubMed

Coloma-Carmona, Ainhoa; Carballo, José Luis; Tirado-González, Sonia

Due to the lack of studies in the Spanish population, this study aims to analyze the barriers perceived by health professionals from different Spanish health centers when attempting to identify and treat problem drinkers and the importance given to this aspect, as well as analyzing the possible differences as a function of the professionals' health teams. We also analyze the psychometric properties of the questionnaire used to assess these barriers. The participants included 107 health professionals: 62.7% belonged to the medical team and 32.4% to the nursing team. After we had reviewed previous studies, collecting the main barriers referred to in them, participants completed an ad hoc questionnaire. The main barriers found were the belief that patients will lie about their actual consumption and will not identify its negative consequences, and the belief that they will reject participating in an intervention for their alcohol consumption. No significant differences between doctors and nurses were found in any of the barriers assessed. The results provide empirical evidence of the reliability of the test for the assessment by both teams of professionals. Studies are needed to examine in greater depth these conclusions, extending the number of variables studied to determine a more complete profile of the health professionals who are reluctant to incorporate the assessment and treatment of problem drinkers in their consultation. This could help to improve the design of programs to facilitate and encourage its implementation in primary care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Translation, Cross-cultural Adaptation and Psychometric Validation of the Korean-Language Cardiac Rehabilitation Barriers Scale (CRBS-K).

PubMed

Baek, Sora; Park, Hee-Won; Lee, Yookyung; Grace, Sherry L; Kim, Won-Seok

2017-10-01

To perform a translation and cross-cultural adaptation of the Cardiac Rehabilitation Barriers Scale (CRBS) for use in Korea, followed by psychometric validation. The CRBS was developed to assess patients' perception of the degree to which patient, provider and health system-level barriers affect their cardiac rehabilitation (CR) participation. The CRBS consists of 21 items (barriers to adherence) rated on a 5-point Likert scale. The first phase was to translate and cross-culturally adapt the CRBS to the Korean language. After back-translation, both versions were reviewed by a committee. The face validity was assessed in a sample of Korean patients (n=53) with history of acute myocardial infarction that did not participate in CR through semi-structured interviews. The second phase was to assess the construct and criterion validity of the Korean translation as well as internal reliability, through administration of the translated version in 104 patients, principle component analysis with varimax rotation and cross-referencing against CR use, respectively. The length, readability, and clarity of the questionnaire were rated well, demonstrating face validity. Analysis revealed a six-factor solution, demonstrating construct validity. Cronbach's alpha was greater than 0.65. Barriers rated highest included not knowing about CR and not being contacted by a program. The mean CRBS score was significantly higher among non-attendees (2.71±0.26) than CR attendees (2.51±0.18) (p<0.01). The Korean version of CRBS has demonstrated face, content and criterion validity, suggesting it may be useful for assessing barriers to CR utilization in Korea.

Perceived Barriers to Healthy Eating and Physical Activity Among Participants in a Workplace Obesity Intervention.

PubMed

Stankevitz, Kayla; Dement, John; Schoenfisch, Ashley; Joyner, Julie; Clancy, Shayna M; Stroo, Marissa; Østbye, Truls

2017-08-01

To characterize barriers to healthy eating (BHE) and physical activity (BPA) among participants in a workplace weight management intervention. Steps to health participants completed a questionnaire to ascertain barriers to physical activity and healthy eating faced. Exploratory factor analysis was used to determine the factor structure for BPA and BHE. The relationships of these factors with accelerometer data and dietary behaviors were assessed using linear regression. Barriers to physical activity included time constraints and lack of interest and motivation, and to healthy eating, lack of self-control and convenience, and lack of access to healthy foods. Higher BHE correlated with higher sugary beverage intake but not fruit and vegetable and fat intake. To improve their effectiveness, workplace weight management programs should consider addressing and reducing barriers to healthy eating and physical activity.

Perceived Benefits and Barriers of a Community-Based Diabetes Prevention and Management Program.

PubMed

Shawley-Brzoska, Samantha; Misra, Ranjita

2018-03-13

This study examined the perceptions of benefits of and barriers to participating in a community-based diabetes program to improve program effectiveness. The Diabetes Prevention and Management (DPM) program was a twenty-two session, 1-year program, modeled after the evidence-based National Diabetes Prevention Program and AADE7 Self-Care Behaviors framework. Community-based participatory research approach was used to culturally tailor the curriculum. Participants included overweight or obese adults with dysglycemia. A benefits and barriers survey was developed to gather information on participants' perception of the program, as well as information on demographics and health literacy levels. Eighty-nine adults participated in the DPM program (73% females; 62% diabetic; 77% had adequate health literacy); 79% of participants completed the benefits and barriers survey. Principal component analysis indicated two components representing benefits (Cronbach's α = 0.83) and barriers (α = 0.65). The majority perceived high benefits and low barriers to program participation; benefits included helpful interaction with health coach or program leader (73%), improved lifestyle modification (65%) due to the program, and satisfaction with the program (75%). Open-ended questions confirmed themes related to benefits of program participation, suggestion for programmatic improvements as well as barriers to participation. Participant feedback could be used to guide interventions and tailor future program implementation.

Perceived Benefits and Barriers of a Community-Based Diabetes Prevention and Management Program

PubMed Central

Shawley-Brzoska, Samantha; Misra, Ranjita

2018-01-01

This study examined the perceptions of benefits of and barriers to participating in a community-based diabetes program to improve program effectiveness. The Diabetes Prevention and Management (DPM) program was a twenty-two session, 1-year program, modeled after the evidence-based National Diabetes Prevention Program and AADE7 Self-Care Behaviors framework. Community-based participatory research approach was used to culturally tailor the curriculum. Participants included overweight or obese adults with dysglycemia. A benefits and barriers survey was developed to gather information on participants’ perception of the program, as well as information on demographics and health literacy levels. Eighty-nine adults participated in the DPM program (73% females; 62% diabetic; 77% had adequate health literacy); 79% of participants completed the benefits and barriers survey. Principal component analysis indicated two components representing benefits (Cronbach’s α = 0.83) and barriers (α = 0.65). The majority perceived high benefits and low barriers to program participation; benefits included helpful interaction with health coach or program leader (73%), improved lifestyle modification (65%) due to the program, and satisfaction with the program (75%). Open-ended questions confirmed themes related to benefits of program participation, suggestion for programmatic improvements as well as barriers to participation. Participant feedback could be used to guide interventions and tailor future program implementation. PMID:29534005

The Americans with Disabilities Act: Implications for Camp Programming.

ERIC Educational Resources Information Center

Bedini, Leandra A.; And Others

1992-01-01

Discusses the effect of the Americans with Disabilities Act (ADA) on camp programing and provides strategies to improve camp accessibility for people with disabilities. Discusses obstacles to integrated programing including ecological and architectural barriers, attitudinal barriers, transportation barriers, barriers of omission, economic…

Coastal single-beam bathymetry data collected in 2015 from the Chandeleur Islands, Louisiana

USGS Publications Warehouse

Stalk, Chelsea A.; DeWitt, Nancy T.; Bernier, Julie C.; Kindinger, Jack G.; Flocks, James G.; Miselis, Jennifer L.; Locker, Stanley D.; Kelso, Kyle W.; Tuten, Thomas M.

2017-02-23

As part of the Louisiana Coastal Protection and Restoration Authority (CPRA) Barrier Island Comprehensive Monitoring Program, scientists from the U.S. Geological Survey (USGS) St. Petersburg Coastal and Marine Science Center conducted a single-beam bathymetry survey around the Chandeleur Islands, Louisiana, in June 2015. The goal of the program is to provide long-term data on Louisiana’s barrier islands and use this data to plan, design, evaluate, and maintain current and future barrier island restoration projects. The data described in this report, along with (1) USGS bathymetry data collected in 2013 as a part of the Barrier Island Evolution Research project covering the northern Chandeleur Islands, and (2) data collected in 2014 in collaboration with the Louisiana CPRA Barrier Island Comprehensive Monitoring Program around Breton Island, will be used to assess bathymetric change since 2006‒2007 as well as serve as a bathymetric control in supporting modeling of future changes in response to restoration and storm impacts. The survey area encompasses approximately 435 square kilometers of nearshore and back-barrier environments around Hewes Point, the Chandeleur Islands, and Curlew and Grand Gosier Shoals. This Data Series serves as an archive of processed single-beam bathymetry data, collected in the nearshore of the Chandeleur Islands, Louisiana, from June 17‒24, 2015, during USGS Field Activity Number 2015-317-FA. Geographic information system data products include a 200-meter-cell-size interpolated bathymetry grid, trackline maps, and xyz point data files. Additional files include error analysis maps, Field Activity Collection System logs, and formal Federal Geographic Data Committee metadata.

Estimating Impacts on Students, Teachers, and Schools of Programs Targeted for Preschool through Transition to College--Lessons for Methodologists from the Designs of 117 Evaluations Being Conducted in the Investing in Innovation Fund (i3) Grant Program.

ERIC Educational Resources Information Center

Price, Cristofer; Wolf, Anne; Goodson, Barbara; Boulay, Beth

2015-01-01

When presenting results from rigorous, field-based evaluations of educational interventions, researchers often reveal methodological barriers they face in designing studies to assessing program effectiveness. The evaluations funded by the Investing in Innovation Fund (i3) present a timely opportunity for identifying relevant and pressing issues…

Providing smoking cessation programs to homeless youth: the perspective of service providers.

PubMed

Shadel, William G; Tucker, Joan S; Mullins, Leslie; Staplefoote, Lynette

2014-10-01

There is almost no information available on cigarette smoking among homeless youth, whether they are currently receiving services for smoking cessation, and how to best help them quit. This paper presents data collected from a series of semi-structured telephone interviews with service providers from 23 shelters and drop-in centers serving homeless youth in Los Angeles County about their current smoking cessation programming, interest in providing smoking cessation services to their clients, potential barriers to providing this service, and ways to overcome these barriers. Results indicated that 84% of facilities did not offer smoking cessation services, although nearly all (91%) were interested in doing so. Barriers to implementing formal smoking cessation programs on site included lack of resources (e.g., money, personnel) to support the programs, staff training, and concern that smoking cessation may not be a high priority for homeless youth themselves. Overall, service providers seemed to prefer a less intensive smoking cessation program that could be delivered at their site by existing staff. Data from this formative needs assessment will be useful for developing and evaluating a smoking cessation treatment that could be integrated into the busy, complex environment that characterizes agencies that serve homeless youth. Copyright © 2014 Elsevier Inc. All rights reserved.

A Model for Service to the Elderly by the Small/Medium Sized Public Library.

ERIC Educational Resources Information Center

Jeffries, Stephen R.

Citing the American Library Association's 1964 statement of libraries' responsibilities to the aging, this paper presents a needs assessment of the elderly and suggests methods by which public libraries can attempt to meet some of these needs, e.g., barrier-free design, programs, materials, and services. The needs assessment of older users…

Weight maintenance, behaviors and barriers among previous participants of a university-based weight control program.

PubMed

Befort, C A; Stewart, E E; Smith, B K; Gibson, C A; Sullivan, D K; Donnelly, J E

2008-03-01

To examine weight loss maintenance among previous participants of a university-based behavioral weight management program and to compare behavioral strategies and perceived barriers between successful and unsuccessful maintainers. Previous program participants (n=179) completed mailed surveys assessing current weight, weight control behaviors and perceived barriers to weight loss maintenance. At 14.1+/-10.8 months following completion of treatment, survey respondents were on average 12.6+/-12.6 kg, or 11.3+/-10.7%, below baseline weight; 76.5% of respondents had successfully maintained weight, defined as maintaining a weight loss of at least 5% below baseline. Compared to unsuccessful maintainers, successful maintainers reported practicing four dietary and three physical activity weight control strategies more often and experiencing five barriers to healthy eating and exercise less often. After accounting for time since treatment and maximum weight loss while in treatment, the strongest correlates of successful weight loss maintenance were frequent exercise and perceived difficulty of weight management. Clinically meaningful weight loss maintenance was achieved by the majority of participants. Findings support the literature indicating that physical activity is one of the strongest predictors of successful weight loss maintenance. Findings also suggest that strategies to reduce the level of perceived effort required for long-term weight control may improve maintenance outcomes.

Management of Sodium-reduced Meals at Worksite Cafeterias: Perceptions, Practices, Barriers, and Needs among Food Service Personnel

PubMed Central

Lee, Jounghee; Park, Sohyun

2015-01-01

Objectives The sodium content of meals provided at worksite cafeterias is greater than the sodium content of restaurant meals and home meals. The objective of this study was to assess the relationships between sodium-reduction practices, barriers, and perceptions among food service personnel. Methods We implemented a cross-sectional study by collecting data on perceptions, practices, barriers, and needs regarding sodium-reduced meals at 17 worksite cafeterias in South Korea. We implemented Chi-square tests and analysis of variance for statistical analysis. For post hoc testing, we used Bonferroni tests; when variances were unequal, we used Dunnett T3 tests. Results This study involved 104 individuals employed at the worksite cafeterias, comprised of 35 men and 69 women. Most of the participants had relatively high levels of perception regarding the importance of sodium reduction (very important, 51.0%; moderately important, 27.9%). Sodium reduction practices were higher, but perceived barriers appeared to be lower in participants with high-level perception of sodium-reduced meal provision. The results of the needs assessment revealed that the participants wanted to have more active education programs targeting the general population. The biggest barriers to providing sodium-reduced meals were use of processed foods and limited methods of sodium-reduced cooking in worksite cafeterias. Conclusion To make the provision of sodium-reduced meals at worksite cafeterias more successful and sustainable, we suggest implementing more active education programs targeting the general population, developing sodium-reduced cooking methods, and developing sodium-reduced processed foods. PMID:27169011

Fish Passage Assessment: Big Canyon Creek Watershed, Technical Report 2004.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Christian, Richard

2004-02-01

This report presents the results of the fish passage assessment as outlined as part of the Protect and Restore the Big Canyon Creek Watershed project as detailed in the CY2003 Statement of Work (SOW). As part of the Northwest Power Planning Council's Columbia Basin Fish and Wildlife Program (FWP), this project is one of Bonneville Power Administration's (BPA) many efforts at off-site mitigation for damage to salmon and steelhead runs, their migration, and wildlife habitat caused by the construction and operation of federal hydroelectric dams on the Columbia River and its tributaries. The proposed restoration activities within the Big Canyonmore » Creek watershed follow the watershed restoration approach mandated by the Fisheries and Watershed Program. Nez Perce Tribal Fisheries/Watershed Program vision focuses on protecting, restoring, and enhancing watersheds and treaty resources within the ceded territory of the Nez Perce Tribe under the Treaty of 1855 with the United States Federal Government. The program uses a holistic approach, which encompasses entire watersheds, ridge top to ridge top, emphasizing all cultural aspects. We strive toward maximizing historic ecosystem productive health, for the restoration of anadromous and resident fish populations. The Nez Perce Tribal Fisheries/Watershed Program (NPTFWP) sponsors the Protect and Restore the Big Canyon Creek Watershed project. The NPTFWP has the authority to allocate funds under the provisions set forth in their contract with BPA. In the state of Idaho vast numbers of relatively small obstructions, such as road culverts, block thousands of miles of habitat suitable for a variety of fish species. To date, most agencies and land managers have not had sufficient, quantifiable data to adequately address these barrier sites. The ultimate objective of this comprehensive inventory and assessment was to identify all barrier crossings within the watershed. The barriers were then prioritized according to the amount of habitat blocked at each site and the fish life history stages impacted. This assessment protocol will hopefully prove useful to other agencies and become a model for use in other watersheds.« less

Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program

PubMed Central

Lee, Hang; Powell, Elizabeth; Birrer, Nicole E.; Poles, Emily; Finkelstein, Daniel; Winkfield, Karen; Percac-Lima, Sanja; Chabner, Bruce; Moy, Beverly

2016-01-01

Introduction. Cancer clinical trial (CT) participation rates are low and financial barriers likely play a role. We implemented a cancer care equity program (CCEP) to address financial burden associated with trial participation. We sought to examine the impact of the CCEP on CT enrollment and to assess barriers to participation. Methods. We used an interrupted time series design to determine trends in CT enrollment before and after CCEP implementation. Linear regression models compared trial enrollment before and after the CCEP. We also compared patient characteristics before and after the CCEP and between CCEP and non-CCEP participants. We surveyed CCEP and non-CCEP participants to compare pre-enrollment financial barriers. Results. After accounting for increased trial availability and the trends in accrual for prior years, we found that enrollment increased after CCEP implementation (18.97 participants per month greater than expected; p < .001). A greater proportion of CCEP participants were younger, female, in phase I trials, lived farther away, had lower incomes, and had metastatic disease. Of 87 participants who completed the financial barriers survey, 49 CCEP and 38 matched, non-CCEP participants responded (63% response rate). CCEP participants were more likely to report concerns regarding finances (56% vs. 11%), medical costs (47% vs. 14%), travel (69% vs. 11%), lodging (60% vs. 9%), and insurance coverage (43% vs. 14%) related to trial participation (all p < .01). Conclusion. CT participation increased following implementation of the CCEP and the program enrolled patients experiencing greater financial burden. These findings highlight the need to address the financial burden associated with CT participation. Implications for Practice: Financial barriers likely discourage patients from participating in clinical trials. Implementation of a cancer care equity program (CCEP) seeking to reduce financial barriers by assisting with travel and lodging costs was associated with increased trial accrual. The CCEP provided assistance to patients particularly in need, including those living farther away, those with lower incomes, and those reporting financial barriers related to trial participation. These findings suggest that financial concerns represent a major barrier to patient participation in clinical trials and underscore the importance of efforts to address these concerns. PMID:26975867

Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program.

PubMed

Nipp, Ryan D; Lee, Hang; Powell, Elizabeth; Birrer, Nicole E; Poles, Emily; Finkelstein, Daniel; Winkfield, Karen; Percac-Lima, Sanja; Chabner, Bruce; Moy, Beverly

2016-04-01

Cancer clinical trial (CT) participation rates are low and financial barriers likely play a role. We implemented a cancer care equity program (CCEP) to address financial burden associated with trial participation. We sought to examine the impact of the CCEP on CT enrollment and to assess barriers to participation. We used an interrupted time series design to determine trends in CT enrollment before and after CCEP implementation. Linear regression models compared trial enrollment before and after the CCEP. We also compared patient characteristics before and after the CCEP and between CCEP and non-CCEP participants. We surveyed CCEP and non-CCEP participants to compare pre-enrollment financial barriers. After accounting for increased trial availability and the trends in accrual for prior years, we found that enrollment increased after CCEP implementation (18.97 participants per month greater than expected; p < .001). A greater proportion of CCEP participants were younger, female, in phase I trials, lived farther away, had lower incomes, and had metastatic disease. Of 87 participants who completed the financial barriers survey, 49 CCEP and 38 matched, non-CCEP participants responded (63% response rate). CCEP participants were more likely to report concerns regarding finances (56% vs. 11%), medical costs (47% vs. 14%), travel (69% vs. 11%), lodging (60% vs. 9%), and insurance coverage (43% vs. 14%) related to trial participation (all p < .01). CT participation increased following implementation of the CCEP and the program enrolled patients experiencing greater financial burden. These findings highlight the need to address the financial burden associated with CT participation. Financial barriers likely discourage patients from participating in clinical trials. Implementation of a cancer care equity program (CCEP) seeking to reduce financial barriers by assisting with travel and lodging costs was associated with increased trial accrual. The CCEP provided assistance to patients particularly in need, including those living farther away, those with lower incomes, and those reporting financial barriers related to trial participation. These findings suggest that financial concerns represent a major barrier to patient participation in clinical trials and underscore the importance of efforts to address these concerns. ©AlphaMed Press.

Connecting Hispanic Women in Baltimore to the Mercy Medical Center Sexual Assault Forensic Examiners/Forensic Nurse Examiners Program: A Preliminary Assessment of Service Utilization and Community Awareness.

PubMed

Adams, Margaret; Fitzgerald, Sheila; Holbrook, Debra

2016-01-01

Sexual violence and gender-based violence represent a major public health problem causing significant negative mental, physical, and social outcomes for victims. The rapidly growing population of Hispanic women in Baltimore are both more vulnerable to sexual assault and less able to access postassault services. In an effort to assess service utilization and community awareness of the Mercy Medical Center Sexual Assault Forensic Examiners/Forensic Nurse Examiners Program, we conducted a retrospective chart review of 2,322 women who were seen by the program between 2010 and 2013 and found that only 2.5% of the women were identified as Hispanic, about half of what Baltimore City demographic data would predict. This exploratory pilot project, augmented by key informant interviews, reveals that Hispanic women are underutilizing sexual assault services. Multiple barriers exist for Hispanic women in obtaining victim services, including lack of awareness within the community that the services exist, cultural factors, language barriers, lack of awareness of legal rights, and a fear of deportation.

ASSESSING BARRIERS AND FACILITATORS OF IMPLEMENTING AN INTEGRATED HIV PREVENTION AND PROPERTY RIGHTS PROGRAM IN WESTERN KENYA

PubMed Central

Lu, Tiffany; Zwicker, Lindsey; Kwena, Zachary; Bukusi, Elizabeth; Mwaura-Muiru, Esther; Dworkin, Shari L.

2013-01-01

Despite the recognized need for structural HIV prevention interventions, few scientific programs have integrated women’s property and inheritance rights with HIV prevention and treatment. The current study focused on a community-led land and property rights intervention that was implemented in two rural areas of Western Kenya with high HIV prevalence rates (24–30%). The program was designed to respond to women’s property rights violations in order to reduce HIV risk at the local level. Through in-depth interviews with twenty program leaders, we identified several facilitators to program implementation, including the leadership of home-based HIV caregivers and involvement of traditional leaders in mediating property rights disputes. We also identified the voluntary basis of the intervention and its lack of integration with the formal justice system as implementation barriers. Our findings can guide future research and design of structural HIV prevention strategies that integrate women’s economic empowerment through property and inheritance rights. PMID:23514082

Assessing barriers and facilitators of implementing an integrated HIV prevention and property rights program in Western Kenya.

PubMed

Lu, Tiffany; Zwicker, Lindsey; Kwena, Zachary; Bukusi, Elizabeth; Mwaura-Muiru, Esther; Dworkin, Shari L

2013-04-01

Despite the recognized need for structural HIV prevention interventions, few scientific programs have integrated women's property and inheritance rights with HIV prevention and treatment. The current study focused on a community-led land and property rights intervention that was implemented in two rural areas of Western Kenya with high HIV prevalence rates (24-30%). The program was designed to respond to women's property rights violations in order to reduce HIV risk at the local level. Through in-depth interviews with twenty program leaders, we identified several facilitators to program implementation, including the leadership of home-based HIV caregivers and involvement of traditional leaders in mediating property rights disputes. We also identified the voluntary basis of the intervention and its lack of integration with the formal justice system as implementation barriers. Our findings can guide future research and design of structural HIV prevention strategies that integrate women's economic empowerment through property and inheritance rights.

Randomized Trial of a Web-Based Intervention to Address Barriers to Clinical Trials.

PubMed

Meropol, Neal J; Wong, Yu-Ning; Albrecht, Terrance; Manne, Sharon; Miller, Suzanne M; Flamm, Anne Lederman; Benson, Al Bowen; Buzaglo, Joanne; Collins, Michael; Egleston, Brian; Fleisher, Linda; Katz, Michael; Kinzy, Tyler G; Liu, Tasnuva M; Margevicius, Seunghee; Miller, Dawn M; Poole, David; Roach, Nancy; Ross, Eric; Schluchter, Mark D

2016-02-10

Lack of knowledge and negative attitudes have been identified as barriers to participation in clinical trials by patients with cancer. We developed Preparatory Education About Clinical Trials (PRE-ACT), a theory-guided, Web-based, interactive computer program, to deliver tailored video educational content to patients in an effort to overcome barriers to considering clinical trials as a treatment option. A prospective, randomized clinical trial compared PRE-ACT with a control condition that provided general clinical trials information produced by the National Cancer Institute (NCI) in text format. One thousand two hundred fifty-five patients with cancer were randomly allocated before their initial visit with an oncologist to PRE-ACT (n = 623) or control (n = 632). PRE-ACT had three main components: assessment of clinical trials knowledge and attitudinal barriers, values assessment with clarification back to patients, and provision of a video library tailored to address each patient's barriers. Outcomes included knowledge and attitudes and preparation for decision making about clinical trials. Both PRE-ACT and control interventions improved knowledge and attitudes (all P < .001) compared with baseline. Patients randomly allocated to PRE-ACT showed a significantly greater increase in knowledge (P < .001) and a significantly greater decrease in attitudinal barriers (P < .001) than did their control (text-only) counterparts. Participants in both arms significantly increased their preparedness to consider clinical trials (P < .001), and there was a trend favoring the PRE-ACT group (P < .09). PRE-ACT was also associated with greater patient satisfaction than was NCI text alone. These data show that patient education before the first oncologist visit improves knowledge, attitudes, and preparation for decision making about clinical trials. Both text and tailored video were effective. The PRE-ACT interactive video program was more effective than NCI text in improving knowledge and reducing attitudinal barriers. © 2015 by American Society of Clinical Oncology.

Assessments and market design for the water market at Xiying Irrigation, Shiyang River Basin, Gansu Province, China

NASA Astrophysics Data System (ADS)

Xu, T.; Zhao, J.; Zheng, H.

2016-12-01

As one of the pilot water markets in China, the market in Xiying Irrigation was built in 2008. Based on the historical trading data, it can be concluded that the studied market is growing but facing quite a few challenges. To solve these challenges, the first step we have done is assessment on the market. Some comparable indices were introduced from network science by us. These indices straightforwardly show the status and major problems in the market. One main problem we have found from surveys and our assessment is that there are barriers between distant seller and buyer. This discovery incentives us to develop a new mechanism for matching sellers and buyers to reduce the loss on social welfare. By modelling the trading barriers between a buyer and a seller as an indicator -- tradable or nontradable, the authors propose a mixed-integer linear programming algorithm to optimize the social welfare. According to the theories on competitive equilibrium, the authors are able to extend the programming to compute a reasonable price profile for each pair of tradable seller and buyer. It can be proved that given the price profile, the optimal strategy for each seller or buyer is to follow the optimal assignment. This mechanism significantly reduces the social welfare loss. However, this study shows that removing the trading barriers can brings more social welfare increments.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries.

PubMed

Leyvraz, Magali; Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark; Neufeld, Lynnette M

2017-05-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d'Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap.

Coverage of Nutrition Interventions Intended for Infants and Young Children Varies Greatly across Programs: Results from Coverage Surveys in 5 Countries123

PubMed Central

Aaron, Grant J; Poonawala, Alia; van Liere, Marti J; Schofield, Dominic; Myatt, Mark

2017-01-01

Background: The efficacy of a number of interventions that include fortified complementary foods (FCFs) or other products to improve infant and young child feeding (IYCF) is well established. Programs that provide such products free or at a subsidized price are implemented in many countries around the world. Demonstrating the impact at scale of these programs has been challenging, and rigorous information on coverage and utilization is lacking. Objective: The objective of this article is to review key findings from 11 coverage surveys of IYCF programs distributing or selling FCFs or micronutrient powders in 5 countries. Methods: Programs were implemented in Ghana, Cote d’Ivoire, India, Bangladesh, and Vietnam. Surveys were implemented at different stages of program implementation between 2013 and 2015. The Fortification Assessment Coverage Toolkit (FACT) was developed to assess 3 levels of coverage (message: awareness of the product; contact: use of the product ≥1 time; and effective: regular use aligned with program-specific goals), as well as barriers and factors that facilitate coverage. Analyses included the coverage estimates, as well as an assessment of equity of coverage between the poor and nonpoor, and between those with poor and adequate child feeding practices. Results: Coverage varied greatly between countries and program models. Message coverage ranged from 29.0% to 99.7%, contact coverage from 22.6% to 94.4%, and effective coverage from 0.8% to 88.3%. Beyond creating awareness, programs that achieved high coverage were those with effective mechanisms in place to overcome barriers for both supply and demand. Conclusions: Variability in coverage was likely due to the program design, delivery model, quality of implementation, and product type. Measuring program coverage and understanding its determinants is essential for program improvement and to estimate the potential for impact of programs at scale. Use of the FACT can help overcome this evidence gap. PMID:28404839

Barriers for Nonparticipation and Dropout of Women in Cardiac Rehabilitation Programs: A Systematic Review.

PubMed

Resurrección, Davinia M; Motrico, Emma; Rigabert, Alina; Rubio-Valera, Maria; Conejo-Cerón, Sonia; Pastor, Luis; Moreno-Peral, Patricia

2017-08-01

Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) programs are effective in reducing mortality and improving the quality of life of patients with CVD. Women are under-represented in CR and have a higher dropout rate than men. We aimed to systematically review the literature on barriers perceived by women with CVD affecting their nonparticipation in and/or dropping out from CR programs. Systematic review was done using MEDLINE, Embase, Scopus, Open Grey, and Cochrane Database from inception to September 2016. Search terms included (1) heart disease and other cardiac conditions, (2) CR and secondary prevention, and (3) nonparticipation in and/or dropout. Databases were searched following the "participants, interventions, comparisons, outcomes, and study design" method. A total of 24 studies (17 descriptive, 6 qualitative, and 1 randomized controlled trial) reporting several barriers were grouped into five broad categories: intrapersonal barriers (self-reported health, health beliefs, lack of time, motivation, and religious reasons); interpersonal barriers (lack of family/social support and work conflicts); logistical barriers (transport, distance, and availability of personal/community resources); CR program barriers (services offered, group format, exercise component, and CR sessions); and health system barriers (lack of referral, cost, negative experiences with the health system, and language). We found differences between the barriers related to nonparticipation in and dropout from CR programs. Women reported multilevel barriers for nonparticipation in and dropout from CR programs. Future clinical guidelines should evaluate and eliminate these barriers to improve adherence to CR programs in women. In addition, understanding the barriers for nonparticipation and dropout may be beneficial for future intervention trials.

Physical activity preferences, motivators, barriers and attitudes of adults with mental illness.

PubMed

Chapman, Justin J; Fraser, Sarah J; Brown, Wendy J; Burton, Nicola W

2016-10-01

Adults with mental illness may have specific attitudes toward physical activity (PA). To assess the PA attitudes of non-institutionalised adults with mental illness, and associations with psychological distress. Participants completed questionnaires on activity preferences (type, context and sources of support), motivators, barriers and attitudes toward personal training (PT). Relationships between responses and distress were assessed using logistic regressions. One-hundred forty-two participants completed the questionnaires. PA context preferences included activities done close to home, outdoors, with professional instruction, with people of the same ability, as part of a healthy lifestyle program and with a social component. The most commonly endorsed source of support was an exercise instructor. Most respondents had never received PT; however, PT had high acceptability. Common barriers included poor physical and mental health, and lack of money. Distress was positively associated with barriers of poor mental health, tiredness, disorganisation, exhaustion and being shy/embarrassed (p ≤ 0.001). Local outdoor walking groups that include social and healthy lifestyle components, and that are led by an exercise instructor who can provide support for overcoming barriers, may best meet PA interests of this group. PT could be an acceptable method for offering individualised support.

Use of Data Libraries for IAEA Nuclear Security Assessment Methodologies (NUSAM) [section 5.4

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shull, D.; Lane, M.

2015-06-23

Data libraries are essential for the characterization of the facility and provide the documented input which enables the facility assessment results and subsequent conclusions. Data Libraries are historical, verifiable, quantified, and applicable collections of testing data on different types of barriers, sensors, cameras, procedures, and/or personnel. Data libraries are developed and maintained as part of any assessment program or process. Data is collected during the initial stages of facility characterization to aid in the model and/or simulation development process. Data library values may also be developed through the use of state testing centers and/or site resources by testing different typesmore » of barriers, sensors, cameras, procedures, and/or personnel. If no data exists, subject matter expert opinion and manufacturer's specifications/ testing values can be the basis for initially assigning values, but are generally less reliable and lack appropriate confidence measures. The use of existing data libraries that have been developed by a state testing organization reduces the assessment costs by establishing standard delay, detection and assessment values for use by multiple sites or facilities where common barriers and alarms systems exist.« less

Simulating smokers' acceptance of modifications in a cessation program.

PubMed Central

Spoth, R

1992-01-01

Recent research has underscored the importance of assessing barriers to smokers' acceptance of cessation programs. This paper illustrates the use of computer simulations to gauge smokers' response to program modifications which may produce barriers to participation. It also highlights methodological issues encountered in conducting this work. Computer simulations were based on conjoint analysis, a consumer research method which enables measurement of smokers' relative preference for various modifications of cessation programs. Results from two studies are presented in this paper. The primary study used a randomly selected sample of 218 adult smokers who participated in a computer-assisted phone interview. Initially, the study assessed smokers' relative utility rating of 30 features of cessation programs. Utility data were used in computer-simulated comparisons of a low-cost, self-help oriented program under development and five other existing programs. A baseline version of the program under development and two modifications (for example, use of a support group with a higher level of cost) were simulated. Both the baseline version and modifications received a favorable response vis-à-vis comparison programs. Modifications requiring higher program costs were, however, associated with moderately reduced levels of favorable consumer response. The second study used a sample of 70 smokers who responded to an expanded set of smoking cessation program features focusing on program packaging. This secondary study incorporate in-person, computer-assisted interviews at a shopping mall, with smokers viewing an artist's mock-up of various program options on display. A similar pattern of responses to simulated program modifications emerged, with monetary cost apparently playing a key role. The significance of conjoint-based computer simulation as a tool in program development or dissemination, salient methodological issues, and implications for further research are discussed. PMID:1738813

Simulating smokers' acceptance of modifications in a cessation program.

PubMed

Spoth, R

1992-01-01

Recent research has underscored the importance of assessing barriers to smokers' acceptance of cessation programs. This paper illustrates the use of computer simulations to gauge smokers' response to program modifications which may produce barriers to participation. It also highlights methodological issues encountered in conducting this work. Computer simulations were based on conjoint analysis, a consumer research method which enables measurement of smokers' relative preference for various modifications of cessation programs. Results from two studies are presented in this paper. The primary study used a randomly selected sample of 218 adult smokers who participated in a computer-assisted phone interview. Initially, the study assessed smokers' relative utility rating of 30 features of cessation programs. Utility data were used in computer-simulated comparisons of a low-cost, self-help oriented program under development and five other existing programs. A baseline version of the program under development and two modifications (for example, use of a support group with a higher level of cost) were simulated. Both the baseline version and modifications received a favorable response vis-à-vis comparison programs. Modifications requiring higher program costs were, however, associated with moderately reduced levels of favorable consumer response. The second study used a sample of 70 smokers who responded to an expanded set of smoking cessation program features focusing on program packaging. This secondary study incorporate in-person, computer-assisted interviews at a shopping mall, with smokers viewing an artist's mock-up of various program options on display. A similar pattern of responses to simulated program modifications emerged, with monetary cost apparently playing a key role. The significance of conjoint-based computer simulation as a tool in program development or dissemination, salient methodological issues, and implications for further research are discussed.

Gender-Specific Barriers to Self-Sufficiency among Former Supplemental Security Income Drug Addiction and Alcoholism Beneficiaries: Implications for Welfare-To-Work Programs and Services

PubMed Central

Hogan, Sean R; Unick, George J.; Speiglman, Richard; Norris, Jean C.

2011-01-01

This study examines barriers to economic self-sufficiency among a panel of 219 former Supplemental Security Income (SSI) drug addiction and alcoholism (DA&A) recipients following elimination of DA&A as an eligibility category for SSI disability benefits. Study participants were comprehensively surveyed at six measurement points following the policy change. Generalized estimating equations were used to examine full-sample and gender-specific barriers to economic self-sufficiency. Results indicate that access to transportation, age, and time are the strongest predictors of achieving self-sufficiency for both men and women leaving the welfare system. Gender-specific barriers are also identified. Future research needs to assess the generalizability of these results to other public assistance recipients. PMID:21625301

Qualitative assessment of Diabetes-STAR: a patient portal with disease management functions.

PubMed

Ross, Stephen E; Nowels, Carolyn T; Haverhals, Leah M; Bull, Sheana S; Lin, Chen-Tan; Main, Deborah S

2007-10-11

Diabetes-STAR is a disease management program integrated with an online patient portal. Of 331 patients enrolled in a randomized trial, we interviewed 37 users about benefits, barriers and recommendations for program improvements. User preferences included 1) addressing differences in types of users, 2) sending out alerts when new information is available, and 3) providing more oversight of user diary data.

Qualitative assessment of take-home naloxone program participant and law enforcement interactions in British Columbia.

PubMed

Deonarine, Andrew; Amlani, Ashraf; Ambrose, Graham; Buxton, Jane A

2016-05-21

The British Columbia take-home naloxone (BCTHN) program has been in operation since 2012 and has resulted in the successful reversal of over 581 opioid overdoses. The study aims to explore BCTHN program participant perspectives about the program, barriers to participants contacting emergency services (calling "911") during an overdose, and perspectives of law enforcement officials on naloxone administration by police officers. Two focus groups and four individual interviews were conducted with BCTHN program participants; interviews with two law enforcement officials were also conducted. Qualitative analysis of all transcripts was performed. Positive themes about the BCTHN program from participants included easy to understand training, correcting misperceptions in the community, and positive interactions with emergency services. Potential barriers to contacting emergency services during an overdose include concerns about being arrested for outstanding warrants or for other illegal activities (such as drug possession) and confiscation of kits. Law enforcement officials noted that warrants were complex situational issues, kits would normally not be confiscated, and admitted arrests for drug possession or other activities may not serve the public good in an overdose situation. Law enforcement officials were concerned about legal liability and jurisdictional/authorization issues if naloxone administration privileges were expanded to police. Program participants and law enforcement officials expressed differing perspectives about warrants, kit confiscation, and arrests. Facilitating communication between BCTHN program participants and other stakeholders may address some of the confusion and remove potential barriers to further improving program outcomes. Naloxone administration by law enforcement would require policies to address jurisdiction/authorization and liability issues.

The feasibility of implementing a communication skills training course in pediatric hematology/oncology fellowship.

PubMed

Weintraub, Lauren; Figueiredo, Lisa; Roth, Michael; Levy, Adam

Communication skills are a competency highlighted by the Accreditation Council on Graduate Medical Education; yet, little is known about the frequency with which trainees receive formal training or what programs are willing to invest. We sought to answer this question and designed a program to address identified barriers. We surveyed pediatric fellowship program directors from all disciplines and, separately, pediatric hematology/oncology fellowship program directors to determine current use of formal communication skills training. At our institution, we piloted a standardized patient (SP)-based communication skills training program for pediatric hematology/oncology fellows. Twenty-seven pediatric hematology/oncology program directors and 44 pediatric program directors participated in the survey, of which 56% and 48%, respectively, reported having an established, formal communication skills training course. Multiple barriers to implementation of a communication skills course were identified, most notably time and cost. In the pilot program, 13 pediatric hematology/oncology fellows have participated, and 9 have completed all 3 years of training. Precourse assessment demonstrated fellows had limited comfort in various areas of communication. Following course completion, there was a significant increase in self-reported comfort and/or skill level in such areas of communication, including discussing a new diagnosis (p =.0004), telling a patient they are going to die (p =.005), discussing recurrent disease (p <.001), communicating a poor prognosis (p =.002), or responding to anger (p ≤.001). We have designed a concise communication skills training program, which addresses identified barriers and can feasibly be implemented in pediatric hematology/oncology fellowship.

Mammography Screening Uptake among Female Health Care Workers in Primary Health Care Centers in Palestine - Motivators and Barriers.

PubMed

Nazzal, Zaher; Sholi, Hisham; Sholi, Suha; Sholi, Mohammad; Lahaseh, Rawya

2016-01-01

Early detection remains the cornerstone of breast cancer control in terms of outcome and survival. Thus far the only breast cancer screening method proven effective is mammography. The awareness of female health care workers (HCW) about breast cancer prevention is of vital importance, as their beliefs and behavior may have a major impact on other women. This study was designed to assess mammography screening uptake among female healthcare workers at primary healthcare centers, and to identify the primary motivators and barriers that affect uptake results. A cross sectional study design was used to assess mammography screening by 299 female healthcare workers who completed a self-administered questionnaire that assessed demographics, screening uptake, motivators and barriers. The mean age was 46 years (within age of risk). The majority (95.1%) demonstrated adequate knowledge about breast cancer and mammography screening and 50% of the participants reported having at least one mammogram; however only 21% of them had regularly scheduled mammograms. The most frequent reported motivator was the perceived benefit that early detection of breast cancer is important for its management (89.6%), followed by the belief that mammography can detect breast cancer before its symptoms appear (84.4%). On the other hand, the most frequent barrier reported was being busy (46.7%), followed by the lack of perceived susceptibility (41.5%). Mammography screening was found to be sub-optimal in a population of HCW's with 50 % stating that they received a mammogram at least once, and a minority reported regular screening. There is a pressing need for educational programs aimed at removing the barriers that limit compliance with recommendations for mammography screening, and to emphasize the importance of early detection in breast cancer treatment. Ensuring the availability and accessibility of screening services, particularly for healthcare workers within their work settings are other important factors that would improve the acceptance and compliance for mammography screening programs.

Translation, Cross-cultural Adaptation and Psychometric Validation of the Korean-Language Cardiac Rehabilitation Barriers Scale (CRBS-K)

PubMed Central

2017-01-01

Objective To perform a translation and cross-cultural adaptation of the Cardiac Rehabilitation Barriers Scale (CRBS) for use in Korea, followed by psychometric validation. The CRBS was developed to assess patients' perception of the degree to which patient, provider and health system-level barriers affect their cardiac rehabilitation (CR) participation. Methods The CRBS consists of 21 items (barriers to adherence) rated on a 5-point Likert scale. The first phase was to translate and cross-culturally adapt the CRBS to the Korean language. After back-translation, both versions were reviewed by a committee. The face validity was assessed in a sample of Korean patients (n=53) with history of acute myocardial infarction that did not participate in CR through semi-structured interviews. The second phase was to assess the construct and criterion validity of the Korean translation as well as internal reliability, through administration of the translated version in 104 patients, principle component analysis with varimax rotation and cross-referencing against CR use, respectively. Results The length, readability, and clarity of the questionnaire were rated well, demonstrating face validity. Analysis revealed a six-factor solution, demonstrating construct validity. Cronbach's alpha was greater than 0.65. Barriers rated highest included not knowing about CR and not being contacted by a program. The mean CRBS score was significantly higher among non-attendees (2.71±0.26) than CR attendees (2.51±0.18) (p<0.01). Conclusion The Korean version of CRBS has demonstrated face, content and criterion validity, suggesting it may be useful for assessing barriers to CR utilization in Korea. PMID:29201826

Promoting Early Brain and Child Development: Perceived Barriers and the Utilization of Resources to Address Them.

PubMed

Garner, Andrew S; Storfer-Isser, Amy; Szilagyi, Moira; Stein, Ruth E K; Green, Cori M; Kerker, Bonnie D; O'Connor, Karen G; Hoagwood, Kimberly E; McCue Horwitz, Sarah

Efforts to promote early brain and child development (EBCD) include initiatives to support healthy parent-child relationships, tools to identify family social-emotional risk factors, and referrals to community programs to address family risk factors. We sought to examine if pediatricians perceive barriers to implementing these activities, and if they utilize resources to address those barriers. Data were analyzed from 304 nontrainee pediatricians who practice general pediatrics and completed a 2013 American Academy of Pediatrics Periodic Survey. Sample weights were used to decrease nonresponse bias. Bivariate comparisons and multivariable regression analyses were conducted. At least half of the pediatricians agreed that barriers to promoting EBCD include: a lack of tools to promote healthy parent-child relationships, a lack of tools to assess the family environment for social-emotional risk factors, and a lack of local resources to address family risks. Endorsing a lack of tools to assess the family environment as a barrier was associated with using fewer screening tools and community resources. Endorsing a lack of local resources as a barrier was associated with using fewer community resources and fewer initiatives to promote parent-child relationships. Interest in pediatric mental health was associated with using more initiatives to promote healthy parent-child relationships, screening tools, and community resources. Although the majority of pediatricians perceive barriers to promoting EBCD, few are routinely using available resources to address these barriers. Addressing pediatricians' perceived barriers and encouraging interest in pediatric mental health may increase resource utilization and enhance efforts to promote EBCD. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Transportation Energy Futures Series: Non-Cost Barriers to Consumer Adoption of New Light-Duty Vehicle Technologies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stephens, T.

2013-03-01

Consumer preferences are key to the adoption of new vehicle technologies. Barriers to consumer adoption include price and other obstacles, such as limited driving range and charging infrastructure; unfamiliarity with the technology and uncertainty about direct benefits; limited makes and models with the technology; reputation or perception of the technology; standardization issues; and regulations. For each of these non-cost barriers, this report estimates an effective cost and summarizes underlying influences on consumer preferences, approximate magnitude and relative severity, and assesses potential actions, based on a comprehensive literature review. While the report concludes that non-cost barriers are significant, effective cost andmore » potential market share are very uncertain. Policies and programs including opportunities for drivers to test drive advanced vehicles, general public outreach and information programs, incentives for providing charging and fueling infrastructure, and development of technology standards were examined for their ability to address barriers, but little quantitative data exists on the effectiveness of these measures. This is one in a series of reports produced as a result of the Transportation Energy Futures project, a Department of Energy-sponsored multi-agency effort to pinpoint underexplored strategies for reducing GHGs and petroleum dependence related to transportation.« less

The Cementitious Barriers Partnership (CBP) Software Toolbox Capabilities in Assessing the Degradation of Cementitious Barriers - 13487

DOE Office of Scientific and Technical Information (OSTI.GOV)

Flach, G.P.; Burns, H.H.; Langton, C.

2013-07-01

The Cementitious Barriers Partnership (CBP) Project is a multi-disciplinary, multi-institutional collaboration supported by the U.S. Department of Energy (US DOE) Office of Tank Waste and Nuclear Materials Management. The CBP program has developed a set of integrated tools (based on state-of-the-art models and leaching test methods) that help improve understanding and predictions of the long-term structural, hydraulic and chemical performance of cementitious barriers used in nuclear applications. Tools selected for and developed under this program have been used to evaluate and predict the behavior of cementitious barriers used in near-surface engineered waste disposal systems for periods of performance up tomore » 100 years and longer for operating facilities and longer than 1000 years for waste disposal. The CBP Software Toolbox has produced tangible benefits to the DOE Performance Assessment (PA) community. A review of prior DOE PAs has provided a list of potential opportunities for improving cementitious barrier performance predictions through the use of the CBP software tools. These opportunities include: 1) impact of atmospheric exposure to concrete and grout before closure, such as accelerated slag and Tc-99 oxidation, 2) prediction of changes in K{sub d}/mobility as a function of time that result from changing pH and redox conditions, 3) concrete degradation from rebar corrosion due to carbonation, 4) early age cracking from drying and/or thermal shrinkage and 5) degradation due to sulfate attack. The CBP has already had opportunity to provide near-term, tangible support to ongoing DOE-EM PAs such as the Savannah River Saltstone Disposal Facility (SDF) by providing a sulfate attack analysis that predicts the extent and damage that sulfate ingress will have on the concrete vaults over extended time (i.e., > 1000 years). This analysis is one of the many technical opportunities in cementitious barrier performance that can be addressed by the DOE-EM sponsored CBP software tools. Modification of the existing tools can provide many opportunities to bring defense in depth in prediction of the performance of cementitious barriers over time. (authors)« less

Stakeholder Perspectives on Workplace Health Promotion: A Qualitative Study of Midsized Employers in Low-Wage Industries

PubMed Central

Hannon, Peggy A.; Hammerback, Kristen; Garson, Gayle; Harris, Jeffrey R.; Sopher, Carrie J.

2014-01-01

Purpose Study goals were to (1) describe stakeholder perceptions of workplace health promotion (WHP) appropriateness, (2) describe barriers and facilitators to implementing WHP, (3) learn the extent to which WHP programs are offered to workers’ spouses and partners and assess attitudes toward including partners in WHP programs, and (4) describe willingness to collaborate with nonprofit agencies to offer WHP. Design Five 1.5-hour focus groups. Setting The focus groups were conducted with representatives of midsized (100–999 workers) workplaces in the Seattle metropolitan area, Washington state. Subjects Thirty-four human resources professionals in charge of WHP programs and policies from five low-wage industries: accommodation/food services, manufacturing, health care/social assistance, education, and retail trade. Measures A semistructured discussion guide. Analysis Qualitative analysis of focus group transcripts using grounded theory to identify themes. Results Most participants viewed WHP as appropriate, but many expressed reservations about intruding in workers’ personal lives. Barriers to implementing WHP included cost, time, logistical challenges, and unsupportive culture. Participants saw value in extending WHP programs to workers’ partners, but were unsure how to do so. Most were willing to work with nonprofit agencies to offer WHP. Conclusion Midsized, low-wage employers face significant barriers to implementing WHP; to reach these employers and their workers, nonprofit agencies and WHP vendors need to offer WHP programs that are inexpensive, turnkey, and easy to adapt. PMID:23113780

Stakeholder perspectives on workplace health promotion: a qualitative study of midsized employers in low-wage industries.

PubMed

Hannon, Peggy A; Hammerback, Kristen; Garson, Gayle; Harris, Jeffrey R; Sopher, Carrie J

2012-01-01

Study goals were to (1) describe stakeholder perceptions of workplace health promotion (WHP) appropriateness, (2) describe barriers and facilitators to implementing WHP, (3) learn the extent to which WHP programs are offered to workers' spouses and partners and assess attitudes toward including partners in WHP programs, and (4) describe willingness to collaborate with nonprofit agencies to offer WHP. Five 1.5-hour focus groups. The focus groups were conducted with representatives of midsized (100-999 workers) workplaces in the Seattle metropolitan area, Washington state. Thirty-four human resources professionals in charge of WHP programs and policies from five low-wage industries: accommodation/food services, manufacturing, health care/social assistance, education, and retail trade. A semistructured discussion guide. Qualitative analysis of focus group transcripts using grounded theory to identify themes. Most participants viewed WHP as appropriate, but many expressed reservations about intruding in workers' personal lives. Barriers to implementing WHP included cost, time, logistical challenges, and unsupportive culture. Participants saw value in extending WHP programs to workers' partners, but were unsure how to do so. Most were willing to work with nonprofit agencies to offer WHP. Midsized, low-wage employers face significant barriers to implementing WHP; to reach these employers and their workers, nonprofit agencies and WHP vendors need to offer WHP programs that are inexpensive, turnkey, and easy to adapt.

Understanding barriers to implementing quality lunch and nutrition education.

PubMed

Cho, Hyunyi; Nadow, Michelle Zbell

2004-10-01

Food services and nutrition education are priorities for the Coordinated School Health Program in Massachusetts, which is a CDC funded partnership between the Massachusetts Departments of Education and Public Health. Despite funding and resources provided by governmental and non-governmental agencies, schools are facing barriers in effectively creating a healthy nutritional environment. A qualitative survey was conducted to understand barriers to implementing quality lunch and nutrition education programs perceived by superintendents, principals, food service directors, nurses, and health educators in Massachusetts. The results suggest that while funding can initially enable schools to provide quality lunch, but without changes in students' preference for unhealthy food and parental and community involvement in fostering students' healthy eating behavior, the lunch programs cannot achieve a sustainable success. Lack of opportunity for communication among food service staff, health educators, and teachers appears to hinder the coordination necessary to promote school lunch as well as school-wide nutrition education. Respondents acknowledged that the state's academic assessment system is the priority issue in their schools, but expressed that the interests and initiatives of superintendents and principals in the lunch and nutrition education programs can be enhanced. Overall, the results suggest that successful implementation of quality lunch and nutrition education programs require not only the collaborative efforts of school administration and staff but also the support of parents, community, and the mass media.

Benefits, barriers, and intentions/desires of nurses related to distance learning in rural island communities.

PubMed

Kataoka-Yahiro, Merle R; Richardson, Karol; Mobley, Joseph

2011-03-01

This study assessed distance learning needs among nurses on the Neighbor Islands in Hawaii. An exploratory study was conducted using a descriptive qualitative design. Of the 37 nurses who completed the study, 7 were nurse administrators and 30 were staff nurses. There were 18 focus groups of nurses recruited from six public hospitals on the Neighbor Islands. Three major themes related to distance learning emerged in this study: benefits, barriers, and intentions/desires. Each major theme had several linkages to categories and subcategories. Overall findings were as follows: (1) cost was mentioned more often in three major thematic areas (benefit, barriers, and intentions/desires); (2) the need to revisit and address current curriculum approaches and practices in distance learning programs was identified; and (3) strong recommendations were made for programs and organizational support for distance learning in hospital settings. These findings have implications for nursing research, education, and practice. Copyright 2011, SLACK Incorporated.

Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training.

PubMed

Kogan, Jennifer R; Conforti, Lisa N; Yamazaki, Kenji; Iobst, William; Holmboe, Eric S

2017-03-01

Faculty development for clinical faculty who assess trainees is necessary to improve assessment quality and impor tant for competency-based education. Little is known about what faculty plan to do differently after training. This study explored the changes faculty intended to make after workplace-based assessment rater training, their ability to implement change, predictors of change, and barriers encountered. In 2012, 45 outpatient internal medicine faculty preceptors (who supervised residents) from 26 institutions participated in rater training. They completed a commitment to change form listing up to five commitments and ranked (on a 1-5 scale) their motivation for and anticipated difficulty implementing each change. Three months later, participants were interviewed about their ability to implement change and barriers encountered. The authors used logistic regression to examine predictors of change. Of 191 total commitments, the most common commitments focused on what faculty would change about their own teaching (57%) and increasing direct observation (31%). Of the 183 commitments for which follow-up data were available, 39% were fully implemented, 40% were partially implemented, and 20% were not implemented. Lack of time/competing priorities was the most commonly cited barrier. Higher initial motivation (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.14, 3.57) predicted change. As anticipated difficulty increased, implementation became less likely (OR 0.67; 95% CI 0.49, 0.93). While higher baseline motivation predicted change, multiple system-level barriers undermined ability to implement change. Rater-training faculty development programs should address how faculty motivation and organizational barriers interact and influence ability to change.

Managing distress in oncology patients: description of an innovative online educational program for nurses.

PubMed

Pasacreta, Jeannie V; Kenefick, Amy L; McCorkle, Ruth

2008-01-01

The American Psychosocial Oncology Society and the Individual Cancer Assistance Network have launched the online continuing education accredited program "ICAN: Distress Management for Oncology Nursing" to address the ability of oncology nurses to assess, treat, and refer patients with a range of psychosocial problems. An important goal of the program is to reduce traditional barriers to psychosocial oncology education by providing the oncology nursing community with easy access to information from experts in the field. There are 4 Internet webcasts: Nurse's Role in Recognizing Distress in Patients and Caregivers; Assessment Recommendations; Treatment Strategies; and Principles and Guidelines for Psychotherapy and Referral. The program examines the prevalence and dimensions of patient distress and offers instruction on how to effectively integrate screening tools, such as the Distress Thermometer and Problem Check List, into clinical practice. It provides details on relevant interventions and referral algorithms based on the National Comprehensive Cancer Network Guidelines for Distress Management. It explores the devastating impact of psychological distress on quality of life, and the unique position of nurses in busy inpatient settings, outpatient clinics, and offices to detect, intervene, and refer to appropriate services. Providing information over the Internet addresses common barriers to learning, including schedule and time constraints.

A controlled investigation of continuing pain education for long-term care staff

PubMed Central

Ghandehari, Omeed O; Hadjistavropoulos, Thomas; Williams, Jaime; Thorpe, Lilian; Alfano, Dennis P; Bello-Haas, Vanina Dal; Malloy, David C; Martin, Ronald R; Rahaman, Omar; Zwakhalen, Sandra MG; Carleton, R Nicholas; Hunter, Paulette V; Lix, Lisa M

2013-01-01

BACKGROUND: The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. OBJECTIVES: To investigate the effectiveness of an expert-based continuing education program in pain assessment/management for LTC staff. METHODS: Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes/beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. RESULTS: Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. CONCLUSIONS: Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers. PMID:23457681

Implementation of an ergonomics intervention in a Swedish flight baggage handling company—A process evaluation

PubMed Central

Mathiassen, Svend Erik; Larsson, Johan; Kwak, Lydia

2018-01-01

Objective To conduct a process evaluation of the implementation of an ergonomics training program aimed at increasing the use of loading assist devices in flight baggage handling. Methods Feasibility related to the process items recruitment, reach, context, dose delivered (training time and content); dose received (participants’ engagement); satisfaction with training; intermediate outcomes (skills, confidence and behaviors); and barriers and facilitators of the training intervention were assessed by qualitative and quantitative methods. Results Implementation proved successful regarding dose delivered, dose received and satisfaction. Confidence among participants in the training program in using and talking about devices, observed use of devices among colleagues, and internal feedback on work behavior increased significantly (p<0.01). Main facilitators were self-efficacy, motivation, and perceived utility of training among the trainees. Barriers included lack of peer support, opportunities to observe and practice behaviors, and follow-up activities; as well as staff reduction and job insecurity. Conclusions In identifying important barriers and facilitators for a successful outcome, this study can help supporting the effectiveness of future interventions. Our results suggest that barriers caused by organizational changes may likely be alleviated by recruiting motivated trainees and securing strong organizational support for the implementation. PMID:29513671

Perceptions and Motivations to Prevent Heart Disease among Puerto Ricans

PubMed Central

Mattei, Josiemer; Mendez, Jacqueline; Falcon, Luis M.; Tucker, Katherine L.

2016-01-01

Objectives We performed a qualitative assessment of Puerto Ricans’ knowledge and perceptions of cardiovascular disease (CVD), and motivations/barriers and preferences to participate in community/ clinical programs for CVD-prevention. Methods Four guided focus group discussions were conducted on a total of 24 Puerto Ricans, aged 40–60 years in Boston, MA. Results Participants were aware of CVD, but less knowledgeable about its prevention. They perceived it as serious, and either had CVD or knew someone who had it. They favored education and activities on nutrition, exercise, clinical advice, and social interaction, in weekly/ biweekly small-group sessions with other Latinos, led in Spanish by a familiar health professional, in a convenient community location. Age- and culture-specific program content and educational materials were preferred. A theme emerged on ‘personal or family motivations’ such as to become healthier and live longer so they would feel better and support their families, or to learn about CVD-prevention. Main barriers included family obligations, weather, safety concerns, transportation, and depressive mood. Conclusions Culturally-tailored CVD-prevention programs for Puerto Ricans should include multiple behavioral and social approaches, and draw on intrinsic motivators while reducing barriers to help enhance efficacy and sustainability. PMID:27103411

Low-voltage high-speed programming gate-all-around floating gate memory cell with tunnel barrier engineering

NASA Astrophysics Data System (ADS)

Hamzah, Afiq; Ezaila Alias, N.; Ismail, Razali

2018-06-01

The aim of this study is to investigate the memory performances of gate-all-around floating gate (GAA-FG) memory cell implementing engineered tunnel barrier concept of variable oxide thickness (VARIOT) of low-k/high-k for several high-k (i.e., Si3N4, Al2O3, HfO2, and ZrO2) with low-k SiO2 using three-dimensional (3D) simulator Silvaco ATLAS. The simulation work is conducted by initially determining the optimized thickness of low-k/high-k barrier-stacked and extracting their Fowler–Nordheim (FN) coefficients. Based on the optimized parameters the device performances of GAA-FG for fast program operation and data retention are assessed using benchmark set by 6 and 8 nm SiO2 tunnel layer respectively. The programming speed has been improved and wide memory window with 30% increment from conventional SiO2 has been obtained using SiO2/Al2O3 tunnel layer due to its thin low-k dielectric thickness. Furthermore, given its high band edges only 1% of charge-loss is expected after 10 years of ‑3.6/3.6 V gate stress.

Policies and Opportunities for Physical Activity in Middle School Environments

ERIC Educational Resources Information Center

Young, Deborah R.; Felton, Gwen M.; Grieser, Mira; Elder, John P.; Johnson, Carolyn; Lee, Jung-Sun; Kubik, Martha Y.

2007-01-01

Background: This study examined physical activity opportunities and barriers at 36 geographically diverse middle schools participating in the Trial of Activity for Adolescent Girls. Methods: Principals, physical education and health education department heads, and program leaders were interviewed to assess policies and instructional practices that…

Determination of minimum height and lateral design load for MASH test level 4 bridge rails.

DOT National Transportation Integrated Search

2011-12-01

The Manual for Assessing Safety Hardware (MASH) prescribes higher design vehicle impact speed and mass for test level 4 barriers compared to its predecessor National Cooperative Highway Research Program (NCHRP) Report 350. This has resulted in a 56 p...

State laws related to billing third parties for healthcare services at public STD clinics in the United States.

PubMed

Cramer, Ryan; Loosier, Penny S; Krasner, Andee; Kawatu, Jennifer

2018-02-07

Health departments (HDs) cite state laws as barriers to billing third parties for sexually transmitted disease (STD) services, but the association between legal/policy barriers and third party HD billing has not been examined. This study investigates the relationship between laws that may limit HDs' ability to bill, clinic perceptions of billing barriers, and billing practices. Two surveys (1) clinic managers [N=246], 2) STD program managers [N=63]) conducted via a multi-regional needs assessment of federally funded HD clinics' capacity to bill for STD services, billing/reimbursement practices, and perceived barriers were combined with an analysis of state laws regarding third party billing for STD services. Statistical analyses examined relationships between laws that may limit HDs' ability to bill, clinic perceptions, and billing practices. Clinic managers reported clinics were less likely to bill Medicaid and other third parties in jurisdictions with a state law limiting their ability to bill compared to respondents who billed neither or one payer (OR=0.31, CI=0.10,0.97) and cited practical concerns as a primary barrier to billing (OR=2.83 CI=1.50,5.37). STD program managers' reports that staff believed STD services should be free (OR=0.34, CI=0.13, 0.90) was associated with not billing (not sure versus no resistance to billing); confidentiality concerns was not a reported barrier to billing among either sample. Practical concerns and clinic staff beliefs that STD services should be free emerged as possible barriers to billing, and laws less so. Attempts to initiate HD billing for STD services may benefit from staff education as well as addressing perceived legal barriers and staff concerns.

Barriers to health care contribute to delays in follow-up among women with abnormal cancer screening: Data from the Patient Navigation Research Program.

PubMed

Ramachandran, Ambili; Snyder, Frederick R; Katz, Mira L; Darnell, Julie S; Dudley, Donald J; Patierno, Steven R; Sanders, Mechelle R; Valverde, Patricia A; Simon, Melissa A; Warren-Mears, Victoria; Battaglia, Tracy A

2015-11-15

There is limited understanding of the association between barriers to care and clinical outcomes within patient navigation programs. Secondary analyses of data from the intervention arms of the Patient Navigation Research Program were performed, which included navigated participants with abnormal breast and cervical cancer screening tests from 2007 to 2010. Independent variables were: 1) the number of unique barriers to care (0, 1, 2, or ≥3) documented during patient navigation encounters; and 2) the presence of socio-legal barriers originating from social policy (yes/no). The median time to diagnostic resolution of index screening abnormalities was estimated using Kaplan-Meier cumulative incidence curves. Multivariable Cox proportional hazards regression examined the impact of barriers on time to resolution, controlling for sociodemographics and stratifying by study center. Among 2600 breast screening participants, approximately 75% had barriers to care documented (25% had 1 barrier, 16% had 2 barriers, and 34% had ≥3 barriers). Among 1387 cervical screening participants, greater than one-half had barriers documented (31% had 1 barrier, 11% had 2 barriers, and 13% had ≥3 barriers). Among breast screening participants, the presence of barriers was associated with less timely resolution for any number of barriers compared with no barriers. Among cervical screening participants, only the presence of ≥2 barriers was found to be associated with less timely resolution. Both types of barriers, socio-legal and other barriers, were found to be associated with delay among breast and cervical screening participants. Navigated women with barriers resolved cancer screening abnormalities at a slower rate compared with navigated women with no barriers. Further innovations in navigation care are necessary to maximize the impact of patient navigation programs nationwide. © 2015 American Cancer Society.

Barriers to healthcare contribute to delays in follow-up among women with abnormal cancer screening: data from the Patient Navigation Research Program

PubMed Central

Ramachandran, Ambili; Snyder, Frederick; Katz, Mira L.; Darnell, Julie; Dudley, Donald; Patierno, Steven R.; Sanders, Mechelle R; Valverde, Patricia A; Simon, Melissa A; Warren-Mears, Victoria; Battaglia, Tracy A.

2015-01-01

Background There is limited understanding of the association between barriers to care and clinical outcomes within patient navigation programs. Methods Secondary analyses of data from the intervention arms of the Patient Navigation Research Program (PNRP), including navigated participants with abnormal breast and cervical cancer screening tests from 2007 to 2010. Independent variables were (a) number of unique barriers to care (0, 1, 2, or 3+) documented during patient navigation encounters and (b) presence of socio-legal barriers originating from social policy (yes/no). Median time to diagnostic resolution of index screening abnormalities was estimated using Kaplan-Meier cumulative incidence curves. Multivariable Cox proportional hazards regression examined the impact of barriers on time to resolution, controlling for socio-demographics and stratifying by study center. Results Among 2600 breast participants, three-quarters had barriers to care (25% 1 barrier, 16% 2 barriers and 34% 3+ barriers). Among 1387 cervical participants, more than half had barriers (31% 1 barrier, 11% 2 barriers, and 13% 3+ barriers). Among breast participants, the presence of barriers was associated with less timely resolution for any number of barriers compared to no barriers. Among cervical participants, only the presence of 2 or more barriers was associated with less timely resolution. Both types of barriers, socio-legal and other barriers, were associated with delay among breast and cervical participants. Conclusions Navigated women with barriers resolve cancer screening abnormalities at a slower rate compared to navigated women with no barriers. Further innovations in navigation care are necessary to maximize the impact of patient navigation programs nationwide. PMID:26385420

Measuring the barriers against seeking consultation for urinary incontinence among Middle Eastern women

PubMed Central

2010-01-01

Background Existing questionnaires to assess barriers against consultation for urinary incontinence (UI) are not appropriate for use in the Middle East culture. The aim of this study was to explore barriers against seeking help for UI and introducing a questionnaire that assess these barriers among those women. This is important before proceeding to any educational programs or having interval clinical audits to help incontinent women. Methods 1- Screening for UI. Women - aged 20 years and older, attending the outpatient Urology and Gynaecology clinics were invited to participate and interviewed by a research nurse. The UDI-6 was administered to assess the presence and type of UI. Women with UI as their chief complaint were excluded. 2- Interviewing study subjects for possible barriers. Subjects who had UI - as determined by the UDI-6-were first asked an open question "what prevented you from seeking medical consultation for urine leakage?"." They were then asked the proposed questions to assess possible barriers. We developed a preliminary questionnaire based on a review of reasons for not seeking incontinence care from the literature and the response of UI sufferers to the open question in this study. The questionnaire was modified many times to reach this final form. 3- Pilot Study to assess characteristics of the questionnaire. Validity and reliability of the final version of the questionnaire were assessed in a small pilot study including 36 women who completed questionnaire at initial visit and again after 2 weeks. Results Of the 1231 subjects who agreed to participate in the study, 348 reported having UI. About 80% of incontinent women have never sought medical advice. Factors significantly associated with seeking help were husband encouragement, prayer affection and having severe UI. Common barriers were embarrassment and assuming UI as a normal part of aging. A pilot study included 36 women to assess the psychometric properties of the questionnaire after modifying it. The number of missing or not interpretable responses per item ranged from 2.2% to 8.7%. Internal consistency of the items was good. The test-retest reliability of individual items of the questionnaire was variable, with weighted kappa statistics ranging from 0.32 to 0.94 (median, 0.76, p 0.000). Conclusions Preliminary data on our proposed questionnaire show that it is an easy to administer, stable and suits the Middle Eastern culture. PMID:20105307

Measuring the barriers against seeking consultation for urinary incontinence among Middle Eastern women.

PubMed

El-Azab, Ahmed S; Shaaban, Omar M

2010-01-27

Existing questionnaires to assess barriers against consultation for urinary incontinence (UI) are not appropriate for use in the Middle East culture. The aim of this study was to explore barriers against seeking help for UI and introducing a questionnaire that assess these barriers among those women. This is important before proceeding to any educational programs or having interval clinical audits to help incontinent women. 1- Screening for UI. Women - aged 20 years and older, attending the outpatient Urology and Gynaecology clinics were invited to participate and interviewed by a research nurse. The UDI-6 was administered to assess the presence and type of UI. Women with UI as their chief complaint were excluded. 2- Interviewing study subjects for possible barriers. Subjects who had UI - as determined by the UDI-6-were first asked an open question "what prevented you from seeking medical consultation for urine leakage?"." They were then asked the proposed questions to assess possible barriers. We developed a preliminary questionnaire based on a review of reasons for not seeking incontinence care from the literature and the response of UI sufferers to the open question in this study. The questionnaire was modified many times to reach this final form. 3- Pilot Study to assess characteristics of the questionnaire. Validity and reliability of the final version of the questionnaire were assessed in a small pilot study including 36 women who completed questionnaire at initial visit and again after 2 weeks. Of the 1231 subjects who agreed to participate in the study, 348 reported having UI. About 80% of incontinent women have never sought medical advice. Factors significantly associated with seeking help were husband encouragement, prayer affection and having severe UI. Common barriers were embarrassment and assuming UI as a normal part of aging. A pilot study included 36 women to assess the psychometric properties of the questionnaire after modifying it. The number of missing or not interpretable responses per item ranged from 2.2% to 8.7%. Internal consistency of the items was good. The test-retest reliability of individual items of the questionnaire was variable, with weighted kappa statistics ranging from 0.32 to 0.94 (median, 0.76, p 0.000). Preliminary data on our proposed questionnaire show that it is an easy to administer, stable and suits the Middle Eastern culture.

Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru.

PubMed

LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Rodriguez Castro, Manuel J A; Valderrama, Roberto; Isquith-Dicker, Leah N; Herrera-Matta, Jaime; Mock, Charles N

2017-04-01

Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited. This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru. Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices. A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.

Perceived Exercise Self-Efficacy, Benefits and Barriers, and Commitment to a Plan for Exercise among Jordanians with Chronic Illnesses.

PubMed

Darawad, Muhammad W; Khalil, Amani A; Hamdan-Mansour, Ayman M; Nofal, Basema M

2016-11-01

To explore Jordanian chronic illnesses patients' perceived exercise self-efficacy, benefits and barriers, and commitment to exercise planning, and to assess the relationship between those variables. Descriptive cross-sectional design. Data were collected from a convenience sample of 402 outpatient Jordanians with chronic illnesses, using Exercise Self-Efficacy Scale, Exercise Benefits and Barriers Scale, and Commitment to a Plan for Exercise Scale. The average BMI was 28.3, and exercise period 3.2 hours/ week. Participants reported moderate perceived self-efficacy (M= 47.5%, SD= 11.7), commitment to exercise planning (M=2.0/3, SD=0.3), exercise barriers (M=2.4/4, SD=0.3), and benefits (M=2.3/4, SD=0.3). Commitment to exercise planning had a significant correlation with barriers (r=0.11) and benefits (r=0.10). Self-efficacy was not found to correlate with other variables. Even though participants reported higher perceived self-efficacy and commitment to exercise plan than that reported in literature, they were found to be overweight and inactive, which indicates the importance of such study. Exercise education programs are needed taking into considerations patients' individual differences. However, the broad grouping of diseases may not produce a homogenous sample, for which disease categories are recommended in future studies. Patients with chronic illness need more encouragement to engage themselves in exercise practices. Exercise educational program for patients with chronic illnesses should consider patients' reported exercise benefits and barriers. © 2014 Association of Rehabilitation Nurses.

Motivators and Barriers to Participation of Ethnic Minority Families in a Family-Based HIV Prevention Program

PubMed Central

Pinto, Rogério M.; McKay, Mary M.; Baptiste, Donna; Bell, Carl C.; Madison-Boyd, Sybil; Paikoff, Roberta; Wilson, Marla; Phillips, Daisy

2010-01-01

SUMMARY Involving low-income, ethnic minority families in lengthy HIV prevention programs can be challenging. Understanding the motivators and barriers to involvement may help researchers and practitioners design programs that can be used by populations most at risk for HIV exposure. The present study discusses motivators and barriers to involvement in the Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP), using data from a sample of 118 families that participated at varying levels in the twelve sessions of the program. Most participants chose motivators that reflect their perceptions of individual and/or family needs (“CHAMP might help me, mine, and other families”), and of characteristics of the program, such as CHAMP staff were friendly, CHAMP was fun. Among barriers to involvement, respondents expressed concerns about confidentiality, and about being judged by program staff. Respondents also reported experiencing many stressful events in their families (e.g., death and violence in the family) that may have been barriers to their involvement. Knowing these motivators and barriers, researchers and practitioners can enhance involvement in HIV prevention programs. PMID:20686648

Motivators and Barriers to Participation of Ethnic Minority Families in a Family-Based HIV Prevention Program.

PubMed

Pinto, Rogério M; McKay, Mary M; Baptiste, Donna; Bell, Carl C; Madison-Boyd, Sybil; Paikoff, Roberta; Wilson, Marla; Phillips, Daisy

2007-05-01

Involving low-income, ethnic minority families in lengthy HIV prevention programs can be challenging. Understanding the motivators and barriers to involvement may help researchers and practitioners design programs that can be used by populations most at risk for HIV exposure. The present study discusses motivators and barriers to involvement in the Collaborative HIV Prevention and Adolescent Mental Health Project (CHAMP), using data from a sample of 118 families that participated at varying levels in the twelve sessions of the program. Most participants chose motivators that reflect their perceptions of individual and/or family needs ("CHAMP might help me, mine, and other families"), and of characteristics of the program, such as CHAMP staff were friendly, CHAMP was fun. Among barriers to involvement, respondents expressed concerns about confidentiality, and about being judged by program staff. Respondents also reported experiencing many stressful events in their families (e.g., death and violence in the family) that may have been barriers to their involvement. Knowing these motivators and barriers, researchers and practitioners can enhance involvement in HIV prevention programs.

Pre- and posttest evaluation of a breast cancer risk assessment program for nurse practitioners.

PubMed

Edwards, Quannetta T; Seibert, Diane

2010-07-01

Numerous studies have shown that healthcare providers, including nurse practitioners (NPs) fail to provide breast cancer risk assessment (BrCRA) in primary care settings. A potential barrier to the use of BrCRA is insufficient knowledge or training of risk assessment. The purpose of this study was to analyze the outcome of a BrCRA program developed to enhance NPs' knowledge of risk assessment and use of empiric risk assessment models. Thirty-five NPs participated in a before-after (pretest-posttest design) study evaluating the effectiveness of a BrCRA education program conducted at a national NP conference. Demographics, pre/post knowledge, and course satisfaction measures were all examined as a part of this pilot study. Continuing education through the implementation of a BrCRA program significantly increased NPs knowledge in assessing breast cancer risk and the use of empiric risk assessment models. Many healthcare providers, including NPs, are inadequately prepared to assess a woman's risk for breast cancer. Understanding breast cancer risk assessment is essential if NPs are to provide appropriate counseling, management, and referral strategies needed to reduce a woman's risk for developing the disease. Continuing education provides one means to enhance NP's knowledge of BrCRA.

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Pollution Prevention (P2) has evolved into one of DOE`s sprime strategies to meet environmental, fiscal, and worker safety obligations. P2 program planning, opportunity identification, and implementation tools were developed under the direction of the Waste Minimization Division (EM-334). Forty experts from EM, DP, ER and DOE subcontractors attended this 2-day workshop to formulate the incentives to drive utilization of these tools. Plenary and small working group sessions were held both days. Working Group 1 identified incentives to overcoming barriers in the area of P2 program planning and resource allocation. Working Group 2 identified mechanisms to drive the completion of P2more » assessments and generation of opportunities. Working Group 3 compiled and documented a broad range of potential P2 incentives that address fundamental barriers to implementation of cost effective opportunities.« less

Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools.

PubMed

Rajan, Sonali; Roberts, Katherine J; Guerra, Laura; Pirsch, Moira; Morrell, Ernest

2017-12-01

School-based health education efforts can positively affect health behaviors and learning outcomes; however, there is limited available time during the school day for separate health education classes. The purpose of this study was to assess the feasibility and sustainability of implementing a classroom-based health education program that integrates skill development with health learning. A wait-list control study design was conducted among 168 6th graders in 2 urban schools. Data on program implementation, feasibility, and health outcomes were collected from students at 3 time points and from 5 teachers across the implementation of the 10-week program. There were barriers to implementation, including time limitations, unexpected school-wide disruptions, and variations in student reading ability and teacher preparedness. However, analyses revealed there were significant increases in self-efficacy regarding fruit and vegetable consumption and outcome expectations following program implementation, which were also sustained post-program implementation. Despite inconsistent implementation in the wait-list control school, small gains were also noted following the completion of the program. Integrating health education efforts within core curricula classes can lead to favorable outcomes. However, implementation barriers must be actively addressed by schools and program developers to improve program fidelity and maximize the sustainability of program gains. © 2017, American School Health Association.

Continuing Education Preferences, Facilitators, and Barriers for Nursing Home Nurses.

PubMed

Dyck, Mary J; Kim, Myoung Jin

2018-01-01

The purpose of the study was to determine the continuing education needs for nursing home nurses in rural central Illinois and to determine any potential facilitators or barriers to obtaining continuing education. Data were collected using the Educational Needs Assessment questionnaire. Descriptive statistics were computed to examine continuing education preferences, facilitators, and barriers among nursing home nurses. Independent samples t tests were used to compare preferences between administrative and staff nurses. The sample included 317 nurses from 34 facilities. The five top needs were related to clinical problems. Administrative nurses had greater needs for professional issues, managerial skills, and quality improvement than staff nurses. Barriers included rural settings, need for vacation time for programs, and inadequate staffing. Continuing education needs of nursing home nurses in Illinois are similar to previous studies conducted in Arizona and North Carolina. Continuing education barriers were mostly organizational, rather than personal. J Contin Nurs Educ. 2018;49(1):26-33. Copyright 2018, SLACK Incorporated.

Possible Barriers to Enrollment in Substance Abuse Treatment among a Diverse Sample of Asian Americans and Pacific Islanders: Opinions of Treatment Clients

PubMed Central

Masson, Carmen L.; Shopshire, Michael S.; Sen, Soma; Hoffman, Kim; Hengl, Nicholas; Bartolome, John; McCarty, Dennis; Sorensen, James L.; Iguchi, Martin

2012-01-01

This mixed methods study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian American and Pacific Islander (AAPI) substance users. AAPI substance users (N = 61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment. Barriers included peer pressure, family influences, and face loss concerns. Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences and develop culturally competent substance abuse treatments for the AAPI population. PMID:22985677

Possible barriers to enrollment in substance abuse treatment among a diverse sample of Asian Americans and Pacific Islanders: opinions of treatment clients.

PubMed

Masson, Carmen L; Shopshire, Michael S; Sen, Soma; Hoffman, Kim A; Hengl, Nicholas S; Bartolome, John; McCarty, Dennis; Sorensen, James L; Iguchi, Martin Y

2013-03-01

This mixed methods study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian American and Pacific Islander (AAPI) substance users. AAPI substance users (N = 61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment. Barriers included peer pressure, family influences, and face loss concerns. Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences and develop culturally competent substance abuse treatments for the AAPI population. Copyright © 2013 Elsevier Inc. All rights reserved.

Rehabilitation Counselor Preparation for Working with Youth with Psychiatric Disabilities

ERIC Educational Resources Information Center

Mellin, Elizabeth A.; Hunt, Brandon; Lorenz, Dawn C.

2009-01-01

Faculty in CORE-accredited rehabilitation counseling programs (N = 46) were surveyed to assess preparation for work with youth with psychiatric disabilities and to identify barriers to developing and maintaining a specialization focused on this population within the curriculum. Although faculty reported that students enrolled in their programs…

Equal Employment Opportunity

Science.gov Websites

personnel decisions be made free of discrimination on the basis of race, color, religion, sex, national to take appropriate steps to ensure that all employment decisions are free from discrimination. It Rehabilitation Act programs, which include periodic agency self-assessments and the removal of barriers to free

Family Assessment Portfolios: A New Way to Jumpstart Family/School Collaboration

ERIC Educational Resources Information Center

Thompson, James R.; Meadan, Hedda; Fansler, Kenneth W.; Alber, Sarah B.; Balogh, Patricia A.

2007-01-01

Many parents and educators have questions before individualized education program (IEP) meetings. However, barriers to effective family/school partnership continue to exist, despite widespread consensus regarding the merits of a family-centered approach to providing services and supports, decades of research documenting positive outcomes from…

Transportation Energy Futures Series. Non-Cost Barriers to Consumer Adoption of New Light-Duty Vehicle Technologies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stephens, Thomas

2013-03-01

Consumer preferences are key to the adoption of new vehicle technologies. Barriers to consumer adoption include price and other obstacles, such as limited driving range and charging infrastructure; unfamiliarity with the technology and uncertainty about direct benefits; limited makes and models with the technology; reputation or perception of the technology; standardization issues; and regulations. For each of these non-cost barriers, this report estimates an effective cost and summarizes underlying influences on consumer preferences, approximate magnitude and relative severity, and assesses potential actions, based on a comprehensive literature review. While the report concludes that non-cost barriers are significant, effective cost andmore » potential market share are very uncertain. Policies and programs including opportunities for drivers to test drive advanced vehicles, general public outreach and information programs, incentives for providing charging and fueling infrastructure, and development of technology standards were examined for their ability to address barriers, but little quantitative data exists on the effectiveness of these measures. This is one in a series of reports produced as a result of the Transportation Energy Futures project, a Department of Energy-sponsored multi-agency effort to pinpoint underexplored strategies for reducing GHGs and petroleum dependence related to transportation. View all reports on the TEF Web page, http://www.eere.energy.gov/analysis/transportationenergyfutures/index.html.« less

Cosmetic dermatologic surgical training in US dermatology residency programs: identifying and overcoming barriers.

PubMed

Bauer, Bruce; Williams, Erin; Stratman, Erik J

2014-02-01

The public and other medical specialties expect dermatologists who offer cosmetic dermatology services to provide competent care. There are numerous barriers to achieving cosmetic dermatology competency during residency. Many dermatology residents enter the workforce planning to provide cosmetic services. If a training gap exists, this may adversely affect patient safety. To identify resources available for hands-on cosmetic dermatology training in US dermatology residency training programs and to assess program director (PD) attitudes toward cosmetic dermatology training during residency and strategies, including discounted pricing, used by training programs to overcome barriers related to resident-performed cosmetic dermatology procedures. An online survey in academic dermatology practices among PDs of US dermatology residency programs. Frequency of cosmetic dermatology devices and injectables used for dermatology resident hands-on cosmetic dermatology training, categorizing PD attitudes toward cosmetic dermatology training during residency and describing residency-related discounted pricing models. Responses from PDs were received from 53 of 114 (46%) US dermatology residency programs. All but 3 programs (94%) offered hands-on cosmetic dermatology training using botulinum toxin, and 47 of 53 (89%) provided training with hyaluronic acid fillers. Pulsed dye lasers represented the most common laser use experienced by residents (41 of 52 [79%]), followed by Q-switched Nd:YAG (30 of 52 [58%]). Discounted procedures were offered by 32 of 53 (60%) programs, with botulinum toxin (30 of 32 [94%]) and fillers (27 of 32 [84%]) most prevalent and with vascular lasers (17 of 32 [53%]) and hair removal lasers (12 of 32 [38%]) less common. Various discounting methods were used. Only 20 of 53 (38%) PDs believed that cosmetic dermatology should be a necessary aspect of residency training; 14 of 52 (27%) PDs thought that residents should not be required to perform any cosmetic dermatology procedures. Although almost every program provides hands-on cosmetic dermatology training, there are barriers to training, including patient preferences, costs of procedures and products, and PD attitudes toward cosmetic dermatology training. To promote patient safety, procedural competency is imperative.

Identifying real and perceived barriers to therapeutic education programs for individuals with inflammatory arthritis.

PubMed

Bain, Lorna; Sangrar, Ruheena; Bornstein, Carolyn; Lukmanji, Sara; Hapuhennedige, Sandani; Thorne, Carter; Beattie, Karen A

2016-09-01

Therapeutic Education Programs (TEPs) grounded in self-management principles have been shown to improve quality of life of patients with chronic conditions and reduce patient-related healthcare costs. Though these programs are becoming more readily available, patients often experience barriers in participating. This study sought to identify barriers faced by inflammatory arthritis (IA) patients in attending a TEP and understand how patients overcame perceived barriers. A mixed-method study design was used. Questionnaires were distributed to individuals with IA who were invited to attend a TEP between 2010 and 2013. Respondents were those that chose not to attend (group A), individuals who attended ≤4 of 10 sessions (group B), individuals who attended ≥5 of 10 sessions prior to May 2013 (group C), and individuals who attended ≥5 of 10 sessions from June 2013 to November 2013 (group D). Individuals in group D were also invited to participate in focus groups to discuss how they had overcome perceived barriers. Real barriers identified by individuals in groups A and B included time, distance, and cost associated with attendance. Individuals who overcame perceived barriers (groups C and D) discussed strategies they used to do so. Aspects of the overall program experience and access to clinic and program also contributed to patients being able to overcome barriers. Time, distance, and cost are external barriers that prevented individuals from utilizing self-management education opportunities. These barriers were overcome if and when individuals had resources available to them. Readiness for behavior change also influenced commitment to participate in the program.

Gender Differences in the Perceived Needs and Barriers of Youth Offenders Preparing for Community Reentry

PubMed Central

Abrams, Laura S.

2010-01-01

This study explored how gender differences may influence the community reentry experiences of incarcerated youth. Structured surveys assessing risk factors for re-offending, perceived reentry needs, and anticipated barriers to meeting these needs were administered to a convenience sample of males (n = 36) and females (n = 35) who were within 60 days of release from two probation camps in Southern California. Bivariate analyses found significant gender differences in prior risk factors, educational aspirations, expressed mental health needs, anticipated use of services, and reentry concerns. Minimal gender differences were detected in perceived employment needs and barriers and self-efficacy to avoid recidivism. The findings support the need for gender-specific reentry programming in some key areas and also draw attention to the importance of removing barriers to successful reentry for all incarcerated youth. PMID:20730108

Challenges Facing Successful Scaling Up of Effective Screening for Cardiovascular Disease by Community Health Workers in Mexico and South Africa: Policy Implications.

PubMed

S, Abrahams-Gessel; Denman, C A; Ta, Gaziano; Ns, Levitt; T, Puoane

The integration of community health workers (CHWs) into primary and secondary prevention functions in health programs and services delivery in Mexico and South Africa has been demonstrated to be effective. Task-sharing related to adherence and treatment, from nurses to CHWs, has also been effectively demonstrated in these areas. HIV/AIDS and TB programs in South Africa have seen similar successes in task-sharing with CHWs in the areas of screening for risk and adherence to treatment. In the area of non-communicable diseases (NCDs), there is a policy commitment to integrating CHWs into primary health care programs at public health facilities in both Mexico and South Africa in the areas of reproductive health and infant health. Yet current programs utilizing CHWs are not integrated into existing primary health care services in a comprehensive manner for primary and secondary prevention of NCDs. In a recently completed study, CHWs were trained to perform the basic diagnostic function of primary screening to assess the risk of suffering a CVD-related event in the community using a non-laboratory risk assessment tool and referring persons at moderate to high risk to local government clinics, for further assessment and management by a nurse or physician. In this paper we compare the experience with this CVD screening study to successful programs in vaccination, reproductive health, HIV/AIDS, and TB specifically to identify the barriers we identified as limitations to replicating these programs in the area of CVD diagnosis and management. We review barriers impacting the effective translation of policy into practice, including scale up issues; training and certification issues; integrating CHW to existing primary care teams and health system; funding and resource gaps. Finally, we suggest policy recommendations to replicate the demonstrated success of programs utilizing task-sharing with CHWs in infectious diseases and reproductive health, to integrated programs in NCD.

Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions.

PubMed

Corriero, Rosemary; Redmon, Ginger

Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients. Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers. This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers. Thirty-eight state immunization programs. Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems. Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.

High Disparity Between Orthopedic Resident Interest and Participation in International Health Electives.

PubMed

Zhang, Steven; Shultz, Paul; Daniels, Alan; Ackelman, Edward; Kamal, Robin N

2016-07-01

Few orthopedic surgical residency programs offer international health electives (IHEs). Efforts to expand these programs have been increasing across medical disciplines. Whether orthopedic residents will participate remains unknown. This study quantified and characterized orthopedic resident interest and barriers to IHEs in US residency programs. A web-based survey was administered to residents from 154 US orthopedic residency programs accredited by the Accreditation Council for Graduate Medical Education 2014 to 2015. Questions assessed demographics and program background, previous medical experience abroad, barriers to participation, and level of interest in participating in an international health elective during their training and beyond. Twenty-seven (17.5%) residency programs responded. Chi-square analysis showed that residents who expressed interest in participating were significantly more likely to have experience abroad compared with those who expressed no interest (P<.004). Analysis using Mann-Whitney U test suggested that those who expressed interest were more likely to believe IHEs are important to resident training (P<.0011; mean Likert scale score of 3.7 vs 2.6), provide valuable experience (P<.001; mean Likert scale score of 4.2 vs 3.2), and should be required for orthopedic residencies (P<.001; mean Likert scale score of 2.8 vs 1.9). Residents are strongly interested in participating in IHEs during their training, and many may integrate global health into future practices. Residents perceive lack of funding and scheduling flexibility as barriers preventing them from participating. Prior experience abroad influences level of interest, and international clinical experience may enhance future perception of its value. [Orthopedics. 2016; 39(4):e680-e686.]. Copyright 2016, SLACK Incorporated.

Counselor Assessments of Training and Adoption Barriers

PubMed Central

Bartholomew, Norma G.; Joe, George W.; Rowan-Szal, Grace A.; Simpson, D. Dwayne

2007-01-01

The prevailing emphasis on adoption of evidence-based practices suggests more focused training evaluations are needed that capture factors in clinician decisions to use new techniques. This includes relationships of post-conference evaluations with subsequent adoption of training materials. Training assessments were therefore collected at two time points from substance abuse treatment counselors who attended training on dual diagnosis and on therapeutic alliance as part of a state-sponsored conference. Customized evaluations were collected to assess counselor perceptions of training quality, relevance, and resources in relation to its utilization during the 6 months following the conference. Higher ratings for relevance of training concepts and materials to service needs of clients, desire to have additional training, and level of program support were each related to greater trial usage during the follow-up period. Primary resource-related and procedural barriers cited by counselors included lack of time and redundancy with existing practices. PMID:17434707

Development of the Motivators of and Barriers to Health-Smart Behaviors Inventory.

PubMed

Tucker, Carolyn M; Rice, Kenneth G; Hou, Wei; Kaye, Lillian B; Nolan, Sarah E M; Grandoit, Delphia J; Gonzales, Lucia; Smith, Mary B; Desmond, Frederic F

2011-06-01

The Motivators of and Barriers to Health-Smart Behaviors Inventory (MB-HSBI) was developed for use in identifying self-reported motivators of and barriers to the following health-promoting behaviors (called health-smart behaviors) that should occur daily to help promote health and overcome illnesses/diseases: eating a healthy breakfast, eating healthy foods and snacks, drinking healthy drinks, and engaging in physical activity. The MB-HSBI was developed through several phases as part of a multisite study on modifying and preventing obesity. A central aspect of the larger study was to identify motivators of and barriers to the targeted health-smart behaviors among African American, Asian, Hispanic, and White adults. After establishing content validity and preliminary pilot testing, the MB-HSBI was administered to a national sample of 926 culturally diverse adults. Factor analyses and most of the internal consistency results supported multiple scales and subscales measuring motivators of and barriers to each of the targeted health-smart behavior domains. Scores correlated in expected directions with health self-efficacy and with importance of health-related behavioral goals. Pending further psychometric support of the MB-HSBI, this inventory or selected scales from it may serve as flexible and novel tools for (a) assessing motivators of and barriers to health-smart behaviors in community and clinical health promotion research studies and (b) developing assessment-based, culturally sensitive intervention programs that are customized to address the motivators of and barriers to health-smart behaviors identified in target communities, particularly those communities whose members are mostly racial/ethnic minorities and/or have low family incomes. 2011 APA, all rights reserved

A state-of-practice survey of policy, plan, and program assessment in Canadian provinces

DOE Office of Scientific and Technical Information (OSTI.GOV)

Noble, Bram F

2004-04-01

Since the introduction of the 1999 Canadian Cabinet Directive on the environmental assessment of policies, plans, and programs (PPPs), higher-order environmental assessment has been receiving increased attention in Canada. However, while practices and systems are advancing at the federal level, there has been very little attention given to recent developments in PPP assessment at the provincial level. This paper presents the results of a Canada-wide survey of PPP assessment principles and practices in 10 Canadian provincial EA jurisdictions. The findings indicate that there exists considerable variability in the provisions for and practice of PPP assessment amongst Canadian provinces, with onlymore » Saskatchewan, Ontario, and Quebec identifying recent practice experience. Included amongst the main barriers to effective implementation at the provincial level are the lack of legislative requirements for strategic EA, and the limited understanding of the nature and benefits of higher-order impact assessment.« less

Effect of gender on awareness of cardiovascular risk factors, preventive action taken, and barriers to cardiovascular health in a group of Austrian subjects.

PubMed

Haidinger, Teresa; Zweimüller, Martin; Stütz, Lena; Demir, Dondue; Kaider, Alexandra; Strametz-Juranek, Jeanette

2012-04-01

The incidence of cardiovascular disease (CVD) is increasing in industrialized countries. Preventive action is an important factor in minimizing CVD-associated morbidity and mortality. However, it is not known whether gender differences affect CVD or risk factor awareness influencing self-assessment of personal risk and preventive action. This study was performed to assess individual CVD and risk factor awareness, preventive action taken, and barriers to cardiovascular health. The study included 573 women and 336 men, randomly chosen to complete an anonymous questionnaire to assess individual CVD and risk factor awareness, preventive action taken, and barriers to cardiovascular health. The data were analyzed using SAS software. Cardiovascular disease was identified in 75% of patients, in both sexes, as the leading cause of death; however, both groups showed significant lack of knowledge about CVD risk factors. Type 2 diabetes was identified correctly in only 27.5%. Preventive action was linked more often to family members in 66.5% of women and 62.8% of men. The primary barrier to cardiovascular health in adults was incorrect assessment of personal CVD risk. More than half of female respondents (56.4%) and male respondents (52.7%) underestimated their risk of CVD. Knowledge about risk factors for CVD needs to be improved in members of both sexes. Because women, in particular, have difficulty in correctly assessing their personal CVD risk, future education programs are warranted to inform both women and men about CVD and its risk factors, thereby helping them to correctly assess their individual risk. However, greater effort is needed to inform men, compared with women, about the various ways in which to prevent CVD and to motivate them to take preventive action. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Identification and Assessment of Factors That Hinder, Prevent, or Discourage Individuals from Enrolling in or Completing Nontraditional Programs in Postsecondary Institutions in Florida. Final Report from September 1, 1984-August 31, 1985.

ERIC Educational Resources Information Center

Robinson, Dolores M.; And Others

Between September 1, 1984, and August 31, 1985, a study examined the barriers to enrollment in and completion of postsecondary-level nontraditional vocational education programs in Florida. Data were collected from students and faculty members at 36 of Florida's 59 area vocational-technical centers and community colleges as well as from on-site…

Continuing education needs assessment of pharmacists in the United Arab Emirates.

PubMed

Hasan, Sanah

2009-12-01

The main objective of this study was to offer an insight on the issue of continuing education (CE) in the UAE and to determine the type and format of CE pharmacists in this country prefer to attend and consider most effective. A multi-theme survey was developed to find the reasons pharmacists choose to attend different CE programs, the survey assessed continuing education needs and preferences of pharmacists. Survey items included the types of formats and topics pharmacists prefer to attend and think are most useful to enhance their knowledge and skill. Finally the survey explored some barriers pharmacists conceive as such to attending effective CE. One hundred thirty-two surveys were included in this study, the vast majority of the participants were bachelor's degree holders who were 40 years and younger. The participant's main types of employment were marketing and hospital practice. Pharmacists' preferences as for the format and topic type for programs they would like to attend were identified and compared to other practice settings. Barriers to attending effective CE programs were also elicited. Interactive workshops were recognized as the most favorable format for CE in this study, computer and internet-based formats were also ranked highly by participants followed by live-in person and printed material-based programs. Topics covering innovations in pharmacy practice and disease management were at the top of priorities for pharmacists who would also like to see more certificate programs be offered to them.

Validation of self-reported breast and cervical cancer screening tests among low-income minority women.

PubMed

Paskett, E D; Tatum, C M; Mack, D W; Hoen, H; Case, L D; Velez, R

1996-09-01

The objective of the Forsyth County Cancer Screening Project is to assess barriers to breast and cervical cancer screening among low-income women and to develop an educational program to address these barriers. To properly assess the barriers, it was first necessary to determine if self-reported rates of breast and cervical cancer screening were accurate. All women who participated in the baseline survey (n = 555) were asked to provide information regarding if, where, and when they had obtained mammograms and Pap smears. Identified health care facilities were then contacted to verify this information. Approximately 80% of responses were verified for at least one of the exams with the information provided. For mammography, 77% of self-reports were correct, whereas 67% of self-reports of Pap smear screening were correct (kappa = 0.54 and 0.15, respectively). For both tests, women thought they had received them more recently than they actually had, by an average of 3 months for mammography and 23 months for Pap smears. Using validated reports of screening did not substantially change identified predictors of screening for mammography. For Pap smear screening, however, most of the identified predictors of screening became nonsignificant when medical chart reports were used instead of self-reports, suggesting that caution should be used in relying on self-reports to design programs to improve cervical cancer screening practices.

Program To Address Sociocultural Barriers to Health Care in Hispanic Communities. National Program Report.

ERIC Educational Resources Information Center

Jackson, Mike; Heroux, Janet

Many members of the Hispanic community are separated from the larger community by language barriers and different cultures and belief systems. These factors can affect Hispanic Americans' ability to seek and gain access to the health care system. The Program To Address Sociocultural Barriers to Health Care in the Hispanic Community, known as…

Online learning tools in an M.Ed. in Earth Sciences program

NASA Astrophysics Data System (ADS)

Richardson, E.

2011-12-01

Penn State's Master of Education in Earth Sciences program is a fully online 30-credit degree program serving mid-career secondary science teachers. Teachers in the program have a diverse background in science and math, are usually many years removed from their most recent degree, and are often deficient in the same geoscience skills as are beginning undergraduates. For example, they habitually assign incorrect causal relationships to concepts that are taught at the same time (such as sea-floor spreading and magnetic field reversals), and they have trouble with both object and spatial visualization. Program faculty also observe anecdotally that many teachers enter the program lacking the ability to describe their mental model of a given Earth science process, making it difficult to identify teachers' knowledge gaps. We have implemented many technical strategies to enhance program content delivery while trying to minimize the inherent barriers to completing quantitative assignments online and at a distance. These barriers include competence with and access to sophisticated data analysis and plotting programs commonly used by scientists. Here, I demonstrate two technical tools I use frequently to strengthen online content delivery and assessment. The first, Jing, is commercially-available, free, and platform-independent. Jing allows the user to make screencasts with narration and embed them into a web page as a flash movie or as an external link. The second is a set of simple sketching tools I have created using the programming language Processing, which is a free, open source, platform-independent language built on Java. The integration of easy-to-use drawing tools into problem sets and other assessments has enabled faculty to appraise a learner's grasp of the material without the steep technical learning curve and expense inherent in most computer graphics packages. A serendipitous benefit of teaching with these tools is that they are easy to learn and freely available and so the teachers in the program learn to use them, too. Qualitative assessment of feedback from the teachers in the program shows that they find the explanations, screencasts, animations, and discussions arising from these tools not only enhance their own learning but also inspire them to try them in their classrooms.

Infant nutrition in Saskatoon: barriers to infant food security.

PubMed

Partyka, Brendine; Whiting, Susan; Grunerud, Deanna; Archibald, Karen; Quennell, Kara

2010-01-01

We explored infant nutrition in Saskatoon by assessing current accessibility to all forms of infant nourishment, investigating challenges in terms of access to infant nutrition, and determining the use and effectiveness of infant nutrition programs and services. We also examined recommendations to improve infant food security in Saskatoon. Semi-structured community focus groups and stakeholder interviews were conducted between June 2006 and August 2006. Thematic analysis was used to identify themes related to infant feeding practices and barriers, as well as recommendations to improve infant food security in Saskatoon. Our study showed that infant food security is a concern among lower-income families in Saskatoon. Barriers that limited breastfeeding sustainability or nourishing infants through other means included knowledge of feeding practices, lack of breastfeeding support, access and affordability of infant formula, transportation, and poverty. Infant nutrition and food security should be improved by expanding education and programming opportunities, increasing breastfeeding support, and identifying acceptable ways to provide emergency formula. If infant food security is to be addressed successfully, discussion and change must occur in social policy and family food security contexts.

Physical activity behavior, barriers to activity, and opinions about a smartphone-based physical activity intervention among rural residents.

PubMed

Kurti, Allison N; Logan, Henrietta; Manini, Todd; Dallery, Jesse

2015-01-01

Rural Americans engage in less physical activity (PA) and experience higher rates of consequent health problems (i.e., obesity, cardiovascular disease) than urban Americans. Although geographic barriers have historically made this population hard to reach, rural individuals are increasingly gaining access to smartphones. Thus, the purpose of this study was to evaluate PA behavior and barriers to PA among rural residents and to gauge their receptiveness to a smartphone-based PA intervention that is currently in the development stage. Rural Floridian adults (n=113), 18 years of age and older, completed surveys to assess PA behavior, PA barriers, and opinions about an intervention to increase PA. Specifically, they were asked to imagine a program that would require them to do PA with their mobile phones and whether they viewed intended aspects of the program as helpful. The present work is therefore formative research that sought to determine the feasibility and acceptability of a smartphone-based intervention among rural residents. RESULTS of the survey will inform the development of a tailored, smartphone-based PA intervention. The 37.2% of participants with low PA levels (<600 metabolic equivalent [MET]-min per week) were more likely to report personal and environmental barriers to PA than the 47.8% of participants with moderate PA levels (≥600 MET-min per week). More barriers were reported among participants who self-reported as white and among participants of older age, lower education level, and lower socioeconomic status. Additionally, 75.9% of participants reported features of the intervention as at least somewhat helpful. The growing ubiquity of smartphones among rural residents, combined with participants' positive response to the program description, supports the acceptability of a smartphone-based PA intervention for rural communities. Given the participants' receptiveness, future research should evaluate the efficacy of smartphone-delivered health behavior interventions among this population.

Physical Activity Behavior, Barriers to Activity, and Opinions About a Smartphone-Based Physical Activity Intervention Among Rural Residents

PubMed Central

Logan, Henrietta; Manini, Todd; Dallery, Jesse

2015-01-01

Abstract Background: Rural Americans engage in less physical activity (PA) and experience higher rates of consequent health problems (i.e., obesity, cardiovascular disease) than urban Americans. Although geographic barriers have historically made this population hard to reach, rural individuals are increasingly gaining access to smartphones. Thus, the purpose of this study was to evaluate PA behavior and barriers to PA among rural residents and to gauge their receptiveness to a smartphone-based PA intervention that is currently in the development stage. Materials and Methods: Rural Floridian adults (n=113), 18 years of age and older, completed surveys to assess PA behavior, PA barriers, and opinions about an intervention to increase PA. Specifically, they were asked to imagine a program that would require them to do PA with their mobile phones and whether they viewed intended aspects of the program as helpful. The present work is therefore formative research that sought to determine the feasibility and acceptability of a smartphone-based intervention among rural residents. Results of the survey will inform the development of a tailored, smartphone-based PA intervention. Results: The 37.2% of participants with low PA levels (<600 metabolic equivalent [MET]-min per week) were more likely to report personal and environmental barriers to PA than the 47.8% of participants with moderate PA levels (≥600 MET-min per week). More barriers were reported among participants who self-reported as white and among participants of older age, lower education level, and lower socioeconomic status. Additionally, 75.9% of participants reported features of the intervention as at least somewhat helpful. Conclusions: The growing ubiquity of smartphones among rural residents, combined with participants' positive response to the program description, supports the acceptability of a smartphone-based PA intervention for rural communities. Given the participants' receptiveness, future research should evaluate the efficacy of smartphone-delivered health behavior interventions among this population. PMID:25379976

The experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice.

PubMed

Henderson, Amanda J; Davies, Jan; Willet, Michaela R

2006-11-01

This paper describes a qualitative program evaluation which sought to identify factors that either assist or impede the adoption of clinical evidence in everyday practice. Thirteen Australian projects were funded in a competitive grant program to adopt innovative strategies to improve the uptake of research evidence in everyday clinical practice. Project leaders' reports were analysed to collate common themes related to 1) critical elements in successful application of research knowledge, 2) barriers to implementing evidence, and 3) lessons for other organisations that might implement a similar project. Despite the diversity of the methods used to establish projects and the range of topics and clinical settings, many similarities were identified in the perceived critical success elements, barriers, and lessons for adopting clinical evidence. Eighteen themes emerged across the data including: leadership support; key stakeholder involvement; practice changes; communication; resources; education of staff; evaluation of outcomes; consumers; knowledge gaps; adoption/implementing staff; access to knowledge; risk assessment; collaboration; effectiveness of clinical research evidence; structure/organisation; cultural barriers; previous experiences; and information technology. Leaders of projects to adopt evidence in clinical practice identified barriers, critical success elements and lessons that impacted on their projects. A range of influences on the adoption of evidence were identified, and this knowledge can be used to assist others undertaking similar projects.

Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors.

PubMed

Kraus, Chadd K; Greenberg, Marna R; Ray, Daniel E; Dy, Sydney Morss

2016-05-01

Emergency medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority. To assess PC competency education in EM residency programs. This was a mixed-mode survey of residency program directors, associate program directors, and assistant program directors at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents, 2) senior resident skills in PC competencies, 3) effectiveness of educational methods, and 4) barriers to training. Response rate was 50% from more than 100 residency programs. Most respondents (64%) identified PC competencies as important for residents to learn, and 59% reported that they teach7 PC skills in their residency program. In Domains 1 and 2, crucial conversations, management of pain, and management of the imminently dying had the highest scores for importance and residents' skill. In Domain 3, bedside teaching, mentoring from hospice and palliative medicine faculty, and case-based simulation were the most effective educational methods. In Domain 4, lack of PC expertise among faculty and lack of interest by faculty and residents were the greatest barriers. There were differences between competency importance and senior resident skill level for management of the dying child, withdrawal/withholding of nonbeneficial interventions, and ethical/legal issues. There are specific barriers and opportunities for PC competency training and gaps in resident skill level. Specifically, there are discrepancies in competency importance and residency skill in the management of the dying child, nonbeneficial interventions, and ethical and legal issues that could be a focus for educational interventions in PC competency training in EM residencies. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Student Financial Aid and Women. ERIC Digest.

ERIC Educational Resources Information Center

Moran, Mary

The impact of student aid policies on women is assessed. Patterns of enrollment and economic profiles differ for male and female students. Women, for example, far surpass men as adult, part-time, independent, and unclassified students, the categories most likely to present barriers to participating in most financial aid programs. Gender issues in…

Perspectives of Stakeholders on Implementing a Farm-to-University Program at an HBCU.

PubMed

Vilme, Helene; López, Ivette A; Walters, Lurleen; Suther, Sandra; Brown, C Perry; Dutton, Matthew; Barber, Janet

2015-07-01

To explore the perspectives of various stakeholders on whether an HBCU has the resources to establish a farm-to-university program that can improve fruits and vegetables intake among African American students. Additionally, this study assessed students' satisfaction with fruits and vegetables served in University dining halls, and their desire for changes in policies to increase local fruits and vegetables access on campus. This study employed a mixed method data collection strategy. Semi-structured interviews were used to explore the stakeholders' perspectives and self-administered questionnaires were used to assess students' satisfaction with fruits and vegetables and desire for policy changes. Barriers reported by both food service administrators and farmers were cost and variation in supply and demand. Students expressed lack of satisfaction with fresh produce served in campus dining halls and a desire for change in policies to increase local fruits and vegetables access on campus. While there is student desire for improved access to fresh produce on campus, there are perceived barriers to overcome. University partnerships are needed to address the desired nutritional improvements.

Acknowledging adult bias: a focus-group approach to utilizing beauty salons as health-education portals for inner-city adolescent girls.

PubMed

Lieberman, Alexis; Harris, Diana

2007-04-01

To assess the feasibility of using beauticians as health literacy agents and beauty salons as health-education portals for adolescent, inner-city, African American girls, the authors conducted focus groups with 25 women: salon clients, salon owners, and medical students. Facilitators to program development included (a) beautician-client relationships, (b) teens' access to health information, and (c) beauticians as information resources. Barriers included (a) adult opinions of teen behaviors, (b) teen mistrust of adults, and (c) low health literacy of beauticians. In developing a health-education program for this population, beauticians and salons may be excellent health information agents and portals if barriers including beautician poor health literacy, adolescent mistrust in adults, and adults' anti-adolescent bias are improved. Program implementation must not solely focus on teens but should also include adult salon users, with the goal of reaching the teens first through these adults and, with time and trust, reaching the teens directly.

Women's experiences after Planned Parenthood's exclusion from a family planning program in Texas.

PubMed

Woo, C Junda; Alamgir, Hasanat; Potter, Joseph E

2016-04-01

We assessed the impact on depot medroxyprogesterone continuation when a large care provider was banned from a state-funded family planning program. We used three methods to assess the effect of the ban: (a) In a records review, we compared how many state program participants returned to two Planned Parenthood affiliates for a scheduled dose of depot medroxyprogesterone acetate (DMPA) immediately after the ban; (b) We conducted phone interviews with 224 former Planned Parenthood patients about DMPA use and access to contraception immediately after the ban; (c) We compared current contraceptive method of our interviewees to that of comparable DMPA users in the National Survey of Family Growth 2006-2010 (NSFG). (a) Fewer program clients returned for DMPA at a large urban Planned Parenthood, compared to a remotely located affiliate (14.4%, vs. 64.8%), reflecting different levels of access to alternative providers in the two cities. (b) Among program participants who went elsewhere for the injection, only 56.8% obtained it at no cost and on time. More than one in five women missed a dose because of barriers, most commonly due to difficulty finding a provider. (c) Compared to NSFG participants, our interviewees used less effective methods of contraception, even more than a year after the ban went into effect. Injectable contraception use was disrupted during the rollout of the state-funded family planning program. Women living in a remote area of Texas encountered more barriers. Requiring low-income family planning patients to switch healthcare providers has adverse consequences. Copyright © 2016 Elsevier Inc. All rights reserved.

Women’s experiences after Planned Parenthood’s exclusion from a family planning program in Texas☆

PubMed Central

Woo, C. Junda; Alamgir, Hasanat; Potter, Joseph E.

2016-01-01

Objective We assessed the impact on depot medroxyprogesterone continuation when a large care provider was banned from a state-funded family planning program. Study Design We used three methods to assess the effect of the ban: (a) In a records review, we compared how many state program participants returned to two Planned Parenthood affiliates for a scheduled dose of depot medroxyprogesterone acetate (DMPA) immediately after the ban; (b) We conducted phone interviews with 224 former Planned Parenthood patients about DMPA use and access to contraception immediately after the ban; (c) We compared current contraceptive method of our interviewees to that of comparable DMPA users in the National Survey of Family Growth 2006–2010 (NSFG). Results (a) Fewer program clients returned for DMPA at a large urban Planned Parenthood, compared to a remotely located affiliate (14.4%, vs. 64.8%), reflecting different levels of access to alternative providers in the two cities. (b) Among program participants who went elsewhere for the injection, only 56.8% obtained it at no cost and on time. More than one in five women missed a dose because of barriers, most commonly due to difficulty finding a provider. (c) Compared to NSFG participants, our interviewees used less effective methods of contraception, even more than a year after the ban went into effect. Conclusions Injectable contraception use was disrupted during the rollout of the state-funded family planning program. Women living in a remote area of Texas encountered more barriers. Implications Requiring low-income family planning patients to switch healthcare providers has adverse consequences. PMID:26680757

A multi-stakeholder evaluation of the Baltimore City virtual supermarket program.

PubMed

Lagisetty, Pooja; Flamm, Laura; Rak, Summer; Landgraf, Jessica; Heisler, Michele; Forman, Jane

2017-10-23

Increasing access to healthy foods and beverages in disadvantaged communities is a public health priority due to alarmingly high rates of obesity. The Virtual Supermarket Program (VSP) is a Baltimore City Health Department program that uses online grocery ordering to deliver food to low-income neighborhoods. This study evaluates stakeholder preferences and barriers of program implementation. This study assessed the feasibility, sustainability and efficacy of the VSP by surveying 93 customers and interviewing 14 programmatic stakeholders who had recently used the VSP or been involved with program design and implementation. We identified the following themes: The VSP addressed transportation barriers and food availability. The VSP impacted customers and the city by including improving food purchasing behavior, creating a food justice "brand for the city", and fostering a sense of community. Customers appreciated using Supplemental Nutrition Assistance Program (SNAP) benefits to pay for groceries, but policy changes are needed allow online processing of SNAP benefits. This evaluation summarizes lessons learned and serves as a guide to other public health leaders interested in developing similar programs. Provisions in the U.S. Department of Agriculture (USDA) Farm Bill 2014 allow for select grocers to pilot online transactions with SNAP benefits. If these pilots are efficacious, the VSP model could be easily disseminated.

Correlates of motivation to quit smoking among alcohol dependent patients in residential treatment

PubMed Central

Martin, Rosemarie A.; Rohsenow, Damaris J.; MacKinnon, Selene Varney; Abrams, David B.; Monti, Peter M.

2006-01-01

Substance use and smoking co-occur at high rates and substance abusers smoke more and have greater difficulty quitting smoking compared to the general population. Methods of increasing smoking cessation among alcoholics are needed to improve their health. This study investigated predictors of motivation to quit smoking among patients early in residential treatment for substance abuse. The 198 alcohol dependent patients were participating is a larger smoking study at an inner-city residential substance abuse treatment program. Motivation was measured by the Contemplation Ladder. A hierarchical multiple regression was conducted to assess whether perceived barriers to smoking cessation and self-efficacy about quitting were associated with motivation to quit smoking independent of the influence of degree of tobacco involvement, substance use, and comorbid depressive symptoms. Motivation was higher with longer previous smoking abstinence, fewer barriers to quitting, and greater self-efficacy but was not influenced by smoking rate, dependence, or gender. While the combination of alcohol and drug use, alcohol and drug problem severity, and depressive symptoms predicted motivation, no one of these variables was significant. Since barriers to change and self-efficacy are potentially modifiable in treatment, these could be salient targets for intervention efforts. This could be integrated into treatment by assessing barriers and providing corrective information about consequences and methods of overcoming barriers and by providing coping skills to increase confidence in one’s ability to quit smoking. PMID:16314049

Implementing a Universal Well-Being Assessment to Mitigate Barriers to Resident Utilization of Mental Health Resources.

PubMed

Sofka, Sarah; Grey, Carl; Lerfald, Nathan; Davisson, Laura; Howsare, Janie

2018-02-01

Physician utilization of well-being resources remains low despite efforts to promote use of these resources. We implemented a well-being assessment for internal medicine residents to improve access and use of mental health services. We scheduled all postgraduate year 1 (PGY-1) and PGY-2 residents at West Virginia University for the assessment at our faculty and staff assistance program (FSAP). While the assessment was intended to be universal (all residents), we allowed residents to "opt out." The assessment visit consisted of an evaluation by a licensed therapist, who assisted residents with a wellness plan. Anonymous surveys were distributed to all residents, and means were compared by Student's t test. Thirty-eight of 41 PGY-1 and PGY-2 residents (93%) attended the scheduled appointments. Forty-two of 58 residents (72%, including PGY-3s) completed the survey. Of 42 respondents, 28 (67%) attended the assessment sessions, and 14 (33%) did not. Residents who attended the sessions gave mean ratings of 7.8 for convenience (1, not convenient, to 9, very convenient), and 7.9 for feeling embarrassed if colleagues knew they attended (1, very embarrassed, to 9, not embarrassed). Residents who attended the assessment sessions reported they were more likely to use FSAP services in the future, compared with those who did not attend ( P  < .001). Offering residents a well-being assessment may have mitigated barriers to using counseling resources. The majority of residents who participated had a positive view of the program and indicated they would return to FSAP if they felt they needed counseling.

STAKEHOLDER INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT AT NATIONAL LEVEL: A STUDY FROM IRAN.

PubMed

Yazdizadeh, Bahareh; Shahmoradi, Safoura; Majdzadeh, Reza; Doaee, Shila; Bazyar, Mohammad; Souresrafil, Aghdas; Olyaeemanesh, Alireza

2016-01-01

This study was carried out to evaluate the opinions of stakeholders on their roles in health technology assessment (HTA) in Iran and to determine the barriers and facilitators existing in the organizations to help increase their involvement in the HTA program. The study was conducted in two stages, semi-structured interviews, and "policy dialogue" with stakeholders. The data were analyzed through the framework approach. The interviews were held with ten stakeholder representatives from various organizations. In addition, Twenty-one representatives participated in the policy dialogue. Based on the findings, all the stakeholder organizations considered themselves as interest groups in all the stages of the HTA process; however, their tendencies and methods of involvement differed from one another. According to the participants, the most important issue to be considered in the context of HTA was that the structures, stages, and procedures of the HTA process must be made transparent. Stakeholder involvement in the HTA program cannot readily take place. Various stakeholders have different interests, responsibilities, infrastructures, and barriers. If a program does not meet these considerations, its chances of succeeding will substantially decrease. Therefore, to prevent overlooking the needs and expectations of stakeholders from the HTA process, it is essential to create opportunities in which their thoughts and ideas are taken into account.

Low-income individuals’ perceptions about fruit and vegetable access programs: A qualitative study

PubMed Central

Haynes-Maslow, Lindsey; Auvergne, Lauriane; Mark, Barbara; Ammerman, Alice; Weiner, Bryan J.

2015-01-01

Objective To examine how fruit and vegetable (F&V) programs address barriers to F&V access and consumption as perceived by low-income individuals. Design From 2011–2012 thirteen focus groups were used to better understand low-income individuals’ perceptions about F&V programs. Setting Five North Carolina counties at community-serving organizations. Participants Low-income participants ages 18 or older were included in the study. A majority were African American females with a high school education or less and received government assistance. Phenomenon of Interest Low-income individuals’ perceptions about how F&V access programs can reduce barriers and increase consumption. Analysis A socioecological framework guided data analysis, and 2 trained researchers coded transcripts, identified major themes, and summarized findings. Results A total of 105 participants discussed that mobile markets could overcome barriers such as availability, convenience, transportation, and quality/variety. Some were worried about safety in higher crime communities. Participants’ opinions about how successful food assistance programs were at overcoming cost barriers were mixed. Participants agreed that community gardens could increase access to affordable, conveniently located produce, but worried about feasibility/implementation issues. Implications for Research and Practice Addressing access barriers through F&V programs could improve consumption. Programs have the potential to be successful if they address multiple access barriers. (200 words). PMID:25910929

Lessons Learned from Implementing a Prostate Cancer Risk Assessment Program for Underserved High-Risk Men in the Community: the Prostate REACH Project.

PubMed

Fleisher, Linda; Davis, Stacy N; Gross, Laura; Bagden, Loretta; Zakrzewski, Debra; González, Evelyn; Kandadai, Venk; Rusten, Cheryl; Baskett, Jerilyn; Obeid, Elias; Giri, Veda N

2016-03-01

Prostate cancer disproportionately affects Black men, who may also encounter barriers to participation in prostate cancer risk assessment. The Prostate Risk, Education and Assessment in the Community with Help (REACH) project was a community-based extension of a comprehensive prostate cancer risk assessment program at a comprehensive cancer center. The goals of the REACH project were the following: (1) establish a community prostate cancer risk assessment clinic, (2) conduct targeted recruitment, and (3) provide navigation services including follow-up for uninsured men. Key implementation steps included the following: (1) choosing a clinic site, (2) establishing patient access procedures, (3) establishing navigator services, (4) developing subsidy fund use guidelines, and (5) designing recruitment and promotion. Through community-based promotion, 64 men inquired about the program and 26 (41 %) participated. Of those screened, 46 % had abnormal results, and 2 men were diagnosed with prostate cancer. Here, we describe a unique demonstration project to implement a comprehensive prostate cancer risk assessment program in an underserved Black community and describe successes and challenges to inform future efforts to promote access to underserved men.

Devolution's policy impact on non-emergency medical transportation in State Children's Health Insurance Programs.

PubMed

Borders, Stephen; Blakely, Craig; Ponder, Linda; Raphael, David

2011-01-01

Proponents of devolution often maintain that the transfer of power and authority of programs enables local officials to craft policy solutions that better align with the needs of their constituents. This article provides one of the first empirical evaluations of this assumption as it relates to non-emergency medical transportation (NEMT) in the State Children's Health Insurance Program (SCHIP). NEMT programs meet a critical need in the areas in which they serve, directly targeting this single key access barrier to care. Yet states have great latitude in making such services available. The authors utilize data from 32 states to provide a preliminary assessment of devolution's consequences and policy impact on transportation-related access to care. Their findings provide mixed evidence on devolution's impact on policy outcomes. Proponents of devolution can find solace in the fact that several states have gone beyond federally mandated minimum requirements to offer innovative programs to remove transportation barriers to care. Detractors of devolution will find continued pause on several key issues, as a number of states do not offer NEMT to their SCHIP populations while cutting services and leaving over $7 billion in federal matching funding unspent.

Characteristics of individuals screening positive for substance use in a welfare setting: implications for welfare and substance-use disorders treatment systems.

PubMed

Morgenstern, Jon; Hogue, Aaron; Dasaro, Christopher; Kuerbis, Alexis; Dauber, Sarah

2008-07-01

This study examined barriers to employability, motivation to abstain from substances and to work, and involvement in multiple service systems among male and female welfare applicants with alcohol- and drug-use problems. A representative sample (N= 1,431) of all persons applying for public assistance who screened positive for substance involvement over a 2-year period in a large urban county were recruited in welfare offices. Legal, education, general health, mental health, employment, housing, and child welfare barriers to employability were assessed, as were readiness to abstain from substance use and readiness to work. Only 1 in 20 participants reported no barrier other than substance use, whereas 70% reported at least two other barriers and 40% reported three or more. Moreover, 70% of participants experienced at least one additional barrier classified as "severe" and 30% experienced two or more. The number and type of barriers differed by gender. Latent class analysis revealed four main barriers-plus-readiness profiles among participants: (1) multiple barriers, (2) work experienced, (3) criminal justice, and (4) unstable housing. Findings suggest that comprehensive coordination among social service systems is needed to address the complex problems of low-income Americans with substance-use disorders. Classifying applicants based on barriers and readiness is a promising approach to developing innovative welfare programs to serve the diverse needs of men and women with substance-related problems.

Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies.

PubMed

Parry, Selina M; Knight, Laura D; Connolly, Bronwen; Baldwin, Claire; Puthucheary, Zudin; Morris, Peter; Mortimore, Jessica; Hart, Nicholas; Denehy, Linda; Granger, Catherine L

2017-04-01

To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers. Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454. Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation; (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement; (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge; (4) motivation and beliefs regarding the benefits/risks; and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment. The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span diverse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice.

An Effective Model for Improving Global Health Nursing Competence.

PubMed

Kang, Sun-Joo

2016-01-01

This paper proposed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by evaluation of four implemented programs by the author. All programs were conducted with students majoring in nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students' needs assessment, program design, and implementation and evaluation factors. The concept and composition of global nursing competence, identified within previous studies, were deemed appropriate in all of our programs. Program composition varied from curricular to extracurricular domains. During the implementation phase, some of the programs included non-Korean students to improve cultural diversity and overcome language barriers. Qualitative and quantitative surveys were conducted to assess program efficacy. Data triangulation from students' reflective journals was examined. Additionally, students' awareness regarding changes within global health nursing, improved critical thinking, cultural understanding, and global leadership skills were investigated pre- and post-program implementation. The importance of identifying students' needs regarding global nursing competence when developing appropriate curricula is discussed.

Implementing a Coach-Delivered Dating Violence Prevention Program with High School Athletes.

PubMed

Jaime, Maria Catrina D; McCauley, Heather L; Tancredi, Daniel J; Decker, Michele R; Silverman, Jay G; O'Connor, Brian; Miller, Elizabeth

2018-05-10

Teen dating violence and sexual violence are severe public health problems. Abusive behaviors within the context of dating or romantic relationships are associated with adverse health outcomes. Promoting positive bystander intervention and increasing knowledge of abusive behaviors are promising strategies for preventing dating and sexual violence. Coaching Boys Into Men (CBIM) is an evidence-based, athletic coach-delivered dating violence prevention program that has been shown to increase positive bystander behaviors and reduce abuse perpetration among high school male athletes. Identifying specific barriers and facilitators based on the coaches' experiences with program delivery combined with the coaches' and athletes' program perceptions may help optimize future CBIM implementation and sustainability. Semi-structured interviews with coaches (n = 36) explored the implementers' perspectives on strategies that worked well and potential barriers to program implementation. Ten focus groups with male athletes (n = 39) assessed their experiences with CBIM and the suitability of having their coaches deliver this program. Coaches described using the CBIM training cards and integrating program delivery during practice. Athletes reported coaches routinely delivering the CBIM program and adding their own personal stories or examples to the discussions. Key facilitators to program implementation include support from the violence prevention advocate, the ease of integrating CBIM into the sports season, and using the program materials. Barriers to implementation included finding sufficient time for the program, dynamics of delivering sensitive program content, and participant constraints. Coaches and athletes alike found the program feasible and acceptable to implement within the sports setting. Both coaches and athletes offered insights on the implementation and the feasibility and acceptability of CBIM within school-based athletic programs. These experiences by implementers and recipients alike can inform future dissemination and implementation efforts of CBIM. Further, by pinpointing where and how coaches were successful in implementing the program and what resonated with athletes, can help better understand how CBIM is effective in promoting athletes to stop violence against women and girls. Coach and athlete reflections on CBIM implementation provide insights for optimizing future program delivery and dissemination.

Perceptions of the use of critical thinking teaching methods.

PubMed

Kowalczyk, Nina; Hackworth, Ruth; Case-Smith, Jane

2012-01-01

To identify the perceived level of competence in teaching and assessing critical thinking skills and the difficulties facing radiologic science program directors in implementing student-centered teaching methods. A total of 692 program directors received an invitation to complete an electronic survey soliciting information regarding the importance of critical thinking skills, their confidence in applying teaching methods and assessing student performance, and perceived obstacles. Statistical analysis included descriptive data, correlation coefficients, and ANOVA. Responses were received from 317 participants indicating program directors perceive critical thinking to be an essential element in the education of the student; however, they identified several areas for improvement. A high correlation was identified between the program directors' perceived level of skill and their confidence in critical thinking, and between their perceived level of skill and ability to assess the students' critical thinking. Key barriers to implementing critical thinking teaching strategies were identified. Program directors value the importance of implementing critical thinking teaching methods and perceive a need for professional development in critical thinking educational methods. Regardless of the type of educational institution in which the academic program is located, the level of education held by the program director was a significant factor regarding perceived confidence in the ability to model critical thinking skills and the ability to assess student critical thinking skills.

The business case for breastfeeding: a successful regional implementation, evaluation, and follow-up.

PubMed

Garvin, Cheza C; Sriraman, Natasha K; Paulson, Amy; Wallace, Elise; Martin, Charley E; Marshall, Liz

2013-08-01

Breastfeeding benefits the health of babies and mothers, but returning to work is a significant barrier for mothers wishing to continue breastfeeding for the recommended 12 months. A resource training kit, The Business Case for Breastfeeding (BC4BF), developed by the Health Resources and Services Administration, U.S. Department of Health and Human Services, was implemented in Southeastern Virginia to assist businesses in developing lactation support programs (LSPs) and eliminating breastfeeding barriers. The primary goals of the 1-year project were to educate 20 businesses about breastfeeding support in the workplace, engage 10 businesses to implement the BC4BF, and assess sustainability via documented policy and environmental changes and integration of the LSP into the business infrastructure. The Transtheoretical Model of Behavior Change was adapted to assess stage of organizational change. A Centers for Disease Control and Prevention tool for measuring community-level policy, systems, and environmental change was adapted to assess worksite policy and environmental changes. Over 20 businesses were educated about the BC4BF. Seventeen engaged in the project. Fourteen significantly increased their stage of change, development of LSPs, written policies, and physical and social environment changes (p≤0.001). A brief follow-up study revealed that all 14 employers maintained their programs 8 months after the program ended, with increased stages of change, policy enforcement, and physical environment (p≤0.05). The BC4BF provided an effective approach to assisting employers in establishing and maintaining LSPs in the workplace across several cities.

An internet survey of the characteristics and physical activity of community-dwelling Australian adults with acquired brain injury: Exploring interest in an internet-delivered self-management program focused on physical activity.

PubMed

Jones, Taryn M; Dean, Catherine M; Dear, Blake F; Hush, Julia M; Titov, Nickolai

2016-01-01

Individuals with acquired brain injury (ABI) are more likely to be physically inactive and experience barriers to accessing services to address inactivity. This study was designed to guide the development of an internet-delivered self-management program to increase physical activity after ABI. The aims of this study were to examine the current physical activity status of community-dwelling Australian adults with ABI, the barriers to physical activity they experience and to explore interest an internet-delivered self-management program aimed at increasing physical activity. An online survey of Australian adults with ABI was used to collect information about demographic characteristics; general health; emotional well-being; mobility and physical activity status, and satisfaction; barriers to physical activity; confidence in overcoming barriers, and; interest in an internet self-management program. Data were analyzed descriptively and correlational analyses examined relationships between variables. Data were analyzed from 59 respondents. Over half were not satisfied with their current physical activity status. The most frequently reported barriers were pain/discomfort, fatigue and fear, and confidence to overcome these barriers was very low. Interest in an internet-delivered self-management program was high (74%) and not related to the amount of physical activity, satisfaction with physical activity and mobility status or total number of barriers. Australian adults with ABI are not satisfied with their activity levels and experience barriers in maintaining their physical activity levels. Participants were interested in accessing an internet-delivered self-management program aimed at improving physical activity levels. Therefore such a program warrants development and evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

Chronic disease management for recently homeless veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population.

PubMed

Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

2013-03-01

Although vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a "digital divide" in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Affairs (VA) HIT-care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the US Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VHA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to "diagnose" barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other 4 enrolled in CCHT usual care. Although barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment.

Vocal Health Education and Medical Resources for Graduate-Level Vocal Performance Students.

PubMed

Latham, Katherine; Messing, Barbara; Bidlack, Melissa; Merritt, Samantha; Zhou, Xian; Akst, Lee M

2017-03-01

Most agree that education about vocal health and physiology can help singers avoid the development of vocal disorders. However, little is known about how this kind of education is provided to singers as part of their formal training. This study describes the amount of instruction in these topics provided through graduate-level curricula, who provides this instruction, and the kinds of affiliations such graduate singing programs have with medical professionals. This is an online survey of music schools with graduate singing programs. Survey questions addressed demographics of the programs, general attitudes about vocal health instruction for singers, the amount of vocal health instruction provided and by whom it was taught, perceived barriers to including more vocal health instruction, and any affiliations the voice program might have with medical personnel. Eighty-one survey responses were received. Instruction on vocal health was provided in 95% of the schools. In 55% of the schools, none of this instruction was given by a medical professional. Limited time in the curriculum, lack of financial support, and lack of availability of medical professional were the most frequently reported barriers to providing more instruction. When programs offered more hours of instruction, they were more likely to have some of that instruction given by a medical professional (P = 0.008) and to assess the amount of instruction provided positively (P = 0.001). There are several perceived barriers to incorporating vocal health education into graduate singing programs. Opportunity exists for more collaboration between vocal pedagogues and medical professionals in the education of singers about vocal health. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

The Educational Toolbox: Kick Start Your Educational Program in Quality Improvement.

PubMed

Hoffman, Rebecca L; Medbery, Rachel L; Vandermeer, Thomas J; Morris, Jon B; Kelz, Rachel R

2015-01-01

To disseminate materials and learning from the proceedings of the Association of Program Directors 2014 Annual Meeting workshop on the integration of quality improvement (QI) education into the existing educational infrastructure. Modern surgical practice demands an understanding of QI methodology. Yet, today׳s surgeons are not formally educated in QI methodology. Therefore, it is hard to follow the historical mantra of "see one, do one, teach one" in the quality realm. Participants were given a brief introduction to QI approaches. A number of concrete examples of how to incorporate QI education into training programs were presented, followed by a small group session focused on the identification of barriers to incorporation. Participants were provided with a worksheet to help navigate the initial incorporation of QI education in 3 steps. Participants were representative of all types of training programs, with differing levels of existing QI integration. Barriers to QI education included lack of resident interest/buy-in, concerns over the availability of educational resources (i.e., limited time to devote to QI), and a limited QI knowledge among surgical educators. The 3 steps to kick starting the educational process included (1) choosing a specific method of QI education, (2) incorporation via barrier, infrastructure, and stakeholder identification, and (3) implementation and ongoing assessment. Recent changes in the delivery of surgical care along with the new accreditation system have necessitated the development of QI education programs for use in surgical education. To continue to make surgery safer and ensure optimal patient outcomes, surgical educators must teach each resident to adopt quality science methodology in a meaningful way. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Voces de la frontera/Voices from the Border: Using Case Studies of Pregnancy, Birth and Parenting along the U.S.-Mexico Border to Identify Shared Measures of Success.

PubMed

Selchau, Katherine; Babuca, Maricela; Bower, Kara; Castro, Yara; Flores, Araceli; Garcia, Jonah O; Reyes, Maria Lourdes F; Rojas, Yvonne; Shattuck, Laura

2017-12-01

Purpose This research analyzes the cases of five women living along the U.S.-Mexico border who overcame challenges during pregnancy or parenting with the support of a federally funded Healthy Start program, designed to eliminate disparities in perinatal health in disadvantaged communities with the poorest birth outcomes. Study objectives were to: (1) identify common factors that affect healthy maternal and child outcomes for Healthy Start participants; and (2) identify a shared definition of what success looks like for Healthy Start participants and opportunities for further study. Description Five border Healthy Start sites (CA, AZ, NM, and TX) contributed case stories from participants who had overcome access barriers to achieve positive pregnancy, birth or parenting outcomes. Case studies were collected using review of successful participant cases and non-structured interviews by Healthy Start staff, and analyzed using participatory methods and thematic analysis. Assessment Common barriers were: lack of insurance; isolation or unsupportive family relationships; timidness and lack of self-advocacy. Healthy Start programs have been successful in securing supportive relationships through the community health worker model; reducing isolation; obtaining insurance access and a medical home; building self-advocacy skills; and supporting participants to pursue their goals. Conclusion Identified barriers are in line with available literature on health care access and provide a U.S.-Mexico border-specific view. The Healthy Start model is effective at helping women to overcome barriers. Learning from this research may contribute to development of shared measures for more impactful evaluation of Healthy Start and similar programs.

Effects of Benthic Barriers on Macroinvertebrate Communities

DTIC Science & Technology

1993-10-01

Aquatic Plant Control Research Program Effects of Benthic Barriers on Macroinvertebrate Communities by Barry S. Payne, Andrew C. Miller Environmental...Plant Control Technical Report A-93-5Resear h Program Oct ber 1993 Effects of Benthic Barriers on Macroinvertebrate Communities by Barry S. Payne...Effects of benthic barriers on macroinvertebrate communities / by Barry S. Payne, Andrew C. Miller, [and] Thomas Ussery ; prepared for U.S. Army Corps of

Utilizing Patient E-learning in an Intervention Study on Preoperative Smoking Cessation.

PubMed

Wong, Jean; Raveendran, Raviraj; Chuang, Junior; Friedman, Zeev; Singh, Mandeep; Patras, Jayadeep; Wong, David T; Chung, Frances

2018-05-01

Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence. In this prospective multicenter study, smokers undergoing elective noncardiac surgery participated in a preoperative smoking cessation program consisting of a patient e-learning program, brief advice, educational pamphlet, tobacco quitline referral, letter to the primary care physician, and pharmacotherapy. The patient e-learning program described (1) the benefits of quitting smoking before surgery; (2) how to quit smoking; and (3) how to cope while quitting. The 7-day point prevalence (PP) abstinence on the day of surgery and at 1, 3 and 6 six months after surgery was separately assessed, and factors most associated with abstinence were identified using multivariable logistic regression analysis. Generalized estimating equation methods were used to estimate effect of the factors associated with abstinence longitudinally. The reach of the program was assessed with the number of smokers who participated in the program versus the number of patients who were referred to the program. A total of 459 patients (68.9% of eligible patients) participated. The 7-day PP abstinence at day of surgery, 1 month, 3 months, and 6 months was 22%, 29%, 25%, and 22%, respectively. The variables predicting abstinence at 6 months were use of pharmacotherapy (odds ratio [OR], 7.32; 95% confidence interval [CI], 3.71-14.44; P < .0001) and number of contacts with a tobacco quitline (OR, 1.60; 95% CI, 1.35-1.90; P < .0001). Presence of other smokers in the household (OR, 0.39; 95% CI, 0.21-0.72; P = .0030) and amount spent on cigarettes weekly at baseline (per $10 increase) (OR, 0.73; 95% CI, 0.61-0.87; P = .0004) were barriers to abstinence. Our preoperative smoking cessation program resulted in a 7-day PP abstinence of 22% at 6 months. A multifaceted intervention including a patient e-learning program may be a valuable tool to overcome some of the barriers to help surgical patients quit smoking.

Sustaining Teen Pregnancy Prevention Programs in Schools: Needs and Barriers Identified by School Leaders.

PubMed

Craft, Lesley R; Brandt, Heather M; Prince, Mary

2016-04-01

To reduce teen pregnancy rates, prevention programs must be consistently available to large numbers of youth. However, prevention efforts have been historically conducted with little emphasis on ensuring program sustainability. This study examined the needs and barriers to sustaining teen pregnancy prevention (TPP) programming in schools after grant funding has ended, as identified by school leadership. A total of 11 qualitative interviews were conducted between June and September 2012 with middle school leaders from 11 schools involved in current implementation of a TPP program in South Carolina. Interviews were audio-recorded, transcribed verbatim, and thematically coded. Identified needs and barriers to sustainability varied across schools. Common barriers to program sustainability included: lack of materials and supplies, insufficient funding (at the school and district level), lack of support and/or parental opposition, and other school/district priorities. School leaders also identified several needs to continue TPP programming, including: continued funding, trainings, outcome/effectiveness data to support the program, and regularly updated curriculum. Schools with greater perceived needs and barriers may be less likely to sustain. Knowledge gained through this research may be used to inform future interventions and sustainability planning efforts, allowing us to maximize prevention programming. © 2016, American School Health Association.

The impact of a College of Nursing Retention Program on the graduation rates of nursing students.

PubMed

Tatem, E; Payne, J L

2000-01-01

This study was designed to measure the impact of a College of Nursing's (CON) Retention Program on students enrolled in a baccalaureate degree nursing program. Within the last ten years, undergraduate nurses increasingly have utilized the CON retention program. These students traditionally face a number of barriers to their academic endeavors. This study was designed to assess the effect of the CON program on the barriers to academic success of students who entered the CON in the Fall classes of 1991, 1992 and 1993. The sample size was 320 students. The control group consisted of 137 students who received no intervention and the experimental group was comprised of 183 students who attended intervention sessions with the Retention Coordinator in the CON. It was hypothesized that the most successful students during this period (1991-1993) were the most frequent attendees of the CON retention program intervention sessions. The alternative hypothesis was that those persons who did not attend the sessions, but were still highly persistent and successful, were enrollees who had entered with high entrance credentials as demonstrated by the transfer grade point averages (GPA). The results of this study indicated the need, use and value of this systematic approach to retention.

36 CFR 1154.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRANSPORTATION BARRIERS COMPLIANCE BOARD ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD § 1154.150 Program accessibility: Existing facilities. (a) General. The agency shall operate each program or activity so that the...

Removing the Barriers to Full Professor: A Mentoring Program for Associate Professors

ERIC Educational Resources Information Center

Buch, Kimberly; Huet, Yvette; Rorrer, Audrey; Roberson, Lynn

2011-01-01

Although associate professors comprise only about 20 percent of all full-time instructional faculty in degree-granting institutions, the rank is important because it is the primary pipeline from which institutional leaders emerge. In this article, the authors describe the results of a campus-wide needs assessment at the University of North…

Development of a Tool to Assess Resident Physicians' Perceived Competence for Patient-Centered Obesity Counseling

ERIC Educational Resources Information Center

Burton, Amy M.; Brezausek, Carl M.; Hendricks, Peter S.; Agne, April A.; Hankins, Shirley L.; Cherrington, Andrea L.

2015-01-01

Physicians report a number of barriers to obesity counseling, among them low perceived competence in the ability to counsel. While there is increasing recognition of the need for resident training on counseling, implementation requires residency programs to have the necessary curricula and tools to evaluate training effectiveness. This study's…

Applying Productivity Indices as an Innovation for Motivating Individual and Institutional Initiatives for Faculty Renewal.

ERIC Educational Resources Information Center

Baker, Merl

1991-01-01

A major barrier to the exploitation of college faculty renewal programs has been a lack of tangible measurements of achievement in academic functions. Functional productivity indices can be used as tools to motivate both individuals and institutions to take advantage of renewal opportunities and assess their renewal experiences. (Author/MSE)

Development of an Outcome Measurement Tool for a Teen Parent Wraparound Program

ERIC Educational Resources Information Center

Fries, Derrick; Carney, Karen J.; Blackman-Urteaga, Laura; Savas, Sue Ann

2012-01-01

This article chronicles the search for and development of an outcome measurement tool for teen parents receiving community-based wraparound services. The criteria for selecting functional assessment tools available in the literature is presented along with the barriers experienced in using two of these well-cited tools. The rationale for in-house…

Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies.

PubMed

Miller, Jordan; MacDermid, Joy C; Richardson, Julie; Walton, David M; Gross, Anita

2017-01-01

Previous evidence suggests self-management programs for people with chronic pain improve knowledge and self-efficacy, but result in small to negligible changes in function. The purpose of this multiple case studies design was to describe the unique responses of six participants to a new self-management program aimed at improving function, to detail each component of the program, and to explore potential explanations for the varied trajectories of each of the participants. Six participants who had been experiencing chronic pain for at least 5 years were included. All participants were enrolled 6 weeks of ChrOnic pain self-ManageMent support with pain science EducatioN and exercise (COMMENCE). Participants completed an assessment at baseline, 7 weeks (1-week follow-up), and 18 weeks (12-week follow-up). Each participant had a unique initial presentation and goals. Assessments included: function as measured by the Short Musculoskeletal Function Assessment - Dysfunction Index, how much participants are bothered by functional difficulties, pain intensity, fatigue, pain interference, cognitive and psychological factors associated with pain and disability, pain neurophysiology, self-efficacy, satisfaction, and perceived change. The self-management program was 6-weeks in length, consisting of one individual visit and one group visit per week. The program incorporated three novel elements not commonly included in self-management programs: pain neurophysiology education, individualized exercises determined by the participants' goals, and additional cognitive behavioural approaches. Participants were all satisfied with self-management support received. Change in function was variable ranging from 59% improvement to 17% decline. Two potential explanations for variances in response, attendance and social context, are discussed. Several challenges were identified by participants as barriers to attendance. A primary care self-management intervention including pain education and individualized exercise has potential to improve function for some people with chronic pain, although strategies to improve adherence and reduce barriers to participation may be needed to optimize the impact.

Access to healthcare insurance and healthcare services among syringe exchange program clients in Massachusetts: qualitative findings from health navigators with the iDU ("I do") Care Collaborative.

PubMed

Stopka, Thomas J; Hutcheson, Marguerite; Donahue, Ashley

2017-05-18

Little is known about access to health insurance among people who inject drugs (PWID) who attend syringe exchange programs (SEPs). The goal of the current study was to assess perceptions of SEP staff, including health navigators and program managers, on access to health insurance and healthcare access among SEP clients following implementation of state and federal policies to enhance universal healthcare access in Massachusetts. Between December 2014 and January 2015, we conducted in-depth interviews (n = 14) with SEP staff, including both program managers and health navigators, to assess knowledge, attitudes, and beliefs related to health insurance enrollment and access to enhanced referrals among SEP clients. We developed a preliminary coding scheme from the interview guide and used a grounded theory approach to guide inclusion of subsequent thematic codes that emanated from the data. We analyzed the coded data thematically in an iterative fashion using a consensus-based approach. We identified five primary themes that emerged from the qualitative interviews, including high levels of health insurance enrollment among SEP clients; barriers to enrolling in health insurance; highly needed referrals to services, including improved access to substance use disorder treatment and hepatitis C virus treatment; barriers to referring clients to these highly needed services; and recommendations for policy change. While barriers to enrollment and highly needed referrals remain, access to and enrollment in healthcare insurance plans among PWID at SEPs in Massachusetts are high. With the uncertain stability of the Affordable Care Act following the US presidential election of 2016, our findings summarize the opportunities and challenges that are connected to health insurance and healthcare access in Massachusetts. SEPs can play an important role in facilitating access to health insurance and enhancing access to preventive health and primary care.

Monitoring the environment and human sentiment on the Great Barrier Reef: Assessing the potential of collective sensing.

PubMed

Becken, Susanne; Stantic, Bela; Chen, Jinyan; Alaei, Ali Reza; Connolly, Rod M

2017-12-01

With the growth of smartphone usage the number of social media posts has significantly increased and represents potentially valuable information for management, including of natural resources and the environment. Already, evidence of using 'human sensor' in crises management suggests that collective knowledge could be used to complement traditional monitoring. This research uses Twitter data posted from the Great Barrier Reef region, Australia, to assess whether the extent and type of data could be used to Great Barrier Reef organisations as part of their monitoring program. The analysis reveals that large amounts of tweets, covering the geographic area of interest, are available and that the pool of information providers is greatly enhanced by the large number of tourists to this region. A keyword and sentiment analysis demonstrates the usefulness of the Twitter data, but also highlights that the actual number of Reef-related tweets is comparatively small and lacks specificity. Suggestions for further steps towards the development of an integrative data platform that incorporates social media are provided. Copyright © 2017 Elsevier Ltd. All rights reserved.

Prescribing Outdoor Physical Activity to Children: Health Care Providers’ Perspectives

PubMed Central

Christiana, Richard W.; James, J. Joy; Battista, Rebecca A.

2017-01-01

Little evidence exists on health care provider (HCP) prescriptions for children’s outdoor physical activity (PA). Semistructured interviews were conducted with 15 children’s HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included. PMID:29152542

Prescribing Outdoor Physical Activity to Children: Health Care Providers' Perspectives.

PubMed

Christiana, Richard W; James, J Joy; Battista, Rebecca A

2017-01-01

Little evidence exists on health care provider (HCP) prescriptions for children's outdoor physical activity (PA). Semistructured interviews were conducted with 15 children's HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included.

Fostering learners' reflection and self-assessment.

PubMed

Westberg, J; Jason, H

1994-05-01

In most medical schools and residency programs, little or no attention is given to fostering learners' reflection or self-assessment. Yet learners who do not value or who are not effective at these skills are unlikely to extract the maximum benefit from their education. They are at risk of becoming unsafe physicians. To be optimally helpful, teachers need access to the diagnostic information about learners that is provided by their reflections and self-assessments. There are major barriers to learners being reflective and self-assessing. Medicine is dominated by unreflective doing. In the fiercely competitive environment of many teaching programs, many learners correctly perceive that it is unsafe to reveal their fears and deficiencies. Learners often retain this cautious posture even after moving to programs where it is unnecessary. Many learners and teachers have grown accustomed to authoritarian educational approaches in which teachers decide what the learners need and unilaterally evaluate their performance. In this review of the available literature, we summarize the compelling reasons for fostering reflection and self-assessment and for helping learners become their own coaches. Specific strategies and tools for creating programs that foster these values and activities are presented.

Identifying Barriers to Study Abroad Program Participation

ERIC Educational Resources Information Center

McKinley, Karen E.

2014-01-01

University administrators, industry professionals, and government leaders encourage college students to participate in study abroad programs. Despite an increase in the number of students going abroad, the percentage of students participating in global programs remain low. This study identified barriers to study abroad program participation at a…

Impacts of the Interim Federal Health Program reforms: A stakeholder analysis of barriers to health care access and provision for refugees.

PubMed

Antonipillai, Valentina; Baumann, Andrea; Hunter, Andrea; Wahoush, Olive; O'Shea, Timothy

2017-11-09

Changes to the Interim Federal Health Program (IFHP) in 2012 reduced health care access for refugees and refugee claimants, generating concerns among key stakeholders. In 2014, a new IFHP temporarily reinstated access to some health services; however, little is known about these changes, and more information is needed to map the IFHP's impact. This study explores barriers occurring during the time period of the IFHP reforms to health care access and provision for refugees. A stakeholder analysis, using 23 semi-structured interviews, was conducted to obtain insight into stakeholder perceptions of the 2014 reforms, as well as stakeholders' position and their influence to assess the acceptability of the IFHP changes. The majority of stakeholders expressed concerns about the 2014 IFHP changes as a result of the continuing barriers posed by the 2012 retrenchments and the emergence of new barriers to health care access and provision for refugees. Key barriers identified included lack of communication and awareness, lack of continuity and comprehensive care, negative political discourse and increased costs. A few stakeholders supported the reforms as they represented some, but limited, access to health care. Overall, the reforms to the IFHP in 2014 generated barriers to health care access and provision that contributed to confusion among stakeholders, the transfer of refugee health responsibility to provincial authorities and the likelihood of increased health outcome disparities, as refugees and refugee claimants chose to delay seeking health care. The study recommends that policy-makers engage with refugee health stakeholders to formulate a policy that improves health care provision and access for refugee populations.

Life modeling of thermal barrier coatings for aircraft gas turbine engines

NASA Technical Reports Server (NTRS)

Miller, R. A.

1989-01-01

Thermal barrier coating life models developed under the NASA Lewis Research Center's Hot Section Technology (HOST) Program are summarized. An initial laboratory model and three design-capable models are discussed. Current understanding of coating failure mechanisms are also summarized. The materials and structural aspects of thermal barrier coatings have been successfully integrated under the HOST program to produce models which may now or in the near future be used in design. Efforts on this program continue at Pratt and Whitney Aircraft where their model is being extended to the life prediction of physical vapor deposited thermal barrier coatings.

Older Adult Participation in Health Promotion Programs: Perspectives of Facility Administrators

ERIC Educational Resources Information Center

Wright, Tim; Hyner, Gerald C.

2011-01-01

Administrators of older adult-centered facilities must identify barriers to the planning and implementation of health promotion programs. In this qualitative research those barriers were identified through in-depth interviews with administrators of older adult-centered facilities. As identified by administrators, the predominant barriers to the…

National Cancer Institute Patient Navigation Research Program: methods, protocol, and measures.

PubMed

Freund, Karen M; Battaglia, Tracy A; Calhoun, Elizabeth; Dudley, Donald J; Fiscella, Kevin; Paskett, Electra; Raich, Peter C; Roetzheim, Richard G

2008-12-15

Patient, provider, and systems barriers contribute to delays in cancer care, a lower quality of care, and poorer outcomes in vulnerable populations, including low-income, underinsured, and racial/ethnic minority populations. Patient navigation is emerging as an intervention to address this problem, but navigation requires a clear definition and a rigorous testing of its effectiveness. Pilot programs have provided some evidence of benefit, but have been limited by evaluation of single-site interventions and varying definitions of navigation. To overcome these limitations, a 9-site National Cancer Institute Patient Navigation Research Program (PNRP) was initiated. The PNRP is charged with designing, implementing, and evaluating a generalizable patient navigation program targeting vulnerable populations. Through a formal committee structure, the PNRP has developed a definition of patient navigation and metrics to assess the process and outcomes of patient navigation in diverse settings, compared with concurrent continuous control groups. The PNRP defines patient navigation as support and guidance offered to vulnerable persons with abnormal cancer screening or a cancer diagnosis, with the goal of overcoming barriers to timely, quality care. Primary outcomes of the PNRP are 1) time to diagnostic resolution; 2) time to initiation of cancer treatment; 3) patient satisfaction with care; and 4) cost effectiveness, for breast, cervical, colon/rectum, and/or prostate cancer. The metrics to assess the processes and outcomes of patient navigation have been developed for the NCI-sponsored PNRP. If the metrics are found to be valid and reliable, they may prove useful to other investigators.

Family Medicine Residency Program Directors Attitudes and Knowledge of Family Medicine CAM Competencies

PubMed Central

Gardiner, Paula; Filippelli, Amanda C.; Lebensohn, Patricia; Bonakdar, Robert

2013-01-01

Context Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. Objective The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate with an online survey tool, whether residency programs are implementing such competencies into their curriculum. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. Design A survey was distributed by the CAFM (Council of Academic Family Medicine) Educational Research Alliance to RDs via email. The survey was distributed to 431 RDs. Of those who received it, 212 responded for a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into residency curriculum. Results Forty-five percent of RDs were aware of the competencies. In term of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included: time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%), and financial resources (29%). Conclusions While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers preventing residencies to implementing the STFM CAM/IM competencies. PMID:24021471

Family medicine residency program directors attitudes and knowledge of family medicine CAM competencies.

PubMed

Gardiner, Paula; Filippelli, Amanda C; Lebensohn, Patricia; Bonakdar, Robert

2013-01-01

Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate whether residency programs are implementing such competencies into their curriculum using an online survey tool. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. A survey was distributed by the Council of Academic Family Medicine (CAFM) Educational Research Alliance to RDs via e-mail. The survey was distributed to 431 RDs. Of those who received it, 212 responded, giving a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into the residency curriculum. Forty-five percent of RDs were aware of the competencies. In terms of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum; yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%); and financial resources (29%). While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers that prevent residencies from implementing the STFM CAM/IM competencies. © 2013 Elsevier Inc. All rights reserved.

Harmonizing disease prevention and police practice in the implementation of HIV prevention programs: Up-stream strategies from Wilmington, Delaware

PubMed Central

2012-01-01

Introduction Improving access to sterile injection equipment is a key component in community-based infectious disease prevention. Implementation of syringe access programs has sometimes been complicated by community opposition and police interference. Case description In 2006, the Delaware legislature authorized a pilot syringe exchange program (SEP). A program designed to prevent, monitor, and respond to possible policing and community barriers before they had a chance to effect program implementation and operation. A program designed to prevent, monitor, and respond to these barriers was planned and implemented by a multidisciplinary team of legal practitioners and public health professionals. Discussion We report on an integrated intervention to address structural barriers to syringe exchange program utilization. This intervention employs community, police and client education combined with systematic surveillance of and rapid response to police interference to preempt the kinds of structural barriers to implementation observed elsewhere. The intervention addresses community concerns and stresses the benefits of syringe exchange programs to officer occupational safety. Conclusions A cohesive effort combining collaboration with and educational outreach to police and community members based on the needs and concerns of these groups as well as SEP clients and potential clients helped establish a supportive street environment for the SEP. Police-driven structural barriers to implementation of public health programs targeting populations engaged in drug use and other illicit behavior can be addressed by up-stream planning, prevention, monitoring and intervention strategies. More research is needed to inform the tailoring of interventions to address police-driven barriers to HIV prevention services, especially among marginalized populations. PMID:22591836

A randomized controlled trial of the Cool Teens CD-ROM computerized program for adolescent anxiety.

PubMed

Wuthrich, Viviana M; Rapee, Ronald M; Cunningham, Michael J; Lyneham, Heidi J; Hudson, Jennifer L; Schniering, Carolyn A

2012-03-01

Computerized cognitive behavioral interventions for anxiety disorders in adults have been shown to be efficacious, but limited data are available on the use of computerized interventions with young persons. Adolescents in particular are difficult to engage in treatment and may be especially suited to computerized technologies. This paper describes the results of a small randomized controlled trial of the Cool Teens program for adolescent anxiety, and examines potential barriers to treatment and user preferences of computerized technology in this population. Forty-three adolescents with a primary diagnosis of anxiety were randomly allocated to the Cool Teens program, a 12-week computerized cognitive-behavioral therapy program for anxiety management, or a 12-week wait list. Effects on symptoms, negative thoughts, and life interference were assessed at post-treatment and 3-month follow-up, based on diagnosis as well as self and maternal report. Using mixed-model analyses, at post-treatment and follow-up assessments, adolescents in the Cool Teens condition, compared with those on the wait list, were found to have significant reductions in the total number of anxiety disorders, the severity of the primary anxiety disorder, and the average severity for all disorders. These results were matched by significant reductions in mother and child questionnaire reports of anxiety, internalizing symptoms, automatic thoughts, and life interference. Further few barriers to treatment were found, and user preferences indicated that the computerized treatment was well suited to adolescents with anxiety. The Cool Teens program is efficacious for treatment of adolescent anxiety. Clinical trial registration information-A randomized controlled trial of the Cool Teens computerized program for anxious adolescents compared with waist list; http://www.anzctr.org.au; ACTRN12611000508976. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Prevalence and types of disease management programs in community pharmacies in California.

PubMed

Law, Anandi V; Okamoto, Mark P; Chang, Peter S

2005-01-01

To (1) evaluate the prevalence and types of disease management (DM) programs provided by independent and chain community pharmacies in the state of California, (2) examine the interest among community pharmacists in establishing programs, and (3) assess perceived barriers to developing a successful DM program in community pharmacy. An exploratory telephone survey was conducted from February 2003 to February 2004 to collect data from community (primarily independent and chainstore) pharmacies across California. The survey evaluated existence (or lack of) and types of DM programs in community pharmacies in California. Pharmacies that did not have a DM program were queried on their interest and decisionmaking authority in establishing new programs. Pharmacies that had existing DM programs were sent a follow-up survey to determine the details of the DM programs, including challenges in establishing DM programs, reimbursement issues, and program effectiveness. The sample comprised 1,875 pharmacies, 60 (3.2%) of which had existing DM programs. There were significantly more independent pharmacies (37) with DM programs than chain-store pharmacies (23), P<0.001. There was a statistically significant difference between independent and chain pharmacies in operating hours, number of pharmacist and nonpharmacist staff members per day, and proximity to a clinic or hospital (P<0.05). The most common type of DM program was diabetes, and the second most common type was asthma. Limited time, limited staff, and limited reimbursement were the 3 most commonly reported barriers to establishing new DM programs. About 20% of the sample that did not have a DM program reported interest in developing DM programs, and an equal percentage reported having the decision-making authority to start a program. There were no differences between independent and chain pharmacies on interest (P = 0.234); however, there were significantly more chain pharmacists that did not have the decision-making authority. Of the 18 of 60 pharmacies (30%) that had DM programs and responded to the follow-up survey, 9 respondents (50%) reported monitoring medications as part of their DM program. Fifteen of 18 (83%) perceived lack of reimbursement as a challenge to implementing DM programs. Only 2 pharmacies reported an increase in revenue as a gain from the program, and 2 reported cost savings. Improved patient satisfaction was reported by 16 of 18 respondents (89%) with DM programs, but only 8 (44%) reported that patient satisfaction was being measured. The study found that the prevalence of DM programs was very low among California community pharmacies and the interest in developing these programs moderate, attributable to several barriers such as lack of time, lack of reimbursement, and lack of trained personnel. Some of these barriers could be addressed to encourage the development and proliferation of DM programs that would improve patient outcomes and expand practice roles of pharmacists.

Attitudes Toward Smoking Cessation Among Sheltered Homeless Parents.

PubMed

Stewart, Holly C; Stevenson, Terrell N; Bruce, Janine S; Greenberg, Brian; Chamberlain, Lisa J

2015-12-01

The prevalence of smoking among homeless adults is approximately 70 %. Cessation programs designed for family shelters should be a high priority given the dangers cigarette smoke poses to children. However, the unique nature of smoking in the family shelter setting remains unstudied. We aimed to assess attitudes toward smoking cessation, and unique barriers and motivators among homeless parents living in family shelters in Northern California. Six focus groups and one interview were conducted (N = 33, ages 23-54). The focus groups and interviews were audiorecorded, transcribed verbatim, and a representative team performed qualitative theme analysis. Eight males and 25 females participated. The following major themes emerged: (1) Most participants intended to quit eventually, citing concern for their children as their primary motivation. (2) Significant barriers to quitting included the ubiquity of cigarette smoking, its central role in social interactions in the family shelter setting, and its importance as a coping mechanism. (3) Participants expressed interest in quitting "cold turkey" and in e-cigarettes, but were skeptical of the patch and pharmacotherapy. (4) Feelings were mixed regarding whether individual, group or family counseling would be most effective. Homeless parents may be uniquely motivated to quit because of their children, but still face significant shelter-based social and environmental barriers to quitting. Successful cessation programs in family shelters must be designed with the unique motivations and barriers of this population in mind.

An international, multidisciplinary, service-learning program: an option in the dental school curriculum.

PubMed

Martinez-Mier, Esperanza A; Soto-Rojas, Armando E; Stelzner, Sarah M; Lorant, Diane E; Riner, Mary E; Yoder, Karen M

2011-04-01

Many health professions students who treat Spanish-speaking patients in the United States have little concept of their culture and health related traditions. The lack of understanding of these concepts may constitute major barriers to healthcare for these patients. International service-learning experiences allow students to work directly in communities from which patients immigrate and, as a result, students gain a better understanding of these barriers. This article describes the implementation of an international, multidisciplinary, service-learning program in a dental school in the United States. The Indiana University International Service-Learning program in Hidalgo, Mexico began in 1999 as an alternative spring break travel and clinical experience for medical students, focusing on the treatment of acute health problems. Travel-related preparatory sessions were offered, and no learning or service objectives had been developed. The program has evolved to include a multidisciplinary team of dental, medical, nursing, public health and social work students and faculty. The experience is now integrated into a curriculum based on the service-learning model that allows students to use their clinical skills in real-life situations and provides structured time for reflection. The program aims to enhance teaching and foster civic responsibility in explicit partnership with the community. Preparatory sessions have evolved into a multidisciplinary graduate level course with defined learning and service objectives. PROGRAM EVALUATION METHODS: In order to assess the program's operation as perceived by students and faculty and to evaluate student's perceptions of learning outcomes, evaluation tools were developed. These tools included student and faculty evaluation questionnaires, experiential learning journals, and a strengths, weaknesses, opportunities and threats analysis. Evaluation data show that after program participation, students perceived an increase in their cultural awareness, cross-cultural communication skills and understanding of barriers and disparities faced by Latinos in the United States. Faculty evaluations offer insights into the lessons learned through the implementation process. The development of a service-learning based curriculum has posed challenges but has enriched international service experiences.

Comparison of native versus nonnative English-speaking nurses on critical thinking assessments at entry and exit.

PubMed

Whitehead, Tanya D

2006-01-01

Diversity of language among healthcare employees and nursing students is growing as diversity increases among the general population. Institutions have begun to develop systems to accommodate diversity and to assimilate workers. One barrier to nonnative English-speaking nurse hires may be posed by readiness for the licensure exam and the critical thinking assessments that are now an expected outcome of nursing programs, and act as a gatekeeper to graduation and to employment. To assist in preparing for high-stakes testing, the Assessment Technologies Institute Critical Thinking Assessment was developed in compliance with credentialing bodies' educational outcomes criteria. This pilot study of 209 nursing students was designed to reveal any possible language bias that might act as a barrier to nonnative English speakers. Nursing students were entered as whole classes to the study to control for selection bias. A sample representative of national nursing enrollment was obtained from 21 universities, with 192 (92%) native English-speaking students and 17 (8%) nonnative English speakers participating in the study. All students were given the Assessment Technologies Institute Critical Thinking Assessment at entry and exit to their nursing program. Average scores on entry were 66% for nonnative speakers and 72% for native speakers. At exit, the nonnative speakers had closed the gap in academic outcomes. They had an average score of 72% compared to 73% for native speakers. The study found that the slight differences between the native and nonnative speakers on 2 exit outcome measures-National Council licensure examination (NCLEX-RN) pass rates and Critical Thinking Assessment-were not statistically significant, demonstrating that nonnative English speakers achieved parity with native English-speaking peers on the Critical Thinking Assessment tool, which is often believed to be related to employment readiness.

Bayesian Chance-Constrained Hydraulic Barrier Design under Geological Structure Uncertainty.

PubMed

Chitsazan, Nima; Pham, Hai V; Tsai, Frank T-C

2015-01-01

The groundwater community has widely recognized geological structure uncertainty as a major source of model structure uncertainty. Previous studies in aquifer remediation design, however, rarely discuss the impact of geological structure uncertainty. This study combines chance-constrained (CC) programming with Bayesian model averaging (BMA) as a BMA-CC framework to assess the impact of geological structure uncertainty in remediation design. To pursue this goal, the BMA-CC method is compared with traditional CC programming that only considers model parameter uncertainty. The BMA-CC method is employed to design a hydraulic barrier to protect public supply wells of the Government St. pump station from salt water intrusion in the "1500-foot" sand and the "1700-foot" sand of the Baton Rouge area, southeastern Louisiana. To address geological structure uncertainty, three groundwater models based on three different hydrostratigraphic architectures are developed. The results show that using traditional CC programming overestimates design reliability. The results also show that at least five additional connector wells are needed to achieve more than 90% design reliability level. The total amount of injected water from the connector wells is higher than the total pumpage of the protected public supply wells. While reducing the injection rate can be achieved by reducing the reliability level, the study finds that the hydraulic barrier design to protect the Government St. pump station may not be economically attractive. © 2014, National Ground Water Association.

A cross-cultural survey of residents' perceived barriers in questioning/challenging authority.

PubMed

Kobayashi, H; Pian-Smith, M; Sato, M; Sawa, R; Takeshita, T; Raemer, D

2006-08-01

To identify perceived barriers to residents' questioning or challenging their seniors, to determine how these barriers affect decisions, and to assess how these barriers differ across cultures. A written questionnaire was administered to residents in teaching hospitals in the US and Japan to assess factors affecting residents' willingness to question or challenge their superiors. The responses were analyzed for statistical significance of differences between the two cultures and to determine the importance of issues affecting decisions. Questionnaires were completed by 175 US and 65 Japanese residents, with an overall response rate of 71%. Trainees from both countries believe that questioning and challenging contribute to safety. The perceived importance of specific beliefs about the workplace differed across cultures in seven out of 22 questions. Residents' decisions to make a challenge were related to the relationships and perceived response of the superiors. There was no statistical difference between the US and Japanese residents in terms of the threshold for challenging their seniors. We have identified attributes of residents' beliefs of communication, including several cross-cultural differences in the importance of values and issues affecting one's decision to question or challenge. In contrast, there was no difference in the threshold for challenging seniors by the Japanese and US residents studied. Changes in organizational and professional culture may be as important, if not more so, than national culture to encourage "speaking up". Residents should be encouraged to overcome barriers to challenging, and training programs should foster improved relationships and communication between trainers and trainees.

Characteristics of Individuals Screening Positive for Substance Use in a Welfare Setting: Implications for Welfare and Substance-Use Disorders Treatment Systems*

PubMed Central

MORGENSTERN, JON; HOGUE, AARON; DASARO, CHRISTOPHER; KUERBIS, ALEXIS; DAUBER, SARAH

2016-01-01

Objective This study examined barriers to employability, motivation to abstain from substances and to work, and involvement in multiple service systems among male and female welfare applicants with alcohol- and drug-use problems. Method A representative sample (N = 1,431) of all persons applying for public assistance who screened positive for substance involvement over a 2-year period in a large urban county were recruited in welfare offices. Legal, education, general health, mental health, employment, housing, and child welfare barriers to employability were assessed, as were readiness to abstain from substance use and readiness to work. Results Only 1 in 20 participants reported no barrier other than substance use, whereas 70% reported at least two other barriers and 40% reported three or more. Moreover, 70% of participants experienced at least one additional barrier classified as “severe” and 30% experienced two or more. The number and type of barriers differed by gender. Latent class analysis revealed four main barriers-plus-readiness profiles among participants: (1) multiple barriers, (2) work experienced, (3) criminal justice, and (4) unstable housing. Conclusions Findings suggest that comprehensive coordination among social service systems is needed to address the complex problems of low-income Americans with substance-use disorders. Classifying applicants based on barriers and readiness is a promising approach to developing innovative welfare programs to serve the diverse needs of men and women with substance-related problems. PMID:18612572

An examination of how women and underrepresented racial/ethnic minorities experience barriers in biomedical research and medical programs

NASA Astrophysics Data System (ADS)

Chakraverty, Devasmita

Women in medicine and biomedical research often face challenges to their retention, promotion, and advancement to leadership positions (McPhillips et al., 2007); they take longer to advance their careers, tend to serve at less research-intensive institutions and have shorter tenures compared to their male colleagues (White, McDade, Yamagata, & Morahan, 2012). Additionally, Blacks and Hispanics are the two largest minority groups that are vastly underrepresented in medicine and biomedical research in the United States (AAMC, 2012; NSF, 2011). The purpose of this study is to examine specific barriers reported by students and post-degree professionals in the field through the following questions: 1. How do women who are either currently enrolled or graduated from biomedical research or medical programs define and make meaning of gender-roles as academic barriers? 2. How do underrepresented groups in medical schools and biomedical research institutions define and make meaning of the academic barriers they face and the challenges these barriers pose to their success as individuals in the program? These questions were qualitatively analyzed using 146 interviews from Project TrEMUR applying grounded theory. Reported gender-role barriers were explained using the "Condition-Process-Outcome" theoretical framework. About one-third of the females (across all three programs; majority White or Black between 25-35 years of age) reported gender-role barriers, mostly due to poor mentoring, time constraints, set expectations and institutional barriers. Certain barriers act as conditions, causing gender-role issues, and gender-role issues influence certain barriers that act as outcomes. Strategies to overcome barriers included interventions mostly at the institutional level (mentor support, proper specialty selection, selecting academia over medicine). Barrier analysis for the two largest URM groups indicated that, while Blacks most frequently reported racism, gender barriers, mentoring, and personal barriers, Hispanics most frequently reported economic barriers, language barriers, institutional and workplace environment barriers, and gender-role barriers. Examining barriers using the "Individual-Institutional" theoretical framework indicated that barriers do not occur in isolation, but due to an interaction between the individual and its institution. Additionally, the barriers of the two groups are qualitatively different and the "one size fits all" approach may not be suitable for interventions. Implications and recommendations were stated.

The early childhood oral health program: a qualitative study of the perceptions of child and family health nurses in South Western Sydney, Australia.

PubMed

Veale, Maxine; Ajwani, Shilpi; Johnson, Maree; Nash, Linda; Patterson, Tiffany; George, Ajesh

2016-05-16

Early childhood caries affects nearly half the population of Australian children aged 5 years and has the potential to negatively impact their growth and development. To address this issue, an Early Childhood Oral Health (ECOH) program, facilitated by Child and Family Health Nurses (CFHNs), commenced in 2007 in New South Wales, Australia. This study builds on the previous evaluation of the program. It aims to explore the perceptions of CFHNs regarding the implementation of the ECOH program in South Western Sydney and the challenges and barriers related to its sustainability. A descriptive qualitative design was used in this study. Two focus groups were conducted with 22 CFHNs who were sampled from two Community Health Centres in South Western Sydney, Australia. Data were transcribed verbatim and thematic analysis was undertaken. Most CFHNs acknowledged the importance of early childhood oral health promotion and were providing education, oral assessments and referrals during child health checks. Many stressed the need for collaboration with other health professionals to help broaden the scope of the program. Some barriers to implementing the program included confusion regarding the correct referral process, limited feedback from dental services and the lack of oral health awareness among parents. The study findings suggest that the ECOH program is being sustained and effectively implemented into practice by CFHNs. Improvement in the referral and feedback process as well as enhancing parental knowledge of the importance of infant and child oral health could further strengthen the effectiveness of the program. Expanding oral health education opportunities into general practice is advocated, while regular on-line training for CFHNs is preferred. Future research should include strategies to reduce non-attendances, and an assessment of the impact on the prevalence of childhood caries of the ECOH program.

Enhancing community capacity to support physical activity: the development of a community-based indoor-outdoor walking program.

PubMed

Riley-Jacome, Mary; Gallant, Mary P; Fisher, Brian D; Gotcsik, Frances S; Strogatz, David S

2010-04-01

The University at Albany Prevention Research Center, guided by a needs assessment in two underserved communities (one urban, one rural), initiated a pilot project that opened a public school for community walking in a rural setting. This study examined a 9-week program for potential barriers, benefits, influential factors, and the physical activity levels of program participants. Evaluation was based on daily logs, pedometer diaries, participant surveys, and focus groups. Results indicated that rural schools provide a useful resource for residents and increase participants' physical activity levels. A more comprehensive rural community walking program has been implemented as a result of these findings.

Barriers to providing palliative care in long-term care facilities

PubMed Central

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-01-01

OBJECTIVE To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. DESIGN Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. SETTING All licensed LTC facilities in Ontario with designated medical directors. PARTICIPANTS Medical directors in the facilities. MAIN OUTCOME MEASURES Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. RESULTS Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff’s capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). CONCLUSION Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care. PMID:17327890

Barriers to providing palliative care in long-term care facilities.

PubMed

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-04-01

To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. All licensed LTC facilities in Ontario with designated medical directors. Medical directors in the facilities. Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.

A Focus Group Assessment to Determine Motivations, Barriers and Effectiveness of a University-Based Worksite Wellness Program

PubMed Central

Hill-Mey, Patricia E.; Merrill, Ray M.; Kumpfer, Karol L.; Reel, Justine; Hyatt-Neville, Beverly

2013-01-01

Background: This study explores university employee perceptions and under­standing about its Worksite Health Promotion Program (WHPP). The WHPP included a Health Risk Appraisal (HRA), biometric screening, publicity for on-campus health programs and facilities, and health coaching. Methods: A qualitative design was used based on a grounded theory ap­proach. Four 90 minutes focus groups with 6-8 participants in each were conducted within a two 2 week period among employees, representing fac­ulty/participants, fac­ulty/nonparticipants, staff/participants, and staff/nonparticipants. Responses to questions about motivations, barriers, and perceived health benefits that impacted participation in the WHPP were digi­tally recorded, transcribed and coded for themes. Results: Incentives effectively motivated participation. Biometric screening had the largest impact on behavior change, followed by the information learned from the HRA. However, despite two-thirds of the employees partici­pating in the pro­gram, lack of a full understanding of WHPP benefits and services lowered partici­pation in follow-up services and supplemental pro­grams. Conclusions: Biometric screening and HRAs effectively motivate program par­ticipation. Communication of benefits and services are important when providing WHPPs. PMID:24688965

What Prevents Adolescents from Seeking Help after a Suicide Education Program?

ERIC Educational Resources Information Center

Cigularov, Konstantin; Chen, Peter Y.; Thurber, Beverly W.; Stallones, Lorann

2008-01-01

Perceived barriers to help-seeking among adolescents attending a suicide education program were examined. A total of 854 high school students in Colorado completed one of two questionnaires, measuring barriers to help-seeking for self or friend. The most prominent barriers for self were: inability to discuss problems with adults,…

A Descriptive Study of Nursing Peer-Review Programs in US Magnet® Hospitals.

PubMed

Roberts, Holli; Cronin, Sherill Nones

2017-04-01

The goal of this study was to assess the types of nursing peer review (NPR) programs in US Magnet® organizations. The 2 most predominant models of NPR programs in the literature are performance evaluation and clinical peer review. The literature on clinical peer review is primarily descriptive, outlining structures and anecdotal outcomes. Participants from hospitals holding Magnet recognition were selected using a stratified random-sampling method. A survey developed by the researchers assessed the presence of NPR. If clinical NPR was in place, program design, evaluation measurements, and barriers were explored. Findings suggest wide variability in NPR models. More than one-third of the respondents conduct peer evaluation as the only mechanism of NPR. Most hospitals with a clinical peer-review program reported a case review structure and process measurements not supported by data. The variations noted in this study suggest more research is needed to measure the effectiveness of NPR models and associated outcomes.

The Ergonomic Program Implementation Continuum (EPIC): integration of health and safety--a process evaluation in the healthcare sector.

PubMed

Baumann, Andrea; Holness, D Linn; Norman, Patrica; Idriss-Wheeler, Dina; Boucher, Patricia

2012-07-01

This article presents a health and safety intervention model and the use of process evaluation to assess a participatory ergonomic intervention. The effectiveness of the Ergonomic Program Implementation Continuum (EPIC) was assessed at six healthcare pilot sites in Ontario, Canada. The model provided a framework to demonstrate evaluation findings. Participants reported that EPIC was thorough and identified improvements related to its use. Participants believed the program contributed to advancing an organizational culture of safety (COS). Main barriers to program uptake included resistance to change and need for adequate funding and resources. The dedication of organizational leaders and consultant coaches was identified as essential to the program's success. In terms of impact on industry, findings contribute to the evidence-based knowledge of health and safety interventions and support use of the framework for creating a robust infrastructure to advance organizational COS and link staff safety and wellness with patient safety in healthcare. Copyright © 2012 National Safety Council and Elsevier Ltd. All rights reserved.

Use of NASA Satellite Data in Aiding Mississippi Barrier Island Restoration Projects

NASA Technical Reports Server (NTRS)

Giardino, Marco; Spruce, Joseph; Kalcic, Maria; Fletcher, Rose

2009-01-01

This presentation discusses a NASA Stennis Space Center project in which NASA-supported satellite and aerial data is being used to aid state and federal agencies in restoring the Mississippi barrier islands. Led by the Applied Science and Technology Project Office (ASTPO), this project will produce geospatial information products from multiple NASA-supported data sources, including Landsat, ASTER, and MODIS satellite data as well as ATLAS multispectral, CAMS multispectral, AVIRIS hyperspectral, EAARL, and other aerial data. Project objectives include the development and testing of a regional sediment transport model and the monitoring of barrier island restoration efforts through remote sensing. Barrier islands provide invaluable benefits to the State of Mississippi, including buffering the mainland from storm surge impacts, providing habitats for valuable wildlife and fisheries habitat, offering accessible recreational opportunities, and preserving natural environments for educating the public about coastal ecosystems and cultural resources. Unfortunately, these highly valued natural areas are prone to damage from hurricanes. For example, Hurricane Camille in 1969 split Ship Island into East and West Ship Island. Hurricane Georges in 1998 caused additional land loss for the two Ship Islands. More recently, Hurricanes Ivan, Katrina, Rita, Gustav, and Ike impacted the Mississippi barrier islands. In particular, Hurricane Katrina caused major damage to island vegetation and landforms, killing island forest overstories, overwashing entire islands, and causing widespread erosion. In response, multiple state and federal agencies are working to restore damaged components of these barrier islands. Much of this work is being implemented through federally funded Coastal Impact Assessment and Mississippi Coastal Improvement programs. One restoration component involves the reestablishment of the island footprints to that in 1969. Our project will employ NASA remote sensing data and products to support these federally funded efforts on multiple fronts. Landsat and ASTER data is being analyzed to assess changes in barrier island land cover over the last 35 years. ASTER, SRTM, and EAARL terrain products and other NASA airborne imagery are being applied in assessing changes in barrier island geomorphology and geospatial extent. MODIS data is being examined as a tool for sediment transport modeling by supplying geospatial data that quantifies in-water sediment concentrations. MODIS satellite data is being assessed for monitoring changes in the spatial extent of individual barrier islands. Results thus far indicate that NASA data products are useful in assessing barrier island conditions and changes. This value is enhanced with additional historical geospatial data, commercial high resolution satellite data, other non-NASA aerial imagery, and field survey data. The project s products are relevant to the Gulf of Mexico Alliance priority issues, including coastal habitat conservation, restoration and coastal community resilience. Such products will be available to state and federal agencies involved with coastal restoration. Potential end-users of these products include the National Park Service, U.S. Geological Survey, U.S. Army Corps of Engineers, Environmental Protection Agency, Mississippi Department of Environmental Quality, and Mississippi Department of Marine Resources.

A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program.

PubMed

Pearsall, Emily A; Meghji, Zahida; Pitzul, Kristen B; Aarts, Mary-Anne; McKenzie, Marg; McLeod, Robin S; Okrainec, Allan

2015-01-01

Explore the barriers and enablers to adoption of an Enhanced Recovery after Surgery (ERAS) program by the multidisciplinary perioperative team responsible for the care of elective colorectal surgical patients. ERAS programs include perioperative interventions that when used together have led to decreased length of stay while increasing patient recovery and satisfaction. Despite the known benefits of ERAS programs, uptake remains slow. Semistructured interviews were conducted with general surgeons, anesthesiologists, and ward nurses at 7 University of Toronto-affiliated hospitals to identify potential barriers and enablers to adoption of 18 ERAS interventions. Grounded theory was used to thematically analyze the transcribed interviews. Nineteen general surgeons, 18 anesthesiologists, and 18 nurses participated. The mean time of each interview was 18 minutes. Lack of manpower, poor communication and collaboration, resistance to change, and patient factors were cited by most as barriers. Discipline-specific issues were identified although most related to resistance to change. Overall, interviewees were supportive of implementation of a standardized ERAS program and agreed that a standardized guideline based on best evidence; standardized order sets; and education of the staff, patients, and families are essential. Multidisciplinary perioperative staff supported the implementation of an ERAS program at the University of Toronto-affiliated hospitals. However, major barriers were identified, including the need for patient education, increased communication and collaboration, and better evidence for ERAS interventions. Identifying these barriers and enablers is the first step toward successfully implementing an ERAS program.

An Integrative Review of Factors Associated with Patient Attrition from Community Health Worker Programs that Support Diabetes Self-Care.

PubMed

Merius, Heidy N; Rohan, Annie J

2017-01-01

An integrative review was conducted using PubMed and CINAHL databases to answer: What is known about adult attrition from community health worker (CHW) programs on diabetes self-care? The 14 articles described patients of multiple races who were mainly of lower socioeconomic status. CHW interventions were given in individual meetings and/or group sessions. Incentives to reduce attrition came in different forms. Barriers involved transportation, family obligations, and scheduling conflicts. Attrition from these programs is a multifactorial problem. Alleviating transportation barrier appears to be protective. Program planners should consider these barriers when planning CHW programs.

Vocational Education in Correctional Institutions: State-of-the-Art Assessment of Programs in Region IV. Volume I, Final Technical Report.

ERIC Educational Resources Information Center

Rice, Eric; And Others

To identify the issues, characteristics, barriers, and needs related to vocational education provisions in Southeastern correctional institutions, a project was developed. Survey data was collected through a 100% sample of adult and juvenile correctional facilities in seven states. Study procedures utilized a combination of state level interviews,…

Sustaining Teen Pregnancy Prevention Programs in Schools: Needs and Barriers Identified by School Leaders

ERIC Educational Resources Information Center

Craft, Lesley R.; Brandt, Heather M.; Prince, Mary

2016-01-01

Background: To reduce teen pregnancy rates, prevention programs must be consistently available to large numbers of youth. However, prevention efforts have been historically conducted with little emphasis on ensuring program sustainability. This study examined the needs and barriers to sustaining teen pregnancy prevention (TPP) programming in…

Head Start Staff Reactions to a Novel Tobacco Intervention: A Qualitative Analysis.

PubMed

Keske, Robyn R; Barker, Kathryn M; Geller, Alan C; Hamasaka, Laura; Sparks, Michael; Moody-Thomas, Sarah; Jolicoeur, Denise; Rees, Vaughan W

2016-11-01

As tobacco use becomes increasingly concentrated in communities of low socio-economic position (SEP), scalable cessation interventions are needed. Head Start programs offer one setting in which a family-focused intervention can be implemented in low SEP communities. We assessed the experiences of Head Start (HS) staff who received training in a pilot motivational interviewing (MI) tobacco intervention, to improve future feasibility. Focus group interviews were conducted with HS staff to assess their reactions to MI training and their use of MI in their work with families. Transcripts were analyzed using thematic analysis and a 4-step approach informed by grounded theory. HS staff reported advantages of MI beyond its use as a tobacco intervention, despite systematic barriers to broad implementation. Facilitators of MI use included enhanced engagement with families, and opportunities for professional development. Barriers to MI use included limited institutional support and low priority for a tobacco intervention among families with pressing social and financial concerns. HS Staff voiced support for broader training in MI interventions in HS programs. System-wide standards to ensure adequate training and support for an MI tobacco intervention were identified as priorities.

Feasibility of Web-based Technology to Assess Adherence to Clinic Appointments in Youth with Sickle Cell Disease

PubMed Central

Modi, Avani C.; Crosby, Lori E.; Hines, Janelle; Drotar, Dennis; Mitchell, Monica J.

2011-01-01

Web-based tools to improve clinic attendance have been effectively used in pediatric conditions but have not been tested in pediatric sickle cell disease (SCD). The goal of this pilot study was to assess barriers to clinic attendance and the feasibility of a web-based assessment tool to promote problem-solving around clinic appointments. Study participants included 30 youth with SCD (M=11.7±3.5 years; 57% male; 60% HbSS; 20% HbSC; 17% HB+Thal) and their primary caregivers. Medical chart review indicated that 61% of participants attended at least two SCD clinic appointments in the past year. The primary barrier to clinic attendance was inability to take off from work/school (33%). Regarding feasibility and acceptability, the computerized program was well-received by patients and caregivers, with youth and caregivers reporting a high degree of usefulness and preference for computerized assessment. Results suggest that this innovative approach shows promise and should be tested on a larger sample of youth with SCD. PMID:22278205

Barriers reported among patients with breast and cervical abnormalities in the patient navigation research program: impact on timely care.

PubMed

Katz, Mira L; Young, Gregory S; Reiter, Paul L; Battaglia, Tracy A; Wells, Kristen J; Sanders, Mechelle; Simon, Melissa; Dudley, Donald J; Patierno, Steven R; Paskett, Electra D

2014-01-01

Patient navigation (PN) is a system-level strategy to decrease cancer mortality rates by reducing barriers to cancer care. Barriers to resolution among participants in the PN intervention arm with a breast or cervical abnormality in the Patient Navigation Research Program and navigators' actions to address those barriers were examined. Data from seven institutions (2005-2010) included 1,995 breast and 1,194 cervical patients. A stratified Cox proportional hazards regression model was used to examine the effects of barriers on time to resolution of an abnormal screening test or clinical finding. The range of unique barriers was 0 to 12 and 0 to 7 among participants with breast and cervical abnormalities, respectively. About two thirds of breast and one half of cervical participants had at least one barrier resulting in longer time to diagnostic resolution among breast (adjusted hazard ratio [HR], 0.744; p < .001) and cervical (adjusted HR, 0.792; p < .001) participants. Patient- and system-level barriers were most common. Frequent navigator actions were making arrangements, scheduling appointments, referrals, and education. Having a barrier resulted in a delay in diagnostic resolution of an abnormal screening test or clinical finding. Health care systems can use these findings to improve existing PN programs or when developing new programs. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

"I sleep better at night:" How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs.

PubMed

Brundage, Michael D; Hart, Margaret; O'Donnell, Jennifer; Reddeman, Lindsay; Gutierrez, Eric; Foxcroft, Sophie; Warde, Padraig

Peer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans and can also have indirect effects on radiation treatment programs. We undertook a systematic, qualitative approach to describing the indirect benefits of peer review, factors that were seen to facilitate or act as barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs). Semistructured qualitative interviews were held with radiation oncology department heads and radiation therapy managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by 2 independent reviewers, and any discordance was resolved by consensus. A total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n = 3), process (n = 9), or outcome (n = 10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs. Although challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans. Copyright © 2016. Published by Elsevier Inc.

Chronic disease management for recently homeless Veterans: a clinical practice improvement program to apply home telehealth technology to a vulnerable population

PubMed Central

Gabrielian, Sonya; Yuan, Anita; Andersen, Ronald M.; McGuire, James; Rubenstein, Lisa; Sapir, Negar; Gelberg, Lillian

2013-01-01

Background Though vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a “digital divide” in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Administration (VA) HIT care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. Methods CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to “diagnose” barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Subjects Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other four enrolled in CCHT usual care. Results Though barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. Conclusions HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment. PMID:23407011

Combining Photovoice and focus groups: engaging Latina teens in community assessment.

PubMed

Hannay, Jayme; Dudley, Robert; Milan, Stephanie; Leibovitz, Paula K

2013-03-01

Latino adolescents, especially girls, experience higher obesity rates and are more likely to be physically unfit than non-Latino white peers. Out-of-school programs to increase physical activity and fitness in older Latino teens are critical, but sustained engagement is challenging. This study combined a community-based participatory research methodology, Photovoice, with focus groups to engage Latina teens and their parents in identifying barriers to physical activity and initiating policy change actions to address them. The study investigates the effectiveness of applying Photovoice as both an evaluation tool and a leadership/advocacy intervention in a community-based obesity prevention program. Focus group data were collected between July 2009 and October 2010 and analyzed between November 2010 and July 2011. Five focus groups were held with adults (n = 41: 95% Latino) and four with teens (n = 36: 81% Latino, 10% non-Hispanic white, 9% African-American). All participants (19 teens, six adults) were Latino. Spanish-speaking staff of a community-based agency, program staff, high school guidance counselors, and a job development agency recruited participants. Teens aged 14-19 years enrolled in New Britain CT, high schools, and their parents were eligible. Data from Photovoice workshops (three with teens, two with parent-teen dyads) were collected and concurrently analyzed between July 2009 and August 2011. Teens criticized school-based physical exercise programs in favor of out-of-school exercise and career advice. Parental restrictions and work, transportation, and safety issues were cited as barriers to afterschool physical activity programs. Photovoice can empower teens and parents to address exercise barriers by promoting advocacy that leads to policy change (e.g., an out-of-school physical education option). Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Barriers to implementing protocols for kidney paired donation and desensitization: survey of U.S. transplant programs.

PubMed

Clark, Emma; Hanto, Ruthanne; Rodrigue, James R

2010-12-01

Special types of kidney transplant exist for patients who have willing but incompatible donors. Two types of transplants that circumvent donor-recipient incompatibility are "kidney paired donation" and "desensitization." Lack of access to these protocols limits living donations and shortens the life span of patients with willing but incompatible donors. To understand potential barriers to implementing kidney paired donation and desensitization, as well as attitudes toward nondirected donation and compatible type O donation, which would maximize the number of kidney paired donation transplants performed via chains. We created a 56-question Web-based survey to elicit information from US transplant program directors about 24 potential barriers to implementing these protocols. Of 166 programs contacted, 96 responded, including 88 complete and 8 partial responses. After pediatric-only programs and multiple responses from the same program were removed, 84 total (78 complete) remained. Respondents were asked to designate each barrier as "major," "minor," or "not a barrier". Availability of dedicated nurse coordinators and the United Network for Organ Sharing's variance request process (although kidney paired donation does not actually require a variance) were significant barriers to kidney paired donation. Most respondents (54%, 42/78) would prefer to participate in a regional rather than a national protocol for kidney paired donation. Risk of complications was the most significant barrier to desensitization. University affiliation, region, and training (nephrologist vs surgeon) had little effect on perception of barriers. Most (92%, 71/78) would evaluate nondirected donations; 53% (41/78) would encourage compatible type O donors to enter kidney paired donation.

Vascular Access Practice Patterns in Canada: A National Survey

PubMed Central

Dumaine, Chance; Kiaii, Mercedeh; Miller, Lisa; Moist, Louise; Oliver, Matthew J.; Lok, Charmaine E.; Hiremath, Swapnil; MacRae, Jennifer M.

2018-01-01

Background: One of the mandates of the Canadian Society of Nephrology’s (CSN) Vascular Access Working Group (VAWG) is to inform the nephrology community of the current status of vascular access (VA) practice within Canada. To better understand VA practice patterns across Canada, the CSN VAWG conducted a national survey. Objectives: (1) To inform on VA practice patterns, including fistula creation and maintenance, within Canada. (2) To determine the degree of consensus among Canadian clinicians regarding patient suitability for fistula creation and to assess barriers to and facilitators of fistula creation in Canada. Design: Development and implementation of a survey. Setting: Community and academic VA programs. Participants: Nephrologists, surgeons, and nurses who are involved in VA programs across Canada. Measurements: Practice patterns regarding access creation and maintenance, including indications and contraindications to fistula creation, as well as program-wide facilitators of and barriers to VA. Methods: A small group of CSN VAWG members determined the scope and created several VA questions which were then reviewed by 5 additional VAWG members (4 nephrologists and 1 VA nurse) to ensure that questions were clear and relevant. The survey was then tested by the remaining members of the VAWG and refinements were made. The final survey version was submitted electronically to relevant clinicians (nephrologists, surgeons, and nurses) involved or interested in VA across Canada. Questions centered around 4 major themes: (1) Practice patterns regarding access creation (preoperative assessment and maturation assessment), (2) Practice patterns regarding access maintenance (surveillance and salvage), (3) Indications and contraindications for arteriovenous (AV) access creation, and (4) Facilitators of and barriers to fistula creation and utilization. Results: Eighty-two percent (84 of 102) of invited participants completed the survey; the majority were nurses or VA coordinators (55%) with the remainder consisting of nephrologists (21%) and surgeons (20%). Variation in practice was noted in utility of preoperative Doppler ultrasound, interventions to assist nonmaturing fistulas, and procedures to salvage failing or thrombosed AV-access. Little consensus was seen regarding potential contraindications to AV-access creation (with the exception of limited life expectancy and poor vasculature on preoperative imaging, which had high agreement). Frequent barriers to fistula utilization were primary failure (77% of respondents) and long maturation times (73%). Respondents from centers with low fistula prevalence also cited long surgical wait times as an important barrier to fistula creation, whereas those from centers with high fistula prevalence cited access to multidisciplinary teams and interventional radiology as keys to successful fistula creation and utilization. Conclusions: There is significant variation in VA practice across Canada and little consensus among Canadian clinicians regarding contraindications to fistula creation. Further high-quality studies are needed with regard to appropriate fistula placement to help guide clinical practice. PMID:29511569

Community-based colorectal cancer intervention in underserved Korean Americans.

PubMed

Ma, Grace X; Shive, Steve; Tan, Yin; Gao, Wanzhen; Rhee, Joanne; Park, Micah; Kim, Jaesool; Toubbeh, Jamil I

2009-11-01

Despite evidence of a decline in both incidence and prevalence of colorectal cancer nationwide, it remains the second most commonly diagnosed cancer and the third highest cause of mortality among Asian Americans, including Korean Americans. This community-based and theoretically guided study evaluated a culturally appropriate intervention program that included a bilingual cancer educational program among Korean Americans including information on CRC risks, counseling to address psychosocial and access barriers, and patient navigation assistance. A two-group quasi-experimental design with baseline and post-intervention assessment and a 12-month follow-up on screening was used in the study. Korean Americans (N=167) were enrolled from six Korean churches. The intervention group received culturally appropriate intervention program addressing accessibility and psychosocial barriers, and navigation assistance for screening. The control group received general health education that included cancer-related health issues and screening. There was a significant difference (p<0.05) between the post-intervention and control groups in awareness of CRC risk factors. There was also a significant improvement in the pre-post across HBM measures in the intervention group for perceived susceptibility (p<0.05) and benefits and barriers to screening (p<0.001). At baseline, 13% of participants in the intervention group and 10% in control group reported having had a CRC cancer screening test in the previous year. At the 12-month post-intervention follow-up, 77.4% of participants in the intervention group had obtained screening compared to 10.8% in the control group. While health disparities result from numerous factors, a culturally appropriate and church-based intervention can be highly effective in increasing knowledge of and access to, and in reducing barriers to CRC screening among underserved Koreans.

Individual, social and environmental factors influencing physical activity levels and behaviours of multiethnic socio-economically disadvantaged urban mothers in Canada: A mixed methods approach

PubMed Central

2012-01-01

Background Existing data provide little insight into the physical activity context of multiethnic socio-economically disadvantaged mothers in Canada. Our primary objectives were: (1) to use focus group methodology to develop tools to identify the individual, social, and environmental factors influencing utilitarian and leisure time physical activities (LTPA) of multiethnic SED mothers; and (2) to use a women specific physical activity survey tool to assess psychosocial barriers and supports and to quantify individual physical activity (PA) levels of multi-ethnic SED mothers in Canada. Methods Qualitative focus group sessions were conducted in West, Central and Eastern Canada with multiethnic SED mothers (n = 6 focus groups; n = 42 SED mothers) and with health and recreation professionals (HRPs) (n = 5 focus groups; n = 25 HRPs) involved in community PA programming for multiethnic SED mothers. Administration of the women specific Kaiser Physical Activity Survey (KPAS) tool was completed by consenting SED mothers (n = 59). Results More than half of SED mothers were employed and had higher total PA scores with occupation included than unemployed mothers. However, nearly 60% of both groups were overweight or obese. Barriers to LTPA included the lack of available, affordable and accessible LTPA programs that responded to cultural and social needs. Concerns for safety, nonsupportive cultural and social norms and the winter climate were identified as key barriers to both utilitarian and LTPA. Conclusions Findings show that multiethnic SED mothers experience many barriers to utilitarian and LTPA opportunities within their communities. The varying LTPA levels among these multi-ethnic SED mothers and the occurrence of overweight and obesity suggests that current LTPA programs are likely insufficient to maintain healthy body weights. PMID:22500882

Development of a Scale to Determine Enrollment Barriers into Allied Health Programs

ERIC Educational Resources Information Center

Barfield, J. P.; Folio, M. Rhonda; Lam, Eddie T. C.; Zhang, James J.

2011-01-01

The purpose of this study was to develop the Scale of Allied Health Education Barriers to identify factors limiting enrollment in college/university allied health education programs. Development of the Scale of Allied Health Education Barriers was conducted through the following four stages: (1) review of literature, (2) focus group studies, (3)…

Exploring Trends and Barriers to Implementation of Branding and Marketing Concepts in the School Nutrition Setting

ERIC Educational Resources Information Center

Castillo, Alexandra; Nettles, Mary Frances

2012-01-01

Purpose/Objectives: The purpose of this research study was to identify perceptions, practices, advantages, and barriers to implementation of branding concepts in school nutrition (SN) programs. Methods: Seven SN directors participated in an expert panel session to discuss trends and barriers to implementation of branding concepts in SN programs.…

Exploring low-income families' financial barriers to food allergy management and treatment.

PubMed

Minaker, Leia M; Elliott, Susan J; Clarke, Ann

2014-01-01

Objectives. Low-income families may face financial barriers to management and treatment of chronic illnesses. No studies have explored how low-income individuals and families with anaphylactic food allergies cope with financial barriers to anaphylaxis management and/or treatment. This study explores qualitatively assessed direct, indirect, and intangible costs of anaphylaxis management and treatment faced by low-income families. Methods. In-depth, semistructured interviews with 23 participants were conducted to gain insight into income-related barriers to managing and treating anaphylactic food allergies. Results. Perceived direct costs included the cost of allergen-free foods and allergy medication and costs incurred as a result of misinformation about social support programs. Perceived indirect costs included those associated with lack of continuity of health care. Perceived intangible costs included the stress related to the difficulty of obtaining allergen-free foods at the food bank and feeling unsafe at discount grocery stores. These perceived costs represented barriers that were perceived as especially salient for the working poor, immigrants, youth living in poverty, and food bank users. Discussion. Low-income families report significant financial barriers to food allergy management and anaphylaxis preparedness. Clinicians, advocacy groups, and EAI manufacturers all have a role to play in ensuring equitable access to medication for low-income individuals with allergies.

Racial differences in the association between partner abuse and barriers to prenatal health care among Asian and native Hawaiian/other Pacific Islander women.

PubMed

Ta, Van M; Hayes, Donald

2010-05-01

Prenatal health care (PNC) is associated with positive maternal and infant health outcomes. There is limited knowledge regarding Native Hawaiians/Other Pacific Islanders (NHOPI) and Asian women's access to PNC especially among those with partner abuse (PA) experience. The objectives of this paper were to (1) describe and examine factors associated with PNC access barriers among mothers, by race; and, (2) determine the association between PA and PNC access, by race. We analyzed 2004-2007 data from Hawai'i's Pregnancy Risk Assessment Monitoring System (n = 7,158). The outcome is > or = 1 experience with a PNC access barrier. PA is experience with physical violence from a partner. Descriptive statistics, and bivariate and multivariate logistic regression analyses stratified by race were conducted. The respondents included 35.7% NHOPI, 37.4% Asian, 20.1% White and 6.6% Other. More than 6% experienced PA, and 25.9% reported > or = 1 PNC access barrier. Experience with PA was significantly associated with NHOPI and Asians reporting > or = 1 barrier to accessing PNC, but was non-significant with Whites. Programs should address barriers to accessing PNC, and target NHOPI and Asian mothers with PA experience to reduce the healthcare disparity and improve quality of life.

Barriers to and enablers of implementing antimicrobial stewardship programs in veterinary practices.

PubMed

Hardefeldt, Laura Y; Gilkerson, J R; Billman-Jacobe, H; Stevenson, M A; Thursky, K; Bailey, K E; Browning, G F

2018-03-23

Antimicrobial stewardship (AMS) programs are yet to be widely implemented in veterinary practice and medical programs are unlikely to be directly applicable to veterinary settings. To gain an in-depth understanding of the factors that influence effective AMS in veterinary practices in Australia. A concurrent explanatory mixed methods design was used. The quantitative phase of the study consisted of an online questionnaire to assess veterinarians' attitudes to antimicrobial resistance (AMR) and antimicrobial use in animals, and the extent to which AMS currently is implemented (knowingly or unknowingly). The qualitative phase used semi-structured interviews to gain an understanding of the barriers to and enablers of AMS in veterinary practices. Data were collected and entered into NVivo v.11, openly coded and analyzed according to mixed methods data analysis principles. Companion animal, equine, and bovine veterinarians participated in the study. Veterinary practices rarely had antimicrobial prescribing policies. The key barriers were a lack of AMS governance structures, client expectations and competition between practices, cost of microbiological testing, and lack of access to education, training and AMS resources. The enablers were concern for the role of veterinary antimicrobial use in development of AMR in humans, a sense of pride in the service provided, and preparedness to change prescribing practices. Our study can guide development and establishment of AMS programs in veterinary practices by defining the major issues that influence the prescribing behavior of veterinarians. © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application.

PubMed

Turner, Kea; Renfro, Chelsea; Ferreri, Stefanie; Roberts, Kim; Pfeiffenberger, Trista; Shea, Christopher M

2018-04-01

 Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies.  Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network. Interviews were recorded, transcribed verbatim, and analyzed for themes using the Expert Recommendations for Implementing Change (ERIC).  Findings suggest that leadership support, clinical training, and computer literacy facilitated implementation, while lack of system integration, staff resistance to change, and provider reluctance to share data served as barriers. To overcome the barriers, implementation support was provided, such as assessing readiness for implementation, developing a standardized and interoperable care plan, and audit and feedback of documentation quality.  Participants used a wide array of strategies to support community pharmacies with implementation and tailored approaches to accommodate pharmacy-specific preferences. Most of the support was delivered preimplementation or in the early phase of implementation and by program or research staff rather than peer-to-peer. Implementing new pharmacy information system requires a significant amount of implementation support to help end-users learn about program features, how to integrate the software into workflow, and how to optimize the software to improve patient care. Future research should identify which implementation strategies are associated with program performance. Schattauer.

A Survey to Assess Barriers to Urban Teaching Careers

ERIC Educational Resources Information Center

Creasey, Gary; Mays, Jennifer; Lee, Robert; D'Santiago, Verenice

2016-01-01

The "Urban Teaching Barriers" survey was created to assess barriers to urban teaching careers. Pre-service teachers (N = 377) completed this instrument, along with questionnaires that assessed urban teaching intentions and urban teaching self-efficacy. Six barrier domains were identified that tapped concerns over (a) lack of resources,…

Barriers to home-based exercise program adherence with chronic low back pain: Patient expectations regarding new technologies.

PubMed

Palazzo, Clémence; Klinger, Evelyne; Dorner, Véronique; Kadri, Abdelmajid; Thierry, Olivier; Boumenir, Yasmine; Martin, William; Poiraudeau, Serge; Ville, Isabelle

2016-04-01

To assess views of patients with chronic low back pain (cLBP) concerning barriers to home-based exercise program adherence and to record expectations regarding new technologies. Qualitative study based on semi-structured interviews. A heterogeneous sample of 29 patients who performed a home-based exercise program for cLBP learned during supervised physiotherapy sessions in a tertiary care hospital. Patients were interviewed at home by the same trained interviewer. Interviews combined a funnel-shaped structure and an itinerary method. Barriers to adherence related to the exercise program (number, effectiveness, complexity and burden of exercises), the healthcare journey (breakdown between supervised sessions and home exercise, lack of follow-up and difficulties in contacting care providers), patient representations (illness and exercise perception, despondency, depression and lack of motivation), and the environment (attitudes of others, difficulties in planning exercise practice). Adherence could be enhanced by increasing the attractiveness of exercise programs, improving patient performance (following a model or providing feedback), and the feeling of being supported by care providers and other patients. Regarding new technologies, relatively younger patients favored visual and dynamic support that provided an enjoyable and challenging environment and feedback on their performance. Relatively older patients favored the possibility of being guided when doing exercises. Whatever the tool proposed, patients expected its use to be learned during a supervised session and performance regularly checked by care providers; they expected adherence to be discussed with care providers. For patients with cLBP, adherence to home-based exercise programs could be facilitated by increasing the attractiveness of the programs, improving patient performance and favoring a feeling of being supported. New technologies meet these challenges and seem attractive to patients but are not a substitute for the human relationship between patients and care providers. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A pilot test of the Latin active hip hop intervention to increase physical activity among low-income Mexican-American adolescents.

PubMed

Romero, Andrea J

2012-01-01

The primary purpose of the current study was to develop, implement, and evaluate a hip hop dance intervention, Latin Active, among low-income Mexican-American adolescents. Mexican-descent adolescents tend to have disproportionate rates of low physical activity, overweight status, and obesity. A 5-week intervention design with pretest and post-test self-report measures. Charter middle school (grades 6-9) health/science classes in a low-income neighborhood were the setting for the Latin Active intervention. Overall, 81 participants were recruited; 73 (n  =  41, female; n  =  32, male) provided active parental consent to complete pretest/post-test surveys. Intervention . The Latin Active program included 10 interactive 50-minute lessons that were delivered twice a week during science/health classes. The curriculum was created on the basis of Social Cognitive Theory, Critical Hip Hop Pedagogy, and feedback from key stakeholders. The lessons focused on increasing physical activity as well as neighborhood barriers. The self-report pretest (n  =  73) and post-test (n  =  56) surveys included measures for frequency of vigorous physical activity, self-efficacy, and neighborhood barriers. Analysis . Paired-sample t-test analyses were conducted to assess mean differences from pretest to post-test results for intervention outcomes by gender. The Latin Active program (with 77% retention at post-test) significantly increased vigorous physical activity and dance (p < .05) and increased self-efficacy (p < .05) among girls, and it decreased perception of neighborhood barriers (p < .05) among boys. CONCLUSION . A hip hop physical activity program, Latin Active demonstrated preliminary efficacy to increase girl's vigorous physical activity and boy's perception of neighborhood barriers to physical activity. Future research will need to use a randomized, controlled design and investigate the effect of the program on measures of body mass index.

Pre-Service Teachers' Uses of and Barriers from Adopting Computer-Assisted Language Learning (CALL) Programs

ERIC Educational Resources Information Center

Samani, Ebrahim; Baki, Roselan; Razali, Abu Bakar

2014-01-01

Success in implementation of computer-assisted language learning (CALL) programs depends on the teachers' understanding of the roles of CALL programs in education. Consequently, it is also important to understand the barriers teachers face in the use of computer-assisted language learning (CALL) programs. The current study was conducted on 14…

Perceived barriers to exercise and healthy eating among women from disadvantaged neighborhoods: Results from a focus groups assessment

PubMed Central

Sharpe, Patricia A.; Parra-Medina, Deborah; Wilcox, Sara

2014-01-01

This study explored perceptions and experiences with barriers to exercise and healthy eating among women from predominately African American, disadvantaged neighborhoods. Four focus groups (n=28) were conducted between April and May 2008 with overweight or obese women (93% African American; 34.3±8.9 years; BMI 40.4±8.5). Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size (e.g. from children, people at the gym), and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise. Lack of support and pressure from family, friends, and co-workers were barriers to healthy eating; participants experienced pressure from family and friends to eat more and were told they did not need to lose weight. Participants discussed the importance of not losing their curves; this concern needs to be considered when developing weight control programs for African American women. The findings of this qualitative study guided the development of a weight loss intervention for women from disadvantaged neighborhoods. PMID:24617795

Perceived barriers to exercise and healthy eating among women from disadvantaged neighborhoods: results from a focus groups assessment.

PubMed

Baruth, Meghan; Sharpe, Patricia A; Parra-Medina, Deborah; Wilcox, Sara

2014-01-01

This study explored perceptions and experiences with barriers to exercise and healthy eating among women from predominately African American, disadvantaged neighborhoods. Four focus groups (n = 28) were conducted between April and May 2008 with overweight or obese women (93% African American; 34.3 ± 8.9 years; body mass index [BMI] 40.4 ± 8.5). Individual, social, and environmental factors were frequently mentioned as barriers to exercise and healthy eating. Insults from strangers about their body size (e.g., from children or people at the gym), and feelings of intimidation and embarrassment about not being able to complete exercises due to their body size were described as barriers to exercise. Lack of support and pressure from family, friends, and co-workers were barriers to healthy eating; participants experienced pressure from family and friends to eat more and were told they did not need to lose weight. Participants discussed the importance of not losing their curves; this concern needs to be considered when developing weight control programs for African American women. The findings of this qualitative study guided the development of a weight loss intervention for women from disadvantaged neighborhoods.

Expertise, Time, Money, Mentoring, and Reward: Systemic Barriers That Limit Education Researcher Productivity-Proceedings From the AAMC GEA Workshop.

PubMed

Yarris, Lalena M; Juve, Amy Miller; Artino, Anthony R; Sullivan, Gail M; Rougas, Steven; Joyce, Barbara; Eva, Kevin

2014-09-01

To further evolve in an evidence-based fashion, medical education needs to develop and evaluate new practices for teaching, learning, and assessment. However, educators face barriers in designing, conducting, and publishing education research. To explore the barriers medical educators face in formulating, conducting, and publishing high-quality medical education research, and to identify strategies for overcoming them. A consensus workshop was held November 5, 2013, at the Association of American Medical Colleges annual meeting. A working group of education research experts and educators completed a preconference literature review focusing on barriers to education research. During the workshop, consensus-based and small group techniques were used to refine the broad themes into content categories. Attendees then ranked the most important barriers and strategies for overcoming them with the highest potential impact. Barriers participants faced in conducting quality education research included lack of (1) expertise, (2) time, (3) funding, (4) mentorship, and (5) reward. The strategy considered most effective in overcoming these barriers involved building communities of education researchers for collaboration and networking, and advocating for education researchers' interests. Other suggestions included trying to secure increased funding opportunities, developing mentoring programs, and encouraging mechanisms to ensure protected time. Barriers to education research productivity clearly exist. Many appear to result from feelings of isolation that may be overcome with systemic efforts to develop and enable communities of practice across institutions. Finally, the theme of "reward" is novel and complex and may have implications for education research productivity.

Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding.

PubMed

Miedema, Baukje; Easley, Julie

2012-06-01

The goal of this study was to assess the rehabilitation needs of young women breast cancer survivors under the age of 50 and to identify factors that may impact or prevent cancer rehabilitation utilization. Utilizing a grounded theory methodology, 35 young breast cancer survivors were interviewed twice in four Atlantic Canadian provinces. A considerable number of barriers exist to receiving rehabilitative care post-treatment for young breast cancer survivors. The systemic barriers include the lack of availability of services, travel issues, cost of services, and the lack of support to address the unique needs for this age group. However, the most complicated barriers to accessing rehabilitative care were personal barriers which related more to choice and circumstances, such as the lack of time due to family responsibilities and appointment fatigue. Many of these personal barriers were rooted in the complex set of gender roles of young women as patients, mothers, workers, and caregivers. The contexts of young women's lives can have a substantial impact on their decisions to seek and receive rehabilitative care after breast cancer treatment. The systemic barriers can be reduced by introducing more services or financial assistance; however, the personal barriers to rehabilitation services are difficult to ameliorate due to the complex set of roles within and outside the family for this group of young breast cancer survivors. Health care providers need to take into consideration the multiple contexts of women's lives when developing and promoting breast cancer rehabilitation services and programs.

Patient, Program, and System Barriers and Facilitators to Detoxification Services in the U.S. Veterans Health Administration: A Qualitative Study of Provider Perspectives.

PubMed

Schultz, Nicole R; Martinez, Rociel; Cucciare, Michael A; Timko, Christine

2016-08-23

Because substance use disorder (SUD) treatment is expanding, and detoxification (detox) is often the entry point to SUD treatment, it is critical to provide ready access to detox services. The purpose of the current study was to examine patient, program, and system barriers or facilitators to detox access within an integrated health care system with variable rates of detox utilization across facilities. Inpatient and outpatient providers from 31 different U.S. Veterans Health Administration detox programs were interviewed. Qualitative analyses identified six facilitators and 11 barriers to detox access. Facilitators included program staff and program characteristics such as encouragement and immediate access, as well as systemic cooperation and patient circumstances. Barriers to detox included programmatic and systemic problems, including lack of available detox services, program rules or admission requirements, funding shortages, stigma related to a SUD diagnosis or receiving detox services, and a deficiency of education and training. Other major barriers pertained to patients' lack of motivation and competing responsibilities. To improve detox access, health care settings should consider enhancing supportive relationships by emphasizing outreach, engagement, and rapport-building with patients, improving systemic communication and teamwork, educating patients on available detox services and the detox process, and addressing patient centered barriers such as resistance to detox or competing responsibilities. In addition, programs should consider open-door and immediate-admission policies. These approaches may improve detox access, which is important for increasing the likelihood of transitioning patients to SUD treatment, thus improving outcomes and reducing utilization of high-cost services.

The Influence of Low-Barrier and Voluntary Service Policies on Survivor Empowerment in a Domestic Violence Housing Organization.

PubMed

Nnawulezi, Nkiru; Godsay, Surbhi; Sullivan, Cris M; Marcus, Suzanne; Hacskaylo, Margaret

2018-01-18

The purpose of community-based domestic violence crisis housing programs (e.g., shelters) is to provide a safe setting that promotes empowerment for survivors of intimate partner violence. For staff to reach this aim, the program must have formal structures and processes in place to support such efforts. This study explored how low-barrier and voluntary service policies influenced staff practices and survivor empowerment. Low-barrier policies require that programs remove barriers that prevent survivors, particularly those who have mental health concerns and/or addictions, from being able to access services. A voluntary service policy states that survivors have the right to choose which services, if any, they would like to engage in during their stay at the program. Survivors' ability to stay at the housing program is not contingent on their participation in program services. This exploratory-sequential (QUAL→ quan) mixed-method study examined how low-barrier and voluntary service policies influenced staff behavior and how these behaviors then related to survivor empowerment. Qualitative results revealed that low-barrier and voluntary service were guided by cultural values of justice and access, encouraged survivor-centered practices among staff, and were believed to promote survivor autonomy. Quantitative results suggested that when survivors perceived they had a choice to engage in program services or meet with an advocate, their empowerment increased. This study has implications for domestic violence organizational practice and provides evidence about the contextual factors that support individual empowerment. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Patient-perceived barriers to a screening program for depression: a patient opinion survey of hemodialysis patients

PubMed Central

Beanlands, Heather; Logan, Alexander; Kurdyak, Paul; Jassal, Sarbjit Vanita

2017-01-01

Abstract Background Depression is a prevalent, yet underdiagnosed, psychiatric disorder among patients with end-stage renal disease. Active case identification through routine screening is suggested; however, patient-related barriers may reduce the effectiveness of screening for, and treating, depression. This study aimed to explore the perceived barriers that limit patients from participating in screening and treatment programs for depression. Methods In a cross-sectional study of chronic maintenance hemodialysis patients, the Perceived Barriers to Psychological Treatment questionnaire, adapted to include screening, was used to measure perceived barriers. The two-item Patient Health Questionnaire was used to identify patients with depressive symptoms. Results Of 160 participants, 73.1% reported at least one barrier preventing them from participation [95% confidence interval (95% CI) 66.2–80.0%]. Patients with depressive symptoms were more likely to perceive at least one barrier to a screening program for depression compared with those without depressive symptoms (96% versus 68.9%, respectively; odds ratio = 10.8; 95% CI 1.4–82.8; P = 0.005). The association of the barrier scores with depressive symptoms remained significant after adjustment for patient’s characteristics. The most common barriers that patients expressed were concerns about the side effects of any antidepressant medications that may be prescribed (40%), concerns about having more medications (32%), feeling that the problem is not severe enough (23%) and perceiving no risk of depression (23%). Conclusions Negative perceptions about depression and its treatment among hemodialysis patients constitute an important barrier to identifying this condition and first need to be addressed before implementing a screening program in this population. PMID:29225813

Spreading the word: A process evaluation of a voluntary AOD prevention program.

PubMed

Edelen, Maria Orlando; Tucker, Joan; D'Amico, Elizabeth

2015-06-01

Research on voluntary after-school alcohol and other drug (AOD) prevention programs is limited. It is important to increase understanding of students' motivation to attend these types of programs and their tendency to transfer program information to peers. This paper summarizes efforts to evaluate process information for CHOICE, a voluntary after-school AOD prevention program for middle-school youth. A survey administered to 1899 students aged 10-16 in seven schools assessed: (1) why students choose to attend CHOICE (2) barriers to attendance; and (3) how program information is disseminated to non-participants. Frequencies of responses from participants and non-participants were compared. Participants were motivated by several features, most notably, the demeanor of the group leaders and enjoyable curriculum content. Barriers to attendance were primarily logistic, but results also suggest that the promotion message should more effectively emphasize that CHOICE is appropriate for everyone. The majority of students knew about CHOICE, both through advertising and conversations with friends. Non-participants' detailed reports of what they heard from friends corresponded closely with what participants reported sharing. The use of dynamic group leaders is critical to engaging students in voluntary programs. Offering the program on different days of the week or at different times (e.g., before school) may improve attendance rates. Peer networks represent a critical pathway for prevention information that can help increase program impact. These results can be used to inform modifications to existing voluntary after-school AOD prevention programs to obtain higher attendance rates and more widespread dissemination of the intervention message. © American Academy of Addiction Psychiatry.

Cardiac rehabilitation in Canada and Arab countries: comparing availability and program characteristics.

PubMed

Turk-Adawi, Karam I; Terzic, Carmen; Bjarnason-Wehrens, Birna; Grace, Sherry L

2015-11-26

Despite the high burden of cardiovascular diseases in Arab countries, little is known about cardiac rehabilitation (CR) delivery. This study assessed availability, and CR program characteristics in the Arab World, compared to Canada. A questionnaire incorporating items from 4 national / regional published CR program surveys was created for this cross-sectional study. The survey was emailed to all Arab CR program contacts that were identified through published studies, conference abstracts, a snowball sampling strategy, and other key informants from the 22 Arab countries. An online survey link was also emailed to all contacts in the Canadian Association of Cardiovascular Prevention and Rehabilitation directory. Descriptive statistics were used to describe all closed-ended items in the survey. All open-ended responses were coded using an interpretive-descriptive approach. Eight programs were identified in Arab countries, of which 5 (62.5 %) participated; 128 programs were identified in Canada, of which 39 (30.5%) participated. There was consistency in core components delivered in Arab countries and Canada; however, Arab programs more often delivered women-only classes. Lack of human resources was perceived as the greatest barrier to CR provision in all settings, with space also a barrier in Arab settings, and financial resources in Canada. The median number of patients served per program was 300 for Canada vs. 200 for Arab countries. Availability of CR programs in Arab countries is incredibly limited, despite the fact that most responses stemmed from high-income countries. Where available, CR programs in Arab countries appear to be delivered in a manner consistent with Canada.

Teachers' Readiness to Implement Nutrition Education Programs: Beliefs, Attitudes, and Barriers

ERIC Educational Resources Information Center

Perikkou, Anastasia; Kokkinou, Eleni; Panagiotakos, Demosthenes B.; Yannakoulia, Mary

2015-01-01

Teachers' attitudes about school food environments and their readiness to implement school-based nutrition programs were investigated. A total of 1,436 primary-school teachers filled out a questionnaire on their demographic and professional characteristics and their attitudes, beliefs, and barriers for implementing health educational programs. The…

The use of physical assessment skills by registered nurses in Australia: issues for nursing education.

PubMed

Birks, Melanie; Cant, Robyn; James, Ainsley; Chung, Catherine; Davis, Jenny

2013-01-01

The purpose of pre-service nursing education programs is to prepare competent graduates who are able to function as safe, professional registered nurses. An extensive element of these programs is the teaching of physical assessment skills, with most programs educating students to perform over 120 such skills. Previous research from North America suggests that the majority of skills taught to nurses in their pre-service programs are not used in practice. As part of a larger study, an online survey was used to explore use of 121 physical assessment skills by Australian nurses. Recruitment occurred via mailed invitation to members of the Australian Nursing Federation. Data were extracted from 1220 completed questionnaires returned by nurses who were mostly employed in New South Wales, were female and experienced nurses. Respondents indicated that they used only 34% of skills routinely. Results reinforce evidence found in the literature that many of the skills taught to nurses are either not used at all (35.5%) or are used rarely (31%). These findings have implications for the teaching of physical assessment skills in pre-service nursing programs, and raise questions about the value of extensive skills teaching in the context of contemporary health care. Further research into barriers to the use of physical assessment skills in nursing and the need for comprehensive skills preparation for the generalist nurse is likely to offer some solutions to these questions.

Relieving the Bottleneck: An Investigation of Barriers to Expansion of Supervision Networks at Genetic Counseling Training Programs.

PubMed

Berg, Jordan; Hoskovec, Jennifer; Hashmi, S Shahrukh; McCarthy Veach, Patricia; Ownby, Allison; Singletary, Claire N

2018-02-01

Rapid growth in the demand for genetic counselors has led to a workforce shortage. There is a prevailing assumption that the number of training slots for genetic counseling students is linked to the availability of clinical supervisors. This study aimed to determine and compare barriers to expansion of supervision networks at genetic counseling training programs as perceived by supervisors, non-supervisors, and Program Directors. Genetic counselors were recruited via National Society of Genetic Counselors e-blast; Program Directors received personal emails. Online surveys were completed by 216 supervisors, 98 non-supervisors, and 23 Program Directors. Respondents rated impact of 35 barriers; comparisons were made using Kruskal-Wallis and Wilcoxon ranked sum tests. Half of supervisors (51%) indicated willingness to increase supervision. All non-supervisors were willing to supervise. However, all agreed that being too busy impacted ability to supervise, highlighted by supervisors' most impactful barriers: lack of time, other responsibilities, intensive nature of supervision, desire for breaks, and unfilled positions. Non-supervisors noted unique barriers: distance, institutional barriers, and non-clinical roles. Program Directors' perceptions were congruent with those of genetic counselors with three exceptions they rated as impactful: lack of money, prefer not to supervise, and never been asked. In order to expand supervision networks and provide comprehensive student experiences, the profession must examine service delivery models to increase workplace efficiency, reconsider the supervision paradigm, and redefine what constitutes a countable case or place value on non-direct patient care experiences.

Findings from an assessment of state Title V workforce development needs.

PubMed

Grason, Holly; Kavanagh, Laura; Dooley, Suzanna; Partelow, Jenelle; Sharkey, Alyssa; Bradley, Katherine J; Handler, Arden

2012-01-01

To describe results of a 2008 assessment of Title V workforce competencies and training needs at the state level, and examine preferences and barriers related to available education and training opportunities. A web-based survey was administered May through August, 2008 to Maternal and Child Health (MCH) and Children and Youth with Special Health Care Needs (CYSHCN) program leaders in all 50 states, and U.S. jurisdictions. Forty-nine MCH (96%) and 44 CYSHCN (86%) programs and four territories completed surveys. A major focus of the survey related to competencies in six core domains: Public Health/Title V Knowledge Base, Communication, Critical Thinking, Management Skills, Family Centered Care and Medical Home, and Leadership Development. The top training needs identified by state Title V programs fall into the global category of critical thinking, including skills in MCH data synthesis and translation, in program evaluation, and in systems thinking. The need to enhance personal rather than organizational leadership skills was emphasized. Blended learning approaches (graduate education), and national conferences with skills building workshops (continuing education) were identified as preferred training modalities. Barriers to training included lack of career opportunities, insufficient agency support, and inability to take leave (graduate education), and travel restrictions, release time limitations, costs, and limited geographic access (continuing education). Both the focus of training and preferred training modalities differed from previous MCH workforce survey findings. Given the changing needs expressed by state Title V leaders as well as their training preferences, it is important that current and future graduate education and continuing education approaches be better aligned to meet these needs and preferences.

Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

PubMed

Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

2014-12-01

The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

Treatment barriers identified by substance abusers assessed at a centralized intake unit.

PubMed

Rapp, Richard C; Xu, Jiangmin; Carr, Carey A; Lane, D Tim; Wang, Jichuan; Carlson, Robert

2006-04-01

The 59-item Barriers to Treatment Inventory (BTI) was administered to 312 substance abusers at a centralized intake unit following assessment but before treatment entry to assess their views on barriers to treatment. Factor analysis identified 25 items in 7 well-defined latent constructs: Absence of Problem, Negative Social Support, Fear of Treatment, Privacy Concerns, Time Conflict, Poor Treatment Availability, and Admission Difficulty. The factorial structure of the barriers is consistent with the findings of other studies that asked substance abusers about barriers to treatment and is conceptually compatible with Andersen's model of health care utilization. Factors were moderately to highly correlated, suggesting that they interact with one another. Selected characteristics were generally not predictive of barrier factors. Overall, results indicate that the BTI has good content validity and is a reliable instrument for assessing barriers to drug treatment. The potential utility of the BTI in assessment settings is discussed.

Aspirations, Barriers, and Community Strengths: A Qualitative Survey of Urban Chicano Youth and Families. Occasional Paper No. 38. Latino Studies Series.

ERIC Educational Resources Information Center

Vera, Elizabeth M.

To initiate a primary prevention program in a Midwestern urban community consisting primarily of Chicanos, needs were assessed by conducting focus group meetings with school administrators, teachers, parents, and children in a public school setting. In each student focus group, 8-10 children were selected from a seventh-grade classroom, an…

The critical role of social workers in home-based primary care.

PubMed

Reckrey, Jennifer M; Gettenberg, Gabrielle; Ross, Helena; Kopke, Victoria; Soriano, Theresa; Ornstein, Katherine

2014-01-01

The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.

Environmental and Psychosocial Barriers to and Benefits of Cervical Cancer Screening in Kenya

PubMed Central

Ragan, Kathleen; Lee Smith, Judith; Saraiya, Mona; Aketch, Millicent

2017-01-01

Abstract Background. Cervical cancer is the second most commonly diagnosed cancer in females and is a leading cause of cancer‐related mortality in Kenya; limited cervical cancer screening services may be a factor. Few studies have examined men's and women's perceptions on environmental and psychosocial barriers and benefits related to screening. Materials and Methods. In 2014, 60 women aged 25–49 years and 40 male partners participated in 10 focus groups (6 female and 4 male), in both rural and urban settings (Nairobi and Nyanza, Kenya), to explore perceptions about barriers to and benefits of cervical cancer screening. Focus groups were segmented by sex, language, geographic location, and screening status. Data were transcribed, translated into English, and analyzed by using qualitative software. Results. Participants identified screening as beneficial for initiating provider discussions about cancer but did not report it as a beneficial method for detecting precancers. Perceived screening barriers included access (transportation, cost), spousal approval, stigma, embarrassment during screening, concerns about speculum use causing infertility, fear of residual effects of test results, lack of knowledge, and religious or cultural beliefs. All participants reported concerns with having a male doctor perform screening tests; however, men uniquely reported the young age of a doctor as a barrier. Conclusion. Identifying perceived barriers and benefits among people in low‐ and middle‐income countries is important to successfully implementing emerging screening programs. The novel findings on barriers and benefits from this study can inform the development of targeted community outreach activities, communication strategies, and educational messages for patients, families, and providers. Implications for Practice. This article provides important information for stakeholders in clinical practice and research when assessing knowledge, beliefs, and acceptability of cervical cancer screening and treatment services in low‐ and middle‐resourced countries. Formative research findings provide information that could be used in the development of health interventions, community education messages, and materials. Additionally, this study illuminates the importance of understanding psychosocial barriers and facilitators to cervical cancer screening, community education, and reduction of stigma as important methods of improving prevention programs and increasing rates of screening among women. PMID:28167567

High Coverage and Utilization of Fortified Take-Home Rations among Children 6-35 Months of Age Provided through the Integrated Child Development Services Program: Findings from a Cross-Sectional Survey in Telangana, India.

PubMed

Leyvraz, Magali; Wirth, James P; Woodruff, Bradley A; Sankar, Rajan; Sodani, Prahlad R; Sharma, Narottam D; Aaron, Grant J

2016-01-01

The Integrated Child Development Services (ICDS) in the State of Telangana, India, freely provides a fortified complementary food product, Bal Amrutham, as a take-home ration to children 6-35 months of age. In order to understand the potential for impact of any intervention, it is essential to assess coverage and utilization of the program and to address the barriers to its coverage and utilization. A two-stage, stratified cross-sectional cluster survey was conducted to estimate the coverage and utilization of Bal Amrutham and to identify their barriers and drivers. In randomly selected catchment areas of ICDS centers, children under 36 months of age were randomly selected. A questionnaire, constructed from different validated and standard modules and designed to collect coverage data on nutrition programs, was administered to caregivers. A total of 1,077 children were enrolled in the survey. The coverage of the fortified take-home ration was found to be high among the target population. Nearly all caregivers (93.7%) had heard of Bal Amrutham and 86.8% had already received the product for the target child. Among the children surveyed, 57.2% consumed the product regularly. The ICDS program's services were not found to be a barrier to product coverage. In fact, the ICDS program was found to be widely available, accessible, accepted, and utilized by the population in both urban and rural catchment areas, as well as among poor and non-poor households. However, two barriers to optimal coverage were found: the irregular supply of the product to the beneficiaries and the intra-household sharing of the product. Although sharing was common, the product was estimated to provide the target children with significant proportions of the daily requirements of macro- and micronutrients. Bal Amrutham is widely available, accepted, and consumed among the target population in the catchment areas of ICDS centers. The coverage of the product could be further increased by improving the supply chain.

Understanding the Business Case for Telemental Health in Rural Communities.

PubMed

Lambert, David; Gale, John; Hartley, David; Croll, Zachariah; Hansen, Anush

2016-07-01

Telemental health has been promoted to address long-standing access barriers to rural mental health care, including low supply and long travel distances. Examples of rural telemental health programs are common; there is a less clear picture of how widely implemented these programs are, their organization, staffing, and services. There is also a need to understand the business case for these programs and assess whether and how they might realize their promise. To address these gaps, a national study was conducted of rural telemental health programs including an online survey of 53 programs and follow-up interviews with 23 programs. This article describes the current landscape and characteristics of these programs and then examines their business case. Can rural telemental health programs be sustained within current delivery systems and reimbursement structures? This question is explored in four areas: need and demand, infrastructure and workforce, funding and reimbursement, and organizational fit and alignment.

Breast cancer survivors' barriers and motives for participating in a group-based physical activity program offered in the community.

PubMed

Wurz, Amanda; St-Aubin, Anik; Brunet, Jennifer

2015-08-01

The purpose of this qualitative study was to explore the barriers and motives experienced by women attending an 8-week group-based physical activity program offered in the community following treatment for breast cancer. Seven women were interviewed during the first and last week of the program. Data were analyzed using thematic analysis. Factors that hindered women's continued participation could be subdivided into situational barriers, which encompassed community (i.e., distance of center and traffic) and institutional factors (i.e., competing roles and responsibilities), and internal barriers, which consisted of cancer-specific limitations. Motives for initial and continued participation were situational (i.e., gaining social support, networking, and being around similar others) and internal (i.e., feeling a sense of personal fulfillment, acquiring health benefits, and recovering from cancer). The findings contribute to a deeper understanding of women's motives to engage in a group-based physical activity program after treatment for breast cancer. Further, they underscore the necessity of considering situational and internal barriers when developing group-based physical activity programs to increase regular participation, optimize adherence, and reduce drop-out.

Barriers to Teaching Social Determinants of Health: Nursing Study-Abroad Programs in a Digital Age.

PubMed

de Ruiter, Hans-Peter

2016-11-01

The social determinants of health are the conditions in which humans are born, grow up, live, work, and age (World Health Organization [WHO], 2012). In nursing programs, this content is typically taught in community health courses. Another strategy for teaching students how to understand the social determinants of health is study-abroad courses. Budding nurses can learn how to assess conditions that influence the health of a community. Conducting this assessment in a culture that differs from the student's own can help highlight what factors impact one's own health. For the past eight years, the author has been teaching the social and cultural determinants of health to nursing students by taking them on 3-week cultural immersion/community health studyabroad programs. Destinations have included Ghana, Austria, the Netherlands, and Thailand. This article presents observations on how the teaching of social determinants of health has changed during the period 2008-2016.

Assessing parents' receptiveness to a vegetable-focussed in-school nutrition intervention.

PubMed

Jongenelis, Michelle I; Pettigrew, Simone; Pratt, Iain S; Wright, Shannon; Myers, Gael

2017-10-01

Crunch&Sip is an Australian school-based initiative designed to increase the consumption of fruit, vegetables, and water among primary school children. To address the significant deficiencies in children's vegetable intake, the present study aimed to examine the responsiveness of parents (the main providers of food for Crunch&Sip) to a modified version of the program that focuses primarily on vegetable consumption. A total of 329 Western Australian parents completed an online questionnaire examining their support for a vegetable focus for Crunch&Sip and any perceived barriers, motivators, and facilitators. Most (80%) parents were supportive of a shift to a vegetable focus for Crunch&Sip. Belief in the effectiveness of Crunch&Sip at improving children's attitudes towards vegetables and increasing children's vegetable consumption was found to be significantly associated with levels of support. The most commonly nominated motivator was to improve their children's eating habits and the main facilitator was the perceived ability of teachers and peers to influence children's food consumption behaviours. Identified potential barriers included the difficulties associated with providing a variety of vegetables, maintaining freshness, and the preparation time required. The primary suggested strategy to overcome these barriers was for schools to conduct education sessions to provide information about vegetable provision options. The results suggest that parents can be supportive of school-based nutrition programs that specifically encourage the consumption of vegetables but they may require guidance to reduce the identified barriers related to vegetable provision. Copyright © 2017 Elsevier Ltd. All rights reserved.

Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach.

PubMed

Cain, Joanna M; Felice, Marianne E; Ockene, Judith K; Milner, Robert J; Congdon, John L; Tosi, Stephen; Thorndyke, Luanne E

2018-03-01

Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

PATTERNS OF PHYSICAL ACTIVITY AMONG AMERICAN INDIAN CHILDREN: AN ASSESSMENT OF BARRIERS AND SUPPORT

PubMed Central

Thompson, Janice L.; Davis, Sally M.; Gittelsohn, Joel; Going, Scott; Becenti, Alberta; Metcalfe, Lauve; Stone, Elaine; Harnack, Lisa; Ring, Kim

2016-01-01

Estimates indicate that 10% to 50% of American Indian and non-Indian children in the U.S. are obese, defined as a body mass index ≥ 95th percentile of the NHANES II reference data. Pathways is a two-phase, multi-site study to develop and test a school-based obesity prevention program in American Indian schoolchildren in grades three through five. During Phase I feasibility prior to initiation of the Pathways trial, data were collected related to physical activity patterns, and the supports of, and barriers to, physical activity. Nine schools from communities representing six different tribal groups participated in this study. Multiple measures were used for data collection including direct observation, paired child interviews, and in-depth interviews and focus groups with adults. Students completed the self-administered Knowledge, Attitudes, and Behaviors (KAB) survey, and a Physical Activity Questionnaire (PAQ). Barriers to physical activity at schools included a lack of facilities, equipment, and trained staff persons for PE. Adults were not consistently active with their children, but they were highly supportive of their children’s activity level. Children reported a strong enjoyment of physical activity and strong peer support to be physically active. Weather conditions, safety concerns, and homework/chores were common barriers to physical activity reported by children and adult caregivers. The information was used to design culturally and age-appropriate, practical interventions including the five physical activity programs for schoolchildren in the Pathways study. PMID:11759094

Identifying, screening and engaging high-risk clients in private non-profit child abuse prevention programs.

PubMed

Barth, R P; Ash, J R; Hacking, S

1986-01-01

Child abuse prevention programs rely on varied strategies to identify, screen, obtain referrals of, and engage high risk parents. Available literature on community-based child abuse prevention projects is not conclusive about project outcomes nor sufficiently descriptive about implementation. From the literature, experience and interviews with staff from more than 20 programs, barriers to implementation are identifiable. Barriers arise during identifying and screening at-risk families, referral, continued collaboration with referrers, and engaging clients in services. The paper describes a diverse set of strategies for surmounting these barriers. Staff characteristics and concrete services partially predict the success of program implementation. So does the program's relationship to other agencies. Child abuse prevention programs assume independent, interdependent, and dependent relationships with other agencies and referrers. Interdependent programs appear to have the best chance of obtaining referrals and maintaining clients who match their program's intent.

Aquatic exercise for residential aged care adults with dementia: benefits and barriers to participation.

PubMed

Henwood, Timothy; Neville, Christine; Baguley, Chantelle; Beattie, Elizabeth

2017-09-01

Pilot work by our group has demonstrated that aquatic exercise has valuable functional and psychosocial benefits for adults living in the residential aged care setting with dementia. The aim of the currents study was to advance this work by delivering the Watermemories Swimming Club aquatic exercise program to a more representative population of older, institutionalized adults with dementia. The benefits of 12 weeks of twice weekly participation in the Watermemories Swimming Club aquatic exercise program were assessed among an exercise and usual care control group of residential aged care adults with advanced dementia. A battery of physical and psychosocial measures were collected before and after the intervention period, and program implementation was also investigated. Seven residential aged care facilities of 24 approached, agreed to participate and 56 residents were purposefully allocated to exercise or control. Twenty-three participants per group were included in the final analysis. Both groups experienced decreases in skeletal muscle index and lean mass (p < 0.001), but exercise stifled losses in muscle strength and transition into sarcopenic. Behavioral and psychological symptoms of dementia and activities of daily living approached significance (p = 0.06) with positive trends observed across other psychosocial measures. This study demonstrates the value of exercise participation, and specifically aquatic exercise in comparison to usual care for older, institutionalized adults with advanced dementia. However, it also highlights a number of barriers to participation. To overcome these barriers and ensure opportunity to residents increased provider and sector support is required.

Burn Survivor Quality of Life and Barriers to Support Program Participation.

PubMed

Baldwin, Stephanie; Yuan, Haimao; Liao, Junlin; Grieve, Brian; Heard, Jason; Wibbenmeyer, Lucy A

2018-03-29

After a serious burn, re-entry into family life, society, and work can be incredibly difficult. Support services such as professional counseling and peer support play a key role for recovering survivors. Herein, we sought to identify support service participation rates, barriers to participation, and quality of life (QOL) among burn survivors treated at a regional burn center. A survey of burn survivors over 18 years old treated for a burn for 5 days or greater between 2006 and 2016 were invited to participate in a survey. The three-part survey contained sections covering demographics, questions regarding support program (SP) awareness, needs and participation, and QOL surveys. Univariate and multivariate regression analyses were performed to identify factors related to SP participation and QOL scores. Nine hundred sixty-eight patients were eligible; 150 responses were received. Over one third (40, 31%) of the responding survivors wanted support, but only half of those (23, 17%) participated in SPs. Distance and awareness of the available programs were two barriers to participation. Those attending SPs were more likely to have had larger burns (OR = 3.7, P = 0.05) and visible burns (OR = 7.5, P = 0.031). Lower scores on selected QOL scales were associated with burns more than 30%, visible burns, female gender, time from burn, and age group. A sizable number of burn survivors want SPs. However, access to these services and advertising their existence are hurdles to overcome. Future burn survivor SPs should focus on psychosocial stresses identified in the QOL assessments.

Implementation of Symptom Protocols for Nurses Providing Telephone‐Based Cancer Symptom Management: A Comparative Case Study

PubMed Central

Green, Esther; Ballantyne, Barbara; Tarasuk, Joy; Skrutkowski, Myriam; Carley, Meg; Chapman, Kim; Kuziemsky, Craig; Kolari, Erin; Sabo, Brenda; Saucier, Andréanne; Shaw, Tara; Tardif, Lucie; Truant, Tracy; Cummings, Greta G.; Howell, Doris

2016-01-01

ABSTRACT Background The pan‐Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence‐informed protocols for symptom management. Aim To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone‐based symptom support to cancer patients. Methods A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases. Results At baseline, >85% nurses rated protocols positively but barriers were identified (64‐80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self‐management. Twenty‐two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p < .01). Protocol adaptations addressed barriers (e.g., health records approval, creating pocket versions, distributing with telephone messages). Chart audits revealed that protocols used were documented for 11% to 47% of patient calls. Sustained use requires organizational alignment and ongoing leadership support. Linking Evidence to Action Protocol uptake was similar to trials that have evaluated tailored interventions to improve professional practice by overcoming identified barriers. Collaborating with knowledge users facilitated interpretation of findings, aided protocol adaptation, and supported implementation. Protocol implementation in nursing requires a tailored approach. A multifaceted intervention approach increased nurses’ use of evidence‐informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses’ confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally. PMID:27243574

The Expanded Capabilities Of The Cementitious Barriers Partnership Software Toolbox Version 2.0 - 14331

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burns, Heather; Flach, Greg; Smith, Frank

2014-01-10

The Cementitious Barriers Partnership (CBP) Project is a multi-disciplinary, multi-institutional collaboration supported by the U.S. Department of Energy (US DOE) Office of Tank Waste Management. The CBP program has developed a set of integrated tools (based on state-of-the-art models and leaching test methods) that help improve understanding and predictions of the long-term structural, hydraulic and chemical performance of cementitious barriers used in nuclear applications. The CBP Software Toolbox – “Version 1.0” was released early in FY2013 and was used to support DOE-EM performance assessments in evaluating various degradation mechanisms that included sulfate attack, carbonation and constituent leaching. The sulfate attackmore » analysis predicted the extent and damage that sulfate ingress will have on concrete vaults over extended time (i.e., > 1000 years) and the carbonation analysis provided concrete degradation predictions from rebar corrosion. The new release “Version 2.0” includes upgraded carbonation software and a new software module to evaluate degradation due to chloride attack. Also included in the newer version are a dual regime module allowing evaluation of contaminant release in two regimes – both fractured and un-fractured. The integrated software package has also been upgraded with new plotting capabilities and many other features that increase the “user-friendliness” of the package. Experimental work has been generated to provide data to calibrate the models to improve the credibility of the analysis and reduce the uncertainty. Tools selected for and developed under this program have been used to evaluate and predict the behavior of cementitious barriers used in near-surface engineered waste disposal systems for periods of performance up to or longer than 100 years for operating facilities and longer than 1000 years for waste disposal. The CBP Software Toolbox is and will continue to produce tangible benefits to the working DOE Performance Assessment (PA) community.« less

Identifying barriers to glycemic control in patients with type 2 diabetes after completion of an accredited education program.

PubMed

Gildea, Chris M; Lantaff, Wendy M; Olenik, Nicole L

The objective of this study was to identify patient-perceived barriers to achieving A1C targets after receiving instruction in an accredited diabetes education program. Qualitative research using semistructured interviews and thematic analyses. One pharmacist-run diabetes center located within an independent community pharmacy in a suburban region of southern Indiana. A total of 17 participants between the ages of 41-78 were interviewed in March and April 2016. Not applicable. Patient-perceived barriers to attaining glycemic control after completion of a pharmacist-taught diabetes self-management education (DSME) program accredited by the American Association of Diabetes Educators. Participants reported a variety of perceived barriers to glycemic control subsequent to the receipt of structured education. Seven major themes emerged: 1) health care provider factors; 2) self-identified indiscretions; 3) psychological barriers and poor social support; 4) knowledge deficits; 5) personal injury or adverse drug events; 6) time constraints and competing life demands; and 7) financial constraints. Participants reported a variety of perceived barriers to achieving A1C targets after completing DSME. Incorporation of solutions and coping mechanisms to these barriers into diabetes education programs may help patients attain glycemic control. Other factors may require individualized attention outside of DSME in follow-up episodes of diabetes care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Substance use and mental illness among nurses: workplace warning signs and barriers to seeking assistance.

PubMed

Cares, Alexa; Pace, Elizabeth; Denious, Jean; Crane, Lori A

2015-01-01

Although some studies have examined the prevalence of substance use among nurses, few have assessed substance use in the workplace or early cues for identifying these health conditions. Primary data collected as part of a larger program evaluation were examined with the purpose of better understanding (a) the context and perceived consequences of substance use and mental illness among nurses and (b) barriers and opportunities for earlier identification and treatment of these issues among nurses, their colleagues, and employers. Anonymous surveys were mailed to 441 active and recent participants of a peer health assistance program in the summer of 2010. The survey examined drug-related behaviors in the workplace; behavioral cues that may permit earlier identification of substance use and mental illness; perceptions of barriers to seeking assistance; and strategies for preventing problems and overcoming barriers to seeking assistance. Responses were received from 302 nurses (69%). Nearly half (48%) reported drug or alcohol use at work, and two fifths (40%) felt that their competency level was affected by their use. More than two thirds of respondents thought their problem could have been recognized earlier. The most highly rated barriers to seeking assistance for substance use and mental illness included fear and embarrassment and concerns about losing one's nursing license. Respondents recommended greater attention be paid to early identification of risk factors during nurses' professional training as a prevention strategy. Findings from this study provide preliminary data that can be used by schools of nursing and health care employers to improve early identification of nurses' substance use and mental illness treatment needs. These data also suggest a need for more research to explore the prevention and early identification of co-occurring disorders in health care settings where nurses practice.

Barriers and Motivators to Participating in mHealth Research Among African American Men.

PubMed

James, Delores C S; Harville, Cedric

2017-11-01

Most African American (AA) men own a smartphone, which positions them to be targeted for a variety of programs, services, and health interventions using mobile devices (mHealth). The goal of this study was to assess AA men's use of technology and the barriers and motivators to participating in mHealth research. A self-administered survey was completed by 311 men. Multinomial logistic regression examined associations between three age groups (18-29 years, 30-50 years, and 51+ years), technology access, and motivators and barriers to participating in mHealth research. Sixty-five percent of men owned a smartphone and a laptop. Men aged 18 to 29 years were more likely willing to use a health app and smartwatch/wristband monitor than older men ( p < .01). Men aged 18 to 29 years were also more likely than older men to be motivated to participate for a free cell phone/upgraded data plan and contribution to the greater good ( p < .05). Older men were more likely than younger ones to be motivated to become more educated about the topic ( p < .05). Younger men were more likely than older ones to report lack of interest in the topic as a barrier to participating ( p < .01), while older men were more likely than younger ones to cite lack of research targeted to minority communities as a barrier ( p < .05). This study suggests that culturally tailored mHealth research using smartphones may be of interest to AA men interested in risk reduction and chronic disease self-management. Opportunities also exist to educate AA men about the topic at hand and why minority men are being targeted for the programs and interventions.

Barriers and Motivators to Participating in mHealth Research Among African American Men

PubMed Central

James, Delores C. S.; Harville, Cedric

2015-01-01

Most African American (AA) men own a smartphone, which positions them to be targeted for a variety of programs, services, and health interventions using mobile devices (mHealth). The goal of this study was to assess AA men’s use of technology and the barriers and motivators to participating in mHealth research. A self-administered survey was completed by 311 men. Multinomial logistic regression examined associations between three age groups (18-29 years, 30-50 years, and 51+ years), technology access, and motivators and barriers to participating in mHealth research. Sixty-five percent of men owned a smartphone and a laptop. Men aged 18 to 29 years were more likely willing to use a health app and smartwatch/wristband monitor than older men (p < .01). Men aged 18 to 29 years were also more likely than older men to be motivated to participate for a free cell phone/upgraded data plan and contribution to the greater good (p < .05). Older men were more likely than younger ones to be motivated to become more educated about the topic (p < .05). Younger men were more likely than older ones to report lack of interest in the topic as a barrier to participating (p < .01), while older men were more likely than younger ones to cite lack of research targeted to minority communities as a barrier (p < .05). This study suggests that culturally tailored mHealth research using smartphones may be of interest to AA men interested in risk reduction and chronic disease self-management. Opportunities also exist to educate AA men about the topic at hand and why minority men are being targeted for the programs and interventions. PMID:26634861

Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders

PubMed Central

2014-01-01

Background Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs. Methods This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses. Results Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services. Conclusions This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility. PMID:24552207

Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders.

PubMed

Smith, Kyla L; Straker, Leon M; McManus, Alexandra; Fenner, Ashley A

2014-02-19

Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs. This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses. Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services. This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility.

Assessing the psychosocial needs and program preferences of adolescents and young adults with cancer.

PubMed

Barakat, Lamia P; Galtieri, Liana R; Szalda, Dava; Schwartz, Lisa A

2016-02-01

Adolescents and young adults (AYA) are a developmentally distinct cancer group, vulnerable to psychosocial late effects and with a range of unmet psychosocial needs. We sought to better understand psychosocial care needs and program preferences to inform development of more easily accessible and effective AYA psychosocial programs. AYA on and off treatment for cancer (n = 111, ages 12-25 years) were approached during an outpatient clinic visit and completed a survey as part of a quality improvement initiative. The survey comprised an open-ended question on challenges related to cancer and treatment and closed-ended questions on access to and preference for various services and programs. Qualitative analyses were used to summarize themes for most significant challenges, and descriptive statistics were used for closed-ended questions. Most common themes for challenges included treatments and associated physical changes, barriers to pursuit of academic/vocational goals, and social isolation. For preferred program focus, AYA ranked highest increasing strength and endurance/reintegration into sports and dealing with physical changes resulting from treatment. AYA's preferred modalities for program delivery were one-on-one/in person and message boards/Facebook. Most of the sample indicated that lack of awareness prevented their accessing available programs. New information was identified that can be used to address access barriers and to offer AYA psychosocial programs in formats that might improve interest and accessibility. Ongoing evaluation of AYA psychosocial programs is recommended to determine acceptability, feasibility, and effectiveness to meet the evolving needs of AYA patients with cancer.

Peace Economics and Program Change in Undergraduate Peace Studies Programs

ERIC Educational Resources Information Center

Reuschlein, Robert W.

2009-01-01

The purpose of this study was to create knowledge about peace economics content of Midwest undergraduate peace studies programs, barriers that constrain economic content expansion, and strategies to overcome these barriers. A 40 question survey of directors and 4 director interviews were used to gather data to test hypotheses on the curriculum…

Durability of Peace Education Effects in the Shadow of Conflict

ERIC Educational Resources Information Center

Rosen, Yigal; Salomon, Gavriel

2011-01-01

Value-oriented instructional programs, such as anti-racism, may often face societal barriers. A case in point are peace education programs in conflictual contexts. Close analysis of peace education programs in regions of conflict and tension suggest that they face formidable barriers that would appear to prevent the attainment of their goals of…

Barriers of physical assessment skills among nursing students in Arab Peninsula

PubMed Central

Alamri, Majed Sulaiman; Almazan, Joseph U.

2018-01-01

Objective: There is a growing demand for health-care nursing services in several health care institutions. Understanding barriers to physical assessment among nursing students create a more detailed assessment in the development of quality patient’s care in nursing practice. This study examined the barriers to physical assessment skills among nursing students in a government university in Arab Peninsula. Methods: A cross-sectional research survey design of 206 nursing students using a standardized questionnaire was used. The questionnaire is composed of 7 subscales in evaluating the barriers to physical assessment skills between the classroom and clinical setting. Independent Samples t-test was used in comparing the gender mean of the nursing students about the barriers to physical assessment. Paired t-test was also used in determining the differences between perceived barriers to physical assessment in the classroom and clinical setting. Results: Subscale “reliance on others and technology,” ward culture, “lack of influence on patient care” have significant differences between perceived barriers in physical assessment among classroom settings and clinical setting. Conclusion: Although nursing students were oriented and educated about physical assessment in the nursing curriculum, this is not often practiced in clinical settings. The point that is if nursing students are incorrectly performing the patient assessment, then no amount of critical thinking could lead to better clinical decisions. Continuous exposure and enhancing the quality of planning and promotion of the nursing students could develop necessary skills. In addition, increasing self-confidence is vital to assess the patient’s health status effectively and minimize the barriers to performing the physical assessment. PMID:29896073

Results of a nurse-led intervention: connecting pediatric cancer patients from the hospital to the school using videoconferencing technologies.

PubMed

Ellis, Sarah J; Drew, Donna; Wakefield, Claire E; Saikal, Samra L; Punch, Deborah; Cohn, Richard J

2013-01-01

The objectives of this study were to assess the feasibility and perceived academic/psychosocial outcomes of a pilot program using videoconferencing facilities to connect children with cancer to their home school. Eight parents, three patients, and five teachers (n = 16) participated in semistructured interviews evaluating the efficacy/feasibility of this program. Results were analyzed using the qualitative framework of Miles and Huberman. Parents reported that videoconferencing provided the family with a sense of normalcy and connection to the outside world (4/8), often boosting patients' mood (6/8). Further benefits included stronger relationships with classmates and teachers (15/16) and improved peer acceptance and school reintegration. There were no notable impacts on patients' academic progression. Reported barriers included: costs, time commitments, bureaucratic hurdles, and technical and logistical difficulties. Videoconferencing technologies provide an important tool to connect childhood cancer patients to their classrooms; however, further solution-based investigation is warranted to overcome existing barriers.

You can't put a dollar amount on presence: young, non-resident, low-income, African American fathers.

PubMed

Fleck, Margaret Ofe; Hudson, Diane Brage; Abbott, Douglas A; Reisbig, Allison M

2013-09-01

The purpose of this transcendental phenomenological study was to describe the lived experiences of young, non-resident, low-income, African-American fathers. Semi-structured interviews were conducted with a convenience sample of 6 men enrolled in the Omaha Healthy Start, Fathers for a Lifetime Program. The following themes were identified: (a) A Work in Progress: Fatherhood Investment; (b) A Little Island by Myself: Barriers to Fathering; (c) I'm Going to be There From Day One to Infinity: Presence; and (d) The Tomorrow Dad: Not Like my Dad. Barriers to fathering created resource-poor environments posing challenges to involvement. Dispelling the myth of the "hit-and-run" father or the "package deal" remains a concern for fathers and their children. Nurses can develop early assessment strategies and interventions to help African American fathers with their parenting involvement. Fathers can be encouraged to attend community-based fathering programs to increase investment opportunities.

EAARL Topography-Colonial National Historical Park

USGS Publications Warehouse

Brock, John C.; Wright, C. Wayne; Nayegandhi, Amar; Stevens, Sara; Travers, Laurinda J.

2008-01-01

These Lidar-derived topography maps were produced as a collaborative effort between the U.S. Geological Survey (USGS) Coastal and Marine Geology Program, Florida Integrated Science Center (FISC) St. Petersburg, the National Park Service (NPS) Inventory and Monitoring Program, Northeast Coastal and Barrier Network, and the National Aeronautics and Space Administration (NASA), Wallops Flight Facility. One objective of this research is to create techniques to survey coral reefs, barrier islands, and various nearshore coastal environments for the purposes of geomorphic change studies, habitat mapping, ecological monitoring, change detection, and event assessment. As part of this project, data from an innovative instrument under development at the NASA Wallops Flight Facility, the NASA Experimental Airborne Advanced Research Lidar (EAARL) are being used. This sensor has the potential to make significant contributions in this realm for measuring subaerial and submarine topography wthin cross-environment surveys. High spectral resolution, water-column correction, and low costs were found to be key factors in providing accurate and affordable imagery to coastal resource managers.

Cable median barrier program in Washington State.

DOT National Transportation Integrated Search

2013-06-01

The purpose of this report is to summarize the evolution and accomplishments of the Washington State Department of Transportations (WSDOTs) cable median barrier program and to bring to conclusion the previous efforts published in the Cable Medi...

How to Overcome Barriers and Establish a Successful Home HD Program

PubMed Central

Chan, Christopher; Blagg, Christopher; Lockridge, Robert; Golper, Thomas; Finkelstein, Fred; Shaffer, Rachel; Mehrotra, Rajnish

2012-01-01

Summary Home hemodialysis (HD) is an underused dialysis modality in the United States, even though it provides an efficient and probably cost-effective way to provide more frequent or longer dialysis. With the advent of newer home HD systems that are easier for patients to learn, use, and maintain, patient and provider interest in home HD is increasing. Although barriers for providers are similar to those for peritoneal dialysis, home HD requires more extensive patient training, nursing education, and infrastructure support in order to maintain a successful program. In addition, because many physicians and patients do not have experience with home HD, reluctance to start home HD programs is widespread. This in-depth review describes barriers to home HD, focusing on patients, individual physicians and practices, and dialysis facilities, and offers suggestions for how to overcome these barriers and establish a successful home HD program. PMID:23037981

Competency-Based Assessment for Clinical Supervisors: Design-Based Research on a Web-Delivered Program

PubMed Central

Williams, Lauren Therese; Grealish, Laurie; Jamieson, Maggie

2015-01-01

Background Clinicians need to be supported by universities to use credible and defensible assessment practices during student placements. Web-based delivery of clinical education in student assessment offers professional development regardless of the geographical location of placement sites. Objective This paper explores the potential for a video-based constructivist Web-based program to support site supervisors in their assessments of student dietitians during clinical placements. Methods This project was undertaken as design-based research in two stages. Stage 1 describes the research consultation, development of the prototype, and formative feedback. In Stage 2, the program was pilot-tested and evaluated by a purposeful sample of nine clinical supervisors. Data generated as a result of user participation during the pilot test is reported. Users’ experiences with the program were also explored via interviews (six in a focus group and three individually). The interviews were transcribed verbatim and thematic analysis conducted from a pedagogical perspective using van Manen’s highlighting approach. Results This research succeeded in developing a Web-based program, “Feed our Future”, that increased supervisors’ confidence with their competency-based assessments of students on clinical placements. Three pedagogical themes emerged: constructivist design supports transformative Web-based learning; videos make abstract concepts tangible; and accessibility, usability, and pedagogy are interdependent. Conclusions Web-based programs, such as Feed our Future, offer a viable means for universities to support clinical supervisors in their assessment practices during clinical placements. A design-based research approach offers a practical process for such Web-based tool development, highlighting pedagogical barriers for planning purposes. PMID:25803172

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barbose, Galen; Wiser, Ryan; Bolinger, Mark

Increasing levels of financial support for customer-sited photovoltaic (PV) systems, provided through publicly-funded incentive programs, has heightened concerns about the long-term performance of these systems. Given the barriers that customers face to ensuring that their PV systems perform well, and the responsibility that PV incentive programs bear to ensure that public funds are prudently spent, these programs should, and often do, play a critical role in ensuring that PV systems receiving incentives perform well. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approachesmore » to encouraging PV system performance used by 32 prominent PV incentive programs in the U.S. We identify eight general strategies or groups of related strategies that these programs have used to address performance issues, and highlight important differences in the implementation of these strategies among programs.« less

Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on Motivational Interviewing, Adolescent Community Reinforcement Approach, Assertive Community Treatment, and Cognitive-behavioral Therapy.

PubMed

Amodeo, M; Lundgren, L; Cohen, A; Rose, D; Chassler, D; Beltrame, C; D'Ippolito, M

2011-11-01

This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952). Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected. Copyright © 2011 Elsevier Ltd. All rights reserved.

Booster Breaks in the workplace: participants’ perspectives on health-promoting work breaks

PubMed Central

Taylor, Wendell C.; King, Kathryn E.; Shegog, Ross; Paxton, Raheem J.; Evans-Hudnall, Gina L.; Rempel, David M.; Chen, Vincent; Yancey, Antronette K.

2013-01-01

Increasing sedentary work has been associated with greater cardiovascular and metabolic risk, as well as premature mortality. Interrupting the sedentary workday with health-promoting work breaks can counter these negative health effects. To examine the potential sustainability of work-break programs, we assessed the acceptance of these breaks among participants in a Booster Break program. We analyzed qualitative responses from 35 participants across five worksites where one 15-min physical activity break was taken each workday. Two worksites completed a 1-year intervention and three worksites completed a 6-month intervention. Responses to two open-ended questions about the acceptance and feasibility of Booster Breaks were obtained from a survey administered after the intervention. Three themes for benefits and two themes for barriers were identified. The benefit themes were (i) reduced stress and promoted enjoyment, (ii) increased health awareness and facilitated behavior change, and (iii) enhanced workplace social interaction. The barrier themes were the need for (iv) greater variety in Booster Break routines and (v) greater management support. This study provides empirical support for the acceptance and feasibility of Booster Breaks during the workday. Emphasizing the benefits and minimizing the barriers are strategies that can be used to implement Booster Breaks in other workplaces. PMID:23466367

Weight gain as a barrier to smoking cessation among military personnel.

PubMed

Russ, C R; Fonseca, V P; Peterson, A L; Blackman, L R; Robbins, A S

2001-01-01

To assess the relationships between active-duty military status, military weight standards, concern about weight gain, and anticipated relapse after smoking cessation. Cross-sectional study. Hospital-based tobacco cessation program. Two hundred fifty-two enrollees, of 253 eligible, to a tobacco cessation program in 1999 (135 men, 117 women; 43% on active duty in the military). Independent variables included gender, body mass index (weight/height2), and military status. Dependent variables included about weight gain with smoking cessation and anticipated relapse. In multivariate regression analyses that controlled for gender and body mass index, active-duty military status was associated with an elevated level of concern about weight gain (1.9-point increase on a 10-point scale; 95% confidence interval [CI], 1.0- to 2.8-point increase), as well as higher anticipated relapse (odds ratio [OR] = 3.6; 95% CI, 1.3 to 9.8). Among subjects who were close to or over the U.S. Air Force maximum allowable weight for height, the analogous OR for active-duty military status was 6.9 (p = .02). Occupational weight standards or expectations may pose additional barriers for individuals contemplating or attempting smoking cessation, as they do among active-duty military personnel. These barriers are likely to hinder efforts to decrease smoking prevalence in certain groups.

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

PubMed Central

2013-01-01

Background Continued inequities in coverage, low quality of care, and high out-of-pocket expenses for health services threaten attainment of Millennium Development Goals 4 and 5 in many sub-Saharan African countries. Existing health systems largely rely on input-based supply mechanisms that have a poor track record meeting the reproductive health needs of low-income and underserved segments of national populations. As a result, there is increased interest in and experimentation with results-based mechanisms like supply-side performance incentives to providers and demand-side vouchers that place purchasing power in the hands of low-income consumers to improve uptake of facility services and reduce the burden of out-of-pocket expenditures. This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Methods Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. Results The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages. Conclusions Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program. PMID:24139603

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda.

PubMed

Okal, Jerry; Kanya, Lucy; Obare, Francis; Njuki, Rebecca; Abuya, Timothy; Bange, Teresah; Warren, Charlotte; Askew, Ian; Bellows, Ben

2013-10-18

Continued inequities in coverage, low quality of care, and high out-of-pocket expenses for health services threaten attainment of Millennium Development Goals 4 and 5 in many sub-Saharan African countries. Existing health systems largely rely on input-based supply mechanisms that have a poor track record meeting the reproductive health needs of low-income and underserved segments of national populations. As a result, there is increased interest in and experimentation with results-based mechanisms like supply-side performance incentives to providers and demand-side vouchers that place purchasing power in the hands of low-income consumers to improve uptake of facility services and reduce the burden of out-of-pocket expenditures. This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages. Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program.

Formative research and stakeholder participation in intervention development.

PubMed

Vastine, Amy; Gittelsohn, Joel; Ethelbah, Becky; Anliker, Jean; Caballero, Benjamin

2005-01-01

To present a model for using formative research and stakeholder participation to develop a community-based dietary intervention targeting American Indians. Formative research included interviews, assessment of food- purchasing frequency and preparation methods, and dietary recalls. Stakeholders contributed to intervention development through formative research, a program planning workshop, group feedback, and implementation training. Foods high in fat and sugar are commonly consumed. Barriers to healthy eating include low availability, perceived high cost, and poor flavor. Stakeholder participation contributed to the development of a culturally appropriate intervention. This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program.

Farmer Participation in U.S. Farm Bill Conservation Programs

NASA Astrophysics Data System (ADS)

Reimer, Adam P.; Prokopy, Linda S.

2014-02-01

Conservation policy in agricultural systems in the United States relies primarily on voluntary action by farmers. Federal conservation programs, including the Environmental Quality Incentives Program, offer incentives, both financial and technical, to farmers in exchange for adoption of conservation practices. Understanding motivations for (as well as barriers to) participation in voluntary programs is important for the design of future policy and effective outreach. While a significant literature has explored motivations and barriers to conservation practice adoption and participation in single programs, few studies in the U.S. context have explored general participation by farmers in one place and time. A mixed-methods research approach was utilized to explore farmer participation in all U.S. Farm Bill programs in Indiana. Current and past program engagement was high, with nearly half of survey respondents reporting participation in at least one program. Most participants had experience with the Conservation Reserve Program, with much lower participation rates in other programs. Most interview participants who had experience in programs were motivated by the environmental benefits of practices, with incentives primarily serving to reduce the financial and technical barriers to practice adoption. The current policy arrangement, which offers multiple policy approaches to conservation, offers farmers with different needs and motivations a menu of options. However, evidence suggests that the complexity of the system may be a barrier that prevents participation by farmers with scarce time or resources. Outreach efforts should focus on increasing awareness of program options, while future policy must balance flexibility of programs with complexity.

Beyond Yes or No: Understanding Undergraduate Students' Responses as Bystanders to Sexual Assault Risk Situations.

PubMed

Hoxmeier, Jill C; McMahon, Sarah; O'Connor, Julia

2017-08-01

The White House Task Force to Protect Students From Sexual Assault recommends bystander engagement programming as part of campus sexual assault prevention efforts. Measuring students' bystander behavior, and thus, assessing the effectiveness of such programming, is a challenging endeavor due to the range of risk situations students may witness, as well as the nuances in potential barriers students may face in these situations. Currently, many studies include dichotomous measures of bystander behavior without gathering further information about students' opportunities to intervene, barriers to intervening, and intervention strategies. The current study sought to implement a more comprehensive approach to understanding the types of sexual assault risk situations students report to witness, as well as their response in those situations, reasons for not intervening, and any gender differences therein. In 2014, undergraduate students ( n = 9,358) at a large, public university in the Northeast completed a web-based survey to assess bystander opportunities and responses for six different risk situations. Results show that prosocial bystander responses varied depending on the risk situation. Of those students with opportunities to intervene, noninterveners reported the situation was "none of their business" or that they were "unsure of what to do." Interveners reported to have either "confronted the situation directly" or "went and got assistance." We also observed significant gender differences in students' reported intervention opportunities and bystander responses. The findings of this study have several important implications for bystander engagement programming and future research.

Why Isn't There More High-fidelity Simulation Training in Diagnostic Radiology? Results of a Survey of Academic Radiologists.

PubMed

Cook, Tessa S; Hernandez, Jessica; Scanlon, Mary; Langlotz, Curtis; Li, Chun-Der L

2016-07-01

Despite its increasing use in training other medical specialties, high-fidelity simulation to prepare diagnostic radiology residents for call remains an underused educational resource. To attempt to characterize the barriers toward adoption of this technology, we conducted a survey of academic radiologists and radiology trainees. An Institutional Review Board-approved survey was distributed to the Association of University Radiologists members via e-mail. Survey results were collected electronically, tabulated, and analyzed. A total of 68 survey responses representing 51 programs were received from program directors, department chairs, chief residents, and program administrators. The most common form of educational activity for resident call preparation was lectures. Faculty supervised "baby call" was also widely reported. Actual simulated call environments were quite rare with only three programs reporting this type of educational activity. Barriers to the use of simulation include lack of faculty time, lack of faculty expertise, and lack of perceived need. High-fidelity simulation can be used to mimic the high-stress, high-stakes independent call environment that the typical radiology resident encounters during the second year of training, and can provide objective data for program directors to assess the Accreditation Council of Graduate Medical Education milestones. We predict that this technology will begin to supplement traditional diagnostic radiology teaching methods and to improve patient care and safety in the next decade. Published by Elsevier Inc.

Surgical residency training and international volunteerism: a national survey of residents from 2 surgical specialties.

PubMed

Matar, Wadih Y; Trottier, Daniel C; Balaa, Fady; Fairful-Smith, Robin; Moroz, Paul

2012-08-01

Many low- and middle-income countries (LMICs) lack basic surgical resources, resulting in avoidable disability and mortality. Recently, residents in surgical training programs have shown increasing interest in overseas elective experiences to assist surgical programs in LMICs. The purpose of this study was to survey Canadian surgical residents about their interest in international volunteerism. We sent a web-based survey to all general and orthopedic surgery residents enrolled in surgical training programs in Canada. The survey assessed residents' interests, attitudes and motivations, and perceived barriers and aids with respect to international volunteerism. In all, 361 residents completed the survey for a response rate of 38.0%. Half of the respondents indicated that the availability of an international surgery elective would have positively influenced their selection of a residency program. Excluding the 18 residents who had volunteered during residency, 63.8% of the remaining residents confirmed an interest in international volunteering with "contributing to an important cause," "teaching" and "tourism/cultural enhancement" as the leading reasons for their interest. Perceived barriers included "lack of financial support" and "lack of available organized opportunities." All (100%) respondents who had done an international elective during residency confirmed that they would pursue such work in the future. Administrators of Canadian surgical programs should be aware of strong resident interest in global health care and accordingly develop opportunities by encouraging faculty mentorships and resources for global health teaching.

A worksite intervention to enhance social cognitive theory constructs to promote exercise adherence.

PubMed

Hallam, J; Petosa, R

1998-01-01

The results suggest social cognitive theory variables associated with the adoption of exercise are changeable in a brief worksite intervention. Self-regulation techniques and outcome-expectancy value improved, but self-efficacy did not improve for the treatment group. One possible explanation is, the intervention did not adequately address the ability to overcome barriers to exercise faced by participants in the intervention. Another explanation may be the effect of experiencing the barriers to exercise faced by subjects during the first 4 weeks of a self-regulated exercise program. Before engaging in exercise, the participants had a perceived level of confidence to overcome barriers to exercise. Once faced with real barriers to exercise, the subjects may have reevaluated their ability to overcome these barriers. It is interesting that the comparison group reported small decreases in all social cognitive theory variables measured in this study. The comparison group received a program of assessment, instruction, and access to facilities that is common to many worksite-based fitness promotion programs. Clearly, this approach did not have a favorable impact on psychosocial variables associated with exercise adherence. These results may be explained by a reevaluation of beliefs and perceived capabilities to exercise, once faced with the real experiences and barriers related to the adoption of an exercise program. The small decreases in social cognitive theory variables in the comparison group may explain high dropout rates in many fitness center programs and warrant further study. Health promotion specialists at the worksite need intervention programs that are safe, effective, and efficient for their employees. This intervention was based in the classroom, and no exercise was performed during class. This is appealing to employees who do not have access to shower facilities at the worksite. Moreover, in many interventions, subjects exercise during class and have limited time to learn specific skills to help them adopt and maintain exercise outside the structure of the intervention. Having established favorable changes in social cognitive theory constructs attributable to the intervention, a follow-up study should be conducted to determine the extent to which these changes predict adherence to regular exercise. These studies would establish the causal linkages between social cognitive theory constructs and regular exercise. There were specific limitations, and the results should be interpreted cautiously. The sample size was relatively small, although similar to other exercise intervention research reviewed by Dishman. Another limitation of the sample was no random assignment to treatment or comparison group. The results apply only to the subjects who volunteered for this study. The measure of outcome-expectancy value is the most vulnerable of those used to measure outcome expectations and outcome expectancies. It is possible that the results of the study would be substantially altered if a better measure were available. The data were collected through self-administered questionnaires. It was assumed the subjects would provide accurate information, but reliance on self-reported data introduces potential sources of error.

Exercising at work: barriers to women's participation.

PubMed

Verhoef, M J; Hamm, R D; Love, E J

1993-06-01

Only a minority of women in an urban random sample have the opportunity to exercise at work, and even fewer women use these opportunities. Lack of time and inconvenient times are the major reasons for not participating in exercise programs at work. Exercise programs at work are used by women who are already physically active, suggesting that workplace exercise programs do not serve the needs of women who may need exercise programs most. Multivariate analysis shows that age, having children, lack of energy, and lack of support are significant barriers to women's exercise participation at work. The results of this study suggest a leadership opportunity for on site occupational health nurses in addressing these barriers to workplace exercise.

Homelessness and the Public's Health: Legal Responses.

PubMed

Hodge, James G; DiPietro, Barbara; Horton-Newell, Amy E

2017-03-01

This commentary addresses public health issues underlying homelessness and related law, policy, and advocacy options. After framing public health issues for affected individuals and the community, legal and policy approaches and related barriers are assessed. Major topics include deficits in housing availability, the role of state-based Medicaid programs, criminalization of homelessness, and the use of emergency declarations seeking to address particular issues related to homelessness in select states and localities.

Muslim Scholars' Knowledge, Attitudes and Perceived Barriers Towards Polio Immunization in Pakistan.

PubMed

Khan, Muhammad Umair; Ahmad, Akram; Salman, Saad; Ayub, Maria; Aqeel, Talieha; Haq, Noman-Ul; Saleem, Fahad; Khan, Muhammad Ubaid

2017-04-01

Pakistan is one of the two countries where polio remains endemic. Among multiple reasons of polio prevalence, false religious beliefs are accounted as major barriers towards polio immunization in Pakistan. Within this context, religious scholars are now engaged in polio immunization campaigns to dismantle the myths and battle the resurgence of polio in Pakistan. The objective of this study was to assess knowledge, attitudes and perceived barriers of Muslim scholars towards polio immunization in Pakistan. A descriptive, cross-sectional survey of Muslim scholars was conducted in Quetta and Peshawar divisions of Pakistan. From October to December 2015, a convenience sample of 770 Muslim scholars was recruited from the local mosques and religious institutions to participate in this study. Knowledge, attitudes, and perceived barriers were assessed by using self-administered, anonymous and pretested questionnaire. Descriptive and regression analyses were used to express the results with p < 0.05 taken as significant. Three hundred and forty-eight (45.2 %) participants exhibited good knowledge about polio with a mean score of 7.16 ± 2.12 (based on 14 questions). Knowledge gaps were identified about the transmission (32.6 %) and consequences of poliovirus (39.9 %). Overall, 527 (68.4 %) participants showed positive attitudes towards polio immunization with a mean attitude score of 27.35 ± 2.68 (based on nine statements). The majority of participants agreed on the need of depoliticizing polio immunization issues (87.1 %), while reservations were noted about their willingness to participate in future polio immunization programs (44.6 %). Security (75.8 %) and vaccine management issues (64 %) were reported by the participants as the major barriers towards polio immunization in Pakistan. The findings showed poor knowledge of Muslim scholars towards polio; however, their attitudes were positive towards polio immunization. More studies are required to assess the knowledge and attitudes of Muslim scholars at the national level to validate the findings of this study.

Mobile detection assessment and response systems (MDARS): a force protection physical security operational success

NASA Astrophysics Data System (ADS)

Shoop, Brian; Johnston, Michael; Goehring, Richard; Moneyhun, Jon; Skibba, Brian

2006-05-01

MDARS is a Semi-autonomous unmanned ground vehicle with intrusion detection & assessment, product & barrier assessment payloads. Its functions include surveillance, security, early warning, incident first response and product and barrier status primarily focused on a depot/munitions security mission at structured/semi-structured facilities. MDARS is in Systems Development and Demonstration (SDD) under the Product Manager for Force Protection Systems (PM-FPS). MDARS capabilities include semi-autonomous navigation, obstacle avoidance, motion detection, day and night imagers, radio frequency tag inventory/barrier assessment and audio challenge and response. Four SDD MDARS Patrol Vehicles have been undergoing operational evaluation at Hawthorne Army Depot, NV (HWAD) since October 2004. Hawthorne personnel were trained to administer, operate and maintain the system in accordance with the US Army Military Police School (USAMPS) Concept of Employment and the PM-FPS MDARS Integrated Logistic Support Plan. The system was subjected to intensive periods of evaluation under the guidance and control of the Army Test and Evaluation Center (ATEC) and PM-FPS. Significantly, in terms of User acceptance, the system has been under the "operational control" of the installation performing security and force protection missions in support of daily operations. This evaluation is intended to assess MDARS operational effectiveness in an operational environment. Initial observations show that MDARS provides enhanced force protection, can potentially reduce manpower requirements by conducting routine tasks within its design capabilities and reduces Soldier exposure in the initial response to emerging incidents and situations. Success of the MDARS program has been instrumental in the design and development of two additional robotic force protection programs. The first was the USAF Force Protection Battle Lab sponsored Remote Detection Challenge & Response (REDCAR) concept demonstration executed by the Air Force Robotics Lab (AFRL). The REDCAR used an MDARS PUV as the central robotic technology and expanded the concept to incorporate a smaller high speed platform (SCOUT) equipped with lethal, non-lethal and challenge components as an engagement platform and, in a marsupial configuration on the MDARS, a small UGV that can be deployed to investigate close quarters areas. The Family of Integrated Rapid Response Equipment (FIRRE) program further expands these concepts by incorporating and adapting other mobile/tactical force protection equipment with a more robust Unmanned Ground Vehicle into an "Expeditionary" configuration to provide the current force with a rapidly deployable force protection system that can operate in austere less structured and protected environments. A USAMPS/ MANCEN sponsored "FIRRE System Demonstration" in Iraq is scheduled to begin in FY '07.

Communication Barriers: A Study of Eastern Mediterranean University Students' and Teachers' of Online Program and Courses

ERIC Educational Resources Information Center

Isman, Aytekin; Altinay, Fahriye

2005-01-01

This research study defines communication barriers in online programs and courses by determining the perceptions of students and teachers at Eastern Mediterranean University. It aims to get the answers to the questions of what sorts of problems students and teachers face while being involved in online courses and online programs. Distance…

Nurses' perceptions of nurse residency: identifying barriers to implementation.

PubMed

Wierzbinski-Cross, Heather; Ward, Kristin; Baumann, Paula

2015-01-01

The purpose of this project was to describe the benefits and components of successful nurse residency programs, as well as gain insight into the perceptions of staff nurses, nurse educators, and nurse leaders regarding value, feasibility, and barriers to implementing nurse residency programs in acute care settings. This study has important implications for implementing an effective residency program.

Confronting Physical Activity Programming Barriers for People with Disabilities: The Empowerment Model

ERIC Educational Resources Information Center

Moran, Thomas Eugene; Taliaferro, Andrea R.; Pate, Joshua R.

2014-01-01

Community-based physical activity programs for people with disabilities have barriers that are unique to their program leader qualifications and the population they serve. Moran and Block (2010) argued that there is a need for practical strategies that are easy for communities to implement, maximize resources, and minimize the impact of barriers…

Using the Health Belief Model to Explain Mothers' and Fathers' Intention to Participate in Universal Parenting Programs.

PubMed

Salari, Raziye; Filus, Ania

2017-01-01

Using the Health Belief Model (HBM) as a theoretical framework, we studied factors related to parental intention to participate in parenting programs and examined the moderating effects of parent gender on these factors. Participants were a community sample of 290 mothers and 290 fathers of 5- to 10-year-old children. Parents completed a set of questionnaires assessing child emotional and behavioral difficulties and the HBM constructs concerning perceived program benefits and barriers, perceived child problem susceptibility and severity, and perceived self-efficacy. The hypothesized model was evaluated using structural equation modeling. The results showed that, for both mothers and fathers, perceived program benefits were associated with higher intention to participate in parenting programs. In addition, higher intention to participate was associated with lower perceived barriers only in the sample of mothers and with higher perceived self-efficacy only in the sample of fathers. No significant relations were found between intention to participate and perceived child problem susceptibility and severity. Mediation analyses indicated that, for both mothers and fathers, child emotional and behavioral problems had an indirect effect on parents' intention to participate by increasing the level of perceived benefits of the program. As a whole, the proposed model explained about 45 % of the variance in parental intention to participate. The current study suggests that mothers and fathers may be motivated by different factors when making their decision to participate in a parenting program. This finding can inform future parent engagement strategies intended to increase both mothers' and fathers' participation rates in parenting programs.

Multiple barriers delay care among women with abnormal cancer screening despite patient navigation.

PubMed

Ramachandran, Ambili; Freund, Karen M; Bak, Sharon M; Heeren, Timothy C; Chen, Clara A; Battaglia, Tracy A

2015-01-01

While there is widespread dissemination of patient navigation programs in an effort to reduce delays in cancer care, little is known about the impact of barriers to care on timely outcomes. We conducted a secondary analysis of the Boston Patient Navigation Research Program (PNRP) to examine the effect that the presence of barriers had on time to diagnostic resolution of abnormal breast or cervical cancer screening tests. We used multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome to examine the effect of the number of barriers, controlling for demographic covariates and clustered by patients' primary navigator. There were 1481 women who received navigation; mean age was 39 years; 32% were White, 27% Black, and 31% Hispanic; 28% had private health insurance; and 38% did not speak English. Overall, half (n=745, 50%) had documentation of one or more barriers to care. Women with barriers were more likely to be older, non-White, non-English language speakers, and on public or no health insurance compared with women without barriers. In multivariable analyses, we found less timely diagnostic resolution as the number of barriers increased (one barrier, adjusted hazard ratio [aHR] 0.81 [95% CI 0.56-1.17], p=0.26; two barriers, aHR 0.55 [95% CI 0.37-0.81], p=0.0025; three or more barriers, aHR 0.31 [95% CI 0.21-0.46], p<0.0001)]. Within a patient navigation program proven to reduce delays in care, we found that navigated patients with documented barriers to care experience less timely resolution of abnormal cancer screening tests.

Age-Associated Perceptions of Physical Activity Facilitators and Barriers Among Women in Rural Southernmost Illinois

PubMed Central

Carnahan, Leslie R.; Peacock, Nadine R.

2016-01-01

Introduction Women living in rural areas in the United States experience disproportionately high rates of diseases such as obesity and heart disease and are less likely than women living in urban areas to meet daily physical activity (PA) recommendations. The purpose of our research was to understand age-specific perceptions of barriers and facilitators to rural women engaging in PA and to identify strategies to promote PA among these women. Methods As part of a community health assessment to learn about women’s health issues, 110 adult women participated in 14 focus groups. The women were divided into 4 age groups, and focus groups were held in various community settings. We used qualitative analysis methods to explore themes in the women’s narratives, including themes related to PA knowledge, PA behavior, and access to PA facilities. Results Participants described multiple and often conflicting individual, social, and environmental barriers and facilitators to PA. Several barriers and facilitators were shared across age groups (eg, competing priorities and inadequate knowledge about PA’s role in disease prevention and disease management). Other barriers (eg, illness and injury) and facilitators (eg, PA as a social opportunity) differed by age group. Conclusion Rural women in southernmost Illinois have often contradictory barriers and facilitators to PA, and those barriers and facilitators are different at different points in a woman’s life. Our findings suggest the need for multilevel, multisector approaches to promote PA. Additionally, this research supports the need for tailored PA promotion programs for rural women to address the barriers these women face across their lifespan. PMID:27685431

Barriers to Specialty Care and Specialty Referral Completion in the Community Health Center Setting

PubMed Central

Zuckerman, Katharine E.; Perrin, James M.; Hobrecker, Karin; Donelan, Karen

2013-01-01

Objective To assess the frequency of barriers to specialty care and to assess which barriers are associated with an incomplete specialty referral (not attending a specialty visit when referred by a primary care provider) among children seen in community health centers. Study design Two months after their child’s specialty referral, 341 parents completed telephone surveys assessing whether a specialty visit was completed and whether they experienced any of 10 barriers to care. Family/community barriers included difficulty leaving work, obtaining childcare, obtaining transportation, and inadequate insurance. Health care system barriers included getting appointments quickly, understanding doctors and nurses, communicating with doctors’ offices, locating offices, accessing interpreters, and inconvenient office hours. We calculated barrier frequency and total barriers experienced. Using logistic regression, we assessed which barriers were associated with incomplete referral, and whether experiencing ≥4 barriers was associated with incomplete referral. Results A total of 22.9% of families experienced incomplete referral. 42.0% of families encountered 1 or more barriers. The most frequent barriers were difficulty leaving work, obtaining childcare, and obtaining transportation. On multivariate analysis, difficulty getting appointments quickly, difficulty finding doctors’ offices, and inconvenient office hours were associated with incomplete referral. Families experiencing ≥4 barriers were more likely than those experiencing ≤3 barriers to have incomplete referral. Conclusion Barriers to specialty care were common and associated with incomplete referral. Families experiencing many barriers had greater risk of incomplete referral. Improving family/community factors may increase satisfaction with specialty care; however, improving health system factors may be the best way to reduce incomplete referrals. PMID:22929162

Creating a Culture of Wellness in Residency.

PubMed

Edmondson, Emma K; Kumar, Anupam A; Smith, Stephanie M

2018-04-17

Despite increased awareness and recognition of the prevalence of physician burnout and the associated risks of depression and suicide, there is a paucity of actionable guidelines for residency programs to mitigate these risks for their residents. In this Invited Commentary, the authors acknowledge that, although there are inherent barriers to resident wellness, there are numerous modifiable barriers that present opportunities for programs to enable culture change and improve resident wellbeing. The authors frame the discussion with a personal narrative written by a resident in their internal medicine program who experienced burnout, depression, and suicidality during his intern year. They aim to inspire residency programs and hospital leadership to identify and intervene upon the modifiable barriers to wellness for residents in their programs in order to shape meaningful cultural change.

Barriers to Employment for Transition-age Youth with Developmental and Psychiatric Disabilities.

PubMed

Noel, Valerie A; Oulvey, Eugene; Drake, Robert E; Bond, Gary R

2017-05-01

Youth with developmental and psychiatric disabilities encounter significant vocational challenges, even when they receive supported employment services. We examined the barriers to employment for 280 transition-age youth with disabilities enrolled in supported employment in eight community rehabilitation centers. Employment team members identified each youth's top three barriers to employment using a 21-item checklist. Lack of work experience, transportation problems, and program engagement issues represented common barriers for both youth with developmental disabilities (53, 36, and 25%) and youth with psychiatric disabilities (20, 33, and 26%). Additional common barriers among youth with developmental disabilities included cognitive problems (32%) and lack of social skills (23%) and among youth with psychiatric disabilities included poor control of psychiatric symptoms (23%). Despite receiving evidence-based employment services, youth with disabilities encounter many barriers to employment. Awareness of typical barriers for transition-age youth, including those specific to different disability groups, may help employment programs anticipate challenges and develop strategies that avoid these barriers and their effects on employment opportunities.

What is killing? People's knowledge about coronary heart disease, attitude towards prevention and main risk reduction barriers in Ismailia, Egypt (descriptive cross-sectional study).

PubMed

Seef, Sameh; Jeppsson, Anders; Stafström, Martin

2013-01-01

Cardiovascular diseases are a public health concern everywhere, especially ischemic or coronary heart diseases (CHD) which are on top of causes list of mortality and morbidity in both genders globally. From which nearly 80% can be because of modifiable risks. In Egypt, there is a lack of studies on the knowledge of people about coronary heart diseases and its modifiable risks. So, this research reported here we designed to measure the dimensions of peoples knowledge about CHD and their attitude towards prevention, and to identify the main risk reduction barriers. By using comprehensive cross-sectional, descriptive research design, all adult individuals attending the family health clinic at Suez Canal University Hospital were eligible for inclusion with total number 125 participants. An interview questionnaire designed and used to collect data. The study revealed that (10.4%) of participants had a history of CHD, and (7.2%) had a family history of CHD. 79.2% Had a satisfactory total knowledge about CHD, and (94.4%) had a positive total attitude towards prevention. Risk reduction barriers as a medical setting barriers were (24%), patient related barriers were (22.4%). Community-societal barriers were almost the same as knowledge barriers which were around (16%). At last the systemic-organizational barriers were (9.6%). The findings settled that, total knowledge about CHD was satisfactory but lower than the level total of attitude. More effort the health system needs to improve the settings and engage patients in their plans and breaking related barriers, with development of health education programs based on needs assessment. Further studies we recommend to explore the reasons and follow up the changes.

Managing urban stormwater for urban sustainability: Barriers and policy solutions for green infrastructure application.

PubMed

Dhakal, Krishna P; Chevalier, Lizette R

2017-12-01

Green infrastructure (GI) revitalizes vegetation and soil, restores hydro-ecological processes destroyed by traditional urbanization, and naturally manages stormwater on-site, offering numerous sustainability benefits. However, despite being sustainable and despite being the object of unrelenting expert advocacy for more than two decades, GI implementation remains slow. On the other hand, the practice of traditional gray infrastructure, which is known to have significant adverse impacts on the environment, is still ubiquitous in urban areas throughout the world. This relationship between knowledge and practice seems unaccountable, which has not yet received adequate attention from academia, policy makers, or research communities. We deal with this problem in this paper. The specific objective of the paper is to explore the barriers to GI, and suggest policies that can both overcome these barriers and expedite implementation. By surveying the status of implementation in 10 US cities and assessing the relevant city, state and federal policies, we identified 29 barriers and grouped them into 5 categories. The findings show that most of the barriers stem from cognitive limitations and socio-institutional arrangements. Accordingly, we suggest 33 policies, also grouped into 5 categories, which span from conducting public education and awareness programs to changing policies and governance structures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Barriers to the use of Veterans Affairs health care services among female veterans who served in Iraq and Afghanistan.

PubMed

Newins, Amie R; Wilson, Sarah M; Hopkins, Tiffany A; Straits-Troster, Kristy; Kudler, Harold; Calhoun, Patrick S

2018-02-08

The study investigated barriers to the utilization of Veterans Affairs (VA) health care services among female veterans who served in served in Iraq and Afghanistan, including reasons for not choosing VA health care, reasons for not seeking mental health treatment, and types of desired VA services. Female respondents to a survey assessing Operation Enduring Freedom/Operation Iraqi Freedom veterans' needs and health (N = 186) completed measures of military history, posttraumatic stress disorder, depression, barriers to VA health care, and preferences for services. Barriers to use of VA health care endorsed by female veterans included receiving care elsewhere and logistical issues. Barriers to utilization of mental health services among female veterans who screened positive for depression or posttraumatic stress disorder included negative treatment biases and concerns about stigma, privacy, and cost. Female veterans endorsed preferences for services related to eligibility education, nonprimary care physical health services, vocational assistance, and a few behavioral/mental health services. Findings highlight the need for ongoing outreach and education regarding eligibility and types of resources for physical and mental health problems experienced by female veterans who served in Iraq and Afghanistan, as well as inform types of VA programming and services desired by female veterans. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Women bound to be active: differences in long-term physical activity between completers and noncompleters of a book club intervention.

PubMed

Huberty, Jennifer L; Ehlers, Diane; Coleman, Jason; Gao, Yong; Elavsky, Steriani

2013-03-01

Ideal approaches to increasing long-term physical activity (PA) adherence in women remain unclear. This study used a longitudinal mixed-methods approach to 1) determine the effectiveness of an 8-month book club intervention for increasing PA participation and self-worth, and reducing barriers at 1-year followup; and 2) identify reasons why completers and noncompleters did or did not maintain PA. One year after the cessation of Women Bound to be Active (WBA), completers (participated in posttesting; n = 30) and noncompleters (did not participate in posttesting; n = 22) responded to questionnaires and interviews assessing their body mass index (BMI), current PA participation, barriers, and global self-worth. Compared with noncompleters, completers reported decreases in BMI, higher motivation for PA, higher ratio of benefits to barriers, and more consistent PA. Both groups still reported barriers to PA, especially time; however, completers more often reported strategies for overcoming these barriers. Completers more directly discussed the impact of their improved self-worth on their PA participation. In the future, a greater focus on time management and self-regulation strategies should be emphasized in PA interventions, specifically those that focus on women. This may help to prevent program and long-term PA attrition.

Stakeholders' Perspectives towards the Use of the Comprehensive Health Assessment Program (CHAP) for Adults with Intellectual Disabilities in Manitoba.

PubMed

Shooshtari, Shahin; Temple, Beverley; Waldman, Celeste; Abraham, Sneha; Ouellette-Kuntz, Héléne; Lennox, Nicholas

2017-07-01

No standardized tool is used in Canada for comprehensive health assessments of adults with intellectual disabilities. This study was conducted to determine the feasibility of implementing the Comprehensive Health Assessment Program (CHAP) in Manitoba, Canada. This was a qualitative study using a purposive sample of physicians, nurse practitioners, support workers and families. Data were collected through individual interviews and focus groups and were analysed using content analysis. Use of the CHAP was perceived as beneficial for persons with intellectual disabilities. Improved continuity of care was of the reported benefits. Six barriers for the future implementation of the CHAP were identified including the time required to complete the CHAP, and the perceived lack of physicians' willingness to do comprehensive assessments. The future implementation of the CHAP was strongly supported. For its successful implementation, training of healthcare professionals and support staff and change in regulations and policies were recommended. © 2016 John Wiley & Sons Ltd.

Interprofessional Education in the Internal Medicine Clerkship Post-LCME Standard Issuance: Results of a National Survey.

PubMed

Alexandraki, Irene; Hernandez, Caridad A; Torre, Dario M; Chretien, Katherine C

2017-08-01

Several decades of work have detailed the value and goals of interprofessional education (IPE) within the health professions, defining IPE competencies and best practices. In 2013, the Liaison Committee for Medical Education (LCME) elevated IPE to a U.S. medical school accreditation standard. To examine the status of IPE within internal medicine (IM) clerkships including perspectives, curricular content, barriers, and assessment a year after the LCME standard issuance. Anonymous online survey. IM clerkship directors from each of the Clerkship Directors in Internal Medicine's 121 U.S. and Canadian member medical schools in 2014. In 2014, a section on IPE (18 items) was included in the Clerkship Directors in Internal Medicine annual survey of its 121 U.S. and Canadian member medical schools. Items (18) assessed clerkship director (CD) perspectives, status of IPE curricula in IM clerkships, and barriers to IPE implementation. Data were analyzed using descriptive statistics and qualitative analysis of free-text responses to one of the survey questions. The overall survey response rate was 78% (94/121). The majority (88%) agreed that IPE is important to the practice of IM, and 71% believed IPE should be part of the IM clerkship. Most (76%) CDs agreed there is need for faculty development programs in IPE; 27% had such a program at their institution. Lack of curricular time, scheduling conflicts, and lack of faculty trained in IPE were the most frequently cited barriers. Twenty-nine percent had formal IPE activities within their IM clerkships, and 38% were planning to make changes. Of those with formal IPE activities, over a third (37%) did not involve student assessment. Since LCME standard issuance, only a minority of IM clerkships have included formal IPE activities, with lectures as the predominant method. Opportunities exist for enhancing educational methods as well as IPE faculty development.

Exploring the feasibility of engaging Traditional Birth Attendants in a prevention of mother to child HIV transmission program in Lilongwe, Malawi.

PubMed

Lippmann, Quinn Kerr; Mofolo, Innocent; Bobrow, Emily; Maida, Alice; Kamanga, Esmie; Pagadala, Nina; Martinson, Francis; van der Horst, Charles; Hosseinipour, Mina; Hoffman, Irving

2012-12-01

To investigate the willingness of Traditional Birth Attendants (TBAs) to provide single dose antiretroviral prophylaxis to infants born to mothers with HIV and the feasibility of providing the TBAs with antiretroviral medication. 2 focus groups with a total of 17 registered TBAs. Lilongwe, Malawi. TBAs were recruited by local health workers and participated in focus groups assessing their attitudes towards participation in a PMTCT program. TBAs were willing to participate in this prevention of mother-to-child HIV transmission (PMTCT) program and helped identify barriers to their participation. Given appropriate support and training, TBAs' participation in PMTCT programs could be an additional way to deliver medication to mothers and neonates who might otherwise miss crucial doses of medication.

Disease management in Canada: surmounting barriers to adoption.

PubMed

Gallant, Christopher R; MacKinnon, Neil J; Sprague, Denise A

2007-01-01

Disease Management (DM) programs are used to optimize economic outcomes and improve patient outcomes. Despite this, relative to the United States, Canadian health care organizations have been slow to adopt them. The objective of this article is to examine the concept of DM programs, the existing evidence to support their use and the barriers to their adoption in Canada. Several solutions aimed at overcoming the barriers to DM in Canada are proposed.

Parenting While Incarcerated: Tailoring the Strengthening Families Program for Use with Jailed Mothers.

PubMed

Miller, Alison L; Weston, Lauren E; Perryman, Jamie; Horwitz, Talia; Franzen, Susan; Cochran, Shirley

2014-09-01

Most incarcerated women are mothers. Parenting programs may benefit women, children and families, yet effectively intervening in correctional settings is a challenge. An evidence-based parenting intervention (the Strengthening Families Program) was tailored and implemented with women in a jail setting. Goals were to assess mothers' needs and interests regarding parenting while they were incarcerated, adapt the program to address those needs, and establish intervention delivery and evaluation methods in collaboration with a community-based agency. Women reported wanting to know more about effective communication; how children manage stress; finances; drug and alcohol use; self-care; and stress reduction. They reported high program satisfaction and reported reduced endorsement of corporal punishment after the intervention. Barriers to implementation included unpredictable attendance from session to session due to changing release dates, transfer to other facilities, and jail policies (e.g., lock-down; commissary hours). Implications for sustainable implementation of parenting programs in jail settings are discussed.

Screening for Food Insecurity in Pediatric Clinical Settings: Opportunities and Barriers.

PubMed

Barnidge, Ellen; LaBarge, Gene; Krupsky, Kathryn; Arthur, Joshua

2017-02-01

Food insecurity is a serious health concern among children in the United States with 15.3 million children living in food insecure households. The American Academy of Pediatrics recommends that pediatricians screen for food insecurity at health maintenance visits as identifying children at risk is a crucial step in the amelioration of food insecurity. Two surveys were administered in a Midwest pediatric clinic. A cross-sectional survey was electronically distributed to pediatric providers to assess perceptions of food insecurity among patients, provider readiness to conduct food security screenings, and barriers to conducting those screenings. A cross-sectional caregiver survey was administered to assess demographics, household food security status, participation in nutrition assistance programs, and barriers to getting enough food to eat. Descriptive statistics and odds ratios were calculated. Eighty-eight percent of physicians believe that food insecurity is a challenge for some of their patients. Only 15 % of providers reported screening for food insecurity, while 80 % were willing to screen. Physicians were most concerned with knowing how to handle a positive screen. Among caregivers, 57 % screened positive for food insecurity. Those experiencing food insecurity were more likely to be non-white, participate in SNAP and to feel discomfort towards the idea of talking to a doctor or nurse about food needs. Caregivers reporting food insecurity were significantly less likely to have a personal vehicle. Effective food insecurity screening requires addressing caregiver and health provider barriers in order to increase the likelihood of identifying households most at risk.

Substance Abuse among the Deaf Population: An Overview of Current Strategies, Programs and Barriers to Recovery.

ERIC Educational Resources Information Center

Lane, Katherine E.

1989-01-01

The paper analyzes the problem of alcohol and drug abuse among the deaf population focusing on: precipitating factors leading to substance abuse; barriers to recovery; and descriptions of several treatment centers, programs, and services. (JDD)

Engaging underserved audiences in informal science education through community-based partnerships

NASA Astrophysics Data System (ADS)

Bouzo, Suzanne

This thesis explores the impact of the Science Education and Engagement of Denver (SEED) Partnership on three of its participant families. The partnership, consisting of large informal science organizations, as well as small community-based organizations, created its programming based on prior research identifying barriers to minority participation in informal science education programs. SEED aims to engage youth and families of emerging populations in science and nature. Three families were examined as a case study to have an in depth investigation about their involvement in the programs sponsored by the partnership. Findings suggest a positive impact on participant feelings and engagement in science and nature. Future recommendations are made for furthering programming as well as conducting a larger scale, more comprehensive program evaluation. This research addresses prior studies that have identified several barriers toward participation of underserved audiences in informal science education programs and how the SEED partnership has addressed specific identified barriers.

Removing Barriers to the Adult Learner: Through Marketing, Management, and Programming. NUCEA Region VI Conference (Las Vegas, Nevada, October 10-13, 1982).

ERIC Educational Resources Information Center

Conter, Robert V., Ed.; Porcelli, Winifred A., Ed.

These proceedings contain the texts of nine presentations delivered at a conference on removing barriers to the adult learner through marketing, management, and programing. Included in the volume are the following papers: "Faculty Perceptions of Adult Learners, Off-Campus Credit Programs, and Teaching Strategies," by Diane…

Increasing Capacity for Stewardship of Oceans and Coasts: Findings of the National Research Council Report

NASA Astrophysics Data System (ADS)

Roberts, S. J.; Feeley, M. H.

2008-05-01

With the increasing stress on ocean and coastal resources, ocean resource management will require greater capacity in terms of people, institutions, technology and tools. Successful capacity-building efforts address the needs of a specific locale or region and include plans to maintain and expand capacity after the project ends. In 2008, the US National Research Council published a report that assesses past and current capacity-building efforts to identify barriers to effective management of coastal and marine resources. The report recommends ways that governments and organizations can strengthen marine conservation and management capacity. Capacity building programs instill the tools, knowledge, skills, and attitudes that address: ecosystem function and change; processes of governance that influence societal and ecosystem change; and assembling and managing interdisciplinary teams. Programs require efforts beyond traditional sector-by-sector planning because marine ecosystems range from the open ocean to coastal waters and land use practices. Collaboration among sectors, scaling from local community-based management to international ocean policies, and ranging from inland to offshore areas, will be required to establish coordinated and efficient governance of ocean and coastal ecosystems. Barriers Most capacity building activities have been initiated to address particular issues such as overfishing or coral reef degradation, or they target a particular region or country facing threats to their marine resources. This fragmentation inhibits the sharing of information and experience and makes it more difficult to design and implement management approaches at appropriate scales. Additional barriers that have limited the effectiveness of capacity building programs include: lack of an adequate needs assessment prior to program design and implementation; exclusion of targeted populations in decision- making efforts; mismanagement, corruption, or both; incomplete or inappropriate evaluation procedures; and, lack of a coordinated and strategic approach among donors. A New Framework Improving ocean stewardship and ending the fragmentation of current capacity building programs will require a new, broadly adopted framework for capacity building that emphasizes cooperation, sustainability, and knowledge transfer within and among communities. The report identifies four specific features of capacity building that would increase the effectiveness and efficiency of future programs: 1. Regional action plans based on periodic program assessments to guide investments in capacity and set realistic milestones and performance measures. 2. Long-term support to establish self-sustaining programs. Sustained capacity building programs require a diversity of sources and coordinated investments from local, regional, and international donors. 3. Development of leadership and political will. One of the most commonly cited reasons for failure and lack of progress in ocean and coastal governance initiatives is lack of political will. One strategy for strengthening support is to identify, develop, mentor, and reward leaders. 4. Establishment of networks and mechanisms for regional collaboration. Networks bring together those working in the same or similar ecosystems with comparable management or governance challenges to share information, pool resources, and learn from one another. The report also recommends the establishment of regional centers to encourage and support collaboration among neighboring countries.

Web-based Intervention to Promote Physical Activity by Sedentary Older Adults: Randomized Controlled Trial

PubMed Central

Gelatt, Vicky A; Seeley, John R; Macfarlane, Pamela; Gau, Jeff M

2013-01-01

Background Physical activity (PA) for older adults has well-documented physical and cognitive benefits, but most seniors do not meet recommended guidelines for PA, and interventions are lacking. Objectives This study evaluated the efficacy of a 12-week Internet intervention to help sedentary older adults over 55 years of age adopt and maintain an exercise regimen. Methods A total of 368 sedentary men and women (M=60.3; SD 4.9) were recruited, screened, and assessed online. They were randomized into treatment and control groups and assessed at pretest, at 12 weeks, and at 6 months. After treatment group participants rated their fitness level, activity goals, and barriers to exercise, the Internet intervention program helped them select exercise activities in the areas of endurance, flexibility, strengthening, and balance enhancement. They returned to the program weekly for automated video and text support and education, with the option to change or increase their exercise plan. The program also included ongoing problem solving to overcome user-identified barriers to exercise. Results The multivariate model indicated significant treatment effects at posttest (P=.001; large effect size) and at 6 months (P=.001; medium effect size). At posttest, intervention participation showed significant improvement on 13 of 14 outcome measures compared to the control participants. At 6 months, treatment participants maintained large gains compared to the control participants on all 14 outcome measures. Conclusions These results suggest that an online PA program has the potential to positively impact the physical activity of sedentary older adult participants. More research is needed to replicate the study results, which were based on self-report measures. Research is also needed on intervention effects with older populations. PMID:23470322

Mentorship in the context of interdisciplinary geriatric research: lessons learned from the RAND/Hartford Program for Building Interdisciplinary Geriatric Research Centers.

PubMed

Keyser, Donna J; Abedin, Zainab; Schultz, Dana J; Pincus, Harold Alan

2012-08-01

In light of the growing trend toward formalized research mentorship for effectively transmitting the values, standards, and practices of science from one generation of researchers to the next, this article provides the results of an exploratory study. It reports on research mentorship in the context of interdisciplinary geriatric research based on experiences with the RAND/Hartford Program for Building Interdisciplinary Geriatric Research Centers. At the end of the 2-year funding period, staff from the RAND Coordinating Center conducted 60- to 90-minute open-ended telephone interviews with the co-directors of the seven centers. Questions focused on interdisciplinary mentorship activities, barriers to implementing these activities, and strategies for overcoming them, as well as a self-assessment tool with regard to programs, policies, and structures across five domains, developed to encourage research mentorship. In addition, the mentees at the centers were surveyed to assess their experiences with interdisciplinary mentoring and the center. According to the interviewees, some barriers to successful interdisciplinary mentoring included the mentor's lack of time, structural support, and the lack of a clear definition of interdisciplinary research. Most centers had formal policies in place for mentor identification and limited policies on mentor incentives. Mentees uniformly reported their relationships with their mentors as positive. More than 50% of mentees reported having a primary mentor from within their discipline and had more contact with their primary mentor than their secondary mentors. Further research is needed to understand the complexity of institutional levers that emerging programs might employ to encourage and support research mentorship. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Intra-family role expectations and reluctance to change identified as key barriers to expanding vegetable consumption patterns during interactive family-based program for Appalachian low-income food preparers.

PubMed

Brown, J Lynne; Wenrich, Tionni R

2012-08-01

Few Americans eat sufficient vegetables, especially the protective deep orange and dark green vegetables. To address this, a community-based wellness program to broaden vegetables served at evening meals targeting Appalachian food preparers and their families was tested in a randomized, controlled intervention. Food preparers (n=50) were predominately married (88%), white (98%), and female (94%), with several children living at home. Experimental food preparers (n=25) attended the program sessions and controls (n=25) were mailed relevant handouts and recipes. At program sessions, participants received nutrition information, hands-on cooking instruction, and prepared recipes to take home for family evaluation. As qualitative assessment, 10 couples from each treatment group (n=20 couples) were randomly selected for baseline and immediate post-intervention interviews to explore impact on the food preparer's family. These in-depth interviews with the food preparer and their adult partner were tape-recorded and transcribed verbatim. Two researchers conducted thematic analysis using constant comparison. Family flexibility about food choices was assessed using roles, rules, and power concepts from Family Systems Theory. Interviews at baseline revealed dinner vegetable variety was very limited because food preparers served only what everyone liked (a role expectation) and deferred to male partner and children's narrow vegetable preferences (power). Control couples reported no change in vegetable dinner variety post-intervention. Most experimental couples reported in-home tasting and evaluation was worthwhile and somewhat broadened vegetables served at dinners. But the role expectation of serving only what everyone liked and the practice of honoring powerful family members' vegetable preferences remained major barriers to change. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

TU-FG-201-12: Designing a Risk-Based Quality Assurance Program for a Newly Implemented Y-90 Microspheres Procedure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vile, D; Zhang, L; Cuttino, L

2016-06-15

Purpose: To create a quality assurance program based upon a risk-based assessment of a newly implemented SirSpheres Y-90 procedure. Methods: A process map was created for a newly implemented SirSpheres procedure at a community hospital. The process map documented each step of this collaborative procedure, as well as the roles and responsibilities of each member. From the process map, different potential failure modes were determined as well as any current controls in place. From this list, a full failure mode and effects analysis (FMEA) was performed by grading each failure mode’s likelihood of occurrence, likelihood of detection, and potential severity.more » These numbers were then multiplied to compute the risk priority number (RPN) for each potential failure mode. Failure modes were then ranked based on their RPN. Additional controls were then added, with failure modes corresponding to the highest RPNs taking priority. Results: A process map was created that succinctly outlined each step in the SirSpheres procedure in its current implementation. From this, 72 potential failure modes were identified and ranked according to their associated RPN. Quality assurance controls and safety barriers were then added for failure modes associated with the highest risk being addressed first. Conclusion: A quality assurance program was created from a risk-based assessment of the SirSpheres process. Process mapping and FMEA were effective in identifying potential high-risk failure modes for this new procedure, which were prioritized for new quality assurance controls. TG 100 recommends the fault tree analysis methodology to design a comprehensive and effective QC/QM program, yet we found that by simply introducing additional safety barriers to address high RPN failure modes makes the whole process simpler and safer.« less

The barriers to environmental sustainability in post-disaster settings: a case study of transitional shelter implementation in Haiti.

PubMed

Abrahams, Daniel

2014-04-01

Disaster recovery operations that do not account for environmental sustainability (ES) risk exacerbating the impact of the disaster and hindering long-term recovery efforts. Yet aid agencies do not always consider ES. This research is a case study of the recovery that followed the 2010 earthquake in Haiti. Using timber and concrete procurement as proxies for broader post-disaster operations, research examined perceptions of ES as well as attempts at and barriers to incorporating it into programming. Identified barriers can be grouped into two categories: (1) prioritisations and perceptions within the disaster response sector that resulted in limited enthusiasm for incorporating ES into programming, and (2) structural and organisational barriers within the disaster response framework that impeded ES attempts and served as a further disincentive to incorporating ES into programming. As a result of those barriers, incorporation of ES was sporadic and inconsistent and often depended on the capacity and motivation of specific implementers. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

Assessment of trauma quality improvement activities at public hospitals in Thailand.

PubMed

Fuangworawong, Phuphit; LaGrone, Lacey N; Chadbunchachai, Witaya; Sornsrivichai, Vorasith; Mock, Charles N; Vavilala, Monica S

2016-09-01

Given the current exceptional burden of injury in Thailand, the proven efficacy of quality improvement programs, and the current scarcity of national-level information on trauma quality improvement program (TQIP) implementation in Thailand, we aimed to examine the use of TQIPs and barriers to TQIP adoption in Thai public trauma centers. We distributed a survey to 110 public hospitals which are designated to provide trauma care in Thailand. The survey assessed the presence or absence of the four core elements of the World Health Organization (WHO) recommended TQIPs (morbidity and mortality (M&M) conferences, preventable death panels, trauma registries, and audit filters), and provider perception of barriers and priorities in TQIP implementation. Responses were received from 80 (72%) respondents. Seventy-two (90%) reported having a trauma registry and seventy (88%) respondents reported use of audit filters. Seventy (88%) respondents reported conducting regular M&M conferences, and 45 (56%) respondents reported the presence of preventable death panels. Thirty-eight (48%) respondents reported presence of all four elements of WHO TQIPs. The most commonly reported barriers to implementing TQIPs were lack of interest (55; 68%) and lack of time (39; 48%)to implement TQIPs. Audit filters were reported by only 25 (31%) of respondents and optimization of audit filters was the most frequently identified next-step in further development of TQIP. Just under half of responding Thai public trauma centers reported implementation of all four elements of the WHO recommended TQIPs. Priority strategies to facilitate TQIP maturation in Thailand should address staff motivation, provision of staff time for TQIP development, and optimization of audit filter use to monitor quality of care. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Faculty Development for Medical School Community-Based Faculty: A Council of Academic Family Medicine Educational Research Alliance Study Exploring Institutional Requirements and Challenges.

PubMed

Drowos, Joanna; Baker, Suzanne; Harrison, Suzanne Leonard; Minor, Suzanne; Chessman, Alexander W; Baker, Dennis

2017-08-01

Community-based faculty play a large role in training medical students nationwide and require faculty development. The authors hypothesized that positive relationships exist between clerkships paying preceptors and requiring faculty development, and between protected clerkship directors' time and delivering face-to-face preceptor training, as well as with the number or length of community-based preceptor visits. Through under standing the quantity, delivery methods, barriers, and institutional support for faculty development provided to community-based preceptors teaching in family medicine clerkships, best practices can be developed. Data from the 2015 Council of Academic Family Medicine's Educational Research Alliance survey of Family Medicine Clerkship Directors were analyzed. The cross-sectional survey of clerkship directors is distributed annually to institutional representatives of U.S. and Canadian accredited medical schools. Survey questions focused on the requirements, delivery methods, barriers, and institutional support available for providing faculty development to community-based preceptors. Paying community-based preceptors was positively correlated with requiring faculty development in family medicine clerkships. The greatest barrier to providing faculty development was community-based preceptor time availability; however, face-to-face methods remain the most common delivery strategy. Many family medicine clerkship directors perform informal or no needs assessment in developing faculty development topics for community-based faculty. Providing payment to community preceptors may allow schools to enhance faculty development program activities and effectiveness. Medical schools could benefit from constructing a formal curriculum for faculty development, including formal preceptor needs assessment and program evaluation. Clerkship directors may consider recruiting and retaining community-based faculty by employing innovative faculty development delivery methods.

What Works to Reduce Unnecessary Care for Bronchiolitis? A Qualitative Analysis of a National Collaborative.

PubMed

Ralston, Shawn L; Atwood, Emily Carson; Garber, Matthew D; Holmes, Alison Volpe

2017-03-01

Unnecessary care is well established as a quality problem affecting acute viral bronchiolitis, one of the most common pediatric illnesses. Although there is an extensive quality improvement literature on the disease, published work primarily reflects the experience of freestanding children's hospitals. We sought to better understand the specific barriers and drivers for successful quality improvement in community and nonfreestanding children's facilities. We undertook a mixed methods study to identify correlates of success in a bronchiolitis quality improvement collaborative of community hospitals and children's hospitals within adult hospitals. We assessed site demographic characteristics, compliance with project interventions, and team engagement for association with end of project performance. We then used performance quartiles on a composite assessment of project measures (use of bronchodilators and steroids) to design a purposive sample of sites approached for qualitative interviews. Team engagement was the only factor quantitatively associated with better performance in the overall cohort. Fifteen sites, from the total cohort of 21, completed qualitative interviews. Qualitative themes around team engagement, including the presence of buy-in for successful sites and the inability to engage colleagues at unsuccessful sites, were important differentiating factors between top and bottom performance quartiles. Regardless of performance quartile, most programs cited intrainstitutional competition for limited resources to do quality improvement work as a specific barrier for pediatrics. The ability to overcome such barriers and specifically garner information technology (IT) resources also differentiated the top and bottom performance quartiles. Team engagement showed a consistent association with success across our quantitative and qualitative evaluations. Competition for limited resources in this cohort of nonfreestanding children's programs, particularly those in hospital IT, was a key qualitative theme. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Barriers to employability among substance dependent and nonsubstance-affected women on federal welfare: implications for program design.

PubMed

Morgenstern, Jon; McCrady, Barbara S; Blanchard, Kimberly A; McVeigh, Katharine H; Riordan, Annette; Irwin, Thomas W

2003-03-01

This study examined barriers to employability among women meeting criteria for a substance dependence disorder who were identified by routine screening conducted in welfare offices. The characteristics of these women were compared to other women on welfare who did not have a substance use disorder. A sample of 214 substance dependent women on federal welfare were recruited to participate in a substance use disorders welfare demonstration project. An additional 69 nonsubstance-affected women on welfare served as a comparison sample. All participants were assessed in welfare settings through a standardized battery of measures. Substance dependent women reported moderate to severe substance use problems. They also reported significantly higher rates than the women with no substance use disorder of other barriers such as domestic violence, mental health problems, legal problems, child welfare investigations and fewer job skills. Findings raise questions about the likely effectiveness of existing welfare reform services in addressing the needs of substance dependent women.

Cost-effectiveness Analysis on Measures to Improve China's Coal-fired Industrial Boiler

DOE PAGES

Liu, Manzhi; Shen, Bo; Han, Yafeng; ...

2015-08-01

Tackling coal-burning industrial boiler is becoming one of the key programs to solve the environmental problem in China. Assessing the economics of various options to address coal-fired boiler is essential to identify cost-effective solutions. This paper discusses our work in conducting a cost-effectiveness analysis on various types of improvement measures ranging from energy efficiency retrofits to switch from coal to other fuels in China. Sensitivity analysis was also performed in order to understand the impacts of some economic factors such as discount rate and energy price on the economics of boiler improvement options. The results show that nine out ofmore » 14 solutions are cost-effective, and a lower discount rate and higher energy price will result in more energy efficiency measures being cost-effective. Both monetary and non-monetary barriers to energy-efficiency improvement are discussed and policies to tackle these barriers are recommended. Our research aims at providing a methodology to assess cost-effective solutions to boiler problems.« less

The potential of local farming on the Navajo Nation to improve fruit and vegetable intake: barriers and opportunities.

PubMed

Setala, Ashley; Bleich, Sara N; Speakman, Kristen; Oski, Jane; Martin, Tammy; Moore, Regina; Tohannie, Marcella; Gittelsohn, Joel

2011-01-01

American Indian populations have low produce intake compared to other ethnic groups and higher rates of diet-related chronic diseases. Programs linking farmers to their community (Farm-to-Table) are an innovative way to alter the food environment. We interviewed Navajo farmers (n = 20), storeowners (n = 7), and non-governmental organization representatives (n = 4) to better understand local farming practices and the potential of a Farm-to-Table program to increase produce intake. Barriers to participation in a Farm-to-Table program included lack of water, insufficient help, and exotic species. Participants expressed concern about high obesity rates and voiced support for a Farm-to-Table program if barriers could be adequately addressed.

Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia.

PubMed

Tuckerman, Jane L; Shrestha, Lexa; Collins, Joanne E; Marshall, Helen S

2016-07-02

Understanding motivators and barriers of health care worker (HCW) vaccination programs is important for determining strategies to improve uptake. The aim of this study was to explore key drivers and HCW decision making related to recommended vaccines and seasonal influenza vaccination programs. We used a qualitative approach with semi-structured one-to-one interviews with 22 HCWs working at a tertiary pediatric and obstetric hospital in South Australia. A thematic analysis and coding were used to examine data. Key motivators that emerged included: sense of responsibility, convenience and ease of access, rotating trolleys, the influenza vaccine being free, basic knowledge about influenza and influenza vaccination, peer pressure, personal values and family culture, as well as the culture of support for the program. Personal decisions were the major barrier to HCWs receiving the influenza vaccine which were predominantly self-protection related or due to previous experience or fear of adverse reactions. Other barriers that emerged were misconceptions about the influenza vaccine, needle phobia and privacy concerns. This study identified both attitudinal and structural barriers that could be addressed to improve uptake of the seasonal influenza vaccine.

Understanding motivators and barriers of hospital-based obstetric and pediatric health care worker influenza vaccination programs in Australia

PubMed Central

Tuckerman, Jane L.; Shrestha, Lexa; Collins, Joanne E.; Marshall, Helen S.

2016-01-01

ABSTRACT Understanding motivators and barriers of health care worker (HCW) vaccination programs is important for determining strategies to improve uptake. The aim of this study was to explore key drivers and HCW decision making related to recommended vaccines and seasonal influenza vaccination programs. We used a qualitative approach with semi-structured one-to-one interviews with 22 HCWs working at a tertiary pediatric and obstetric hospital in South Australia. A thematic analysis and coding were used to examine data. Key motivators that emerged included: sense of responsibility, convenience and ease of access, rotating trolleys, the influenza vaccine being free, basic knowledge about influenza and influenza vaccination, peer pressure, personal values and family culture, as well as the culture of support for the program. Personal decisions were the major barrier to HCWs receiving the influenza vaccine which were predominantly self-protection related or due to previous experience or fear of adverse reactions. Other barriers that emerged were misconceptions about the influenza vaccine, needle phobia and privacy concerns. This study identified both attitudinal and structural barriers that could be addressed to improve uptake of the seasonal influenza vaccine. PMID:27245460

Embedding climate change risk assessment within a governance context

DOE Office of Scientific and Technical Information (OSTI.GOV)

Preston, Benjamin L

Climate change adaptation is increasingly being framed in the context of climate risk management. This has contributed to the proliferation of climate change vulnerability and/or risk assessments as means of supporting institutional decision-making regarding adaptation policies and measures. To date, however, little consideration has been given to how such assessment projects and programs interact with governance systems to facilitate or hinder the implementation of adaptive responses. An examination of recent case studies involving Australian local governments reveals two key linkages between risk assessment and the governance of adaptation. First, governance systems influence how risk assessment processes are conducted, by whommore » they are conducted, and whom they are meant to inform. Australia s governance system emphasizes evidence-based decision-making that reinforces a knowledge deficit model of decision support. Assessments are often carried out by external experts on behalf of local government, with limited participation by relevant stakeholders and/or civil society. Second, governance systems influence the extent to which the outputs from risk assessment activities are translated into adaptive responses and outcomes. Technical information regarding risk is often stranded by institutional barriers to adaptation including poor uptake of information, competition on the policy agenda, and lack of sufficient entitlements. Yet, risk assessments can assist in bringing such barriers to the surface, where they can be debated and resolved. In fact, well-designed risk assessments can contribute to multi-loop learning by institutions, and that reflexive problem orientation may be one of the more valuable benefits of assessment.« less

Physical Activity for Campus Employees: A University Worksite Wellness Program.

PubMed

Butler, Carling E; Clark, B Ruth; Burlis, Tamara L; Castillo, Jacqueline C; Racette, Susan B

2015-04-01

Workplaces provide ideal environments for wellness programming. The purpose of this study was to explore exercise self-efficacy among university employees and the effects of a worksite wellness program on physical activity, cardiorespiratory fitness, and cardiovascular disease (CVD) risk factors. Participants included 121 university employees (85% female). The worksite wellness program included cardiovascular health assessments, personal health reports, 8 weeks of pedometer-based walking and tracking activities, and weekly wellness sessions. Daily step count was assessed at baseline, Week 4, and Week 8. Exercise self-efficacy and CVD risk factors were evaluated at baseline and follow-up. Daily step count increased from 6566 ± 258 (LSM ± SE) at baseline to 8605 ± 356 at Week 4 and 9107 ± 388 at Week 8 (P < .0001). Steps increased among normal weight, overweight, and obese subgroups. Exercise self-efficacy correlated with baseline steps (P < .05). Small improvements were observed in cardiorespiratory fitness, body mass index, blood pressure, blood glucose, total cholesterol, and triglycerides (all P < .01). A worksite wellness program was effective for improving physical activity, cardiorespiratory fitness, and CVD risk factors among university employees. Exercise barriers and outcome expectations were identified and have implications for future worksite wellness programming.

Physical activity for campus employees: a university worksite wellness program

PubMed Central

Butler, Carling E.; Clark, B. Ruth; Burlis, Tamara L.; Castillo, Jacqueline C.; Racette, Susan B.

2014-01-01

Background Workplaces provide ideal environments for wellness programming. The purpose of this study was to explore exercise self-efficacy among university employees and the effects of a worksite wellness program on physical activity, cardiorespiratory fitness, and CVD risk factors. Methods Participants included 121 university employees (85% female). The worksite wellness program included cardiovascular health assessments, personal health reports, 8 weeks of pedometer-based walking and tracking activities, and weekly wellness sessions. Daily step count was assessed at baseline, week 4, and week 8. Exercise self-efficacy and CVD risk factors were evaluated at baseline and follow-up. Results Daily step count increased from 6566 ± 258 (LSM ± SE) at baseline to 8605 ± 356 at week 4 and 9107 ± 388 at week 8 (P < .0001). Steps increased among normal weight, overweight, and obese sub-groups. Exercise self-efficacy correlated with baseline steps (P < .05). Small improvements were observed in cardiorespiratory fitness, BMI, blood pressure, blood glucose, total cholesterol, and triglycerides (all P < .01). Conclusions A worksite wellness program was effective for increasing physical activity, cardiorespiratory fitness, and CVD risk factors among university employees. Exercise barriers and outcome expectations were identified and have implications for future worksite wellness programming. PMID:24905703

The Cementitious Barriers Partnership Experimental Programs and Software Advancing DOE’s Waste Disposal/Tank Closure Efforts – 15436

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burns, Heather; Flach, Greg; Smith, Frank

2015-01-27

The U.S. Department of Energy Environmental Management (DOE-EM) Office of Tank Waste Management-sponsored Cementitious Barriers Partnership (CBP) is chartered with providing the technical basis for implementing cement-based waste forms and radioactive waste containment structures for long-term disposal. DOE needs in this area include the following to support progress in final treatment and disposal of legacy waste and closure of High-Level Waste (HLW) tanks in the DOE complex: long-term performance predictions, flow sheet development and flow sheet enhancements, and conceptual designs for new disposal facilities. The DOE-EM Cementitious Barriers Partnership is producing software and experimental programs resulting in new methods andmore » data needed for end-users involved with environmental cleanup and waste disposal. Both the modeling tools and the experimental data have already benefited the DOE sites in the areas of performance assessments by increasing confidence backed up with modeling support, leaching methods, and transport properties developed for actual DOE materials. In 2014, the CBP Partnership released the CBP Software Toolbox –“Version 2.0” which provides concrete degradation models for 1) sulfate attack, 2) carbonation, and 3) chloride initiated rebar corrosion, and includes constituent leaching. These models are applicable and can be used by both DOE and the Nuclear Regulatory Commission (NRC) for service life and long-term performance evaluations and predictions of nuclear and radioactive waste containment structures across the DOE complex, including future SRS Saltstone and HLW tank performance assessments and special analyses, Hanford site HLW tank closure projects and other projects in which cementitious barriers are required, the Advanced Simulation Capability for Environmental Management (ASCEM) project which requires source terms from cementitious containment structures as input to their flow simulations, regulatory reviews of DOE performance assessments, and Nuclear Regulatory Commission reviews of commercial nuclear power plant (NPP) structures which are part of the overall US Energy Security program to extend the service life of NPPs. In addition, the CBP experimental programs have had a significant impact on the DOE complex by providing specific data unique to DOE sodium salt wastes at Hanford and SRS which are not readily available in the literature. Two recent experimental programs on cementitious phase characterization and on technetium (Tc) mobility have provided significant conclusions as follows: recent mineralogy characterization discussed in this paper illustrates that sodium salt waste form matrices are somewhat similar to but not the same as those found in blended cement matrices which to date have been used in long-term thermodynamic modeling and contaminant sequestration as a first approximation. Utilizing the CBP generated data in long-term performance predictions provides for a more defensible technical basis in performance evaluations. In addition, recent experimental studies related to technetium mobility indicate that conventional leaching protocols may not be conservative for direct disposal of Tc-containing waste forms in vadose zone environments. These results have the potential to influence the current Hanford supplemental waste treatment flow sheet and disposal conceptual design.« less

Process Evaluation of a Workers' Health Surveillance Program for Meat Processing Workers.

PubMed

van Holland, Berry J; Brouwer, Sandra; de Boer, Michiel R; Reneman, Michiel F; Soer, Remko

2017-09-01

Objective To evaluate the implementation process of a workers' health surveillance (WHS) program in a Dutch meat processing company. Methods Workers from five plants were eligible to participate in the WHS program. The program consisted of four evaluative components and an intervention component. Qualitative and quantitative methods were used to evaluate seven process aspects. Data were gathered by interviews with stakeholders, participant questionnaires, and from registries of the company and occupational health service. Results Two recruitment strategies were used: open invitation or automatic participation. Of the 986 eligible workers, 305 participated in the program. Average reach was 53 %. Two out of five program components could not be assessed on dose delivered, dose received and fidelity. If components were assessable, 85-100 % of the components was delivered, 66-100 % of the components was received by participants, and fidelity was 100 %. Participants were satisfied with the WHS program (mean score 7.6). Contextual factors that facilitated implementation were among others societal developments and management support. Factors that formed barriers were program novelty and delayed follow-up. Conclusion The WHS program was well received by participants. Not all participants were offered the same number of program components, and not all components were performed according to protocol. Deviation from protocol is an indication of program failure and may affect program effectiveness.

Family Medicine Maternity Care Call to Action: Moving Toward National Standards for Training and Competency Assessment.

PubMed

Magee, Susanna R; Eidson-Ton, W Suzanne; Leeman, Larry; Tuggy, Michael; Kim, Thomas O; Nothnagle, Melissa; Breuner, Joseph; Loafman, Mark

2017-03-01

Maternity care is an integral part of family medicine, and the quality and cost-effectiveness of maternity care provided by family physicians is well documented. Considering the population health perspective, increasing the number of family physicians competent to provide maternity care is imperative, as is working to overcome the barriers discouraging maternity care practice. A standard that clearly defines maternity care competency and a systematic set of tools to assess competency levels could help overcome these barriers. National discussions between 2012 and 2014 revealed that tools for competency assessment varied widely. These discussions resulted in the formation of a workgroup, culminating in a Family Medicine Maternity Care Summit in October 2014. This summit allowed for expert consensus to describe three scopes of maternity practice, draft procedural and competency assessment tools for each scope, and then revise the tools, guided by the Family Medicine and OB/GYN Milestones documents from the respective residency review committees. The summit group proposed that achievement of a specified number of procedures completed should not determine competency; instead, a standardized competency assessment should take place after a minimum number is performed. The traditionally held required numbers for core procedures were reassessed at the summit, and the resulting consensus opinion is proposed here. Several ways in which these evaluation tools can be disseminated and refined through the creation of a learning collaborative across residency programs is described. The summit group believed that standardization in training will more clearly define the competencies of family medicine maternity care providers and begin to reduce one of the barriers that may discourage family physicians from providing maternity care.

Barriers and facilitators to healthy eating and disease self-management among older adults residing in subsidized housing.

PubMed

Petroka, Katherine; Campbell-Bussiere, Rania; Dychtwald, Dan K; Milliron, Brandy-Joe

2017-09-01

As adults transition into older ages, meeting age-specific dietary recommendations can become increasingly challenging, especially for low-income seniors who reside in publicly subsidized rental housing. The primary objectives of this study were to: 1) identify barriers and facilitators to healthy eating and self-management of nutrition-related chronic illnesses experienced by low-income seniors residing in a subsidized housing setting; and 2) assess the interest in community nutrition programming among low-income seniors residing in a subsidized housing setting. A qualitative study design, using food focus groups and food pantry observations, was used. Participants included 24 male and female senior adults, between 65 and 75 years of age, residing in a subsidized housing community in Philadelphia, PA. This setting also included the unique features of a community garden and food pantry. Data were manually analyzed using a content analysis approach, which included familiarization, identification of themes, categorization and interpretation; and verified using NVivo 10. Personal barriers, including food cost and accessibility, physical limitations, desire for convenience, and low self-efficacy to change dietary habits, inhibited motivation to change. External barriers in the food environment, including lack of transportation and distance of markets to access fresh produce, were commonly cited; as well as negative influences of the internal environment, such as the presence of vending machines, common cultural cooking and eating practices, and the lack of social cohesion. Facilitators focused on food preparation and recipe adaptation. Participants expressed an interest in learning more about food, nutrition, and health through community-based programming.

A Community-Based Partnership to Successfully Implement and Maintain a Breast Health Navigation Program.

PubMed

Drake, Bettina F; Tannan, Shivon; Anwuri, Victoria V; Jackson, Sherrill; Sanford, Mark; Tappenden, Jennifer; Goodman, Melody S; Colditz, Graham A

2015-12-01

Breast cancer screening combined with follow-up and treatment reduces breast cancer mortality. However, in the study clinic, only 12 % of eligible women ≥40 years received a mammogram in the previous year. The objective of this project was to implement patient navigation, in our partner health clinic to (1) identify women overdue for a mammogram; and (2) increase mammography utilization in this population over a 2-year period. Women overdue for a mammogram were identified. One patient navigator made navigation attempts over a 2-year period (2009-2011). Navigation included working around systems- and individual-level barriers to receive a mammogram as well as the appropriate follow-up post screening. Women were contacted up to three times to initiate navigation. The proportion of women navigated and who received a mammogram during the study period were compared to women who did not receive a mammogram using Chi square tests for categorical variables and t tests for continuous variables with an α = 0.05. Barriers to previous mammography were also assessed. With 94.8 % of eligible women navigated and 94 % of these women completing mammography, the implementation project reached 89 % of the target population. This project was a successful implementation of an evidence-based patient navigation program that continues to provide significant impact in a high-need area. Cost was the most commonly cite barrier to mammography. Increasing awareness of resources in the community for mammography and follow-up care remains a necessary adjunct to removing structural and financial barriers to accessing preventive services.

The Teaching of Ethics and Professionalism in Plastic Surgery Residency: A Cross-Sectional Survey.

PubMed

Bennett, Katelyn G; Ingraham, John M; Schneider, Lisa F; Saadeh, Pierre B; Vercler, Christian J

2017-05-01

The ethical practice of medicine has always been of utmost importance, and plastic surgery is no exception. The literature is devoid of information on the teaching of ethics and professionalism in plastic surgery. In light of this, a survey was sent to ascertain the status of ethics training in plastic surgery residencies. A 21-question survey was sent from the American Council of Academic Plastic Surgeons meeting to 180 plastic surgery program directors and coordinators via email. Survey questions inquired about practice environment, number of residents, presence of a formal ethics training program, among others. Binary regression was used to determine if any relationships existed between categorical variables, and Poisson linear regression was used to assess relationships between continuous variables. Statistical significance was set at a P value of 0.05. A total of 104 members responded to the survey (58% response rate). Sixty-three percent were program directors, and most (89%) practiced in academic settings. Sixty-two percent in academics reported having a formal training program, and 60% in private practice reported having one. Only 40% of programs with fewer than 10 residents had ethics training, whereas 78% of programs with more than 20 residents did. The odds of having a training program were slightly higher (odds ratio, 1.1) with more residents (P = 0.17). Despite the lack of information in the literature, formal ethics and professionalism training does exist in many plastic surgery residencies, although barriers to implementation do exist. Plastic surgery leadership should be involved in the development of standardized curricula to help overcome these barriers.

Barrier Reduction Program for Women: Final Report.

ERIC Educational Resources Information Center

McWilliams, Katie

Cedar Valley College's Barrier Reduction Program for Women (BRPW) offers workshops and individual career consultations to help area women meet their personal needs, increase their knowledge of career opportunities, and realize their individual potential. This descriptive and evaluative report begins by examining the diverse characteristics and…

Demonstration of fuel resistant to pellet-cladding interaction. Phase I. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rosenbaum, H.S.

1979-03-01

This program has as its ultimate objective the demonstration of an advanced fuel design that is resistant to the failure mechanism known as fuel pellet-cladding interaction (PCI). Two fuel concepts are being developed for possible demonstration within this program: (a) Cu-barrier fuel, and (b) Zr-liner fuel. These advanced fuels (known collectively as barrier fuels) have special fuel cladding designed to protect the Zircaloy cladding tube from the harmful effects of localized stress, and reactive fission products during reactor service. This is the final report for PHASE 1 of this program. Support tests have shown that the barrier fuel resists PCImore » far better than does the conventional Zircaloy-clad fuel. Power ramp tests thus far have shown good PCI resistance for Cu-barrier fuel at burnup > 12 MWd/kg-U and for Zr-liner fuel > 16 MWd/kg-U. The program calls for continued testing to still higher burnup levels in PHASE 2.« less

Processes, barriers and facilitators to implementation of a participatory ergonomics program among eldercare workers.

PubMed

Rasmussen, Charlotte Diana Nørregaard; Lindberg, Naja Klærke; Ravn, Marie Højbjerg; Jørgensen, Marie Birk; Søgaard, Karen; Holtermann, Andreas

2017-01-01

This study aimed to investigate the processes of a participatory ergonomics program among 594 eldercare workers with emphasis on identified risk factors for low back pain and solutions, and reveal barriers and facilitators for implementation. Sixty-nine per cent of the identified risk factors were physical ergonomic, 24% were organisational and 7% were psychosocial risk factors. Most solutions were organisational (55%), followed by physical (43%) and psychosocial solutions (2%). Internal factors (e.g. team or management) constituted 47% of the barriers and 75% of the facilitators. External factors (e.g. time, financial resources, collaboration with resident or relatives) constituted 53% of the barriers and 25% of the facilitators. This study revealed the processes and implementation of a participatory ergonomics program among eldercare workers. The findings can be transferred to workers, workplaces, health and safety professionals, and researchers to improve future participatory ergonomics programs. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.

PubMed

Hofler, Lisa G; Cordes, Sarah; Cwiak, Carrie A; Goedken, Peggy; Jamieson, Denise J; Kottke, Melissa

2017-01-01

To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.

Understanding barriers to implementation of an adaptive land management program

USGS Publications Warehouse

Jacobson, S.K.; Morris, J.K.; Sanders, J.S.; Wiley, E.N.; Brooks, M.; Bennetts, R.E.; Percival, H.F.; Marynowski, S.

2006-01-01

The Florida Fish and Wildlife Conservation Commission manages over 650,000 ha, including 26 wildlife management and environmental areas. To improve management, they developed an objective-based vegetation management (OBVM) process that focuses on desired conditions of plant communities through an adaptive management framework. Our goals were to understand potential barriers to implementing OBVM and to recommend strategies to overcome barriers. A literature review identified 47 potential barriers in six categories to implementation of adaptive and ecosystem management: logistical, communication, attitudinal, institutional, conceptual, and educational. We explored these barriers through a bureau-wide survey of 90 staff involved in OBVM and personal interviews with area managers, scientists, and administrators. The survey incorporated an organizational culture assessment instrument to gauge how institutional factors might influence OBVM implementation. The survey response rate was 69%. Logistics and communications were the greatest barriers to implementing OBVM. Respondents perceived that the agency had inadequate resources for implementing OBVM and provided inadequate information. About one-third of the respondents believed OBVM would decrease their job flexibility and perceived greater institutional barriers to the approach. The 43% of respondents who believed they would have more responsibility under OBVM also had greater attitudinal barriers. A similar percentage of respondents reported OBVM would not give enough priority to wildlife. Staff believed that current agency culture was hierarchical but preferred a culture that would provide more flexibility for adaptive management and would foster learning from land management activities. In light of the barriers to OBVM, we recommend the following: (1) mitigation of logistical barriers by addressing real and perceived constraints of staff, funds, and other resources in a participatory manner; (2) mitigation of communication barriers through interpersonal and electronic communication channels; (3) development of an OBVM external advisory committee; and (4) adoption of characteristics of an organizational culture that promotes flexibility and learning. ??2006 Society for Conservation Biology.

Understanding barriers to implementation of an adaptive land management program.

PubMed

Jacobson, Susan K; Morris, Julie K; Sanders, J Scott; Wiley, Eugene N; Brooks, Michael; Bennetts, Robert E; Percival, H Franklin; Marynowski, Susan

2006-10-01

The Florida Fish and Wildlife Conservation Commission manages over 650,000 ha, including 26 wildlife management and environmental areas. To improve management, they developed an objective-based vegetation management (OBVM) process that focuses on desired conditions of plant communities through an adaptive management framework. Our goals were to understand potential barriers to implementing OBVM and to recommend strategies to overcome barriers. A literature review identified 47 potential barriers in six categories to implementation of adaptive and ecosystem management: logistical, communication, attitudinal, institutional, conceptual, and educational. We explored these barriers through a bureau-wide survey of 90 staff involved in OBVM and personal interviews with area managers, scientists, and administrators. The survey incorporated an organizational culture assessment instrument to gauge how institutional factors might influence OBVM implementation. The survey response rate was 69%. Logistics and communications were the greatest barriers to implementing OBVM. Respondents perceived that the agency had inadequate resources for implementing OBVM and provided inadequate information. About one-third of the respondents believed OBVM would decrease their job flexibility and perceived greater institutional barriers to the approach. The 43% of respondents who believed they would have more responsibility under OBVM also had greater attitudinal barriers. A similar percentage of respondents reported OBVM would not give enough priority to wildlife. Staff believed that current agency culture was hierarchical but preferred a culture that would provide more flexibility for adaptive management and would foster learning from land management activities. In light of the barriers to OBVM, we recommend the following: (1) mitigation of logistical barriers by addressing real and perceived constraints of staff, funds, and other resources in a participatory manner; (2) mitigation of communication barriers through interpersonal and electronic communication channels; (3) development of an OBVM external advisory committee; and (4) adoption of characteristics of an organizational culture that promotes flexibility and learning.

Office of Science and Technology&International Year EndReport - 2005

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bodvarsson, G.S.

2005-10-27

Source Term, Materials Performance, Radionuclide Getters, Natural Barriers, and Advanced Technologies, a brief introduction in each section describes the overall organization and goals of each program area. All of these areas have great potential for improving our understanding of the safety performance of the proposed Yucca Mountain repository, as processes within these areas are generally very conservatively represented in the Total System Performance Assessment. In addition, some of the technology thrust areas in particular may enhance system efficiency and reduce risk to workers. Thus, rather modest effort in the S&T Program could lead to large savings in the lifetime repositorymore » total cost and significantly enhanced understanding of the behavior of the proposed Yucca Mountain repository, without safety being compromised, and in some instances being enhanced. An overall strength of the S&T Program is the significant amount of integration that has already been achieved after two years of research. As an example (illustrated in Figure 1), our understanding of the behavior of the total waste isolation system has been enhanced through integration of the Source Term, Materials Performance, and Natural Barriers Thrust areas. All three thrust areas contribute to the integration of different processes in the in-drift environment. These processes include seepage into the drift, dust accumulation on the waste package, brine formation and precipitation on the waste package, mass transfer through the fuel cladding, changes in the seepage-water chemical composition, and transport of released radionuclides through the invert and natural barriers. During FY2005, each of our program areas assembled a team of external experts to conduct an independent review of their respective projects, research directions, and emphasis. In addition, the S&T Program as a whole was independently reviewed by the S&T Programmatic Evaluation Panel. As a result of these reviews, adjustments to the S&T Program will be implemented in FY2006 to ensure that the Program is properly aligned with OCRWM's priorities. Also during FY2005, several programmatic documents were published, including the Science and Technology Program Strategic Plan, the Science and Technology Program Management Plan, and the Science and Technology Program Plan. These and other communication products are available on the OCRWM web site under the Science and Technology section (http://www.ocrwm.doe.gov/osti/index.shtml).« less

ECUT: Energy Conversion and Utilization Technologies program. Biocatalysis project

NASA Technical Reports Server (NTRS)

1990-01-01

The Biocatalysis Project is a mission-oriented, applied research and exploratory development activity directed toward resolution of the major generic technical barriers that impede the development of biologically catalyzed commercial chemical production. The approach toward achieving project objectives involves an integrated participation of Universities, Industrial Companies and Government Research Laboratories. The Project's technical activities were organized into three work elements: molecular modeling and applied genetics; bioprocess engineering; and bioprocess design and assessment.

Barriers and Perceived Stress Levels of Internationals Living in the United States

ERIC Educational Resources Information Center

Davis, Terah L.

2017-01-01

This study explored the perceived stress level of international students who faced barriers to employment upon graduation from an American post-secondary institution. The Barriers to Employment Success Inventory (BESI) was used to assess employment barriers and the Perceived Stress Scale (PSS) assessed the perceived level of stress experienced by…

Increasing Rural Adults' Participation in Collegial Programs: Exemplary Programs. Proceedings of the Rural Action Conference "Programs and Activities to Overcome Barriers to Rural Adult Participation in Postsecondary Education" (Blacksburg, Virginia, June 1-3, 1987).

ERIC Educational Resources Information Center

Sullins, W. Robert, Ed.; And Others

Approximately 85 educators from six states participated in a regional conference designed to showcase exemplary and collaborative programs to overcome many of the barriers faced by rural adults in pursuing higher education. After the keynote address, "The Role of Adult Learning in Revitalizing Rural Communities," by Cornelia Butler Flora, the…

Cleared DoD Employees at Risk - Report 2 A Study of Barriers to Seeking Help

DTIC Science & Technology

2002-01-01

PERSEREC examined the relationship between DoD security policy and federally mandated employee assistance programs ( EAPs ) for civilians and...counseling/referral services for military personnel to identify any barriers for cleared DoD employees to using these programs . The study, based largely on...appendices that provides background information for the interested reader on such topics as the EAP movement, military counseling/referral programs , and DoD personnel security policies and programs .

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.

PubMed

Blando, James; Ridenour, Marilyn; Hartley, Daniel; Casteel, Carri

2015-01-01

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals.

PubMed

Blando, James; Ridenour, Marilyn; Hartley, Daniel; Casteel, Carri

2014-12-04

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

A Qualitative Examination of Health Barriers and Facilitators Among African American Mothers in a Subsidized Housing Community.

PubMed

Cotter, Elizabeth W; Hamilton, Natia S; Kelly, Nichole R; Harney, Megan B; Greene, LaShaun; White, Kelly A; Mazzeo, Suzanne E

2016-09-01

Although African American families are at particular risk for obesity and its associated health comorbidities, few interventions have directly targeted low-income members of this group living in subsidized public housing. Using a consensual qualitative research approach, we conducted 11 interviews with African American mothers living in two public housing communities to enhance understanding of their perceived barriers and facilitators to health. Five primary domains emerged, including barriers (access, financial, personal, and neighborhood concerns), resources (personal and community), current behaviors (diet, physical activity, and program participation), definition of health (mental well-being, physical well-being, and health behaviors), and needs/interests in programming (health behavior-specific programs, non-health-related programs, child-focused programming, and qualities of programs and their leaders). Results demonstrate the complex interaction among social, environmental, and personal factors on health behaviors for this priority population, and highlight the need for community members' involvement in the development of community-based obesity prevention programming. © 2016 Society for Public Health Education.

Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients.

PubMed

Varnell, Charles D; Rich, Kristin L; Nichols, Melissa; Dahale, Devesh; Goebel, Jens W; Pai, Ahna L H; Hooper, David K; Modi, Avani C

2017-11-01

Patient-identified barriers to immunosuppressive medications are associated with poor adherence and negative clinical outcomes in transplant patients. Assessment of adherence barriers is not part of routine post-transplant care, and studies regarding implementing such a process in a reliable way are lacking. Using the Model for Improvement and PDSA cycles, we implemented a system to identify adherence barriers, including patient-centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non-judgmental discussion around adherence. We performed time-series analysis of our process measure. Secondary analyses examined the endorsement and concordance of adherence barriers between patient-caregiver dyads. After three methods of testing, the most reliable delivery system was an EHR-integrated tablet that alerted staff of patient eligibility for assessment. Barriers were endorsed by 35% of caregivers (n=85) and 43% of patients (n=60). The most frequently patient-endorsed barriers were forgetting, poor taste, and side effects. Caregivers endorsed forgetting and side effects. Concordance between patient-caregiver dyads was fair (k=0.299). Standardized adherence barriers assessment is feasible in the clinical care of pediatric kidney transplant patients. Features necessary for success included automation, redundant systems with designated staff to identify and mitigate failures, aligned reporting structures, and reliable measurement approaches. Future studies will examine whether barriers predict clinical outcomes (eg, organ rejection, graft loss). © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Factors Associated With Participation in a University Worksite Wellness Program.

PubMed

Beck, Angela J; Hirth, Richard A; Jenkins, Kristi Rahrig; Sleeman, Kathryn K; Zhang, Wei

2016-07-01

Healthcare reform legislation encourages employers to implement worksite wellness activities as a way to reduce rising employer healthcare costs. Strategies for increasing program participation is of interest to employers, though few studies characterizing participation exist in the literature. The University of Michigan conducted a 5-year evaluation of its worksite wellness program, MHealthy, in 2014. MHealthy elements include Health Risk Assessment, biometric screening, a physical activity tracking program (ActiveU), wellness activities, and participation incentives. Individual-level data were obtained for a cohort of 20,237 employees who were continuously employed by the university all 5 years. Multivariate logistic regression was used to assess the independent predictive power of characteristics associated with participation in the Health Risk Assessment, ActiveU, and incentive receipt, including employee and job characteristics, as well as baseline (2008) healthcare spending and health diagnoses obtained from claims data. Data were collected from 2008 to 2013; analyses were conducted in 2014. Approximately half of eligible employees were MHealthy participants. A consistent profile emerged for Health Risk Assessment and ActiveU participation and incentive receipt with female, white, non-union staff and employees who seek preventive care among the most likely to participate in MHealthy. This study helps characterize employees who choose to engage in worksite wellness programs. Such information could be used to better target outreach and program content and reduce structural barriers to participation. Future studies could consider additional job characteristics, such as job type and employee attitudinal variables regarding health status and wellness program effectiveness. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Assessing Controls on the Geometry and Dimensions of Modern Barrier Islands

NASA Astrophysics Data System (ADS)

Mulhern, J.; Johnson, C. L.; Martin, J. M.

2015-12-01

Barrier islands are highly ephemeral features, shaped by wave, tide, and storm energy. The processes that govern the size, shape, and motion of barrier islands are not well constrained, yet central to coastal dynamics. While the global distribution of barrier islands has been mapped and assessed, there is little consensus on the forces controlling barrier island formation, motion, or preservation. This study presents a new semi-global database of modern barrier islands to better understand their morphology and spatial distribution. We have mapped, in Google Earth, the subaerial extent of >350 barrier islands and spits, measuring spatial characteristic such as exposed area, perimeter, length, and width. These objects are cross-referenced with parameters that potentially control morphology, including tidal range, wave height, climate, distance from the continental shelf, proximity to fluvial output, and tectonic setting. This approach provides a more optimal framework to assess controls on coastal features, including barrier island morphology, and to investigate potential geometric scaling relationships. Preliminary analysis shows trends in the spatial characteristics of barrier islands. There is a strong linear relationship between the perimeter and length (y= -0.59 + 0.42x, R2=0.95). Linear trends also relate length to area when the data are separated by tidal range to wave height ratio. Assessment of barrier island shape supports the hypothesis of Hayes (1979) that barrier islands in wave-dominated settings are long and linear while those in mixed energy setting are more rounded. The barrier islands of the Texas Gulf of Mexico are larger than the global average for the database, with distinctly longer length values (41.16 km vs. 15.77 km respectively) and larger areas (103.81 km2 vs. 42.14 km2 respectively). Initial assessment shows that tidal range and wave height are primary controls barrier island dimensions. Future work will consider climate, latitude, fluvial input, and tectonic regime as additional factors. Assessing modern barrier islands will lend insight into potential paleomorphodynamic relationships and help determine how islands are transferred into the rock record, with implications for sequence stratigraphy, subsurface reservoirs, etc.

Restoring stream habitat connectivity: a proposed method for prioritizing the removal of resident fish passage barriers.

PubMed

O'Hanley, Jesse R; Wright, Jed; Diebel, Matthew; Fedora, Mark A; Soucy, Charles L

2013-08-15

Systematic methods for prioritizing the repair and removal of fish passage barriers, while growing of late, have hitherto focused almost exclusively on meeting the needs of migratory fish species (e.g., anadromous salmonids). An important but as of yet unaddressed issue is the development of new modeling approaches which are applicable to resident fish species habitat restoration programs. In this paper, we develop a budget constrained optimization model for deciding which barriers to repair or remove in order to maximize habitat availability for stream resident fish. Habitat availability at the local stream reach is determined based on the recently proposed C metric, which accounts for the amount, quality, distance and level of connectivity to different stream habitat types. We assess the computational performance of our model using geospatial barrier and stream data collected from the Pine-Popple Watershed, located in northeast Wisconsin (USA). The optimization model is found to be an efficient and practical decision support tool. Optimal solutions, which are useful in informing basin-wide restoration planning efforts, can be generated on average in only a few minutes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Human papillomavirus vaccine motivators and barriers among community college students: Considerations for development of a successful vaccination program.

PubMed

Hirth, Jacqueline M; Batuuka, Denise N; Gross, Tyra T; Cofie, Leslie; Berenson, Abbey B

2018-02-14

Previous interventions in colleges to improve human papillomavirus (HPV) vaccination have not been highly successful. Although barriers have been assessed in traditional colleges, less is known about vaccination barriers in community colleges. We approached students aged 18-26 years old enrolled at a community college for an in-person semi-structured qualitative interview on HPV vaccination and health, with questions guided by the Theory of Planned Behavior. Data collection took place between April 2015 and December 2015. Thematic analysis techniques were used to analyze the data. During interviews with 19 students, 4 themes emerged, including: general vaccine attitudes, barriers to HPV vaccination, motivators to HPV vaccination, and social influences. Participants felt that vaccines were beneficial, but were concerned about side effects. They felt that getting the HPV vaccine would be inconvenient, and they did not know enough about it to decide. Most would not trust their friends' opinions, but would want to know about side effects that their vaccinated friends experienced. Successful interventions at community colleges should include several components to increase convenience as well as utilize interactive methods to promote HPV vaccine awareness. Copyright © 2018. Published by Elsevier Ltd.

Evaluation of the Osteoporosis Health Belief Scale in Korean Women

PubMed Central

Kim, Tae-Hee; Lee, Young-Sang; Byun, Dong Won; Jang, Seyeon; Jeon, Dong-Su

2013-01-01

Background The Osteoporosis Health Belief Scale (OHBS) is a 42-item questionnaire designed to assess susceptibility, seriousness, calcium benefits, calcium barriers, exercise benefits, exercise barriers, and health motivation related to osteoporosis. We aimed to evaluate its psychometric properties to enable the provision of educational tips regarding osteoporosis. Methods All women who had visited the department of obstetrics and gynecology (OBGYN) and whose bone mineral density was measured from January 2010 to December 2011 were enrolled by interview using the OHBS. We also evaluated the women's general clinical characteristics. Results One hundred seventy-seven women were enrolled in the present study. In the present study, the barriers to calcium intake subscale had the lowest mean score (15.03±3.02), and the Benefit of Exercise subscale had the highest (23.02±3.03). The scores for participants in their 20s were significantly higher than scores for those in their 70s on the Benefits of Exercise subscale and Barriers to Exercise subscale (P=0.014 and P=0.022, respectively). Conclusions Education for health motivation to prevent osteoporosis is important for young women. Additional systematic education programs are needed for the general population. PMID:24524052

Barriers and Advantages to Student Participation in the School Breakfast Program Based on the Social Ecological Model: A Review of the Literature

ERIC Educational Resources Information Center

Lopez-Neyman, Stephanie M.; Warren, Cynthia A.

2016-01-01

Participation in school meals is a preventive measure against childhood hunger. Participation in the School Breakfast Program (SBP) continues to lag behind that of the National School Lunch Program. The purpose of this literature review was to investigate the barriers and advantages to student participation in the SBP. Using the adaptable…

Stress Reduction Through a Brief Writing Intervention With Women in Jail.

PubMed

Pankey, Tyson; Kelly, Patricia J; Ramaswamy, Megha

2016-07-01

To assess the feasibility/acceptability of writing as a stress reduction strategy with incarcerated women. The authors implemented a writing intervention in which six women wrote on topics of their choosing for 20 minutes on 5 consecutive days. Feasibility was assessed with investigator field notes; daily post-writing evaluations assessed intervention acceptability. The study also assessed the continuation of writing at 1-month postintervention and acceptability of instruments for evaluation of future interventions. Implementation barriers were minimal; participants voiced enthusiasm about the program and continued to write 3 to 4 days per week in the month postintervention. No problems were encountered in the completion of evaluation instruments. Writing is a feasible, reproducible stress relief intervention for incarcerated women. © The Author(s) 2016.

How does a lifestyle intervention during pregnancy influence perceived barriers to leisure-time physical activity? The Norwegian fit for delivery study, a randomized controlled trial.

PubMed

Haakstad, Lene A H; Vistad, Ingvild; Sagedal, Linda Reme; Lohne-Seiler, Hilde; Torstveit, Monica K

2018-05-03

To develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy. This secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ≤20 gestational weeks, age ≥ 18 years and body mass index ≥19 kg/m 2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n = 303) or standard prenatal care (n = 303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n = 589) and following intervention (gestational week 36, n = 509), as well as six months (n = 470) and 12 months (n = 424) postpartum. Following intervention (gestation week 35.4 ± 1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: "... I do not have the time" (intervention: 22 vs. control: 38, p = 0.030), mother-child safety concerns: "... afraid to harm the baby" (intervention: 8 vs. control: 25, p = 0.002) and self-efficacy: "... I do not believe/think that I can do it" (intervention: 3 vs. control: 10, p = 0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants. The intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum. ClinicalTrials.gov: NCT01001689 , registered July 2, 2009.

Identifying Behavioral Barriers to Campus Sustainability: A Multi-Method Approach

ERIC Educational Resources Information Center

Horhota, Michelle; Asman, Jenni; Stratton, Jeanine P.; Halfacre, Angela C.

2014-01-01

Purpose: The purpose of this paper is to assess the behavioral barriers to sustainable action in a campus community. Design/methodology/approach: This paper reports three different methodological approaches to the assessment of behavioral barriers to sustainable actions on a college campus. Focus groups and surveys were used to assess campus…

Using Photovoice with at-risk youth in a community-based cooking program.

PubMed

Thomas, Heather Clarke; Irwin, Jennifer D

2013-01-01

We examined the facilitators of and barriers to participants' application of cooking skills beyond Cook It Up!, a pilot community-based cooking program targeting at-risk youth aged 13 to 18. Photovoice is a qualitative research method using still-picture cameras to document participants' health and community realities. Four participants photographed items they perceived as facilitators of or barriers to the application of cooking skills. At a facilitated discussion group, youth discussed why they took certain pictures and how the photos best exemplified facilitators and barriers. Participants agreed upon the themes arising from the dialogue. Data trustworthiness tools were used to ensure that themes arising from the dialogue truly represented participants' perspectives. Four major themes emerged as facilitators: aptitude, food literacy, local and fresh ingredients, and connectedness. Access to unhealthy foods was the only barrier that participants identified. Participants and researchers decided to advocate for the sustainability of community-based cooking programs offered for high school credit. Participants' photos would enhance advocacy efforts with education stakeholders. Cook It Up! provided youth with cooking techniques for healthy, economical, homemade meals, but proof was needed of the transferability of skills outside the program environment. Youth in this study identified important facilitators that enabled the continued use of their cooking skills, and one barrier. Findings underscore the importance of community-based cooking programs tailored to at-risk youth.

Randomized trial of two e-learning programs for oral health students on secondary prevention of eating disorders.

PubMed

DeBate, Rita D; Severson, Herbert H; Cragun, Deborah; Bleck, Jennifer; Gau, Jeff; Merrell, Laura; Cantwell, Carley; Christiansen, Steve; Koerber, Anne; Tomar, Scott L; Brown, Kelli McCormack; Tedesco, Lisa A; Hendricson, William; Taris, Mark

2014-01-01

The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygiene students were randomized to either the Intervention (interactive program; n=259) or Alternative (existing program; n=58) conditions. Hierarchical linear modeling assessed for posttest differences between groups while controlling for baseline measures. Improvement among Intervention participants was superior to those who completed the Alternative program for three of the six outcomes: benefits/barriers, self-efficacy, and skills-based knowledge (effect sizes ranging from 0.43 to 0.87). This study thus suggests that interactive training programs may be better than flat-text e-learning programs for improving the skills-based knowledge and self-efficacy necessary for behavior change.

Cementitious Barriers Partnership (CBP): Training and Release of CBP Toolbox Software, Version 1.0 - 13480

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, K.G.; Kosson, D.S.; Garrabrants, A.C.

2013-07-01

The Cementitious Barriers Partnership (CBP) Project is a multi-disciplinary, multi-institutional collaboration supported by the Office of Tank Waste Management within the Office of Environmental Management of U.S. Department of Energy (US DOE). The CBP program has developed a set of integrated tools (based on state-of-the-art models and leaching test methods) that improve understanding and predictions of the long-term hydraulic and chemical performance of cementitious barriers used in nuclear applications. Tools selected for and developed under this program are intended to evaluate and predict the behavior of cementitious barriers used in near-surface engineered waste disposal systems for periods of performance upmore » to or longer than 100 years for operating facilities and longer than 1,000 years for waste management purposes. CBP software tools were made available to selected DOE Office of Environmental Management and field site users for training and evaluation based on a set of important degradation scenarios, including sulfate ingress/attack and carbonation of cementitious materials. The tools were presented at two-day training workshops held at U.S. National Institute of Standards and Technology (NIST), Savannah River, and Hanford included LeachXS{sup TM}/ORCHESTRA, STADIUM{sup R}, and a CBP-developed GoldSim Dashboard interface. Collectively, these components form the CBP Software Toolbox. The new U.S. Environmental Protection Agency leaching test methods based on the Leaching Environmental Assessment Framework (LEAF) were also presented. The CBP Dashboard uses a custom Dynamic-link library developed by CBP to couple to the LeachXS{sup TM}/ORCHESTRA and STADIUM{sup R} codes to simulate reactive transport and degradation in cementitious materials for selected performance assessment scenarios. The first day of the workshop introduced participants to the software components via presentation materials, and the second day included hands-on tutorial exercises followed by discussions of enhancements desired by participants. Tools were revised based on feedback obtained during the workshops held from April through June 2012. The resulting improved CBP Software Toolbox, including evaluation versions of and LeachXS{sup TM}/ORCHESTRA and STADIUM{sup R} has been made available to workshop and selected other participants for further assessment. Inquiries about future workshops and requests for access to the Toolbox software can be made via the CBP web site [1]. (authors)« less

Factors Affecting Attendance at an Adapted Cardiac Rehabilitation Exercise Program for Individuals with Mobility Deficits Poststroke.

PubMed

Marzolini, Susan; Balitsky, Amaris; Jagroop, David; Corbett, Dale; Brooks, Dina; Grace, Sherry L; Lawrence, Danielle; Oh, Paul I

2016-01-01

The aim of this study was to determine the factors affecting attendance at an adapted cardiac rehabilitation program for individuals poststroke. A convenience sample of ambulatory patients with hemiparetic gait rated 20 potential barriers to attendance on a 5-point Likert scale upon completion of a 6-month program of 24 prescheduled weekly sessions. Sociodemographic characteristics, depressive symptoms, cardiovascular fitness, and comorbidities were collected by questionnaire or medical chart. Sixty-one patients attended 77.3 ± 12% of the classes. The longer the elapsed time from stroke, the lower the attendance rate (r = -.34, P = .02). The 4 greatest barriers influencing attendance were severe weather, transportation problems, health problems, and traveling distance. Health problems included hospital readmissions (n = 6), influenza/colds (n = 6), diabetes and cardiac complications (n = 4), and musculoskeletal issues (n = 2). Of the top 4 barriers, people with lower compared to higher income had greater transportation issues (P = .004). Greater motor deficits of the stroke-affected leg were associated with greater barriers related to health issues (r = .7, P = .001). The only sociodemographic factor associated with a higher total mean barrier score was non-English as the primary language spoken at home (P = .002); this factor was specifically related to the barriers of cost (P = .007), family responsibilities (P = .018), and lack of social support (P = .001). No other associations were observed. Barriers to attendance were predominantly related to logistic/transportation and health issues. People who were more disadvantaged socioeconomically (language, finances), and physically (stroke-related deficits) were more affected by these barriers. Strategies to reduce these barriers, including timely referral to exercise programs, need to be investigated. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Implementation of integrated dual disorders treatment: a qualitative analysis of facilitators and barriers.

PubMed

Brunette, Mary F; Asher, Dianne; Whitley, Rob; Lutz, Wilma J; Wieder, Barbara L; Jones, Amanda M; McHugo, Gregory J

2008-09-01

Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers.

Barriers to Transition-related Healthcare among Korean Transgender Adults: Focused on Gender Identity Disorder Diagnosis, Hormone Therapy, and Sex Reassignment Surgery.

PubMed

Lee, Hyemin; Park, Jooyoung; Choi, Bokyoung; Yi, Horim; Kim, Seung-Sup

2018-02-27

Previous literature has documented that transgender people may encounter barriers when they use transition-related healthcare services. This study aims to investigate the experiences of transition-related healthcare and the barriers to those services among transgender adults in South Korea. In 2017, we conducted a nationwide cross-sectional survey of 278 transgender adults in South Korea. We assessed the prevalence of transition-related healthcare such as Gender Identity Disorder (GID) diagnosis, hormone therapy, and sex reassignment surgery. To understand the barriers to those procedures, we asked the participants for their reason not to receive each of the three procedures. We also examined their experiences of and reasons for using non-prescribed hormone medication. We found that 91.0% have been diagnosed with GID (N=253/278), 88.0% have received hormone therapy (N=243/276), and 42.4% had any type of sex reassignment surgery (N=115/271). Cost was the most common barrier to transition-related healthcare among the Korean transgender adults. Other common barriers were identified: Negative experiences in healthcare settings, lack of healthcare professionals and facilities, and social stigma against transgender people. Among those who have taken hormone therapy, 25.1% (N=61/243) reported that they had experience of purchasing hormone medication without medical prescription. Our findings suggest that transgender people face barriers to transition-related healthcare in South Korea. These barriers may preclude transgender individuals from safely accessing to transition-related healthcare. Improving access to transition-related healthcare requires institutional interventions including expanding national health insurance coverage on those procedures and providing transition-related training programs for healthcare professionals in South Korea.

Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients.

PubMed

Madore, Shannon; Kilbourn, Kristin; Valverde, Patricia; Borrayo, Evelinn; Raich, Peter

2014-08-01

Medically underserved women with recently diagnosed breast cancer face a number of significant obstacles that impact the timeliness and quality of their care. The Breast CARES (Cancer Advocacy, Resources Education and Support) intervention combined patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers. The study aimed to learn more about the types of barriers encountered by the participants. The study also sought to understand the relationship between patient-reported barriers and patient-reported psychosocial distress in underserved women recently diagnosed with breast cancer. Data were analyzed using a mixed-methods approach. Participants were assessed pre- and post-intervention. Psychosocial measures included cancer-related distress, depression, anxiety, social support, and quality of life. Case notes and responses to process evaluation questions were used to determine whether the CARES intervention adequately addressed the needs of the participants. The mean age of participants (N = 20) was 54 years (SD = 12.5), 40% were Hispanic, 70% were unemployed, 50% were uninsured, and 20% were mono-lingual in Spanish. Qualitative analysis revealed four categories of barriers: psychosocial, medical, logistical, and communication. Similarities and differences existed between the PN and TC regarding how barriers were addressed. Post-intervention psychosocial scores indicate a decrease in depression and cancer-related distress and an increase in social support. The participants reported that participation in the Breast CARES program helped them overcome financial barriers (73%), transportation problems (60%), and communication barriers with medical staff (73%). This study demonstrates the unique and complementary roles for PNs and TCs in overcoming barriers to treatment adherence faced by underserved breast cancer patients.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

PubMed

Poremski, Daniel; Woodhall-Melnik, Julia; Lemieux, Ashley J; Stergiopoulos, Vicky

2016-02-01

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

Assessing To Address Barriers to Learning. An Introductory Packet.

ERIC Educational Resources Information Center

California Univ., Los Angeles. Center for Mental Health Schools.

Schools committed to the success of all children must have an array of activities designed to address barriers to learning. This introductory packet contains some aids to help school staff find new ways of thinking about how schools should assess barriers to learning. The following items are included in the packet: (1) a chart of "Barriers to…

Scholarly Activities of Family Medicine Faculty: Results of a National Survey.

PubMed

Hinojosa, Jose; Benè, Kristen L; Hickey, Colleen; Marvel, Kim

2006-12-01

This survey examined how family medicine residency programs define scholarly activity, the productivity of programs, and perceived barriers to scholarly work. Five types of residency programs are compared: university-based, community-based (unaffiliated, university-affiliated, university-administered), and military. A 13 item web-based questionnaire was sent to all 455 U. S. family medicine residency programs. The survey solicited demographic information as well as program expectations of faculty, presence of a research coordinator/director, activities considered scholarly, productivity, and perceived barriers. A total of 177 surveys were completed for a response rate of 38%, similar to response rates of web-based surveys in the literature. 67.6% of programs encouraged, but did not require scholarly activity, and 44.5% indicated their program had no research coordinator/ director. University-based programs had the highest levels of productivity compared to other program types. Primary barriers to scholarly activity noted were lack of time (73/138, 53%) and lack of supportive infrastructure (37/138, 27%). While interpretations are limited by the response rate of the survey, results provide an increased understanding of how programs define scholarly activity as well as reference points for faculty productivity. This information can help program directors when setting criteria for scholarly work.

Renewal and change for health care executives.

PubMed

Burke, G C; Bice, M O

1991-01-01

Health care executives must consider renewal and change within their own lives if they are to breathe life into their own institutions. Yet numerous barriers to executive renewal exist, including time pressures, fatigue, cultural factors, and trustee attitudes. This essay discusses such barriers and suggests approaches that health care executives may consider for programming renewal into their careers. These include self-assessment for professional and personal goals, career or job change, process vs. outcome considerations, solitude, networking, lifelong education, surrounding oneself with change agents, business travel and sabbaticals, reading outside the field, physical exercise, mentoring, learning from failures, a sense of humor, spiritual reflection, and family and friends. Renewal is a continuous, lifelong process requiring constant learning. Individual executives would do well to develop a framework for renewal in their careers and organizations.

An Empirical Investigation into Programming Language Syntax

ERIC Educational Resources Information Center

Stefik, Andreas; Siebert, Susanna

2013-01-01

Recent studies in the literature have shown that syntax remains a significant barrier to novice computer science students in the field. While this syntax barrier is known to exist, whether and how it varies across programming languages has not been carefully investigated. For this article, we conducted four empirical studies on programming…

Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation

PubMed Central

Renton, Tian; Tang, Herman; Ennis, Naomi; Cusimano, Michael D; Bhalerao, Shree; Schweizer, Tom A

2014-01-01

Background Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers. Objective The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program? Methods Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score. Results The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms. Conclusions There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool. PMID:25249003

Web-based intervention programs for depression: a scoping review and evaluation.

PubMed

Renton, Tian; Tang, Herman; Ennis, Naomi; Cusimano, Michael D; Bhalerao, Shree; Schweizer, Tom A; Topolovec-Vranic, Jane

2014-09-23

Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers. The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program? Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score. The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms. There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool.

Addressing multilevel barriers to cervical cancer screening in Korean American women: A randomized trial of a community-based intervention.

PubMed

Fang, Carolyn Y; Ma, Grace X; Handorf, Elizabeth A; Feng, Ziding; Tan, Yin; Rhee, Joanne; Miller, Suzanne M; Kim, Charles; Koh, Han Seung

2017-05-15

Korean American women have among the lowest rates of cervical cancer screening in the United States. The authors evaluated a multicomponent intervention combining community education with navigation services to reduce access barriers and increase screening rates in this underserved population. It was hypothesized that cervical cancer screening rates would be higher among women who received the intervention program compared with those in the control program. Korean American women (N = 705) were recruited from 22 churches. In this matched-pair, group-randomized design, 347 women received the intervention, which consisted of a culturally relevant cancer education program combined with provision of navigation services. The control group (N = 358) received general health education, including information about cervical cancer risk and screening and where to obtain low-cost or no-cost screening. Screening behavior was assessed 12 months after the program. Screening behavior data were obtained from 588 women 12 months after the program. In both site-level and participant-level analyses, the intervention program contributed to significantly higher screening rates compared with the control program (odds ratio [OR], 25.9; 95% confidence interval [CI], 10.1-66.1; P < .001). In sensitivity analysis, the treatment effect remained highly significant (OR, 16.7; 95% CI, 8.1-34.4; P < .001). A multicomponent intervention combining community cancer education with navigation services yielded significant increases in cervical cancer screening rates among underscreened Korean American women. Community-accessible programs that incorporate cancer education with the delivery of key navigation services can be highly effective in increasing cervical cancer screening rates in this underserved population. Cancer 2017;123:1018-26. © 2016 American Cancer Society. © 2016 American Cancer Society.

Expanding Educators' Contributions to Continuous Quality Improvement of American Board of Medical Specialties Maintenance of Certification.

PubMed

Nora, Lois Margaret; Pouwels, Mellie Villahermosa; Irons, Mira

2016-01-01

The American Board of Medical Specialties board certification has transformed into a career-long process of learning, assessment, and performance improvement through its Program for Maintenance of Certification (MOC). Medical educators across many medical professional organizations, specialty societies, and other institutions have played important roles in shaping MOC and tailoring its overarching framework to the needs of different specialties. This Commentary addresses potential barriers to engagement in work related to MOC for medical school (MS) and academic health center (AHC) educators and identifies reasons for, and ways to accomplish, greater involvement in this work. The authors present ways that medical and other health professions educators in these settings can contribute to the continuous improvement of the MOC program including developing educational and assessment activities, engaging in debate about MOC, linking MOC with institutional quality improvement activities, and pursuing MOC-related scholarship. MS- and AHC-based educators have much to offer this still-young and continually improving program, and their engagement is sought, necessary, and welcomed.

Surgical residency training and international volunteerism: a national survey of residents from 2 surgical specialties

PubMed Central

Matar, Wadih Y.; Trottier, Daniel C.; Balaa, Fady; Fairful-Smith, Robin; Moroz, Paul

2012-01-01

Background Many low- and middle-income countries (LMICs) lack basic surgical resources, resulting in avoidable disability and mortality. Recently, residents in surgical training programs have shown increasing interest in overseas elective experiences to assist surgical programs in LMICs. The purpose of this study was to survey Canadian surgical residents about their interest in international volunteerism. Methods We sent a web-based survey to all general and orthopedic surgery residents enrolled in surgical training programs in Canada. The survey assessed residents’ interests, attitudes and motivations, and perceived barriers and aids with respect to international volunteerism. Results In all, 361 residents completed the survey for a response rate of 38.0%. Half of the respondents indicated that the availability of an international surgery elective would have positively influenced their selection of a residency program. Excluding the 18 residents who had volunteered during residency, 63.8% of the remaining residents confirmed an interest in international volunteering with “contributing to an important cause,” “teaching” and “tourism/cultural enhancement” as the leading reasons for their interest. Perceived barriers included “lack of financial support” and “lack of available organized opportunities.” All (100%) respondents who had done an international elective during residency confirmed that they would pursue such work in the future. Conclusion Administrators of Canadian surgical programs should be aware of strong resident interest in global health care and accordingly develop opportunities by encouraging faculty mentorships and resources for global health teaching. PMID:22854155

Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study

PubMed Central

Craig Rushing, Stephanie; Jessen, Cornelia; Gorman, Gwenda; Torres, Jennifer; Lambert, William E; Prokhorov, Alexander V; Miller, Leslie; Allums-Featherston, Kelly; Addy, Robert C; Peskin, Melissa F; Shegog, Ross

2016-01-01

Background American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. Objective We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet’s potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. Methods This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths’ perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. Results Sites had sufficient computer access and Internet connectivity to implement the 6 programs with adequate fidelity; however, variable bandwidth (ranging from 0.24 to 93.5 megabits per second; mean 25.6) and technical issues led some sites to access programs via back-up modalities (eg, uploading the programs from a Universal Serial Bus drive). The number of youth providing engagement ratings varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN). Across programs, youth rated the programs as easy to use (68-91%), trustworthy (61-89%), likeable (59-87%), and impactful (63-91%). Most youth understood the words in the programs (60-83%), although some needed hints to complete the programs (16-49%). Overall, 37-66% of the participants would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons. Conclusions Findings demonstrate the potential of the Internet to enhance the reach and implementation of evidence-based health promotion programs, and to engage AI/AN youth. Provision of back-up modalities is recommended to address possible connectivity or technical issues. The dissemination of Internet-based health promotion programs may be a promising strategy to address health disparities for this underserved population. Trial Registration Clinicaltrials.gov NCT01303575; https://clinicaltrials.gov/ct2/show/NCT01303575 (Archived by WebCite at http://www.webcitation.org/6m7DO4g7c) PMID:27872037

Internet-Based Delivery of Evidence-Based Health Promotion Programs Among American Indian and Alaska Native Youth: A Case Study.

PubMed

Markham, Christine M; Craig Rushing, Stephanie; Jessen, Cornelia; Gorman, Gwenda; Torres, Jennifer; Lambert, William E; Prokhorov, Alexander V; Miller, Leslie; Allums-Featherston, Kelly; Addy, Robert C; Peskin, Melissa F; Shegog, Ross

2016-11-21

American Indian and Alaska Native (AI/AN) youth face multiple health challenges compared to other racial/ethnic groups, which could potentially be ameliorated by the dissemination of evidence-based adolescent health promotion programs. Previous studies have indicated that limited trained personnel, cultural barriers, and geographic isolation may hinder the reach and implementation of evidence-based health promotion programs among AI/AN youth. Although Internet access is variable in AI/AN communities across the United States, it is swiftly and steadily improving, and it may provide a viable strategy to disseminate evidence-based health promotion programs to this underserved population. We explored the potential of using the Internet to disseminate evidence-based health promotion programs on multiple health topics to AI/AN youth living in diverse communities across 3 geographically dispersed regions of the United States. Specifically, we assessed the Internet's potential to increase the reach and implementation of evidence-based health promotion programs for AI/AN youth, and to engage AI/AN youth. This randomized controlled trial was conducted in 25 participating sites in Alaska, Arizona, and the Pacific Northwest. Predominantly AI/AN youth, aged 12-14 years, accessed 6 evidence-based health promotion programs delivered via the Internet, which focused on sexual health, hearing loss, alcohol use, tobacco use, drug use, and nutrition and physical activity. Adult site coordinators completed computer-based education inventory surveys, connectivity and bandwidth testing to assess parameters related to program reach (computer access, connectivity, and bandwidth), and implementation logs to assess barriers to implementation (program errors and delivery issues). We assessed youths' perceptions of program engagement via ratings on ease of use, understandability, credibility, likeability, perceived impact, and motivational appeal, using previously established measures. Sites had sufficient computer access and Internet connectivity to implement the 6 programs with adequate fidelity; however, variable bandwidth (ranging from 0.24 to 93.5 megabits per second; mean 25.6) and technical issues led some sites to access programs via back-up modalities (eg, uploading the programs from a Universal Serial Bus drive). The number of youth providing engagement ratings varied by program (n=40-191; 48-60% female, 85-90% self-identified AI/AN). Across programs, youth rated the programs as easy to use (68-91%), trustworthy (61-89%), likeable (59-87%), and impactful (63-91%). Most youth understood the words in the programs (60-83%), although some needed hints to complete the programs (16-49%). Overall, 37-66% of the participants would recommend the programs to a classmate, and 62-87% found the programs enjoyable when compared to other school lessons. Findings demonstrate the potential of the Internet to enhance the reach and implementation of evidence-based health promotion programs, and to engage AI/AN youth. Provision of back-up modalities is recommended to address possible connectivity or technical issues. The dissemination of Internet-based health promotion programs may be a promising strategy to address health disparities for this underserved population. Clinicaltrials.gov NCT01303575; https://clinicaltrials.gov/ct2/show/NCT01303575 (Archived by WebCite at http://www.webcitation.org/6m7DO4g7c). ©Christine M Markham, Stephanie Craig Rushing, Cornelia Jessen, Gwenda Gorman, Jennifer Torres, William E Lambert, Alexander V Prokhorov, Leslie Miller, Kelly Allums-Featherston, Robert C Addy, Melissa F Peskin, Ross Shegog. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 21.11.2016.

Get Connected: an HIV prevention case management program for men and women leaving California prisons.

PubMed

Myers, Janet; Zack, Barry; Kramer, Katie; Gardner, Mick; Rucobo, Gonzalo; Costa-Taylor, Stacy

2005-10-01

Individuals leaving prison face challenges to establishing healthy lives in the community, including opportunities to engage in behavior that puts them at risk for HIV transmission. HIV prevention case management (PCM) can facilitate linkages to services, which in turn can help remove barriers to healthy behavior. As part of a federally funded demonstration project, the community-based organization Centerforce provided 5 months of PCM to individuals leaving 3 state prisons in California. Program effects were measured by assessing changes in risk behavior, access to services, reincarnation, and program completion. Although response rates preclude definitive conclusions, HIV risk behavior did decrease. Regardless of race, age, or gender, those receiving comprehensive health services were significantly more likely to complete the program. PCM appears to facilitate healthy behavior for individuals leaving prison.

Promising Practices for Making Recreation Programming Matter for People who Experience Mental Illness.

PubMed

Hutchinson, Susan L; Fenton, Lara

2018-05-01

There is merit in understanding how recreation-oriented programs for adults living with mental illness address barriers to participation and how programming is structured to create safe and inclusive environments, resulting in programming that amplifies the benefits of recreation for mental well-being. Following an environmental scan of programs targeting adults living with mental illness in Canada, ten coordinators in community mental health settings were interviewed. Four themes were constructed to reflect characteristics deemed to be 'promising practices' related to recreation-oriented programming: (a) barriers and solutions to individual participation, (b) characteristics of welcoming and supportive environments, (c) leadership characteristics, and (d) program characteristics.

LGBT Coverage in U.S. Dental Schools and Dental Hygiene Programs: Results of a National Survey.

PubMed

Hillenburg, Kenneth L; Murdoch-Kinch, Carol A; Kinney, Janet S; Temple, Henry; Inglehart, Marita R

2016-12-01

The aims of this study were to assess curricular coverage of lesbian, gay, bisexual, and transgender (LGBT) content in U.S. and Canadian dental schools and U.S. dental hygiene programs, including hours of LGBT content, pedagogy used, and assessment methods, and to determine whether respondents perceived their institution's coverage as adequate. Data were collected from academic deans at 32 U.S. and two Canadian dental schools and from program directors at 71 U.S. dental hygiene programs (response rates 49%, 20%, 23%, respectively). The results showed that 29% of responding dental schools and 48% of responding dental hygiene programs did not cover LGBT content. Among the respondents, dental schools dedicated on average 3.68 hours and dental hygiene programs 1.25 hours in required settings to LGBT content. Lectures (dental schools 68%, dental hygiene programs 45%) and small group instruction (43%, 25%) were reported as the most common methodology used in teaching this content. Most of the responding dental schools and dental hygiene programs covered HIV (85%, 53%), oral disease risk (63%, 54%), and barriers to accessing health care for LGBT people (58%, 38%). Up to a third reported no need for coverage of topics such as sexual orientation (21%, 32%), coming out (29%, 37%), transitioning (29%, 38%), and sex reassignment surgery (32%, 35%). Assessment was through written examinations (41%, 30%) and faculty-observed patient interactions (21%, 23%); some respondents (20%, 33%) reported no assessment of learning outcomes. The most frequently endorsed strategies for increasing LGBT content were receiving curricular material focusing on LGBT-related health issues and health disparities and having trained faculty to teach LGBT content.

Diversifying the Midwifery Workforce: Inclusivity, Culturally Sensitive Bridging, and Innovation.

PubMed

Tyson, Holliday; Wilson-Mitchell, Karline

2016-11-01

Midwifery educators and regulators in Canada have begun to address diversity, equity, and inclusion in admission processes and program curricula. Populations served by midwives value internationally educated midwives from their countries of origin. The International Midwifery Pre-Registration Program at Ryerson University in Toronto, Ontario, provides assessment, midwifery workplace orientation, and accelerated education for internationally educated midwives on behalf of the regulatory College of Midwives of Ontario. Between 2003 and 2015, midwives from 41 countries participated in the bridging program, and 214 (80%) successfully completed the program and qualified for licensure. Of these 214 graduates, 100% passed the Canadian Midwifery Registration Examination and 193 (90%) were employed full time as midwives within 4 months of graduation. The program curriculum enables the integration of these midwives into health care workplaces utilizing innovative approaches to assessment and competency enhancement. Critical to the bridging process are simulation-based practices to develop effective psychomotor learning, virtual and real primary care community placements, and coaching in empathetic, client-centered communication. Cultural sensitivity is embedded into the multiple assessment and learning modalities, and addresses relevant barriers faced by immigrant midwives in the workplace. Findings from the 13 years of the program may be applicable to increase diversity in other North American midwifery settings. This article describes the process, content, outcomes, and findings of the program. Midwifery educators and regulators may consider the utility of these approaches for their settings. © 2016 by the American College of Nurse-Midwives.

Addressing substance abuse and violence in substance use disorder treatment and batterer intervention programs.

PubMed

Timko, Christine; Valenstein, Helen; Lin, Patricia Y; Moos, Rudolf H; Stuart, Gregory L; Cronkite, Ruth C

2012-09-07

Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems. We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse. Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program's mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV + status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs. SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical needs. However, policy change can modify barriers to treatment integration and service linkage, such as reimbursement restrictions and lack of staff training.

Fee-for-service cancer rehabilitation programs improve health-related quality of life.

PubMed

Kirkham, A A; Neil-Sztramko, S E; Morgan, J; Hodson, S; Weller, S; McRae, T; Campbell, K L

2016-08-01

Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates. After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session. Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629). Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for delivery of exercise to more cancer survivors.

EAARL Topography-Sagamore Hill National Historic Site

USGS Publications Warehouse

Brock, John C.; Wright, C. Wayne; Nayegandhi, Amar; Patterson, Matt; Travers, Laurinda J.

2007-01-01

This Web site contains lidar-derived bare earth (BE) and first return (FR) topography maps and GIS files for the Sagamore Hill National Historic Site. These lidar-derived topography maps were produced as a collaborative effort between the U.S. Geological Survey (USGS) Coastal and Marine Geology Program, FISC St. Petersburg, Florida, the National Park Service (NPS), Northeast Coastal and Barrier Network, Inventory and Monitoring Program, and the National Aeronautics and Space Administration (NASA) Wallops Flight Facility. One objective of this research is to create techniques to survey coral reefs and barrier islands for the purposes of geomorphic change studies, habitat mapping, ecological monitoring, change detection, and event assessment. As part of this project, data from an innovative instrument under development at the NASA Wallops Flight Facility, the NASA Experimental Airborne Advanced Research Lidar (EAARL) are being used. This sensor has the potential to make significant contributions in this realm for measuring subaerial and submarine topography wthin cross-environment surveys. High spectral resolution, water-column correction, and low costs were found to be key factors in providing accurate and affordable imagery to costal resource managers.

EAARL topography: George Washington Birthplace National Monument

USGS Publications Warehouse

Brock, John C.; Wright, C. Wayne; Patterson, Matt; Nayegandhi, Amar; Patterson, Judd

2007-01-01

This Web site contains Lidar-derived topography (first return and bare earth) maps and GIS files for George Washington Birthplace National Monument in Virginia. These lidar-derived topography maps were produced as a collaborative effort between the U.S. Geological Survey (USGS) Coastal and Marine Geology Program, FISC St. Petersburg, the National Park Service (NPS), Northeast Coastal and Barrier Network, Inventory and Monitoring Program, and the National Aeronautics and Space Administration (NASA) Wallops Flight Facility. One objective of this research is to create techniques to survey coral reefs and barrier islands for the purposes of geomorphic change studies, habitat mapping, ecological monitoring, change detection, and event assessment. As part of this project, data from an innovative instrument under development at the NASA Wallops Flight Facility, the NASA Experimental Airborne Advanced Research Lidar (EAARL) are being used. This sensor has the potential to make significant contributions in this realm for measuring subaerial and submarine topography wthin cross-environment surveys. High spectral resolution, water-column correction, and low costs were found to be key factors in providing accurate and affordable imagery to coastal resource managers.

A Systematic Review of the Literature Addressing Veterinary Care for Underserved Communities.

PubMed

LaVallee, Elizabeth; Mueller, Megan Kiely; McCobb, Emily

2017-01-01

Currently, there is a care gap in veterinary medicine affecting low-income and underserved communities, resulting in decreased nonhuman-animal health and welfare. The use of low-price and community veterinary clinics in underserved populations is a strategy to improve companion-animal health through preventative care, spay/neuter, and other low-price care programs and services. Little research has documented the structure and effectiveness of such initiatives. This systematic review aimed to assess current published research pertaining to accessible health care, community-based veterinary medicine, and the use of community medicine in teaching programs. The review was an in-depth literature search identifying 51 publications relevant to the importance, benefits, drawbacks, and use of low-price and community clinics in underserved communities. These articles identified commonly discussed barriers to care that may prevent underserved clientele from seeking veterinary care. Five barriers were identified including the cost of veterinary care, accessibility of care, problems with or lack of veterinarian-client communication, culture/language, and lack of client education. The review also identified a need for additional research regarding evidence of effectiveness and efficiency in community medicine initiatives.

Strategies and perceived barriers to recruitment of underrepresented minority students in physician assistant programs.

PubMed

DiBaise, Michelle; Salisbury, Helen; Hertelendy, Attila; Muma, Richard D

2015-03-01

The purpose of this descriptive cross-sectional study was to identify the characteristics and effectiveness of recruitment strategies for underrepresented minorities (URM) and barriers to URM applicants to physician assistant programs. A 108-question survey was e-mailed to 168 physician assistant programs; 36 partial and 67 fully completed surveys were returned. The fully completed surveys were used in the data analysis. Participants were asked about the use of 20 recruitment strategies and the importance of 34 perceived barriers to enrollment of URM applicants. Of the 20 recruitment strategies, only 4 were used by close to 50% or more of programs: site visits (61.2%), preadmission counseling (58.2%), student loans (57.6%), and presentations targeted to minority students (47.8%). Only 9% of programs used enrichment courses, but this strategy was rated as most effective. Of the 34 barriers, the most frequent was low undergraduate grade point average (GPA) (82.5%). Self-reported success in recruitment was correlated with increased URM matriculation. Higher proportion of African American and Hispanic faculty on admissions committees was correlated with increased rates of URM matriculation. According to a similar survey, compared with medical schools, physician assistant programs use URM recruitment strategies less frequently and perceive financial barriers as a larger problem. The academically competitive physician assistant applicant pool decreases the need for recruitment of all students. Use of GPA and standardized test scores as sole criteria for admission and lack of recruitment of URM students lead to a decrease in diversity. If the physician assistant profession desires to improve student diversity in programs, they should consider using a more holistic approach for the admission process, which may allow for a more flexible and individualized review of applicants.

Home-based cycling program tailored to older people with lumbar spinal stenosis: Barriers and facilitators.

PubMed

Pauwels, Charlotte; Roren, Alexandra; Gautier, Adrien; Linières, Jonathan; Rannou, François; Poiraudeau, Serge; Nguyen, Christelle

2018-05-01

Lumbar-flexion-based endurance training, namely cycling, could be effective in reducing pain and improving function and health-related quality of life in older people with chronic low back pain. To assess barriers and facilitators to home-based cycling in older patients with lumbar spinal stenosis (LSS). We conducted a retrospective mixed-method study. Patients≥50 years old followed up for LSS from November 2015 to June 2016 in a French tertiary care center were screened. The intervention consisted of a single supervised session followed by home-based sessions of cycling, with dose (number of sessions and duration, distance and power per session) self-determined by patient preference. The primary outcome was assessed by a qualitative approach using semi-structured interviews at baseline and 3 months and was the identification of barriers and facilitators to the intervention. Secondary outcomes were assessed by a quantitative approach and were adherence monitored by a USB stick connected to the bicycle, burden of treatment assessed by the Exercise Therapy Burden Questionnaire (ETBQ) and clinical efficacy assessed by change in lumbar pain, radicular pain, disability, spine-specific activity limitation and maximum walking distance at 3 months. Overall, 15 patients were included and data for 12 were analyzed at 3 months. At baseline, the mean age was 70.9 years (95% CI: 64.9-76.8) and 9/15 patients (60.0%) were women. Barriers to cycling were fear of pain and fatigue, a too large bicycle, burden of hospital follow-up and lack of time and motivation. Facilitators were clinical improvement, surveillance and ease-of-use of the bicycle. Adherence remained stable overtime. The burden of treatment was low [mean ETBQ score: 21.0 (95% confidence interval: 11.5-30.5)]. At 3 months, 7/12 patients (58.3%) self-reported clinical improvement, with reduced radicular pain and disability [mean absolute differences: -27.5 (-43.3 to -11.7), P<0.01 and -17.5 (-32.1 to -2.9), P=0.01, respectively]. For people with LSS, home-based cycling is a feasible intervention. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Barriers and enabling factors for work-site physical activity programs: a qualitative examination.

PubMed

Fletcher, Gena M; Behrens, Timothyh K; Domina, Lorie

2008-05-01

Work sites offer a productive setting for physical activity (PA) promoting interventions. Still, PA participation remains low. Thus, the purpose of this study was to examine the reasoning behind commonly reported barriers and enabling factors to participation in PA programs in a work-site setting. Employees from a large city government were recruited to participate in focus groups, stratified by white- and blue-collar occupations. Responses from open-ended questions about factors influencing participation in PA programs were audio recorded and transcribed verbatim. Resulting data were analyzed with open and axial coding. The sample consisted of 60 employees composing 9 focus groups. Although time was the most common barrier between both groups, white-collars workers responded that scheduling and work conflicts were the most common barrier concerning time. Blue-collar workers indicated shift work as their most common barrier. In addition, health was a significant enabling factor for both occupational categories. White-collar workers were much more concerned with appearances and were more highly motivated by weight loss and the hopefulness of quick results than were blue-collar workers. These findings are important in the understanding of PA as it relates to the reasoning behind participation in work-site programs in regard to occupational status.

Facilitators and barriers to employment among veterans with spinal cord injury receiving 12 months of evidence-based supported employment services.

PubMed

Cotner, Bridget A; Njoh, Eni N; Trainor, John K; O'Connor, Danielle R; Barnett, Scott D; Ottomanelli, Lisa

2015-01-01

Return to work is associated with positive rehabilitation outcomes for persons with spinal cord injury (SCI); however, more research is needed on vocational support for persons with disabilities seeking employment. The association between facilitators and barriers of employment and employment outcome was examined among Veterans with SCI who participated in an evidence-based supported employment (EBSE) program. Using a mixed-methods, nested case-control design, data on facilitators and barriers to employment were extracted from qualitative interviews and quantitative measures administered in person to 34 Veterans with SCI who completed 12 months of an EBSE program. Participants who did (case) and did not (control) obtain competitive employment were matched on time since SCI. Facilitators and barriers to employment were compared between the groups. Self-report measures administered at baseline were examined; there were no statistically significant factors that predicted employment outcomes after 12 months of EBSE program participation. Qualitative interview data revealed program-specific facilitators and Veteran characteristics that were associated with employment outcomes. Qualitative data illustrate how the integration of the vocational rehabilitation specialist on the medical team is helpful for addressing identified disability-specific barriers, including practical matters such as transportation and caregiving schedules, to facilitate employment outcomes.

Facilitators and Barriers to Employment Among Veterans with Spinal Cord Injury Receiving 12 Months of Evidence-Based Supported Employment Services

PubMed Central

Njoh, Eni N.; Trainor, John K.; O’Connor, Danielle R.; Barnett, Scott D.; Ottomanelli, Lisa

2015-01-01

Background: Return to work is associated with positive rehabilitation outcomes for persons with spinal cord injury (SCI); however, more research is needed on vocational support for persons with disabilities seeking employment. Objective: The association between facilitators and barriers of employment and employment outcome was examined among Veterans with SCI who participated in an evidence-based supported employment (EBSE) program. Methods: Using a mixed-methods, nested case-control design, data on facilitators and barriers to employment were extracted from qualitative interviews and quantitative measures administered in person to 34 Veterans with SCI who completed 12 months of an EBSE program. Participants who did (case) and did not (control) obtain competitive employment were matched on time since SCI. Facilitators and barriers to employment were compared between the groups. Results: Self-report measures administered at baseline were examined; there were no statistically significant factors that predicted employment outcomes after 12 months of EBSE program participation. Qualitative interview data revealed program-specific facilitators and Veteran characteristics that were associated with employment outcomes. Conclusions: Qualitative data illustrate how the integration of the vocational rehabilitation specialist on the medical team is helpful for addressing identified disability-specific barriers, including practical matters such as transportation and caregiving schedules, to facilitate employment outcomes. PMID:25762857

Physical activity programming in family child care homes: providers' perceptions of practices and barriers.

PubMed

Fees, Bronwyn; Trost, Stewart; Bopp, Melissa; Dzewaltowski, David A

2009-01-01

To examine family child care home (FCCH) providers' perceptions of appropriate physical activity (PA), current practices, and perceived barriers to inclusion of PA within their programs. A trained facilitator lead 4 focus group sessions of FCCH providers. Questions addressed providers' planning for PA, resources and barriers, and perceptions of children's engagement. Family child care homes. 32 FCCH providers (100% female) caring for children 6 weeks to 5 years old in predominantly mixed-age programs. Types of and extent to which PA was offered for children and perceived barriers to PA in this setting. Authors coded and analyzed transcriptions based on a socioecological framework using qualitative data analysis software. Majority of providers reported running and dancing to music as the most common PA, generally in an unstructured context. Frequency varied from none to twice a day. Few providers reported planning intentionally for PA; any plans followed children's interests. Barriers to inclusion of PA included personal, programming, parent, environmental, and financial reasons. Providers requested training on PA, particularly ideas for experiences in mixed-age groups. Type, frequency, consistency, and duration of PA among FCCH homes vary widely. Implications include training on PA and resources tailored to the unique characteristics of family child care homes.

Perceived barriers to online education by radiologic science educators.

PubMed

Kowalczyk, Nina K

2014-01-01

Radiologic science programs continue to adopt the use of blended online education in their curricula, with an increase in the use of online courses since 2009. However, perceived barriers to the use of online education formats persist in the radiologic science education community. An electronic survey was conducted to explore the current status of online education in the radiologic sciences and to identify barriers to providing online courses. A random sample of 373 educators from radiography, radiation therapy, and nuclear medicine technology educational programs accredited by the Joint Review Committee on Education in Radiologic Technology and Joint Review Committee on Educational Programs in Nuclear Medicine Technology was chosen to participate in this study. A qualitative analysis of self-identified barriers to online teaching was conducted. Three common themes emerged: information technology (IT) training and support barriers, student-related barriers, and institutional barriers. Online education is not prevalent in the radiologic sciences, in part because of the need for the clinical application of radiologic science course content, but online course activity has increased substantially in radiologic science education, and blended or hybrid course designs can effectively provide opportunities for student-centered learning. Further development is needed to increase faculty IT self-efficacy and to educate faculty regarding pedagogical methods appropriate for online course delivery. To create an excellent online learning environment, educators must move beyond technology issues and focus on providing quality educational experiences for students.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barbose, Galen; Wiser, Ryan; Bolinger, Mark

In the U.S., the increasing financial support for customer-sited photovoltaic (PV) systems provided through publicly-funded incentive programs has heightened concerns about the long-term performance of these systems. Given the barriers that customers face to ensuring that their PV systems perform well, and the responsibility that PV incentive programs bear to ensure that public funds are prudently spent, these programs should, and often do, play a critical role in addressing PV system performance. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approaches to encouragingmore » PV system performance used by 32 prominent PV incentive programs in the U.S. We identify eight general strategies or groups of related strategies that these programs have used to address factors that affect performance, and describe key implementation details. Based on this review, we then offer recommendations for how PV incentive programs can be effectively designed to mitigate potential performance issues.« less

Best-Practice Physical Activity Programs for Older Adults: Findings From the National Impact Study

PubMed Central

Seymour, Rachel B.; Campbell, Richard T.; Whitelaw, Nancy; Bazzarre, Terry

2009-01-01

Objectives. We assessed the impact of existing best-practice physical activity programs for older adults on physical activity participation and health-related outcomes. Methods. We used a multisite, randomized trial with 544 older adults (mean age 66 years) and measures at baseline, 5, and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program. Results. For adults who participated in a multiple-component physical activity program, we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time (P < .001), adherence in the face of barriers (P = .01), increased upper- and lower-body strength (P = .02, P = .01), and exercise participation (P = .01). Conclusions. Best-practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults. US public policy should encourage these inexpensive health promotion programs. PMID:19059858

BARRIERS AND FACILITATORS TO THE IMPLEMENTATION OF A NATIONAL HIV LINKAGE, RE-ENGAGEMENT, AND RETENTION IN CARE PROGRAM

PubMed Central

Maulsby, Cathy; Sacamano, Paul; Jain, Kriti M.; Enobun, Blessing; Brantley, Meredith L.; Kim, Hae-Young; Riordan, Morey; Werner, Melissa; Holtgrave, David R.

2018-01-01

The 2020 National HIV AIDS Strategy (NHAS) sets a target of 90% of diagnosed people living with HIV (PLWH) retained in HIV care. Access to Care (A2C) was a national HIV linkage, re-engagement, and retention in care program funded by AIDS United with support from the Corporation for National and Community Service that aimed to link and retain the most vulnerable PLWH into high-quality HIV care. This study explores the barriers and facilitators of implementing the A2C program from the perspective of program staff. Ninety-eight qualitative interviews were conducted with staff at implementing organizations over the 5 years of the project. Barriers included challenges with recruiting and retaining participants, staffing and administration, harmonizing partnerships, and addressing the basic and psychosocial needs of participants. Facilitators included strong relationships with partner organizations, flexible program models, and the passion and dedication of staff. Findings will inform the development of future programs and policy. PMID:29068718

Optimum cable barrier design and placement for the state of Oklahoma.

DOT National Transportation Integrated Search

2013-01-01

This research evaluated the effectiveness of ODOTs cable barrier program. Site inspections of all known cable barrier systems were conducted. : Locations of most cable sites were found to be within guidelines for effective use. Comparison to sites...

Parallel barrier effectiveness : Dulles noise barrier project

DOT National Transportation Integrated Search

1990-05-01

In an effort to minimize the cost and maximize the effectiveness of highway noise barriers, the Federal Highway Administration and a National Pooled Fund Panel (made up of 14 States) funded a field study program on an experimental highway noise barri...

A home monitoring program including real-time wireless home spirometry in idiopathic pulmonary fibrosis: a pilot study on experiences and barriers.

PubMed

Moor, C C; Wapenaar, M; Miedema, J R; Geelhoed, J J M; Chandoesing, P P; Wijsenbeek, M S

2018-05-29

In idiopathic pulmonary fibrosis (IPF), home monitoring experiences are limited, not yet real-time available nor implemented in daily care. We evaluated feasibility and potential barriers of a new home monitoring program with real-time wireless home spirometry in IPF. Ten patients with IPF were asked to test this home monitoring program, including daily home spirometry, for four weeks. Measurements of home and hospital spirometry showed good agreement. All patients considered real-time wireless spirometry useful and highly feasible. Both patients and researchers suggested relatively easy solutions for the identified potential barriers regarding real-time home monitoring in IPF.

Implementation of an Evidence-Based Exercise Program for Older Adults in South Florida

PubMed Central

Page, Timothy; Vieira, Edgar; Seff, Laura

2016-01-01

Introduction. This study aimed to examine how well an evidence-based physical activity program could be translated for wide scale dissemination and adoption to increase physical activity among community-dwelling older adults. Methods. Between October 2009 and December 2012, reach, fidelity, dosage, ease of implementation, and barriers to translation of EnhanceFitness (EF) were assessed. To assess effectiveness, a pretest-posttest design was used to measure increases in functional fitness (chair stands, arm curls, and the up-and-go test). Results. Fourteen community-based agencies offered 126 EF classes in 83 different locations and reached 4,490 older adults. Most participants were female (72%). Thirty-eight percent of participants did not complete the initial 16-week EF program. The 25% who received the recommended dose experienced an increase in upper and lower body strength and mobility. Further, participants reported high satisfaction with the program. Conclusion. EF was successfully implemented in a variety of settings throughout South Florida and reached a large number of older adults. However, challenges were encountered in ensuring that those who participated received a program dose that would lead to beneficial gains in functional fitness. PMID:27800182

Analyzing Barriers to Energy Conservation in Residences and Offices: The Rewire Program at the University of Toronto

ERIC Educational Resources Information Center

Stokes, Leah C.; Mildenberger, Matto; Savan, Beth; Kolenda, Brian

2012-01-01

Conducting a barriers analysis is an important first step when designing proenvironmental behavior change interventions. Yet, detailed information on common barriers to energy conservation campaigns remains unavailable. Using a pair of original surveys, we leverage the theory of planned behavior to report on the most important barriers for…

Barriers to Optimal Palliative Care of Lung Transplant Candidates

PubMed Central

Colman, Rebecca E.; Curtis, J. Randall; Nelson, Judith E.; Efferen, Linda; Hadjiliadis, Denis; Levine, Deborah J.; Meyer, Keith C.; Padilla, Maria; Strek, Mary; Varkey, Basil

2013-01-01

Background: The provision of effective palliative care is of great importance to patients awaiting lung transplantation. Although the prospect of lung transplantation provides hope to patients and their families, these patients are usually very symptomatic from their underlying disease. Methods: An e-mail questionnaire was sent to members of the American College of Chest Physicians’ Transplant NetWork and the Pulmonary Council of the International Society for Heart and Lung Transplantation (ISHLT). The survey included questions about barriers to providing palliative care, the availability of palliative care services, and recommended strategies to improve palliative care for lung transplant candidates. Results: The 158 respondents represented approximately 65% of transplant programs in the ISHLT registry. Respondents were in practice a mean of 11.3 (± 9) years, 70% were pulmonologists, 17% were surgeons, and 13% were other care providers. Barriers were classified into domains including patient factors, family factors, physician factors, and institutional/transplant program/lung allocation system factors. Significant patient/family barriers included unrealistic patient/family expectations about survival, unwillingness to plan end-of-life care, concerns about abandonment or inappropriate care after enrollment in a palliative care program, and family disagreements about care goals. For institutional/program/allocation system barriers, only the requirement for weight loss or gain to meet program-specific BMI requirements was identified. Significant physician barriers included competing time demands and the seemingly contradictory goals of transplant vs palliative care. Strategies recommended to improve palliative care included routine advance care planning for patients awaiting transplantation, access to palliative care specialists, training of transplant physicians in symptom management, and regular meetings among transplant physicians, nurses, patients, and families. Conclusions: Physicians providing care to lung transplant candidates reported considerable barriers to the delivery and acceptance of palliative care and identified specific strategies to improve palliative care for lung transplant candidates. PMID:22922517

Thermal Gradient Cyclic Behavior of a Thermal/Environmental Barrier Coating System on SiC/SiC Ceramic Matrix Composites

NASA Technical Reports Server (NTRS)

Zhu, Dongming; Lee, Kang N.; Miller, Robert A.

2002-01-01

Thermal barrier and environmental barrier coatings (TBCs and EBCs) will play a crucial role in future advanced gas turbine engines because of their ability to significantly extend the temperature capability of the ceramic matrix composite (CMC) engine components in harsh combustion environments. In order to develop high performance, robust coating systems for effective thermal and environmental protection of the engine components, appropriate test approaches for evaluating the critical coating properties must be established. In this paper, a laser high-heat-flux, thermal gradient approach for testing the coatings will be described. Thermal cyclic behavior of plasma-sprayed coating systems, consisting of ZrO2-8wt%Y2O3 thermal barrier and NASA Enabling Propulsion Materials (EPM) Program developed mullite+BSAS/Si type environmental barrier coatings on SiC/SiC ceramic matrix composites, was investigated under thermal gradients using the laser heat-flux rig in conjunction with the furnace thermal cyclic tests in water-vapor environments. The coating sintering and interface damage were assessed by monitoring the real-time thermal conductivity changes during the laser heat-flux tests and by examining the microstructural changes after the tests. The coating failure mechanisms are discussed based on the cyclic test results and are correlated to the sintering, creep, and thermal stress behavior under simulated engine temperature and heat flux conditions.

Using a Root Cause Analysis Curriculum for Practice-Based Learning and Improvement in General Surgery Residency.

PubMed

Ramanathan, Rajesh; Duane, Therese M; Kaplan, Brian J; Farquhar, Doris; Kasirajan, Vigneshwar; Ferrada, Paula

2015-01-01

To describe and evaluate a root cause analysis (RCA)-based educational curriculum for quality improvement (QI) practice-based learning and implementation in general surgery residency. A QI curriculum was designed using RCA and spaced-learning approaches to education. The program included a didactic session about the RCA methodology. Resident teams comprising multiple postgraduate years then selected a personal complication, completed an RCA, and presented the findings to the Department of Surgery. Mixed methods consisting of quantitative assessment of performance and qualitative feedback about the program were used to assess the value, strengths, and limitations of the program. Urban tertiary academic medical center. General surgery residents, faculty, and medical students. An RCA was completed by 4 resident teams for the following 4 adverse outcomes: postoperative neck hematoma, suboptimal massive transfusion for trauma, venous thromboembolism, and decubitus ulcer complications. Quantitative peer assessment of their performance revealed proficiency in selecting an appropriate case, defining the central problem, identifying root causes, and proposing solutions. During the qualitative feedback assessment, residents noted value of the course, with the greatest limitation being time constraints and equal participation. An RCA-based curriculum can provide general surgery residents with QI exposure and training that they value. Barriers to successful implementation include time restrictions and equal participation from all involved members. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Research training among pediatric residency programs: a national assessment.

PubMed

Abramson, Erika L; Naifeh, Monique M; Stevenson, Michelle D; Todd, Christopher; Henry, Emilie D; Chiu, Ya-Lin; Gerber, Linda M; Li, Su-Ting T

2014-12-01

The Accreditation Council for Graduate Medical Education (ACGME) states that "residents should participate in scholarly activity." However, there is little guidance for effectively integrating scholarly activity into residency. This study was conducted to understand how pediatric residency programs meet ACGME requirements and to identify characteristics of successful programs. The authors conducted an online cross-sectional survey of all pediatric residency program directors in October 2012, assessing program characteristics, resident participation in scholarly activity, program infrastructure, barriers, and outcomes. Multivariate logistic regression was used to identify characteristics of programs in the top quartile for resident scholarly activity participation. The response rate was 52.8% (105/199 programs). Seventy-seven (78.6%) programs required scholarly activity, although definitions were variable. When including only original research, systematic reviews or meta-analyses, and case reports or series with references, resident participation averaged 56% (range 0%-100%). Characteristics associated with high-participation programs included a scholarly activity requirement (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 1.03-30.0); program director belief that all residents should present work regionally or nationally (OR = 4.7, 95% CI = 1.5-15.1); and mentorship by >25% of faculty (OR = 3.6, CI = 1.2-11.4). Only 47.1% (41) of program directors were satisfied with resident participation, and only 30.7% (27) were satisfied with the quality of research training provided. The findings suggest that resident scholarly activity experience is highly variable and suboptimal. Identifying characteristics of successful programs can improve the resident research training experience.

Barriers and Facilitating Factors for Implementation of Genetic Services: A Public Health Perspective.

PubMed

Cornel, Martina C; van El, Carla G

2017-01-01

More than 15 years after the publication of the sequence of the human genome, the resulting changes in health care have been modest. At the same time, some promising examples in genetic services become visible, which contribute to the prevention of chronic disease such as cancer. These are discussed to identify barriers and facilitating factors for the implementation of genetic services. Examples from oncogenetics illustrate a high risk of serious disease where prevention is possible, especially in relatives. Some 5% of breast cancers and colorectal cancers are attributable to an inherited predisposition. These cancers occur at a relatively young age. DNA testing of relatives of affected patients may facilitate primary and secondary prevention. Training of non-genetic health care workers and health technology assessment are needed, as is translational research in terms of bringing genomics to health care practice while monitoring and evaluating. Stratified screening programs could include cascade screening and risk assessment based on family history. New roles and responsibilities will emerge. A clear assessment of the values implied is needed allowing to balance the pros and cons of interventions to further the responsible innovation of genetic services.

Assessing barriers to change in drinking behavior: results of an online employee screening program.

PubMed

Aseltine, Robert H; Demarco, Frank J; Wallenstein, Gene V; Jacobs, Douglas G

2009-01-01

The impact of alcohol abuse on worker productivity is considerable and appears to be increasing over time. Although early screening and intervention may help prevent or reduce the damaging health and productivity effects of problem drinking, barriers to behavioral change may render broad-based prevention efforts ineffectual. This study examined the correlates of two potential barriers to changes in drinking behavior--underestimation of drinking and lack of knowledge of helping resources--using data from web-based employee alcohol screenings. Anonymous screening data from 1185 employees of ten companies participating in the 2003 National Alcohol Screening Day were analyzed. The AUDIT, a 10-item screening instrument developed by the World Health Organization, was used to measure drinking behavior; employees' subjective assessments of their drinking were also obtained. Over 53% of participants subjectively underestimated their drinking relative to their AUDIT results, and 58% of respondents did not know whether their medical insurance included benefits for alcohol treatment. Logistic regression analysis revealed that younger and male respondents tended to have the highest AUDIT scores and also (along with married respondents) were most likely to underestimate their drinking. Younger, unmarried respondents were least likely to be aware of their alcohol treatment insurance benefits. Current corporate efforts to curtail problem drinking among employees may not adequately address barriers to change. Targeting at-risk employee groups for alcohol screening and dissemination of information about health insurance benefits and treatment options is recommended, as is providing personalized feedback based on screening results to raise awareness of at-risk drinking and available helping resources.

A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities.

PubMed

Hunting, Gemma; Shahid, Nida; Sahakyan, Yeva; Fan, Iris; Moneypenny, Crystal R; Stanimirovic, Aleksandra; North, Taylor; Petrosyan, Yelena; Krahn, Murray D; Rac, Valeria E

2015-12-09

Despite research demonstrating the potential effectiveness of Telehomecare for people with Chronic Obstructive Pulmonary Disease and Heart Failure, broad-scale comprehensive evaluations are lacking. This article discusses the qualitative component of a mixed-method program evaluation of Telehomecare in Ontario, Canada. The objective of the qualitative component was to explore the multi-level factors and processes which facilitate or impede the implementation and adoption of the program across three regions where it was first implemented. The study employs a multi-level framework as a conceptual guide to explore the facilitators and barriers to Telehomecare implementation and adoption across five levels: technology, patients, providers, organizations, and structures. In-depth semi-structured interviews and ethnographic observations with program stakeholders, as well as a Telehomecare document review were used to elicit key themes. Study participants (n = 89) included patients and/or informal caregivers (n = 39), health care providers (n = 23), technicians (n = 2), administrators (n = 12), and decision makers (n = 13) across three different Local Health Integration Networks in Ontario. Key facilitators to Telehomecare implementation and adoption at each level of the multi-level framework included: user-friendliness of Telehomecare technology, patient motivation to participate in the program, support for Telehomecare providers, the integration of Telehomecare into broader health service provision, and comprehensive program evaluation. Key barriers included: access-related issues to using the technology, patient language (if not English or French), Telehomecare provider time limitations, gaps in health care provision for patients, and structural barriers to patient participation related to geography and social location. Though Telehomecare has the potential to positively impact patient lives and strengthen models of health care provision, a number of key challenges remain. As such, further implementation and expansion of Telehomecare must involve continuous assessments of what is working and not working with all stakeholders. Increased dialogue, evaluation, and knowledge translation within and across regions to understand the contextual factors influencing Telehomecare implementation and adoption is required. This can inform decision-making that better reflects and addresses the needs of all program stakeholders.

Air Force Commanders and Barriers to Entry into a Doctoral Business Program

ERIC Educational Resources Information Center

Williams, Tony; LeMire, Steven D.

2011-01-01

The authors examined professionally qualified Air Force commanders' barriers to entry into a business doctoral degree program related to the factors of time, financial means, academics, and motivation. Of the 116 present commanders, 63% were interested in pursuing a doctorate in business. For the commanders interested in obtaining a doctorate…

Postsecondary Transitions of Mississippi Band of Choctaw Indians Tribal Scholarship Program Students

ERIC Educational Resources Information Center

Carlyle, Gregory A.; Thompson, Nicole L.; Hare, R. Dwight; Miller, Nicole C.; Purvis, Leslie

2011-01-01

The purpose of this study was to explore the postsecondary education transition experiences of graduates of Choctaw Central High School (CCHS) who received support from the tribal scholarship program (TSP), to better understand the barriers to successful postsecondary completion and means of overcoming barriers. A total of 87 TSP-supported…

Access Barriers to Distance Education in Secondary Career and Technical Education Programs in Central Virginia

ERIC Educational Resources Information Center

Goodwyn, Patrell Vachyi

2010-01-01

The qualitative phenomenological study explored the perceived institutional access barriers to distance education at comprehensive high schools with secondary career and technical education programs in central Virginia. Semi-structured interviews were conducted to gather data via email, telephone, and face-to-face. A purposive sample of 24…

Exploring Weight and Lifestyle: Mexican Immigrant Men’s Perspectives

PubMed Central

Martinez, Joseph; Powell, Jamie; Agne, April; Scarinci, Isabel; Cherrington, Andrea

2013-01-01

Objective Despite interest in family-centered obesity and diabetes prevention programs for Latinos, few studies have assessed men’s perspectives on obesity-related behaviors. The objective of this study was to explore Mexican immigrant men’s perspectives regarding weight, diet, and physical activity as they relate to the individual and the family. Design and Sample This was a focus group study with a convenience sample of Mexican immigrant men (n=16). Measures A moderator’s guide was used to elicit perceptions of personal and family behaviors influencing weight, and lifestyle. Results Mean age of participants was 41 years (SD+/− 12.7), and 100% were born in Mexico. Mean time in Alabama was 8 years. Perceived benefits of a healthy weight included improved mobility and decreased morbidities. Perceived barriers to a healthy lifestyle included demanding work schedules and an environment not conducive to walking. Participants described immigration as having a negative impact on family unity and established meal structures. Conclusion Previous studies among Latinas cite husband resistance as a barrier to sustained diet and lifestyle change; however, men in this study voiced openness to programs for obesity and diabetes prevention. Future family-centered programs should engage men and promote communication within the family on common goals related to health and illness prevention. PMID:23078420

Evaluation of Subsurface Engineered Barriers at Waste Sites Volumes 1 and 2

EPA Pesticide Factsheets

This report provides the U.S. Environmental Protection Agency’s (EPA) waste programs with a national retrospective analysis of barrier field performance, as well as information that useful in developing guidance on the use and evaluation of barrier systems

44 CFR 71.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... located in an area identified as being in the Coastal Barrier Resources System (CBRS) both as of October... part, otherwise protected area means an undeveloped coastal barrier within the boundaries of an area... SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program IMPLEMENTATION OF COASTAL BARRIER...

Inclusion of disability-related content in nurse practitioner curricula.

PubMed

Smeltzer, Suzanne C; Blunt, Elizabeth; Marozsan, Heather; Wetzel-Effinger, Lisa

2015-04-01

To examine the integration of disability-content in a national sample of nurse practitioner curricula. Responses of National Organization of Nurse Practitioner Faculties (NONPF) members to an online 34-item survey designed to assess disability-related content included in nurse practitioner (NP) curricula; populations of people with disabilities addressed; models of disability; and resources used to teach about disability, facilitators and barriers to inclusion of disability, and respondents' assessment of the adequacy of coverage of disability in their programs. A survey used previously to assess integration of disability content in undergraduate nursing programs was modified to make it relevant to NP curricula. Nursing faculty and people with disability validated the survey to ensure its completeness and sensitivity to the disability community. Participating programs represent 111 (33.6%) NP programs. Lack of disability-related content reported by NP faculty in the majority of programs suggests that there is considerable room for improvement in efforts to address this often vulnerable population. Because people with disabilities can be found in any setting where health care is provided, all NPs need to be prepared to care for people with disabilities across the life span. Strategies need to be developed and implemented to increase the awareness of NP faculty about the health issues of people with disabilities and integration of disability-related content without disrupting existing overloaded NP curricula. © 2014 American Association of Nurse Practitioners.

Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review.

PubMed

Willson, Melina L; Vernooij, Robin W M; Gagliardi, Anna R

2017-06-01

This study described the number and characteristics of questionnaires used to assess barriers of guideline use among physicians. A scoping review was conducted. MEDLINE and EMBASE were searched from 2005 to June 2016. English-language studies that administered a questionnaire to assess barriers of guideline use among practicing physicians were eligible. Summary statistics were used to report study and questionnaire characteristics. Questionnaire content was assessed with a checklist of 57 known barriers. Each of the 178 included studies administered a unique questionnaire. The number of questionnaires increased yearly from 2005 to 2015. Few were pilot-tested (50, 28.1%) or tested for psychometric properties (3, 1.7%). Two were based on theory. None probed for the full range of known barriers. Ten included a free-text option. The majority assessed professional barriers (177, 99.4%) but few of the 14 factors within this domain. Questionnaire characteristics did not change over time. Organizations administered questionnaires that were not reliable or valid and did not comprehensively assess barriers and may have selected interventions unlikely to promote guideline use. Research is needed to construct a questionnaire that is practical, adaptable, and robust and leads to the selection of interventions that support guideline use. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Primary Care Provider Perceptions of the Effectiveness of Two Self-Management Support Programs for Vulnerable Patients with Diabetes

PubMed Central

Ratanawongsa, Neda; Bhandari, Vijay K; Handley, Margaret; Rundall, Thomas; Hammer, Hali; Schillinger, Dean

2012-01-01

Background Primary care providers (PCPs) in safety net settings face barriers to optimizing care for patients with diabetes. We conducted this study to assess PCPs' perspectives on the effectiveness of two language-concordant diabetes self-management support programs. Methods One year postintervention, we surveyed PCPs whose patients with diabetes participated in a three-arm multiclinic randomized controlled trial comparing usual care (UC), weekly automated telephone self-management (ATSM) support with nurse care management, and monthly group medical visits (GMVs). We compared PCP perspectives on patient activation to create and achieve goals, quality of care, and barriers to care using regression models accounting for within-PCP clustering. Results Of 113 eligible PCPs caring for 330 enrolled patients, 87 PCPs (77%) responded to surveys about 245 (74%) enrolled patients. Intervention patients were more likely to be perceived by PCPs as activated to create and achieve goals for chronic care when compared with UC patients (standardized effect size, ATSM vs UC, +0.41, p = 0.01; GMV vs UC, +0.31, p = 0.05). Primary care providers rated quality of care as higher for patients exposed to ATSM compared to UC (odds ratio 3.6, p < 0.01). Compared with GMV patients, ATSM patients were more likely to be perceived by PCPs as overcoming barriers related to limited English proficiency (82% ATSM vs 44% GMV, p = 0.01) and managing medications (80% ATSM vs 53% GMV, p = 0.01). Conclusions Primary care providers perceived that patients receiving ATSM support had overcome barriers, participated more actively, and received higher quality diabetes care. These views of clinician stakeholders lend additional evidence for the potential to upscale ATSM more broadly to support PCPs in their care of diverse, multilinguistic populations. PMID:22401329

Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders.

PubMed

Lauvergeon, Stéphanie; Burnand, Bernard; Peytremann-Bridevaux, Isabelle

2012-06-22

Chronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation. To meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients. Our results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors. Even if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders.

Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders

PubMed Central

2012-01-01

Background Chronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation. Methods To meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients. Results Our results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors. Conclusions Even if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders. PMID:22726820

Approaches used by employee assistance programs to address perpetration of intimate partner violence.

PubMed

Walters, Jennifer L Hardison; Pollack, Keshia M; Clinton-Sherrod, Monique; Lindquist, Christine H; McKay, Tasseli; Lasater, Beth M

2012-01-01

Employee Assistance Programs (EAPs) are workplace resources available to employees with problems impacting work performance. EAPs are well-positioned to address intimate partner violence (IPV), a major public health problem with workplace impacts. A purposeful sample of 28 EAPs across the United States was surveyed to identify policies and programs to address IPV, including perpetration. Most EAPs did not report having standardized approaches for addressing IPV perpetration. EAPs also described significant barriers to identifying IPV perpetrators, with the majority relying on self-disclosure on the part of the perpetrator when contacting the EAP. These results suggest that many EAPs--even when interacting with employees who present with issues known to correlate with IPV--are missing a potential opportunity to assess and intervene with IPV perpetrators.

Managing health habits for myocardial infarction (MI) patients.

PubMed

Song, R; Lee, H

2001-08-01

The study examined effects of the heart camp as a motivation enhancement program on cardiac risk reduction and behavioral modification in myocardial infarction (MI) patients. A total of 86 outpatients participated at the first heart camp and 45 returned to the second one in 8 weeks. The first and second heart camps were daylong programs consisted of health assessment, education classes, and Q&A session with interdisciplinary team approach. At the completion of the heart camp, the participants showed significantly lower scores in cardiac risk factors, and significant improvements in motivational variables, especially, perceived benefits and perceived barriers as well as in the performance of diet and exercise behaviors. The study results confirm that it is possible to enhance motivation for chronic patients like MI patients by even short period of comprehensive educational program.

Perceived barriers to seeking mental health care among United States Marine Corps noncommissioned officers serving as gatekeepers for suicide prevention.

PubMed

VanSickle, Marcus; Werbel, Aaron; Perera, Kanchana; Pak, Kyna; DeYoung, Kathryn; Ghahramanlou-Holloway, Marjan

2016-08-01

Reducing mental health stigma and perceived barriers to care is a necessary strategy for addressing the public health problem of suicide among the United States Armed Forces. The purpose of this study was threefold: (a) to empirically evaluate the principal component structure of the Perceived Barriers to Care (PBTC) measure; (b) to gain an understanding of the perceived barriers to seeking mental health services among Marine Corps noncommissioned officers (NCOs) selected to participate in a primary suicide prevention training program, Never Leave a Marine Behind (NLMB); and (c) to explore the relationship among sex, education, prior exposure to suicide within one's military unit, and perceived barriers to seeking mental health services. The data for the PBTC (N = 1,758) were drawn from a previously performed pretest/posttest program evaluation study of the Marine Corp's NLMB program, which took place over 6 months in 2009 (April-October). The three highest perceptions of barriers to care reported by NCOs for their Marines were related to being embarrassed, having members of one's unit have less confidence in the Marine, and concerns about being treated differently by military unit leadership. Three principal components for PBTC were identified, accounting for approximately 59% of the total variance. Higher education and prior exposure to suicide within one's military unit significantly correlated with greater perceived barriers to care; sex was not significantly correlated with greater perceived barriers to care. Implications of these findings, in relation to future research, are further discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Assessing Opportunities to Enhance Comprehensive Health Promotion and Wellness Programming in a State Community College System.

PubMed

Linnan, Laura A; Arandia, Gabriela; Naseer, Carolyn; Li, Jiang; Pomerantz, Meg; Diehl, Sandra J

2017-01-01

BACKGROUND North Carolina has the third largest community college system in the nation and reaches residents in all 100 counties. Few studies have focused on the health of employees who work at these institutions. We assessed the current status of and interest in supporting health promotion efforts among North Carolina Community College System members. METHODS North Carolina Community College System presidents completed a brief 15-item survey assessing support for and interest in offering health promotion programs. Wellness coordinators completed a 60-item questionnaire assessing current health promotion programming and organizational, environmental, and policy supports for health promotion efforts. Onsite interviews with a sub-sample of Wellness coordinators offered insights into important implementation considerations. We examined differences by campus size with Fisher's exact test. RESULTS All 58 presidents (100%) and 51 wellness coordinators (88%) completed surveys. Ten percent of colleges offered comprehensive employee health promotion programming. Most offered physical activity (70.6%), tobacco cessation (51.0%), weight loss/management (49.0%), and/or nutrition counseling (47.1%). Larger colleges were more likely to offer programming and environmental support. Nearly all presidents (89.7%) believed it is "very" or "extremely" important to offer health promotion programs to employees, and most (84%) were interested in promoting health through a university partnership. LIMITATIONS Despite very high survey response rates from presidents and wellness coordinators at each community college, onsite interviews were only done at select campuses, limiting the generalizability and scope of conclusions derived from interview data. CONCLUSION Community colleges in North Carolina are promising settings for promoting employee health. Findings identify resources, barriers, and technical assistance that could facilitate greater adoption and implementation of programs. ©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

A qualitative assessment of factors influencing acceptance of a new rotavirus vaccine among health care providers and consumers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Manish M Patel, Alan P Janssen, Richard Tardif, Mark Herring, Umesh Parashar

2007-10-18

In 2006, a new rotavirus vaccine (RotaTeq) was licensed in the US and recommended for routine immunization of all US infants. Because a previously licensed vaccine (Rotashield) was withdrawn from the US for safety concerns, identifying barriers to uptake of RotaTeq will help develop strategies to broaden vaccine coverage. Our qualitative assessment provides complementary data to recent quantitative surveys and suggests that physicians and parents are likely to adopt the newly licensed rotavirus vaccine. Increasing parental awareness of the rotavirus disease burden and providing physicians with timely post-marketing surveillance data will be integral to a successful vaccination program.

28 CFR 91.55 - Categorical exclusions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... an approved State Coastal Zone Management Program, a coastal barrier or a portion of a barrier within the Coastal Barrier Resources System, a river or portion of a river included in or designated for... source aquifer recharge area designated by the Environmental Protection Agency (EPA). The resulting...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cappers, Peter; MacDonald, Jason; Goldman, Charles

In this study, we attempt to provide a comprehensive examination of various market and policy barriers to demand response providing ancillary services in both ISO/RTO and non-ISO/RTO regions, especially at the program provider level. It is useful to classify barriers in order to create a holistic understanding and identify parties that could be responsible for their removal. This study develops a typology of barriers focusing on smaller customers that must rely on a program provider (i.e., electric investor owned utility or IOU, ARC) to create an aggregated DR resource in order to bring ancillary services to the balancing authority.ii Themore » barriers were identified through examinations of regulatory structures, market environments, and product offerings; and discussions with industry stakeholders and regulators. In order to help illustrate the differences in barriers among various wholesale market designs and their constituent retail environments, four regions were chosen to use as case studies: Colorado, Texas, Wisconsin, and New Jersey. We highlight the experience in each area as it relates to the identified barriers.« less

A qualitative assessment of a community pharmacy cognitive pharmaceutical services program, using a work system approach.

PubMed

Chui, Michelle A; Mott, David A; Maxwell, Leigh

2012-01-01

Although lack of time, trained personnel, and reimbursement have been identified as barriers to pharmacists providing cognitive pharmaceutical services (CPS) in community pharmacies, the underlying contributing factors of these barriers have not been explored. One approach to better understand barriers and facilitators to providing CPS is to use a work system approach to examine different components of a work system and how the components may impact care processes. The goals of this study were to identify and describe pharmacy work system characteristics that pharmacists identified and changed to provide CPS in a demonstration program. A qualitative approach was used for data collection. A purposive sample of 8 pharmacists at 6 community pharmacies participating in a demonstration program was selected to be interviewed. Each semistructured interview was audio recorded and transcribed, and the text was analyzed in a descriptive and interpretive manner by 3 analysts. Themes were identified in the text and aligned with 1 of 5 components of the Systems Engineering Initiative for Patient Safety (SEIPS) work system model (organization, tasks, tools/technology, people, and environment). A total of 21 themes were identified from the interviews, and 7 themes were identified across all 6 interviews. The organization component of the SEIPS model contained the most (n=10) themes. Numerous factors within a pharmacy work system appear important to enable pharmacists to provide CPS. Leadership and foresight by the organization to implement processes (communication, coordination, planning, etc.) to facilitate providing CPS was a key finding across the interviews. Expanding technician responsibilities was reported to be essential for successfully implementing CPS. To be successful in providing CPS, pharmacists must be cognizant of the different components of the pharmacy work system and how these components influence providing CPS. Copyright © 2012 Elsevier Inc. All rights reserved.

A qualitative assessment of a community pharmacy cognitive pharmaceutical services program, using a work system approach

PubMed Central

Chui, Michelle A.; Mott, David A.; Maxwell, Leigh

2012-01-01

Background Although lack of time, trained personnel, and reimbursement have been identified as barriers to pharmacists providing cognitive pharmaceutical services (CPS) in community pharmacies, the underlying contributing factors of these barriers have not been explored. One approach to better understand barriers and facilitators to providing CPS is to use a work system approach to examine different components of a work system and how the components may impact care processes. Objectives The goals of this study were to identify and describe pharmacy work system characteristics that pharmacists identified and changed to provide CPS in a demonstration program. Methods A qualitative approach was used for data collection. A purposive sample of 8 pharmacists at 6 community pharmacies participating in a demonstration program was selected to be interviewed. Each semistructured interview was audio recorded and transcribed, and the text was analyzed in a descriptive and interpretive manner by 3 analysts. Themes were identified in the text and aligned with 1 of 5 components of the Systems Engineering Initiative for Patient Safety (SEIPS) work system model (organization, tasks, tools/technology, people, and environment). Results A total of 21 themes were identified from the interviews, and 7 themes were identified across all 6 interviews. The organization component of the SEIPS model contained the most (n = 10) themes. Numerous factors within a pharmacy work system appear important to enable pharmacists to provide CPS. Leadership and foresight by the organization to implement processes (communication, coordination, planning, etc.) to facilitate providing CPS was a key finding across the interviews. Expanding technician responsibilities was reported to be essential for successfully implementing CPS. Conclusions To be successful in providing CPS, pharmacists must be cognizant of the different components of the pharmacy work system and how these components influence providing CPS. PMID:21824822

Parenting While Incarcerated: Tailoring the Strengthening Families Program for Use with Jailed Mothers

PubMed Central

Miller, Alison L.; Weston, Lauren E.; Perryman, Jamie; Horwitz, Talia; Franzen, Susan; Cochran, Shirley

2015-01-01

Most incarcerated women are mothers. Parenting programs may benefit women, children and families, yet effectively intervening in correctional settings is a challenge. An evidence-based parenting intervention (the Strengthening Families Program) was tailored and implemented with women in a jail setting. Goals were to assess mothers' needs and interests regarding parenting while they were incarcerated, adapt the program to address those needs, and establish intervention delivery and evaluation methods in collaboration with a community-based agency. Women reported wanting to know more about effective communication; how children manage stress; finances; drug and alcohol use; self-care; and stress reduction. They reported high program satisfaction and reported reduced endorsement of corporal punishment after the intervention. Barriers to implementation included unpredictable attendance from session to session due to changing release dates, transfer to other facilities, and jail policies (e.g., lock-down; commissary hours). Implications for sustainable implementation of parenting programs in jail settings are discussed. PMID:26612963

Eat Smart! Ontario's Healthy Restaurant Program: focus groups with non-participating restaurant operators.

PubMed

Dwyer, John J M; Macaskill, Lesley A; Uetrecht, Connie L; Dombrow, Carol

2004-01-01

Eat Smart! Ontario's Healthy Restaurant Program is a standard provincial health promotion program. Public health units give an award of excellence to restaurants that meet nutrition, food safety, and non-smoking seating standards. The purpose of this study was to determine why some restaurant operators have not applied to participate in the program, and how to get them to apply. Four focus group interviews were conducted with 35 operators who didn't apply to participate. The analysis of responses yielded various themes. The participants' perceived barriers to participation were misunderstandings about how to qualify for the program, lack of time, concern about different non-smoking bylaw requirements, and potential loss of revenue. Their perceived facilitators to participation were convenience of applying to participate, franchise executives' approval to participate, a 100% non-smoking bylaw, flexibility in the assessment of restaurants, the opportunity for positive advertising, alternative payment for food handler training, and customer demand. Program staff can use the findings to develop and use strategies to encourage participation.

Implementation of a National Workplace Wellness Program for Health Workers in Botswana

PubMed Central

Ledikwe, Jenny H.; Semo, Bazghina-werq; Sebego, Miram; Mpho, Maureen; Mothibedi, Heather; Mawandia, Shreshth; O’Malley, Gabrielle

2017-01-01

The Botswana workplace wellness program (WWP) for health care workers (HCWs) was initiated in 2007. WWP implementation was assessed using a sequential, explanatory, mixed methods design including a national implementation assessment (27 health districts) and in-depth interviews (n = 38). Level of implementation varied across districts with health screening, therapeutic recreation, and health promotion implemented more frequently than occupational health activities and psychosocial services. Facilitators to WWP implementation included establishment of a dedicated, diverse WWP committee; provision of administrative support, and integration of activities into organizational culture. Barriers included competing priorities related to delivery of health services to clients, limited technical ability to deliver occupation health activities and psychosocial support, receipt of health services from colleagues, and limited appreciation for personal wellness by some HCWs. Ensuring the well-being of HCWs is critical in reaching international health goals. PMID:28742763

Perceived exercise barriers are reduced and benefits are improved with lifestyle modification in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial.

PubMed

Thomson, Rebecca L; Buckley, Jonathan D; Brinkworth, Grant D

2016-03-09

This study assessed the perceived benefits and barriers to exercise participation in overweight and obese women with polycystic ovary syndrome (PCOS) and monitored changes in response to a lifestyle intervention. Forty-three overweight/obese PCOS women (Age, 30.3(6.2) yrs; BMI, 36.4(5.6) kg/m(2)) were randomised to one of three 20-week lifestyle programs: diet only (DO, n = 13), diet and aerobic exercise (DA, n = 11) and diet and combined aerobic-resistance exercise (DC, n = 19). Exercise Benefits/Barriers Scale (EBBS), weight, aerobic fitness, depression and PCOS specific health-related quality of life were measured. Barriers score was related to depression (r = 0.45, P = 0.002) and aerobic fitness (r = -0.32, P = 0.04), while benefits score was related to aerobic fitness (r = 0.41, P = 0.007). EBBS, benefits and barriers scores improved overtime (P ≤ 0.001). Benefits subscales psychological outlook and social interaction increased (P ≤ 0.001) and life enhancement and preventative health did not change (P ≥ 0.3). Physical performance increased only in DA (P = 0.009). There were no differences between treatments for any of the other subscales (P ≥ 0.2). Barriers subscales exercise milieu, time expenditure and physical exertion reduced (P ≤ 0.003) and family discouragement did not change (P = 0.6). This study demonstrated that lifestyle modification consisting of an energy-restricted diet with or without exercise training improved the perceived benefits from and barriers to exercise. Australian New Zealand Clinical Trials Register ACTRN12606000198527, registered 26 May 2006.

Assessing tribal youth physical activity and programming using a community-based participatory research approach.

PubMed

Perry, Cynthia; Hoffman, Barbara

2010-01-01

American Indian youth experience a greater prevalence of obesity compared with the general U.S. population. One avenue to reverse the trend toward increasing obesity prevalence is through promoting physical activity. The goal of this project was to understand tribal youths' current patterns of physical activity behavior and their beliefs and preferences about physical activity. This assessment used a community-based participatory research approach. Sample included 35 Native youth aged 8-18. A Community Advisory Board was created that specifically developed an exercise survey for this assessment to explore physical activity patterns, preferences, and determinants. Twenty-six youth completed the survey. Descriptive statistics were analyzed, exploring differences by age group. Nine youth participated in 2 focus groups. Qualitative data were analyzed with thematic analysis. Youth distinguished between sports and exercise, with each possessing different determinants. Common motivators were friends, coach, and school, and barriers were lack of programs and school or work. None of the youth reported meeting the recommended 60 min of strenuous exercise daily. This tribal academic partnership responded to a tribal concern by developing an exercise survey and conducting focus groups that addressed tribal-specific questions. The results are informing program development.

Focus on Success: An Explanatory Embedded Multiple-Case Study on How Youth Successfully Navigate Workforce Development Programs in Southern Nevada

ERIC Educational Resources Information Center

Villalobos, Ricardo

2017-01-01

This explanatory qualitative study investigated the perspectives of participant's and practitioner's perceived barriers to success and the necessary navigational expertise for overcoming the identified barriers. This multiple-case study research design examined three WIA out-of-school youth workforce development programs in Southern Nevada, with…

Man's Impact on the Environment: The Barrier Beach as an Ecosystem.

ERIC Educational Resources Information Center

Brevard County School Board, Cocoa, FL.

This environmental education program deals with man's impact on the barrier beach. The program contained in the guide is developed around the following nine questions: (1) What is a definition of the ecosystem being investigated?; (2) What are some of the biotic and abiotic features of the ecosystem and how do these features interrelate?; (3)…

A Mixed-Methods Study: Self-Efficacy and Barriers to Participation in Workplace Wellness Programs

ERIC Educational Resources Information Center

Perez-Calhoon, Massiel

2017-01-01

America needs a healthy workforce to sustain the country. The scourge of obesity continues to plague Americans despite government initiatives such as the Affordable Care Act and wellness programs in the workplace to combat this epidemic. However, despite initiatives to make America healthy, barriers continued to impede the nation's health. Lack of…

Cooperative Education as a Strategy for School-to-Work Transition.

ERIC Educational Resources Information Center

Ascher, Carol

1994-01-01

Despite the proven record of cooperative education (CE) in high school vocational programs and professional college-level programs, several barriers must be overcome before CE can be spread in its current form or used as a model for enlarged school-to-work transition efforts. Among the barriers identified are the following: the diminished status…

Inclusive High School Service Learning Programs: Methods for and Barriers to Including Students with Disabilities

ERIC Educational Resources Information Center

Dymond, Stacy K.; Renzaglia, Adelle; Chun, Eul Jung

2008-01-01

The purpose of this study was to determine methods for and barriers to including students with disabilities in high school service learning programs (HSSLPs) with non-disabled peers. Focus groups were conducted with adult stakeholders at five schools nominated as having exemplary inclusive HSSLPs and at least 3 years experience implementing such…

Barriers Encountered in the Transfer of Educational Training to Workplace Practice in Saudi Arabia

ERIC Educational Resources Information Center

Almannie, Mohamed

2015-01-01

This study introduces a critical issue in the practicality of training programs, not only in Saudi Arabia, but also in other developing countries where billions of dollars are spent on training human resources without evaluation of these programs on workplace practice and organization development. This study investigates barriers encountered in…

Barriers to International Student Mobility: Evidence from the Erasmus Program

ERIC Educational Resources Information Center

Souto-Otero, Manuel; Huisman, Jeroen; Beerkens, Maarja; de Wit, Hans; Vujic, Suncica

2013-01-01

In this article, we look at the barriers to international student mobility, with particular reference to the European Erasmus program. Much is known about factors that support or limit student mobility, but very few studies have made comparisons between participants and nonparticipants. Making use of a large data set on Erasmus and non-Erasmus…

Breaking the Communication Barrier: Guidelines to Aid Communication within Pair Programming

ERIC Educational Resources Information Center

Zarb, Mark; Hughes, Janet

2015-01-01

Pair programming is a software development technique with many cited benefits in learning and teaching. However, it is reported that novice programmers find several barriers to pairing up, typically due to the added communication that is required of this approach. This paper will present a literature review discussing the issue of communication,…

Vegetable and Fruit Breaks in Australian Primary Schools: Prevalence, Attitudes, Barriers and Implementation Strategies

ERIC Educational Resources Information Center

Nathan, Nicole; Wolfenden, Luke; Butler, Michelle; Bell, Andrew Colin; Wyse, Rebecca; Campbell, Elizabeth; Milat, Andrew J.; Wiggers, John

2011-01-01

School-based vegetable and fruit programs can increase student consumption of vegetables and fruit and have been recommended for adoption by Australian schools since 2005. An understanding of the prevalence and predictors of and the barriers to the adoption of school-based vegetable and fruit programs is necessary to maximize their adoption by…

Perceptions about exercise and intrinsic motivation of students attending a health-related physical education program.

PubMed

Papacharisis, Vassilios; Goudas, Marios

2003-12-01

The present study examined effects of sex, attitude towards physical activity, perceived barriers for participation in physical activity, and students' perception of their parents' participation in physical activity on the intrinsic motivation of students participating in a health related program in physical education. 643 students (303 boys and 340 girls) responded to questionnaires measuring intrinsic motivation, attitudes towards physical activity, perceived barriers to exercise and perceived parents' participation in physical activity. Mean age was 12.9 yr. (SD=1.2, range 11-14 years). Analysis indicated that students' intrinsic motivation towards the program was influenced by perceived barriers to exercise. Sex, attitudes towards physical activity, and perceived parents' participation in physical activity seem to be less important.

Why Army Program Managers Struggle As Life Cycle Managers: A Study of the PM’s Roles, Responsibilities, and Barriers In the Execution of Operations and Support

DTIC Science & Technology

2016-09-01

Support Strategies (PBPSS), throughout the system life cycle .  Maximizing competition, to include small business participation.  Developing...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA JOINT APPLIED PROJECT WHY ARMY PROGRAM MANAGERS STRUGGLE AS LIFE CYCLE MANAGERS...SUBTITLE WHY ARMY PROGRAM MANAGERS STRUGGLE AS LIFE CYCLE MANAGERS: A STUDY OF THE PM’S ROLES, RESPONSIBILITIES, AND BARRIERS IN THE EXECUTION OF

Clinical balance assessment: perceptions of commonly-used standardized measures and current practices among physiotherapists in Ontario, Canada.

PubMed

Sibley, Kathryn M; Straus, Sharon E; Inness, Elizabeth L; Salbach, Nancy M; Jaglal, Susan B

2013-03-20

Balance impairment is common in multiple clinical populations, and comprehensive assessment is important for identifying impairments, planning individualized treatment programs, and evaluating change over time. However, little information is available regarding whether clinicians who treat balance are satisfied with existing assessment tools. In 2010 we conducted a cross-sectional survey of balance assessment practices among physiotherapists in Ontario, Canada, and reported on the use of standardized balance measures (Sibley et al. 2011 Physical Therapy; 91: 1583-91). The purpose of this study was to analyse additional survey data and i) evaluate satisfaction with current balance assessment practices and standardized measures among physiotherapists who treat adult or geriatric populations with balance impairment, and ii) identify factors associated with satisfaction. The questionnaire was distributed to 1000 practicing physiotherapists. This analysis focuses on questions in which respondents were asked to rate their general perceptions about balance assessment, the perceived utility of individual standardized balance measures, whether they wanted to improve balance assessment practices, and why. Data were summarized with descriptive statistics and utility of individual measures was compared across clinical practice areas (orthopaedic, neurological, geriatric or general rehabilitation). The questionnaire was completed by 369 respondents, of which 43.4% of respondents agreed that existing standardized measures of balance meet their needs. In ratings of individual measures, the Single Leg Stance test and Berg Balance Scale were perceived as useful for clinical decision-making and evaluating change over time by over 70% of respondents, and the Timed Up-and-Go test was perceived as useful for decision-making by 56.9% of respondents and useful for evaluating change over time by 62.9% of respondents, but there were significant differences across practice groups. Seventy-nine percent of respondents wanted to improve their assessments, identifying individual, environmental and measure-specific barriers. The most common barriers were lack of time and knowledge. This study offers new information on issues affecting the evaluation of balance in clinical settings from a broad sample of physiotherapists. Continued work to address barriers by specific practice area will be critical for the success of any intervention attempting to implement optimal balance assessment practices in the clinical setting.

Integration of Surveillance for STDs, HIV, Hepatitis, and TB: A Survey of U.S. STD Control Programs.

PubMed

Dowell, Deborah; Gaffga, Nicholas H; Weinstock, Hillard; Peterman, Thomas A

2009-01-01

Integration of surveillance for sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), hepatitis, and tuberculosis (TB) may improve disease prevention and control. We determined the extent of surveillance integration in these programs, the benefits of integration, and barriers to increased integration. We e-mailed a survey to the 58 federally funded local and state STD control programs and followed up with phone interviews of nine program representatives. The response rate was 81%. Many had compared infections by population subgroup for STDs and HIV (89%), STDs and hepatitis (53%), or STDs and TB (28%). Most (74%) had examined co-infections with HIV and STDs at the individual level and entered STD and HIV surveillance data into the same database (54%). All respondents thought some integration would be useful. Many (72%) used integrated data to disseminate information or change program strategies. The most commonly reported barriers to integration were policies preventing work with HIV data (85%) and incompatible databases (59%). Most STD control programs in the United States have some experience integrating surveillance data, but the degree of integration varies widely. Specific barriers to further integration were identified. The Centers for Disease Control and Prevention can help address these barriers by facilitating access to information and sharing technical solutions. Local and state programs can continue advancing surveillance integration by improving understanding of where integrated data are needed, increasing the use of available data, and pressing for appropriate and secure data sharing.

Survey of Kidney Biopsy Clinical Practice and Training in the United States.

PubMed

Yuan, Christina M; Nee, Robert; Little, Dustin J; Narayan, Rajeev; Childs, John M; Prince, Lisa K; Raghavan, Rajeev; Oliver, James D

2018-05-07

Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. An anonymous, on-line survey of all Walter Reed training program graduates ( n =82; 1985-2017) and all United States nephrology program directors ( n =149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. Walter Reed graduates' response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus >10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did <50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers ( P =0.02), or whose fellows performed ≥50 biopsies ( P <0.01). Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements. Copyright © 2018 by the American Society of Nephrology.

Confronting barriers and recognizing opportunities: Developing effective community-based environmental monitoring programs to meet the needs of Aboriginal communities

DOE Office of Scientific and Technical Information (OSTI.GOV)

McKay, Ariana J., E-mail: ariana.mckay@outlook.com; Johnson, Chris J., E-mail: chris.johnson@unbc.ca

Aboriginal communities can be negatively affected by resource development, but often they do not have a full opportunity to participate in project review and the resulting monitoring and mitigation activities. Cumulative impacts of resource development are also typically neglected in monitoring protocols that focus on a limited number of environmental values, rather than adopting a long-term, holistic view of development over time and space. Community-based environmental monitoring (CBEM) is emerging as a way to meaningfully include local Aboriginal citizens in the decision-making process as well as the assessment of the long-term impacts of the development of natural resources. We exploredmore » opportunities and barriers for developing CBEM programs that meet the needs of small and rural Aboriginal communities that are faced with the rapid and wide-spread development of natural resources. We conducted interviews with a local Aboriginal community, and natural resource management practitioners who could provide perspectives on the application of CBEM to resource management in north-central British Columbia, Canada. Results demonstrate that CBEM offers a locally adapted and culturally appropriate approach to facilitate the participation of Aboriginal communities in natural resource decision making and management. The interpretation of the specific role and purpose of CBEM differed among participants, depending on their objectives for and concerns about natural resource development. However, all parties were consistent in viewing CBEM as an effective method for engaging in dialogue, cooperation, and tracking environmental change. The development or improvement of CBEM programs should consider the efficacy of monitoring protocols, social cohesion and relationships, ability to inform decision-making, and effectiveness of CBEM for the members of the community. - Highlights: • We explored how to develop effective CBEM with a focus on Aboriginal communities. • We identified opportunities and barriers for developing CBEM programs. • CBEM can facilitate Aboriginal community participation in natural resource management.« less

Participation in Biodiversity Conservation: Motivations and Barriers of Australian Landholders

ERIC Educational Resources Information Center

Moon, Katie; Cocklin, Chris

2011-01-01

Biodiversity conservation programs that appeal to landholders' motivations and minimise their barriers to participation may result in both increased uptake rates and improved ecological outcomes. To understand their motivations and barriers to conserve biodiversity, qualitative interviews were conducted with 45 landholders who had participated in…

Parallel noise barrier prediction procedure : report 2 user's manual revision 1

DOT National Transportation Integrated Search

1987-11-01

This report defines the parameters which are used to input the data required to run Program Barrier and BarrierX on a microcomputer such as an IBM PC or compatible. Directions for setting up and operating a working disk are presented. Examples of inp...

Curriculum development of 6for6: Longitudinal research skills program for rural and remote family physicians.

PubMed

McCarthy, Patti; Bethune, Cheri; Fitzgerald, Shari; Graham, Wendy; Asghari, Shabnam; Heeley, Thomas; Godwin, Marshall

2016-02-01

To address barriers challenging the engagement of rural and remote family physicians (RRFPs) in research, Memorial University of Newfoundland in St John's has developed a longitudinal faculty development program (FDP) called 6for6. To establish and evaluate a longitudinal FDP that promotes a foundation of research activity. Program description Informed by a needs assessment in phase 1, phase 2 saw the 6for6 curriculum designed, developed, and implemented to reflect the unique needs of RRFPs. Preliminary evaluations have been conducted and results will be presented after year 1 of the program. The 6for6 FDP has been positively received by participants, and it is evident that they will serve as champions of rural research capacity building. It is anticipated that by April 2017, 18 RRFPs will be equipped with the research and leadership skills required to foster research networks within and outside their communities.

A conceptual framework for transferring research to practice.

PubMed

Simpson, D Dwayne

2002-06-01

Systematic evaluations of efforts to transfer research-based interventions and procedures into general practice at community drug treatment programs have been limited. However, practical experiences as well as results from studies of technology transfer and organizational behavior in related fields provide a basis for proposing a heuristic model of key factors that influence this process. The successful completion of four stages of activity typically involved in program change (exposure, adoption, implementation, and practice of new interventions) appears to be influenced by several organizational considerations (e.g., institutional readiness for change, resources, and climate) as well as staff attributes. Assessment instruments for measuring organizational functioning (based on ratings aggregated for staff and patients in a program) are introduced, along with preliminary evidence for their validity. A better conceptual understanding of the process of program change and common barriers that may be encountered is needed for effectively transferring research to practice.

Using evaluation methods to guide the development of a tobacco-use prevention curriculum for youth: a case study.

PubMed

Bridge, P D; Gallagher, R E; Berry-Bobovski, L C

2000-01-01

Fundamental to the development of educational programs and curricula is the evaluation of processes and outcomes. Unfortunately, many otherwise well-designed programs do not incorporate stringent evaluation methods and are limited in measuring program development and effectiveness. Using an advertising lesson in a school-based tobacco-use prevention curriculum as a case study, the authors examine the role of evaluation in the development, implementation, and enhancement of the curricular lesson. A four-phase formative and summative evaluation design was developed to divide the program-evaluation continuum into a structured process that would aid in the management of the evaluation, as well as assess curricular components. Formative and summative evaluation can provide important guidance in the development, implementation, and enhancement of educational curricula. Evaluation strategies identified unexpected barriers and allowed the project team to make necessary "time-relevant" curricular adjustments during each stage of the process.

Laparoscopic Suturing as a Barrier to Broader Adoption of Laparoscopic Surgery.

PubMed

Lim, Sangtaeck; Ghosh, Sudip; Niklewski, Paul; Roy, Sanjoy

2017-01-01

Laparoscopic surgery is increasingly replacing the open procedure because of its many patient-related benefits that are well aligned with policies and programs that seek to optimize health system performance. However, widespread adoption of laparoscopic surgery has been slow, in part, because of the complexity of laparoscopic suturing. The objective of this study was to review the clinical and economic impacts of laparoscopic suturing in key procedures and to assess its role as a barrier to the broader adoption of laparoscopic surgery. A medical literature search of MEDLINE, EMBASE, and BIOSIS from January 2010 through June 2016 identified 47 relevant articles. Laparoscopic suturing and intracorporeal knot tying may result in extended surgical time, complications, and surgeon errors, while improving patient quality of life through improved cosmesis, diet toleration, and better bowel movements. Despite advancement in surgical techniques and the availability of newer surgical tools, the complexity of laparoscopic suturing continues to be a barrier to greater adoption of MIS. The results of the study underscore the need for development of proficiency in laparoscopic suturing, which may help improve patient outcomes and reduce healthcare costs.

Perceived benefits and barriers and self-efficacy affecting the attendance of health education programs among uninsured primary care patients.

PubMed

Kamimura, Akiko; Nourian, Maziar M; Jess, Allison; Chernenko, Alla; Assasnik, Nushean; Ashby, Jeanie

2016-12-01

Lifestyle interventions have shown to be effective in improving health status, health behaviors, and self-efficacy. However, recruiting participants to health education programs and ensuring the continuity of health education for underserved populations is often challenging. The goals of this study are: to describe the attendance of health education programs; to identify stages of change to a healthy lifestyle; to determine cues to action; and to specify factors affecting perceived benefits and barriers to healthy food choices and physical activity among uninsured primary care patients. Uninsured primary care patients utilizing a free clinic (N=621) completed a self-administered survey from September to December of 2015. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of cues to action in attending health education programs. While self-efficacy increases perceived benefits and decreases perceived barriers for physical activity, it increases both perceived benefits and perceived barriers for healthy food choices. The participants who had attended health education programs did not believe that there were benefits for healthy food choices and physical activity. This study adds to the body of literature on health education for underserved populations. Copyright © 2016 Elsevier Ltd. All rights reserved.

Examining the Benefits and Barriers of Instructional Gardening Programs to Increase Fruit and Vegetable Intake among Preschool-Age Children

PubMed Central

Davis, Kristen L.

2017-01-01

Research exists on using instructional gardening programs with school age children as a means of improving dietary quality and for obesity prevention. This article examines the potential use of instructional gardens in childcare settings to improving fruit and vegetable intake in young children. A qualitative study was conducted with childcare providers. Participants (n = 20) were recruited via e-mails, letters, and follow-up phone calls. Interviews were recorded, transcribed, and coded to identify themes within two areas (1) childcare providers perceptions of children's fruit and vegetable consumption and (2) components necessary to initiate or improve instructional gardening programs. Themes associated with provider's perceptions of child fruit and vegetable consumption included benefits of consumption, willingness to try fruits and vegetables, meeting recommendations, and influence of the home and childcare environments on child eating. Benefits, barriers, and resources needed were identified as themes related to starting or improving instructional gardening programs. Benefits to gardening with preschoolers are consistent with those found in school-age populations. While several barriers exist, resources are available to childcare providers to address these barriers. Increased knowledge and awareness of resources are necessary to improve the success of gardening programs in the childcare setting with the goal of improving child diet quality. PMID:28607563

Examining the Benefits and Barriers of Instructional Gardening Programs to Increase Fruit and Vegetable Intake among Preschool-Age Children.

PubMed

Davis, Kristen L; Brann, Lynn S

2017-01-01

Research exists on using instructional gardening programs with school age children as a means of improving dietary quality and for obesity prevention. This article examines the potential use of instructional gardens in childcare settings to improving fruit and vegetable intake in young children. A qualitative study was conducted with childcare providers. Participants ( n = 20) were recruited via e-mails, letters, and follow-up phone calls. Interviews were recorded, transcribed, and coded to identify themes within two areas (1) childcare providers perceptions of children's fruit and vegetable consumption and (2) components necessary to initiate or improve instructional gardening programs. Themes associated with provider's perceptions of child fruit and vegetable consumption included benefits of consumption, willingness to try fruits and vegetables, meeting recommendations, and influence of the home and childcare environments on child eating. Benefits, barriers, and resources needed were identified as themes related to starting or improving instructional gardening programs. Benefits to gardening with preschoolers are consistent with those found in school-age populations. While several barriers exist, resources are available to childcare providers to address these barriers. Increased knowledge and awareness of resources are necessary to improve the success of gardening programs in the childcare setting with the goal of improving child diet quality.

Barriers to health education in adolescents: health care providers' perspectives compared to high school adolescents.

PubMed

Abedian, Kobra; Shahhosseini, Zohreh

2015-11-01

Although adolescence is marked by profound and dynamic changes, it is virtually neglected by health care providers, by society, and even by most parents, teachers, and health professionals. The aim of this study was to investigate barriers to health education in adolescents from health care providers' views compared to teens. The study population consisted of 72 health care providers and 402 high school female students in Northern Iran in 2012. They completed a self-administered questionnaire about their views on barriers to adolescents' health education. It is revealed that the major barrier to adolescents' health education from a health care providers' perspective is "Lack of private room for adolescents' health education", while "Lack of adolescents' interest to content of educational programs" is a significantly greater barrier to health education among adolescents. The results suggest that for adolescent health education, specific strategies should be used in adolescent health promotion programs.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cappers, Peter; MacDonald, Jason; Goldman, Charles

This study provides an examination of various market and policy barriers to demand response providing ancillary services in both ISO/RTO and non-ISO/RTO regions, especially at the program provider level. It is useful to classify barriers in order to create a holistic understanding and identify parties that could be responsible for their removal. This study develops a typology of barriers focusing on smaller customers that must rely on a program provider (i.e., electric investor owned utility or IOU, ARC) to create an aggregated DR resource in order to bring ancillary services to the balancing authority. The barriers were identified through examinationsmore » of regulatory structures, market environments, and product offerings; and discussions with industry stakeholders and regulators. In order to help illustrate the differences in barriers among various wholesale market designs and their constituent retail environments, four regions were chosen to use as case studies: Colorado, Texas, Wisconsin, and New Jersey.« less

Structural barriers in access to medical marijuana in the USA-a systematic review protocol.

PubMed

Valencia, Celina I; Asaolu, Ibitola O; Ehiri, John E; Rosales, Cecilia

2017-08-07

There are 43 state medical marijuana programs in the USA, yet limited evidence is available on the demographic characteristics of the patient population accessing these programs. Moreover, insights into the social and structural barriers that inform patients' success in accessing medical marijuana are limited. A current gap in the scientific literature exists regarding generalizable data on the social, cultural, and structural mechanisms that hinder access to medical marijuana among qualifying patients. The goal of this systematic review, therefore, is to identify the aforementioned mechanisms that inform disparities in access to medical marijuana in the USA. This scoping review protocol outlines the proposed study design for the systematic review and evaluation of peer-reviewed scientific literature on structural barriers to medical marijuana access. The protocol follows the guidelines set forth by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. The overarching goal of this study is to rigorously evaluate the existing peer-reviewed data on access to medical marijuana in the USA. Income, ethnic background, stigma, and physician preferences have been posited as the primary structural barriers influencing medical marijuana patient population demographics in the USA. Identification of structural barriers to accessing medical marijuana provides a framework for future policies and programs. Evidence-based policies and programs for increasing medical marijuana access help minimize the disparity of access among qualifying patients.

Comparison of Home Retrofit Programs in Wisconsin

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cunningham, Kerrie; Hannigan, Eileen

2013-03-01

To explore ways to reduce customer barriers and increase home retrofit completions, several different existing home retrofit models have been implemented in the state of Wisconsin. This study compared these programs' performance in terms of savings per home and program cost per home to assess the relative cost-effectiveness of each program design. However, given the many variations in these different programs, it is difficult to establish a fair comparison based on only a small number of metrics. Therefore, the overall purpose of the study is to document these programs' performance in a case study approach to look at general patternsmore » of these metrics and other variables within the context of each program. This information can be used by energy efficiency program administrators and implementers to inform home retrofit program design. Six different program designs offered in Wisconsin for single-family energy efficiency improvements were included in the study. For each program, the research team provided information about the programs' approach and goals, characteristics, achievements and performance. The program models were then compared with performance results-program cost and energy savings-to help understand the overall strengths and weaknesses or challenges of each model.« less