Project description:BackgroundWith the emergence of the coronavirus disease 2019 (COVID-19) and rapid vaccine development, research interest in vaccine hesitancy (VH) has increased. Research usually focuses on quantitative estimates which largely neglected the qualitative underpinnings of this phenomenon. This study aimed to explore the beliefs and views towards COVID-19 vaccination among Arabs in different countries. Furthermore, we explored the effect of confidence in the healthcare system, misinformation, and scientific approaches adopted to mitigate COVID-19 on how individuals are following the recommended preventative actions including vaccination.MethodsThis study was based on the Strategic Advisory Group of Experts (SAGE)-VH Model: A qualitative design that utilized in-depth, online interviews. The study was conducted in seven Arab countries (Egypt, Qatar, Kingdom of Saudi Arabia, Libya, Sudan, United Arab Emirates and Jordan) from June 2020 to December 2021. Transcripts were analyzed using NVivo 12 Software.ResultsA total of 100 participants, 44 males and 56 females, of different age groups (37.1 ± 11.56 years) were interviewed. Findings revealed six themes as enablers and barriers to COVID-19 vaccination. Many participants indicated trusting the vaccines, the healthcare systems, and the vaccination policies were the main driver to get the vaccine. Participants showed concerns towards potential long-term vaccine effects. A consistent inclination towards collective responsibility, which is the willingness to protect others by own vaccination, was also reported.ConclusionEnablers and barriers of COVID-19 vaccination acceptance in the Arab region, from sociocultural and political perspectives, are critical to guide policymakers in designing target-oriented interventions that can improve vaccine acceptance.
Project description:ObjectiveThere is a growing concern about the sustainability of healthcare and the impacts of 'overuse' on patients and systems. Quaternary prevention (P4), a concept promoting the protection of patients from medical interventions in which harms outweigh benefits, is well positioned to stimulate reflection and inspire solutions, yet has not been widely adopted. We sought to identify enablers and barriers to a P4 approach, according to field experts and advocates in one health system.DesignQualitative methodology, using semistructured interviews and a grounded theory approach facilitated thematic analysis and development of a conceptual model.SettingVirtual interviews, conducted in British Columbia, Canada.Participants12 field experts, recruited based on their interest and work related to P4 and related concepts.ResultsFour factors were seen as promoting or hindering P4 efforts depending on context: relationship between patient and clinician, education of clinicians and the public, health system design and influencers. We extracted four broad enablers of P4: evidence-based medicine, personal experiences and questioning attitude, public P4 campaigns and experience in resource-poor contexts. There were six barriers: peer pressure between clinicians, awareness and screening campaigns, cognitive biases, cultural factors, complexity of the problem and industry influence.ConclusionsElicited facilitators and impediments to the application of P4 were similar to those seen in existing literature but framed uniquely; our findings place increased emphasis on the clinician-patient relationship as central to decision-making and position other drivers as influencing this relationship. A transition to a model of care that explicitly integrates conscious protection of patients by reducing overtesting, overdiagnosis and overtreatment will require changes across health systems and society.
Project description:Cancer is a life-threatening illness affecting all dimensions of a person's health. Cancer survivors must build resilience to face this adversity and continue their life projects. The present study explores the enablers, barriers, and strategies to build resilience among cancer survivors. This qualitative, descriptive exploratory study will use purposive sampling to recruit cancer survivors and healthcare professionals from two hospital centers in Lisbon and Tagus Valley. Interviews will be conducted until data saturation occurs. Data analysis will be performed using an inductive content analysis process with the help of the QDA Miner Lite database. The findings from this study will generate knowledge that may help stakeholders to identify effective strategies to build resilience among cancer survivors. By implementing strategies to foster resilience, healthcare professionals can potentially promote positive adaptations to cancer by strengthening resilience enablers and reducing the impact of barriers.
Project description:Background: Hypertension remains a significant public health challenge in Ghana. Understanding the experiences of hypertensive patients can inform strategies to improve their management. This study explored the perceived enablers and barriers to hypertension management among patients in the Ashanti region, Ghana, using the Chronic Care Model as a framework. Methods: In-depth interviews were conducted with 20 hypertensive patients receiving care at Komfo Anokye Teaching Hospital. Inductive thematic analysis was employed to identify key themes and subthemes. Results: Several barriers to hypertension management emerged, including economic constraints, environmental and lifestyle factors, knowledge and awareness deficits, medication-related issues, and policy and provider-level barriers. Conversely, enablers such as patient empowerment, education, healthcare access, and policy and provider support and relationships were identified. Conclusions: Effective hypertension management requires addressing a complex interplay of barriers and enablers. Interventions targeting economic factors, lifestyle modifications, knowledge dissemination, medication adherence, and systemic improvements are crucial. Additionally, empowering patients, enhancing education, improving healthcare access, and fostering strong provider-patient relationships can significantly contribute to better outcomes. Future research should investigate the impact of a multi-level intervention on hypertension management in Ghana.
Project description:In hospitals, patient falls prevention education is frequently delivered by nurses and allied health professionals. Hospital falls rates remain high globally, despite the many systems and approaches that attempt to mitigate falling. The aim of this study was to investigate health professional views on the enablers and barriers to providing patient falls education in hospitals. Four focus groups with 23 nursing and allied health professionals were conducted at 3 hospitals. Three researchers independently coded the data and findings were analysed thematically with a descriptive qualitative approach to identify and develop themes according to barriers and enablers. Barriers included (i) limited interprofessional communication about patient falls; (ii) sub-optimal systems for falls education for patients and health professionals, and (iii) perceived patient-related barriers to falls education. Enablers to providing patient falls education included: (i) implementing strategies to increase patient empowerment; (ii) ensuring that health professionals had access to effective modes of patient education; and (iii) facilitating interprofessional collaboration. Health professionals identified the need to overcome organisational, patient and clinician-related barriers to falls education. Fostering collective responsibility amongst health professionals for evidence-based falls prevention was also highlighted.
Project description:ObjectiveCardiovascular disease is the main cause of death worldwide. The leading risk factor, hypertension, is a major public health issue in Senegal, putting the health system under pressure. This qualitative study aimed to investigate how patients progress along the cascade of care of hypertension screening, diagnosis, treatment and control in Dakar, Senegal, in the context of the CARDIO4Cities initiative-a multisectoral urban population health initiative targeting cardiovascular risk factors in various cities globally.Design and settingA qualitative case study in Dakar, Senegal, was conducted to map the cascade of hypertension care and identify enablers and barriers for patient progression across the cascade of care.Participants and analysisTwelve semistructured interviews were conducted with community and healthcare actors in three districts of the city of Dakar. A systems thinking lens and method, called process mapping, was used to guide the qualitative research and the analysis of the results.ResultsThe process analysis delineated four themes as enablers of patient progression: improved management processes in primary care for hypertension; community outreach and engagement; data generation for healthcare provider monitoring of the hypertension cascade of care; and providing access to hypertension screening, monitoring and management tools. Barriers across the cascade were patients' low socio-economic status; trivialisation and denial of the disease; systemic challenges in the health system, such as high healthcare provider turnover; traditional gender roles that influence access to healthcare; and inefficiencies of new tools hindering healthcare provider engagement and workflow integration.ConclusionsA wide range of patient, health system and contextual factors were identified as facilitating and hindering the progression of hypertension patients across the cascade of care in Dakar, Senegal. The structural determinants of health and systemic challenges in the health system were highlighted as prominent barriers, suggesting the need for upstream, system-oriented interventions for hypertension care in Dakar.
Project description:BackgroundAudit and feedback entails systematic documentation of clinical performance based on explicit criteria or standards which is then fed back to professionals in a structured manner. There are potential significant returns on investment from partnerships between existing clinical audit programmes in coordinated programmes of research to test ways of improving the effect of their feedback to drive greater improvements in health care delivery and population outcomes. We explored barriers to and enablers of embedding audit and feedback trials within clinical audit programmes.MethodsWe purposively recruited participants with varied experience in embedded trials in audit programmes. We conducted qualitative semi-structured interviews, guided by behavioural theory, with researchers, clinical audit programme staff and health care professionals. Recorded interviews were transcribed, and data coded and thematically analysed.ResultsWe interviewed 31 participants (9 feedback researchers, 14 audit staff and 8 healthcare professionals, many having dual roles). We identified barriers and enablers for all 14 theoretical domains but no relationship between domains and participant role. We identified four optimal conditions for sustainable collaboration from the perspectives of stakeholders: resources, that is, recognition that audit programmes need to create capacity to participate in research, and research must be adapted to fit within each programme's constraints; logistics, namely, that partnerships need to address data sharing and audit quality, while securing research funding to ensure operational success; leadership, that is, enthusiastic and engaged audit programme leaders must motivate their team and engage local stakeholders; and relationships, meaning that trust between researchers and audit programmes must be established over time by identifying shared priorities and meeting each partner's needs.ConclusionSuccessfully embedding research within clinical audit programmes is likely to require compromise, logistical expertise, leadership and trusting relationships to overcome perceived risks and fully realise benefits.
Project description:BackgroundThe management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation of a quality improvement programme Rescue for Emergency Surgery Patients Observed to uNdergo acute Deterioration (RESPOND).MethodsThe research used ethnographic methods, including over 100 hours of observations on surgical units in three English hospitals in order to understand the everyday context of care. Observations focused on the coordination of activities such as handovers and how rescue featured as part of this. We also conducted 27 interviews with a range of clinical and managerial staff and patients. We employed a thematic analysis approach, combined with a theoretically focused implementation coding framework, based on Normalisation Process Theory.ResultsWe found that organisational infrastructural support in the form of a leadership support and clinical care outreach teams with capacity were enablers in implementing the patient-led escalation system. Barriers to implementation included making changes to professional practice without discussing the value and legitimacy of operationalising patient concerns, and ensuring equity of use. We found that organisational work is needed to overcome patient fears about disrupting social and cultural norms.ConclusionsThis paper reveals the need for infrastructural support to facilitate the implementation of a patient-led escalation system, and leadership support to normalise the everyday process of involving patients and families in escalation. This type of system may not achieve its goals without properly understanding and addressing the concerns of both nurses and patients.
Project description:BackgroundInternational efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.MethodsTwenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.ResultsFour key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.DiscussionOur findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.
Project description:ObjectiveTo identify barriers and enablers to COVID-19 vaccination in renal transplant recipients who are undecided about vaccination.MethodsAn online survey was distributed to 876 adult kidney transplant recipients at a tertiary referral service, who had not been vaccinated against COVID-19. The survey assessed willingness to be vaccinated, attitudes toward COVID-19 vaccines, and barriers and enablers to proceeding with vaccination.ResultsThe survey response rate was 54% (473/876). Three hundred and forty-six (73.1%) participants planned to receive vaccination (yes group), 105 (22.2%) were undecided, and 22 (4.7%) refused vaccination. The undecided group were younger but were not different in other demographic characteristics to the yes group. The undecided group were less positive toward (34.29% vs. 91.3%, p < .001) and more concerned about (93.3% vs. 25.1%, p < .001) vaccination than the yes group. Their concerns related to vaccine safety (including harm to their transplant), poor efficacy, and a lack of rigorous testing in transplant recipients. Undecided recipients had received less vaccine-specific information from medical specialists than the yes group. Most undecided participants (95.1%) were willing to proceed with vaccination with appropriate supports. The most desired supports were information and a recommendation to proceed with vaccination from their treating transplant specialist and team.Conclusion(s)Concerns about vaccine safety (including harm to transplant), poor vaccine efficacy, and lack of rigorous testing were barriers to vaccine uptake. Most undecided recipients would proceed with vaccination with specific recommendations and vaccine information provided by their transplant specialist/team. These simple interventions can be readily implemented to optimize vaccine uptake.