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ABSTRACT For patients with mental illnesses (MIs), emergency departments (EDs) are often the entry point into the healthcare system, or their only resort for quickly accessing mental health treatment. A better understanding of the various barriers justifying high ED use among patients with MIs may help recommend targeted interventions that better meet their needs. This explorative qualitative study aimed to identify such barriers and the solutions brought forth to reduce ED use based on the perspectives of clinicians and managers working in EDs, other hospital departments or the community sector. Interviews were conducted between April 2021 and February 2022; 86 mental health professionals (22% were nurses) from four large urban ED sites in Quebec (Canada) were interviewed. Barriers were identified in relation to patient profiles, healthcare system and organisational features and professional characteristics. The key barriers that were found to explain high ED use were patients having serious MIs (e.g., psychotic disorders) or social issues (e.g., poverty), lack of coordination and patient referrals between EDs and other health services, insufficient access to mental health and addiction services and inadequacy of care. Very few solutions were implemented to improve care for high ED users. Better deployment of ED interventions in collaboration with outpatient care may be prioritised to reduce high ED use for patients with MIs. Improvements to the referral and transfer processes to outpatient care, particularly through care plans and case management programs, may be implemented to reduce high ED use and improve outpatient care among patients with multiple health and social needs. [ABSTRACT FROM AUTHOR]

The global loss of coastal habitats is putting communities at risk of erosion and flooding, as well as impacting ecosystem function, cultural values, biodiversity, and other services. Coastal habitat restoration can provide a nature-based solution to the increasing need for climate adaptation on the coast while recovering lost ecosystems. Despite the benefits of using nature-based coastal protection to manage coastal hazards, there are scientific, sociopolitical and economic barriers to the broad use of this approach. Understanding the details of these barriers from the perspective of multiple stakeholders is essential to identifying solutions to overcome them. Using a workshop with participants that are key partners and stakeholders (from government, engineering consulting firms, and non-governmental organisations) in the management, design, and delivery of a coastal protection solution we aimed to: (1) gain a better understanding of the barriers faced by multiple stakeholders involved in the implementation of nature-based coastal protection; and (2) identify tangible solutions to these barriers to increase or support implementation, help focus attention on areas for future research, and inform pathways forward for the governance of nature-based coastal protection. We defined 19 barriers to nature-based coastal protection, but the primary ones that are experienced during the delivery of a project are a lack of: education and awareness; community support; necessary expertise and technical guidance; and uncertainty around: the risk reduction that can be achieved; planning and regulatory processes; and ownership of the structure. Two barriers that do not persist during the design stages of a project but are overarching as to whether nature-based coastal protection is considered in the first place, are government support and the availability of funding. The importance of these primary barriers changes depending on the method of nature-based coastal protection. We conclude by identifying both immediate actions and long-term solutions for enabling nature-based coastal protection in response to each of the primary barriers. [ABSTRACT FROM AUTHOR]

AIM: We aimed to identify the barriers to compliance with infection prevention and control (IPC) measures and gather solutions by interviewing health care workers (HCWs) in intensive care units (ICUs). BACKGROUND: In the European Union, 33,000 deaths occur annually due to antibiotic-resistant infections. More than 70% of these antibiotic-resistant infections are directly related to healthcare-associated infections (HAIs). The implementation of IPC measures is critical in ICUs, where the risk of transmission of these resistant bacteria is highest. However, the compliance rate of HCWs with IPC is not the desired levels. METHODS: In-depth interviews were conducted with 20 HCWs (Table 1) in five tertiary hospitals in Istanbul between 1 March and 31 May 2024. A purposive sampling method was used to include at least three HCWs from each hospital. The conceptual framework of the semi-structured interview guide was based on the Health Belief Model. RESULTS: Many HCWs (13/20) believed that the activities of infection control committees (13/20) and IPC training programmes (6/15) were not sufficient to increase compliance with IPC measures. A majority (14/18) of HCWs believe that financial sanctions would be an effective tool to increase compliance with IPC measures. The barriers and solutions of HCWs in ICUs that make compliance with IPC measures difficult are detailed in Table 2. CONCLUSIONS: According to HCWs, increased workload, structural issues, and inefficient training modules were identified as the main IPC barriers. Qualitative research conducted with HCWs can guide us in identifying areas to focus on when planning IPC implementations.

This research project explored the factors affecting the adoption of an innovative and active English language teaching (ELT) strategy by Lao teachers. It also investigated why many teachers found it difficult to adopt the strategy and how an understanding of this difficulty resulted in the creation of an in-service teacher training program. Qualitative data were collected in two time ranges, the first in 2009-2013 obtained from 84 Lao English language teachers, and the second in Summer 2023 consisting of an audio interview with the first author which was an update on what had occurred 10 years after the original data collection. Findings from the first dataset indicated that teachers’ internal realities, specifically socio-economic standing, locus of control, self-efficacy, and problem-solving bent, mediated their responses to external realities, namely poverty and limitations in teacher training, student attainment, testing and resources, and the culture-infused school code. These internal and external realities functioned as barriers to the adoption of innovative ELT strategies. Applications of these findings resulted in the creation of a culturally relevant in-service teacher training program, one that incorporated an awareness of these internal and external realities. which then enabled Lao teachers to implement innovative ELT strategies. This paper aims to demonstrate what successful culturally relevant in-service teacher training looks like in rural Laos.

The global loss of coastal habitats is putting communities at risk of erosion and flooding, as well as impacting ecosystem function, cultural values, biodiversity, and other services. Coastal habitat restoration can provide a nature-based solution to the increasing need for climate adaptation on the coast while recovering lost ecosystems. Despite the benefits of using nature-based coastal protection to manage coastal hazards, there are scientific, socio-political and economic barriers to the broad use of this approach. Understanding the details of these barriers from the perspective of multiple stakeholders is essential to identifying solutions to overcome them. Using a workshop with participants that are key partners and stakeholders (from government, engineering consulting firms, and non-governmental organisations) in the management, design, and delivery of a coastal protection solution we aimed to: (1) gain a better understanding of the barriers faced by multiple stakeholders involved in the implementation of nature-based coastal protection; and (2) identify tangible solutions to these barriers to increase or support implementation, help focus attention on areas for future research, and inform pathways forward for the governance of nature-based coastal protection. We defined 19 barriers to nature-based coastal protection, but the primary ones that are experienced during the delivery of a project are a lack of: education and awareness; community support; necessary expertise and technical guidance; and uncertainty around: the risk reduction that can be achieved; planning and regulatory processes; and ownership of the structure. Two barriers that do not persist during the design stages of a project but are overarching as to whether nature-based coastal protection is considered in the first place, are government support and the availability of funding. The importance of these primary barriers changes depending on the method of nature-based coastal protection. We conclude by identifying both immediate actions and long-term solutions for enabling nature-based coastal protection in response to each of the primary barriers.

Green Logistics (GL) and Reverse Logistics (RL) concepts are important for the sustainable development of logistics activities. Although the concept of RL seems to be a part of GL, it is not correct to consider all activities carried out within RL within the scope of GL and it is important to integrate these two concepts. To support the Sustainable Development Goals (SDGs), these two concepts are discussed in an integrated manner in this study. The main objectives of this study are to find barriers in the RL and GL concepts, to cluster barriers, and to present solution strategies. In this study, 21 barriers to GL and 28 barriers to RL are determined by a detailed literature review under the categories of Management & Organizational, Economic & Financial, Social, Technology & Infrastructure, Environment, and Legal. GL and RL barriers are clustered and 17 solution strategies are presented within the scope of Green Reverse Logistics (GRL) with the support of a literature review and expert opinion. Developed solution strategies are examined by the Fuzzy DEMATEL, FUCOM, and SWARA methods. The solution strategies are assessed, and their impact levels are ranked through the applied methods. As a result of the study, it is seen that the strategies that affect all strategies the most are “Provision of financial, administrative, and infrastructure support” and “Increase of public awareness on environmental”. In the results of the research, it is determined that the four most effective solution strategies are “Increase of public awareness on environmental”, “Collaboration between functions & stakeholders”, “Provision of financial, administrative, and infrastructure support”, and “Benchmarking the practices”. Such a detailed study has not been found, and it is thought that the study will lead to the development of a sustainable understanding in terms of both addressing GRL problems together and developing solution strategies. Implementing the strategies in the order determined as a result of the study will support the effective removal of barriers to GRL.

This research project explored the factors affecting the adoption of an innovative and active English language teaching (ELT) strategy by Lao teachers. It also investigated why many teachers found it difficult to adopt the strategy and how an understanding of this difficulty resulted in the creation of an in-service teacher training program. Qualitative data were collected in two time ranges, the first in 2009-2013 obtained from 84 Lao English language teachers, and the second in Summer 2023 consisting of an audio interview with the first author which was an update on what had occurred 10 years after the original data collection. Findings from the first dataset indicated that teachers' internal realities, specifically socio-economic standing, locus of control, self-efficacy, and problem-solving bent, mediated their responses to external realities, namely poverty and limitations in teacher training, student attainment, testing and resources, and the culture-infused school code. These internal and external realities functioned as barriers to the adoption of innovative ELT strategies. Applications of these findings resulted in the creation of a culturally relevant in-service teacher training program, one that incorporated an awareness of these internal and external realities. which then enabled Lao teachers to implement innovative ELT strategies. This paper aims to demon1strate what successful culturally relevant in-service teacher training looks like in rural Laos. [ABSTRACT FROM AUTHOR]

The main purpose of this descriptive-analytical study was to identify and explain the barriers to protection of water resources in the Urmia Lake Basin. Participants in this research were key experts and informants in UL Rehabilitation Headquarters, Urmia University, Agriculture-Jihad Organizations, Regional Water Companies, Departments of Environmental Protection and Agricultural and Natural Resources Research and Education Centers in three provinces of West Azerbaijan, East Azerbaijan and Kurdistan among which 19 people were selected through purposive sampling method for doing the research. Semi-structured interviews (in individual and group form) were used to collect data and the data were analyzed using MAXQDA software. The results of the study showed that barriers to water resources protection in the Urmia Lake Basin were in the form of 28 different signs among which not using the real participation of stakeholders in water resources management (among the signs related to social-cultural barriers), lack of promotion of sustainable and compatible livelihoods with water resources at the basin level (among the signs related to economic barriers), lack of sufficient coherence for decision-making between local, provincial and national levels (among the signs related to organizational-Institutional barriers), the lack of comprehensive water distribution law (among the signs related to legal-administrative barriers) and top-down management of water resources (among the signs related to management barriers) had the highest priorities compared to other signs. Finally, based on the research findings, some strategies were presented to eliminate barriers to the protection of water resources in the Urmia Lake Basin. [ABSTRACT FROM AUTHOR]

Turki Alanzi Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia Purpose: In this paper I present a perspective of mobile health (mHealth) technologies for diabetes in conjunction with an overview of the current status of mHealth technologies for diabetes self-management and the clinical evidence in the Kingdom of Saudi Arabia. In addition, a small survey to identify the barriers to mHealth for diabetes care in the Kingdom and the relevant solutions are discussed. Participants and methods: In order to study the relevant obstacles for adopting mHealth solutions for diabetes care and to suggest appropriate solutions, a small survey study was conducted with a specific questionnaire deployed to >40 anonymous leading health care professionals and decision-makers of the Kingdom. The survey was distributed by means of a link to the target population through a WhatsApp group. The data were collected during 1 month, and three reminders were sent to the group to complete the survey. Basic descriptive statistics were used to analyze the survey data. Results: The high percentages of agreement among the participants suggest that mHealth expertise and human shortage; funding and infrastructure investments; legal, privacy standardization and regulatory obstacles; and health care organizational and bureaucracy impediments are barriers to the implementation of mHealth technologies in the self-management of diabetes in this region. However, most of these barriers can be mitigated by the creation of the appropriate leadership and clinical environment in the current health care system. Conclusion: The mHealth technologies for diabetes self-management have not yet been translated successfully in the Kingdom of Saudi Arabia as it was detected in the literature review carried out in this work. Among other possibilities, the causes of this situation are the existence of human, organizational, funding, bureaucracy, and legal barriers, as shown by the results of the survey conducted among decision-makers and senior clinicians of the Kingdom of Saudi Arabia. Keywords: mHealth, diabetes self-management, Kingdom of Saudi Arabia, barriers and solutions

BACKGROUND: There is a growing global movement toward quality and safety in healthcare and quality improvement (QI) in general surgery. The first step in any QI initiative is identifying the challenges and barriers to achieve such goals and then to define appropriate actions. This study aims to provide an overview of the QI challenges in Iranian hospitals' surgery-related processes and suggest applied solutions accordingly. METHODS: This is a sequential (qual-quant) mixed-method study from November 2019 to January 2020, involving 21 face-to-face interviews with hospital managers, quality officers, and surgery-related clinicians and staff, followed by a Delphi consensus-seeking stage to finalize solutions. MAXQDA software was applied for organizing the concepts, and thematic content analysis was used for analyzing the data as an inductive approach to extract the emerging themes and sub-themes. RESULTS: The managerial problems were classified into four groups of (I) defects and delays in completing patient medical records, (II) irregularity and the lack of transparency in the direction of processes in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poor safety considerations. The proposed solutions included imposing stricter regulations for competing for medical records, such as reduction of payments, development of guiding brochures or protocols for patients on their arrival, assigning a certain number of experienced nurses and surgeons for schedule management, rewarding the report of medical and surgical error cases, and developing a regular monitoring program for the proper implementation of surgical safety guidelines. CONCLUSION: There are various managerial barriers that hamper QI in hospitals' surgery-related processes. Implementing simple but agreed solutions can lead to saving patients' lives, reduction of the unnecessary use of resources, and enhance of patient and staff satisfaction.

Em Portugal surge, em 2006, a Rede Nacional de Cuidados Continuados Integrados - RNCCI, que procura proporcionar cuidados continuados às pessoas idosas e cidadãos com dependência. Neste contexto, onde os enfermeiros desempenham um papel preponderante, há uma grande lacuna de estudos que possam inclusive apontar as barreiras nos Cuidados Continuados (CC). Considerando este facto, este estudo teve como objectivo conhecer as barreiras percebidas pelos(as) enfermeiros(as) no desenvolvimento dos cuidados continuados a pessoas idosas, numa unidade de cuidados continuados integrados e as possíveis soluções para melhorar a sua efectividade. A abordagem qualitativa e o método exploratório-descritivo foram adoptados no desenvolvimento deste estudo. Os dados foram recolhidos através de entrevista semi-estruturada com treze enfermeiros(as) e analisados com base no método hermenêutico-dialéctico. Os resultados do estudo evidenciaram que as barreiras e as possíveis soluções são maioritariamente de ordem administrativa, financeira e organizacional, as quais dificultam a efectividade dos cuidados continuados às pessoas idosas nesta unidade.En Portugal surge, en 2006, la Red Nacional de Cuidados Continuos Integrados - RNCCI, que pretende proporcionar cuidados continuos a las personas ancianas y ciudadanos con depedencia. En este contexto, donde los enfermeros desempeñan un papel preponderante, hay una gran laguna de estudios, que pueden incluso apuntar a las barreras en los Cuidados Continuos (CC). Considerando este hecho, este estudio ha tenido como objetivo, conocer las barreras percibidas por los(as) enfermeros(as) en el desarrollo de los cuidados continuos a personas ancianas en una unidad de cuidados continuos integrados y las posibles soluciones para mejorar su efectividad. El abordaje cualitativo y el método exploratorio-descriptivo fueron adoptados en el desarrollo de este estudio. Los datos fueron recogidos a través de entrevistas semi-estructuradas con trece enfermeros(as) y analizados con base en el método hermenéutico-dialéctico. Los resultados del estudio evidenciaron que las barreras y las posibles soluciones son mayoritariamente de orden administrativo, financiero y organizacional, las cuales dificultan la efectividad de los cuidados continuos a las personas ancianas en esta unidad.The National Network for Integrated Continuing Care (RNCCI) was created in Portugal, in 2006 to provide continuing care for the elderly and for dependent citizens. In this context, where nurses play an class="medium-text1">a leading role, there is a lack of studies which could identify barriers to Continuing Care (CC). Therefore, the aim of this study was to identify the barriers perceived by nurses to the development of continuing care for the elderly in an Integrated Continuing Care Unit and possible solutions to improve effectiveness. A qualitative, exploratory, descriptive approach was adopted for the study. Data were collected through semi-structured interviews with 13 nurses and analyzed using a hermeneutic-dialectic method. The results showed that the barriers and possible solutions which hinder the effectiveness of CC for the elderly in this unit are mainly administrative, financial and organisational.

The National Network for Integrated Continuing Care (RNCCI) was created in Portugal, in 2006 to provide continuing care for the elderly and for dependent citizens. In this context, where nurses play a leading role, there is a lack of studies which could identify barriers to Continuing Care (CC). Therefore, the aim of this study was to identify the barriers perceived by nurses to the development of continuing care for the elderly in an Integrated Continuing Care Unit and possible solutions to improve effectiveness. A qualitative, exploratory, descriptive approach was adopted for the study. Data were collected through semi-structured interviews with 13 nurses and analyzed using a hermeneutic-dialectic method. The results showed that the barriers and possible solutions which hinder the effectiveness of CC for the elderly in this unit are mainly administrative, financial and organisational. [ABSTRACT FROM AUTHOR]