Abstract Objective To systematically review patient-reported barriers and facilitators to shared decision making (SDM) and develop a taxonomy of patient-reported barriers. Methods Systematic review ...and thematic synthesis. Study findings/results for each included paper were extracted verbatim and entered into qualitative software for inductive analysis. Results Electronic and follow-up searches yielded 2956 unique references; 289 full-text articles were retrieved, of which 45 articles from 44 unique studies met inclusion criteria. Key descriptive themes were grouped under two broad analytical themes: how the healthcare system is organized (4 descriptive themes) and what happens during the decision-making interaction (4 descriptive themes, 10 sub-themes). Predominant emergent themes related to patients’ knowledge and the power imbalance in the doctor–patient relationship. Patients need knowledge and power to participate in SDM – knowledge alone is insufficient and power is more difficult to attain. Conclusion Many barriers are potentially modifiable, and can be addressed by attitudinal changes at the levels of patient, clinician/healthcare team, and the organization. The results support the view that many patients currently can’t participate in SDM, rather than they won’t participate because they do not want to. Practice implications Future implementation efforts should address patient-reported factors together with known clinician-reported barriers and the wider organizational context.
Facilitators of professional development (PD) for mathematics teachers currently gain increasing attention, as their practices are crucial for the success of spreading mathematics educational ideas ...and innovations into schools and strengthening the professional expertise of teachers. So far, mainly two components of facilitation have been empirically researched: facilitators’ knowledge resources and facilitation moves. In this paper, we propose to develop a more comprehensive conceptual framework in order to explain facilitators’ practices and underlying decisions. For this purpose, we lift Schoenfeld’s ROG framework for teachers' decision-making (comprising resources, orientations, and goals) to the facilitator level, and add identity as a fourth component to obtain what we call the ROGI framework. We draw on data collected simultaneously in two PD projects for mathematics teachers in Germany and in Israel. Through three cases of facilitation, we illustrate how the adapted ROGI framework helps to understand processes of decision-making made by facilitators during mathematics professional development sessions.
Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as ...face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care.
This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice.
A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice.
A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on the context, these determinants hinder or facilitate successful implementation of eMH.
Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients' mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided.
Recently, perovskite solar cells (PSC) with high power‐conversion efficiency (PCE) and long‐term stability have been achieved by employing 2D perovskite layers on 3D perovskite light absorbers. ...However, in‐depth studies on the material and the interface between the two perovskite layers are still required to understand the role of the 2D perovskite in PSCs. Self‐crystallization of 2D perovskite is successfully induced by deposition of benzyl ammonium iodide (BnAI) on top of a 3D perovskite light absorber. The self‐crystallized 2D perovskite can perform a multifunctional role in facilitating hole transfer, owing to its random crystalline orientation and passivating traps in the 3D perovskite. The use of the multifunctional 2D perovskite (M2P) leads to improvement in PCE and long‐term stability of PSCs both with and without organic hole transporting material (HTM), 2,2′,7,7′‐tetrakis‐(N,N‐di‐p‐methoxyphenyl‐amine)‐9,9′‐spirobifluorene (spiro‐OMeTAD) compared to the devices without the M2P.
Self‐crystallized multifunctional 2D perovskite (M2P) is formed on top of a 3D perovskite light absorber. The M2P layer performs as a hole‐transfer facilitator and a surface‐trap passivator in perovskite solar cells (PSCs). PSCs using the developed 3D/2D perovskites achieve a power conversion efficiency of 20.79% with highly improved long‐term stability compared to devices without M2P.
OBJECTIVES:Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to ...implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years).
METHODS:Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach.
RESULTS:Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization.
CONCLUSIONS:Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required.
The many genres of action learning have contributed to solving business and social problems, individual development and organisational learning. Different authors have scrutinised the role of the ...action-learning facilitator in upholding the precepts of action learning. Whilst the responsibilities of the facilitator to the group are significant, this paper concentrates on the personal transformation of facilitators who have transitioned into the role in an application of business-driven action learning. Hence, this study explores how individuals who took on the role of action-learning facilitator experienced genuine personal development. This exploration, within a South African context, offers a perspective on facilitator growth, a subject which has not gained much traction in the action-learning literature. The findings offer insight into the internalisation of action-learning principles, critical shifts and heightened learnings for facilitators.
•Novice facilitators’ changes in practices in two different countries are examined.•Despite the different contexts, changes in practices are found to be similar.•Practices are linked to facilitators’ ...resources, orientations, goals and identity.•Managing mathematics teachers' PD discussions can be learned and developed.•Recommendations for supporting novice facilitators of are presented.
Novice facilitators of professional development (PD) programs for mathematics teachers often face challenges in leading productive discussions and achieving the goals of these programs. Although research in this area is gradually accumulating, not much is known about how novice facilitators address these challenges and change their practices accordingly. This paper presents case studies of two novice facilitators of PD programs in two different countries. The analyses look at their work over one year, to illustrate the changes in their practices while managing discussions. The results show that although the facilitators operated in different contexts, their practices and their processes of change resembled, suggesting that these processes are not idiosyncratic. We argue that novice facilitators’ changes in practices correspond to changes in their resources, orientations, goals, and identities and that PD program teams can support these changes.
This survey evaluated the levels of self-perceived knowledge, confidence, attitude and practice patterns of school-based speech-language pathologists (SLPs) in Hong Kong regarding their management of ...pediatric voice disorders.
SLPs with experience working in school settings in Hong Kong were invited to complete an anonymous online survey. The survey ascertained SLPs’ perception of their knowledge, confidence, attitude and practice patterns regarding their management of pediatric voice disorders. It also explored the barriers and facilitators to effective service provision for children with voice problems in schools.
A total of 85 responses were received, of which 56 respondents with complete responses were selected for analysis. Results showed that respondents in general did not consider themselves having sufficient knowledge on pediatric voice. They did not feel fully confident in managing pediatric voice cases. Even though they exhibited a positive attitude and agreed that pediatric voice management was important, discrepancies were noted between their attitude and practice. Barriers that hinder practice include the lack of professional guidelines, insufficient time and resource as well as difficulties to conduct comprehensive voice assessments with children.
The study findings urge the needs of enhancing school-based SLPs’ perceived knowledge and competence in managing pediatric voice disorders. The study also identifies strategic directions to improve service provision for children with voice disorders in schools.
Interview and questionnaire studies have identified barriers and challenges to preventing surgical site infections (SSIs) by focusing on compliance with recommendations and care bundles using ...interviews, questionnaires and expert panels. This study proposes a more comprehensive investigation by using observations of clinical practice plus interviews which will enable a wider focus.
To comprehensively identify the factors which affect SSI prevention using cardiac surgery as an exemplar.
The study consisted of 130 h of observed clinical practice followed by individual semi-structured interviews with 16 surgeons, anaesthetists, theatre staff, and nurses at four cardiac centres in England. Data were analysed thematically.
The factors were complex and existed at the level of the intervention, the individual, the team, the organization, and even the wider society. Factors included: the attributes of the intervention; the relationship between evidence, personal beliefs, and perceived risk; power and hierarchy; leadership and culture; resources; infrastructure; supplies; organization and planning; patient engagement and power; hospital administration; workforce shortages; COVID-19 pandemic; ‘Brexit’; and the war in Ukraine.
This is one of the first studies to provide a comprehensive overview of the factors affecting SSI prevention. The factors are complex and need to be fully understood when trying to reduce SSIs. A strong evidence base was insufficient to ensure implementation of an intervention.
We sought to describe the experiences of physicians who successfully incorporated abortion care into their practices in the United States. We explored facilitators of and barriers to abortion ...provision.OBJECTIVESWe sought to describe the experiences of physicians who successfully incorporated abortion care into their practices in the United States. We explored facilitators of and barriers to abortion provision.In this qualitative study, we conducted semistructured interviews with a national sample of obstetrician-gynecologists and family medicine physicians providing abortion care. Interviews addressed facilitators of and barriers to abortion provision, lessons learned and recommendations for future providers. We analyzed data using a content analysis approach.STUDY DESIGNIn this qualitative study, we conducted semistructured interviews with a national sample of obstetrician-gynecologists and family medicine physicians providing abortion care. Interviews addressed facilitators of and barriers to abortion provision, lessons learned and recommendations for future providers. We analyzed data using a content analysis approach.We interviewed 14 obstetrician-gynecologists and 11 family medicine physicians providing abortion care as part of their practices. We identified four categories of facilitators and barriers: personal, community, training, and workplace factors. Major facilitators included supportive leadership and professional mentorship. Major barriers included antagonistic colleagues and leadership. Lessons learned included proactively assessing leadership support, identifying institutional allies, actively minimizing workplace conflict and being perceived as a team player. Recommended resources to increase abortion provision included clinical support, mentorship, funding, negotiation coaching, and access to clinical policies.RESULTSWe interviewed 14 obstetrician-gynecologists and 11 family medicine physicians providing abortion care as part of their practices. We identified four categories of facilitators and barriers: personal, community, training, and workplace factors. Major facilitators included supportive leadership and professional mentorship. Major barriers included antagonistic colleagues and leadership. Lessons learned included proactively assessing leadership support, identifying institutional allies, actively minimizing workplace conflict and being perceived as a team player. Recommended resources to increase abortion provision included clinical support, mentorship, funding, negotiation coaching, and access to clinical policies.Institutional leadership support emerged as a critical facilitator for initiating and continuing to offer abortion care. Efforts to expand abortion access should include investments in supportive leadership, both in academic and community practices.CONCLUSIONSInstitutional leadership support emerged as a critical facilitator for initiating and continuing to offer abortion care. Efforts to expand abortion access should include investments in supportive leadership, both in academic and community practices.Maximizing abortion access is essential to counteract the legislative and political restrictions imposed on abortion care. Institutional support is a critical facilitator of abortion provision, and efforts to expand abortion access should include investments in supportive leadership and health care administration.IMPLICATIONSMaximizing abortion access is essential to counteract the legislative and political restrictions imposed on abortion care. Institutional support is a critical facilitator of abortion provision, and efforts to expand abortion access should include investments in supportive leadership and health care administration.
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