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Barefoot, Maria R. "Identifying information need through storytelling." Reference Services Review 46, no. 2 (June 11, 2018): 251–63. http://dx.doi.org/10.1108/rsr-02-2018-0009.
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PurposeThe purpose of this paper is to explore the use of multicultural narratives from the website Humans of New York in a one credit information literacy course to teach concepts of information need with respect to cultural literacy and social justice.Design/methodology/approachThis case study examines student responses to an in-class activity which used a problem-based learning approach. Students were asked to examine narratives and identify possible information access or use issues and to consider the cultural differences that may help or hinder information access or use.FindingsStudents’ writing samples show evidence of comprehension in the areas of cultural literacy and understanding information need and the development empathy with people of diverse racial, cultural and socioeconomic backgrounds. Students directly identified information need issues such as financial barriers, social stigma, lack of access to legal aid and the risk of physical harm. Students indirectly recognized concepts related to cultural literacy and social justice such as cultural norms, classism and structural racism.Originality/valueWhile the Framework for Information Literacy for Higher Education has listed a number of social justice and cultural literacy concepts within the knowledge practices and disposition statements, the library literature has not yet studied these concepts in conjunction with teaching information need. This case study presents a lesson plan that could be applied in library classrooms to teach both cultural literacy and information need concepts.
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Murray, Linda, Shandell Elmer, and Jennifer Elkhair. "Perceived Barriers to Managing Medications and Solutions to Barriers Suggested by Bhutanese Former Refugees and Service Providers." Journal of Transcultural Nursing 29, no. 6 (April 5, 2018): 570–77. http://dx.doi.org/10.1177/1043659618768702.
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Introduction: The purpose of this study was to explore perceived barriers to managing medications and potential solutions to such barriers among Bhutanese former refugees and service providers in Tasmania, Australia. Method: Thirty Bhutanese former refugees and service providers recruited through community health programs participated in a community-based participatory research design. Data were elicited through a structured focus group process and analyzed using content analysis. Results: Perceived barriers to managing medications included language barriers, low health literacy, and culturally unresponsive interactions with services. Themes identifying potential solutions to barriers referred to the functional health literacy of individuals (providing reassurance, checking understanding, and involving support networks) and creating supportive health care environments (consistent service providers, culturally responsive care, assistance navigating services, using trained interpreters). Discussion: Creating environments conducive to interactive and critical health literacy about medications is as important for culturally congruent care as supporting the functional health literacy of individuals.
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Bromley, Matt. "Three tenets of effective Pupil Premium practice." SecEd 2019, no. 14 (September 1, 2019): 25–31. http://dx.doi.org/10.12968/sece.2019.14.25.
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For this Best Practice Focus, Matt Bromley describes three steps of Pupil Premium practice – touching upon identifying barriers, planning solutions, success criteria, evaluating impact, early intervention, language and literacy, cultural capital, literacy, numeracy, and transition
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Tieu, Lina, Dean Schillinger, Urmimala Sarkar, Mekhala Hoskote, Kenneth J. Hahn, Neda Ratanawongsa, James D. Ralston, and Courtney R. Lyles. "Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?" Journal of the American Medical Informatics Association 24, e1 (July 8, 2016): e47-e54. http://dx.doi.org/10.1093/jamia/ocw098.
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Objective: With the rapid rise in the adoption of patient portals, many patients are gaining access to their personal health information online for the first time. The objective of this study was to examine specific usability barriers to patient portal engagement among a diverse group of patients and caregivers. Materials and Methods: We conducted interviews using performance testing and think-aloud methods with 23 patients and 2 caregivers as they first attempted to use features of a newly launched patient portal. Results: In navigating the portal, participants experienced basic computer barriers (eg, difficulty using a mouse), routine computer barriers (eg, mistyping, navigation issues), reading/writing barriers, and medical content barriers. Compared to participants with adequate health literacy, participants with limited health literacy required 2 additional minutes to complete each task and were more likely to experience each type of navigational barrier. They also experienced more inaccuracies in interpreting a test result and finding a treatment plan within an after-visit summary. Discussion: When using a patient portal for the first time, participants with limited health literacy completed fewer tasks unassisted, had a higher prevalence of encountering barriers, took longer to complete tasks, and had more problems accurately interpreting medical information. Conclusion: Our findings suggest a strong need for tailored and accessible training and support to assist all vulnerable patients and/or caregivers with portal registration and use. Measuring the health literacy of a patient population might serve as a strong proxy for identifying patients who need the most support in using health technologies.
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Huh, Jina, Jejo Koola, Alejandro Contreras, Alanah Castillo, Melissa Ruiz, Keely Tedone, Melissa Yakuta, and Melody Schiaffino. "Consumer Health Informatics Adoption among Underserved Populations: Thinking beyond the Digital Divide." Yearbook of Medical Informatics 27, no. 01 (August 2018): 146–55. http://dx.doi.org/10.1055/s-0038-1641217.
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Objectives: Underserved populations can benefit from consumer health informatics (CHI) that promotes self-management at a lower cost. However, prior literature suggested that the digital divide and low motivation constituted barriers to CHI adoption. Despite increased Internet use, underserved populations continue to show slow CHI uptake. The aim of the paper is to revisit barriers and facilitators that may impact CHI adoption among underserved populations. Methods: We surveyed the past five years of literature. We searched PubMed for articles published between 2012 and 2017 that describe empirical evaluations involving CHI use by underserved populations. We abstracted and summarized data about facilitators and barriers impacting CHI adoption. Results: From 645 search results, after abstract and full-text screening, 13 publications met the inclusion criteria of identifying barriers to and facilitators of underserved populations' CHI adoption. Contrary to earlier literature, the studies suggested that the motivation to improve health literacy and adopt technology was high among studied populations. Beyond the digital divide, barriers included: low health and computer literacy, challenges in accepting the presented information, poor usability, and unclear content. Factors associated with increased use were: user needs for information, user-access mediated by a proxy person, and early user engagement in system design. Conclusions: While the digital divide remains a barrier, newer studies show that high motivation for CHI use exists. However, simply gaining access to technology is not sufficient to improve adoption unless CHI technology is tailored to address user needs. Future interventions should consider building larger empirical evidence on identifying CHI barriers and facilitators.
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Devraj, Radhika, and Gireesh V. Gupchup. "Identifying Aspects of Pharmacists' Attitudes and Barriers toward Health Literacy: A Factor Analytic Study." Annals of Pharmacotherapy 45, no. 6 (June 2011): 771–79. http://dx.doi.org/10.1345/aph.1p686.
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Donahue, Emily, Apurva Uniyal, and Terry David Church. "19751 Identifying Barriers to Diabetes Technology in Low-Income, Type 1 Patients." Journal of Clinical and Translational Science 5, s1 (March 2021): 142. http://dx.doi.org/10.1017/cts.2021.763.
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ABSTRACT IMPACT: This research will aid clinical and policy solutions on lessening the vast health disparities and overall access issues for low-income, type 1 diabetes patients. OBJECTIVES/GOALS: Identify key barriers to accessing continuous glucose monitors (CGMS) and care options for low-socioeconomic status (SES) patients on public insurance. Low-SES patients with type 1 diabetes (T1D) have lower utilization rates of effective diabetes management technologies and worse clinical outcomes. METHODS/STUDY POPULATION: A literature review was conducted to understand the current research landscape for T1D and lead to the identification of potential barriers which included socioeconomic status, low-income, health literacy, and racial/ethnic minority. Clinicaltrials.gov was searched using the keyword ‘type 1 diabetes’ in conjunction with the identified barriers (as well as the keyword ‘barrier’). A follow up review of each state’s Medicaid programs was conducted to analyze cost and access options for CGMs and the overall financial burden of the disease on low-SES T1D patients. States that offered CGM coverage were further analyzed to determine reimbursement rates and actual out-of-pocket cost for patients. RESULTS/ANTICIPATED RESULTS: Of 285 trials identified from Clinicaltrial.gov searches, only seven relevant trials examined barriers and T1D for low-SES patients. Additionally, many of these studies, both in and outside of the clinical trial space, seldom distinguished between type 1 and type 2 diabetes’‘ an important distinction given that T1D has a higher financial burden and a quicker onset of complications. Currently, 39 states offer various insurance coverage through their Medicaid programs, but have clinical restrictions and requirements such as pediatric coverage only or minimum blood glucose requirement checks. Additionally, there is vast variability in reimbursement rates between states ($0-$800). DISCUSSION/SIGNIFICANCE OF FINDINGS: Study results indicate less effective diabetes management for low-SES T1D patients and a need for more intersectional clinical trial research. Differences in state’s Medicaid CGM coverage, expressed in disparate clinical outcomes for these T1D patients, belies financial incentives to health improvements, as annual US T1D costs are $14.4 billion.
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Osborne, Lisa A., Hazel M. Lockhart-Jones, Rodden M. Middleton, Simon Thompson, Inocencio D. C. Maramba, Kerina H. Jones, David V. Ford, and J. Gareth Noble. "Identifying and Addressing the Barriers to the Use of an Internet-Register for Multiple Sclerosis." International Journal of Healthcare Information Systems and Informatics 8, no. 1 (January 2013): 1–16. http://dx.doi.org/10.4018/jhisi.2013010101.
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Given the potential of health internet-registers, this study examined how such registers can be made more effective and efficient. This involved investigating the actual barriers to usage experienced by those for whom such registers are established to help. To elicit responses regarding the opinions, views, and experiences of participants, concerning their various reasons for non-progression or non-completion of the pilot UK MS Register, a list of ten potential key areas of difficulty, in the form of short statements, was e-mailed to participants. A content analysis revealed that there were four main areas of concern that could represent potential barriers for health internet-registers, in general, and that need to be considered when establishing, designing, and developing such registers: technical aspects of using the internet; computer literacy and ability, encompassing website design, clarity, and user-friendliness; symptom mismatches with register content; and condition-specific effects and impacts as barriers to internet-register use.
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Panahi, Sirous, AzitaShahraki Mohammadi, Azadeh Sayarifard, and Ahmad Ashouri. "Identifying the prerequisites, facilitators, and barriers in improving adolescents' mental health literacy interventions: A systematic review." Journal of Education and Health Promotion 9, no. 1 (2020): 322. http://dx.doi.org/10.4103/jehp.jehp_623_20.
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Neff, Anna J., Stephen Lau, Alex Wing-Kai Wong, and Carolyn Baum. "4411 Identifying Environmental Barriers to Participation for Community-Dwelling Adults with Stroke: A Descriptive Pilot Study." Journal of Clinical and Translational Science 4, s1 (June 2020): 134. http://dx.doi.org/10.1017/cts.2020.398.
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OBJECTIVES/GOALS: The purpose of this study is to identify and quantitatively describe environmental barriers to community engagement and activity participation for adults with stroke and low income. Repeated electronic surveys collected in real time will reduce recall bias and improve characterization of barriers. METHODS/STUDY POPULATION: 20-30 community-dwelling adults with stroke and low income will be recruited for this pilot study. Inclusion criteria: > 1 month post stroke and evidence that they have the vision, literacy, and cognitive capacities to answer survey questions on a smart device. Exclusion criteria: severe aphasia, severe mental illness or substance abuse within 3 months, and ataxia. Participants will complete standardized assessments of daily activities, engagement in and perceptions about community activities, social support, and perceived environmental barriers. Participants then complete four surveys per day for 14 days using an app on an iPod Touch, reporting activities attempted and barriers encountered. RESULTS/ANTICIPATED RESULTS: This is the first study of this kind and is a work in progress. We anticipate that the environmental barriers reported will include physical (e.g. built structures, climate, and natural terrain), social (e.g. support or lack thereof; stigma), political (e.g. access to transportation; healthcare services), and technological barriers (e.g. difficulties with personal equipment and/or technologies such as elevators, ticket kiosks, etc.). DISCUSSION/SIGNIFICANCE OF IMPACT: An increased understanding of the barriers facing community-dwelling adults with stroke and low income will facilitate the development of culturally-appropriate and more accessible self-management programs to help this population re-engage in their communities and return to pre-stroke activities.
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Adeosun, I., A. Adegbohun, T. Peters, O. Jeje, A. Bello, and O. Manuwa. "Perceived barriers to help-seeking for depression among secondary school students in Lagos, Nigeria." Babcock University Medical Journal (BUMJ) 1, no. 1 (March 31, 2015): 1–6. http://dx.doi.org/10.38029/bumj.v1i1.19.
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Objective: In spite of a wide range of effective treatment options, a huge treatment gap persists for depression among adolescents especially in low and middle-income countries. The barriers to help seeking for depression among Nigerian adolescents are currently under-researched. Identifying these barriers is critical to the design of interventions towards better utilisation of mental health services. This study assessed the barriers to help-seeking for depression among adolescent secondary school students in Lagos Nigeria.
Method: Using a cross-sectional study design, 156 adolescent students attending a public co-educational secondary school in Lagos, south-West Nigeria completed a vignette-based questionnaire which assessed barriers to help-seeking for depression. The vignette depicted an adolescent with depression according to the DSM-1V criteria.
Result: The mean age of the participants was 15.9 (± 1.1) years and 49% were males. The most commonly perceived barrier to help-seeking for depression was stigma (50.6%). Other barriers reported included disapproval by families/friends (21.2%), illness-related factors (7.7%), negative attitudes to treatment (7.1%), financial constraint (5.1%), ignorance (3.9%) and preference for spiritual treatment (3.9%).
Conclusion: Stigma, ignorance, misperceptions and negative attitudes to treatment are major barriers to help-seeking for depression among adolescents. Destigmatisation and mental health literacy interventions are crucial steps towards facilitating help-seeking among adolescents with depression.
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Benda1, Natalie C., Jeffrey Higginbotham, Rollin J. Fairbanks, Li Lin, and Ann M. Bisantz. "Using Cognitive Work Analysis to Design Communication Support Tools for Patients with Language Barriers." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 61, no. 1 (September 2017): 120–24. http://dx.doi.org/10.1177/1541931213601514.
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Patients with language barriers face healthcare disparities associated with access to care, satisfactions with care, and the quality and safety of the care they receive. The central solution to addressing these barriers is through the use of professional interpreters but there are difficulties associated with consistently using these services. This study used cognitive work analysis to identify the goals, constraints and affordances associated with patient communication to develop support requirements for communicating with patients with language barriers. Specific communication support objectives discovered included: supporting various cultural background and levels of health literacy, identifying when information is not properly conveyed, and providing a means to convey the information in a different way to allow for subsequent checks in understanding. These objectives can be utilized as inputs for the development of tools to support communication with patients with language barriers.
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Mazloomy Mahmoodabad, Seyed Saeed, Ali Akbar Vaezi, Tahere Soltani, Azadeh Nadjarzadeh, Seyedeh Mahdieh Namayandeh, Mohammad Hossein Soltani, and Hossien Fallahzadeh. "Identifying the inhibitory factors of dietary salt reduction in women: a qualitative study, Yazd, Iran." International Journal of Human Rights in Healthcare 13, no. 5 (August 28, 2020): 485–98. http://dx.doi.org/10.1108/ijhrh-01-2020-0003.
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Purpose Increased dietary salt content is one of the effective factors of hypertension and a major public health challenge globally. Although the positive effects of dietary salt reduction on health are universally accepted, people can hardly reduce their salt intake. The purpose of this study is to identify the inhibitory factors of dietary salt reduction among 20–65-year-old women in Yazd City, Iran. Design/methodology/approach This study was conducted using a deductive content analysis approach based on the communication for the behavioral impact (COMBI) framework. The purposeful sampling method was applied with maximum variation in terms of different educational levels, age groups, occupational status and residential areas to select the participants. Snowball sampling was used to select health-care professionals. Furthermore, semi-structured interviews and focus-group discussions were conducted with 31 local women and 11 health-care professionals working in the City until data saturation was achieved. Data were analyzed using Graneheim and Landsman’s method. Findings After data analysis, 617 initial codes were extracted over the perceived barriers. After merging similar codes, 223 codes were extracted. The barriers were classified into five main categories of family, personal, organizational, educational and socio-cultural barriers. Originality/value Based on the COMBI framework, the results demonstrated that the most important barriers for reducing salt intake were negative attitude toward restrictions on dietary salt intake, insufficient and incorrect beliefs about the health risk of salt, lack of family support, inadequate health literacy and low self-efficacy in Yazd City. Among these barriers, lack of family support was considered as the most effective factor in reducing salt consumption. So, by focusing on this area and providing the community with the required education, the amount of salt consumed by families can be reduced.
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Siddiqui, Mujtaba Hasan, Iqbal Akhtar Khan, Fauzia Moyeen, and Khawar Abbas Chaudhary. "Identifying Barriers to Therapeutic Adherence in Type 2-Diabetes: A Complex and Multidimensional Clinical Issue." Asploro Journal of Biomedical and Clinical Case Reports 2, no. 1 (June 5, 2019): 22–28. http://dx.doi.org/10.36502/2019/asjbccr.6149.
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The problem of therapeutic non-adherence is a serious issue adversely affecting the adequate control and management of Type2 Diabetes (T2D).This unwelcoming situation has been studied well on various spots on the globe, with diverse results. The present study, aimed at identifying the barriers to therapeutic adherence, was conducted on a set of proven cases of T2D, managed by primary healthcare providers. The adherence rate to medication alone was 42% while to medication plus lifestyle recommendations 27%. Whereas sub-optimal health literacy, complexity of prescription and socioeconomic aspects were the main determinants, lapse on the part of healthcare system cannot be underscored. The present qualitative study was a preliminary investigation on a small sample .The magnitude of the problem necessitates that a large scale multi-centre in-depth quantitative study in 5 dimensions (recommended by WHO): socio-economic factors, health care team and system related factors, condition related factors , therapy related factors and patient related factors, be done on priority basis. This would pave the way for planning a well-designed intervention programme.
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Bhanvadia, Sumeet Kaur, Siamak Daneshmand, Mariana Stern, and Lourdes Baezconde-Garbanati. "3512 Identifying Patient-Level Barriers to Non-Muscle Invasive Bladder Cancer Treatment and Surveillance Adherence in Low-Income Latino Patients: A Mixed-Methods Study." Journal of Clinical and Translational Science 3, s1 (March 2019): 90. http://dx.doi.org/10.1017/cts.2019.207.
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OBJECTIVES/SPECIFIC AIMS: To evaluate the determinants of non-adherence to guideline treatment and surveillance and unique barriers to care in LIU Latinos with NMIBC that will inform the development of novel patient educational materials and navigation programs that could improve adherence and thus, oncologic outcomes. METHODS/STUDY POPULATION: We will recruit 40 Latino patients with new or existing NMIBC diagnoses who present to the Urology clinic at a large, tertiary public hospital in Los Angeles from November 2018 to March 2019. Quantitative (surveys) and qualitative (semi-structured interviews) data will be collected, analyzed and integrated in order to comprehensively determine patient-level barriers to adherence. RESULTS/ANTICIPATED RESULTS: We expect to identify a unique set of patient-level barriers to adherence to NMIBC care that is unique to this population that center around 1) structural barriers to care, 2) knowledge, attitudes, and beliefs that pertain to education, acculturation, gender and values, and 3) general and disease-specific health literacy. DISCUSSION/SIGNIFICANCE OF IMPACT: The barriers to surveillance and treatment NMIBC care are significant, particularly in LIU and minority patients, which is important as non-adherence to guideline care is linked to poorer cancer outcomes. The data generated herein will inform the development of tools and programs to aid in reducing or eliminating these barriers, but also will inform discussions on the effectiveness of current clinical practices for low-income Latino patients.
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Smith, Graeme D., Veronica Lai, and Sara Poon. "Building the case for health literacy in gastroenterology." Gastrointestinal Nursing 19, no. 7 (September 2, 2021): 26–30. http://dx.doi.org/10.12968/gasn.2021.19.7.26.
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Living with a chronic gastrointestinal (GI) disorder, such as inflammatory bowel disease, can be a very challenging for patients. A range of skills can be required to deal with some of the issues and uncertainties associated with living with a GI disease, including the ability to identify and find appropriate healthcare services for worsening symptoms; communicate concerns to health professionals; understand information pertaining to illness prevention and self-management; weigh up the potential risks and benefits of adherence to complex medication regimes; and comprehend the written instructions on prescribed medication. All of these activities represent important features of the concept of health literacy, involving the ability to read textual information, understand material in forms and documents, deal with issues of numeracy, engage in verbal communication and navigate healthcare services. Although the full impact of health literacy in chronic GI disease remains unknown, lower levels of health literacy have been identified as a potentially modifiable risk factor, related to communication barriers and poorer health-related outcomes in other chronic illnesses. In this clinical review, issues associated with health literacy in chronic GI disease are explored, highlighting the impact of low health literacy in gastroenterology; identifying potential factors of living with low levels of health literacy; and introducing approaches to measurement of health literacy and interventions that can be used by nurses to help improve health literacy in patients. Focus is placed on health literacy related to reading and comprehension of vital GI health-related materials.
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Ali, Diab, Monica Gillie, and Kathy Jo Carstarphen. "Bridging the digital divide for vulnerable patient telehealth." Innovation in Aging 4, Supplement_1 (December 1, 2020): 928. http://dx.doi.org/10.1093/geroni/igaa057.3404.
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Abstract In New Orleans, Louisiana, 61% of advanced age patients have low health literacy, 50% report financial insecurity, and more than one-third have high hospital readmission rates and medical complexity scores. This population has been disproportionately impacted by the COVID-19 pandemic and the system-wide transition to remote, virtual visits. While COVID-19 has accelerated needs for impactful remote care and research, this has been impeded by low telehealth literacy and structural barriers, such as lack of internet and devices. There are major gaps in the literature regarding telemedicine services in geriatric and complex populations and efficacy rates are variable in these populations. There is currently no telehealth literacy screening tool designed for identifying patients with barriers requiring additional interventions to succeed, no uniform understanding of the factors affecting use or how to increase engagement, and telehealth models requiring fluent use of technology for older adults have been met with poor rates of completed visits and associated harm. Following a dedicated 358.5 hours to training 309 geriatric, complex patients in telemedicine using our pre-existing telehealth model, averaging 4.78 hours per patient, only 18.8% of these patients were subsequently able to connect to the provider virtually. Here we describe lessons learned and tools developed from the Ochsner MedVantage Network Innovation project, including the development of a telehealth literacy screening tool, the adaptation and provision of simplified, user-friendly tablets, and a randomized control trial to determine if increased accessibility to telehealth leads to improved healthcare outcomes, such as decreased hospital admissions and emergency department utilization.
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Lewis, Ebony T., Abela Mahimbo, Christine Linhart, Margaret Williamson, Mark Morgan, Kathrine Hammill, John Hall, and Magnolia Cardona. "General practitioners’ perceptions on the feasibility and acceptability of implementing a risk prediction checklist to support their end-of-life discussions in routine care: a qualitative study." Family Practice 37, no. 5 (April 16, 2020): 703–10. http://dx.doi.org/10.1093/fampra/cmaa036.
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Abstract Background General practitioners’ (GPs) play a central role in facilitating end-of-life discussions with older patients nearing the end-of-life. However, prognostic uncertainty of time to death is one important barrier to initiation of these discussions. Objective To explore GPs’ perceptions of the feasibility and acceptability of a risk prediction checklist to identify older patients in their last 12 months of life and describe perceived barriers and facilitators for implementing end-of-life planning. Methods Qualitative, semi-structured interviews were conducted with 15 GPs practising in metropolitan locations in New South Wales and Queensland between May and June 2019. Data were analysed thematically. Results Eight themes emerged: accessibility and implementation of the checklist, uncertainty around checklist’s accuracy and usefulness, time of the checklist, checklist as a potential prompt for end-of-life conversations, end-of-life conversations not an easy topic, end-of-life conversation requires time and effort, uncertainty in identifying end-of-life patients and limited community literacy on end-of-life. Most participants welcomed a risk prediction checklist in routine practice if assured of its accuracy in identifying which patients were nearing end-of-life. Conclusions Most participating GPs saw the value in risk assessment and end-of-life planning. Many emphasized the need for appropriate support, tools and funding for prognostic screening and end-of-life planning for this to become routine in general practice. Well validated risk prediction tools are needed to increase clinician confidence in identifying risk of death to support end-of-life care planning.
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Dalmer, Nicole. "Health Literacy Promotion: Contemporary Conceptualizations and Current Implementations in Canadian Health Librarianship." Journal of the Canadian Health Libraries Association / Journal de l'Association des bibliothèques de la santé du Canada 34, no. 1 (July 21, 2014): 12. http://dx.doi.org/10.5596/c13-004.
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Research questions: What are the current conceptualizations of health literacy, and what strategies are Canadian health librarians in public, academic, and hospital libraries enacting to put health literacy promotion into practice? Data sources: Serving as the basis of this scoping review, library and information science, health sciences, and interdisciplinary databases were searched using key terms relating to health literacy promotion as it relates to services, programming, or resources used in a variety of library settings. A web searched allowed for the inclusion of grey literature sources. Study selection: Data sources were searched using a combination of subject headings and keywords relating to health literacy and librarians or libraries, which served as the inclusion criteria. Sources were also selected for their Canadian context or content and for health literacy promotion programs or services that took place in academic, public, or hospital library settings. Data extraction: Data sources included journal articles, government publications, library association reports, dissertations, grey literature, reviews, and newspaper articles. Data were extracted from selected Canadian data sources, identifying the type of library in which health literacy promotion-related programs were situated, the program's scope, topics covered, and the resources used or developed. Results: The established link between low health literacy and poor health outcomes allows librarians to play an active role in promoting the quality of life of their patrons. Summaries from research articles and publications from library associations provide descriptions of health literacy promotion efforts in public libraries, followed by an examination of the role librarians play in promoting health literacy skills or knowledge in academic and hospital libraries. Conclusion: Analyses of recent health literacy initiatives and programming, including educational programs, electronic or web resources, and cross-discipline committees reveal the diversity of innovative tactics implemented by librarians to promote health literacy. Health literacy awareness is a tool all librarians can incorporate into their interactions with patrons. Current barriers and sources for future inquiry surrounding health literacy promotion in libraries highlight the need for librarians to promote their skill set as a means to gain inclusion as key players in national action plans concerning health literacy promotion.
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Kramer, J. M., I. T. Hwang, M. Levin, D. Acevedo-García, and L. Rosenfeld. "Identifying environmental barriers to participation: Usability of a health-literacy informed problem-identification approach for parents of young children with developmental disabilities." Child: Care, Health and Development 44, no. 2 (December 7, 2017): 249–59. http://dx.doi.org/10.1111/cch.12542.
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Kotwal, Ashwin A., Viraj A. Master, Ashesh B. Jani, Gertrude Fraser, Andrew M. Wolf, Daniel Shin-Ping Wang, Howard Duncan, Kwesi Ewur, Angela Marie Taber, and Kerry L. Kilbridge. "Development of a screening tool to assess prostate cancer health literacy." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 127. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.127.
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127 Background: Poor comprehension of prostate cancer (PCa) related terms can create barriers to informed discussions on screening, treatment, and measuring outcomes, and contribute to disparities in African American (AA) men. We developed a screening tool to assess for low PCa-related health literacy. Methods: We assessed PCa-related literacy in a sample of 189 AA men, age >40 years from diverse socioeconomic status (SES) using a 27-item scale derived comprehension of commonly used terms for urinary, bowel and sexual function. Using item-response models we examined differential item functioning by education. We developed rapid screening tools based on understanding of 1 or 2 words to predict overall comprehension. Receiver operating characteristic curves assessed the sensitivity and specificity for individuals understanding less than a pre-specified threshold of 70% on the overall scale, defined as “low literacy.” Results are being tested in an independent sample of 110 AA men. Results: The 27-item scale had good internal reliability (Cronbach alpha = 0.93). 47% of the sample met criteria for low literacy. Lower education groups had relatively poor comprehension of sexual function terms compared to higher education groups. 1-item scales using comprehension of the term “rectal urgency” had a sensitivity of 95% for identifying low literacy, “erection” had a specificity of 98%, and “vaginal intercourse” had a sensitivity of 91% and specificity of 81%. Combining “vaginal intercourse” and “rectal urgency” yielded a 2-item scale with strong characteristics (sensitivity 88%, specificity 89%), as did combining “vaginal intercourse” and “erection” (sensitivity 94%, specificity 81%). Conclusions: Rapid screening tools assessing PCa-related literacy performed well in a community sample of AA men with varied SES. Providers can use these tools to identify those at risk of poor comprehension to tailor outcome measurement and shared decision making. [Table: see text]
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Jou, Katerina, Madeline R. Sterling, Rosio Ramos, Francesse Antoine, David M. Nanus, and Erica Phillips. "Eliciting the Social Determinants of Cancer Prevention and Control in the Catchment of an Urban Cancer Center." Ethnicity & Disease 31, no. 1 (January 21, 2021): 23–30. http://dx.doi.org/10.18865/ed.31.1.23.
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Objective: The objectives of this study were two-fold: 1) to engage community stakeholders in identifying the top three social determinant of health (SDOH) barriers to the early detection and treatment of cancer in their respective communities; and 2) to develop a tailored plan responsive to the potential social risks identified within the catchment of an urban academic cancer center.Methods: Stakeholders from four neighborhoods in Brooklyn, New York with disproportionate cancer burden were recruited; the nominal group technique, a semi-quantitative research method, was used to elicit the SDOH barriers. Responses were consolidated into categories and ranked by points received.Results: 112 stakeholders participated in four community-based meetings. The SDOH categories of economic stability, education, and community and social context were identified as the top barriers. The themes of lost wages/employment, competing priorities, and the inability to afford care embodied the responses about economic stability. The domain of education was best described by the themes of low health literacy, targeted health topics to fill gaps in knowledge, and recommendations on the best modalities for improving health knowledge. Lastly, within the category of community and social context, the themes of stigma, bias, and discrimination, eroding support systems, and cultural misconceptions were described.Conclusion: The implications of our study are three-fold. First, they highlight the strengths of the nominal group technique as a methodology for engaging community stakeholders. Second, our analysis led to identifying a smaller set of social priorities for which tailored screening and practical solutions could be implemented within our health care system. Third, the results provide insight into the actual types of interventions and resources that communities expect from the health care sector.Ethn Dis. 2021;31(1):23-30; doi:10.18865/ ed.31.1.23
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Zukswert, Jenna M., Megan K. Barker, and Lisa McDonnell. "Identifying Troublesome Jargon in Biology: Discrepancies between Student Performance and Perceived Understanding." CBE—Life Sciences Education 18, no. 1 (March 2019): ar6. http://dx.doi.org/10.1187/cbe.17-07-0118.
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The excessive “jargon” load in biology may be a hurdle for developing conceptual understanding as well as achieving core competencies such as scientific literacy and communication. Little work has been done to characterize student understanding of biology-specific jargon. To address this issue, we aimed to determine the types of biology jargon terms that students struggle with most, the alignment between students’ perceived understanding and performance defining the terms, and common errors in student-provided definitions. Students in two biology classes were asked to report their understanding of, and provide definitions for, course-specific vocabulary terms: 1276 student responses to 72 terms were analyzed. Generally, students showed an overestimation of their own understanding. The least accurate self-assessment occurred for terms to which students had substantial prior exposure and terms with discordant meanings in biology versus everyday language. Students were more accurate when assessing their understanding of terms describing abstract molecular structures, and these were often perceived as more difficult than other types of terms. This research provides insights about which types of technical vocabulary may create a barrier to developing deeper conceptual understanding, and highlights a need to consider student understanding of different types of jargon in supporting learning and scientific literacy.
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Lee, Joseph, Jithin Varghese, Rose Brooks, and Benjamin J. Turpen. "A Primary Care Provider’s Guide to Accessibility After Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 79–84. http://dx.doi.org/10.46292/sci2602-79.
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Individuals with spinal cord injury (SCI) continue to have shorter life expectancies, limited ability to receive basic health care, and unmet care needs when compared to the general population. Primary preventive health care services remain underutilized, contributing to an increased risk of secondary complications. Three broad themes have been identified that limit primary care providers (PCPs) in providing good quality care: physical barriers; attitudes, knowledge, and expertise; and systemic barriers. Making significant physical alterations in every primary care clinic is not realistic, but solutions such as seeking out community partnerships that offer accessibility or transportation and scheduling appointments around an individual’s needs can mitigate some access issues. Resources that improve provider and staff disability literacy and communication skills should be emphasized. PCPs should also seek out easily accessible practice tools (SCI-specific toolkit, manuals, modules, quick reference guides, and other educational materials) to address any knowledge gaps. From a systemic perspective, it is important to recognize community SCI resources and develop collaboration between primary, secondary, and tertiary care services that can benefit SCI patients. Providers can address some of these barriers that lead to inequitable health care practices and in turn provide good quality, patient-centered care for such vulnerable groups. This article serves to assist PCPs in identifying the challenges of providing equitable care to SCI individuals.
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Vuckovic, Karen M., Rebecca (Schuetz) Bierle, and Catherine J. Ryan. "Navigating Symptom Management in Heart Failure: The Crucial Role of the Critical Care Nurse." Critical Care Nurse 40, no. 2 (April 1, 2020): 55–63. http://dx.doi.org/10.4037/ccn2020685.
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High-acuity, progressive care, and critical care nurses often provide care for patients with heart failure during an exacerbation of acute disease or at the end of life. Identifying and managing heart failure symptoms is complex and requires early recognition and early intervention. Because symptoms of heart failure are not disease specific, patients may not respond to them appropriately, resulting in treatment delays. This article reviews the complexities and issues surrounding the patient’s ability to recognize heart failure symptoms and the critical care nurse’s role in facilitating early intervention. It outlines the many barriers to symptom recognition and response, including multimorbidities, age, symptom intensity, symptom escalation, and health literacy. The influence of self-care on heart failure management is also described. The critical care nurse plays a crucial role in teaching heart failure patients to identify and respond appropriately to their symptoms, thus promoting early intervention.
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Moskow, Jaclynn M., Nicole Cook, Carisa Champion-Lippmann, Saint Anthony Amofah, and Angela S. Garcia. "Identifying opportunities in EHR to improve the quality of antibiotic allergy data." Journal of the American Medical Informatics Association 23, e1 (November 9, 2015): e108-e112. http://dx.doi.org/10.1093/jamia/ocv139.
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Abstract Background Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics. Methods Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed. Results Among patients, 9.1% ( n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR. Conclusions Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients’ records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated.
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Santana, E., J. Gonzalez, D. Byrd, and M. Rivera Mindt. "The Roles of Health Literacy and Physician-Patient Relationship in Self-Reported Health Outcomes Within a Diverse Sample of Persons Living with HIV." Archives of Clinical Neuropsychology 34, no. 7 (August 30, 2019): 1273. http://dx.doi.org/10.1093/arclin/acz029.40.
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Abstract Objective Barriers like poor health literacy and patient-provider communication add to health disparities in diverse populations. Perceived autonomy has been shown to improve patients’ health satisfaction and knowledge of their illness. However, no studies have examined these issues in HIV patients. This study examined the roles of health literacy and physician-patient relationship in health outcomes (e.g., mental health and emotional/physical functioning) in persons living with HIV (PLWH). Participants and Method This cross-sectional study included 91 PLWH (74% Latinx and 26% non-Latinx White; 68% Male) who completed the Test of Functional Health Literacy in Adults (TOFHLA), Physician–Patient Relationship Scale (PPRS), and Medical Outcomes Study-HIV Health Survey (MOS). The study variables included: TOFHLA total score, PPRS Part Decision- Making (PDM) and Trust subscales, and MOS Mental Health and Health Transition subscales. Results A linear regression showed that our model (ethnicity, TOFHLA, PPRS PDM and Trust) predicted MOS HT (R2 = .14, p < 0.05), such that Latinx ethnicity (β = .30) and better TOFHLA scores (β = -.22) predicted better MOS HT scores (ps < .05). Another regression showed that our model predicted MOS MH (R2 = 0.07, p = <.01), such that greater PPRS PDM scores predicted better MOS MH scores (β = .27, p = <.01). Conclusions Ethnicity and better health literacy were related to improved emotional/physical functioning over a 4-week period and greater shared decision-making was related to better overall mental health. These findings highlight the importance of identifying sociocultural factors and interpersonal processes of care to inform culturally-tailored interventions that can result in enhanced and effective treatment for PLWH patients and in improved physical and mental health outcomes.
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Rowlands, Gill, Bimasal Tabassum, Paul Campbell, Sandy Harvey, Anu Vaittinen, Lynne Stobbart, Richard Thomson, Mandy Wardle-McLeish, and Joanne Protheroe. "The Evidence-Based Development of an Intervention to Improve Clinical Health Literacy Practice." International Journal of Environmental Research and Public Health 17, no. 5 (February 26, 2020): 1513. http://dx.doi.org/10.3390/ijerph17051513.
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Low health literacy is an issue with high prevalence in the UK and internationally. It has a social gradient with higher prevalence in lower social groups and is linked with higher rates of long-term health conditions, lower self-rated health, and greater difficulty self-managing long-term health conditions. Improved medical services and practitioner awareness of a patient’s health literacy can help to address these issues. An intervention was developed to improve General Practitioner and Practice Nurse health literacy skills and practice. A feasibility study was undertaken to examine and improve the elements of the intervention. The intervention had two parts: educating primary care doctors and nurses about identifying and enhancing health literacy (patient capacity to get hold of, understand and apply information for health) to improve their health literacy practice, and implementation of on-screen ‘pop-up’ notifications that alerted General Practitioners (GPs) and nurses when seeing a patient at risk of low health literacy. Rapid reviews of the literature were undertaken to optimise the intervention. Four General Practices were recruited, and the intervention was then applied to doctors and nurses through training followed by alerts via the practice clinical IT system. After the intervention, focus groups were held with participating practitioners and a patient and carer group to further develop the intervention. The rapid literature reviews identified (i) key elements for effectiveness of doctors and nurse training including multi-component training, role-play, learner reflection, and identification of barriers to changing practice and (ii) key elements for effectiveness of alerts on clinical computer systems including ‘stand-alone’ notification, automatically generated and prominent display of advice, linkage with practitioner education, and use of notifications within a targeted environment. The findings from the post-hoc focus groups indicated that practitioner awareness and skills had improved as a result of the training and that the clinical alerts reminded them to incorporate this into their clinical practice. Suggested improvements to the training included more information on health literacy and how the clinical alerts were generated, and more practical role playing including initiating discussions on health literacy with patients. It was suggested that the wording of the clinical alert be improved to emphasise its purpose in improving practitioner skills. The feasibility study improved the intervention, increasing its potential usefulness and acceptability in clinical practice. Future studies will explore the impact on clinical care through a pilot and a randomised controlled trial.
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McKee, Michael M., Peter C. Hauser, Sara Champlin, Michael Paasche-Orlow, Kelley Wyse, Jessica Cuculick, Lorraine R. Buis, Melissa Plegue, Ananda Sen, and Michael D. Fetters. "Deaf Adults’ Health Literacy and Access to Health Information: Protocol for a Multicenter Mixed Methods Study." JMIR Research Protocols 8, no. 10 (October 9, 2019): e14889. http://dx.doi.org/10.2196/14889.
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Background Deaf American Sign Language (ASL) users often struggle with limited health literacy compared with their hearing peers. However, the mechanisms driving limited health literacy and how this may impact access to and understanding of health information for Deaf individuals have not been determined. Deaf individuals are more likely than hearing individuals to use the internet, yet they continue to report significant barriers to health information. This study presents an opportunity to identify key targets that impact information access for a largely marginalized population. Objective This study aims to elucidate the role of information marginalization on health literacy in Deaf ASL users and to better understand the mechanisms of health literacy in this population for the purpose of identifying viable targets for future health literacy interventions. Methods This is an exploratory mixed methods study to identify predictors and moderators of health literacy in the Deaf population. These predictors of health literacy will be used to inform the second step that qualitatively explains the findings, including how Deaf individuals access and understand Web-based health information. Multiple interviewer- and computer-based instruments underwent translation and adaptation, from English to ASL, to make them accessible for the Deaf participants in our study. A planned sample of 450 Deaf ASL users and 450 hearing native English speakers, aged 18 to 70 years, will be recruited from 3 partnering sites: Rochester, NY; Flint, MI; and Chicago, IL. These individuals will participate in a single data collection visit. A subset of participants (approximately 30) with key characteristics of interest will be invited for a second data collection visit to observe and inquire more about their ability to directly access, navigate, and comprehend Web-based health information. The study will help assess how the ways health literacy and information are visualized may differ between Deaf individuals and hearing individuals. The study will also survey participants’ ownership and use of computer and mobile devices and their level of Web-based information use, including health information. Results Adaptation and translation of protocols and instruments have been completed and are now in use for the study. Recruitment is underway and will continue until late 2020. Results from this study will be used to provide a guide on how to structure Web-based health information in a way that maximizes accessibility and improves health literacy for Deaf individuals. Conclusions The results from this mixed methods proposal will advance what is known about health literacy and health information accessibility for Deaf individuals. This innovative study will generate rich data on how to formulate health information and health literacy interventions more accurately to take advantage of visual learning skills. International Registered Report Identifier (IRRID) PRR1-10.2196/14889
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Boehmer, Leigh, Upal Kunal Basu Roy, Janelle Schrag, Nikki A. Martin, Gregory D. Salinas, Brandon Coleman, Alexandra Howson, and Latha Shivakumar. "Identifying barriers to equitable biomarker testing in underserved patients with NSCLC: A mixed-methods study to inform quality improvement opportunities." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 123. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.123.
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123 Background: Despite recent advances in cancer precision medicine, patients from underserved communities do not have equal access to biomarker testing and targeted therapies. This study used a mixed-methods approach to identify barriers to equitable precision medicine access among underserved patients with non-small cell lung cancer (NSCLC). Methods: Paired national surveys (one clinician-facing and one patient-facing) were developed respectively by the Association of Community Cancer Centers (ACCC) and LUNGevity Foundation. Administered online in spring/summer 2020, the surveys were designed to identify key attitudes/barriers related to biomarker testing, resource needs, and current practice patterns for pertinent stakeholders. Survey data was triangulated with data from focus groups (2 clinician and 6 patient) conducted in fall 2020. The study was approved by Advarra IRB. Results: A total of 99 clinicians responded, with 67% (66/99) representing oncologists from community cancer programs. 248 patients responded to the LUNGevity survey, with 161 coming from the general population and 87 from the LUNGevity network (patients with relatively high income and education levels). Most clinicians surveyed indicated they were “very” (34%) or “extremely” likely (44%) to discuss biomarker testing with NSCLC patients. Academic clinicians, however, were more likely than community-based clinicians to order testing at the time of initial biopsy (76% vs 52%, P =.02). Academic clinicians were also more likely to involve the patient’s family in biomarker testing discussions (85% vs 59%, P =.009). Patient survey results identified that medical oncologists are the primary source of biomarker testing information; 64% of LUNGevity-connected and 37% of underserved patients. Eighty-five percent of LUNGevity-connected patients receive biomarker testing versus 52% for general patients (p < 0.05). Notably, more than a quarter (27%) of underserved patients who have undergone biomarker testing do not know their results. Clinician focus group participants corroborated survey findings that most clinicians receive testing results in 7-14 days, but for 23% of community and 6% of academic clinicians the process can take over 2 weeks. They identified disparities in offering biomarker testing and results to patients with known or presumed low socioeconomic status (SES) and/or health literacy. This was supported by patient survey data, which showed biomarker testing was proactively offered to only 40% of low-SES patients. Conclusions: This study identifies key areas of ongoing need related to equitable biomarker testing. Quality-improvement opportunities exist to address both clinician and patient barriers to guideline-concordant biomarker testing for underserved patients with NSCLC.
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Merkley, Cari. "Hands on Digital Information Literacy Training from Peers is Preferred by Public Service Library Staff." Evidence Based Library and Information Practice 9, no. 4 (December 5, 2014): 58. http://dx.doi.org/10.18438/b89g71.
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A Review of:
Robertson, R. (2014). Reframing ourselves: Digital information literacy skills of frontline public library staff. New Zealand Library and Information Management Journal, 53(3). doi:10.1080/00048623.2011.10722203
Abstract
Objective – To explore how and where public library employees acquire digital information literacy (DIL) skills.
Design – Qualitative study using semi-structured interviews.
Setting – Two public libraries in New Zealand.
Subjects – Nine front line public library staff members.
Methods – A convenience sample of nine library employees was interviewed about their existing DIL skills, how and where they learned them, any barriers to this learning, and how they defined DIL in others. Interviewees ranged in age from 40 to 64 and included both those new to libraries and those with over 25 years in the profession. The interview transcripts were analyzed for key themes and placed in the theoretical framework of Kolb’s experiential learning cycle (Robertson, 2014).
Main Results – Five participants described their own DIL skills as average or below average. The remaining participants classified their skills as above average. Participants recounted acquiring DIL skills in the course of their work through formal workplace training sessions, peer support, or individual exploration; through personal exploration of tools on their own time; or through a mix of work and personal learning opportunities. The barriers they identified to their learning included insufficient time to train and practice the skills learned and the lack of access to relevant technologies. Participants noted problems such as accessing key hardware and insufficient Internet connectivity at work because of issues with organizational infrastructure and at home due to personal financial constraints. Participants largely preferred informal hands-on training by peers to formal training sessions, which were described by some as too general or held too far in advance of the implementation of new technology. The data suggested participants largely fell into Kolb’s accommodating or diverging learning styles because of their preference for “concrete experience” (Robertson, 2014).
Conclusion – Libraries may improve staff acquisition of DIL skills by increasing hands on learning opportunities and providing dedicated time to review and practice skills learned. Other suggestions included identifying potential digital peer mentors among staff and providing them with the necessary resources (time, money, and a defined role) to support their colleagues, breaking training into parts allowing time for practice, creating training plans tied to performance evaluation, and using incentives to encourage staff to participate in self-directed training.
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Sutton, Linda, Lisi Lotz, Eileen V. Horn, and Trudy Pendergraft. "Perceptions of process barriers to lung cancer screening at community oncology programs." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19218-e19218. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19218.
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e19218 Background: Lung cancer screening (LCS) has potential to detect earlier stage cancer, favorably impacting patient outcomes, however evolving data suggest that LCS is underutilized. Because LCS is an extensive process with diverse barriers specific to each clinical setting, a multidisciplinary quality improvement (QI) initiative was undertaken to develop and test LCS processes to improve effective LCS. Baseline findings and approaches are presented. Methods: To inform the development of effective strategies to improve LCS, a survey was developed to examine perceptions and barriers to LCS across a group of community oncology programs in the Duke Cancer Network (DCN). The survey analyzed contextual, institutional, and patient factors influencing utilization of LCS. Survey results were used to support purpose-driven multidisciplinary teams to develop site-specific improvement plans for LCS with the support of QI consultants from Bite-Size QI. Results: Surveys were sent to 62 administrators and providers at 12 community oncology programs, with 36 respondents across 9 sites. LCS rates ranged between 4%-16% at participating sites. Respondents identified the lack of processes and infrastructure to support LCS as the most common challenges. Processes related to identification of LCS candidates, conduct of shared decision-making (SDM), follow up of lung nodules, and recurring screens were named specifically. Contributing factors identified were lack of robust community outreach, patient education, and protocols for providers. With regard to SDM, both administrators and providers reported systematic issues including provider time constraints and nonexistent or inconsistent identification/tracking systems, with patient compliance and health literacy as further barriers. The lack of these processes not only affected patients receiving initial LCS, but also how recurrent screenings were tracked. Conclusions: Identifying challenges in processes facilitated creation of improvement projects for participating sites. Initial improvement projects focus on patient notification of LCS results through follow up letters, integration of tracking LCS into hospital systems, development of patient education, community outreach and smoking cessation programs. Follow-up analyses will be undertaken to evaluate each approach.
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Weir, Kristie Rebecca, Vasi Naganathan, Carissa Bonner, Kirsten McCaffery, Debbie Rigby, Andrew J. McLachlan, and Jesse Jansen. "Pharmacists’ and older adults’ perspectives on the benefits and barriers of Home Medicines Reviews – a qualitative study." Journal of Health Services Research & Policy 25, no. 2 (September 10, 2019): 77–85. http://dx.doi.org/10.1177/1355819619858632.
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Objectives Conducting a medication review is one way to optimize medications and support older people to reduce the burden of polypharmacy. In Australia, a service called a Home Medicines Review (HMR) is conducted by pharmacists as part of a nationally funded program. HMRs aim to identify and resolve problems associated with polypharmacy and improve collaboration between patient, pharmacist and general practitioner. The aim of this study was to explore the benefits of and barriers to HMRs from the perspective of older patients and pharmacists. Methods This qualitative study involved observations of HMRs ( n = 12) and telephone interviews with 32 participants including 11 accredited pharmacists, 17 older adults aged 65 years and above, with 4 of their companions, in Australia. The researcher observing took notes during the HMR and added more detail and reflections afterwards. Transcribed audio-recordings and observational notes were thematically coded using framework analysis. Results Older patients and their companions found the HMR useful and they appreciated the opportunity to learn more about their medicines. However, many did not understand the purpose of the HMR, had limited understanding about their medicines and some did not want to know more. Pharmacists found HMRs useful for identifying medication errors and improving adherence. They also reported barriers to effective HMRs relating to patients (resistance to the evaluation of their medicines, misunderstanding about the aim of the HMR) and GPs (limited information upon referral, and limited follow-up afterwards). Conclusions Older patients and pharmacists reported a range of benefits for HMRs in terms of optimizing medicines use. Barriers to effective HMR use need to be addressed, including gaps in inter-professional communication and factors related to patient involvement, such as limited medicines understanding and health literacy.
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Khorassani, Farah, Shannon Tellier, and Demetra Tsapepas. "Pharmacist’s Role in Improving Medication Adherence in Transplant Recipients With Comorbid Psychiatric Disorders." Journal of Pharmacy Practice 32, no. 5 (March 19, 2018): 568–78. http://dx.doi.org/10.1177/0897190018764074.
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Medication nonadherence rates are high in both the transplant and psychiatric populations. The consequence of medication nonadherence posttransplant is graft rejection and psychiatric decompensation, highlighting the importance of optimizing adherence to medication regimens. Pharmacists may work with transplant patients with psychiatric comorbidity to improve medication adherence through identifying patient-specific barriers and recommending an appropriate intervention. Multiple evidence-based practices for improving nonadherence have been detailed in the transplant and psychiatric population. Medication adherence aids, medication management, patient education, and motivational interviewing are all strategies that may be used to improve adherence. Selecting which interventions to make will be based on the reasons for a patient’s nonadherence. Most patients benefit from medication management, patient education, and medication adherence aids. Selection of medication adherence aids may be based on patient demographics, technology literacy, and preference. Motivational interviewing may be considered in patients with intentional nonadherence relating to a lack of insight into their illness or the importance of taking medication. Pharmacists may promote adherence and potentially improve patient outcomes in transplant recipients with comorbid psychiatric disorders through assisting patients with designing a tailored medication adherence plan.
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Garbie, Ibrahim. "Identifying challenges facing manufacturing enterprises toward implementing sustainability in newly industrialized countries." Journal of Manufacturing Technology Management 28, no. 7 (September 4, 2017): 928–60. http://dx.doi.org/10.1108/jmtm-02-2017-0025.
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Purpose The purpose of this paper is to present and identify the challenges toward implementing sustainability strategies both strategic and tactical (STs) and performance measures (PMs) facing industrial organizations in newly industrialized countries. Design/methodology/approach Conducting a comprehensive survey on the published papers focused on the area of sustainability and/or sustainable development (S/SD) in manufacturing enterprises to identify the most common critical challenges. Setting with industrialists to determine which challenges the industrial organizations facing while implementing the S/SD strategies in terms of strategic, tactic and PMs. Using support logic techniques such as interpretive structural modeling (ISM) and interpretive ranking process (IRP) as modeling approaches to examine the contextual relationship among the STs and PMs individually “first phase,” to clarify and identify the most and least dominant factors, and to rank STs with respect to the PMs “second phase.” Findings The investigation shows that some challenges are more dominant and influential. Literacy and an awareness of sustainability, globalization and international issues and competitive strategies have emerged as the most dominant and key driving factors for STs in the ISM model, while the whole PMs are driven by remanufacturing and recycling factors in the ISM model. In addition, drivers and barriers to implementing S/SD challenges received the highest rank in the IRP model. Research limitations/implications Most of the STs and PMs were identified from academicians. Most of the manufacturing companies participated in the discussion; unfortunately, all are not familiar with the S/SD as a whole. They see to the S/SD from very narrow scope like climate change, environmental and energy issues only based on what they heard from media. Most of them are not fully interested to join with academicians to progress the work. Practical implications Most of the manufacturing companies are keen to investigate extremely sustainability challenges. Although this paper has a goal to provide a comprehensive framework to analyze, investigate and model sustainability challenges for industrial/manufacturing companies in different industrial sectors, most of the STs and PMs were identified from academicians. Most of the industrial/manufacturing companies participated in the discussion; unfortunately, all are not familiar with the S/SD as a whole. This study will help manufacturing/industrial companies to analyze and investigate the challenges toward implementing S/SD. Originality/value The originality of this paper is to identify the most common ST and PM challenges facing industrial organization toward implementing S/SD, modeling them into logical techniques and comparing between STs with respect to PMs.
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Nsiah-Kumi, Phyllis A. "Communicating effectively with vulnerable populations during water contamination events." Journal of Water and Health 6, S1 (March 1, 2008): 63–75. http://dx.doi.org/10.2166/wh.2008.041.
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Water contamination events are a public health concern worldwide with significant potential to impact the global community. When communicating with the public during these crisis situations, it is vital to consider the multiple audiences who receive the messages. Before developing or delivering messages to a particular community, it is essential to be familiar with the community's characteristics, needs, concerns, and who is considered credible to that community. Vulnerable populations are those with difficulties in comprehension or accessibility that may limit their full understanding of risks and may mitigate the effectiveness of public health strategies. Vulnerable populations include, but are not limited to, the urban/rural poor, those who are mentally ill, intellectually disabled, medically vulnerable, at the extremes of age (children and the elderly), racial/ethnic minorities, and those with low literacy or limited English proficiency. A water contamination event poses a unique opportunity to work with diverse populations to effectively convey important health messages. Each population needs to receive appropriate public health messages. Becoming familiar with vulnerable populations and their needs prior to a water contamination event will help in identifying barriers and developing and refining effective messages in such a crisis. In water contamination crises, our publics’ health depends on effective, targeted crisis communication.
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Pascual, Julio, Patricia Pozo-Rosich, Irene Carrillo, Sandra Rodríguez-Justo, Dolores Jiménez-Hernández, Almudena Layos-Romero, Cristina Bailón-Santamaría, et al. "Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report." BMJ Open 10, no. 10 (October 2020): e037190. http://dx.doi.org/10.1136/bmjopen-2020-037190.
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BackgroundHeadache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process.PurposeTo establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare.MethodA qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness.ResultsSeven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%).ConclusionsThis proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.
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Lord, Sarah, Sarah K. Moore, Alex Ramsey, Susan Dinauer, and Kimberly Johnson. "Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers." JMIR Mental Health 3, no. 2 (June 28, 2016): e24. http://dx.doi.org/10.2196/mental.4927.
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Background Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings. Objectives In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings. Methods Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation. Results Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over usual care, the ability to adapt the app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients’ mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation. Conclusions The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches.
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Bemrich-Stolz, Christina J., Jeffrey D. Lebensburger, Jewell H. Halanych, and Thomas H. Howard. "Adult Care Experiences and Barriers to Transition in Adult Patients with Sickle Cell Anemia." Blood 118, no. 21 (November 18, 2011): 3155. http://dx.doi.org/10.1182/blood.v118.21.3155.3155.
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Abstract Abstract 3155 Background: With improvements in care in the pediatric age group, most patients with sickle cell disease (SCD) live to adulthood. Though life expectancy is increasing, there is evidence that patients experience increasing mortality at the time of transition from pediatric to adult care. As care of adult patients is beyond the scope of pediatrics, transition to adult providers becomes a necessary part of comprehensive care for youths with SCD. When present, transition programs often focus on development of self management skills, improving health literacy, and other life skills beyond simply identifying and transferring to an adult provider. Most studies of pediatric patients with SCD and other chronic illnesses have focused on the concerns of patients prior to transition, but few have examined the experience of patients who have entered adult care. Using semi-structured interviews, our study examined adult SCD patients' transition experiences and difficulties faced in adult care that may contribute to the increased mortality during this time. Methods: Participants seen at the UAB Sickle Cell Clinic were recruited to participate in a semi-structured interview. To elicit the broadest experiences of adult care, we did not restrict the interviews to young adults, but recruited any interested participant with SCD >18 years old. The interview consisted of open ended questions with additional prompts regarding specific barriers found in the literature. One author (CB) performed all interviews, either in the UAB Sickle Cell Clinic or by telephone. Interviews continued until data saturation was achieved. All interviews were audio recorded and transcribed, then analyzed in three stages. First, transcripts were reviewed and coded independently by two authors (CB and JL). Second, the authors met to reconcile code definitions and agree on an overall coding scheme, which was based both on a priori themes from previous studies as well as inductive codes noted during analysis. Finally, the authors re-coded the transcripts based on the agreed upon coding scheme and reconciled differences. Results: Interviews were completed with 10 participants aged 24–55 years old. All patients had medical insurance, with 9 on disability. Transition topics discussed included timing of and preparation for transfer, development of independence, feelings about and experiences in pediatric and adult care. We confirmed that adults with SCD experienced many of the concerns noted in previous studies of pre-transition adolescents. Participants experienced distrust from adult physicians, mostly regarding pain. Though all participants feel that as adults, they successfully transitioned to independence in care for their disease, a number of them continue to regularly consult their parents regarding their care and/or live with their parents. Participants confirmed that a number of physicians they encountered were not familiar with sickle cell care and were concerned that the care they received from non-hematologists was inappropriate. None of the participants received formal preparation for transfer, though half were referred directly to an adult hematologist from pediatric care. Participants noted poor coordination of care between primary care physicians and hematologists, and difficulty identifying physicians willing to care for them. Those who had spent time in the work force noted difficulty maintaining employment. Conclusions: We found that concerns expressed by adolescents prior to transition in previous studies were well-founded and experienced in adulthood by a number of participants. Many patients feel poorly treated and have found few adult providers familiar with SCD. Since this study included patients engaged in a specialized sickle cell clinic, selection bias is a limitation. Though skills taught in many transition programs may help to overcome these barriers, systemic changes must also take place to address these external issues reported by patients who have transitioned to adult care. Disclosures: No relevant conflicts of interest to declare.
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Muhlestein, Whitney, Alice Song, David G. Schlundt, and Lola B. Chambless. "2252." Journal of Clinical and Translational Science 1, S1 (September 2017): 72. http://dx.doi.org/10.1017/cts.2017.255.
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OBJECTIVES/SPECIFIC AIMS: “Loss to follow up” is a common phenomenon and challenge in clinical medicine. Missed appointments are a well-documented source of waste in the health care system, and can lead to strained patient-physician relationships and inferior quality of care. Meningiomas are relatively common, benign tumors that arise from the dural coverings of the brain. Although complete surgical resection is considered curative, surgically excised meningiomas have a well-documented propensity to recur, necessitating continued imaging surveillance of postresection patients. A recent retrospective study at our institute demonstrated that 20% of postresection patients fail to return for follow up within a year of their surgery. Although social determinants of health have been associated with failure to follow up in this population, there has been no research identifying patient-reported barriers that result in loss to follow up in this patient population. The purpose of this study is to identify specific barriers that prevent patients from returning for surveillance. METHODS/STUDY POPULATION: We used an IRB approved, prospective brain tumor clinical database to identify patients who underwent surgical resection of intracranial meningioma at our institution between 2001 and 2013. “Loss to follow up” was defined as failure to attend follow-up appointments with neurosurgery, radiation oncology, or neuro-oncology within a year of the most recent assigned follow-up interval, as recorded in the electronic medical record. Structured interviews were conducted with patients who met study criteria and specific barriers to follow-up were elicited, transcribed, and coded. In 2 cases, a primary caregiver participated in all or portions of the interview with the patient. A general assessment of patient knowledge about meningioma and a screening for basic health literacy were also conducted. RESULTS/ANTICIPATED RESULTS: There were 80 patients in the brain tumor clinical database met chart review criteria for inclusion in the study. A total of 9 structured interviews were conducted; 1 interview was excluded from analysis for failure to meet study criteria. In total, 24 unique obstacles to follow up were recorded. These were stratified and grouped into 4 broad categories: 2 of 8 (25%) patients identified environmental factors, including distance to appointment and challenges with insurance coverage as barriers to follow up; 2 patients (25%) identified psychosocial factors, including poor communication with and distrust of their neurosurgeon as barriers to follow up; 2 (25%) patients identified health factors, including poor health and old age, as barriers to follow up; 6 patients identified healthcare systems factors as barriers to follow up, with 6 patients (75%) reporting seeing a non-specialist for follow up after surgery and 4 patients (50%) reporting not being told by their neurosurgeon that they would need continued follow up. Of those patients seen by non-specialists, only 1 reported any recent brain imaging by those providers. All patients had limited to no prior knowledge of meningiomas before their diagnosis. Four (50%) patients reported satisfaction with the level education about meningiomas they received from their physician. Of these patients, 3 (75%) correctly reported that meningiomas may recur following surgery. Of the patients who did not report satisfaction with physician counseling, 3 (75%) did not realize that meningiomas can recur. DISCUSSION/SIGNIFICANCE OF IMPACT: Healthcare system factors, including uncoordinated transition of postoperative care to non-neurosurgeons and uncertain postoperative surveillance schedules, represent that most common patient-identified barriers to follow up after meningioma resection. Improving transition of care from specialists to non-specialists, including designation of appropriate imaging surveillance schedules, as well as improving communication between specialists and patients about the need for continued follow up, represent clear points for intervention that could improve care for this patient population. In addition, consistent and clear counseling about meningioma and its disease course may reduce loss to follow up following meningioma resection. It is important to note, however, that the small sample size represents a significant limitation of the study.
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Yu, Cheong M., Alice Lu, Emilie Touma, Pamela Wax, Amador Rosales, Colleen M. Smyrniotis, Daniel H. Schneider, Jane L. Holl, and Amisha Wallia. "Understanding Facilitators and Barriers in the Hospital Discharge Processes of Newly Prescribed Insulin: A Mixed-Methods Study." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A431—A432. http://dx.doi.org/10.1210/jendso/bvab048.880.
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Abstract Patients, newly prescribed insulin, being discharged from the hospital are at high risk of adverse outcomes. An electronic enterprise data warehouse (EDW) algorithm was created and validated to identify these inpatients electronically. Qualitative interviews were also conducted to assess barriers in the discharge process. The EDW algorithm to identify inpatients (09/01/18-08/31/19), newly prescribed insulin at discharge, was created by identifying screening indicators (e.g., admission/discharge medication lists, discharge summary). Iterative adjustments to the algorithm were made after chart review and included review of medication reconciliation (med rec), admission/discharge orders, and insulin orders (types/delivery). The EDW list was compared to the list of patients who received insulin teaching from the Certified Diabetes Care and Education Specialist (CDCES), during the same period. Providers (N=8, 3 endocrine attending MDs, 2 fellow MDs, 3 resident MDs) were interviewed in key informant interviews (N=3) and focus groups (N=2); transcripts were independently coded by 2 coders, utilizing a constant comparative method to generate key themes. The EDW list (N=554) was audited by EHR review (n = 42, 8%); 83% (35/42) were correctly identified as newly discharged on insulin. Of the 7 incorrectly identified, 4 likely had incomplete med rec. The EDW algorithm was unable to correctly identify patients with inaccurate/incomplete med rec, patients transferring from outside hospitals or those without e-Rx at discharge (vouchers, call-in). The CDCES list (N=257) was audited (n=25, 10%), and of patients not meeting criteria (n=15), some had prior insulin prescribed (n=5), and most ended up not discharged on insulin after CDCES insulin teaching (n=9). Comparison of the EDW and CDCES lists had 177 patients (32% of EDW list) in common, with 377 on the EDW list with no CDCES consultation. An audit (n=21/377, 5%) of these EDW patients, who did not have CDCES or endocrinology consultation, revealed patients across service lines, with minimal formal documentation of insulin training/education. Key identified themes from interviews identified barriers including lack of availability of a CDCES after-hours and on weekends, low health literacy/numeracy, and lack of time during stay. In training MDs noted variability in discharge prescribing by supervising MDs and the need to assess “chart lore,” given cut and paste documentation in EHR. This study suggests that an EDW algorithm can be used to identify patients newly being discharged on insulin, for whom teaching by a CDCES is recommended. The data suggest the need for more targeted and increased CDCES capacity as only a portion of those eligible for insulin teaching were seen while others were seen but then not discharged on insulin. Additional resources for insulin teaching are needed and standardized training and documentation need to be developed.
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Hermes, Eric, Laura Burrone, Elliottnell Perez, Steve Martino, and Michael Rowe. "Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers." JMIR Mental Health 5, no. 2 (May 18, 2018): e42. http://dx.doi.org/10.2196/mental.9600.
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Background Access to evidence-based interventions for common mental health conditions is limited due to geographic distance, scheduling, stigma, and provider availability. Internet-based self-care programs may mitigate these barriers. However, little is known about internet-based self-care program implementation in US health care systems. Objective The objective of this study was to identify determinants of practice for internet-based self-care program use in primary care by eliciting provider and administrator perspectives on internet-based self-care program implementation. Methods The objective was explored through qualitative analysis of semistructured interviews with primary care providers and administrators from the Veterans Health Administration. Participants were identified using a reputation-based snowball design. Interviews focused on identifying determinants of practice for the use of internet-based self-care programs at the point of care in Veterans Health Administration primary care. Qualitative analysis of transcripts was performed using thematic coding. Results A total of 20 physicians, psychologists, social workers, and nurses participated in interviews. Among this group, internet-based self-care program use was relatively low, but support for the platform was assessed as relatively high. Themes were organized into determinants active at patient and provider levels. Perceived patient-level determinants included literacy, age, internet access, patient expectations, internet-based self-care program fit with patient experiences, interest and motivation, and face-to-face human contact. Perceived provider-level determinants included familiarity with internet-based self-care programs, changes to traditional care delivery, face-to-face human contact, competing demands, and age. Conclusions This exploration of perspectives on internet-based self-care program implementation among Veterans Health Administration providers and administrators revealed key determinants of practice, which can be used to develop comprehensive strategies for the implementation of internet-based self-care programs in primary care settings.
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Worrall-Carter, Linda, Karen Daws, Muhammad Aziz Rahman, Sarah MacLean, Kevin Rowley, Shawana Andrews, Andrew MacIsaac, et al. "Exploring Aboriginal patients’ experiences of cardiac care at a major metropolitan hospital in Melbourne." Australian Health Review 40, no. 6 (2016): 696. http://dx.doi.org/10.1071/ah15175.
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Objectives The aim of the present study was to explore Aboriginal patients’ lived experiences of cardiac care at a major metropolitan hospital in Melbourne. Methods The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012–13. A phenomenological approach was used to analyse the data. Results Eight themes emerged from the data, each concerning various aspects of participants’ experiences: ‘dislike of hospitals’, ‘system failures’, ‘engagement with hospital staff’, ‘experiences of racism’, ‘health literacy and information needs’, ‘self-identifying as Aboriginal’, ‘family involvement in care’ and ‘going home and difficulties adapting’. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences. Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community. What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system. What does this paper add? Aboriginal patients’ lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care. What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.
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Beaumont, C. Ellsworth, and C. Benjamin. "Identifying Gaps in Metastatic Breast Cancer Patient Knowledge and Their Communication Experiences With Health Care Professionals and Developing Visually Based Solutions to Overcome Those Gaps." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 108s. http://dx.doi.org/10.1200/jgo.18.66400.
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Background: Metastatic breast cancer (MBC) is the fifth most common cause of death from cancer globally.1 MBC is incurable and its trajectory complicated. Patients have only a few days to choose treatments after an unexpected diagnosis, and most conversations with health care professionals (HCPs) are oral, a communication method with low retention accuracy (14%).2 Patients and caregivers feel ill prepared and overwhelmed. Yet when visuals are introduced into HCP/patient communication, accurate recall can be as high as 85% for low-literacy populations.2 Aim: Test if visually based communication tools can be used by HCPs to increase MBC patient and caregiver understanding of MBC as incurable, and confidence in making treatment decisions for quality of life. Methods: Survey of MBC patients (n=487) communication experience prior to treatment of Stage IV; interviews with HCPs (n=20) in the clinic to identify communication barriers with patients; empathy role play with HCPs and patients to clarify viewpoints (n=7); analysis of patient materials; in-depth interviews with MBC patients and communication experts (n=12); iterative design process of communication tool prototype with MBC patient group (n=48) and HCPs. Results: Only 1 in 8 patients were educated with visuals during initial discussions with HCPs. Less than half of patients (46%) included HER2 and hormone receptor status when asked to describe their subtype. One-third of patients felt they did not have enough knowledge to participate in decision-making for treatment and 58% of patients felt rushed to start; 71% did not recall discussing goals/hobbies; and just 62% discussed pain and symptom management. HCPs want to deliver difficult news in a clear and empathetic way, reduce repetition, save time educating patients, and have better tools for caregivers; current patient materials are impersonal and overwhelming. Iterative development and testing of the MBC Communication Toolkit prototype with HCPs and patients showed patients understood treatment options more easily with a visual metaphor while HCPs using the prototype said the images were effective for communicating symptoms and treatment options. Conclusion: A visual approach to improving communication between MBC patients and caregivers and their HCPs seems possible based on positive results of patient interpretation and practitioner feedback. Visual tools can help HCPs engage patients with information to enable them to understand their disease, goals, and nature of treatments so they can make informed, appropriate decisions. REFERENCES 1. International Agency for Research on Cancer: Breast cancer: estimated incidence, mortality and prevalence worldwide in 2012. Available at https://globocan.iarc.fr/Pages/fact-sheets_cancer.aspx 2. Houts PS, Witmer JT, Egeth HE, et al: Using pictographs to enhance recall of spoken medical instructions II. Patient Educ Couns 43:231-242, 2001 https://doi.org/10.1016/S0738-3991(00)00171-3
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Schmit, Cason, Kobi V. Ajayi, Alva O. Ferdinand, Theodoros Giannouchos, Gurudev Ilangovan, W. Benjamin Nowell, and Hye-Chung Kum. "Communicating With Patients About Software for Enhancing Privacy in Secondary Database Research Involving Record Linkage: Delphi Study." Journal of Medical Internet Research 22, no. 12 (December 15, 2020): e20783. http://dx.doi.org/10.2196/20783.
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Background There is substantial prior research on the perspectives of patients on the use of health information for research. Numerous communication barriers challenge transparency between researchers and data participants in secondary database research (eg, waiver of informed consent and knowledge gaps). Individual concerns and misconceptions challenge the trust in researchers among patients despite efforts to protect data. Technical software used to protect research data can further complicate the public's understanding of research. For example, MiNDFIRL (Minimum Necessary Disclosure For Interactive Record Linkage) is a prototype software that can be used to enhance the confidentiality of data sets by restricting disclosures of identifying information during the record linkage process. However, software, such as MiNDFIRL, which is used to protect data, must overcome the aforementioned communication barriers. One proposed solution is the creation of an interactive web-based frequently asked question (FAQ) template that can be adapted and used to communicate research issues to data subjects. Objective This study aims to improve communication with patients and transparency about how complex software, such as MiNDFIRL, is used to enhance privacy in secondary database studies to maintain the public's trust in researchers. Methods A Delphi technique with 3 rounds of the survey was used to develop the FAQ document to communicate privacy issues related to a generic secondary database study using the MiNDFIRL software. The Delphi panel consisted of 38 patients with chronic health conditions. We revised the FAQ between Delphi rounds and provided participants with a summary of the feedback. We adopted a conservative consensus threshold of less than 10% negative feedback per FAQ section. Results We developed a consensus language for 21 of the 24 FAQ sections. Participant feedback demonstrated preference differences (eg, brevity vs comprehensiveness). We adapted the final FAQ into an interactive web-based format that 94% (31/33) of the participants found helpful or very helpful. The template FAQ and MiNDFIRL source code are available on GitHub. The results indicate the following patient communication considerations: patients have diverse and varied preferences; the tone is important but challenging; and patients want information on security, identifiers, and final disposition of information. Conclusions The findings of this study provide insights into what research-related information is useful to patients and how researchers can communicate such information. These findings align with the current understanding of health literacy and its challenges. Communication is essential to transparency and ethical data use, yet it is exceedingly challenging. Developing FAQ template language to accompany a complex software may enable researchers to provide greater transparency when informed consent is not possible.
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Islam, M. Hedaitul, Md Rayhan Sarker, Md Israil Hossain, Kauser Ali, and K. M. Asadun Noor. "Towards Sustainable Supply Chain Management (SSCM): A Case of Leather Industry." Journal of Operations and Strategic Planning 3, no. 1 (June 2020): 81–98. http://dx.doi.org/10.1177/2516600x20924313.
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At present, sustainable supply chain management (SSCM) has gained a great momentum in this competitive business world for any kind of industry. Leather industry (leather, leather products, and footwear) is the second export earning sector of Bangladesh which is scrambling to implement SSCM in its working cycle. There are lot of challenges that are creating barriers for this industry owners in establishing sustainability practices in their supply chain management. There is lack of enough research in identifying the challenges of SSCM for leather industry of Bangladesh. That’s why, it is very imperative to identify the challenges of SSCM for leather industry in Bangladesh which will guide the industry owners to combat these challenges. In this research, we have not only identified the challenges of SSCM for leather industry but also evaluated the relationship among them. Besides, a priority list of identified challenges is depicted through which the industry owners can easily find out the major and minor challenges. Five industrial experts were selected from export-oriented leather and footwear factories in order to sort out the appropriate challenges. Decision-making trial and evaluation laboratory (DEMATEL) technique was applied to assess the relationship among identified 18 challenges and divided them into two groups such as cause and effect. The casual challenges are lack of knowledge and experience, lack of technical expertise, corruption, social unawareness, lack of acceptance of new technology, lack of training on SSCM, poor organizational culture, market competition and uncertainty, lack of commitment from top management and lack of integration of IT system. On the other hand, lack of eco-literacy among supply chain stakeholders, financial constraints, lack of government rules and regulations, cost of sustainability, limitations of capacity, lack of management initiatives for reverse logistics, demand for lower price and lack of energy and waste management policy were identified as effect group challenges. This study will help the decision-makers of leather industry in formulating strategic policies to address these challenges for in implementing SSCM in leather industry that will drive these sectors toward sustainable development.
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Rasmussen, Karsten Boye. "Sharing qualitative research data, improving data literacy and establishing national data services." IASSIST Quarterly 43, no. 4 (January 2, 2020): 1–2. http://dx.doi.org/10.29173/iq972.
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Welcome to the fourth issue of volume 43 of the IASSIST Quarterly (IQ 43:4, 2019).
The first article is authored by Jessica Mozersky, Heidi Walsh, Meredith Parsons, Tristan McIntosh, Kari Baldwin, and James M. DuBois – all located at the Bioethics Research Center, Washington University School of Medicine, St. Louis, Missouri in USA. They ask the question “Are we ready to share qualitative research data?”, with the subtitle “Knowledge and preparedness among qualitative researchers, IRB Members, and data repository curators.” The subtitle indicates that their research includes a survey of key personnel related to scientific data sharing. The report is obtained through semi-structured in-depth interviews with 30 data repository curators, 30 qualitative researchers, and 30 IRB staff members in the USA. IRB stands for Institutional Review Board, which in other countries might be called research ethics committee or similar. There is generally an increasing trend towards data sharing and open science, but qualitative data are rarely shared. The dilemma behind this reluctance to share is exemplified by health data where qualitative methods explore sensitive topics. The sensitivity leads to protection of confidentiality, which hinders keeping sufficient contextual detail for secondary analyses. You could add that protection of confidentiality is a much bigger task in qualitative data, where sensitive information can be hidden in every corner of the data, that consequently must be fine-combed, while with quantitative data most decisions concerning confidentiality can be made at the level of variables. The reporting in the article gives insights into the differences between the three stakeholder groups. An often-found answer among researchers is that data sharing is associated with quantitative data, while IRB members have little practice with qualitative. Among curators, about half had curated qualitative data, but many only worked with quantitative data. In general, qualitative data sharing lacks guidance and standards.
The second article also raises a question: “How many ways can we teach data literacy?” We are now in Asia with a connection to the USA. The author Yun Dai is working at the Library of New York University Shanghai, where they have explored many ways to teach data literacy to undergraduate students. These initiatives, described in the article, included workshops and in-class instruction - which tempted students by offering up-to-date technology, through online casebooks of topics in the data lifecycle, to event series with appealing names like “Lying with Data.” The event series had a marketing mascot - a “Lying with Data” Pinocchio - and sessions on being fooled by advertisements and getting the truth out of opinion surveys. Data literacy has a resemblance to information literacy and in that perspective, data literacy is defined as “critical thinking applied to evaluating data sources and formats, and interpreting and communicating findings,” while statistical literacy is “the ability to evaluate statistical information as evidence.” The article presents the approaches and does not conclude on the question, “How many?” No readers will be surprised by the missing answer, and I am certain readers will enjoy the ideas of the article and the marketing focus.
With the last article “Examining barriers for establishing a national data service,” the author Janez Štebe takes us to Europe. Janez Štebe is head of the social science data archives (Arhiv Družboslovnih Podatkov) at the University of Ljubljana, Slovenia. The Consortium of European Social Science Data Archives (CESSDA) is a distributed European social science data infrastructure for access to research data. CESSDA has many - but not all - European countries as members. The focus is on the situation in 20 non-CESSDA member European countries, with emerging and immature data archive services being developed through such projects as the CESSDA Strengthening and Widening (SaW 2016 and 2017) and CESSDA Widening Activities (WA 2018). By identifying and comparing gaps and differences, a group of countries at a similar level may consider following similar best practice examples to achieve a more mature and supportive open scientific data ecosystem. Like the earlier articles, this article provides good references to earlier literature and description of previous studies in the area. In this project 22 countries were selected, all CESSDA non-members, and interviewees among social science researchers and data librarians were contacted with an e-mail template between October 2018 and January 2019. The article brings results and discussion of the national data sharing culture and data infrastructure. Yes, there is a lack of money! However, it is the process of gradually establishing a robust data infrastructure that is believed to impact the growth of a data sharing culture and improve the excellence and the efficiency of research in general.
Submissions of papers for the IASSIST Quarterly are always very welcome. We welcome input from IASSIST conferences or other conferences and workshops, from local presentations or papers especially written for the IQ. When you are preparing such a presentation, give a thought to turning your one-time presentation into a lasting contribution. Doing that after the event also gives you the opportunity of improving your work after feedback. We encourage you to login or create an author login to https://www.iassistquarterly.com (our Open Journal System application). We permit authors to “deep link” into the IQ as well as to deposit the paper in your local repository. Chairing a conference session with the purpose of aggregating and integrating papers for a special issue IQ is also much appreciated as the information reaches many more people than the limited number of session participants and will be readily available on the IASSIST Quarterly website at https://www.iassistquarterly.com. Authors are very welcome to take a look at the instructions and layout:
https://www.iassistquarterly.com/index.php/iassist/about/submissions
Authors can also contact me directly via e-mail: kbr@sam.sdu.dk. Should you be interested in compiling a special issue for the IQ as guest editor(s) I will also be delighted to hear from you.
Karsten Boye Rasmussen - December 2019
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Caves, Richard E., and Pankaj Ghemawat. "Identifying mobility barriers." Strategic Management Journal 13, no. 1 (January 1992): 1–12. http://dx.doi.org/10.1002/smj.4250130102.
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Aurelus, Edna. "BREAKING BARRIERS." International Journal of Research -GRANTHAALAYAH 7, no. 8 (August 31, 2019): 29–33. http://dx.doi.org/10.29121/granthaalayah.v7.i8.2019.635.
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Motivation/Background: Information system has been expanding globally at an unstoppable rate. Different apps are being developed daily in the quest to educate people about health determinants that could guarantee quality lifestyle for all. However, health literacy is an extremely important factor that must be taking into account when providing this health information.
Method: Extensive literature review was completed using, Cochrane, Medline, Elsevier and Psych info. Articles were selected based on information that include health literacy and health information technology.
Results: The findings report barriers and benefits that exist when using health information technology to educate people on healthy lifestyle. Health literacy creates elicit more understanding for consumers.
Conclusion: patients who fall into the category of vulnerable population face multiple challenges caused by health disparities and obstacles with health literacy. Implementation health literacy into our daily practice can be impactful to positive patients’ health outcomes.
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Chez, Ronald A. "Identifying Low-Literacy Patients." Primary Care Update for OB/GYNS 6, no. 2 (January 1999): 72–74. http://dx.doi.org/10.1016/s1068-607x(98)00187-5.
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