Barriers and facilitators to implementing practices for prevention of childhood obesity in primary care: A mixed methods systematic review.
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SUBMITTER: Ray D
PROVIDER: S-EPMC9285925 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo identify positive and negative deviant cases using quantitative fidelity data from a previous implementation of a nutrition intervention, Together, We Inspire Smart Eating (WISE), and to determine barriers and facilitators to fidelity by conducting qualitative interviews with deviant cases.DesignExplanatory sequential mixed methods.SettingHead Start Program agencies in 2 southern US states.ParticipantsQuantitative fidelity data were collected in 42 Head Start classrooms. Recruitment for qualitative interviews prioritized those who were positive or negative deviants across fidelity components (African American, n = 21; white, n = 19; and Hispanic, n = 3).InterventionWISE introduces children to fruits and vegetables using evidence-based practices of role modeling, positive feeding, mascot use, and hands-on exposure.AnalysisA directed content analysis approach informed by the integrated Promoting Action on Research Implementation in Health Service framework.Phenomenon of interestBarriers and facilitators to WISE evidence-based practices implementation.ResultsQualitative analyses identified themes of culture, leadership support, and mechanisms for embedding change as key contextual factors. Key findings related to recipient characteristics were beliefs about what works, personalized strategies to use WISE, and classroom management. Primary themes for the innovation construct were time and preparation, degree of fit, and WISE advantage. Finally, findings relative to the construct of facilitation included trainer support and desire for additional training.Conclusions and implicationsThe study of cases at the extreme ends of the fidelity spectrum can provide unique perspectives on barriers and facilitators to implementation of interventions.
| S-EPMC6788974 | biostudies-literature
Project description:Childhood obesity is a growing global health concern. Although mobile health apps have the potential to deliver behavioural interventions, their impact is commonly limited by a lack of sufficient engagement. The purpose of this study was to explore barriers and facilitators to engagement with a family-focused app and its perceived impact on motivation, self-efficacy, and behaviour. Parents with at least one child under 18 and healthcare professionals working with children were recruited; all participants were allocated to use the NoObesity app over a 6-month period. The mixed-methods design was based on the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks. Qualitative and quantitative data were gathered through semi-structured interviews, questionnaires, and app use data (logins and in-app self-reported data). 35 parents were included in the final analysis; quantitative results were analysed descriptively and thematic analysis was conducted on the qualitative data. Key barriers to engagement were boredom, forgetting, and usability issues and key barriers to potential impact on behaviours were accessibility, lack of motivation, and family characteristics. Novelty, gamification features, reminders, goal setting, progress monitoring and feedback, and suggestions for healthy foods and activities were key facilitators to engagement with the app and behaviours. A key observation was that intervention strategies could help address many motivation and capability barriers, but there was a gap in strategies addressing opportunity barriers. Without incorporating strategies that successfully mitigate barriers in all three determinants of behaviour, an intervention is unlikely to be successful. We highlight key recommendations for developers to consider when designing the features and implementation of digital health interventions. Trial Registration: ClinicalTrials.gov (NCT05261555).
| S-EPMC10971669 | biostudies-literature
Project description:Continuous quality improvement (CQI) programs may result in quality of care and outcome improvement. However, the implementation of such programs has proven to be very challenging. This mixed methods systematic review identifies barriers and facilitators pertaining to the implementation of CQI programs in colonoscopy services and how they relate to endoscopists, nurses, managers, and patients.We developed a search strategy adapted to 15 databases. Studies had to report on the implementation of a CQI intervention and identified barriers or facilitators relating to any of the four groups of actors directly concerned by the provision of colonoscopies. The quality of the selected studies was assessed and findings were extracted, categorized, and synthesized using a generic extraction grid customized through an iterative process.We extracted 99 findings from the 15 selected publications. Although involving all actors is the most cited factor, the literature mainly focuses on the facilitators and barriers associated with the endoscopists' perspective. The most reported facilitators to CQI implementation are perception of feasibility, adoption of a formative approach, training and education, confidentiality, and assessing a limited number of quality indicators. Receptive attitudes, a sense of ownership and perceptions of positive impacts also facilitate the implementation. Finally, an organizational environment conducive to quality improvement has to be inclusive of all user groups, explicitly supportive, and provide appropriate resources.Our findings corroborate the current models of adoption of innovations. However, a significant knowledge gap remains with respect to barriers and facilitators pertaining to nurses, patients, and managers.
| S-EPMC4751006 | biostudies-other
Project description:ObjectivesChildhood obesity is one of the worldwide considerable public health challenges and many factors can play a role in its management. Therefore, this article examined the facilitators and barriers of childhood obesity prevention (COP) policies.MethodsThis systematic review of qualitative studies was conducted via a search of the SCOPUS, PubMed, and Google Scholar databases between 1 January 2010 and 11 February 2022 and examined factors that influence the implementation of COP policies at a community approach.ResultsThe parents' reluctance to engage in COP activities, lack of sufficient knowledge, and financial problems were the most reported barriers at the individual level. In addition, the beliefs about COP at the sociocultural level and limited funding and resources, time limitations in stakeholders at the implementation level, and lack of policy support at the structural level were the most frequently reported barriers. Further, effective communication between stakeholders and parents and school staff at the sociocultural level and flexibility of the intervention, delivery of healthy food programs in schools, low-cost and appropriate resources, and the availability of appropriate facilities are the most frequently reported facilitators in the structural level.ConclusionIndividual, sociocultural, and structural level-related barriers and facilitators influence the implementation of COP policies. Most of the barriers and facilitators in this systematic review were related to the structural level.
| S-EPMC9874939 | biostudies-literature
Project description:BackgroundIn the United States, primary care providers (PCPs) routinely balance acute, chronic, and preventive patient care delivery, including cancer prevention and screening, in time-limited visits. Clinical decision support (CDS) may help PCPs prioritize cancer prevention and screening with other patient needs. In a three-arm, pragmatic, clinic-randomized control trial, we are studying cancer prevention CDS in a large, upper Midwestern healthcare system. The web-based, electronic health record (EHR)-linked CDS integrates evidence-based primary and secondary cancer prevention and screening recommendations into an existing cardiovascular risk management CDS system. Our objective with this study was to identify adoption barriers and facilitators before implementation in primary care.MethodsWe conducted semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) with 28 key informants employed by the healthcare organization in either leadership roles or the direct provision of clinical care. Transcribed interviews were analyzed using qualitative content analysis.ResultsEHR, CDS workflow, CDS users (providers and patients), training, and organizational barriers and facilitators were identified related to Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals CFIR domains.ConclusionIdentifying and addressing key informant-identified barriers and facilitators before implementing cancer prevention CDS in primary care may support a successful implementation and sustained use. The CFIR is a useful framework for understanding pre-implementation barriers and facilitators. Based on our findings, the research team developed and instituted specialized training, pilot testing, implementation plans, and post-implementation efforts to maximize identified facilitators and address barriers.Trial registrationclinicaltrials.gov , NCT02986230 , December 6, 2016.
| S-EPMC6668099 | biostudies-literature
Project description:Participation in high-quality early childhood education and care (ECEC) benefits children and society. Policy recognition of this manifests through government subsidy strategies to increase ECEC access in the years immediately preceding school. Yet despite this action, many children do not receive the recommended amount. This study utilizes a mixed-methods design to investigate ECEC participation barriers and facilitators in three Australian communities. Parents and service providers completed online questionnaires (45 parents, 63 providers) and semi-structured interviews (21 parents, 16 providers). Results showed that issues related to both direct (e.g., fees) and indirect (e.g., travel) costs are particularly important barriers for families, and are well-recognized by providers. A range of factors were also considered important for facilitating participation (e.g., effective promotion of the benefits linked to high-quality play-based learning in formal settings, professional training of staff). Findings demonstrated the ecological complexity of participation. Strategies to address barriers and harness facilitators are required across multiple levels.
| S-EPMC8905567 | biostudies-literature
Project description:BackgroundThe prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders.MethodsA qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran.ResultsThe identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents.ConclusionThe existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders.
| S-EPMC8665716 | biostudies-literature
Project description:BackgroundChildhood obesity prevention interventions have engaged coalitions in study design, implementation, and/or evaluation to improve research outcomes; yet, no systematic reviews have been conducted on this topic. This mixed methods review aims to characterize the processes and dynamics of coalition engagement in community-based childhood obesity prevention interventions.MethodsData Sources: Studies extracted from Ovid MEDLINE, PubMed, and Web of Science; complementary original survey and interview data among researchers of included studies. Eligible Studies: Multisetting community-based obesity prevention interventions in high-income countries targeting children 0-12 years with anthropometric, behavioral, or environmental/policy outcomes. The Community-Based Participatory Research (CBPR) Conceptual Model was used as an overarching framework.ResultsThirteen studies met inclusion criteria. Elements of CBPR were evident across all studies with community engagement in problem identification (n = 7), design/planning (n = 11), implementation (n = 12), evaluation (n = 4), dissemination (n = 2), and sustainability (n = 10) phases. Five studies reported favorable intervention effects on anthropometric (n = 4), behavioral (n = 1), and/or policy (n = 1) outcomes; descriptive associations suggested that these studies tended to engage community members in a greater number of research phases. Researchers involved in 7 of 13 included studies completed a survey and interview. Respondents recalled the importance of group facilitation, leadership, and shared understanding to multisector coalition work. Perceived coalition impacts included community capacity building and intervention sustainability.ConclusionsThis review contributes to a deeper understanding of intervention processes and dynamics within communities engaged in childhood obesity prevention. Future research should more rigorously assess and report on coalition involvement to assess the influence of coalitions on multiple outcomes, including child weight status.
| S-EPMC6249669 | biostudies-literature
Project description:The 'Sepsis 6', a care bundle of basic, but vital, measures (e.g. intravenous fluid, antibiotics) has been implemented to improve sepsis treatment. However, uptake has been variable. Tools from behavioral sciences, such as the Theoretical Domains Framework (TDF) may be used to understand and address such implementation issues. This study used a behavioral science approach to identify barriers and facilitators towards Sepsis Six implementation at a case study hospital.Semi-structured interviews based on the TDF were conducted with a sample group of consultants, junior doctors and nurses from Emergency Department, Medical and Surgical Admissions, to explore barriers/facilitators to Sepsis Six performance. Transcripts were analyzed following the combined principles of content and framework analysis. Emerging themes informed a questionnaire to explore generalizability and importance across a sample of 261 stakeholders. Median importance and agreement ratings for each theme were calculated overall and for each role and clinical area. These were used to identify important barriers and important facilitators as targets for performance improvement.No new belief statements were discovered and data saturation was deemed achieved after 10 interviews. 1699 utterances were coded into 64 belief statements, then collated into a 51-item questionnaire. 113 questionnaire responses were obtained (44.3% response rate). Important barriers included insufficient audit and feedback, poor teamwork and communication, concerns about using the Sepsis Six in certain patients, insufficient training, and resource concerns. Facilitators included confidence in knowledge and skills, beliefs in overall benefits of the bundle, beliefs that identification and management of septic patients fell within everyone's role, and that regular use of the bundle made it easier to remember. Some beliefs were applicable for the entire group, others were specific to particular staff groups.A range of barriers and facilitators towards Sepsis Six performance across different staff groups were systematically identified using a theoretically-informed approach. This can inform development of targeted performance improvement interventions.
| S-EPMC5606082 | biostudies-other
Project description:BackgroundTelemonitoring of blood pressure (BP) may improve BP control. However, many patients are not using BP telemonitoring due to personal, technological, and health system barriers. Individuals are required to have electronic health literacy (e-HL), defined as knowledge and skills to use technology services effectively, such as BP telemonitoring.ObjectiveThe objective was to determine the facilitators and barriers experienced by patients with hypertension in telemonitoring of BP using the e-HL framework (e-HLF).MethodsThis study was a prospective mixed-methods study using a convergent design. We recruited a convenience sample of 21 patients with hypertension. The qualitative section was online or phone individual in-depth interviews based on the e-HLF, which has seven domains. The quantitative section was an online survey consisting of demographics, an e-HL questionnaire, and patient-provider communication preferences. A joint display was used in the mixed-methods analysis.ResultsFive themes including knowledge, motivation, skills, systems, and behaviors along with 28 subthemes comprising facilitators or barriers of BP telemonitoring were identified. The mixed-methods results showed concordance between the participants' e-HL status and their experiences in the ability to actively engage with BP monitoring and managing digital services (domain 3) of the e-HLF. Other e-HL domains showed discordance.ConclusionPatients may engage with BP telemonitoring when they feel the usefulness of concurrent access to telemonitoring services that suit their needs.
| S-EPMC10387707 | biostudies-literature