Telerehabilitación respiratoria en fibrosis quística: experiencia de pacientes, padres y profesionales durante la pandemia de COVID-19. Estudio cualitativo

Introducción: la rehabilitación respiratoria (RR) se recomienda en pacientes con fibrosis quística (FQ). Durante la pandemia de COVID-19 los programas de RR debieron cerrarse o migrar a modalidades de telerehabilitación, imponiendo nuevos desafíos a pacientes y equipos de salud. El objetivo de este estudio fue explorar las percepciones de pacientes, padres y profesionales sobre la transición a la telerehabilitación respiratoria durante la pandemia de COVID-19. Método: estudio cualitativo. Se consideraron pacientes con FQ mayores de 8 años. También a padres y equipos de salud. El tamaño muestral se determinó mediante saturación teórica. Se realizaron entrevistas semiestructuradas y grupos focales vía Zoom. El análisis de datos se realizó mediante los métodos de codificación abierta y axial. El análisis se realizó utilizando el software Atlas. Ti 7.5.7. Resultados: se incluyó a 4 pacientes adultos, 1 pediátrico y 2 padres, además de 4 profesionales de equipos de salud. Existió una percepción general positiva respecto a la RR y la telerehabilitación. Entre las barreras destacó la falta de equipamiento para la telerehabilitación en domicilio y la organización diaria de los pacientes. Entre los facilitadores destacó la disponibilidad de equipos y redes que permitieran la conectividad y el apoyo familiar. Existió una valoración positiva hacia la continuidad de la telerehabilitación en la etapa post pandémica. Conclusiones: la telerehabilitación fue percibida como una alternativa viable y efectiva, sin embargo, aspectos de la conectividad, disponibilidad de equipamiento y la rutina diaria de los pacientes debe ser considerada a la hora de implementar modalidades telemáticas de atención.

Introduction: Pulmonary rehabilitation (PR) is recommended in patients with Cystic Fibrosis (CF). During the COVID-19 pandemic, PR programs had to migrate to telerehabilitation modalities, imposing new challenges for patients and health teams. The objective of this study was to explore the perceptions of patients, parents, and professionals regarding the transition to respiratory telerehabilitation experienced during the COVID-19 pandemic. Method: Qualitative study. Parents and health teams were included in the case of patients with CF over eight years old. Theoretical saturation determined the sample size. Semi-structured interviews and focus groups were conducted using the Zoom platform. Data analysis was carried out using open and axial coding methods. The analysis was performed using Atlas Ti software 7.5.7. Results: Four adult patients, one pediatric patient, two parents, and four health team professionals entered the study. There was a positive perception regarding PR and telerehabilitation. Among the barriers, the lack of equipment for telerehabilitation at home and the daily organization of patients stood out. Among the facilitators, the availability of equipment and networks that allowed connectivity and family support stood out. Patients rated the continuity of telerehabilitation in the post-pandemic stage positively. Conclusions: Telerehabilitation was perceived as a viable and effective alternative; however, aspects related to connectivity, availability of equipment, and the daily routine of patients must be considered when implementing telematics care modalities.

Obstacles and Facilitators in Daily Living Activities Among Persons with Spinal Cord Injury: A Systemic Review

@#Introduction: This systematic review aimed to investigate the level of participation, obstacles, and facilitator factors that influence activities of daily living among persons with spinal cord injury (SCI). Methods: A comprehensive search was conducted in four online databases, namely Google Scholar, PubMed, OT Seeker, and Cochrane Library covering the ten-years period from January 2012 to December 2022. Inclusion criteria encompassed original published studies in English focusing on daily activities, work, participation, obstacles, and facilitators in persons with SCI. Non-peer review sources (e.g., abstracts, grey literature, preprints), and studies unrelated to occupational therapy were excluded. The selected studies were assessed for quality using McMaster University Occupational Therapy Evidence-Based Practice critical review form. Results: Out of the 678 articles identified, ten studies were included after the screening, exploring participation in daily living activities, employment, return to work, leisure activities, family tasks, and community mobility among persons with SCI. Obstacles and facilitators influencing participation in activities of daily living were classified using the International Classification of Functioning, Disability, and Health (ICF) framework. This review highlighted that long-term participation is challenging for persons with SCI, affected by obstacles such as body functions, pain, low self-esteem, and environmental and social factors. Conclusion: The findings underscore the importance of adopting a multidisciplinary rehabilitation approach to enhance participation in daily activities for persons with SCI. Occupational therapy plays a significant role in improving participation levels among persons with SCI.

The influencing Factors of Doctor-patient Shared Decision Making: A Qualitative Study / 中国医学伦理学

To explore the barriers and facilitators of shared decision making, 23 clinicians were selected for semi-structured interviews by purpose sampling and convenience sampling with phenomenological methods in qualitative research, and 7-step of Colaizzi was used to analyze the interview data. Three themes and twelve subthemes were extracted, included: individual factors of doctors (role cognition, perceived outcomes, communication skills, clinical expertise, cognitive bias) , individual factors of patients (general information, lack of disease knowledge, willingness to participate in decision making) and environmental factors (clinical situation, social environment, resources and social influence) . There were many barriers and facilitators in the implementation of doctor-patient shared decision making. It is necessary to scientifically analyze and actively deal with the influence of each factor, and find reasonable countermeasures to promote the clinical implementation of shared decision making.

Barreras y facilitadores para la búsqueda de ayuda profesional en salud mental, desde la perspectiva de adolescentes con depresión / Barriers and facilitators to mental health help-seeking, from the perspective of adolescents with depression

La prevalencia de depresión en adolescentes es aproximadamente 7% en Chile. Sólo entre 18% y 34% de jóvenes con depresión accede a ayuda profesional. Objetivo: El objetivo de esta investigación fue analizar barreras y facilitadores para la búsqueda de ayuda profesional en salud mental, desde la perspectiva de adolescentes entre 15 y 17 años con depresión en Santiago de Chile. Método: Se llevó a cabo un estudio cualitativo exploratorio y descriptivo desde el enfoque fenomenológico. Se realizaron diez entrevistas semi estructuradas a adolescentes, que fueron analizadas con teoría fundamentada. Resultados: Las principales barreras fueron estigma, minimización de síntomas y preocupación por confidencialidad. Los principales facilitadores fueron contar con red de apoyo, reconocimiento de síntomas e intervenciones escolares que favorecen la detección de síntomas. Conclusiones: Se debe trabajar de manera conjunta con adolescentes, sus familias, pares y sistema escolar brindando información sobre la depresión y su tratamiento.

The prevalence of depression in adolescents is approximately 7% in Chile. Only between 18% and 34% of young people with depression access professional help. Objective: The aim of this research was to analyze the barriers and facilitators for seeking professional help in mental health, from the perspective of adolescents between 15 and 17 years of age with depression in Santiago, Chile. Methodology: An exploratory and descriptive qualitative study was carried out from the phenomenological approach. Ten semi-structured interviews were conducted with adolescents and analyzed with grounded theory. Results: The main barriers were stigma, minimization of symptoms, and concerns about confidentiality. The main facilitators were having a support network, symptom recognition, and school interventions that favor symptom detection. Conclusions: Joint work should be done with adolescents, their families, peers, and school system providing information about depression and its treatment.

Barriers and Facilitators Factors to Uptake of Cervical Cancer Screening Among Women in Low- and Middle-income Countries: A Narrative Review

@#Cervical cancer is a worldwide health issue. Each year, it kills hundreds of thousands of women worldwide. Despite the availability of screening tests, the incidence of cervical cancer remains high in low and middle-income countries. In this review, we survey the current literature on factors affecting cervical cancer screening uptake among women in low and middle-income countries. It also highlights potential strategies for improving screening uptake and suggests directions for future research. Knowledge about cervical cancer and its screening, socio-demographic factors, personal and behavioural factors, cultural factors and beliefs, and health service factors are considered the main barriers and facilitators to cervical cancer screening uptake among women in low and middle-income countries. Understanding the facilitators and barriers to cervical cancer screening encountered by women in low and middle-income countries can improve screening uptake by overcoming inequalities in resource and information access. Culturally sensitive screening programs, improvement of the health system, and health education interventions to raise awareness of screening and its benefits can be effective strategies to improve screening uptake among women in low and middle-income countries.

Barreras y facilitadores para la práctica de actividad física en niños y jóvenes con parálisis cerebral: una revisión sistemática / Barriers and facilitators for the practice of physical activity in children and young people with cerebral paralysis: a systematic review / Barreiras e facilitadores para a prática de atividade física em crianças e jovens com paralisia cerebral: uma revisão sistemática

Objetivo: describir los principales facilitadores y barreras presentados en la población con parálisis cerebral (PC) y cómo estos ayudan o dificultan la práctica de actividad física. Metodología: se realizó una revisión sistemática de los últimos 10 años siguiendo lo expuesto en la declaración PRISMA, para lo que se utilizaron las bases de datos Web of Science, Scopus y PubMed. La estrategia de búsqueda arrojó un total de 99 documentos de los que finalmente fueron seleccionados 11 estudios. Resultados: los estudios establecen que existe una variedad de factores fisiológicos, psicológicos, sociales y macro ambientales que actúan tanto para promover como inhibir la participación en el deporte y el ejercicio en adolescentes con PC. Por otro lado, los facilitadores que más se dan a conocer, son la familia como foco principal, acompañada de su entorno y la estimulación temprana realizada desde que son pequeños. Conclusión: las barreras son un aspecto modificable y que pueden ser disminuidas con el objetivo de potenciar los facilitadores para aumentar la práctica de actividad física siendo duradera en el tiempo. Las principales barreras son la falta de acceso, los cambios en su cuerpo respecto a la práctica de actividad física, factores medioambientales, falta de profesionales que estén relacionados con el área, y el acceso a la actividad física en ambientes y espacios seguros. La familia juega un rol fundamental desde edades tempranas para incentivar a los niños, niñas o adolescentes con PC a realizar actividades físicas y/o deportivas.

Objective: To describe the main facilitators and barriers presented in population with cerebral palsy (PC) and how they help or hinder the practice of physical activity. Methods: A systematic review of the last 10 years was carried out, following what was stated in the PRISMA declaration, for which the Web of Science, Scopus and PubMed databases were used. The search strategy yielded a total of 99 documents where 11 studies were finally selected. Results: Studies have established that there are a variety of macro physiological, psychological, social, and environmental factors that both promote and inhibit participation in sport and exercise in adolescents with PC. On the other hand, the most common facilitators in the research are the family as the main focus, accompanied by their environment and the early stimulation that they get from an early age. Conclusion: Barriers are a modifiable aspect which can be reduced to empower facilitators that increase the practice of physical activity, being sustainable over time. The main barriers are lack of access, changes in the body regarding the practice of physical activity, environmental factors, lack of professionals who are related to the field, and access to physical activity in safe environments and spaces. Family plays a fundamental role from an early age in encouraging children or adolescents with CP to carry out physical and/or sports activities.

Objetivo: Descrever os principais facilitadores e barreiras que ocorrem na população com paralisia cerebral (PC) e como eles auxiliam ou dificultam a prática de atividade física. Metodologia: Realizou-se uma revisão sistemática dos últimos 10 anos seguindo o estabelecido na declaração PRISMA, para a qual foram utilizadas as bases de dados Web of Science, Scopus e PubMed. A estratégia de busca lançou um total de 99 documentos dos quais 11 estudos foram finalmente selecionados. Resultados: Os estudos estabeleceram que há uma variedade de fatores fisiológicos, psicológicos, sociais e macroambientais que atuam tanto para promover quanto para inibir a participação em esportes e exercícios em adolescentes com PC. Por outro lado, os facilitadores mais conhecidos na variedade de estudos têm como eixo principal a família, acompanhada de seu ambiente e da estimulação precoce que desenvolveram desde a infância. Conclusão: As barreiras são um aspecto modificável que pode ser reduzido com o objetivo de capacitar os facilitadores para aumentar a prática de atividade física de forma duradoura. As principais barreiras são a falta de acesso, as alterações em seus corpos devido à prática de atividade física, fatores ambientais, a falta de profissionais relacionados à área e o acesso à atividade física em ambientes e espaços seguros. A família desempenha desde cedo um papel fundamental para estimular as crianças e adolescentes com PC a realizarem atividades físicas e/ou esportivas.

Facilitators And Barriers to Hypertension Control, Fol-lowing the Implementation of India Hypertension Con-trol Initiative (IHCI) In Thiruvananthapuram District – A Qualitative Study

Background: India Hypertension Control Initiative (IHCI) was launched in 2017 to improve the control rate of hypertensive patients on treatment. Thiruvananthapuram was one of the 26 districts in the coun-try where the programme was initially rolled out. Methods: A qualitative cross-sectional study was conducted among stakeholders involved in the imple-mentation of IHCI of Thiruvananthapuram district. Purposive sampling method was used for the selec-tion of samples. A total of 25 in-depth interviews were carried out. Results: The major facilitators which propelled hypertension control were uniformity in drug prescrip-tion, proper documentation of patient data along with indicators for measuring control rates and a de-faulter tracking mechanism. Clinical inertia among doctors, increased workload and sending of bystand-ers for monthly follow-up are the major barriers that affected hypertension control. Conclusions: Replication of good practices performed under IHCI into similar health settings or pro-grammes can be encouraged. Apart from the few barriers seen at the programme level, the already exist-ing barriers at the health system level need to be addressed immediately through efforts such as e-Health incorporation and trainings.

Barreras y facilitadores en la atención primaria de salud en personas con discapacidad física / Barriers and facilitators in primary health care for people with physical disabilities

Introducción: La discapacidad se considera un problema de salud a nivel mundial. Las personas con discapacidad física son susceptibles de padecer distintos problemas de salud. A pesar de ser un grupo priorizado, el acceso a los servicios de salud es menor que el de la población en general, debido a barreras de distintos tipos. Objetivo: Describir las barreras y facilitadores de acceso a la atención primaria de salud en personas con discapacidad física. Métodos: Se realizó una revisión bibliográfica cuya metodología estuvo basada en la búsqueda, selección, revisión, interpretación y síntesis de la evidencia científica relacionada con el problema de investigación. Se utilizó como fuente de literatura científica primaria la publicada en las bases de datos Scielo, Redalyc, Latindex y PudMed en los últimos 5 años, con los términos de búsqueda MeSH en idoma español, inglés y portugués. Desarrollo: Se identificó un total de 67 documentos de los cuales se empleó 46 en la investigación realizada. Los restantes 21 manuscritos fueron excluidos por presentar deficiencias metodológicas que limitaban su utilización. Las principales barreras son las condiciones físicas de las unidades de salud; el funcionamiento del Sistema de Salud; el acceso de las personas con discapacidad a la atención primaria de salud; y las características del paciente y su entorno familiar. El principal facilitador es el relacionado con el Sistema de Salud. Conclusiones: El acceso de las personas con discapacidad física a los servicios de salud está condicionado por situaciones que se interpretan como barreras o facilitadores. En este sentido los factores relacionados con el sistema de salud nacional y con las características y el entorno de la persona con discapacidad pueden comportarse como barrera o como facilitador, en dependencia de su expresión(AU)

Introduction: Disability is considered a health problem worldwide. People with physical disabilities are susceptible to different health problems. Despite being a prioritized group, access to health services is lower than that of the general population, conditioned by the presence of different types of barriers. Objective: To describe the barriers and facilitators of access to primary health care in people with physical disabilities. Methods: A bibliographic review was carried out whose methodology was based on the search, selection, review, interpretation and synthesis of the scientific evidence related to the research problem. It was used as a source of primary scientific literature published in the databases Scielo, Redalyc, Latindex and PudMed in the last 5 years, with the MeSH search terms in Spanish, English and Portuguese. Results: A total of 67 documents were identified, of which 46 were used in the research carried out. The remaining 21 manuscripts were excluded due to methodological deficiencies that limited their use. Conclusions: The access of people with physical disabilities to health services is conditioned by situations that are interpreted as barriers or facilitators. In this sense, the factors related to the national health system and the characteristics and environment of the person with a disability can act as a barrier or as a facilitator, depending on their expression(AU)

Barreras y facilitadores para la formulación de políticas públicas que regulan los ambientes alimentarios obesogénicos: revisión de la literatura / Barriers and facilitators to policymaking public policies that regulate obesogenic food environments: review of the literature

INTRODUCCIÓN: Los ambientes alimentarios determinan en gran medida el comportamiento alimentario de la población, por lo que se asocian a la epidemia de obesidad. Es responsabilidad de los Estados formular e implementar políticas para intervenir los ambientes alimentarios obesogénicos. El éxito de las políticas dependerá de factores que actúan como barreras o facilitadores. OBJETIVO: Identificar las barreras y facilitadores que se presentan al formular e implementar políticas públicas que aborden los ambientes alimentarios obesogénicos. MATERIAL Y MÉTODO: Estudio secundario en base a revisión narrativa. La identificación, tamizaje y selección de los artículos publicados se guio por el diagrama PRISMA. Para la identificación se recurrió a las bases de datos electrónicas PubMed, Scielo, Scopus y Web of Science (WOS), ingresando campos de búsqueda y palabras clave. En el tamizaje se eliminaron los duplicados y se aplicaron criterios de inclusión. La calidad metodológica de los estudios elegibles se evaluó con el protocolo CASPe. RESULTADOS: Se revisaron estudios cualitativos que usaron entrevistas a actores claves. Las barreras identificadas para el proceso de formulación de políticas de ambientes alimentarios obesogénicos son el impacto económico negativo, falta de evidencia científica sobre la efectividad de las políticas, influencia de la industria alimentaria, debilidades de coordinación y cooperación técnica. Los facilitadores identificados son el compromiso político de los Estados con las agencias internacionales, enfoque de trabajo conjunto con la industria alimentaria y el apoyo académico. CONCLUSIÓN: La formulación de políticas para intervenir ambientes alimentarios obesogénicos está especialmente limitada por la industria alimentaria. Es relevante generar evidencia científica del impacto que, las regulaciones implementadas, han tenido en los factores económicos y sobre la salud de la población. La colaboración entre gobiernos e industria alimentaria, podría derivar políticas que, además de impactar positivamente la salud de la población, sean una oportunidad para el sector privado y la generación de empleo.

INTRODUCTION: Food environments largely determine the eating behavior of the population, which is why they are associated with the obesity epidemic. It is the responsibility of States to formulate and implement policies to intervene in obesogenic food environments. The success of the policies will depend on factors that act as barriers or facilitators. OBJECTIVE: To identify the barriers and facilitators for the formulation and implementation of public policies that address obesogenic food environments. MATERIAL AND METHOD: Secondary study based on narrative review. The identification, screening and selection of published articles was guided by the PRISMA diagram. For the identification, the electronic databases PubMed, Scielo, Scopus and Web of Science (WOS) were used, entering search fields and keywords. In the screening, duplicates were eliminated and inclusion criteria were applied. The methodological quality of eligible studies was assessed using the CASPe protocol. RESULTS: Qualitative studies that used interviews with key actors were reviewed. The barriers identified for the process of formulating policies on obesogenic food environments are the negative economic impact, lack of scientific evidence on the effectiveness of policies, influence of the food industry, weaknesses in coordination and technical cooperation. The identified facilitators are the political commitment of the States with international agencies, a joint work approach with the food industry and academic support. CONCLUSION: Policymaking to intervene in obesogenic food environments is especially limited by the food industry. It is relevant to generate scientific evidence of the impact that the implemented regulations have had on economic factors and on the health of the population. Collaboration between governments and the food industry could derive policies that, in addition to having a positive impact on the health of the population, would mean an opportunity for the private sector and the generation of employment.

The Tele-Evaluation Facilitators Model

@#Telehealth has become an alternative service delivery of different healthcare professionals, including occupational therapists, upon the onset of the COVID-19 pandemic. Occupational therapists have adapted to this platform to deliver service in response to the global crisis. This conceptual framework explores the facilitators of occupational therapy evaluation provided via telehealth. It aims to provide insights to clinicians and clients in engaging tele-evaluation. It also aims to establish primary considerations to ensure a thorough evaluation process. The Tele-Evaluation Facilitators Model (TFM) describes the occupational therapy evaluation in the therapy setting. It outlines the OT evaluation process, adapting it to the telehealth setting. The process emphasizes the importance of client-caregiver interaction in creating and achieving occupational therapy goals. Moreover, surrounding the tele-evaluation process, the model highlights the facilitators of tele-evaluation, enabling a comprehensive evaluation process despite the challenges and barriers of this alternative service delivery. Across practice settings, the COVID-19 pandemic necessitated a shift in service delivery to telehealth, and occupational therapists adapted accordingly. Evaluation frameworks exist for telehealth services, but none are unique to occupational therapy evaluation. As a result, an occupational therapy framework that highlights the facilitators of telehealth evaluation will benefit occupational therapy. TFM consists of three domain areas: (1) Family Involvement, (2) Accessibility, (3) Professional Development. This framework promotes telehealth evaluation to clinicians and clients who have hesitations and difficulties in this service delivery model.

The Barriers and Facilitators of Family-Witnessed Resuscitation (FWR) in Adult Patients in the Emergency Department (EDS): A Systematic Review

@#Aims: Aims: When attending family members, the procedure for the resuscitation of cardiac arrest patients remains controversial. There have been conflicts on why healthcare professionals, should include the family during resuscitation. This systematic review seeks to identify the barriers and facilitators related to the FWR of adult patients at Emergency Department. Design: A systematic review was conducted on ten studies. This review utilized a clearly formulated research question then the data was gathered and analysed from the included studies. Data Source: Studies on the barriers and facilitators related to allowing family members to attend were included during January 2020 to May 2020. Methods: A systematic review of studies that investigate the barriers and facilitators of the FWR of adult patients at emergency department. All studies evaluated the barriers and facilitators related to allowing family members to attend cardiopulmonary resuscitation. This systematic review was registered in PROSPERO with the registration number CRD42020169383. Results: This review has demonstrated that the facilitators reduce conflict and provide a supportive presence that builds the emotional adequacy and closure related to the resuscitation. These policies can eliminate barriers, such as conflicts in EDs and negative attitudes, and expedite the accommodation of the professional as well as individual staff’s needs during witnessed resuscitation.

The influencing Factors of Doctor-patient Shared Decision Making: A Qualitative Study / 中国医学伦理学

To explore the barriers and facilitators of shared decision making, 23 clinicians were selected for semi-structured interviews by purpose sampling and convenience sampling with phenomenological methods in qualitative research, and 7-step of Colaizzi was used to analyze the interview data. Three themes and twelve subthemes were extracted, included: individual factors of doctors (role cognition, perceived outcomes, communication skills, clinical expertise, cognitive bias) , individual factors of patients (general information, lack of disease knowledge, willingness to participate in decision making) and environmental factors (clinical situation, social environment, resources and social influence) . There were many barriers and facilitators in the implementation of doctor-patient shared decision making. It is necessary to scientifically analyze and actively deal with the influence of each factor, and find reasonable countermeasures to promote the clinical implementation of shared decision making.

Barriers and facilitators to adherence for antiretroviral therapy the perspectives of patients from a wellness center in the Mpumalanga Province, South Africa

Introduction. Patients' non-adherence to antiretroviral treatment remains a public health concern in many developing countries, especially in South Africa. Objectives: The objective of the study was to explore the barriers and facilitators of patients' ART adherence in one health care facility in Mpumalanga Province, South Africa. Methods: A qualitative, exploratory, and descriptive design was employed to collect data using a semi-structured interview guide through individual in-depth interviews among twenty (20) purposively selected patients. The thematic analysis approach was used to generate themes from the data. Results: A majority of the participants were female (n=12, 60%), married (n=13, 65%), and employed (n=12, 60%). Barriers to ART adherence include insufficient medical staff at the health center and waiting time being too long. Facilitators included service providers' positive attitude, clear instructions for taking medication, benefits of adhering to ART, and dangers of defaulting treatment. Conclusion: Barriers and facilitators for adherence included several factors related to the health system, health care workers, and the patients. Achievement of optimal adherence to ART requires the commitment of both patients and providers

Facilitators and barriers of patient involvement in hospital services: integrative review / Facilitadores y barreras para la participación del paciente en los servicios hospitalarios: revisión integrativa / Facilitadores e barreiras do envolvimento do paciente nos serviços hospitalares: revisão integrativa

ABSTRACT Objective to identify the facilitating factors and barriers that influence patient involvement in hospital services. Method integrative review; search of articles published between January 2011 and December 2020, in the electronic databases PubMed, Web of Science, Cinahl, Lilacs and Scopus, using descriptors related to "patient involvement", Barriers, Facilitators, in English, Spanish and Portuguese. Data collection was performed from May to June 2021, identifying 32 publications that met the inclusion criteria. Results the analysis resulted in three categories of facilitating factors and barriers: communication, actors of involvement and organizational culture, allowing the elaboration of a theoretical model of patient involvement. This model shows that in the centrality of the process are the actors involved, that is, patients and professionals, inserted in an organizational context, being influenced by leadership, culture, environment, available resources and processes, where communication permeates as a basis for involvement. Conclusion the facilitating factors and barriers identified in this review, synthesized in a theoretical model, allow transcending theoretical knowledge for practice. The complexity to operationalize this model requires patients, professionals, health services and society join forces to make this theoretical proposition a practice incorporated by the services.

RESUMEN Objetivo incidir en los factores y barreras de la implicación del paciente en los servicios hospitalarios. Método revisión integradora; búsqueda de artículos publicados entre enero de 2011 y diciembre de 2020, en las bases de datos electrónicas PubMed, Web of Science, Cinahl, Lilacs y Scopus, utilizando descriptores relacionados con "involucramiento del paciente", Barreras, Facilitadores, en inglés, español y portugués. La recolección de datos se realizó de mayo a junio de 2021, identificándose 32 publicaciones que cumplieron con los criterios de inclusión. Resultados el análisis resultó en las tres categorías de facilitadores y barreras: comunicación, factores de involucramiento y cultura organizacional, permitiendo la elaboración de un modelo teórico de involucramiento. Este modelo muestra que en la centralidad del proceso están los actores involucrados, es decir, pacientes y profesionales, insertos en un contexto organizacional, siendo influenciados por el liderazgo, la cultura, el ambiente, los recursos disponibles y los procesos, donde la comunicación permea como base para el involucramiento. Conclusión los factores y barreras identificados en esta revisión sintetizados en un modelo teórico, permiten trascender el conocimiento teórico para la práctica. La complejidad para operacionalizar este modelo requiere que los pacientes, los profesionales, los servicios de salud y la sociedad se unan para hacer de esta propuesta teórica una práctica incorporada por los servicios.

RESUMO Objetivo identificar os fatores facilitadores e as barreiras que influenciam no envolvimento do paciente nos serviços hospitalares. Método revisão integrativa; realizada busca de artigos publicados entre janeiro de 2011 e dezembro de 2020, nas bases eletrônicas PubMed, Web of Science, Cinahl, Lilacs e Scopus, utilizando descritores relacionados a "patient involvement", Barriers, Facilitators, nos idiomas inglês, espanhol e português. Coleta de dados realizada de maio a junho de 2021, identificando-se 32 publicações que atenderam aos critérios de inclusão. Resultados a análise resultou em três categorias de fatores facilitadores e barreiras: comunicação, atores do envolvimento e cultura organizacional, permitindo a elaboração de um modelo teórico de envolvimento do paciente. Esse modelo mostra que na centralidade do processo estão os atores envolvidos, ou seja, pacientes e profissionais, inseridos em um contexto organizacional, sendo influenciados pela liderança, cultura, ambiente, recursos disponíveis e processos, onde a comunicação perpassa como base para o envolvimento. Conclusão os fatores facilitadores e as barreiras identificadas nesta revisão, sintetizados num modelo teórico, permitem transcender o conhecimento teórico para a prática. A complexidade para operacionalizar esse modelo requer que pacientes, profissionais, serviços de saúde e sociedade unam os esforços para tornar esta proposição teórica em uma prática incorporada pelos serviços.

Facilitators and barriers to implementation of the Pharmacy DOTS Initiative in selected project sites in the Philippines

@#<p style="text-align: justify;"><strong>Objectives:</strong> The Pharmacy DOTS Initiative (PDI) was relaunched on a larger scale in 2014 through the Innovations and Multi-Sectoral Partnerships to Achieve Control of Tuberculosis (IMPACT) project. This paper aimed to assess the PDI program through IMPACT by identifying the facilitating and hindering factors in its implementation. The identified factors are classified as to the affected stakeholders or processes.</p><p style="text-align: justify;"><strong>Methods:</strong> Semi-structured interviews were conducted with the PDI Program Manager and four NTP coordinators from selected project sites. Thematic analysis was done to determine the recurring facilitating and hindering factors as identified by the key informants.</p><p style="text-align: justify;"><strong>Results:</strong> Facilitating factors identified include cooperation of the stakeholders, capability-building and a good referral system. The barriers to the implementation were grouped into patient-related, pharmacy-related, health center-related, program-related as well as external factors.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The referral system created through PDI facilitated the flow of referrals starting from the pharmacy. This enabled presumptive patients to have access to health facilities for TB. Hindering factors contributed to the inability of the engaged pharmacies to sustain their consistency and commitment in conducting the PDI interventions.</p><p style="text-align: justify;"><strong>Key Words:</strong> barriers, facilitators, tuberculosis, directly observed therapy, program evaluation, pharmacy</p>

Why pregnant women delay to initiate and utilize free antenatal care service:a qualitative study in the Southern District of Mzimba,Malawi / 《全球健康杂志（英文）》

Aim:The study aimed to explore factors related to the initiation and utilization of focused antenatal care (FANC)in the Southern District of Mzimba,Malawi.Methods:This study used an exploratory qualitative design.Total of 22 in-depth interviews with pregnant women and community midwife assistants were conducted from December 2015 to January 2016 in Mzimba.Thematic analysis approach was adopted to identify the facilitator and barriers of the FANC initiation and utilization.Results:Facilitator of FANC initiation and utilization included seeking pregnancy confirmation,medical treatment for an existing health problem and the support by community health extension workers.Barriers included the additional cost to free FANC service,lack of essential equipment,unfriendly adolescent reproductive health service,and HIV stigma.Conclusion:Early initiation of FANC relies on both woman's awareness and community support.Promoting the use of FANC should focus on creating an enabling environment,e.g.,increasing investment of essential med-ical equipment,reducing additional costs of FANG services,eliminating the discrimination against adolescent pregnancy and people living with HIV,and strengthening health personnel's training.

Enfermeria basada en la evidencia: revisión de alcance

RESUMEN Objetivos: Identificar la evidencia científica sobre el concepto, desarrollo y función, de la Enfermería Basada en la Evidencia (EBE) y analizar críticamente esta herramienta, sus elementos facilitadores y barreras para su implementación. Material y Método: Revisión de alcance según propuesta del Joanna Briggs Institute. Se consideró el rango de tiempo entre 1997 y 2019 para recuperar artículos y revisiones en inglés, portugués y español. Se utilizaron descriptores del tesauro Medical Subject Headings y términos booleanos para aplicar las estrategias de búsqueda en 4 bases de datos: PubMed, EBSCOhost, Scopus y Science Direct. Se complementó la búsqueda con la técnica de bola de nieve aplicada a la lista de referencias de los artículos relevantes seleccionados. Para evaluar la validez y el impacto de los resultados de los artículos de revisión y cualitativos se aplicó el Critical Appraisal Skills Programme Español (CASPE), y para estudios observacionales el Strengthening the Reporting of Observational studies in Epidemiology (STROBE). Para establecer los niveles de evidencia se utilizó Canadian Task Force on Preventive Health Care (CTPFCHC). Resultados: De 163.074 manuscritos iniciales, fueron seleccionados 44 para análisis y extraer datos referentes a: Historia de la EBE; Concepto y función de EBE; Etapas, barreras y facilitadores. Conclusiones: El concepto de EBE pone de manifiesto la necesidad de utilizar esta herramienta para planificar los cuidados mediante el uso del pensamiento crítico y reflexivo; la importancia de realizar el cuidado a la cabecera del paciente y cultivar un cuidado basado en la mejor evidencia, enmarcado, todo ello, en un contexto de humanización, así como considerar las barreras y facilitadores de esta herramienta.

ABSTRACT Objective: To identify the scientific evidence on the concept, development and function of Evidence-Based Nursing (EBN) and to critically analyze this tool, its facilitating elements and barriers for implementation. Material and Method: Scoping review according to the proposal of the Joanna Briggs Institute. The period between 1997 and 2019 was considered to retrieve articles and reviews in English, Portuguese and Spanish. Medical Subject Headings thesaurus descriptors and Boolean operators were used to apply search strategies in 4 databases: Pubmed, EBSCOhost, Scopus, Science Direct. The search was complemented with the snowball technique applied to the reference list of the relevant selected articles. The Critical Appraisal Skills Programme Español (CASPE) was used to assess the validity and impact of the articles review and qualitative results, and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) was used for the observational studies. To establish the levels of evidence, The Canadian Task Force on Preventive Health Care (CTPFCHC) was used. Results: Out of 163,074 initial manuscripts, 44 were selected for analysis and data extraction regarding history of EBN; concept and function of EBN; stages, barriers and facilitators. Conclusions: The concept of EBN highlights the need to use this tool to plan nursing care through critical and reflective thinking; the importance of providing direct patient care and promoting care based on the best evidence, in a context of humanization and considering the tool's barriers and facilitators.

RESUMO Objetivo: Identificar as evidências científicas sobre o conceito, desenvolvimento e função da Enfermagem Baseada em Evidências (EBE) e analisar criticamente esta ferramenta, seus elementos facilitadores e as barreiras para sua implementação. Material e Método: Revisão do escopo de acordo com a proposta do Instituto Joanna Briggs. Considerou-se o período entre 1997 e 2019 para recuperar artigos e revisões em inglês, português e español. Foram utilizados descritores do tesauro Medical Subject Headings e operadores booleanos para aplicar estratégias de pesquisa en 4 bancos de dados diferentes: Pubmed, EBSCOhost, Scopus, Science Direct. A pesquisa foi complementada com a técnica de bola de neve aplicada à lista de referência dos artigos selecionados relevantes. O Critical Appraisal Skills Programme Español (CASPE) foi usado para avaliar a validade e o impacto da revisão dos artigos e os resultados qualitativos, e para os estudos de observação utilizou-se o Strengthening the Reporting of Observational studies in Epidemiology (STROBE). A Canadian Task Force on Preventive Health Care (CTPFCHC) foi utilizada para establecer os níveis de evidência. Resultados: Dos 163.074 manuscritos iniciais, 44 foram selecionados para análise e extração de dados referentes à história da EBN; conceito e função da EBN; etapas, barreiras e facilitadores. Conclusões: O conceito de EBN destaca a necessidade de utilizar esta ferramenta de planejamento de cuidado, através do uso do pensamento crítico e reflexivo; a importância de realizar o cuidado à beira do leito do paciente e promover cuidados baseados nas melhores evidências, em um contexto de humanização e considerando as barreiras e facilitadores desta ferramenta.

Evaluación de una intervención educativa para mejorar el consumo de frutas, vegetales y la actividad física de docentes en tres centros educativos públicos en Costa Rica / Evaluation of an educational intervention to improve teachers' fruit and vegetable intake and physical activity practice in three public schools in Costa Rica

Resumen: Introducción: El modelo Póngale Vida ® para la prevención de la obesidad infantil reconoce a docentes de las escuelas como actores clave para esta labor, pero para ello se requiere fortalecer los conocimientos y las prácticas para la promoción de la alimentación saludable y la actividad física de los escolares. Objetivo: Evaluar los resultados de la intervención educativa para mejorar la autoeficacia en consumo de frutas y vegetales y en actividad física en docentes de tres centros educativos públicos urbanos de Costa Rica. Metodología: Se aplicó y evaluó la propuesta educativa de Jara y Rivera (2011) con 70 docentes. Hubo evaluaciones antes y después de la aplicación de la intervención. Las variables evaluadas fueron demográficas, de estilo de vida y medición de la autoeficacia para actividad física y consumo de frutas y vegetales, valoraciones bioquímicas y antropométricas. A través de grupos focales, se identificó tanto facilitadores como barreras a nivel personal, familiar y laboral. Resultados: Posterior a la intervención, casi 25 % de docentes incrementó la práctica de actividad física y la autoeficacia para las prácticas de actividad física y consumo de frutas y vegetales. Las barreras identificadas fueron la doble carga de trabajo asociada al rol de género femenino, creencias limitantes y la falta de urgencia para la prevención de enfermedades. Conclusiones: La propuesta educativa favoreció el aumento de la autoeficacia en el consumo de frutas y vegetales, así como la práctica de actividad física de la población docente.

Abstract: Introduction: The Póngale Vida ® model for the prevention of childhood obesity recognizes schoolteachers as key actors in this work, but this requires strengthening their knowledge and practices to promote healthy eating and physical activity for school children. Objective: To evaluate an educational intervention to increase teacher's self-efficacy for fruit and vegetable consumption and physical activity, within three public schools in Costa Rica. Methods: Jara and Rivera's educational proposal for intervention (2011) was implemented and evaluated with 70 teachers. There were evaluations before and after the intervention, it had demographic characteristics, lifestyle variables, self-efficacy measurements for physical activity and fruit and vegetables consumption; also, biochemical and anthropometric measures. Focus groups were used to identify facilitators and barriers at personal, family and work levels. Results: After the intervention, almost 25% of teachers increased their physical activity practices, as well as self efficacy for physical activity practice and fruits and vegetables consumption. The main barriers were a double work burden linked with feminine gender roles, limiting beliefs, and, lack of urgency in preventing diseases. Conclusions: The educational intervention contributed in increasing self-efficacy regarding eating fruit and vegetables and the practice of physical activity of participating teachers.

Navegando por los servicios de salud públicos: experiencias de mujeres de sectores populares en la periferia de Buenos Aires / Navigating the public health services: the experiences of women who live in the periphery of Buenos Aires city

Resumen Con base en datos cualitativos de seis grupos focalizados, realizados durante los años 2015 y 2016, con mujeres de 18 a 60 años residentes en un barrio de sectores populares del conurbano norte bonaerense, analizamos las lógicas de utilización y sus experiencias con los servicios de salud públicos. Nos centramos en las barreras que las participantes identifican para acceder a la infraestructura sanitaria pública del barrio (Centro de Salud y postas sanitarias) y en los establecimientos hospitalarios de la localidad, considerando las necesidades, expectativas y demandas de cuidado médico, no sólo curativo, sino también preventivo y de salud mental. Observamos las consecuencias de las barreras en el acceso a la atención, cómo reaccionan frente a ellas y los recursos que algunas mujeres y sus grupos familiares movilizan para sortearlas (contar con medios para desplazarse a otras localidades, el pago de bolsillo para consultas y tratamientos privados, contar con cobertura de obra social, etc.).

Abstract Based on the qualitative data gathered from six focus groups conducted between 2015 and 2016 with women aged from 18 to 60, it is analyzed how they utilize public health services. Focusing on the barriers of access to local (the community health center and primary health posts) and to nearby hospitals, it is considered their health needs, expectations and demands to both preventive and curative care. Access to mental health care is also addressed. We observe how women and their families respond when facing these barriers and the resources they can mobilize to overcome them (spatial mobility, relative financial capacity, access to social security and private health coverage etc.). Also, the negative consequences of organizational barriers and deficiencies of the public services network on neighbors' health are shown.

Perspectives of adolescents, parents, and teachers on barriers and facilitators of physical activity among school-age adolescents: a qualitative analysis

BACKGROUND@#Physical activity levels are low among adolescents in Morocco; however, the influences on physical activity behavior of adolescents have not yet been explored in a qualitative study. Here, we explored potential social-ecological barriers and facilitators of physical activity in Moroccan adolescents with the goal of developing a successful intervention program aimed at improving their physical activity level.@*METHODS@#For this study, we conducted 17 focus group discussions (100 participants, composed of 56 adolescents, 26 parents, and 18 teachers from two middle schools in Taza city, Morocco). Discussions during focus groups were facilitated by a semi-structured interview guide. Guide questions were underpinned by the social-ecological model as a theoretical framework. Data analysis was carried out by two coders using thematic analysis.@*RESULTS@#We found that barriers and facilitators of physical activity in adolescents are organized into six themes that belong to different levels of the social-ecological model. Three themes belonged to the intrapersonal level (perceived motivating and limiting factors, physical activity awareness, and time constraints), two themes were classified into the interpersonal/cultural level (social support and gender and cultural norms), and one theme belonged to the environmental level (access to opportunities). Most of the themes were at the individual level, with each theme including both barriers and facilitators.@*CONCLUSIONS@#Adolescent participation in physical activity can be facilitated or hampered by many factors. Results from the focus group discussions showed that these factors belonged to different levels of the social-ecological model, but most were at the individual level. Our findings have several implications. First, they may offer suggestions for a tailored intervention program aimed at improving adolescent physical activity. Second, they can improve quantitative research by enriching the battery of questions of physical activity instruments (e.g., a question related to physical disability). Third, the proposed thematic map can contribute to understanding interactions and causal pathways in the social-ecological model.