E-mental health implementation in inpatient care: Exploring its potential and future challenges.

Background: There is a great evidence base today for the effectiveness of e-mental health, or the use of technology in mental healthcare. However, large-scale implementation in mental healthcare organisations is lacking, especially in inpatient specialized mental healthcare settings. Aim: The current study aimed to gain insights into the factors that promote or hinder the implementation of e-mental health applications on organisational, professional and patient levels in Belgium. Methods: Four Belgian psychiatric hospitals and psychiatric departments of general hospitals invited their professionals and patients to use Moodbuster, which is a modular web-based platform with a connected smartphone application for monitoring. The platform was used in addition to treatment as usual for three to four months. The professionals and patients completed pre- and post-implementation questionnaires on their reasons to participate or to decline participation and experiences with the Moodbuster platform. Results: Main reasons for the organisations to participate in the implementation study were a general interest in e-mental health and seeing it is a helpful add-on to regular treatment. The actual use of Moodbuster by professionals and patients proved to be challenging with only 10 professionals and 24 patients participating. Implementation was hindered by technical difficulties and inpatient care specific factors such as lack of structural facilities to use e-mental health and patient-specific factors. Professionals saw value in using e-mental health applications for bridging the transition from inpatient to outpatient care. Twenty-two professionals and 31 patients completed the questionnaire on reasons not to participate. For the patients, lack of motivation because of too severe depressive symptoms was the most important reason not to participate. For professionals, it was lack of time and high workload. Conclusions: The current implementation study reveals several important barriers to overcome in order to successfully implement e-mental health in inpatient psychiatric care.

Can Health-Enhancing Sporting Programs in Sports Clubs Lead to a Settings-Based Approach? An Exploratory Qualitative Study.

There is limited knowledge about how a settings-based approach can be best applied in a sports club setting. This qualitative exploratory study examined whether and how sporting programs focusing on individual behavior change (i.e., increasing physical activity levels of inactive people) and implemented on the micro-level of the sports club, can be a first step towards a settings-based approach (i.e., inclusion of the meso- and macro-level of the sports club). In addition, this study explored factors that influenced the inclusion of the meso- and macro-level of the sports club. Telephone interviews were conducted with representatives of sixteen sports clubs about program activities on all levels of the sports club. Thematic analyses were performed to explore stimulating and hindering factors. After multiple years, six sports clubs also had program activities on the meso-level and twelve sports clubs had activities on the macro-level. Program activities differed per level within a sports club and on the same level between sports clubs. Cultural and social factors influenced macro-level activities, while predominantly economic factors influenced meso-level activities. Based on these factors, sports clubs could develop, prioritize, and choose strategies that support them in developing a settings-based approach when increasing physical activity levels of inactive citizens.

Identifying management practices that drive production-line workers' engagement through qualitative analysis.

INTRODUCTION: Engagement research - most often defined by a worker's psychological state of vigor, dedication, and absorption - pays little attention to production-line workers. This study therefore explores factors that drive workers' engagement with health and safety (H&S) in a production-line context as well as their perception of managerial influence Furthermore, the study adds to the body of research by exploring H&S engagement concepts through the use of qualitative research methods. METHOD: 38 semi-structured interviews were conducted and analyzed through template analysis to identify themes that promote and hinder engagement. RESULTS: The main engagement drivers were found to be: (a) the displayed safety focus of the company in organizational and social aspects; (b) the quality of the communication approach with respect to quality, consistency and direction; and (c) the environment encompassing the relationship between workers and supervisors and peers as well as the psychological environment. Notably, a trusting relationship between supervisors and workers appeared to be the most influential driver in determining engaged H&S behavior. Discussion and impact in industry: The study highlights factors that could be adapted to improve engagement and consequently enhance H&S approaches. Originality: The study reported in this paper offers a unique insight into individual production workers' perceived drivers of H&S engagement using Qualitative Analysis. Practical applications: The study identified the important role that supervisors play in workers' H&S engagement levels and what skills they need to employ to enhance workers' engagement in general and in the context of H&S behavior and performance. Furthermore, the importance of psychological and sociological factors in safety approaches are highlighted and were found to be key for creating safer workplaces.

Factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries: a mixed-method study.

The study aims to find the factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries. The design of the study is a mixed-method sequential explanatory study. The setting is Shifa International Hospital and Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Participants are health care workers. A questionnaire and structured key informant interviews probed the perspectives and perceptions of different stakeholders regarding the factors which hinder the implementation of surgical site infection control guidelines. Two-hundred fifty-two health care workers took part in the survey. The response rate was 90%. The majority of the participants was based in private teaching hospitals (63.9%) and 36.1% in the public sector teaching hospitals. The factors of surveillance, knowledge, education, and culture had low scores. Qualitative data analysis revealed the hindering factors in the implementation of surgical site infection control guidelines in the operating rooms of low-income country. The important one are lack of a surveillance system, education, and culture of infection control. This study identified hindering factors regarding implementation of surgical site infection control guidelines in the operating rooms at the institutional and individual level involved in patient care. The identification of these hindering factors may help politicians, policy makers, and institutions to identify the strategies for overcoming these hindering factors. Education is the key factor for success. By offering training to health care workers, we significantly contribute to decrease the incidence of SSIs in the low-income country.

Factors hindering clinical training of students in selected nursing educational institutions in Southeastern Nigeria.

BACKGROUND/AIM: Clinical training is an integral part of professional nursing education as it equips students with the required knowledge, skills, attitudes, and values needed for optimal practice in real-life situations. Inappropriate professional attributes have been observed among nursing graduates, while challenges to acquisition of clinical skills have been understudied in Nigeria. PURPOSE: This study investigated system factors related to the provision of infrastructure/equipment, training/supervisory activities, and students' factors that may hinder clinical training of nursing students in two selected institutions in Southeastern Nigeria. METHODS: This cross-sectional descriptive study purposively enlisted 283 students from a diploma and a degree nursing education program. Data were collected with researchers' developed questionnaire and analyzed in percentages, and means, with a mean decision criterion of <3.0 for identifying significant hindering factors. T-test was used for inferential statistics at p<0.05 level of significance. RESULTS: Major hindering factors identified include: non participation of teachers in students' clinical supervision; non-completion of relevant level classroom instructions and practical demonstrations before each clinical experience, inadequate equipment to practice in the clinical areas, with no preceptors to coach them at each shift (mean scores <3.0). Significant differences (p-value<0.05) exist in the deficiencies identified between the institutions. While the degree program students had significantly less opportunity for return demonstration under supervision and independent practice in the laboratory; the diploma program students had significantly fewer teachers in their school and patients in their clinical area, clinical nurses as role models were not following the standard procedures in practice and students were not evaluated by supervisors at the end of each clinical experience. CONCLUSION: Identified factors in these training environments could hinder learners' interest and acquisition of professional attributes. Rectifying these situations could enhance the acquisition and display of appropriate professional performance behavior in practice by nursing graduates.

Opportunities and barriers to on-farm composting and compost application: A case study from northwestern Europe.

Maintaining and increasing soil quality and fertility in a sustainable way is an important challenge for modern agriculture. The burgeoning bioeconomy is likely to put further pressure on soil resources unless they are managed carefully. Compost has the potential to be an effective soil improver because of its multiple beneficial effects on soil quality. Additionally, it fits within the bioeconomy vision because it can valorize biomass from prior biomass processing or valorize biomass unsuitable for other processes. However, compost is rarely used in intensive agriculture, especially in regions with high manure surpluses. The aim of this research is to identify the barriers to on-farm composting and the application of compost in agriculture, using a mixed method approach for the case of Flanders. The significance of the 28 identified barriers is analyzed and they are categorized as market and financial, policy and institutional, scientific and technological and informational and behavioral barriers. More specifically, the shortage of woody biomass, strict regulation, considerable financial and time investment, and lack of experience and knowledge are hindering on-farm composting. The complex regulation, manure surplus, variable availability and transport of compost, and variable compost quality and composition are barriers to apply compost. In conclusion, five recommendations are suggested that could alleviate certain hindering factors and thus increase attractiveness of compost use in agriculture.

Cambio terapéutico en el tratamiento de los trastornos alimentarios: Contenidos, factores facilitadores y obstaculizadores / Therapeutic change in the treatment of eating disorders: Contents, facilitating and hindering factors

Objetivo: Identificar factores facilitadores y obstaculizadores del cambio terapéutico en el tratamiento de pacientes con trastornos alimentarios (TA). Método: Estudio cualitativo-exploratorio, basado en la Grounded Theory. Se realizó un muestreo intencionado y entrevistas en profundidad a una muestra conformada en Chile por 20 pacientes de sexo femenino y 8 terapeutas y en Argentina por 4 pacientes y 6 terapeutas. Resultados: El cambio se presenta como punto de inflexión, en tanto las pacientes describen un momento en que logran reconocer la necesidad de cambiar. Posteriormente son capaces de verbalizar los contenidos de éste a diferentes niveles y en relación al TA. Conclusiones: Al conjugar aspectos facilitadores y obstaculizadores, y en la medida que los primeros sean preponderantes, irán surgiendo cambios que podrían articularse como componentes de la identidad.

Aim: To identify facilitating and hindering factors in the therapeutic change within the treatment of ED patients. Method: Qualitative-exploratory research, based on Grounded Theory. Purposive sampling and in-depth interviews were carried out in a sample of 20 patients and 8 therapists in Chile and 4 patients and 6 therapists in Argentina. Results: Therapeutic change occurred as a turning point in patients, which they described as a moment when they recognized the need for change. Subsequently, they were able to articulate the change as they experienced it in different areas of functioning. Conclusions: When combining facilitating and hindering aspects and the former overcome the latest, there will be changes that ultimately may be articulated in components of personal identity.

Return to work after an acute coronary syndrome: patients' perspective.

OBJECTIVES: To describe the time perspective of return to work and the factors that facilitate and hinder return to work in a group of survivors of acute coronary syndrome (ACS). METHODS: Retrospective semi-structured telephone survey 2 to 3 years after hospitalization with 84 employed Dutch ACS-patients from one academic medical hospital. RESULTS: Fifty-eight percent of patients returned to work within 3 months, whereas at least 88% returned to work once within 2 years. Two years after hospitalization, 12% of ACS patients had not returned to work at all, and 24% were working, but not at pre-ACS levels. For all ACS-patients, the most mentioned categories of facilitating factors to return to work were having no complaints and not having signs or symptoms of heart disease. Physical incapacity, co-morbidity, and mental incapacity were the top 3 categories of hindering factors against returning to work. CONCLUSION: Within 2 years, 36% of the patients had not returned to work at their pre-ACS levels. Disease factors, functional capacity, environmental factors, and personal factors were listed as affecting subjects' work ability level.

Return to Work after an Acute Coronary Syndrome: Patients' Perspective

OBJECTIVES: To describe the time perspective of return to work and the factors that facilitate and hinder return to work in a group of survivors of acute coronary syndrome (ACS). METHODS: Retrospective semi-structured telephone survey 2 to 3 years after hospitalization with 84 employed Dutch ACS-patients from one academic medical hospital. RESULTS: Fifty-eight percent of patients returned to work within 3 months, whereas at least 88% returned to work once within 2 years. Two years after hospitalization, 12% of ACS patients had not returned to work at all, and 24% were working, but not at pre-ACS levels. For all ACS-patients, the most mentioned categories of facilitating factors to return to work were having no complaints and not having signs or symptoms of heart disease. Physical incapacity, co-morbidity, and mental incapacity were the top 3 categories of hindering factors against returning to work. CONCLUSION: Within 2 years, 36% of the patients had not returned to work at their pre-ACS levels. Disease factors, functional capacity, environmental factors, and personal factors were listed as affecting subjects' work ability level.