Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.

OBJECTIVE: Vaccinating healthcare workers (HCWs) against COVID-19 has been a public health priority since rollout began in late 2020. Promoting COVID-19 vaccination among HCWs would benefit from identifying modifiable behavioural determinants. We sought to identify and categorize studies looking at COVID-19 vaccination acceptance to identify modifiable factors to increase uptake in HCWs.
METHODS: Rapid evidence review.
METHODS: We searched MEDLINE and Cochrane databases until May 2021 and conducted a grey literature search to identify cross-sectional, cohort, and qualitative studies. Key barriers to, and enablers of, vaccine acceptance were categorized using the Theoretical Domains Framework (TDF), a comprehensive theoretical framework comprising 14 behavioural domains.
RESULTS: From 19,591 records, 74 studies were included. Almost two-thirds of responding HCWs were willing to accept a COVID-19 vaccine (median = 64%, interquartile range = 50-78%). Twenty key barriers and enablers were identified and categorized into eight TDF domains. The most frequently identified barriers to COVID-19 vaccination were as follows: concerns about vaccine safety, efficacy, and speed of development (TDF domain: Beliefs about consequences); individuals in certain HCW roles (Social/professional role and identity); and mistrust in state/public health response to COVID-19 (Social influences). Routinely being vaccinated for seasonal influenza (Reinforcement), concerns about contracting COVID-19 (Beliefs about consequences) and working directly with COVID-19 patients (Social/professional role and identity) were key enablers of COVID-19 vaccination among HCWs.
CONCLUSIONS: Our review identified eight (of a possible 14) behavioural determinants of COVID-19 vaccine acceptance among HCWs that, if targeted, could help design tailored vaccination messaging, policy, campaigns, and programs to support HCWs vaccination uptake.

Embracing the Bayesian approach, we aimed to synthesise evidence regarding barriers and enablers to physical activity in adults with heart failure (HF) to inform behaviour change intervention. This approach helps estimate and quantify the uncertainty in the evidence and facilitates the synthesis of qualitative and quantitative studies. Qualitative evidence was annotated using the Theoretical Domains Framework and represented as a prior distribution using an expert elicitation task. The maximum a posteriori probability (MAP) for the probability distribution for the log OR was used to estimate the relationship between physical activity and each determinant according to qualitative, quantitative, and qualitative and quantitative evidence combined. The probability distribution dispersion (SD) was used to evaluate uncertainty in the evidence. Three qualitative and 16 quantitative studies were included (N = 2739). High pro-b-type natriuretic peptide (MAP = -1.16; 95%CrI: [-1.21; -1.11]) and self-reported symptoms (MAP = - 0.48; 95%CrI: [ -0.40; -0.55]) were suggested as barriers to physical activity with low uncertainty (SD = 0.18 and 0.19, respectively). Modifiable barriers were symptom distress (MAP = -0.46; 95%CrI: [-0.68; -0.24], SD = 0.36), and negative attitude (MAP = -0.40; 95%CrI: [-0.49; -0.31], SD = 0.26). Modifiable enablers were social support (MAP = 0.56; 95%CrI: [0.48; 0.63], SD = 0.26), self-efficacy (MAP = 0.43; 95%CrI: [0.32; 0.54], SD = 0.37), positive physical activity attitude (MAP = 0.92; 95%CrI: [0.77; 1.06], SD = 0.36).

OBJECTIVE: This study aimed to identify, evaluate and summarise current evidence in relation to the factors that influence the conducting of research by nurses in clinical practice.
METHODS: This study used mixed methods systematic review.
METHODS: CINAHL, EMBASE, MEDLINE, Scopus and ASSIA, with dates limited from 2015 to 2020, were used to conduct a systematic search of the literature.
METHODS: The Joanna Briggs Institute approach was followed, with results reported according to the Preferred Reporting System for Systematic Reviews and Meta-Analyses. The associated checklist for systematic reviews was also used. A standardised data extraction tool was then used, with quality appraisal guided by the Mixed Methods Appraisal Tool, with a subsequent convergent qualitative synthesis.
RESULTS: Sixteen papers were identified for inclusion, nine quantitative, six qualitative and one mixed methods. Four themes were identified: research competence and culture, proactive research mentorship, research resources and making a difference. These were critically discussed in relation to barriers and enablers to the conduct of research by nurses in clinical practice. Commonly cited barriers included a lack of research knowledge, confidence and access to resources, particularly protected time, while enablers such as educational partnerships, identifying research-motivated clinical nurses and access to research role models were also apparent in the literature.
CONCLUSIONS: Globally, nurses in clinical practice are clearly motivated to engage in the research process despite apparent barriers that have a significant impact on productivity. Nevertheless, there are also enablers to building research capacity apparent that offer methodological and structural approaches to empower this group to conduct research.

BACKGROUND: The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients have led to a renewed focus on strengthening PPI. There is a growing awareness of the benefits of PPI in research as well as a need to address power inequities and a lack of diversity and inclusion. This review was undertaken to look at evidence for theories, barriers and enablers in PPI across health, social care and patient safety that could be used to strengthen PPI and address a perceived knowledge and theory gap with PPI in patient safety.
METHODS: We searched MEDLINE, EMBASE and PsycINFO from inception to August 2018, using both MeSH and free-text terms to identify published empirical literature. Protocols in PROSPERO were also searched to identify any systematic reviews in progress. The extracted information was analysed using a narrative approach, which synthesises data using a descriptive method.
RESULTS: Forty-two reviews were identified and grouped by key outcomes. Twenty-two papers mentioned theory in some form, 31 mentioned equality and diversity (although with no theory mentioned in this area), and only 19 cited equality and diversity as a barrier or enabler. Thirty-four reviews identified barriers and enablers at different organisational levels: personal/individual; attitudes; health professional; roles and expectations; knowledge, information and communication; financing and resourcing; training; general support; recruitment and representation, PPI methods and working with communities and addressing power dynamics.
CONCLUSIONS: The review findings suggest that a commitment to PPI and partnership working is dependent on taking a whole system approach. This needs to consider the complex individual and organisational enablers and constraints to this process and address imbalances of power experienced by different groups. Addressing equality and diversity and use of a theory-driven approach to guide PPI are neglected areas. The long tradition of involvement across health and social care can provide considerable expertise in thinking about ways to strengthen approaches to PPI. This is especially important in patient safety, with a much newer tradition of developing PPI than other areas of healthcare.

Continuous Quality Improvement (CQI) programs have been taken up widely by Indigenous primary health care (PHC) services in Australia and there has been national policy commitment to support this. However, international evidence shows that implementing CQI is challenging, impacts are variable and little is known about the factors that impede or enhance effectiveness. A scoping review was undertaken to explore uptake and implementation in Indigenous PHC, including barriers and enablers to embedding CQI in routine practice. We provide guidance on how research and evaluation might be intensified to support implementation.
Searches were conducted in MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews. Key websites and publications were handsearched. Studies conducted in Indigenous PHC which demonstrated some combination of CQI characteristics and assessed some aspect of implementation were included. A two stage analysis was undertaken. Stage 1 identified the breadth and focus of literature. Stage 2 investigated barriers and enablers. The Framework for Performance Assessment in PHC (2008) was used to frame the analysis. Data were extracted on the study type, approach, timeframes, CQI strategies, barriers and enablers.
Sixty articles were included in Stage 1 and 21 in Stage 2. Barriers to implementing CQI processes relate primarily to professional and organisational processes and operate at multiple levels (individual, team, service, health system) whereas barriers to improved care relate more directly to knowledge of best practice and team processes that facilitate appropriate care. Few studies described implementation timeframes, number of CQI cycles or improvement strategies implemented and only two applied a change theory.
Investigating barriers and enablers that modify implementation and impacts of CQI poses conceptual and methodological challenges. More complete description of CQI processes, implementation strategies, and barriers and enablers could enhance capacity for comparisons across settings and contribute to better understanding of key success factors.