BACKGROUND: The need for dental data in healthcare services and the inadequacy of paper records due to their inherent limitations have led to a shift towards electronic dental record systems (EDR). Implementing EDR comes with numerous barriers and challenges. Therefore, this research was conducted to identify the implementation barriers and facilitators for EDRs.
METHODS: This descriptive-analytical cross-sectional study was conducted on dentists working in public and private clinics in Tehran, Iran. A questionnaire consisting of three sections was designed to collect data on the demographic information of dentists, the barriers in five categories including financial barriers (6 questions), organizational barriers (11 questions), technical barriers (5 questions), personal barriers (3 questions), and ethical and legal barriers (6 questions), as well as facilitators for the implementation of EDR (15 questions) based on the literature, using a five-point Likert scale. 130 dentists from 60 dental clinics participated in the study. The data were analyzed using descriptive statistics (calculating frequency distribution, mean, and standard deviation). The mean scores were classified into four categories based on quartiles from very low importance to very high importance including very low importance (mean ≤ 1.25), low importance (1.25 ≥ mean < 2.5), important (2.5 ≥ mean < 3.75), and very high importance (mean ≥ 3.75). Finally, each of the barriers and facilitators among user dentists and non-user dentists was compared using the Mann-Whitney U test. The data were analyzed using SPSS software.
RESULTS: The findings indicate that dentists consider all barriers and challenges in implementing EDR to be important, and all the proposed facilitators for addressing these challenges to be very important. Among these important barriers are the rapid turnover of managers and policymakers at higher levels (3.69 out of 5) as a personal barrier, legal issues related to electronic records (3.65 out of 5) as an ethical-legal barrier, the lack of necessary standards for data exchange between different systems (3.64 out of 5) as a technical barrier, dentists\' limited awareness of the benefits of this system (3.63 out of 5) as a personal barrier, and the lack of suitable legal infrastructure for EDR implementation (3.62 out of 5) as an ethical-legal barrier. Additionally, among the very important facilitators, training dentists and staff on EDR (4.31 out of 5) is noteworthy.
CONCLUSIONS: To address the important barriers to EDR implementation, including legal-ethical barriers, legal institutions, and regulators must establish relevant laws and regulations to overcome these obstacles. Furthermore, if system users learn about the features, goals, benefits, and positive impact of EDR on their work and gain the necessary awareness, their resistance to changes will decrease, and their interest and readiness to accept EDR will increase.

OBJECTIVE: Enhanced Recovery After Surgery (ERAS) is a concept that covers evidence-based practices and requires multidisciplinary teamwork, and nurses play a key role in this team. This qualitative research is conducted to describe the experiences of nurses implementing ERAS and the obstacles they encounter in practice.
METHODS: This research was conducted using the phenomenology pattern, one of the qualitative research designs.
METHODS: The research study group was determined by criterion sampling, one of the purposeful sampling methods.The criterion for participation in this study is to follow at least one of the steps of the ERAS protocol and volunteer to participate in the study. In this context, 12 nurses who met the inclusion criteria participated in the study. Data were obtained from May 1 to May 31, 2023 using an introductory information form and a semistructured interview form. The introductory information form asked questions such as age, gender, marital status, working year, ERAS application time, and total working year. The semistructured interview form, developed by the authors based on the related literature, consisted of four open-ended questions 1The obtained data were analyzed using the seven-step Colaizzi method.
RESULTS: The study identified three themes: the importance of the ERAS protocol, the obstacles to the ERAS protocol, compliance with the ERAS protocol and applicability. Nine subthemes were found: reducing complications and accelerating the healing process, increasing the level of satisfaction, lack of knowledge, leader confusion, resistance to change, lack of team cooperation, policy, leadership, and education.
CONCLUSIONS: This study revealed the experiences of nurses who implement at least one component of ERAS protocols regarding the obstacles to the implementation of the protocol. As a result, nurses stated that lack of information and team cooperation, leader complexity, and resistance to change were obstacles to the protocol. Identifying the obstacles encountered in the implementation of the protocols is important for producing solution suggestions.

BACKGROUND: SMS text messages through mobile phones are a common means of interpersonal communication. SMS text message surveys are gaining traction in health care and research due to their feasibility and patient acceptability. However, challenges arise in implementing SMS text message surveys, especially when targeting marginalized populations, because of barriers to accessing phones and data as well as communication difficulties. In primary care, traditional surveys (paper-based and online) often face low response rates that are particularly pronounced among disadvantaged groups due to financial limitations, language barriers, and time constraints.
OBJECTIVE: This study aimed to investigate the potential of SMS text message-based patient recruitment and surveys within general practices situated in lower socioeconomic areas. This study was nested within the Reducing Alcohol-Harm in General Practice project that aimed to reduce alcohol-related harm through screening in Australian general practice.
METHODS: This study follows a 2-step SMS text message data collection process. An initial SMS text message with an online survey link was sent to patients, followed by subsequent surveys every 3 months for consenting participants. Interviews were conducted with the local primary health network organization staff, the participating practice staff, and the clinicians. The qualitative data were analyzed using constructs from the Consolidated Framework for Implementation Research.
RESULTS: Out of 6 general practices, 4 were able to send SMS text messages to their patients. The initial SMS text message was sent to 8333 patients and 702 responses (8.2%) were received, most of which were not from a low-income group. This low initial response was in contrast to the improved response rate to the ongoing 3-month SMS text message surveys (55/107, 51.4% at 3 months; 29/67, 43.3% at 6 months; and 44/102, 43.1% at 9 months). We interviewed 4 general practitioners, 4 nurses, and 4 administrative staff from 5 of the different practices. Qualitative data uncovered barriers to engaging marginalized groups including limited smartphone access, limited financial capacity (telephone, internet, and Wi-Fi credit), language barriers, literacy issues, mental health conditions, and physical limitations such as manual dexterity and vision issues. Practice managers and clinicians suggested strategies to overcome these barriers, including using paper-based surveys in trusted spaces, offering assistance during survey completion, and offering honoraria to support participation.
CONCLUSIONS: While SMS text message surveys for primary care research may be useful for the broader population, additional efforts are required to ensure the representation and involvement of marginalized groups. More intensive methods such as in-person data collection may be more appropriate to capture the voice of low-income groups in primary care research.
UNASSIGNED: RR2-10.3399/BJGPO.2021.0037.

UNASSIGNED: To estimate the level of physical activity among geriatric population, to determine the motivating factors for being active and identifying barriers that prevent participants from engaging in physical activity.
UNASSIGNED: A community-based cross-sectional study was carried out at one of the wards within Ahmedabad city following multi-stage random sampling. The calculated sample size was 230. A pre-designed, validated, short version International Physical Activity Questionnaire (IPAQ) and Behaviour Regulation in Exercise Questionnaire (BREQ-3) were used for data collection by personal interview. From selected sampling-frame, geriatric people residing in every 5th household were interviewed after obtaining oral informed consent following simple-random sampling.
UNASSIGNED: Of total 230 study participants, 67 (29.13%) were physically active (cumulative for Category 2 and Category 3), while the remaining 163 (70.87%) were found physically inactive (i.e., minimally active [Category 1]). Motivational scores, particularly in identified regulation, showed higher median scores across subdomains of the BREQ-3. Amotivation exhibited a strong negative correlation with physical activity, while intrinsic regulation displayed a strong positive correlation.
UNASSIGNED: More than two-third of study participants were physically inactive. Level of educational status, type of previous occupation involved, presence of addiction, BMI, electronic device usage duration per day and presence of chronic illness were statistically significant determinants to decide involvement of elderly people in category of physical activity. Amotivation, external and introjected regulation had negative correlation with physical activity, while intrinsic regulation and RAI (Relative Autonomy Index) showed positive correlation with physical activity. None of the behavioural regulators had statistically significant association with category of physical activity.

The increasing incidence of chronic conditions on a global scale requires a comprehensive approach to palliative care, which is recognized as an essential element of the continuum of care for people with life-threatening conditions. It has been argued that the integration of early palliative care for people with chronic conditions is beneficial. Nevertheless, barriers to integrating early palliative care have been extensively not reviewed. This review aimed to explore the barriers and facilitators of integrating early palliative care for people living with chronic conditions, employing a socio-ecological framework to provide a critical understanding of the influencing factors at multiple levels. The method was a mini review. This review emphasizes the complex and diverse factors that either hinder or facilitate progress in four areas: individual (such as gaps in knowledge and emotional reactions), interpersonal (such as support from family caregiver), healthcare professionals and policy (such as barriers in education, guidelines, and collaboration among professionals), and community (such as societal knowledge and attitudes). Each level presents unique challenges and opportunities for enhancing early palliative care integration, from addressing misconceptions and fears at the individual level, to fostering supportive policies and community awareness. In conclusion, the effective management of early palliative care requires a comprehensive strategy that spans various dimensions, including educational initiatives, policy adjustments, and active involvements of the community. Healthcare systems are supposed to enhance the integration of early palliative care into the trajectory of chronic conditions and enhance the quality of life of affected persons and their families by recognizing and addressing the socio-ecological elements involved.

BACKGROUND: Exercise has been demonstrated to result in improvements in physical function, cognition, and quality of life in People with Parkinson\'s (PwP) but its adoption is variable.
OBJECTIVE: To investigate exercise preferences, levels, influencing factors among a diverse Parkinson\'s disease (PD) population, to understand exercise adoption patterns and plan informed interventions.
METHODS: A cross-sectional survey collected data through online platforms and paper-based methods. The Exercise Index (ExI) calculated exercise level based on frequency and duration.
RESULTS: Of 2976 PwP, 40.6% exercised regularly, 38.3% occasionally, and 21.2% did not exercise. The overall mean ExI was 18.99 ± 12.37. Factors associated with high exercise levels included exercising in groups (ExI 24-26), weightlifting (ExI 27 (highest)), using muscle-building equipment (ExI 25-26), and exercising at home following an app (ExI 26). A positive trend between ExI and varied exercise groups, locations, types, and equipment was observed. No expected benefit from exercise achieved the lowest ExI (8). Having at least two exercise-promoting factors, a bachelor\'s degree or higher, receiving exercise advice at initial visits, and aged ≤40 years at PD onset were strong predictors of exercise (adjust OR = 7.814; 6.981; 4.170; 3.565). Falls and \"other\" most troublesome PD symptoms were negative predictors (aOR = 0.359; 0.466). Barriers to exercise did not predict the odds of exercise.
CONCLUSIONS: The study shows that PwP\'s exercise behavior is influenced by their exercise belief, age at PD onset, doctor\'s advice at initial visits, education level, symptoms, and exercise-promoting factors. High exercise levels were associated with certain types of exercises and exercising in groups.

The benefits of regular physical activity for individuals with disabilities (IWDs) are well recognized. Nonetheless, IWDs report several barriers to physical activity participation, including limited access to qualified and experienced personal trainers. Limited research exists from personal trainers\' perspective. This qualitative study aimed to examine the experiences of personal trainers who successfully improve the fitness of IWDs. Individual interviews were conducted with ten personal trainers, focusing on educational and occupational background, experiences training IWDs, and experiences training IWDs within gyms. Thematic analysis produced five themes: (1) personal trainers working with IWDs need specialized education and extensive, often multidisciplinary, experience; (2) personal trainers are most successful when they have the opportunity to work with IWDs who have a diverse range of disabilities and differing expressions of each; (3) a robust network between personal trainers and allied healthcare providers is necessary to support IWDs; (4) access to physical activity is enhanced when trainers manage resources appropriately; and (5) personal trainers can empower IWDs to be advocates for their physical activity needs. Future research could examine the effects of an adaptive hands-on educational intervention among personal trainers to enhance IWDs\' health and fitness.

OBJECTIVE: Initiation of palliative care early in the disease trajectory is beneficial for patients with a life-limiting disease. However, palliative care is still introduced rather late or not at all. Therefore, this study aims to explore barriers and facilitators to early initiation of palliative care as perceived by nurses working on pneumology and nephrology.
METHODS: A descriptive interview-based study was conducted from a critical realist perspective until data sufficiency was reached. Fifteen nurses presented and discussed a patient for whom palliative care was initiated too late. Template analysis was conducted to develop themes and subthemes.
RESULTS: Five key themes were extracted: (1) communication, (2) fear, (3) personal beliefs about life and death, (4) ambiguity in terminology and (5) workload and time pressure. Barriers related to poor interdisciplinary communication were therapeutic obstinance, hierarchy, unawareness of the patient\'s wishes and fear of saying something inappropriate. Other barriers were patients\' religious beliefs which often hindered the use of sedatives or morphine and led to discomfort and time restraints. A palliative support team in hospital and advance care planning (ACP) were enablers for early palliative care.
CONCLUSIONS: This study started from a negative experience, leading to identification of a lot of barriers and only a few facilitators. The limited sample size and the restriction to two wards within one single hospital limit the diversity of perspectives and the generalisability of the findings.
CONCLUSIONS: More attention is needed for ACP and interdisciplinary communication. Palliative care, including ACP, and interdisciplinary communication should be included in the basic curricula of all healthcare professional courses. Further research is needed to explore barriers and facilitators to early initiation of palliative care in other healthcare settings and patient populations. This is crucial in order to develop and implement sustainable interventions for specific groups of patients.

BACKGROUND: Mobile health (mHealth) offers significant benefits for patients with stroke, facilitating remote monitoring and personalized health care solutions beyond traditional settings. However, there is a dearth of comprehensive data, particularly qualitative insights, on the barriers to mHealth access. Understanding these barriers is crucial for devising strategies to enhance mHealth use among patients with stroke.
OBJECTIVE: This study aims to examine the recent literature focusing on barriers to mHealth access among patients with stroke.
METHODS: A systematic search of PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text was conducted for literature published between 2017 and 2023. Abstracts and full texts were independently screened based on predetermined inclusion and exclusion criteria. Data synthesis was performed using the convergent integrated analysis framework recommended by the Joanna Briggs Institute.
RESULTS: A total of 12 studies met the inclusion criteria. The majority were qualitative studies (about 42%), followed by mixed methods (25%), pilot studies (about 17%), nonrandomized controlled trials (about 8%), and observational studies (about 8%). Participants included patients with stroke, caregivers, and various health care professionals. The most common mHealth practices were home-based telerehabilitation (30%) and poststroke mHealth and telecare services (20%). Identified barriers were categorized into two primary themes: (1) at the patient level and (2) at the health provider-patient-device interaction level. The first theme includes 2 subthemes: health-related issues and patient acceptability. The second theme encompassed 3 subthemes: infrastructure challenges (including software, networking, and hardware), support system deficiencies, and time constraints.
CONCLUSIONS: This systematic review underscores significant barriers to mHealth adoption among patients with stroke. Addressing these barriers in future research is imperative to ensure that mHealth solutions effectively meet patients\' needs.

UNASSIGNED: Children and neonates are more susceptible to diseases and are a vulnerable group in medication administration (MA). Nurses interact directly with patients, ensuring safety and preventing unintended outcomes. Health Information Technology (HIT) has transformed health care, aiding nurses in decision-making and treatment responses. Despite its benefits, technology presents challenges that must be overcome to facilitate the nursing practice. Therefore, the present study aimed to explore the barriers to HIT use in the process of MA in children and neonates in a developing country.
UNASSIGNED: Semi-structured face-to-face interviews were conducted with 22 health care professionals across seven pediatric and neonatal settings. Also, observations were made of these settings for 3 weeks. A qualitative analysis was performed using the conventional content analysis method, recommended by Colaizzi\'s seven-step approach.
UNASSIGNED: The results showed that the most significant barriers to adopting technology in MA process could be classified into two main categories: \"inappropriate management approaches\" with two sub-categories (\"Managers\' reluctance to adopt new technology\", \"lack of adequate budget for hardware resources\"), and \"resistance to change\" with two sub-categories (\"A desire to use conventional (traditional) approaches in care\", \"cultural issues and impracticality of providing some specialized technology services\").
UNASSIGNED: The findings revealed MA process complexities, which have been insufficiently examined in the current literature. We have highlighted the need for improved \"effectiveness of HIT systems in administering medication processes, budget for hardware resources, and managers\" interest in using new technology. The present findings can guide the development of more effective and user-friendly HIT systems in pediatric and neonatal care settings.