BACKGROUND: Although several digital health interventions (DHIs) have shown promise in the care of skin diseases their uptake in Germany has been limited. To fully understand the reasons for the low uptake, an in-depth analysis of patients\' and health care providers\' barriers and facilitators in dermatology is needed.
OBJECTIVE: The objective of this study was to explore and compare attitudes, acceptability, barriers, and facilitators of patients, dermatologists, and nurses toward DHIs in dermatology.
METHODS: We conducted 6 web-based focus groups each with patients (n=34), dermatologists (n=30), and nurses (n=30) using a semistructured interview guide with short descriptions of DHIs described in the literature. A content analysis was performed using deductive constructs, following the unified theory of acceptance and use of technology framework, and inductive categories.
RESULTS: Patients identified many positive performance expectancies, such as reduced travel times and improvement in follow-up appointments. Dermatologists also stated positive effects (eg, promotion of standardized care), but also negative implications of health care digitalization (eg, increased workload). All stakeholders reported that a DHI should bring additional value to all stakeholders. A lack of digital competence among patients was identified as the major barrier to adoption by all 3 groups. Nurses and dermatologists want apps that are easy to use and easy to implement into their daily routines. Trust in selected institutions, colleagues, and physicians was identified as a facilitator. Patients reported their dependence on the dermatologists\' acceptance. All groups expressed concerns about data privacy risks and dermatologists stated insecurities toward data privacy laws.
CONCLUSIONS: To ensure successful digitalization in dermatology, apps should be user-friendly, adapted to users\' skill levels, and beneficial for all stakeholders. The incorporation of dermatologists\' perspectives is especially important as their acceptance may impact use among patients and nurses. DHIs should ensure and be transparent about data privacy. The found barriers and facilitators can be used for implementation strategies.

UNASSIGNED: Preventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations.
UNASSIGNED: Following ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study\'s qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents\' perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis.
UNASSIGNED: Parents\' perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child\'s weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings.
UNASSIGNED: Minority ethnic communities\' perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.

OBJECTIVE: The aim of this research was to identify patient barriers and facilitators of abdominal aortic aneurysm (AAA) screening in London.
METHODS: A survey was distributed to 4211 adults, who had been invited for AAA screening in 2023. Barriers and facilitators were identified by comparing responses between attenders and non-attenders, using univariate logistic regression.
RESULTS: 271 surveys were returned. Attendance was higher among respondents with a body mass index (BMI) > 25 (odds ratio [OR]: 2.72, 95% CIs [1.15, 6.46]; p < 0.05) and those with one or more comorbidities (OR: 3.82, 95% CIs [1.63, 8.98]; p < 0.01), but lower among those who had not visited a healthcare appointment within the past 6 months (OR: 0.41, 95% CIs [0.18, 0.94]). Attendance was also lower among those who believe screening is only useful for people with symptoms (OR: 0.37; 95% CIs [0.16, 0.89]; p < 0.05), find it difficult to make time for medical appointments (OR: 0.25, 95% CIs [0.10, 0.60]; p < 0.01), find it difficult to get to medical appointments (OR: 0.40, 95% CIs [0.17, 0.91]; p < 0.05), have more important medical problems to worry about (OR: 0.28, 95% CIs [0.12, 0.64]; p < 0.01), cannot afford to travel to medical appointments (OR: 0.16, 95% CIs [0.07, 0.38]; p < 0.001), need help getting to appointments (OR: 0.33, 95% CIs [0.13, 0.86]; p < 0.05), have caring responsibilities (OR: 0.15, 95% CIs [0.06, 0.34]; p < 0.001), and forget about appointments (OR: 0.21, 95% CIs [0.09, 0.49]; p < 0.001).
CONCLUSIONS: This study provides suggestive data on characteristics that might be associated with not attending AAA screening in London. The study design limitations mean that further work is required to evaluate these characteristics more reliably.

OBJECTIVE: To explore barriers and facilitators for reducing low-value home-based nursing care.
METHODS: Qualitative exploratory study.
METHODS: Seven focus group interviews and two individual interviews were conducted with homecare professionals, managers and quality improvement staff members within seven homecare organizations. Data were deductively analysed using the Tailored Implementation for Chronic Diseases checklist.
RESULTS: Barriers perceived by homecare professionals included lack of knowledge and skills, such as using care aids, interactions between healthcare professionals and general practitioners creating expectations among clients. Facilitators perceived included reflecting on provided care together with colleagues, clearly communicating agreements and expectations towards clients. Additionally, clients\' and relatives\' behaviour could potentially hinder reduction. In contrast, clients\' motivation to be independent and involving relatives can promote reduction. Lastly, non-reimbursement and additional costs of care aids were perceived as barriers. Support from organization and management for the reduction of care was considered as facilitator.
CONCLUSIONS: Understanding barriers and facilitators experienced by homecare professionals in reducing low-value home-based nursing care is crucial. Enhancing knowledge and skills, fostering cross-professional collaboration, involving relatives and motivating clients\' self-care can facilitate reduction of low-value home-based nursing care. Implications for profession and patient care: De-implementing low-value home-based nursing care offers opportunities for more appropriate care and inclusion of clients on waitlists.
CONCLUSIONS: Addressing barriers with tailored strategies can successfully de-implement low-value home-based nursing care.
UNASSIGNED: The Consolidated Criteria for Reporting Qualitative Research checklist was used. No patient or public contribution.

BACKGROUND: Implementation of the World Health Organization (WHO) recommended Advanced HIV Disease screening package, remains poor in most settings with limited resources. More than 50% of newly diagnosed-HIV clients are missed on screening as a result of implementation barriers. It is important to mitigate the existing barriers and leverage enablers\' inorder to maximize uptake of the advanced HIV disease screening. This study aimed to identify strategies for scaling up implementation of advanced HIV disease screening among newly HIV-diagnosed clients in pre-ART phase using a Consolidated Framework for Implementation Research-Expert Recommendation for Implementing Change (CFIR-ERIC) guiding tool.
METHODS: A qualitative study was conducted at Rumphi district hospital in Malawi (August - September, 2023). Two sessions of Focus group discussions (FDGs) involving key stakeholders were facilitated to identify specific strategies following the initial study on exploration of barriers and facilitators of advanced HIV disease screening package. Participants comprised healthcare providers, purposively selected from key hospital departments. A deductive approach was used to analyze FDG transcripts where emerging themes were mapped with ERIC list of strategies. CFIR-ERIC Matching tool version 1.0, was used to generate an output of the most to least expert-endorsed Level 1 and Level 2 strategies.
RESULTS: About 25 key healthcare workers participated in FDGs. Overall, 6 Level 1 strategies (≥ 50% expert endorsement score) and 4 Level 2 strategies (≥ 20%, ≤ 49% expert endorsement score) were identified, targeting barriers associated with availability of resources, intervention complexity, access to knowledge and information, communication; and implementation leads. Most of the reported strategies were cross-cutting and aimed at enhancing clinical knowledge of the intervention (distributing training materials, educational meetings), developing stakeholders\' interrelations (network weaving) as well as improving clinical workflow (environmental restructuring). Use of evaluative and iterative strategies such as monthly data collection for evaluation were also recommended as part of continuous improvement while an AHD coordinator was recommended to be formally appointed inorder to spearhead coordination of AHD screening services.
CONCLUSIONS: Through the involvement of key stakeholders and the use of CFIR-ERIC matching tool, this study has identified cross-cutting strategies that if well implemented, can help to mitigate contextual barriers and leverage enablers for an improved delivery of AHD screening package.

UNASSIGNED: Among the chronically ill, end-of-life conversations are often delayed until emergently necessary and the quality of those conversations and subsequent decision-making become compromised by critical illness, uncertainty, and anxiety. Many patients receive treatment that they would have declined if they had a better understanding of benefits and risks. Primary care providers are ideal people to facilitate end-of-life conversations, but these conversations rarely occur in the out-patient setting.
UNASSIGNED: To investigate the self-reported experiences of physicians and advanced practice nurses with conversational barriers and facilitators while leading end-of-life discussions in the primary care setting.
UNASSIGNED: A qualitative descriptive study.
UNASSIGNED: Six physicians and eight advanced practice nurses participated in singular semi-structured interviews. Results were analyzed using a qualitative descriptive design and content analysis approach to coding.
UNASSIGNED: Reported barriers in descending order included resistance from patients and families, insufficient time, and insufficient understanding of prognosis and associated expectations. Reported facilitators in descending order included established trusting relationship with provider, physical and/or cognitive decline and poor prognosis; and discussion standardization per Medicare guidelines.
UNASSIGNED: Recommendations for improving the end-of-life conversational process in the primary care setting include further research regarding end-of-life conversational facilitators within families, the improvement of patient/family education about hospice/palliative care resources and examining the feasibility of longer appointment allotment.1.

BACKGROUND: Worldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery.
METHODS: The Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature.
CONCLUSIONS: Despite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care.
BACKGROUND: This scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ.

UNASSIGNED: Low back pain management has evolved with researchers advocating for a biopsychosocial management model. The biopsychosocial management model has been predominantly applied in high-income countries and underexplored in low- and middle-income countries including Ghana. This study aimed to explore the potential barriers and facilitators to patients with chronic low back pain (CLBP) and physiotherapists engagement with a biopsychosocial intervention (exercise and patient education) as part of a feasibility study.
UNASSIGNED: This was a qualitative study embedded within a mixed-methods, sequential, feasibility study, in Ghana, applying semi-structured interviews. Two categories of participants involved in this study were, two trained physiotherapists, and six patients with CLBP, sampled within the feasibility study.
UNASSIGNED: Regarding the barriers and facilitators to the delivery of the BPS intervention, five interlinked themes emerged from the thematic analysis. These were: structure and process of delivery; patients\' expectations; patients\' health beliefs, autonomy, and engagement; external influences and personal and professional characteristics of physiotherapists.
UNASSIGNED: The themes that emerged from this study demonstrated many positive facilitators based on participants\' improved understanding of LBP and the clarity and purpose of the biopsychosocial intervention. The results therefore demonstrate a potential to deliver the biopsychosocial intervention in a Ghanaian context.
A biopsychosocial approach to managing chronic low back pain offers a promising alternative to patients and physiotherapists in Ghana.A biopsychosocial approach to managing chronic low back pain has the potential to improve physiotherapists’ thoughts and attitudes, and have a positive influence on their professional development in Ghana.A biopsychosocial approach to managing chronic low back pain has the potential to reverse patients’ maladaptive beliefs, improve their understanding of their condition, improve outcomes in Ghana.

OBJECTIVE: 1 in 7 Canadians with Human Immunodeficiency Virus (HIV) do not know their status. Patients at increased risk of HIV routinely access the emergency department (ED), yet few are tested, representing a missed opportunity for diagnosis and linkage-to-care. Rapid HIV testing provides reliable results within the same ED encounter but is not routinely implemented. The objective of this study was to identify barriers and facilitators to rapid HIV testing in Ontario EDs.
METHODS: We employed a mixed-methods, convergent, parallel design study including online surveys and semi-structured interviews of physicians, nurses, and allied health across four hospitals in Toronto and Thunder Bay, Ontario. Data were analyzed in equal priority using descriptive statistics for quantitative data and thematic analysis for qualitative data guided by the Theoretical Domains framework and Capability, Opportunity, Motivation Behaviour change model.
RESULTS: Among 187 survey respondents, 150 (80%) felt implementing rapid HIV testing would be helpful in the ED. Facilitators included availability of resources to link patients to care after testing (71%), testing early in patient encounters (41%), and having dedicated staff with lived experience support testing (34%). Motivation to offer testing included opportunities to support an underserved population (66%). Challenges to implementation included limited time during ED patient encounters (51%) and a lack of knowledge around HIV testing (42%) including stigma. Interview themes confirmed education, and integration of people with lived experience being essential to provide rapid HIV testing and linkage-to-care in the ED.
CONCLUSIONS: Implementation of rapid HIV testing in the ED is perceived to be important irrespective of practice location or profession. Intrinsic motivations to support underserved populations and providing linkage-to-care are novel insights to facilitate testing in the ED. Streamlined implementation, including clear testing guidelines and improved access to follow-up care, is felt to be necessary for implementation.
UNASSIGNED: OBJECTIFS: 1 Canadien sur 7 atteint du virus de l’immunodéficience humaine (VIH) ne connaît pas son statut. Les patients présentant un risque accru de contracter le VIH ont régulièrement accès au service des urgences (SU), mais peu d’entre eux sont testés, ce qui représente une occasion manquée de diagnostic et de lien avec les soins. Le dépistage rapide du VIH fournit des résultats fiables dans la même situation d’urgence, mais n’est pas systématiquement mis en œuvre. L’objectif de cette étude était d’identifier les obstacles et les facilitateurs au dépistage rapide du VIH dans les urgences de l’Ontario. MéTHODES: Nous avons utilisé une étude de conception mixte, convergente et parallèle, y compris des sondages en ligne et des entrevues semi-structurées auprès de médecins, d’infirmières et d’auxiliaires de la santé dans quatre hôpitaux de Toronto et de Thunder Bay, en Ontario. Les données ont été analysées en priorité égale à l’aide de statistiques descriptives pour les données quantitatives et d’analyses thématiques pour les données qualitatives guidées par le cadre des domaines théoriques et le modèle de changement de capacité, d’opportunité et de motivation. RéSULTATS: Parmi 187 répondants au sondage, 150 (80 %) étaient d’avis que la mise en œuvre d’un dépistage rapide du VIH serait utile à l’urgence. Les facilitateurs comprenaient la disponibilité de ressources pour lier les patients aux soins après le test (71 %), le dépistage précoce lors des rencontres avec les patients (41 %) et la présence d’un personnel dévoué avec des tests de soutien de l’expérience vécue (34 %). La motivation à offrir des tests comprenait des occasions de soutenir une population mal desservie (66 %). Les difficultés de mise en œuvre comprenaient un temps limité pendant les rencontres avec les patients aux urgences (51 %) et un manque de connaissances sur le dépistage du VIH (42 %), y compris la stigmatisation. Les thèmes des entrevues ont confirmé que l’éducation et l’intégration des personnes ayant une expérience vécue sont essentielles pour fournir un dépistage rapide du VIH et un lien avec les soins aux urgences.
CONCLUSIONS: La mise en œuvre du dépistage rapide du VIH aux urgences est perçue comme importante, quel que soit le lieu de pratique ou la profession. Les motivations intrinsèques à soutenir les populations mal desservies et à fournir un lien avec les soins sont de nouvelles idées pour faciliter les tests à l’urgence. Une mise en œuvre simplifiée, y compris des lignes directrices claires sur les tests et un meilleur accès aux soins de suivi, est jugée nécessaire pour la mise en œuvre.

UNASSIGNED: Hearing aid use is lowest in 0-3-year-olds with hearing loss, placing spoken language development at risk. Existing interventions lack effectiveness and are typically not based on a theoretically driven, comprehensive understanding of the factors influencing infant hearing aid use. The present study is the first to address this gap in understanding.
UNASSIGNED: A 55-item online survey based on the Theoretical Domains Framework (TDF) was completed by 56 parents of 0-3-year-old hearing aid users.
UNASSIGNED: Participants reported a wide range of barriers across TDF domains, which were associated with parent-reported hearing aid use and more pronounced in parents of lower hearing aid users. The most strongly reported domains across participants were \"emotion\" (e.g. feelings of worry when using hearing aids), \"beliefs about capabilities\" (e.g. belief in ability to use hearing aids consistently), and \"environmental context and resources\" (e.g. child removing hearing aids).
UNASSIGNED: Parents report a wider range of barriers to infant hearing aid use than existing investigations suggest and current interventions address. Interventions would benefit from: (i) targeting a wider range of TDF domains in their design; and (ii) implementing the present TDF survey to identify and target family-specific barriers to infant hearing aid use.