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PubMed2005

Psychological barriers to Internet usage among older adults in the UK.

The Internet is an important tool in assisting the older population to lead independent and social lives. However, the majority of Internet users are under 55. This study investigated the following psychological barriers to Internet use by older adults: perceived usefulness, perceived ease of use, Internet efficacy, perceived complexity of navigation and perceived complexity of terminology. Twenty-three subjects (aged 55 - 75 years) were interviewed in the UK. The influences of age, computer and Internet experience, and training on these psychological barriers were explored. The results showed that the majority of the older adults who had a positive perception of usefulness, ease of use, and efficacy of the Internet or e-mail, used the Internet or e-mail more often. In addition, it was found that computer or Internet experience increased perceptions of ease of use and efficacy of the Internet and reduced perceived complexity of navigation. There was no difference between the two age groups (55 - 65 and 66 - 75 years) in these psychological barriers. It was concluded that increased marketing of the Internet (aimed at the older user), more simple and uniformly designed Internet pages, more user-friendly online help and error message terminology, and increased provision of training for the older user would assist uptake of the World Wide Web.

Adaptation, Psychological↗
PubMed2004

Setting priorities and identifying barriers for general practice research in Europe. Results from an EGPRW meeting.

BACKGROUND: In spring 2002, WONCA Europe, the European Society of General Practice/Family Medicine and its Network organizations reached consensus on a 'new' European definition of general practice. Subsequently, the European General Practice Research Workshop (EGPRW) started working on a European General Practice Research Agenda. This topic was addressed during the 2002 EGPRW autumn meeting. OBJECTIVE: Our aim was to explore the views of European general practice researchers on needs and priorities as well as barriers for general practice research in Europe. METHODS: In seven discussion groups, 43 general practice researchers from 18 European countries had to answer the following questions. (i) What major topics should be included in a research agenda for general practice in your country? (ii) What are the barriers to adequate implementation of general practice research in your country? Group answers were listed and subsequently categorized by two authors. RESULTS: Research on 'clinical issues' (common diseases, chronic diseases, etc.), including diagnostic strategies, was considered to be the core content of general practice research, with primary care-based morbidity registration essential for surveillance of disease, clinical research and teaching in general practice. There was also consensus on the need for research on education and teaching. 'Insufficient funding opportunities' was perceived to be the major barrier to the development of general practice research. CONCLUSIONS: These findings could be used as a basis for national checklists of 'content of' and 'conditions for' general practice research. European general practice research training programmes should be developed further.

Communication Barriers↗
PubMed1999

Small steps, great strides. Local groups take on health care's toughest issues--slowly but surely.

Three of the major issues affecting health care today are global in nature: poverty, violence and the aging of the American population. In the absence of a concerted national effort to deal with them, communities across the country are experimenting with their own local solutions. The Valencia County Coalition in New Mexico, for instance, is breaking down the barriers between low-income residents and the state's Medicaid managed care program. Another example: The DeKalb Medical Center in Decatur, Ga., opened a unit to treat elderly patients' acute medical problems and keep them functional so they can go straight home from the hospital rather than to subacute or skilled nursing care.

Aged↗
PubMed2002

[Implementation of a new prescription system. A qualitative survey of organizational barriers].

INTRODUCTION: The aim of this study was to identify organisational difficulties faced by physicians and nurses when using drug prescribing sheets for the recording of both drug prescriptions and drug administration. MATERIAL AND METHODS: Qualitative interviews with seven physicians and eight nurses from two general internal medicine wards. Main outcome measures were the difficulties explicitly identified during the interviews. RESULTS: The implementation of procedures conflicted with existing structure, culture, and routines. Insufficient competence within the system to use the drug prescribing sheets created resistance and made people create their own solutions to the problems they faced. A total of nine difficulties were identified: 1) insufficient knowledge and uncertainty about procedures, 2) ignorance of sources of error, 3) unclear responsibilities, 4) low community spirit, 5) insufficient communication, 6) clinician autonomy and low acceptance of change, 7) strong professional identity, 8) low priority task, and 9) logistic problems. DISCUSSION: Unawareness of procedures, insufficient dissemination of knowledge, and insufficient cooperation and skepticism among those who put drug handling into practice is likely to have an impact on the quality of health care. The identification of these obstacles may help managers to improve the quality of the drug handling process and make it possible to select a framework for changing the clinical behavior of doctors and nurses.

Communication Barriers↗
PubMed2006

Internal medicine residents' perceptions of cross-cultural training. Barriers, needs, and educational recommendations.

BACKGROUND: Physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds. Despite widespread interest in cross-cultural care, little is known about resident physicians' perceptions of what will best enable them to provide quality care to diverse patient populations. OBJECTIVES: To assess medicine residents' (1) perceptions of cross-cultural care, (2) barriers to care, and (3) training experiences and recommendations. DESIGN, SETTING, AND PATIENTS: Qualitative individual interviews were conducted with 26 third-year medicine residents at Massachusetts General Hospital in Boston (response rate=87%). Interviews were recorded, transcribed, and analyzed. RESULTS: Despite significant interest in cross-cultural care, almost all of the residents reported very little training during residency. Most had gained cross-cultural skills through informal learning. A few were skeptical about formal training, and some expressed concern that it is impossible to understand every culture. Challenges to the delivery of cross-cultural care included managing patients with limited English proficiency, who involve family in critical decision making, and who have beliefs about disease that vary from the biomedical model. Residents cited many implications to these barriers, ranging from negatively impacting the patient-physician relationship to compromised care. Training recommendations included making changes to the educational climate and informal and formal training mechanisms. CONCLUSIONS: If cross-cultural education is to be successful, it must take into account residents' perspectives and be focused on overcoming residents' cited barriers. It is important to convey that cross-cultural education is a set of skills that can be taught and applied, in a time-efficient manner, rather than requiring an insurmountable knowledge base.

Attitude of Health Personnel↗
PubMed1999

Barriers to informed consent in clinical trials.

Clinical trials are a type of scientific study conducted in human beings. They are designed to evaluate the safety and effectiveness of new drugs, procedures, or other means of treating, diagnosing, or preventing diseases. The ethical issues involved in clinical trials are nothing new, but because of the increased access to studies, they are steadily affecting more people. The sheer volume of clinical trials, as well as the number of patients and professionals involved in them, has increased in the past decade. Informed consent is a key element of clinical research. Meaningful informed consent requires that subjects weight the associated risks and benefits of an experimental intervention and then voluntarily give consent. One concern regarding informed consent in research is the confusion between therapeutic intervention and experimental treatment. This confusion could lead to barriers in informed consent. This column addresses this concern and includes a case study to illustrate the misunderstandings that might arise from the patient who is compelled to consent to clinical trials because of his sense of hopelessness from a chronic health condition and the traditional medical intervention he is receiving.

Adult↗
PubMed2000

Dental students' attitudes toward smoking cessation guidelines.

Dentists can be effective in helping their patients achieve smoking cessation. To plan a didactic program, we explored the smoking cessation attitudes and practices of dental students and identified barriers to service provision in the dental setting. We assessed 244 fourth-year dental students at New York University College of Dentistry through a self-report survey. The instrument included a twenty-nine-item measure assessing attitudes towards tobacco-use counseling and adherence to National Cancer Institute tobacco cessation guidelines. The survey also assessed demographics, tobacco use history, and level of preparation to provide services. Generally, students endorsed tobacco prevention practices, but perceived barriers to service provision. Students provided counseling inconsistently, with 69 percent asking about smoking, 58 percent advising cessation, 24 percent offering assistance, and 22 percent providing followup on a routine basis. Those who provided more counseling were more likely to have undergone formal training in smoking cessation, did not feel time was a barrier to counseling, and had more favorable beliefs about dentists' role in promoting smoking cessation. Study findings indicate great receptivity among students as well as a critical need and opportunity to include comprehensive cessation counseling training in the dental curriculum.

Adult↗
PubMed2001

Beliefs and attitudes of Samoan women toward early detection of breast cancer and mammography utilization.

BACKGROUND: Among Pacific Islanders in Hawaii, the breast has been the foremost cancer site. Among Samoans, it is a leading cancer site along with sites for respiratory cancers. A recent study reported that cancer has been diagnosed at relatively advanced stages in younger Samoans. METHODS: An exploratory, qualitative design was used with a semi-structured, open ended, talk story interview with Samoan women aged 40 years and older who spoke English and who had no personal history of breast cancer. The coding of interviews was validated with a faculty member unrelated to the study. Interviews were stopped at 15 participants once thematic patterns were saturated. Content analysis was performed. Triangulation to validate results was performed with research assistants and one participant. RESULTS: Participants ranged from 40-73 years of age, had lived in the U.S. 3-40 years, and most were married, born in Samoa or American Samoa, and had health insurance. Their education ranged from ninth grade to some college. Their health promotion activities included eating right, exercising, immunizing their children, and visiting their physician for an annual examination. Most had had positive or neutral experiences with western health care. Most reported that they would use Samoan medicine if available. Priorities reported were health, family, and education. Women considered the care and health of their families their responsibility. All had negative perceptions of cancer. Most had had mammograms. Reported major barriers to mammography were fear, not a priority, and pain. Reported major motivators were physician recommendation, prevention, and fear. Over half of the women reported concern over their breasts being touched either by themselves or by others. CONCLUSIONS: The study participants had strong beliefs that cancer meant death and, therefore, no cure. Samoan women emphasized the health and education of their families and their role in family health care. Therefore, health care providers should promote health and breast screening by emphasizing that family health care also means caring for oneself. Although Samoan women reported that they used western health care, most women also were willing to use traditional Samoan medicine if it was available. Their understanding the causes of cancer included currently accepted explanations and uncommonly accepted views of causation. Correcting misinformation, teaching, addressing fears (motivators as well as barriers), using female health providers for screening, conveying respect for privacy and person, reinforcing that examination of the breast is not sexual, and gently handling breasts during examinations are important considerations for the prevention of breast cancer in Samoan women.

Adult↗
PubMed1993

Inner-city women and AIDS: the psycho-social benefits of unsafe sex.

The paper describes and analyzes findings from a larger study of the links between low levels of condom use and impoverished, urban, African-American women's experiences and understandings of heterosexual relationships. The research identifies and explores psycho-social barriers to safer-sex. This article examines, in detail, HIV/AIDS risk denial and women's strategic use of unsafe (condomless) sex and "monogamy narratives" to build and to maintain this denial. The tendency to view urban African-American women's conjugal affiliations as instrumental is questioned.

AIDS Serodiagnosis↗
PubMed2001

Teaching the adult ostomy patient.

Ostomy education is based on principles of adult learning, including assessment of the learners' readiness, ability, and need to learn. Such teaching incorporates specific strategies designed to promote cognitive, affective, and psychomotor learning and strategies to overcome potential cultural barriers. In addition, modifications may be included to meet the needs of aged or disabled patients who have cognitive deficits or low literacy skills. Finally, ostomy education must include an evaluation of its effectiveness. This article reviews general guidelines for planning, implementing, and evaluating patient education for adult patients with ostomies.

Adult↗
PubMed2006

Understanding and overcoming the barriers of implementing patient decision aids in clinical practice.

Patient decision aids (ptDAs) have been developed to assist patients with difficult health-related decisions. Despite their proven effects on decision quality in numerous efficacy trials, we lack an evidence-based approach for implementing them as part of the process of care. Pragmatic trials of ptDAs have uncovered a myriad of implementation challenges; therefore we need a better understanding of the barriers and strategies to overcome them to facilitate their widespread uptake. The following paper provides an overview of the barriers related to the uptake of ptDAs within the process of care and the strategies, opportunities and research priorities to overcome them. This report is based on our interpretation of the literature and our collective experience in implementing ptDAs within trials and other contexts.

Communication Barriers↗
PubMed1994

AIDS prevention struggles in ethnocultural neighborhoods: why research partnerships with community based organizations can't wait.

Community based AIDS prevention programming and research in minority neighborhoods are growing. The AIDS epidemic has demoralized many minority communities and has added to enormously stressing social conditions. Obstacles to effective AIDS prevention programming must be removed before stable, accessible, and culturally relevant services can be provided. A pilot study was conducted to identify the obstacles to AIDS research or intervention in ethnic minority neighborhoods. Twenty-nine administrators and counselors from Community Based Organizations completed questionnaires concerning reasons for entering the field of AIDS prevention, enjoyment of work, hopefulness towards AIDS efforts, priority of AIDS funding, and opinions about most and least helpful prevention efforts in minority communities. Barriers identified as most problematic include insufficient funds, lack of culturally relevant materials, denial of the epidemic in minority communities, distrust of majority culture institutions, and myths/beliefs regarding AIDS contraction, transmission, and origin. Future research ideas are identified to improve culturally relevant AIDS prevention interventions in ethnocultural neighborhoods.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The Interhospital Interpreter Project.

My family immigrated to Canada when I was a child. Soon after we arrived, I became ill with acute appendicitis. For days, I lay in pain while my parents searched desperately for a physician. But in the small Ontario town where we had moved, there were no cultural interpreters. My parents faced not just a language barrier, but the barrier of a lack of knowledge of the health care system. They were unaware that an ill person could seek treatment in the emergency department of a general hospital. My parents finally found someone who could help, and I was treated just hours before my appendix would have ruptured. I will never forget those days of pain and fear.

Communication Barriers↗
PubMed2007

Medical and non-medical barriers to outpatient treatment of fever and neutropenia in children with cancer.

BACKGROUND: A number of clinical trials have employed clinical criteria that can identify pediatric patients at low-risk for complicated episodes of fever and neutropenia (F&N) and have successfully treated low-risk patients in the outpatient setting. Despite this, inpatient management remains the standard of care. This trial tested the hypothesis that a strategy of initial hospitalization followed by continuation of therapy in the outpatient setting could be practically implemented in the majority of episodes. PROCEDURE: Patients presenting with F&N were initially evaluated to determine if they had high-risk clinical criteria that would exclude them from this approach. Eligible patients were then hospitalized and treated with iv antibiotics. On subsequent days the attending physician determined whether the patient had exhibited improvement and could continue therapy in the outpatient setting with oral antibiotics. Outpatients were seen three times weekly and continued antibiotics until recovery from F&N. RESULTS: Outpatient oral antibiotic therapy was practically implemented in less than one-quarter of episodes of pediatric F&N. Forty-nine percent of episodes were excluded from study by medical and social protocol exclusion criteria. One hundred five episodes were enrolled and among these 59 episodes included outpatient management. Common barriers to outpatient care included serious medical comorbidities, non-medical barriers including language and distance of residence from the medical center, and lack of interest. The average duration of outpatient care was 3.6 days following an average of 3.5 days of hospitalization. Ninety percent did not require rehospitalization. They experienced no complications. CONCLUSIONS: In only a minority of episodes can outpatient antibiotic management be implemented. Medical comorbidities and social barriers can make the transition to outpatient care difficult. However, initial hospitalization followed by oral antibiotic outpatient management appears safe and effective for low-risk patients who exhibit good responses to initial antibiotic therapy in hospital.

Administration, Oral↗
PubMedDate not supplied

Culturally appropriate care for pregnant Latina women who are victims of domestic violence.

Latina women who are pregnant and experiencing domestic violence face many barriers to accessing care and finding culturally appropriate services. These barriers are entwined in a complex web of social, cultural, economic, political, and legal issues. Leininger's cultural care model is presented as a framework to discuss culturally appropriate assessment of Latina women in various health care settings. Recommendations are made for the role of nurses in primary prevention interventions at the individual and community levels.

Acculturation↗
PubMed2001

Primary care providers' views of precepting nurse practitioner students.

PURPOSE: To explore perceived barriers to and facilitators of precepting as viewed by experienced community-based preceptors. DATA SOURCES: Twenty-four nurse practitioner and physician preceptors participated in a 20-minute telephone interview, using a semi-structured format. The interviews were audio-taped and transcribed. Constant comparative analysis was used to organize the preceptors' responses into thematic categories. CONCLUSIONS: Overall, most preceptors were satisfied with the precepting experience; however, many preceptors cited increasing difficulty with teaching students in primary care sites due various organizational constraints such as the imperative to increase productivity. Good communication with school of nursing faculty was cited as the key factor to continued willingness to precept. IMPLICATIONS FOR PRACTICE: Understanding factors that are important for preceptors continuing in their clinical teaching role is important for schools of nursing, especially given the increasing time-limitations that many providers face due to social and economic changes in health-care delivery.

Adult↗
PubMed2004

Acculturation and adherence: issues for health care providers working with clients of Mexican origin.

Providing care to clients who come from different countries is a challenge for the American health care providers as they traverse the issues of cultural health beliefs and practices and language and knowledge deficits. It is just as difficult for the clients as they face new cultural customs, language barriers, and unfamiliar health care systems and medical management plans. Both parties face acculturation and adherence challenges. This article intends to address these issues as they pertain to clients of Mexican origin and to identify key points to be considered by providers when working with this population.

Acculturation↗