Assessing the Adoption, Acceptability and Fidelity of the Alcohol Use Disorders Test for Alcohol Use Disorders screening in HIV Clinics in Malawi

BACKGROUND

Alcohol use disorders (AUD) are a common cause of poor treatment outcomes among people with HIV (PWH). In Malawi, routine screening for AUD among PWH is unavailable. We piloted the utility of the Alcohol Use Disorders Identification Test (AUDIT) in screening for AUD among PWH and assessed its adoption, acceptability and fidelity in HIV clinics in Malawi.

METHODS

We implemented the AUDIT tool at Mchinji, Kapiri and Kochirira hospitals in Mchinji District between April and May 2021. AUD were defined and classified based on WHO classification as low-risk, harmful/hazardous alcohol use or alcohol dependence. We calculated the prevalence of AUD, the proportion of providers who conducted AUD screening (adoption) and the proportion of providers who conducted AUD screening as intended (fidelity) and compared between clinics. Lastly, we assessed acceptability through a survey among providers.

RESULTS

Out of 2036 PWH, 875 (43%) were screened for AUD and 51% were female, mean age was 41 years (SD±12) and 338 (39%) had AUD. Adoption was highest at Mchinji (58%) compared to Kapiri (31%) and Kochiria (29%) (P<0.001). Overall Fidelity was 96%, and it was highest at Kapiri (99%) compared to Mchinji (95%) and Kochirira (98%) (P=0.01). AUD screening with AUDIT was highly acceptable as most providers agreed or completely agreed that the AUDIT was important (100%), easy to use (96%), satisfactory (96%), agreed to continue use (61%) and recommended it for other facilities in the district (100%).

CONCLUSION

AUD were common among PWH. While the adoption of AUDIT for AUD screening was moderate, acceptability and fidelity were high. The impact of AUD on HIV treatment outcomes needs to be assessed to determine the role of routine AUD screening in HIV clinics in Malawi.

Adoption of improved chickpea technologies for productivity enhancement in the North Western Ethiopian highlands

Efforts have been made on promoting improved chickpea technologies. However, the result is not that much impressive. This study aimed to analyze drivers of technology adoption. 224 respondents were used for this study. Multivariate Probit (MVP) and Seemingly Unrelated Regression (SUR) models were employed. The results from MVP model, marginal success probability of adoption decision were 60%, 19%, and 17% for a variety, bio-inoculant, and chemical fertilizer, respectively. Distance from farmers' training center, farm income, livestock holding, and field day participation have significantly affected for adoption of chickpea varieties. A social network, market information, and field day participation have significantly influenced the adoption of bio-inoculant fertilizer. In addition, household size, asset owned, and field day participation has significantly influenced the adoption of chemical fertilizer. Field day participation was the most important variable for the adoption decision of chickpea technologies as a package. The results from SUR model, farmers' training center distance, farm income, livestock holding, social network and agricultural training have significantly influenced adoption intensity of improved varieties. Age, farming experience, livestock holding, social network, education status, and field day and training participation have significantly influenced the intensity of bio-inoculant adoption. In addition, Age, education status, radio owned, training participation, asset owned and farmer's perception have significantly influenced the intensity of chemical fertilizer adoption. Training participation is the most determinant factor for adoption intensity of improved technologies. Hence, government should emphasize on improving of extension services, provision of education, encouraging livestock rearing, strengthening credit access for farmers, strengthening rural infrastructure, and considering community social network for adoption of chickpea technologies.

Enablers and barriers to adopt the locally developed Masi mechanical ventilator amid COVID-19 pandemic in Peru

Background

Limited supply of resources during the COVID-19 emergency encouraged the local development of the Masi mechanical ventilator (MV). Despite the efforts to promote Masi, adopting this innovation faced multiple obstacles, regardless of its performance. We explored the perceptions among healthcare personnel towards incorporating Masi to provide ventilatory support to COVID-19 patients during the second wave in Peru (January to June 2021).

Methods

We conducted twelve in-depth virtual interviews. Topics included experience when handling Masi, the impact of the training received, confidence in the device, barriers perceived, and enablers identified. All participants provided verbal informed consent.

Results

Most of the participants were male physicians. Participants belonged to seven hospitals that exhibited a wide range of healthcare capacities. Globally, the adoption of Masi MV was driven by the scarcity of ventilatory devices in the wards and reinforced by appropriate training and prompt technical support. Participants reported that Masi's structural and operational features played both advantages and disadvantages. Hospital infrastructure readiness, availability of commercial MVs, mistrust in its simple appearance, and resistance to change among healthcare personnel were perceived as barriers, while low-cost, prompt technical support and user-friendliness were valuable enablers. The first two enablers were observed in participants regardless of their attitude towards Masi. Despite the small number of participants for this qualitative study, it is important to note that the sample size was sufficient to reach saturation, as the topics discussed with participants became redundant and did not yield new information.

Conclusions

The perceptions among healthcare personnel to incorporate Masi as a mechanical ventilator for COVID-19 patients showed that communication, training and experience, and peer encouragement were essential to secure its use and sustainability of the technology. A priori judgments and perceptions unrelated to the performance of the novel device were observed, and its proper management may define its further implementation. Altogether our study suggests that along with strengthening local technological development, strategies to improve their adoption process must be considered as early as possible in medical innovations.

How to promote the adoption of intelligent spray technology in farmers' cooperatives? --Based on the perspective of evolutionary game

In order to accelerate the development of smart agriculture and realize the green transformation of agriculture, the coupling of prospect theory and evolutionary game theory is introduced. Construct a two-party evolutionary game model for the adoption of intelligent spray technology in farmers' cooperatives, analyze the evolution of farmers' cooperatives and government strategy selection and its influencing factors according to the replication dynamic equation, and conduct numerical simulation experiments through Matlab software. The results show that the adoption of intelligent spray technology by farmers' cooperatives and the government's choice of subsidies are the two optimal stable states of the evolutionary system. The government's subsidy policy can effectively stimulate farmers' cooperatives to adopt intelligent spray technology, but when the government subsidy coefficient is greater than or equal to 70%, the decision-making evolution of the government and farmers' cooperatives is unstable. The increase in farmers' awareness of pesticide hazards, the scale of operation of farmers' cooperatives, the price of high-quality agricultural products, and the sensitivity of farmers' cooperatives to profits and losses contribute to the promotion of intelligent spray technology, and the damage probability of intelligent spray technology has a restraining effect.

Adoption, Fostering, and Parental Absence in Vanuatu

Alloparenting, wherein people provide care to children who are not their biological offspring, is a key aspect of human child-rearing. In the Pacific, many children are adopted or fostered by custodial alloparents even when both biological parents are still alive. From a behavioral ecology perspective, such behaviors are puzzling: why parent someone else's child at your expense? Furthermore, little is known about how these arrangements are made in Pacific Islander societies today, who provides care, and what kinds of outcomes fostered children experience. A better understanding of these proximate factors may help reveal the ultimate drivers behind custodial alloparenting. Here, we report findings from a survey carried out with the caregivers of 282 children in rural areas of Vanuatu, an island nation in Melanesia. Most fostered and adopted children lived with relatives such as aunts, uncles, and grandparents (87.5%) rather than unrelated caregivers, with a strong preference for maternal kin. The most common reasons for these arrangements were that the parents had separated (16.7%), were engaging in labor migration (27.1%), or a combination of both (27.1%). Results for investment in children's education and their educational outcomes were mixed, although children removed from crisis situations did more poorly than children removed for aspirational reasons. Our findings suggest that custodial alloparenting helps families adapt to socioeconomic transitions and changing marriage practices. Outcomes may depend on a range of factors, such as the reason children were transferred out of the natal home to begin with.

Evaluating change in a pressured healthcare system: a cross-sectional study of implementation outcomes using routine data indicators and proxies

BACKGROUND

Implementation evaluation should focus on implementation success, guided by theories and frameworks. With high staff vacancies in the health services, it is important to consider pragmatic methods of data collection for implementation evaluation. This paper presents a cross-sectional rapid evaluation of a handheld medical device designed for remote examinations, piloted in Northern England. By using downloaded device data and administrative records mapped to domains from the implementation outcomes framework, this evaluation offers a pragmatic example of assessing implementation success.

METHODS

The pilot design was pragmatic: sites volunteered, decided which services to use the device in, and launched when ready. The pilot and evaluation together lasted 1 year. Data was downloaded from the devices, and administrative records for the pilot accessed. Variables were mapped to five of the implementation outcomes, after reviewing with the device manufacturer and pilot team to assess robustness.

RESULTS

N=352 care episodes were recorded using the device with 223 patients. Out of 19 sites 'signed up' to the pilot, 5 launched and delivered 10 of 35 proposed projects: a site and project adoption rate of 26 and 29%, respectively. Six sites signed up to an extension period; three had launched and three had not during the original timelines, indicating some sustainability. Feasibility was high, with only one in seven care episodes needing to be repeated due to poor device quality or error (sound/audio/internet). Fidelity of device usage was low for two of the eight available device examinations. Device and staffing costs were high but potential cost savings were attributable to fewer in-person appointments.

CONCLUSIONS

Through using device and administrative data, this evaluation minimised burden on busy healthcare staff yet was still guided by an evaluation framework. Five out of the eight implementation outcomes were measured, including sustainability and costs. The findings give insight into implementation challenges, particularly around adoption. For future research, it is recommended to engage with staff to prioritise outcome measurements and to focus on meaningful interpretation of indicators.

A comparison study between metropolitan and rural hospital-based telehealth activity to inform adoption and expansion

INTRODUCTION

In Queensland, Australia, the public hospital system has used telehealth for almost three decades. Although telehealth activity has been growing consistently, there are substantial variations across geographic regions. We explored factors which contribute to this variation in telehealth adoption.

METHODS

This was a multi-method comparative study of two matched metropolitan health services and two matched rural health services. The health services were matched according to the number of providers and hospitals but had different rates of telehealth use. Comparative rates of telehealth visits were analysed using descriptive statistics. Qualitative data was obtained from 63 semi-structured interviews with telehealth administrators, clinicians and senior managers involved in telehealth policies and procedures. Data were analysed using a framework analysis.

RESULTS

The metropolitan health service that had more telehealth use had greater investment in telehealth, higher population referral areas, highly developed communication strategies and understanding of the value proposition for telehealth, and reported fewer information technology and administration systems difficulties. In rural health services, telehealth activity was influenced by onboarding processes, clinician willingness to practice, strategic challenges and primary care activity.

DISCUSSION

Telehealth adoption can be influenced by funding, cross-organisational strategic policies and a multi-faceted approach to address clinician reluctance to use telehealth.

Adoption and intensity use of malt barley technology package by smallholder farmers in Ethiopia: A double hurdle model approach

Ethiopia has an enormous production potential for malted barley due to its ideal agroecology, notably in the central and Bale highlands. However, local production cannot meet the demand for both new and old malt and brewing plants. Millions of dollars have been invested to import malt at the national level. The objective of this study was to investigate the factors that influence smallholder farmers' adoption and level of use of the malt barley technology package. A multistage sampling procedure was employed to choose representative kebeles and households. The study relied on actual data collected from 201 randomly selected barley-producing households. Descriptive statistics and Double Hurdle economic models were used to analyze the data. The descriptive findings show that malt barley varieties and the malt barley technology package were adopted at rates of 0.3 and 0.9, respectively. The Double Hurdle model results reveal that factors such as the household head's age, the total area under cultivation, the availability of information on malt barley production, distance from the main road, participation in the field day program, and membership in the agricultural cooperative all had an effect on smallholder farmers' decisions to adopt and use the malt barley technology package. The recommendation made by this research was to boost farmers' knowledge of malt barley production through training and field trip programs. Organizing smallholder farmers in nearby agricultural cooperatives, as well as ensuring access to roads and public transit for easy access to agricultural inputs and output markets.

Implementing an evidence-based prize contingency management protocol for stimulant use

INTRODUCTION

Contingency management (CM) is an efficacious treatment for stimulant use disorders. Support materials for the clinical delivery of prize-based CM are widely accessible, but few resources are available to support design and preparation for CM implementation. This guide aims to fill that gap.

METHOD/RESULTS

The article outlines a suggested prize CM protocol and discusses the best practices most aligned with the evidence base and acceptable-if-necessary modifications. This guide also highlights modifications that are not evidence-based and not recommended. In addition, I discuss practical and clinical aspects of preparing for CM implementation.

CONCLUSIONS

Deviations from evidence-based practices are common, and poorly designed CM is unlikely to impact patient outcomes. This article provides planning stage guidance to support programs' adoption of evidence-based prize CM for the treatment of stimulant use disorders.

Adoption of improved management practices of livestock: Case of small-scale farmers in rural Bangladesh

This study examines the drivers of improved livestock management practices (ILMP) adoption in rural Bangladesh using data from the International Food Policy Research Institute's (IFPRI) Bangladesh Integrated Household Survey (BIHS). This study investigated four improved management practices: artificial insemination, concentrate feed, vaccination, and deworming. The binary logit and multivariate probit (MVP) models were used to analyse the data. According to the findings, approximately 65% of farmers practiced deworming, but only about 20% of farmers vaccinated their livestock. Logit regression analysis suggested that rural households with mobile phones and televisions were 5.2% and 3.8% more likely to adopt. Furthermore, compared to their peers, farmers who have maintained contact with livestock extension agents are 11% more likely to adopt. The MVP model indicated that likelihood of using concentrate feed increases with income, while artificial insemination is more prevalent among farmers who raise livestock for sale. Policy implication included the need for more extension agent-delivered awareness development programmes to educate livestock farmers on the benefits of ILMP. Scale-appropriate management practices can also play an important role. Farmers should be guaranteed of the availability of livestock feed and veterinary services at reasonable prices to promote adoption.

Ten years of implementation outcomes research: a scoping review

BACKGROUND

Proctor and colleagues' 2011 paper proposed a taxonomy of eight implementation outcomes and challenged the field to address a research agenda focused on conceptualization, measurement, and theory building. Ten years later, this paper maps the field's progress in implementation outcomes research. This scoping review describes how each implementation outcome has been studied, research designs and methods used, and the contexts and settings represented in the current literature. We also describe the role of implementation outcomes in relation to implementation strategies and other outcomes.

METHODS

Arksey and O'Malley's framework for conducting scoping reviews guided our methods. Using forward citation tracing, we identified all literature citing the 2011 paper. We conducted our search in the Web of Science (WOS) database and added citation alerts sent to the first author from the publisher for a 6-month period coinciding with the WOS citation search. This produced 1346 titles and abstracts. Initial abstract screening yielded 480 manuscripts, and full-text review yielded 400 manuscripts that met inclusion criteria (empirical assessment of at least one implementation outcome).

RESULTS

Slightly more than half (52.1%) of included manuscripts examined acceptability. Fidelity (39.3%), feasibility (38.6%), adoption (26.5%), and appropriateness (21.8%) were also commonly examined. Penetration (16.0%), sustainability (15.8%), and cost (7.8%) were less frequently examined. Thirty-two manuscripts examined implementation outcomes not included in the original taxonomy. Most studies took place in healthcare (45.8%) or behavioral health (22.5%) organizations. Two-thirds used observational designs. We found little evidence of progress in testing the relationships between implementation strategies and implementation outcomes, leaving us ill-prepared to know how to achieve implementation success. Moreover, few studies tested the impact of implementation outcomes on other important outcome types, such as service systems and improved individual or population health.

CONCLUSIONS

Our review presents a comprehensive snapshot of the research questions being addressed by existing implementation outcomes literature and reveals the need for rigorous, analytic research and tests of strategies for attaining implementation outcomes in the next 10 years of outcomes research.

Factors affecting the acceptance of tele-psychiatry: a scoping study

BACKGROUND

In today's digital world, providing services through telemedicine has become an essential issue in health systems, and the Covid-19 pandemic has made this necessity even more apparent. On the other hand, mental health services are needed more than ever, and their nature makes their delivery via telemedicine more feasible than other specialized services. This study aimed to determine the factors affecting the acceptance of telemedicine among users of this technology in the field of mental health.

METHODS

This article is a scoping review based on the PRISMA guidelines and without any time limit until June 20, 2022. The search was performed in PubMed, Scopus, Web of Science, and PsycINFO databases using keywords related to the three fields of telemedicine, acceptance, and mental disorders. Two authors independently selected the studies based on inclusion and exclusion criteria. Then the data were collected using a data extraction form, and finally, the results were determined using the content analysis method.

RESULTS

Five main factors affect the acceptance of telemedicine among users of this technology in the field of mental health: perceived effectiveness, users' understanding of the effects of telemedicine on the quality and outcomes of care delivery, technological aspects, organizational change capacity, the nature of the disease and psychological and psychosocial factors. These main factors are associated with 21 related sub-factors.

CONCLUSIONS

Revealing the factors affecting the acceptance of telemedicine among recipients and providers of services, as key actors in health systems, can help managers and policymakers to successfully implement telemedicine in the less-regarded field of mental health, especially in the early stages.

Adoption of soil and water conservation technologies and its effects on soil properties: Evidences from Southwest Ethiopia

In Ethiopia, national wide soil and water conservation (SWC) is going on since 2010/11in all agro-climatic zones and farming systems. Therefore, this study evaluated the effects of soil bund on soil physico-chemical properties and factors determining farmers' decision on the adoption of SWC technologies in a watershed located in the sub-humid climate of southwest Ethiopia. Two sub-watersheds, namely Nada and Gulufa in the Gilgel Gibe I catchment, were selected for this study. Thirty-six soil samples were collected from non-conserved croplands and croplands conserved with soil bunds (older than 4 years) at three slope positions, namely lower (5-10%), middle (10-15%), and upper (>15%). Both composite and undisturbed top soil (0-30 cm) samples were collected and soil physicochemical properties were determined following standard laboratory procedures. The generated soil physicochemical data was analyzed using one-way ANOVA and the mean separation was carried out by the Tukey test using R-version 3.5.2. To generate survey data, 267 households were randomly selected from the two sub-watersheds and interviewed using a structured questionnaire. The collected survey data was analyzed using a binary logit model using STATA software version 13. The result showed that the implemented soil bund significantly (p < 0.05) improved soil BD, SMC, pH, SOC, TN and CEC at the three slope positions for both the Nada and Gulufa sub-watersheds. The binary logit model showed that personal, socio-economic, institutional, and physical factors influencing the decision of a farmer's adoption. This revealed the need to consider personal, socio-economic, institutional, and physical factors to enhance the willingness probability of adoption. Besides, the improvements in soil properties as a result of conservation practices can help to create awareness.

Preferences and Experiences Regarding Pregnancy Options Counseling in Adolescence and Young Adulthood: A Qualitative Study

PURPOSE

Perspectives of adolescents and young adults (AYAs) experiencing pregnancy options counseling (POC) are absent from the literature. This study explores AYA experiences and preferences related to POC to inform best practice guidelines.

METHODS

We conducted semistructured phone interviews in 2020-2021 among US-based individuals, 18-35 years old, who experienced a pregnancy less than 20 years of age. We performed qualitative descriptive analysis of positive and negative attributes of AYA's experiences with POC.

RESULTS

Fifty participants reported 59 pregnancies (16 parenting, 19 abortions, 18 adoptions, three miscarriages) between the ages of 13 and 19 years. Positive attributes of POC experienced included: (1) provider communication that was compassionate, respectful, supportive, and attentive to nonverbal cues; (2) provider neutrality; (3) discussion of all pregnancy options; (4) asking about feelings, choice, life plans, and additional supports; (5) provision of informational materials; and (6) warm handoffs/follow-up facilitation. Negative attributes of POC experienced included: (1) judgmental, impersonal, or absent communication; (2) lack of counseling on all options and/or coercive/directive counseling; (3) insufficient time and supportive resources; and (4) confidentiality concerns. We identified no differences in these perspectives across pregnancy outcomes reported. Participants generally desired counseling about all options, with rare exceptions of ambivalence.

DISCUSSION

Individuals who experienced an adolescent pregnancy described similar positive and negative attributes of POC regardless of preferred pregnancy outcome. Their perspectives highlight how crucial interpersonal communication skills are for effective POC for AYA. POC training across health care specialties should emphasize confidential, compassionate, and nonjudgmental care for AYA patients.

A mixed methods study assessing the adoption potential of a saliva-based malaria rapid test in the Democratic Republic of Congo

BACKGROUND

The reliance on blood for thin and thick blood smear microscopy-using a relatively invasive procedure has presented challenges to the use of reliable diagnostic tests in non-clinical settings at the point-of-need (PON). To improve the capacity of non-blood-based rapid diagnostic tests to confirm subclinical infections, and thereby identify and quantify the human reservoir at the PON, a cross-sectoral collaboration between university researchers and commercial partners produced an innovative, non-invasive saliva-based RDT capable of identifying novel, non-hrp2/3 parasite biomarkers. While this new saliva-based malaria asymptomatic and asexual rapid test (SMAART-1) shows increased detection sensitivity and precision potential by identifying a new P. falciparum protein marker (PSSP17), appraising its utility in the field-particularly with respect to its adoption potential with children and adults in high risk, endemic regions-is necessary to warrant its continued development.

METHODS

The purpose of this study was to assess the acceptability and adoption potential of the SMAART-1 at select PON sites in the Kinshasa Province. Teachers, community health workers, nurses, and laboratory technicians participated in data collection at three distinct community sites in Kinshasa Province, Democratic Republic of the Congo. Three data collection methods were utilized in this mixed methods study to provide an overarching acceptability evaluation of the SMAART-1 at PON field sites: observation checklists of SMAART-1 implementation, focus group discussions, and surveys with local health care practitioners-particularly teachers and community health workers.

RESULTS

Findings indicate participants were interested in and supportive of the SMAART-1 protocol, with approximately 99% of the participants surveyed indicating that they either "agreed" or "strongly agreed" with the statement that they "would use the saliva-based malaria asymptomatic rapid test as part of a community malaria detection and treatment programme." Data also suggest that the protocol was broadly appealing for its testing sensitivity and ease of use.

CONCLUSIONS

The SMAART-1 protocol's clinically reliable results demonstrate a promising new level of sensitivity and precision for detecting parasite biomarkers. This study's mixed-methods assessment of the protocol's utility and adoption potential in the field, with a target user audience, advances its development and points to opportunities to formalize and expand evaluation efforts.

Adoption and sustainability of bitcoin and the blockchain technology in Nigeria

The rise of cryptocurrency, especially bitcoin, has opened up a lot of doors in the world of Financial Technology (FinTech) by attracting investors, media, and financial industry regulators. Bitcoin operates on blockchain technology, and its value is not a determinant of the value of a tangible asset, an organisation, or a country's economy. Instead, it relies on an encryption technique that allows tracking of all transactions. Globally, over $2 trillion has been generated through cryptocurrency trading. Due to these financial prospects, the youths in Nigeria have cashed in on this virtual currency to create employment and wealth. This research investigates the adoption and sustainability of bitcoin and blockchain in Nigeria. A survey method with a non-probability purposive sampling technique and a homogeneous approach was employed to collect 320 responses via an online survey. Descriptive and correlational analysis in IBM SPSS version 25 was used to analyse the collected data. According to the findings, bitcoin is the most popular cryptocurrency, with 97.5% acceptance, and is expected to be the leading virtual currency in the next five years. The research findings will help researchers and authorities comprehend the need for cryptocurrency adoption, leading to its sustainability.

Educators' perspectives of adopting virtual patient online learning tools to teach clinical reasoning in medical schools: a qualitative study

BACKGROUND

Learning tools using virtual patients can be used to teach clinical reasoning (CR) skills and overcome limitations of using face-to-face methods. However, the adoption of new tools is often challenging. The aim of this study was to explore UK medical educators' perspectives of what influences the adoption of virtual patient learning tools to teach CR.

METHODS

A qualitative research study using semi-structured telephone interviews with medical educators in the UK with control over teaching materials of CR was conducted. The Consolidated Framework for Implementation Research (CFIR), commonly used in healthcare services implementation research was adapted to inform the analysis. Thematic analysis was used to analyse the data.

RESULTS

Thirteen medical educators participated in the study. Three themes were identified from the data that influenced adoption: the wider context (outer setting); perceptions about the innovation; and the medical school (inner context). Participants' recognition of situations as opportunities or barriers related to their prior experiences of implementing online learning tools. For example, participants with experience of teaching using online tools viewed limited face-to-face placements as opportunities to introduce innovations using virtual patients. Beliefs that virtual patients may not mirror real-life consultations and perceptions of a lack of evidence for them could be barriers to adoption. Adoption was also influenced by the implementation climate of the setting, including positioning of CR in curricula; relationships between faculty, particularly where faculty were dispersed.

CONCLUSIONS

By adapting an implementation framework for health services, we were able to identify features of educators, teaching processes and medical schools that may determine the adoption of teaching innovations using virtual patients. These include access to face-to-face teaching opportunities, positioning of clinical reasoning in the curriculum, relationship between educators and institutions and decision-making processes. Framing virtual patient learning tools as additional rather than as a replacement for face-to-face teaching could reduce resistance. Our adapted framework from healthcare implementation science may be useful in future studies of implementation in medical education.

Positive attitudes toward adoption of a multi-component intervention strategy aimed at improving HIV outcomes among adolescents and young people in Nampula, Mozambique: perspectives of HIV care providers

BACKGROUND

Service providers' attitudes toward interventions are essential for adopting and implementing novel interventions into healthcare settings, but evidence of evaluations in the HIV context is still limited. This study is part of the CombinADO cluster randomized trial (ClinicalTrials.gov NCT04930367), which is investigating the effectiveness of a multi-component intervention package (CombinADO strategy) aimed at improving HIV outcomes among adolescents and young adults living with HIV (AYAHIV) in Mozambique. In this paper we present findings on key stakeholder attitudes toward adopting study interventions into local health services.

METHODS

Between September and December 2021, we conducted a cross-sectional survey with a purposive sample of 59 key stakeholders providing and overseeing HIV care among AYAHIV in 12 health facilities participating in the CombinADO trial, who completed a 9-item scale on attitudes towards adopting the trial intervention packages in health facilities. Data were collected in the pre-implementation phase of the study and included individual stakeholder and facility-level characteristics. We used generalized linear regression to examine the associations of stakeholder attitude scores with stakeholder and facility-level characteristics.

RESULTS

Overall, service-providing stakeholders within this setting reported positive attitudes regarding adopting intervention packages across study clinic sites; the overall mean total attitude score was 35.0 ([SD] = 2.59, Range = [30-41]). The study package assessed (control or intervention condition) and the number of healthcare workers delivering ART care in participating clinics were the only significant explanatory variables to predict higher attitude scores among stakeholders (β = 1.57, 95% CI = 0.34-2.80, p = 0.01 and β = 1.57, 95% CI = 0.06-3.08, p = 0.04 respectively).

CONCLUSIONS

This study found positive attitudes toward adopting the multi-component CombinADO study interventions among HIV care providers for AYAHIV in Nampula, Mozambique. Our findings suggest that adequate training and human resource availability may be important in promoting the adoption of novel multi-component interventions in healthcare services by influencing healthcare provider attitudes.

Adoption of IWGDF guidance on prevention and management of foot problems in diabetes for local use in Iran by ADAPTE methodology: a step toward best practice

Purpose

Adoption of international working group on the diabetic foot (IWGDF) guidance on prevention and management of foot problems in patients with diabetes was the study aim.

Methods

The ADAPTE process consisted of three main phases of set-up, adoption, and finalization with overall 24 steps was used. In set- up phase, organizing committee by a multidisciplinary approach was established. In adoption phase, comprehensive search in databases and guideline resources was done. According to the inclusion criteria, the 2015IWGDF guidance was selected for adoption process. Quality, currency, content and consistency of the guidance were assessed. Also, consensus on different level of agreement for each recommendation were reported. On finalization phase, the adopted version was reviewed by the guidance developer and the final guidance for local use in Iran was disseminated.

Results

The 2015 IWGDF guidance with 77 recommendations was adopted after screening of 1760 documents retrieved from Jan. 2006 to Nov. 2016. An organizing committee was established according to a multidisciplinary approach including 73 members with endocrinology, orthopedic & vascular surgery, dermatology, infectious diseases, physical medicine and rehabilitation specialties, general practitioners and nurses. This guidance obtained a good quality in all six domains of AGREE II instrument (Score ≥ 80%), good currency, content, and consistency. Also, during the third round of Delphi, the consensus on the agreement level of each recommendation were greater than 80% and 77 recommendations of the original guidance were kept in the adopted version.

Conclusion

The 2015 IWGDF guidance with 77 recommendations adopted for local use in different health care settings of Iran.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01121-0.

Examining the key determinants of the jordanian customer's adoption of genetically modified food

Genetically modified food (GMF) is one of the most debated issues in the food market. There has been considerable interest from both academic researchers and policy makers regarding the antecedents and consequences of the commercial adoption of GMF applications. Conceptually, GMF can be defined as "Genetically modified (hereafter GM) foods are produced from genetically modified seeds or ingredients derived from plants or animals whose DNA has been manipulated using genetic engineering methods" [1, p. 2861]. However, only a limited number of studies have tested the related issues of GMF products from a customer perspective. Thus, this project intends to discover and examine the main drivers and hindrances in predicting customers' intention and buying decision behaviour in developing Arabian countries (i.e., Jordan). A diffusion of innovations (DOIs) model was selected as the theoretical basis for the current study project. A field survey study was conducted to collect the requested quantitative data from a convenience sample of Jordanian customers. Statistical results largely supported the role of relative advantage, compatibility, trialability, social approval, awareness, perceived risk and price value on the behavioural intention to adopt GMF products, which in turn significantly predicted actual adoption behaviour. The results of the current project will hopefully expand the current academic understanding of the main factors that predict Jordanian customers' perception and adoption of GMF products.

Understanding the factors affecting AI services adoption in hospitality: The role of behavioral reasons and emotional intelligence

This study explores the reasons (for and against) the adoption of AI in the hospitality industry among Pakistani customers. The hypothesis was tested using the sample obtained from Pakistani hospitality customers. The data is collected via an online survey and analyzed with the structural equation modeling and PROCESS macro. The study results indicate that cultural values positively associate reasons for, attitudes, and intentions to adopt. Moreover, the results prove that attitude mediates the relationship between reasons (for and against) and intention to adopt AI services in hospitality. Furthermore, the finding shows that customer emotional intelligence has no moderation effect on attitude and intention to adopt AI services. This study highlights technological complexity and safety concerns are the most significant barriers in the studied context. Further, addressing reason against (technological complexity and safety concerns) may allow policymakers to lessen the present customer attitude-intention gap by tackling the factors that cause customers to resist adopting AI services in hospitality. In this respect, marketers should develop a marketing campaign strategy focusing on the benefits of the adoption of AI services in comparison to employee service. This is the first empirical study examining cultural values, reasons (for and against) attitudes, their relationship with intentions, and moderating role of an attractive, important, yet ignored variable, customer emotional intelligence. This study confirms that the behavioral reasoning theory can better describe the customers' adoption behavior of AI services in the hospitality sector.

Examining the Acceptance of Blockchain by Real Estate Buyers and Sellers

Buying and selling real estate is time consuming and labor intensive, requires many intermediaries, and incurs high fees. Blockchain technology provides the real estate industry with a reliable means of tracking transactions and increases trust between the parties involved. Despite the benefits of blockchain, its adoption in the real estate industry is still in its infancy. Therefore, we investigate the factors that influence the acceptance of blockchain technology by buyers and sellers of real estate. A research model was designed based on the combined strengths of the unified theory of technology acceptance and use model and the technology readiness index model. Data were collected from 301 real estate buyers and sellers and analyzed using the partial least squares method. The study found that real estate stakeholders should focus on psychological factors rather than technological factors when adopting blockchain. This study adds to the existing body of knowledge and provides valuable insights to real estate stakeholders on how to implement blockchain technology.

Adoption of emergency department crowding interventions among US hospitals between 2007 and 2020

BACKGROUND

To deal with emergency department (ED) crowding, the American College of Emergency Physicians (ACEP) established a task force to develop a list of low-cost, high-impact solutions. In this study, we report on the trend in the adoption rate of ACEP-recommended ED crowding interventions by US hospitals.

METHODS

We analyzed the National Hospital Ambulatory Medical Care Survey data from 2007 to 2020 (N = 3874 hospitals). The primary outcome was whether a hospital adopted each of the ACEP-recommended interventions, which were grouped into three overlapping categories: technology-based, flow modifications, and physical-based (e.g., changing ED layout).

RESULTS

On average, the most frequently adopted intervention was bedside registration (85.1%) and the least frequently adopted intervention was kiosk check-in (8.3%). The adoption of ED crowding interventions increased significantly between 2007 and 2020, except for expanding ED treatment space which declined by 45.0% from 30.3% in 2007 to 15.7% in 2020. The largest adoption rate increase occurred in having a separate operating room for ED cases with a 188.5% increase in adoption rate followed by radio-frequency identification (RFID) tracking (151.2%), and kiosk check-in (144.2%).

CONCLUSIONS

The adoption rate of ED crowding interventions by hospitals has risen, however most effective ED crowding interventions are still underutilized. The trends for each intervention did not always increase linearly, with certain periods showing greater fluctuations in adoption rate. Hospitals tend to implement technology-based interventions, compared to physical-based interventions and flow modification interventions.

Event history analysis on racial disparities in the path to adoption for Black and White children

BACKGROUND

Black children are significantly overrepresented in many phases of the U.S. child welfare system.

OBJECTIVE

The purpose of this study is to investigate racial disproportionality and disparities in the adoption process and factors that predict the length of time to adoption.

PARTICIPANTS AND SETTING

This study utilized administrative data from the 2014 year of the Adoption and Foster Care Analysis and Reporting System (AFCARS) collected in 50 States, the District of Columbia, and Puerto Rico.

METHODS

The disproportionality metric (DM) and disparity index (DI) were constructed for Black and White children, and event history analyses were conducted to calculate the probability of adoption while considering the time to adoption finalization.

RESULTS

DM indicated that Black children (0.81) were underrepresented in adoption, and DI indicated that the likelihood of adoption for Black children (0.73) was one third lower than that for White children. The event history analyses revealed that White children were 1.27 times more likely to be adopted than Black children. White children had considerably fewer days from termination of parental rights to adoption finalization with a median time of 273.5 days compared to 328 days for Black children. Factors that extended adoption time included child intellectual, physical, and emotional/behavioral disabilities, visual and hearing impairments, parental alcohol abuse and disability, and child maltreatment histories, while parental drug abuse and longer stays in out-of-home care shortened the adoption process. We also found a significant interaction effect of race and neglect on adoption. Neglected Black children had a longer time to adoption than neglected White children.

CONCLUSIONS

More dedicated outreach programs and resources must be developed to ensure the effectiveness of adoption services and cultural continuity for Black children.

The adoption of conservation practices in the Corn Belt: the role of one formal farmer network, Practical Farmers of Iowa

Substantial evidence has shown that involvement in peer-to-peer farming networks influences whether a farmer decides to try a new practice. Formally organized farmer networks are emerging as a unique entity that blend the benefits of decentralized exchange of farmer knowledge within the structure of an organization providing a variety of sources of information and forms of engagement. We define formal farmer networks as farmer networks with a distinct membership and organizational structure, leadership that includes farmers, and an emphasis on peer-to-peer learning. This study complements existing ethnographic research on the benefits of organized farmer networking by examining farmers in one longstanding formal farmer network, Practical Farmers of Iowa. Using a nested, mixed-method research design, we analyzed survey and interview data to understand how participation and forms of engagement in the network are associated with the adoption of conservation practices. Responses from 677 farmers from a regular member survey disseminated by Practical Farmers of Iowa in 2013, 2017, and 2020 were pooled and analyzed. GLM binomial and ordered logistic regression results indicate that greater participation in the network, particularly through in-person formats, has a strong and significant association with greater adoption of conservation practices. Logistic regression results show that building relationships in the network is the most important variable for predicting whether a farmer reported adopting conservation practices as a result of participation in PFI. In-depth interviews with 26 surveyed member farmers revealed that PFI supports farmers to adopt by providing information, resources, encouragement, confidence building, and reinforcement. In-person learning formats were more important to farmers relative to independent formats because they were able to have side conversations with other farmers, ask questions, and observe results. We conclude that formal networks are a promising way to expand the use of conservation practices, particularly through targeted efforts to increase relationship building in the network through face-to-face learning opportunities.