Results of a multi-site pragmatic hybrid type 3 cluster randomized trial comparing level of facilitation while implementing an intervention in community-dwelling disabled and older adults in a Medicaid waiver

Background

Evidence-based interventions that optimize physical function for disabled and older adults living in the community who have difficulty with daily living tasks are available. However, uptake has been limited, particularly in resource-constrained (Medicaid) settings. Facilitation may be an effective implementation strategy. This study’s aim was to compare internal facilitation (IF) versus IF and external facilitation (EF) on adoption and sustainability of an intervention in a Medicaid home and community-based waiver.

Methods

In a hybrid type 3 trial, waiver sites (N = 18) were randomly assigned to implement the intervention using a bundle of strategies with either IF or IF and EF. Adoption and sustainability were assessed via Stages of Implementation Completion (SIC) for each site. Clinician attitudes toward evidence-based practice and self-efficacy were evaluated among 539 registered nurses, social workers, and occupational therapists. Medicaid beneficiary outcomes of activities of daily living, depression, pain, falls, emergency department visits, and hospitalizations were evaluated in a sample of N = 7030 as reflected by electronic health records data of the Medicaid waiver program. Linear mixed-effects models were used to compare outcomes between trial arms while accounting for cluster-randomized design.

Results

The mean SIC scores were 72.22 (standard deviation [SD] = 16.98) in the IF arm (9 sites) and 61.33 (SD = 19.29) in the IF + EF arm (9 sites). The difference was not statistically significant but corresponded to the medium clinically important effect size Cohen’s d = 0.60. Clinician implementation outcomes of attitudes and self-efficacy did not differ by trial arm. Beneficiary depression was reduced significantly in the IF + EF arm compared to the IF arm (p = .04, 95% confidence interval for the difference [0.01, 0.24]). No differences between trial arms were found for other beneficiary outcomes.

Conclusions

Level of facilitation did not enhance capacity for adoption and sustainability of an evidence-based intervention in a Medicaid setting that cares for disabled and older adults. Improved beneficiary depression favored use of IF and EF compared to IF alone, and no differences were found for other outcomes. These findings also suggest level of facilitation may not have impacted beneficiary outcomes.

Trial registration

ClinicalTrials.gov, NCT03634033; date registered August 16, 2018.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-022-01232-5.

Artificial intelligence applications for sustainable solid waste management practices in Australia: A systematic review

Solid waste generation and its impact on human health and the environment have long been a matter of concern for governments across the world. In recent years, there has been increasing emphasis on resource recovery (reusing, recycling and extracting energy from waste) using more advanced approaches such as artificial intelligence (AI) in Australia. AI is a powerful technology that is increasingly gaining popularity and application in various fields. The adoption of AI techniques offers alternative innovative approaches to solid waste management (SWM). Although there are previous studies on AI technologies and SWM, no study has assessed the adoption of AI applications in solving the diverse SWM problems for achieving sustainable waste management in Australia. Moreover, there are inconsistencies and a lack of awareness on how AI technologies function in relation to their application to SWM. This study examines the application of AI technologies in various areas of SWM (generation, sorting, collection, vehicle routing, treatment, disposal and waste management planning) to enhance sustainable waste management practices in Australia. To achieve the aims of this study, prior studies from 2005 to 2021 from various databases are collected and analyzed. The study focuses on the adoption of AI applications on SWM, compares the performance of AI applications, explores the benefits and challenges, and provides best practice recommendations on how resource efficiency can be optimized to improve economic, environmental and social outcomes. This study found that AI-based models have better prediction abilities when compared to other models used in forecasting solid waste generation and recycling. Findings show that waste generation in Australia has been steadily increasing and requires upgraded and improved recovery infrastructure and the appropriate adoption of AI technologies to enhance sustainable SWM. Australia's adoption of AI recycling technologies would benefit from a national approach that seeks consistency across jurisdictions, while catering for regional differences. This study will benefit researchers, governments, policy-makers, municipalities and other waste management organizations to increase current recycling rates, eliminate the need for manual labor, reduce costs, maximize efficiency, and transform the way we approach the management of solid waste.

An ecological approach to understanding Women's reproductive health and pregnancy decision making in Greenland

Using a community based participatory research framework and ecological systems theory we explored the experiences of reproductive health among Inuit women living in a remote Northwestern settlement in Greenland to understand the multiple diverse factors that influence their pregnancy outcomes. We conducted 15 in depth interviews with Inuit women between the ages of 19 and 45. Key factors influencing women's pregnancy decision making were: 1) precursors to pregnancy; 2) birth control use; 3) adoption and abortion; and 4) access to reproductive health care. Our results highlight the need to identify pathways through research, policy, health promotion, and health care practice that can support Inuit women in Greenland to be reproductively healthy and make informed decisions about pregnancy that resonate with their cultural beliefs as well as the realities of their everyday lives. We recommend the integration of cultural messaging into interdisciplinary approaches for preventive reproductive health care with women living in remote Arctic communities.

The Ethical Standards of Sunni Muslim Physicians Regarding Fertility Technologies that are Religiously Forbidden

This research project is pioneering in that it is the first to provide empirical data regarding the ethical standards of Sunni Muslim physicians toward religiously prohibited reproductive technologies, a topic which is considered taboo in Muslim society. A total of 689 Sunni Muslim physicians rated their acceptance of 14 fertility treatments. They expressed objections to assisted reproductive technologies entailing gender selection, egg, sperm and embryo donation, and surrogacy. The findings show that the Sunni Muslim medical establishment avoids fertility options that are considered in violation of Islamic law, and Sunni Muslim physicians tend to obey religious law.

Exploring the relationship between adoption and psychological trauma for children who are adopted from care: A longitudinal case study perspective

Children who have been adopted from care are very likely to have experienced early adversity that may result in psychological trauma. A current debate in the field is whether adoption provides a pathway to healing for traumatised children, helping them to recover from past psychological harm, or creates trauma for children through the very nature of being an adopted child.

OBJECTIVE

This study aimed to use longitudinal data pertaining to children who had been adopted from care to examine the relationship between being adopted from care and psychological trauma.

PARTICIPANTS AND SETTING

Seventeen adopted children had been interviewed in their adoptive homes during the third wave of the Care Pathways and Outcomes study (McSherry et al., 2013), when they were aged between nine and 14 years old. Ten of these children were selected for specific consideration in this article. Checklists for early adversities and psychological trauma were used to support the creation of case studies that highlighted the extent of psychological trauma in the children's lives.

RESULTS

The adopted children either experienced possible pre-care psychological trauma, with the impact of this reducing over time, in utero developmental harm due to their mother's alcohol misuse during pregnancy, inherited an intellectual disability, with the resultant difficulties superseding any concern regarding possible pre-care psychological trauma, or possible psychological trauma when moving from an established foster placement to adoption. Recommendations for policy and practice are provided.

"Forever family is like a manufactured Hallmark idea": Adoption discontinuity experiences of intercountry adoptees

BACKGROUND

Media stories over the past decade have sensationalized cases of intercountry adoption discontinuity, a phenomenon largely missing from the research literature.

OBJECTIVE

This study sought to understand how intercountry adoptees with adoption discontinuity histories experience legal, relational, and residential permanency losses through the framework of ambiguous loss and trauma.

PARTICIPANTS AND SETTING

Twenty intercountry adoptees in the United States who experienced adoption discontinuity as minor children.

METHODS

Participants were recruited through social media sites and professional and informal organizations serving intercountry adoptees.

RESULTS

Participants described multiple experiences with legal, residential, and relational permanency losses often in multiple combinations, multiple times, and in multiple settings. Participants also experienced racial, ethnic and cultural identity losses in addition to their permanency ruptures.

CONCLUSION

More research on the lived experiences of intercountry adoptees with adoption discontinuity histories is needed. Adoptees experience trauma in their pre-adoptive histories as well as in the adoption process itself and need adoptive parents skilled in trauma-informed parenting. In addition, there is a need for robust trauma-informed support for adoptees throughout their lifetime.

What about trauma? Accounting for trauma exposure and symptoms in the risk of suicide among adolescents who have been adopted

BACKGROUND

Research suggests that individuals who have been adopted are at increased risk for suicidal behaviors, but this research does not account for the role of trauma.

OBJECTIVES

The study provided rates of trauma exposure among individuals who were adopted with child welfare involvement. The study also examined risk of suicidal ideation (SI) and behaviors (SB) based on adoption status, first as bivariate associations and then in context of trauma exposure and symptoms.

PARTICIPANTS AND SETTING

Participants in the LONGSCAN study were recruited at multiple US sites based on various risk factors for maltreatment. The current study included only those individuals with adequate information at key timepoints (n = 894), 106 (11.9%) of whom were adopted.

METHODS

Measures were collected at multiple timepoints, including caregiver-report, self-report, and review of child welfare records. Data were analyzed through logistic regression and descriptive statistics.

RESULTS

High rates of potentially traumatic experiences were found among individuals who were adopted (over 93%). The bivariate logistic regression replicated previous findings that adolescents who were adopted had increased likelihood of endorsing SI (OR 2.14, 95% CI 1.27-3.60, p = .004) and SB (OR 2.40, 95% CI 1.24-4.63, p = .009) compared to non-adopted peers. However, when polytrauma and traumatic stress symptoms were added to the model, adoption was no longer a significant predictor for SI (OR 1.35, 95% CI 0.70-2.60, p = .369) or SB (OR 1.46, 95% CI 0.68-3.13, p = .332).

CONCLUSIONS

Although much remains to be explored about the association between adoption and risk for suicidal thoughts and behaviors, the current study indicates that traumatic stress plays a critical role.

Adoption and trauma: Risks, recovery, and the lived experience of adoption

BACKGROUND

Although a very heterogeneous group, adopted persons may present developmental and mental health problems of varying severity. Pre-placement adversity and trauma have often been linked to these problems. It has been also suggested that adoption itself is a psychological trauma, predisposing the individual to emotional difficulties.

OBJECTIVES

This article examines the links between early adversity, trauma, and adoption. We begin by defining trauma and then describe the way in which pre-placement adversity can undermine neurobehavioral and interpersonal functioning, increasing the risk for long-term psychological difficulties. Next, we examine children's recovery when placed in a stable adoptive home. Finally, we explore adoption as a lived experience, highlighting contextual and developmental factors that facilitate the person's positive or negative attributions about being adopted, leading to varying patterns of emotional adjustment.

CONCLUSIONS

Although pre-placement adversity increases adopted individuals' risk for maladjustment, the human brain and behavior are malleable, and placement in a nurturing adoptive home often facilitates recovery from early adversity, with significant heterogeneity in the extent of recovery within and across domains of functioning. While there is no evidence that early adoption is a trauma for the individual, ongoing negative life circumstances, attachment difficulties, and developmentally-mediated attributions about adoption can undermine the person's self-esteem, identity, relationships, and sense of well-being. Conclusions and suggestions for future research are offered.

Emotional-behavioral problems, attachment and verbal skills in late-adopted adolescents: The role of pre-adoption adversities and adoption variables

BACKGROUND

There are few studies on late-adopted adolescents' outcomes -e.g., emotional-behavioral problems, attachment and cognitive status- and their possible predictive factors, none from Italy.

OBJECTIVE

This paper aimed to investigate emotional-behavioral problems, attachment representations, and verbal skills in late-adopted adolescents in Italy and to explore the predictive role of pre-adoption adversities and adoption variables for worse adoptees' outcomes.

PARTICIPANTS AND SETTING

The study included N = 79 late-adopted (mean age at adoption = 6 years) adolescents, between 11 and 18 years, placed via both intercountry and domestic adoption.

METHODS

Parents provided information about pre-adoption and adoption history and filled the Children's Behavior Checklist 6-18 for measuring participants' emotional-behavioral problems. Attachment representations were assessed through the Friend and Family Interview administered directly to adolescents, like the verbal comprehension index of the Wechsler Intelligence Scale for Children (4th edition) for measuring participants' verbal IQ.

RESULTS

Maltreatment and its interaction with multiple placements were the main predictors of other problems-i.e., social, thought, and identity difficulties (respectively, p = .007 and p = .029)-while intercountry adoption was the unique predictor of both externalizing and total problems (respectively, p = .047 and p = .015). However, domestic adoption was the most important predictor both for higher insecurity and disorganized attachment representations and lower verbal skills (all p < .044); even stronger if domestic adoption interacted with pre-adoptive institutionalization.

CONCLUSIONS

Pre-adoption adversities as well as domestic vs. intercountry adoption, but not the age at placement, contributed to adolescent adoptees' developmental outcomes.

Long-term effects of pre-adoptive risk on emotional and behavioral functioning in children adopted from foster care

BACKGROUND

Children adopted from foster care are at heightened risk for emotional and behavioral challenges, potentially due to early trauma exposure and related risk factors. Research has demonstrated that adoptees with greater pre-adoptive risk exhibit higher rates of internalizing and externalizing problems across childhood and into adulthood. However, these studies have been limited by their use of individual risk factors or sum scores of cumulative risk and their measurement of internalizing and externalizing behaviors separately.

OBJECTIVE

The current study aimed to examine effects of pre-adoptive risk on long-term functioning in children adopted from foster care.

METHOD

In a longitudinally-followed sample of 82 adoptees, we utilized latent growth curve modeling to examine effects of two latent indices of pre-adoptive risk, postnatal (i.e., trauma-related) risk and prenatal risk (not including prenatal substance exposure, since it was nearly ubiquitous in this sample), on adoptee internalizing, externalizing, and latent scores of dysregulation across childhood. Additionally, in three separate models, we tested whether baseline levels and change across childhood in internalizing, externalizing, and dysregulation mediated effects of prenatal and postnatal risk on adolescent/young-adult functioning.

RESULTS

Greater postnatal risk, but not prenatal risk, predicted higher levels of internalizing and dysregulation across childhood. However, only dysregulation mediated the effect of postnatal risk on adolescent/young-adult functioning.

CONCLUSIONS

These results are consistent with prior research evidencing long-term effects of postnatal pre-adoptive risk, but not prenatal risk, in adoptees. Furthermore, they suggest that trauma exposure in this population may result in a profile of broad dysregulation that increases risk for maladjustment into adulthood.

Patterns of adversity and post-traumatic stress among children adopted from care

BACKGROUND

Children adopted from care are more likely to have experienced early adversity, but little is known about the impact of early adversity on later post-traumatic stress (PTS) symptoms.

OBJECTIVE

To investigate sub-groups of adversity in a sample of adopted children and examine the association with later PTS symptoms.

PARTICIPANTS AND SETTING

A study of British children adopted from care using social worker records (N = 374) and questionnaire-based longitudinal study of n = 58 children over 4-years post adoptive placement.

METHODS

We used latent class analysis to identify subgroups of children based on commonalities in perinatal and postnatal adversity experienced prior to adoption and examined differences in PTS symptoms at 4-years post-placement between subgroups.

RESULTS

Nearly one in five (19 %) children were in the clinical or borderline ranges for symptoms of PTS arousal, 14 % for PTS avoidance and 8 % for PTS intrusion. The 5-class solution fitted the data best, with one class characterized by children with a low probability of experiencing any adversity, one perinatal adversity class and three classes capturing different patterns of adversity. The multiple complex adversity class involving both perinatal and postnatal adversity had significantly higher symptoms of PTS avoidance and arousal than other sub-groups.

CONCLUSIONS

The prevalence and complexity of PTS symptoms among adoptive children highlights the need for effective interventions considering different profiles of early adversity.

The trauma and healing of consciousness

BACKGROUND

Throughout my graduate coursework, several classes focused on trauma. Considering my experiences, I searched to gain insight into group level trauma adoptees face due to our unique status and common societal factors that influence adoption. Exploring the trauma literature, I found that none of the terms quite represented the complex characteristics of adoption.

OBJECTIVE

Realizing the limitations of current trauma definitions, I sought to name group trauma for adoptees and thereby legitimize and validate my and other adoptees' experiences.

PARTICIPANTS AND SETTING

I am the sole participant. The research was conducted in St. Louis, Missouri.

METHODS

In this autoethnography, I recount academic experiences that have shaped my emerging and interconnected identities as an adoptee and social worker. I analyze the traumatic and empowering impacts of gaining more information about adoption as a politically and economically influenced system.

RESULTS

Examining my intertwined adoption and academic journeys, I propose a trauma and healing of consciousness framework to understand trauma for groups of individuals like adoptees whose trauma is not recognized using historical, collective, or intergenerational models.

CONCLUSIONS

The term trauma of consciousness expands existing theories of trauma while including social groups for whom group trauma was not previously recognized. Understanding the trauma of consciousness is imperative because healing cannot begin until the existence of the trauma is recognized. Further exploration on the trauma of consciousness is needed to recognize its impact and to develop creative interventions that can provide hope and enable people to move forward.

Rediscovering latent trauma: An adopted adult's perspective

Though studies showing a causal relationship between adoption and trauma are scarce, there is enough cross-disciplinary research to suggest such a connection. Likewise, there are many adult adopted persons, like myself, who see their adoption narratives as traumatic in one way or another. Mental health outcomes for adopted people also indicate adoption might be a source of and not just a preventative measure against trauma. In this paper, I utilize an autoethnographic approach to highlight the relationship between infant adoption and what I refer to as "latent traumatic memories." Recounting several major life events that led to traumatic upheavals in my understanding of my own identity as an adopted person, I then relate my story to current research on trauma experienced very early in life and how it is remembered implicitly in the body. My account, I argue, highlights the need to further research adopted people's evolving views about their adoption and how and to what extent certain events in adulthood precipitate the rediscovery of latent trauma.

Changes in Attachment Disorder symptoms in children internationally adopted and in residential care

BACKGROUND

A high incidence of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) has been reported for children with experiences of trauma and other forms of adversity.

OBJECTIVE

The present study aims to explore symptoms of RAD and DSED in children in two protection alternatives (international adoption and residential care) after experiences of early adversity.

PARTICIPANTS AND SETTING

The participants were 146 children: 40 children adopted into Spanish families from Russia, 49 children in residential care in Spanish institutions (40.8% in long-term foster centers) and 57 community comparison children.

METHODS

The Relationship Problems Questionnaire was used to explore both RAD and DSED. All adoptive parents and institutional caregivers retrospectively reported the problems at time of placement (Wave 0), as well as the symptoms observed at the time of the study, with children aged 4-8 years old (Wave 1). At this stage, the assessment of the community comparison group was added.

RESULTS

Adopted and children in residential care presented high levels of RAD and DSED symptoms at placement. For adoptees, previous experiences of abuse and neglect were marginally associated with the initial presence of RAD symptoms and a significant recovery was observed after an average of three years in their families, with a certain level of longitudinal continuity between initial and later assessments. In children currently placed in long-term residential centers in Spain, DSED symptoms worsened from W0 to W1.

CONCLUSIONS

Adoption appears to be an effective intervention that promotes recovery of RAD and DSED symptomatology after early adversity, whereas institutionalization causes negative effects.

Educational Technology Adoption in Instructional Delivery in the New Global reality

Educational technology is a discipline that has a lot of roles to play in the global education system yet, its services had been neglected over the years in Nigeria. The new global reality that was occasioned by the upsurge of COVID-19 has made educational technology a very consequential discipline with conspicuous roles to play in the face of such a global pandemic. COVID-19 has halted many human activities across the globe. Its effect in the education system has resulted to re-adjustment in the school calendar, prolonged graduation dates, and reduced research output. To combat this, many education systems now adopt the services of educational technology thereby changing the old norm. But for this new norm to be sustainable, this paper argues that the education system must show a pragmatic attitude towards the adoption of such innovation rather than a conservative attitude. Therefore, using the diffusion theory of innovation, this paper argues that necessity called for compulsory adoption of innovation in the Nigerian education system. This new opportunity, however, looks bleak as many educational practitioners lack the required skills and attitude to adopt the innovation. It, therefore, concludes that educational practitioners need in-service training to be part of these changes. The government is suggested to apply a systematic approach in procuring and installing ICT facilities that will enhance the diffusion of this innovation into the school system.

Managing innovation: a qualitative study on the implementation of telehealth services in rural emergency departments

BACKGROUND

Telehealth studies have highlighted the positive benefits of having the service in rural areas. However, there is evidence of limited adoption and utilization. Our objective was to evaluate this gap by exploring U.S. healthcare systems' experience in implementing telehealth services in rural hospital emergency departments (TeleED) and by analyzing factors influencing its implementation and sustainability.

METHODS

We conducted semi-structured interviews with 18 key informants from six U.S. healthcare systems (hub sites) that provided TeleED services to 65 rural emergency departments (spoke sites). All used synchronous high-definition video to provide the service. We applied an inductive qualitative analysis approach to identify relevant quotes and themes related to TeleED service uptake facilitators and barriers.

RESULTS

We identified three stages of implementation: 1) the start-up stage; 2) the utilization stage; and 3) the sustainment stage. At each stage, we identified emerging factors that can facilitate or impede the process. We categorized these factors into eight domains: 1) strategies; 2) capability; 3) relationships; 4) financials; 5) protocols; 6) environment; 7) service characteristics; and 8) accountability.

CONCLUSIONS

The implementation of healthcare innovation can be influenced by multiple factors. Our study contributes to the field by highlighting key factors and domains that play roles in specific stages of telehealth operation in rural hospitals. By appreciating and responding to these domains, healthcare systems may achieve more predictable and favorable implementation outcomes. Moreover, we recommend strategies to motivate the diffusion of promising innovations such as telehealth.

Implementation fidelity, attitudes, and influence: a novel approach to classifying implementer behavior

Background

The current study sought to (1) describe a new classification approach for types of implementer behavior and (2) explore the implementer behavior change in response to tailored implementation facilitation based on the classifications.

Methods

A small-scale, cluster-randomized hybrid type III implementation trial was conducted in 38 early care and education classrooms that were part of the Together, We Inspire Smart Eating (WISE) program. WISE focuses on 4 evidence-based practices (EBPs), which are implemented by teachers to promote nutrition. External facilitators (N = 3) used a modified Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) to complete immersion (i.e., observations) and thematic content analyses of interviews to identify the characteristics of teachers’ behavior at varying levels of implementation fidelity. Three key factors—attitudes toward the innovation, fidelity/adaptations, and influence—were identified that the research team used to classify teachers’ implementation behavior. This process resulted in a novel classification approach. To assess the reliability of applying the classification approach, we assessed the percent agreement between the facilitators. Based on the teachers’ classification, the research team developed a tailored facilitation response. To explore behavior change related to the tailored facilitation, change in fidelity and classification across the school year were evaluated.

Results

The classifications include (1) enthusiastic adopters (positive attitude, meeting fidelity targets, active influence), (2) over-adapting adopters (positive attitude, not meeting fidelity targets, active influence), (3) passive non-adopters (negative attitude, not meeting fidelity targets, passive influence), and (4) active non-adopters (negative attitudes, not meeting fidelity targets, active influence). The average percent agreement among the three facilitators for classification was 75%. Qualitative data support distinct patterns of perceptions across the classifications. A positive shift in classification was observed for 67% of cases between the mid-point and final classification. Finally, we generated an expanded classification approach to consider additional combinations of the three factors beyond those observed in this study.

Conclusions

Data from this study support the ability to apply the classification approach with moderate to high reliability and to use the approach to tailor facilitation toward improved implementation. Findings suggest the potential of our approach for wider application and potential to improve tailoring of implementation strategies such as facilitation.

Relational uncertainty: Does parental perception of adopted children's academic success change over time?

While initial findings suggested that children who are adopted (adoptees) perform less well academically, this result is not consistent across the literature. To explain these, often conflicting, results, researchers acquired a lagging view, in which adoptees need to "catch up" to their non-adopted peers. According to the lagging view, those adopted at a younger age have less catching up to do than those adopted when they are older. However, the lagging view does not account for the period in which adoptees and their new families adjust to one another. A period that we refer to as relational uncertainty. This is particularly relevant as data on adoptees' academic performance is largely based on parent reports. The overarching goal of this study was to determine if parental perception of adoptees' academic achievement changed over time, after accounting for the impact of age of adoption. Using a nationally representative dataset, we found that after accounting for age of adoption the length of time that children resided in their adoptive homes predicted parental perception of academic performance. Specifically, after accounting for age of adoption, parental perception of adoptees' academic performance demonstrated early consistency followed by a significant decline. We also investigated if the relation, of those factors previously associated with parental perception of adoptees' academic performance, remained after variance was accounted for by both age of adoption and children's length of stay in their adoptive homes. Several previous factors (where the child lived pre-adoption and the socioeconomic status of their adoptive household) and child characteristics (sex and the first language the child learned to speak) demonstrated a continued association. Results indicate the need for a paradigm shift in how we view parent reports of adoptees' academic achievement, as well as the frequently reported factors surrounding adoptees' academic performance. The implications for how to support adoptees' academic achievement are discussed.

Global electric vehicle adoption: implementation and policy implications for India

Present transport system of conventional vehicle in India has faced challenges due to enormous amount of air pollution, health hazards to human, rising oil price, insufficient indigenous fossil fuel reserve, heavy expenditure on oil import, energy insecurity, etc. Electrical vehicle (EV) is considered to be alternatives of conventional vehicles that can overcome these shortcomings. The aim of the study is to get an overview of the electric vehicle policies of government of India and its state governments to find out their relevance and impact on EV adoption in India. Exploratory research is used in present case to carry out the study. Currently, the EV industry in India is in preliminary condition and in growing stage. Government of India has framed policies such as "NEMMP 2020," "FAME-I," "FAME-II," and Vehicle Scrappage policy. Seventeen of its state governments have framed EV policy. These policies facilitated various types of incentives, infrastructure development, fund allocation, research and development, production, and sales. This will have strong impact on EV demand generation, conversion of conventional vehicles to e-vehicle resulting E-mobility transformation and EV hub in the region that is at par with other EV-developed countries in the world. However, lack of policy and technology availability in the domain of disposal and reprocessing of Li-ion battery is found to be a future limitation of EV prospect in Indian context which needs to be looked into.

Implementation outcomes of a health systems strengthening intervention for perinatal women with common mental disorders and experiences of domestic violence in South Africa: Pilot feasibility and acceptability study

BACKGROUND

South Africa has a high burden of perinatal common mental disorders (CMD), such as depression and anxiety, as well as high levels of poverty, food insecurity and domestic violence, which increases the risk of CMD. Yet public healthcare does not include routine detection and treatment for these disorders. This pilot study aims to evaluate the implementation outcomes of a health systems strengthening (HSS) intervention for improving the quality of care of perinatal women with CMD and experiences of domestic violence, attending public healthcare facilities in Cape Town.

METHODS

Three antenatal care facilities were purposively selected for delivery of a HSS programme consisting of four components: (1) health promotion and awareness raising talks delivered by lay healthcare workers; (2) detection of CMD and domestic violence by nurses as part of routine care; (3) referral of women with CMD and domestic violence; and (4) delivery of structured counselling by lay healthcare workers in patients' homes. Participants included healthcare workers tasked with delivery of the HSS components, and perinatal women attending the healthcare facilities for routine antenatal care. This mixed methods study used qualitative interviews with healthcare workers and pregnant women, a patient survey, observation of health promotion and awareness raising talks, and a review of several documents, to evaluate the acceptability, appropriateness, feasibility, adoption, fidelity of delivery, and fidelity of receipt of the HSS components. Thematic analysis was used to analyse the qualitative interviews, while the quantitative findings for adoption and fidelity of receipt were reported using numbers and proportions.

RESULTS

Healthcare workers found the delivery and content of the HSS components to be both acceptable and appropriate, while the feasibility, adoption and fidelity of delivery was poor. We demonstrated that the health promotion and awareness raising component improved women's attitudes towards seeking help for mental health conditions. The detection, referral and treatment components were found to improve fidelity of receipt, evidenced by an increase in the proportion of women undergoing routine detection and referral, and decreased feelings of distress in women who received counselling. However, using a task-sharing approach did not prove to be feasible, as adding additional responsibilities to already overburdened healthcare workers roles resulted in poor fidelity of delivery and adoption of all the HSS components.

CONCLUSIONS

The acceptability, appropriateness and fidelity of receipt of the HSS programme components, and poor feasibility, fidelity of delivery and adoption suggest the need to appoint dedicated, lay healthcare workers to deliver key programme components, at healthcare facilities, on the same day.

Parenthood among individuals with Turner syndrome: results of an online survey of attitudes towards pregnancy, adoption, and surrogacy

Choosing a route to parenthood can be a difficult decision for individuals with Turner syndrome, who must consider the unlikely possibility of spontaneous pregnancy, the potential need for assisted reproductive technology such as in vitro fertilization (IVF), and the risks of pregnancy-related complications. In addition, there are other options for parenthood, such as surrogacy and adoption. The perspectives of individuals with Turner syndrome regarding routes to parenthood have not been described in the literature, despite thorough investigation into the feasibility and safety of pregnancy in this population. We conducted a novel online survey of 226 individuals with Turner syndrome to assess their interest in parenthood, their perspectives on available routes to parenthood, and the factors that influence their decision-making. One-quarter of the respondents were already parents, including 54.5% who had achieved pregnancy and 45.5% who adopted. Of those who were not parents, 68.5% expressed a desire to become a parent. Overall, participants had the strongest interest in adoption as a route to parenthood. Interest in adoption was significantly associated with fear of pregnancy-related risks to their health and the health of a future child. Participants also reported interest in pregnancy and IVF. Interest in both pregnancy and IVF were significantly associated with a desire to experience pregnancy and to have a biological child. This study provides important insights into the perspective of individuals with Turner syndrome with respect to building a family and serves as a valuable counseling resource for clinicians facilitating patient decision-making about options for parenthood.

Adoption openness and adoption stigma: a retrospective study of adult adoptees

This study explored adult adoptees' experiences and challenges concerning their adoption and the extent to which adoption issues were openly discussed within the adoptive family. Listening to the perspective of adoptees is important as their experiences, and expectations can influence their well-being and the success of their placement. Fourteen adult adoptees participated in this study. Qualitative data were gathered using semi-structured interviews. Interviews took place between June 2020 and November 2020. The analysis of transcripts was conducted according to the interpretative phenomenological analysis (IPA) guidelines. Three themes related to the aims of the current research emerged from the data: (a) adoption secrecy, (b) adoptees' expectations for communication openness, and (c) adoption stigma. This study provides valuable insight into adoption communication openness, recognition of adoption stigma, and adoption microaggressions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s43545-022-00339-2.

Barriers and facilitators of personal health record adoption in Indonesia: Health facilities' perspectives

BACKGROUND

Personal health record (PHR) has been extensively used in developed countries; however, it has been limitedly adopted in developing countries. This study was conducted in Indonesia: a developing country with the largest population in Southeast Asia. PHR that is integrated with health providers is needed to achieve a transformation from a health provider-centered to a patient-centered healthcare system.

OBJECTIVE

To qualitatively analyze barriers and facilitators of PHR adoption by health facilities in Indonesia from the technological, organizational, environmental, and individual factors.

METHODS

In this qualitative study, we used semi-structured interviews with three health facility directors, 17 IT heads, eight physicians, and three nurses from 10 primary healthcare facilities, nine government hospitals, and six private hospitals in Indonesia. Interview data were analyzed using thematic analysis in NVivo 12. The analysis stages involved familiarizing data, generating initial codes, searching themes, evaluating themes, defining and naming themes, and writing reports.

RESULTS

Regarding technological factors, the barriers to PHR adoption include security and privacy, interoperability, and infrastructure. Organizational support can facilitate PHR adoption in terms of organizational factors, while a lack of human resources is a barrier to PHR adoption. Regarding environmental factors, the lack of government regulations is the barrier to PHR adoption, while competition between health facilities and vendor support could facilitate PHR adoption. Finally, regarding individual factors, perceived usefulness and ease of use can be facilitators of PHR adoption, while user attitudes and e-health literacy can be barriers to PHR adoption.

CONCLUSIONS

This study is expected to comprehensively understand PHR adoption in Indonesia and could be applied to other developing countries with similar technological, legal, or cultural characteristics as Indonesia. This study also provides information that can guide health regulators, health facilities, or PHR vendors in planning the implementation of integrated PHR.

Integrating Attachment Processes with Lifespan Integration Therapy: a Hermeneutic Single Case Efficacy Design with an Adopted Child

PURPOSE

Adopted children are at heightened risk for developing attachment insecurity due to relational disruptions experienced early in life. A newly developed therapy, Lifespan Integration (LI; Pace in Lifespan Integration: Connecting ego states through time (5th ed.), 2012), shows promise in reducing psychopathology and other detrimental outcomes with individuals exhibiting disrupted attachment. In this study, the efficacy of LI for addressing attachment processes with adopted children in middle childhood was investigated.

METHODS

A Hermeneutic Single Case Efficacy Design (Elliott in Psychotherapy Research, 12(1), 1-21, 2002 & The handbook of humanistic psychology: Theory, research and practice (2nd ed., pp. 351-360), 2015) was used to gather quantitative and qualitative data from an adoptive parent-child dyad experiencing LI therapy for the first time. The research participant, a 12-year-old male, received 10 sessions of LI therapy with his adoptive mother present to facilitate a more secure attachment.

RESULTS

Client change and the contribution of LI to this change was advocated by expert case developers, and adjudicated by three experts, who concluded that change occurred and that this change was due to LI therapy. Changes in internal attachment processes, and the attachment bond between the parent and child of this dyad, was observed.

CONCLUSIONS

This case provides evidence that attachment disruptions can potentially be repaired in middle childhood and ought to be targeted for intervention in early childhood and beyond to prevent later socio-emotional and psychological issues.

Experiences of Mothers Who Relinquished Their Child for Adoption in Pakistan: A Qualitative Study

The literature suggests long-term consequences and lack of support for birthmothers following relinquishment of their child for adoption (Memarnia in Listening to the experience of birth mothers whose children have been taken into care or adopted, 2014). But there was not any work done to study in-depth experiences of birthmothers after giving away their child in Pakistan. So, the purpose of the present study was to explore the experiences of mothers who relinquished their child for adoption. As the present study was intended to explore lived experiences of a particular group, the phenomenological research design was used to conduct this qualitative study. An interview protocol was devised to explore the experiences of birthmothers. The sample was comprised of five birthmothers who relinquished their child for adoption and fulfilled the criteria. Semi-structured interviews were conducted with the birthmothers, and all the interviews were audio-recorded and transcribed before analysis. Interpretive Phenomenological Analysis (IPA) was used to interpret the transcripts of interviews. Further, data verification was done through peer scrutiny, by debriefing sessions with the supervisor, and enriches the description of the phenomenon. Four main themes were emerged: Reasons to Relinquish, Psychological Distress, Coping Strategies, and Disenfranchised Grief. The study present that the experience of relinquishment has a negative impact on birthmother and highlights the need for proper measures to regulate the process of adoption and involvement of psychologists during the process of adoption. Moreover, it stresses the need for acknowledgment of the experience and psychological services for birthmothers who relinquish their child.