Factors impacting the adoption of big data in healthcare: A systematic literature review

BACKGROUND

The term "big data" refers to the vast volume, variety, and velocity of data generated from various sources-e.g., sensors, social media, and online platforms. Big data adoption within healthcare poses an intriguing possibility for improving patients' health, increasing operational efficiency, and enabling data-driven decision-making. Despite considerable interest in the adoption of big data in healthcare, empirical research assessing the factors impacting the adoption process is lacking. Therefore, this review aimed to investigate the literature using a systematic approach to explore the factors that affect big data adoption in healthcare.

METHODS

A systematic literature review was conducted. The methodical and thorough process of discovering, assessing, and synthesizing relevant studies provided a full review of the available data. Several databases were used for the information search. Most of the articles retrieved from the search came from popular medical research databases, such as Scopus, Taylor & Francis, ScienceDirect, Emerald Insights, PubMed, Springer, IEEE, MDPI, Google Scholar, ProQuest Central, ProQuest Public Health Database, and MEDLINE.

RESULTS AND CONCLUSION

The results of the systematic literature review indicated that several theoretical frameworks (including the technology acceptance model; the technology, organization, and environment framework; the interactive communication technology adoption model; diffusion of innovation theory; dynamic capabilities theory; and the absorptive capability framework) can be used to analyze and understand technology acceptance in healthcare. It is vital to consider the safety of electronic health records during the use of big data. Furthermore, several elements were found to determine technological acceptance, including environmental, technological, organizational, political, and regulatory factors.

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria

BACKGROUND

School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents.

METHODS

The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes.

RESULTS

The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level.

CONCLUSIONS

The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Good agricultural practices (GAP) adoption intensity and production constraints in apple orchards of western Nepal

The declaration of 'Fruits Decade 2016/17-2026/27' and the enaction of the 'NepalGAP Scheme' by the Government of Nepal has redirected increased public investments to promote apple production and marketability in the western high hills of Nepal. This study explores major good agricultural practices (GAP) related to orchard management, factors influencing their adoption intensity, and key underlying constraints to production using cross-sectional survey data from apple growers in Dolpa district, Nepal. The results showed that farmers mostly adopted GAP such as frequent weeding, intercropping, and nutrient management in apple orchards. Based on the negative binomial regression estimates, household characteristics such as gender of the orchard owner, experience, and number of literate household members were found influential in determining the GAP adoption intensity. The analysis of the problem severity index implied that apple production is mostly constrained by limited access to production inputs and transportation. The findings provide useful insights to the farmers and policymakers regarding the current scenario of GAP adoption along with the diversity of barriers that severely limits the realization of apple production potential in western Nepal.

Adoption of ICT4D and its determinants: A systematic review and meta-analysis

Various Digital Agricultural Technologies (DAT) have been developed and implemented around the world. This study aims to estimate the overall adoption rate and identify the determinant factors for a better adoption perspective after decades of innovation and dissemination. A systematic review was conducted on published studies that reported adoption rates and determinant factors using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. We used meta-regression and the partial correlation coefficient to estimate the effect size and establish the correlation between socioeconomic characteristics and the adoption of various technologies reported. Fifty-two studies with 32400 participants met the selection criteria and were included in the study. The results revealed an overall pooled adoption rate of 39 %, with the highest adoption rates in developing countries in Africa and South America. Socioeconomic factors such as age, education, gender, and income were found to be the main determinants and should be considered when designing technology for sustainable adoption. The study also found that young farmers were more susceptible to adoption. Moreover, farmers with higher income levels and educational attainment are more likely to use technology linked to agricultural production, market access, and digital advising, implying that high-income farmers with more education are more tech-savvy. However, this does not exclude low-income and low-educated farmers from adopting the technologies, as many models and strategies with socioeconomic considerations were developed. It is one of the reasons behind the underlying enthusiasm for digital agricultural adoption in low and middle-income countries.

Farmer's climate smart livestock production adoption and determinant factors in Hidebu Abote District, Central Ethiopia

This study aimed to identify the status, determining factors, and challenges in adopting climate smart livestock production practices by farmers. Three-staged sampling techniques were used to select the research sites and 233 sample farmer household respondents. Data were collected mainly using a pre-tested structured questionnaire. Key informant interviews and focus group discussions were also conducted to complement the household survey data. Descriptive statistics and an ordered logistic regression model were applied to analyze the quantitative data. The result revealed that the most adopted practices were composting (85.41%) and manure management (70.39%) while the least adopted technologies were biogas generation (3.86%) and rotation grazing (22.32%). The adoption status of the sampled farmers was also categorized into low (19.74%), medium (67.81%), and high adopter (12.45%). The high cost of improved breed, use of manure for fuel, free grazing, lack of information and awareness were the major constraints to adopting the climate smart livestock production technologies. The result also revealed that education, grazing land, total livestock holding, and extension agent contact contributed significantly and positively to the adoption of smart livestock production technology, while the distance from the water source had an insignificant and negative effect on the adoption status of climate smart livestock production practices. The study suggests the relevance of the cooperation of stakeholders and strengthening extension services for the maximum benefits of climate smart livestock production.

English as a foreign language students' acceptance of Google Classroom in writing classes: A case study in Vietnam

Google Classroom is a virtual education platform created by Google that allows both instructors and learners to actively participate in educational environments inside and outside of the classroom in an innovative way. This research aims to determine how university students perceived the adoption of Google Classroom in writing classes. This research was a convergent parallel mix-methods approach in which data were gathered through a 5-point Likert scale questionnaire and semi-structured interviews. The participants of this study included 130 university students in Vietnam. The results revealed that students expressed their approval of using Google Classroom in writing classes and that they had a positive view since it benefited them greatly in their learning writing process. This study suggests practical implications for language educators to use Google Classroom in writing classes.

Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey

BACKGROUND

The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment.

OBJECTIVE

This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers.

METHODS

A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence.

RESULTS

Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect.

CONCLUSIONS

These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health.

TRIAL REGISTRATION

RR2-10.2196/41040.

Assessing soil erosion and farmers' decision of reducing erosion for sustainable soil and water conservation in Burji woreda, southern Ethiopia

Inadequate conservation practice affects the sustainable production of agricultural watersheds due to erosion and fertility decline. Understanding soil erosion and implementing site-specific conservation practice could enhance agriculture-based rural development. The study was aimed to document soil erosion problem and soil and water conservation effort. The specific objectives of this study were to assess soil erosion severity, practices to reduce erosion, and determinants of the decision to reduce erosion. Data were collected by interviewing 198 farm household heads, undertaking four focus group discussions, and assessing rill erosion in 10 farm fields in Morayo and Wacho sub-watersheds of southern Ethiopia. Descriptive statistics and binary logit model were applied to analyze the data. Results indicated that many of the farm households, 63% in Morayo and 83% in the Wacho sub-watershed, perceived moderate to severe soil erosion, which is characterized by big rills and small gullies on the farmlands. Rill densities of 231.4 m ha-1 and 84.1 m ha-1 in the Morayo and Wacho sub-watersheds were observed, respectively. The estimated annual soil loss due to rills was 61.2 and 23.4 Mg ha-1 in the Morayo and Wacho sub-watersheds, respectively. The soil erosion from rills alone exceeds the expected tolerable soil erosion (11 tons ha-1 year-1). Due to erosion, about 90% of farmers perceived farmland degradation as described by a progressive decline in crop yield. Farmers used to practice traditional techniques to reduce erosion and government introduced conservation measures such as soil and stone bunds. However, many farmers did not use well-promoted conservation measures such as bunds, which could have negative impact on long-term erosion control effort and sustainable implementation of the conservation options. Among the assessed explanatory variables, educational level, farm distance from home, slope of the cultivated land, and frequency of extension contact were significantly affected (p < 0.05) farmers' sustainable use of conservation measures. Development planners and policy makers are advised to consider site-specific and innovative approaches to implement conservation measures in sustainable approach in the smallholder crop-livestock mixed agriculture system.

Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations: findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden

BACKGROUND

Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups.

METHODS

We conducted a 4 year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau's Compatibility Gaps to understand assimilation.

RESULTS

The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change.

CONCLUSIONS

In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures.

The 'peptide for life' initiative in the emergency department study

AIMS

Natriuretic peptide (NP) uptake varies in Emergency Departments (EDs) across Europe. The 'Peptide for Life' (P4L) initiative, led by Heart Failure Association, aims to enhance NP utilization for early diagnosis of heart failure (HF). We tested the hypothesis that implementing an educational campaign in Western Balkan countries would significantly increase NP adoption rates in the ED.

METHODS AND RESULTS

This registry examined NP adoption before and after implementing the P4L-ED study across 10 centres in five countries: Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia, and Serbia. A train-the-trainer programme was implemented to enhance awareness of NP testing in the ED, and centres without access received point-of-care instruments. Differences in NP testing between the pre-P4L-ED and post-P4L-ED phases were evaluated. A total of 2519 patients were enrolled in the study: 1224 (48.6%) in the pre-P4L-ED phase and 1295 (51.4%) in the post-P4L-ED phase. NP testing was performed in the ED on 684 patients (55.9%) during the pre-P4L-ED phase and on 1039 patients (80.3%) during the post-P4L-ED phase, indicating a significant absolute difference of 24.4% (95% CI: 20.8% to 27.9%, P < 0.001). The use of both NPs and echocardiography significantly increased from 37.7% in the pre-P4L-ED phase to 61.3% in the post-P4L-ED phase. There was an increased prescription of diuretics and SGLT2 inhibitors during the post-P4L-ED phase.

CONCLUSIONS

By increasing awareness and providing resources, the utilization of NPs increased in the ED, leading to improved diagnostic accuracy and enhanced patient care.

Demographics and tenure of the Chilean urban dog population. A mathematical model

BACKGROUND

Irresponsible dog ownership in urban areas is a public health concern with significant implications for human, animal, and environmental welfare. Factors such as abandonment, variations in adoption, insufficient supervision, emerging identification initiatives, and collective feeding impact the growth of stray dog populations and the transmission of diseases. Developing a modeling tool to understand the dynamics of canine population growth and the effect of human behavior on this phenomenon is essential.

METHODS

An ordinary differential equation model was developed to depict the growth dynamics and movements of urban dog populations, distinguishing between those with owners (restricted and semi-restricted) and those without (stray and community dogs). Two equilibrium states of the system were analyzed: with and without the presence of individually owned dogs. An increase rate for the population of individually owned dogs was calculated, and a local sensitivity analysis was conducted to assess the impact of parameters on the reduction of this population. Additionally, two global sensitivity analysis methods were used to evaluate the simultaneous influence of the parameters.

RESULTS

Findings indicate that system equilibrium depends on various dog categories. Although total eradication of stray and community dogs is unlikely, equilibrium levels are directly related to subpopulation growth rates, responsible ownership practices, and adoption and abandonment rates. The growth rates of the population of dogs without individual owners have a direct and proportional influence on their regulation, while adoption rates have an inverse and proportional effect. The study, through global sensitivity analysis, identifies key parameters for each dog subpopulation. For restricted dogs, environmental carrying capacity is the most variable factor; for semi-restricted dogs, awareness of responsible ownership is crucial. The abandonment of restricted dogs significantly impacts stray dog dynamics, while the transition from stray to community status is an important variable factor for community dogs.

CONCLUSION

Addressing the situation of unowned dogs requires a collective effort to reduce risks associated with the spread of zoonotic diseases, environmental pollution, and biodiversity loss, thus contributing to public health and environmental conservation.

A Mixed Methods Examination of Decision-Making During Program Exploration and Implementation in Schools

Schools are a critical setting to promote healthy youth development through the provision of evidence-based programs (EBPs), yet preventive EBPs in schools are underutilized. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework highlights numerous factors that may influence program adoption during the Exploration phase and progress monitoring during the Implementation phase. However, no research has systematically and simultaneously identified the factors that influence school administrators' decision-making during these important processes. We conducted semi-structured interviews with 24 school administrators in the Midwestern region of the U.S. to understand how they weigh various considerations that inform their adoption and progress monitoring of prevention programs. Results indicated that school administrators consider five separate factors during the adoption decision, prioritized in the following order: need for the program, school community buy-in, contextual fit, resources, and program characteristics (including the evidence-base). Further, administrators consider five indicators to monitor program performance, prioritized as follows: intervention fidelity, quantitative and qualitative data that determine if the identified need was met, school community buy-in, resource consumption, and program characteristics. Implications for prevention scientists and suggestions for future research are discussed.

Determinants of mobile health (M-Health) application adoption, usage and discontinuity among corporate workers diagnosed with hypertension and diabetes

PURPOSE

This study examined the determinants of mobile health (M-Health) application, adoption, usage and discontinuation among corporate workers diagnosed with hypertension and diabetes in Ghana.

DESIGN/METHODOLOGY/APPROACH

The diffusion innovation and reasoned action theories were employed using an exploratory design. Three hundred corporate workers diagnosed with diabetes and hypertension from three health facilities for the past six months were sampled for the study using a multi-stage sampling technique and administered questionnaires. Descriptive statistics and logistic regression tools were employed in the analysis of data.

FINDINGS

The study found a significant number of factors influencing m-health applications adoption, usage and discontinuity. These factors include nature and demand of job, perceived advantage, compatibility, complexity, triability, aesthetics and trust. Aesthetics emerged as the strongest predictive factor for the adoption, usage and discontinuity of use among diabetic and hypertensive corporate workers. With the adoption of M-Health applications, compatibility, as well as nature and demand of job, were significant predictors. With the usage of M-Health applications, complexity, triability, aesthetics and trust were significant predictors. Moreover, perceived advantage, compatibility, complexity and triability influenced significantly the choice to discontinue using M-Health applications. The study concluded that M-Health application functionalities play a valuable role in patients' intention to adopt, use and discontinue the use of an M-Health application in Ghana.

ORIGINALITY/VALUE

This exploratory study offers in-depth insight into how major M-Health application features affect its adoption, usage and discontinuity, providing crucial information for future research and the improvement of chronic condition healthcare delivery.

Enabling food system innovation: accelerators for change

It is widely accepted that current food systems are not on a trajectory for achieving the Sustainable Development Goals by the end of the decade. Technological innovation will have a considerable role to play in different parts of the food system; many promising options exist or are in the pipeline, some of which may be highly disruptive to existing value chains. Scaling up the innovations required, at the same time as protecting those who may lose out in the short term, will require a strong enabling environment. Here we apply an existing framework of eight change accelerators to six case studies of historical agricultural innovation. We estimated the degree to which each accelerator had been addressed at some stage in the innovation process, as a measure of the gap between what was needed and what was achieved. For the innovations that are being taken to scale and widely utilized, these accelerator gaps are small. Uptake of other innovations is stalled, and for these we found large gaps for one or more of the eight accelerators. Impactful innovation processes address all eight change accelerators at some point, with different phasing of the accelerators depending on the nature of the technology and on the impact pathway being pursued. This simple framework, when used in combination with narratives of uptake based on theories of change and impact pathways, may provide an effective means of screening future innovation processes to help prioritize and guide investment that can lead to more resilient, sustainable and equitable food systems.

Implementation Requires Evaluation of Adoption: Lessons From a Multimodal Pain Regimen Order Set

INTRODUCTION

Multimodal pain regimen (MMPR) protocols are the standard of care per the 2020 Trauma Quality Improvement Program guidelines. MMPR implementation methodology in trauma services has not been reported. The primary objective of this study was to evaluate the adoption of an MMPR order set at a level 1 trauma center and to describe its implementation. We hypothesized that order set utilization would be about 50%, and barriers to adoption would be related to personal biases.

METHODS

This was a mixed-methods study at a level 1 trauma center. We retrospectively evaluated MMPR utilization from July 1, 2021 to February 28, 2022. Agile implementation was the method used to implement a clinical decision support tool for the MMPR: a flow chart order set in the electronic medical record. This methodology utilizes short experiment sprints during which data are collected to guide the next iterations. During this process quantitative as well as qualitative data were collected. This included end user testing of the order set and a survey distributed to surgical residents about the order set. Manual thematic network analysis was employed to identify basic and organizing themes from the survey responses.

RESULTS

A total of 587 trauma patients were admitted during the study period and 95 patients (16.2%) had MMPR ordered through the order set. The survey response rate was 19% (13/68). We identified ease of use, desire for options, inadequate education, and assumption of personal expertise as the four basic themes from the survey. These basic themes were further analyzed to two organizing themes: heuristics and overconfidence bias.

CONCLUSIONS

The MMPR order set was easy to use but had low adoption at our center in the first 8 months of implementation. Agile implementation methodology provided an ideal framework to identify reasons for low adoption and guide the next sprint to address personal biases, improve heuristics, and provide effective education and dissemination. Evaluation of utilization and qualitative analysis are key components to ensuring clinical decision support tool adoption.

Adoption of additive manufacturing in oral and maxillofacial surgery among university and non-university hospitals in Sweden: findings from a nationwide survey

PURPOSE

Additive manufacturing (AM) is an innovative printing technology that can manufacture 3-dimensional solid objects by adding layers of material from model data. AM in oral and maxillofacial surgery (OMFS) provides several clinical applications such as surgical guides and implants. However, the adoption of AM in OMFS is not well covered. The purpose was to study the adoption of AM in OMFS in university and non-university hospitals in Sweden. Three research questions were addressed: What is the degree of using AM solutions in university and non-university hospitals?; What are AM solutions used?; How are the AM solutions accessed (production mode) in university hospitals and non-university hospitals?

METHODS

A survey was distributed to OMF surgeons in Sweden. The questionnaire consisted of 16 questions. Data were analyzed through descriptive and content analysis.

RESULTS

A total of 14 university and non-university hospitals were captured. All 14 hospitals have adopted AM technology and 11 of the hospitals adopted AM in OMFS. Orthognathic and trauma surgery are two major types of surgery that involve AM technology where material extrusion and vat polymerization are the two most used AM technologies in OMFS. The primary application of AM was in medical models and guides.

CONCLUSION

Majority of Swedish university hospitals and non-university hospitals have adopted AM in OMFS. The type of hospital (university or non-university hospital) has no impact on AM adoption. AM in OMFS in Sweden can be perceived to be a mature clinical application.

Determinants of adoption of urban agricultural practices in eastern Haraghe zone of Oromia region and Dire Dawa City administration, eastern Ethiopia

Although urban agriculture (UA) can aid economic development, food inflation, unemployment, and nutritional insecurity often necessitate urban households to engage in various agricultural practices. Hence, the study aimed to identify UA practices adopted and their determinants in the Eastern Haraghe zone of the Oromia region and Dire Dawa City Administration, Eastern Ethiopia. Data was collected from 385 randomly selected urban households using a semi-structured questionnaire. Descriptive statistics and a Multivariate Probit (MVP) model were used to analyze the data. The results of the MVP model reveal that sex, age, education level, land size, extension contact, credit access, community group participation, training, and household non-farm income significantly influenced vegetable farming adoption. On the other hand, livestock production adoption was also affected by factors such as sex, land size, perception, credit access, farming experience, community group participation, market distance, training, and non-farm income. Crop-fruit production adoption was also influenced by factors like age, perception, farming experience, market distance, training, and dependency ratio. Improving the ability to use the land for UA purposes, empowering female-headed households, improving livestock breeds, creating awareness through short-term training, and improving credit accessibility are important recommendations to enhance the adoption of UA practices in the study areas.

Uterus transplantation: what the world's religions have to say

Uterus transplantation (UTx) has evolved from a purely experimental procedure to a clinical treatment option available outside the clinical trial context, offering women with absolute uterine-factor infertility an opportunity to experience pregnancy. As UTx becomes better established and more widely known and performed, it is likely to be sought out by geographically and culturally diverse patients, particularly those whose religious beliefs impose barriers to other paths to achieve parenthood, such as gestational surrogacy and adoption. Many religions do not currently have official positions on UTx, meaning that clinicians involved in screening candidates can expect questions about how the UTx process aligns with various religious beliefs. This article provides a broad background on the current positions major world religions have taken on UTx (or its components) and the alternative paths to parenthood of gestational surrogacy and adoption. It is intended to help clinicians communicate the information necessary for individuals interested in uterus donation or transplantation to determine-in consultation with their spiritual advisors or religious authorities when needed-how these options align with religious beliefs or teachings.

Modeling the Adoption of 5760 Clinical Studies Into Practice Across 5 Surgical Specialties

INTRODUCTION

No studies exist that explore the factors that influence the process of synthesizing new knowledge into perioperative standards of care and the operating room. We sought to model the adoption of clinical research into surgical practice and identify modifiable factors influencing the latency of this translation.

METHODS

We created a data set comprised of all UpToDate articles between 2011 and 2020, sampled at 3-mo intervals, to explore how research is incorporated at the point-of-care (POC)-studying 5760 new references from 204 journals across five surgical specialties, compared to all uncited articles published during the same interval. UpToDate authors serve as specialty curators of the vast surgical literature, with an audience of more than a million clinicians in over 180 countries across 3200 institutions. Unlike society guidelines, UpToDate also provides the necessary granularity to quantify the time in bringing research to the bedside. Our main outcomes are citation rates and time-to-citation, split by specialty, journal, article type, and topics. We also model the influence of impact factor, geography, and funding and, finally, propose new impact indices to help with prioritizing surgical literature.

RESULTS

We highlight variation in adoption of clinical research by specialty. We show, despite representing a lower quality of evidence, surgical case reports are one of the most cited article types. Furthermore, most clinical trials (94%-100%) in surgical journals are never incorporated into POC reference lists. While few, pragmatic trials were the most likely to be cited of any article type in any surgical specialty (40%). Journal impact factor did not correlate with time-to-citation or proportion of articles cited in three of five surgical specialties, suggesting differences in how specialties synthesize/value research from specialty journals. Our two metrics, the Clinical Relevancy and Immediacy Indices, were defined to capture this impact/relevance to surgical practice. Of the five surgical subspecialties, gynecology references were >5-fold more likely to get cited, had a larger fraction of higher quality evidence incorporated, and demonstrated more success with POC adoption of practice guidelines. We also quantified the cost of translating research to surgical practice per specialty and generated maps that highlight institutions successful in translating research to the POC. The higher expenditure of National Institutes of Health funding in gynecology may reflect the cost of higher quality research per citation.

CONCLUSIONS

Understanding translational latency is the first step to exposing blocks that slow the adoption of research into everyday surgical practice and to understanding why increasing research funding has not yielded comparative gains in surgical outcomes. Our approach reveals new methods to monitoring the efficiency of research investments and evaluating the efficacy of policies influencing the translation of research to surgical practice.

Longing to belong: The ambiguous loss of Indigenous fostered/adopted individuals

BACKGROUND

Indigenous fostered/adopted individuals report high levels of grief because of their foster care/adoption. Little has been done, however, to explore how grief is experienced and the factors that contribute to said grief for fostered/adopted Indigenous individuals.

OBJECTIVE

This study examined the experiences of loss and grief of Indigenous individuals fostered/adopted during childhood.

PARTICIPANTS AND SETTING

Participants were 102 Indigenous fostered/adopted individuals who described the experiences of loss and grief related to adoption.

METHODS

This study utilized secondary data from the Fostered and Adopted Individuals Project. Inductive thematic analysis was conducted on open-ended survey data.

RESULTS

Two themes emerged: (1) ambiguous loss as a result of foster care and adoption and (2) the effects of the ambiguous loss that stem from foster care and adoption. Indigenous fostered/adopted persons experienced ambiguous loss in foster care and adoption. Their loss remained unresolved due to a loss of access to information about their family and tribe of origin. Although family of origin, tribal community, and culture were not physically present due to separation by foster care/adoption, they remained psychologically present. As a result of ambiguous loss, participants experienced disenfranchised grief, wondering and longing to belong, and mental health and substance abuse.

CONCLUSION

This study is the first of its kind to explore the loss and grief experiences of fostered/adopted Indigenous individuals using ambiguous loss theory. Ambiguous loss theory offers a framework for contextualizing the loss and grief that begins at separation and is present in adulthood.

Exploring the Role of 'Intermediaries' between Non-Operating Landowners and Tenant Farmers in Promoting Conservation on Rented Farmland

Promoting conservation on rented farmland is a challenge for stakeholders working with non-operating landowners (NOLs) and tenant farmers (operators). We conducted an online survey to identify stakeholders who engage with NOLs, and understand how their positioning as 'intermediaries' could be leveraged to help bridge the NOL-operator communication gap. A majority of identified stakeholders/intermediaries worked in government agencies, university extension, law firms, or farm management companies. Intermediaries believed that NOLs trusted them for several conservation activities, however, they believed that NOLs were more influenced by operators than by intermediaries. The message that engaging in conservation can help preserve the farm for future generation was perceived to be influential in motivating NOLs. Our findings suggest the need for a holistic approach to engage NOLs by accounting for trust in and influence of intermediaries and operators, and the salience of conservation messages and messaging when promoting conservation behaviors on rented farmlands.

A model for enterprise resource planning implementation in the Saudi public sector organizations

Studies dedicated to user's adoption, acceptance, and use of IT have been rampant since the advent of computers and IT. Therefore, it becomes essential to assess the value of IT to organizations and to understand the determinants of such value in terms of acceptance, integration, and technology use. In this regard, Enterprise Resource Planning (ERP) adoption remains challenging for professionals and practitioners alike. Previous research neglected many vital factors, such as user involvement (participation, engagement, and resilience) and environmental factors (change management, competitiveness, and pandemic pressure). Therefore, this study aims to identify the most significant factors that influence the successful adoption of ERP and propose a conceptual model. The Technology Acceptance Model with DeLone and McLean Information Success Models were the base for the study. The findings of this study reveal a conceptual model that facilitates the successful adoption of ERP systems. Through the identification of critical factors, one factor emerged as a permanent component in the adoption process. This conceptual model provides valuable insights for organizations seeking to implement and adopt ERP systems effectively. The study's findings offer valuable insights for firms pursuing long-term economic success through ERP adoption. Understanding the influencing factors enables efficient and effective deployment. Implications are relevant to organizations, ERP vendors, and decision-makers, guiding informed decision-making and prioritizing success factors.

How to adopt technologies in home care: a mixed methods study on user experiences and change of home care in Finland

BACKGROUND

There is a need for better adoption of technology to meet the needs of home care professionals, older people, and informal caregivers.

METHODS

Mixed methods were used to describe and analyse quantitative and qualitative data in a Finnish governmental programme called KATI. The study was three-fold: it 1) listed what kinds of technologies were piloted and deployed in a national study, 2) provided information from the perspectives of home care professionals about requirements to use technology by using focus-group interviews, and 3) assessed experiences of how the adoption of technology changes work and work processes over time by using repeated surveys. Informants in interviews (n = 25) and surveys (n = 90) were home care professionals, who also described the perspectives of older people and informal caregivers. The conceptual models framing the study were adapted from the Technology Acceptance Model and DirVA PROVE-IT.

RESULTS

There were 80 technology pilots, in which variety of technologies were followed in home care. Familiarity with, commitment to and understanding of technology benefits were considered to be requirements for the technology to be used. The adoption of technology provided new skills and information about older people's wellbeing, realisation of treatment and new possibilities in home care. It developed new procedures to focus on older people's needs and motivated professionals by gained concrete aid. It enabled them to leave out some concrete procedures as unnecessary. On the other hand, there were also pessimistic and negative experiences when technology use provided nothing new or did not change anything.

CONCLUSIONS

The adoption of technology is dependent on the technology and its integration into the prevailing service practice. When they both work, it is possible to leave out unnecessary procedures in care, allocate resources and save time. It is possible to be aware of older people's safety and how they cope at home, find new ways to get involved in older people's lives, gain insight, and make changes at work. Continuous on-site training, modifications in service practices and communication throughout organisations is needed.

Three-Year Custody Outcomes Among Infants Investigated by Child Protection Systems for Prenatal Substance Exposure in California

OBJECTIVE

Infants affected by prenatal alcohol and drug use are more likely to be removed from parental custody than those in the general population, although it is unclear whether their custody outcomes differ from infants investigated by child protection systems (CPS) for other reasons. This analysis seeks to compare trajectories of involvement and custody outcomes among infants investigated by CPS with and without documentation of prenatal substance exposure (PSE).

METHOD

We used vital birth records linked to administrative CPS records to examine the timing of system involvement and 3-year custodial outcomes among investigated infants with and without identified PSE. We defined PSE according to documentation on the state's standardized hotline screening form, which CPS completes upon referral for alleged maltreatment. We estimated the likelihood a child was in nonparental custody at age 3 by specifying multivariable generalized linear models, adjusted for covariates available in the birth record.

RESULTS

In our sample of 22,855 infants investigated by CPS in 2017 in California, more than 26% had documentation of PSE. These infants experienced an accelerated timeline of system penetration and were 2.2 times as likely to be in nonparental placement at age 3.

DISCUSSION

PSE confers an independent risk of custody interruption among infants investigated by CPS. The younger age of these infants, complexity of parental substance use, and potential misalignment of administrative permanency timelines with parental recovery all suggest the need for increased research, policy, and programmatic interventions to serve this vulnerable population.

Adoption of on-farm feed safety practices among livestock farmers: Evidence from Saudi Arabia

Compliance with feed safety standards and practices on the farm promotes sustainable livestock production and can positively affect the environment and human health. This study aims to examine farmers' on-farm adoption of feed safety practices and determine the differences in adoption according to the socio-economic characteristics of farmers. An online survey was conducted to collect the study data. The study participants consisted of 442 livestock farmers in Riyadh region, Saudi Arabia. The study findings revealed that farmers highly adopted categories of feed purchasing (77.9 %) and feed mixing and distribution (75.05 %), whereas they were considered as a moderate level adoption regarding feed storing (70.9 %). The cluster analysis results showed two main patterns of adoption- "high adopters" and "moderate adopters"-based on the average level of adoption for 25 feed safety practices examined. The cluster of "high adopters" accounted for 59.9 % of the sample and had higher average adoption in all practices examined. The findings revealed that there are significant differences between the two segments of farmers, corresponding to gender, membership in livestock association, extension contact, raising sheep, and feeding system. This study proposes the regular monitoring of farms to ensure strict adherence to feed safety regulations, with the implementation of awareness and capacity development initiatives pertaining to feed safety concerns.

Gender differentiation on the determinants and intensity of adoption of Purdue improved cowpea storage (PICS) bags in Northern Nigeria

Postharvest and storage of agricultural produce such as cowpea remains a significant challenge in sub-Sahara Africa. This study assessed gender differentiation on the determinants and intensity of adoption of Purdue-improved cowpea storage (PICS) bags in northern Nigeria. Primary data was collected via a well-questionnaire from Kano, Kaduna, Gombe, Bauchi, Plateau, and the Niger States. Each State was purposively selected based on the concentration and availability of female PICS bag users. From the sampling frame 2989, 20% of male and female small-scale cowpea farmers were randomly selected, totalling 598 cowpea farmers. Descriptive and double-hurdle regression models were used. The result of the socioeconomic analysis indicated that farmers' mean age was 42 years, with an average of 8 persons per household and a dependency ratio of 1.19. Years of schooling were 10 with a farming experience of 25 years and 2.17 ha as the average farm size. Results of the Logit model in males were significant for (extension contact, PICS information from other farmers and radio sources, and cowpea income, bags non-available) and for females (age, awareness, extension contact, PICS information from other farmers and radio source, bags non-available). The truncated regression model was significant in males (cowpea income) and females (education, output, and bags non-available). Adopting PICS bag technology by cowpea farming households enhanced female farmers' adoption. Therefore, policymakers should implement methods to motivate female farmers to adopt this technology further.

Impact of adoption of climate-smart agriculture on food security in the tropical moist montane ecosystem: The case of Geshy watershed, Southwest Ethiopia

The traditional rain-fed agriculture system of Ethiopia is suffering from climate change impacts and extremes. It must be improved to feed the growing population and create a resilient society. Climate-smart agriculture (CSA) is currently promoted as an approach intended to increase sustainable agricultural productivity, enhance household resilience, and reduce greenhouse gas emissions. This study was, therefore, undertaken to examine how food security can be improved by the adoption of multiple climate-smart agriculture (CSA) practices of smallholder farmers in a moist tropical montane ecosystem of Southwest Ethiopia. Data was collected from 384 purposively selected households through cross-sectional study design using a semi-structured questionnaire. Eight Focus group discussions and fifteen key informant interviews were also conducted to check the reliability of the survey data collected. In the study area, a total of eighteen CSA practices, adopted by farmers, were identified. Using principal component analysis, these practices were further grouped into five packages and a multinomial endogenous switching regression model was used to link these packages to the food security status. The findings revealed a great variation in the proportion of households using CSA practices where 92.3 % were using crop management practices whereas 11.2 % were using soil and water conservation practices. The study found that the maximum effect of CSA adoption on food security was by farmers who adopted all the five category CSA technologies. Households that adopted this package were more food secure by 41.2 % in terms of per capita annual food expenditure, 39.8% in terms of Household Food Insecurity Access Scale (HFIAS), and 12.1% in terms of Household Food Consumption Score (HFCS) than the non-adopters. The adoption of this group of practices was further influenced positively by farm size, gender, and productive farm asset values. Using CSA practices in combinations and to a relatively larger extent can potentially solve food security problems. Motivating farmers by providing income-generating activities and discouraging land fragmentation through public education is essential. This in turn improves CSA adoption and initiates production assets investment that can absorb climate change risks.

Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings

BACKGROUND

Over the past three decades, policy actors and actions have been highly influential in supporting the implementation of evidence-based practices (EBPs) in mental health settings. An early examination of these actions resulted in the Policy Ecology Framework (PEF), which was originally developed as a tactical primer for state and local mental health regulators in the field of child mental health. However, the policy landscape for implementation has evolved significantly since the original PEF was published. An interrogation of the strategies originally proposed in the PEF is necessary to provide an updated menu of strategies to improve our understanding of the mechanisms of policy action and promote system improvement.

OBJECTIVES

This paper builds upon the original PEF to address changes in the policy landscape for the implementation of mental health EBPs between 2009 and 2022. We review the current state of policy strategies that support the implementation of EBPs in mental health care and outline key areas for policy-oriented implementation research. Our review identifies policy strategies at federal, state, agency, and organizational levels, and highlights developments in the social context in which EBPs are implemented. Furthermore, our review is organized around some key changes that occurred across each PEF domain that span organizational, agency, political, and social contexts along with subdomains within each area.

DISCUSSION

We present an updated menu of policy strategies to support the implementation of EBPs in mental health settings. This updated menu of strategies considers the broad range of conceptual developments and changes in the policy landscape. These developments have occurred across the organizational, agency, political, and social contexts and are important for policymakers to consider in the context of supporting the implementation of EBPs. The updated PEF expands and enhances the specification of policy levers currently available, and identifies policy targets that are underdeveloped (e.g., de-implementation and sustainment) but are becoming visible opportunities for policy to support system improvement. The updated PEF clarifies current policy efforts within the field of implementation science in health to conceptualize and better operationalize the role of policy in the implementation of EBPs.

An audit of the dissemination strategies and plan included in international food-based dietary guidelines

OBJECTIVE

Food-based dietary guidelines (FBDG) are an important resource to improve population health; however, little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDG.

DESIGN

A cross-sectional audit of FBDG with a published English-language version sourced from the United Nations FAO repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel and message). For guidelines with a dissemination plan, we described goals, audience, strategies and expertise and resources according to the Canadian Institute for Health Research guidance.

SETTING

FBDG from fifty-three countries mostly from high-income (n 28, 52·8 %), and upper-middle income (n 18, 34 %) areas were included.

PARTICIPANTS

n/a.

RESULTS

The source of guidelines was most frequently health departments (79·2 %). The message included quantities and types of foods, physical activity recommendations and 88·7 % included summarised versions of main messages. The most common channels were infographics and information booklets, and the main end-users were the public. For twelve countries (22·6 %), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the Canadian Institute for Health Research.

CONCLUSIONS

The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDG had formal dissemination plans and of those there was limited detailed provided.

Intention to adopt improved indigenous chicken breeds among smallholder farmers in Machakos county, Kenya. Do socio-psychological factors matter?

Consumption of poultry meat, eggs, and other animal-sourced commodities has dramatically risen by almost 86 %, with the demand of indigenous chicken products almost doubling over the past few decades. In Kenya, poultry farmers prefer indigenous chicken (IC) due to their resilience to harsh climatic conditions, high feed conversion rates, delicious end products, ability to scavenge and potential to reduce greenhouse gas emissions among other factors. Despite the high demand for poultry and its products, the gap between demand and production remains high. Poultry farmers try to keep pace with the demand by integrating the recommended improved IC breeds into their production system. Although there exists some understanding on the determinants of the farmers to adopt improved IC, still there is scanty information on how socio-psychological factors influence the intention to adoption improved IC among the farmers in Kenya. Thus, this study sought to investigate the determinants of intention to adopt improved IC while specially focusing on the role of socio-psychological factors. A total of 374 IC farmers in Machakos county were selected using a multistage sampling technique. Partial Least Square - Structural Equation Modelling (PLS-SEM) was employed to analyze the data. Results from descriptive statistics showed that approximately 90 % of IC farmers in the study area were aware of the improved indigenous chicken breeds. However, the adoption of the improved IC was below average (44.9 %). The path analysis results revealed that Subjective Norm (SN) was the main determinant of farmer's intention to adopt improved IC breeds, followed by Attitude (ATT) and Perceived Behavioral Control (PBC). The study recommends more emphasis to be given to psycho-social issues through well designed public and private interventions that will promote adoption of improved breeds among IC farmers.

Gaelic games players' awareness and use of, and attitudes towards injury prevention exercise programmes

OBJECTIVE

The aim was to determine the awareness of and use of injury prevention exercise programmes (IPEPs) among adult Gaelic games players and to investigate Gaelic games players' attitudes to injury prevention and barriers and facilitators to successful IPEPs use.

METHODS

A recruitment email was sent to all clubs and county boards throughout Ireland (whose email was available online) and the survey was advertised on social media platforms. Adult players completed an anonymous survey, including awareness, use, and attitudes towards injury prevention and injuries. Frequencies and descriptive statistics were conducted, a chi-squared test was used to assess any differences in awareness and use of IPEPs, a Mann-Whitney U test was used to examine differences between groups for attitudes to injury prevention (men vs women; elite vs non-elite).

RESULTS

A third of players (32.4%) stated awareness of IPEPs. However, only 13.4% correctly identified one. A significantly greater number of men (35.7%) used IPEPs compared to women (26.5%) (p = 0.04). The Activate (65.5%) and GAA15 (32.5%) were most used. Players had a positive attitude towards injury prevention but agreed that injuries were an issue (68.2%) and stated that their coach didn't have enough knowledge how to use IPEPs was a large barrier (41.6%).

CONCLUSION

Despite this positive attitude to injury prevention and believing injuries are an issue, adoption remains low. Organisations/clubs should educate players on the benefits of using IPEPs and support structures put in place to gain greater implementation, which is critical to mitigating the risk of injury.

Developing and Validating a Questionnaire to Measure Attitude toward Child Adoption: A Psychometric Process

Background

Despite the mutual benefit of adoption, due to the adverse attitude related to the barriers perceived by the couples, some people are not interested in adoption. The purpose of this study was to develop and validate a questionnaire to measure attitudes toward child adoption.

Materials and Methods

This secondary analysis is part of a larger study on 178 infertile couples referring to the Afzalipour Infertility Center in Kerman, Iran. Factor Analysis (FA) was performed. The sampling was conducted using the convenience sampling method. The questionnaire was implemented using a mixed-method approach in three phases. Firstly, a pool was created. The second phase involved content validity. Lastly, construct validity was conducted.

Results

The final version of the questionnaire with 20 questions had a total Cronbach's alpha of 0.70%. Six factors with eigenvalues of higher than 1.00 were extracted, which accounted for 52% of the total variance. These factors were "spiritual-psychological status of the new parents," "psychological status of the adopted child," "undesirable behaviors of others in the future," "anxiety of the new parents," "physical-behavioral characteristics of the adopted child," and "socio-economic factors." The model extracted from the Exploratory Factor Analysis (EFA) was confirmed by Confirmatory Factor Analysis (CFA). The 6-factor structure adequately fitted the data (Comparative Fit Index (CFI) = 0.93; root mean square error of approximation [RMSEA] = 0.047; X2/df = 1.393; p = 0.002.

Conclusions

The internal consistency and construct validity of the questionnaire were confirmed. This instrument can be used in clinical and research practices.

Single parent adoption in India: Mental health and legal perspectives and the way forward

Single parent adoption (SPA) is a relatively new construct worldwide and in India. The Ministry of Women and Child Development, Government of India, has laid down criteria for adoption in general and SPA in particular, in conjunction with the Juvenile Justice Act (Care and Protection of Children), 2015. There is scant literature on this topic of SPA, more so in India, that looks into the various psychological nuances of SPA from a mental health professional's (MHP) perspective. This review paper aims to assess SPA from the perspective of a MHP that will focus on its various legal nuances as well as the psychological connotations attached to it. For this, a search strategy was employed that included a thorough literature search from two databases (PubMed and Google Scholar) with relevant keywords related to the topic. The various legal issues pertaining to SPA in the current scenario, the psychological issues and challenges faced by single parents, the behavioral outcomes of adoptees who are adopted by single parents, and ways to deal with the various obstacles of SPA are discussed.

Saving unwanted children: a proposal for a National Rearing Institute

Unwanted children are carried, born, and reluctantly raised each year; they are prone to abortion, abandonment, neglect, and abuse. Meanwhile, many developed societies are suffering from depopulation. To address these two issues concurrently, I propose that governments should grant pregnant women and mothers an irreversible and unconditional one-time chance to relinquish all their legal rights and obligations associated with each of their children under a specific age to a National Rearing Institute that adopts the children and rears them to the age when they can fully exercise their rights as adult citizens. I call this set of policy arrangements "Project New Republicans." This project aims to (1) protect and support the best interests of unwanted children, (2) maximize the health outcomes of the mothers who gave birth to these children and help the mothers to achieve self-realization, and (3) preserve an influx to the population from procreation against depopulation. The project is primarily grounded on both the utilitarian and intra- / inter-generational accounts of justice. It also ameliorates the oppression and domination of women by unjust social structures in alignment with the human rights-based approach.

Survey among FELASA members about rehoming of animals used for scientific and educational purposes

Rehoming is an important fate, which should be considered for animals used for scientific and educational purposes, and which is highlighted in the European Directive 2010/63 EU. In 2018, the Federation of European Laboratory Animal Science Associations (FELASA) convened a working group to review current literature and identify existing practices with the aim of issuing general recommendations on the rehoming of research animals. In order to understand the number and species of animals being rehomed and which species and information to include in the recommendations, the working group launched a survey that was distributed among FELASA members, yielding 97 valid records for analysis. Most respondents of the survey considered the rehoming of cats, dogs, mice, rats, rabbits, pigs and minipigs. The most important issues reported by the respondents were related to availability/suitability of animals, availability of adopters and legal issues. Based on the data and information collected in this survey, the working group decided on the format and content of the future recommendations: a first section containing a general protocol for rehoming, addressing the issues raised by the respondents, and a second section containing species-specific information and advice about cats, dogs, small prey mammals, equines, primates, camelids and minipigs.

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.

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.