Search Results (53)

Background: Individuals with intellectual and developmental disabilities (IDD) experience persistent health disparities that result in poorer health outcomes, reduced quality of life, and inequitable access to healthcare. Objective: This narrative review synthesized existing literature to identify key barriers to health equity and contributors to health disparities among individuals with IDD. Method: This study was a narrative (non-systematic) review that adopted a qualitative synthesis approach. A literature review was conducted across PubMed, CINAHL, PsycINFO, Medline, and Google Scholar to identify peer-reviewed articles published between 2010 and 2025 that address health disparities, health inequities, healthcare barriers, and social determinants of health among individuals with IDD. Thematic analysis was employed to synthesize the included studies and identify recurring patterns and themes. Results: A total of 88 articles were included. Two overarching domains shaping health disparities were identified: barriers to health equity and contributing factors. Seven barrier categories emerged: attitudinal, communication, policy, programmatic, social, physical, and transportation. Five key contributors were also identified: limited access to healthcare, comorbid conditions, low health literacy, adverse social determinants of health, and caregiver burden. Conclusions: Health disparities among individuals with IDD are driven by intersecting social, structural, and healthcare system barriers rather than individual limitations alone. This review informs policymakers, public health professionals, and interventionists on how to advance health equity for individuals with IDD through targeted, person-centered interventions. Full article

The transportation sector is a major contributor to global greenhouse gas emissions, making electric vehicle (EV) adoption critical for decarbonization. This study investigates EV adoption determinants in Turkey using explainable machine learning, focusing on economic, infrastructure, and attitudinal factors while exploring driver behavior and fuel-efficiency awareness. Data from 304 participants were collected; after excluding undecided responses, the final analytical sample comprised 232 participants. Multiple algorithms (Random Forest, XGBoost, Logistic Regression, and SVM) were evaluated, addressing class imbalance via SMOTETomek. SHAP analysis identified policy-relevant predictors. Results reveal that EV adoption intentions are primarily driven by perceived cost impact, EV knowledge, and charging infrastructure accessibility, showing substantially stronger effects than driver behavior. Exploratory analysis indicates that aggressive driving correlates with lower fuel-efficiency awareness, whereas maintenance and eco-driving support higher awareness. The best-performing Random Forest model achieved 89.36% accuracy and a 0.9348 F1-score. Rather than claiming novelty in ML application, this study contributes an interpretable framework and emerging-market evidence contrasting economic/infrastructure factors against behavioral variables. Findings provide actionable insights for policy, highlighting cost-focused incentives, infrastructure deployment, and targeted awareness campaigns. Full article

Forest ecosystems are increasingly degraded by natural disasters and human activities, intensifying the need for large-scale restoration. Because restoration outcomes are long-term, uncertain, and largely non-market, understanding how environmental attitudes relate to public preferences and willingness to pay (WTP) is important for socially acceptable and financially feasible policy design. Using a discrete choice experiment in Korea, this study applies a hybrid choice framework that incorporates latent attitudinal variables into a mixed logit structure, allowing attitudes to interact with preference heterogeneity across restoration attributes. Results show significant heterogeneity in choices and WTP. The model identifies two segments with distinct trade-off patterns: one is more sensitive to risk and payment burden, while the other places relatively greater value on restoration and access-related improvements. Although attitudinal indicators are statistically relevant, segment differentiation is more strongly associated with risk sensitivity and cost aversion than with attitudes alone. Compared with conventional choice models, the latent-attitude specification improves behavioural interpretability and model fit, and yields policy-relevant WTP estimates. Overall, the findings indicate that attitudinal information is complementary to economic and risk-related factors, supporting more targeted and publicly aligned forest-restoration policies. Full article

Research on men’s mental health points out gender differences in help-seeking and access to care. Traditional masculine norms (i.e., emotional repression, self-reliance, “being strong”) and gender bias might conceal distress, delay treatment, and help to explain higher burdens of addiction, violence, and suicide alongside lower recorded affective/anxiety diagnoses. An exploratory narrative review was conducted. PubMed, Scopus, and Web of Science were searched for 2015–2025 studies using MeSH and terms on men’s mental health, masculinities, and stigma. Eleven studies identified attitudinal barriers (i.e., self-stigma, shame, symptom minimization, mistrust, etc.) and structural barriers (i.e., limited tailored services, navigation difficulties, costs, bureaucracy, etc.) that delay identification of psychological distress symptoms, weaken therapeutic alliance, and increase dropout, especially when therapy is perceived as impersonal or ineffective. Intersectional factors (i.e., class, age, ethnicity) further contribute to access and they need to be included in the field of men’s mental health. Gender-sensitive approaches and alternative masculinity role models have the potential to enhance engagement and legitimize emotional experience. To sum up, hegemonic masculinity-related gender norms, acquired through gender-differentiated socialization, are associated with adverse mental health outcomes among men. A lack of gender-sensitive awareness campaigns to reduce stigma around men’s mental health may hinder prevention, delaying early identification and timely intervention. Therefore, men’s mental health care should integrate gender and intersectionality transversally to improve prevention, access, diagnosis, treatment, adherence, and outcomes, supported by professional training and tailored therapeutic tools in clinical routine practice. These findings underscore the need to promote healthier, more egalitarian masculinities and to deconstruct stigmas associated with help-seeking and mental health service. Full article

(1) Background: Education serves as a catalyst for social transformation toward sustainability, yet limited empirical evidence exists regarding primary education’s contribution to regional sustainable development, particularly in island contexts facing unique environmental and economic pressures. This study examined primary education teachers’ perceptions, practices, and challenges in implementing Education for Sustainable Development (ESD) in Zakynthos, Greece. (2) Methods: A triangulated quantitative approach surveyed a representative sample of 105 primary education teachers from the Zakynthos Primary Education Directorate using a 28-item structured questionnaire assessing ESD knowledge, teaching practices, barriers, and improvement strategies. Teacher questionnaire data were triangulated with KEPEA (Center for Environmental Education and Sustainability) program documentation (103 programs, 2020–2025) and school implementation records from 75 participating schools. Data were analyzed using descriptive statistics, Mann–Whitney U tests, Kruskal–Wallis tests, and Spearman correlations. (3) Results: Most teachers (65.7%) reported adequate knowledge of sustainable development concepts, with 75.3% incorporating ESD into teaching practice often or very often. Triangulation revealed convergent findings: environmental sustainability dominated teacher perceptions (67.3%) and KEPEA programming (78.4%), while economic sustainability received limited attention (18.1%). Female teachers demonstrated significantly higher ESD knowledge (U = 892.5, p < 0.05, r = 0.34). The majority (98.1%) considered ESD integration important, yet only 48.5% felt adequately prepared to teach sustainability topics. A notable attitude-action gap emerged: while 86.6% valued community partnerships, only 47.6% engaged frequently, and KEPEA documented 33.7% of formal collaborations. Primary barriers included insufficient curriculum time (61.9%) and limited resources (51.4%). Teachers identified training programs (71.4%) and access to educational materials (71.4%) as priority interventions. (4) Conclusions: Primary education teachers in Zakynthos demonstrate strong commitment to ESD but face structural barriers limiting implementation effectiveness. The environmental-economic imbalance suggests a need for professional development, integrating economic sustainability concepts through place-based approaches relevant to the island’s tourism-dependent economy. The attitude-action gap in partnerships indicates structural rather than attitudinal barriers requiring policy intervention. Findings support targeted teacher training, curriculum reform, and strengthened school-community collaboration to enhance ESD’s contribution to regional sustainable development. Full article

Access to health care is a fundamental human right established in various legal frameworks worldwide. However, increasing evidence indicates that individuals with physical disabilities in rural Ethiopia continue to face barriers and disparities in accessing health care, leading to unmet needs and worsening health. Guided by Critical Disability Theory and Intersectionality Theory, this instrumental case study explored the barriers to accessing primary health care (PHC) for adults with physical disabilities in rural Ethiopia and examined how disability intersects with poverty, gender, and rurality to shape exclusion. Following purposeful sampling, we conducted 14 interviews and one focus group discussion (n = 7) with adults with physical disabilities, supplemented by PHC facility infrastructure observation. Using reflexive thematic analysis, we identified intersecting barriers across four domains: physical and environmental barriers, socioeconomic marginalization, socio-cultural stigma and attitudinal barriers, and systemic weaknesses in health service delivery. This revealed that disability-related barriers are rooted in structural ableism and intersecting inequities, underscoring the urgent need for inclusive policies and disability-inclusive practices. Such practices include enforcing accessibility standards, expanding community-based health insurance to cover disability-specific needs, supporting transportation, and providing disability-specific training for health professionals. Implementing these practices is essential to advancing disability rights and ensuring equitable health access in Ethiopia. Full article

This study examines consumer attitudes and experiences related to ride-sharing services in the Western Transdanubia region of Hungary. Despite the growing global popularity of shared mobility solutions, there is little empirical evidence on regional consumer acceptance patterns in the Hungarian context. Based on a structured questionnaire survey involving 500 respondents, this research explores the relationship between satisfaction with past ride-sharing experiences and the intention to reuse such services in the future. The results reveal a high willingness to reuse among those who have already tried ridesharing, yet the correlation analysis shows that satisfaction dimensions alone are not significant predictors of reuse intention. In contrast, attitudinal factors, such as preference over other transport modes, willingness to make recommendations, and perceived accessibility, exhibit strong correlations with acceptance of ride-sharing. The findings emphasise the key role of attitudes and trust in shaping consumer decisions. The paper contributes to the literature by providing regionally grounded empirical insights and offers practical and policy-level recommendations to support the diffusion of sustainable shared mobility services. Full article

This study examines the motivations, socio-demographic profiles, and behavioural orientations of residents in Northern Italy toward mountain and forest visitation, with a focus on their propensity to engage in forest-based health and wellness activities. The analysis draws on a large stratified survey conducted between December 2023 and January 2024, involving 1218 respondents, of whom 976 reported regular forest visitations. Exploratory factor analysis identifies two main attitudinal dimensions: “Health and Wellness-Driven Forest Engagement”, centred on psychophysical restoration, and “Comfort-Oriented Forest Use”, related to accessibility and low physical effort. Regression models show that wellness-oriented engagement is strongly associated with psychological well-being, walking and hiking habits, and gender, while comfort-oriented use reflects seasonal patterns and preferences for easily accessible forests. A small subset of respondents reports discomfort in forest environments, forming a distinct attitudinal barrier. Overall, the results indicate substantial potential for forest-based wellness tourism to support healthier lifestyles and diversify mountain economies. Policy implications highlight the need for accessible infrastructures, targeted communication, and the integration of wellness-oriented services into regional development strategies. Full article

Agricultural producers experience elevated stress, limited mental health access, and cultural norms that can discourage help-seeking. This study examined farmers’ preferences for receiving mental health information and the barriers that impede care. Data came from a regional needs assessment of 1024 producers across 12 Midwestern states who completed online or paper surveys, including questions on willingness to seek or receive information and the 30-item Barriers to Access to Care Evaluation. Analyses included descriptive, bivariate, and multivariate methods to explore demographic and behavioral predictors. Results indicated that while 74.1% were open to receiving mental health information, notable proportions were unwilling to seek (27.8%) or receive (28.4%) it, and 18.7% were unwilling to do either. Preferred sources were medical providers, mental health professionals, and family members, with agricultural retailers least favored. Women, younger producers, veterans, those with mental health symptoms, and individuals with higher education, anxiety, or depression showed distinct patterns of openness and barrier endorsement. Attitudinal barriers were the most common across groups. Findings highlight the importance of culturally relevant approaches that leverage trusted messengers, reduce stigma, and tailor interventions to specific subgroups to strengthen mental health outreach in agricultural communities. Full article

Background: Help-seeking for mental health care remains low in Oman and globally, contributing to increased morbidity and mortality. Identifying barriers is essential to improving access. This study is the first to examine the prevalence of mental health problems and help-seeking behavior in Al Dhahira governorate, Oman. Methods: It is a cross-sectional study conducted between 1 August and 30 September 2023, in the three cities of Al Dhahira Governorate, Oman. It employed a convenient, proportionate sampling approach and involved willing Omani adults aged 18–64 from the 18 areas of Al Dhahira governorate. Data were collected using the Barriers to Access to Care Evaluation (BACE-III) Arabic Version questionnaire, which was self-completed by the participants. IBM SPSS Statistics (Version 23) was used for data analysis. Results: A total of 357 participants were involved in the study. It was found that the prevalence of mental health problems (self-reported) was 11.5% and only 5.3% sought professional help. Age (p-value = 0.046) and marital status (p-value = 0.028) were found to be significantly associated with having mental health problems. While the significantly associated factors with stigma barriers were city (p-value = 0.039) and education level (p-value = 0.023), the associated factor with attitudinal barriers was educational level (p-value = 0.049). The independent predictors for seeking mental health care and having mental health problems were government worker (p-value = 0.014) and Yanqul residency (p-value = 0.003). Conclusions: In the Al Dhahira governorate, the prevalence of mental health problems was found to be low. Stigma and attitudinal barriers affect seeking help significantly in the governorate. Integrating mental health into the primary care setting and increasing awareness to overcome these barriers will improve access to mental health services. Full article

Within transport systems, train stations cover a primary role as places where access to different modes of transport must be realised effectively, providing a valuable opportunity to make rail services, public transport, and soft mobility more attractive. This research seeks to shed some light on how Italian travellers perceive the quality of train stations, and to identify priorities for action in relation to design, building, and operation that might help revitalise their attractiveness. The methodology involved designing a questionnaire capable of identifying significant correlations between attitudinal and behavioural variables via an exploratory factor analysis, reaching around 400 respondents through a snowball sampling plan. The factor “sociality and daily life” showed the importance that people place on the vitality of urban places. Travellers also consider other factors, like the overall service quality, the cleanliness and safety of a train station, the walkability of connections within the node, and the possibility of reaching the station by bicycle. The profiling of respondents using a cluster analysis based on latent factors points to specific policies, showing how actions targeting stations can have positive effects on the use of rail transport and on the propensity towards intermodality and sustainable mobility. A safe, “living” place can mitigate the risk of social degradation, while promoting walking and cycling. Full article

Industry 4.0 (I4.0) is reshaping manufacturing by integrating advanced digital technologies and is increasingly seen as an enabler of the circular economy (CE). However, most research treats digitalisation and circularity separately, with limited empirical insight regarding their combined implementation. This study investigates I4.0 adoption to support sustainability and CE across industries, focusing on how enterprise size influences adoption patterns. Based on survey data from 69 enterprises, the research examines which technologies are applied, at what stages of the product life cycle, and what barriers and drivers influence uptake. Findings reveal a modest but growing adoption led by the Internet of Things (IoT), big data, and integrated systems. While larger firms implement more advanced tools (e.g., robotics and simulation), smaller enterprises favour accessible solutions (e.g., IoT and cloud computing). A positive link is observed between digital adoption and CE practices, though barriers remain significant. Five main categories of perceived obstacles are identified: political/institutional, financial, social/market-related, technological/infrastructural, and legal/regulatory. Attitudinal resistance, particularly in micro and small enterprises, emerges as an additional challenge. Based on these insights, and to support the twin transition, the paper proposes targeted policies, including expanded funding, streamlined procedures, enhanced training, and tools for circular performance monitoring. Full article

Background/Objectives: Pharmacists are highly accessible healthcare providers who have frequent, repeated contact with diverse patient populations. They are poised to offer expanded and comprehensive healthcare, including mental health services. One potential barrier to this is a lack of knowledge, confidence, or training in mental health, which may be overcome with a program like Mental Health First Aid (MHFA) training. The aim of this systematic review and meta-analysis is to fill this gap in knowledge by critically evaluating all studies of MHFA training for pharmacists or pharmacy students that report on knowledge, attitudes, or self-efficacy outcomes. Methods: A systematic review was performed to identify all relevant studies. Data was extracted and a random-effects meta-analysis was performed for knowledge and attitudes/self-efficacy outcomes, respectively. Subgroup analyses were performed based on survey question type, geographic location, and population studied. Results: Overall, MHFA training significantly increased pharmacists’ and pharmacy students’ knowledge (Hedges’ g = 0.228) and combined attitudinal/self-efficacy measures (Hedges’ g = 0.376). Subgroup analyses based on question type, study quality, design, population studied, and location showed similar, significant effects. Conclusions: MHFA training appears to have significant effects on pharmacist and pharmacy student knowledge, attitudes, and self-efficacy. Future work should establish the durability of these effects. Full article

Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n = 34) and managers (n = 12) and 4 with patients (n = 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake. Full article

Shared autonomous vehicles (SAVs) are emerging as a potential tool for sustainable transportation, yet their impact on travel behavior and environmental outcomes remains uncertain. This review evaluates the sustainability implications of SAV adoption, including its potential to reduce emissions through optimized fleet operations, enhance social equity by improving mobility access, and increase economic efficiency through resource-sharing models. This systematic literature review examines 107 articles from English and Chinese databases, focusing on SAVs’ effects on total travel demand, mode choice, and in-vehicle time use. Findings indicate that SAVs could increase vehicle miles traveled due to unoccupied relocation and new demand from previously underserved demographics, though advanced booking and dispatch systems may mitigate this increase. The study identifies 59 factors influencing SAV adoption, categorized as user-centric, contextual, and psycho-attitudinal. Analysis of in-vehicle time use shows varied activities, from productivity to leisure, with contradictory findings in the value of travel time (VOT) compared to conventional vehicles: while some studies report up to 34% lower VOT for SAVs due to multitasking opportunities, others find up to 29% higher VOT. Privacy and personal space emerge as important factors, with users showing a high willingness to pay to avoid additional passengers. The review highlights underexplored variables and methodological limitations in current research, including psychological influences and mode substitution dynamics. These insights inform policymakers and urban planners on how to integrate SAVs into sustainable transportation systems by mitigating their environmental impact, promoting equitable access, and ensuring alignment with smart urban planning strategies. Full article