Search Results (485)

This study explores the role of solidarity finance in promoting local development and the empowerment of marginalized communities through financial inclusion and access to community credits. It focuses on how solidarity-based financial mechanisms provide accessible credit with fewer barriers, fostering productive activities and economic resilience. This study employed a quantitative and exploratory design, analyzing data from 51 community funds in Ecuador out of a total of 220 through a self-administered online survey, validated by auditing professionals and answered by community representatives. The 25-item questionnaire gathered data on organizational dynamics, financial practices, and perceptions of sustainability. Descriptive analysis was complemented with an analysis of variance to test hypotheses concerning associativity, self-management, and organizational performance. The results show that while associativity, self-management, and organizational management are perceived as institutional strengths, aspects such as autonomy and solidarity received lower evaluations, suggesting critical areas for strategic improvement. Notably, significant differences emerged between self-management–organization and solidarity–organization groups, emphasizing the importance of associativity (collaboration) in enhancing the sustainability of solidarity finance, which proves to be a vital mechanism for community empowerment and local development; however, its long-term sustainability depends on strengthening internal dimensions, particularly autonomy and solidarity, and reinforcing associativity as a core driver of organizational resilience. Full article

Background and Objectives: Diabetes is a global public health challenge, with increasing prevalence worldwide. The implementation of artificial intelligence (AI) in the management of this condition offers potential benefits in improving healthcare outcomes. This study primarily investigates the barriers and facilitators perceived by healthcare professionals in the adoption of AI. Secondarily, by analyzing both quantitative and qualitative data collected, it aims to support the potential development of AI-based programs for diabetes management, with particular focus on a possible bottom-up approach. Materials and Methods: A scoping review was conducted following PRISMA-ScR guidelines for reporting and registered in the Open Science Framework (OSF) database. The study selection process was conducted in two phases—title/abstract screening and full-text review—independently by three researchers, with a fourth resolving conflicts. Data were extracted and assessed using Joanna Briggs Institute (JBI) tools. The included studies were synthesized narratively, combining both quantitative and qualitative analyses to ensure methodological rigor and contextual depth. Results: The adoption of AI tools in diabetes management is influenced by several barriers, including perceived unsatisfactory clinical performance, high costs, issues related to data security and decision-making transparency, as well as limited training among healthcare workers. Key facilitators include improved clinical efficiency, ease of use, time-saving, and organizational support, which contribute to broader acceptance of the technology. Conclusions: The active and continuous involvement of healthcare workers represents a valuable opportunity to develop more effective, reliable, and well-integrated AI solutions in clinical practice. Our findings emphasize the importance of a bottom-up approach and highlight how adequate training and organizational support can help overcome existing barriers, promoting sustainable and equitable innovation aligned with public health priorities. Full article

The rapid evolution of Industry 4.0 technologies has resulted in a scenario in which collaborative networks are essential to overcome the challenges related to their implementation. However, the frameworks to guide such collaborations remain underexplored. This study addresses this gap by proposing Business Rules and Goals Models to operationalize Industry 4.0 solutions through enterprise collaboration. Using the For Enterprise Modeling (4EM) method, the research integrates qualitative insights from expert opinions, including interviews with 12 professionals (academics, industry professionals, and consultants) from Brazilian manufacturing sectors. The Goals Model identifies five main objectives—competitiveness, efficiency, flexibility, interoperability, and real-time collaboration—while the Business Rules Model outlines 18 actionable recommendations, such as investing in digital infrastructure, upskilling employees, and standardizing information technology systems. The results reveal that cultural resistance, limited resources, and knowledge gaps are critical barriers, while interoperability and stakeholder integration emerge as enablers of digital transformation. The study concludes that successfully adopting Industry 4.0 requires technological investments, organizational alignment, structured governance, and collaborative ecosystems. These models provide a practical roadmap for companies navigating the complexities of Industry 4.0, emphasizing adaptability and cross-functional synergy. The research contributes to the literature on collaborative networks by connecting theoretical frameworks with actionable enterprise-level strategies. Full article

Oral health during pregnancy is essential for maternal and child well-being, as hormonal and physiological changes increase women’s susceptibility to oral diseases. Despite the recognized importance of prenatal dental care, adherence to dental services remains a challenge in the public health context. This study aimed to analyze oral health and the use of dental services during pregnancy through the perception of pregnant women. It represents the qualitative phase of a mixed-method study conducted with 25 pregnant women (with and without dental care) receiving prenatal care in the Brazilian Unified Health System (SUS). Participants were selected through saturation sampling, and data were collected via semi-structured interviews, followed by content analysis. The findings revealed four major themes: barriers and facilitators to dental care, changes during pregnancy and oral health. Discomfort from oral changes was a common concern. Barriers included misinformation, fear, cultural beliefs, and service organization. In contrast, facilitating factors were identified, such as care prioritization, support from healthcare teams, health education, and access through SUS. This study concludes that emotional, cultural, and contextual aspects shape the use of dental services during pregnancy. Access through SUS is perceived as an important facilitator, which simultaneously presents organizational weaknesses that need to be addressed. Full article

Background/Objectives: Access to health services is often limited due to socio-economic and organizational determinants of health systems, which lead to increased unmet healthcare needs. This study aimed to identify access barriers for the general population in Greece, including those that may have emerged following the COVID-19 pandemic. Methods: This was a cross-sectional survey of 1002 Greek citizens. A questionnaire regarding socio-demographics, healthcare utilization, and access to health services was used. Interviews took place between October and November 2022. Results: Of 837 participants who used health services in 2022, 82.6% had a medical consultation, 80.6% took diagnostic tests, and 63.6% visited a pharmacy for pharmaceuticals. Of those having a medical consultation, 33.1% did so at an NHS health unit, while 75% of the participants taking diagnostic tests visited a contracted private laboratory. Out of the 135 participants requiring hospitalization, 62% were hospitalized in a public hospital, while 85% of the participants requiring pharmaceuticals visited a private pharmacy. Access barriers in the past year were reported by 48% of the participants requiring a medical consultation, 34% of the participants requiring diagnostic tests, and 40% of the participants requiring hospitalization. The most common barriers were long waiting times and financial constraints. The main barrier to accessing pharmaceuticals was the availability and administration of the product. Conclusions: The identified healthcare access barriers highlight the vulnerabilities of the current health system in Greece, which were further exposed during the COVID-19 pandemic crisis. Addressing socioeconomic factors that are considered key access indicators should be the focus of future health policy initiatives. Full article

Operations management personnel emphasize the maintenance of workforce empowerment on the shop floor. This is made possible by implementing effective operations and human resource management practices. However, organizations are adept at controlling the workforce empowerment domain within operational scenarios. In the current industry revolution scenario, industry personnel often face failure due to a laggard mindset in the face of industry revolutions. There are higher possibilities of failure because of standardized operations controlling the shop floor. Organizations utilize well-established human resource concepts, including McClelland’s acquired needs theory, Herzberg’s two-factor theory, and Maslow’s hierarchy of needs, in order to enhance the workforce’s performance on the shop floor. Current SME individuals require fast-paced approaches for tracking the performance and idleness of a workforce in order to control them more efficiently in both flexible and transformational stages. The present study focuses on investigating the parameters and factors that contribute to workforce empowerment in an industrial revolution scenario. The present research is used to develop a framework utilizing operations and human resource management approaches in order to identify and address the issues responsible for deteriorating workforce contributions. The framework includes HRM and operations management practices, including Herzberg’s two-factor theory, Maslow’s theory, and lean and smart approaches. The developed framework contains four phases for achieving desired outcomes on the shop floor. The developed framework is validated by implementing it in a real-life electric vehicle manufacturing organization, where the human resources and operations team were exhausted and looking to resolve employee-related issues instantly and establish a sustainable work environment. The current industry is transforming from Industry 3.0 to Industry 4.0, and seeks future-ready innovations in operations, control, and monitoring of shop floor setups. The operations management and human resource management practices teams reviewed the results over the next three months after the implementation of the developed framework. The results revealed an improvement in workforce empowerment within the existing work environment, as evidenced by reductions in the number of absentees, resignations, transfer requests, and medical issues, by 30.35%, 94.44%, 95.65%, and 93.33%, respectively. A few studies have been conducted on workforce empowerment by controlling shop floor scenarios through modifications in operations and human resource management strategies. The results of this study can be used to fulfil manufacturers’ needs within confined constraints and provide guidelines for efficiently controlling workforce performance on the shop floor. Constraints refer to barriers that have been decided, including production time, working time, asset availability, resource availability, and organizational policy. The study proposes a decision-making plan for enhancing shop floor performance by providing suitable guidelines and an action plan, taking into account both workforce and operational performance. Full article

Background/Objectives: Despite its significant impact on learning, classroom acoustics and students’ hearing difficulties are often overlooked compared with more visible issues like lighting. Hearing loss—frequently underestimated and invisible—affects both students and teachers, potentially leading to fatigue, reduced participation, and academic challenges. The A.BA.CO. project in Italy was developed to address these issues by promoting improved classroom design, technological solutions, and better auditory communication accessibility in schools. Objective: This article presents the A.BA.CO. project, offering context and an overview of the preliminary analyses conducted by its multidisciplinary team. The goal is to share insights and propose organizational frameworks, technical solutions, and best practices concerning the hearing, communication, and auditory learning challenges experienced by students with hearing impairments. Results: The A.BA.CO. team’s analyses identified key barriers to inclusion for students with (or without) hearing impairments, such as poor classroom acoustics, excessive noise, and suboptimal seating arrangements. The project underscores the importance of improved acoustic environments and the integration of assistive technologies, including speech-to-text systems. The findings highlight the need for interdisciplinary collaboration to design accessible and inclusive educational settings for all learners. Conclusions: Embedding educational audiology within school systems—alongside enhancements in classroom acoustics and the use of assistive technologies and other technological solutions—is essential to ensure that all students, regardless of hearing ability, have equitable access to learning and full participation in educational life. Full article

As climate change intensified water scarcity in Southern Europe, tourism-dependent regions such as Portugal’s Algarve faced growing pressure to adapt their water management systems. This study investigated how hotel groups in the Algarve have adopted and communicated water reuse technologies—specifically desalination and greywater recycling—under environmental, institutional, and reputational constraints. A comparative qualitative case study was conducted involving three hotel groups—Vila Vita Parc, Pestana Group, and Vila Galé—selected through purposive sampling based on organizational capacity and technology adoption stage. The analysis was supported by a supplementary mini-case from Mallorca, Spain. Publicly accessible documents, including sustainability reports, media coverage, and policy frameworks, were thematically coded using organizational environmental behavior theory and the OECD Principles on Water Governance. The results demonstrated that (1) higher organizational capacity was associated with greater maturity in water reuse implementation; (2) communication transparency increased alongside technological advancement; and (3) early-stage adopters encountered stronger financial, regulatory, and operational barriers. These findings culminated in the development of the Maturity–Communication–Governance (MCG) Framework, which elucidates how internal resources, stakeholder signaling, and institutional alignment influence sustainable infrastructure uptake. This research offered policy recommendations to scale water reuse in tourism through financial incentives, regulatory simplification, and public–private partnerships. The study contributed to the literature on sustainable tourism and decentralized climate adaptation, aligning with UN Sustainable Development Goals 6.4, 12.6, and 13. 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

Background: Sexuality is a central aspect of being human, even if people experience it in different ways in various stages of life. Sexuality in older people may be expressed, as well as affection, companionship, touch, and physical contact. However, older peoples’ sexual needs are not properly considered by themselves, caregivers, or healthcare professionals. Reviews on barriers related to identification and satisfaction of sexual needs of people living in nursing home are scarce. In this scenario we intended to summarize the state of evidence regarding sexual need identification and satisfaction among older people living in nursing homes and possible barriers that could limit sexual need identification and satisfaction. Methods: We carried out a narrative review. The included studies responded to the research question, using the following key words: nursing homes, sexuality or sexual need, or sexual behavior, older people. Searched databases included PubMed, Embase, CINAHL, PsycInfo, and Scopus. Results: After searching and screening we included 22 studies, finding three main topics: 1. identification of sexual needs by residents and healthcare personnel attitude and practice; 2. barriers and reasons hindering the identification of sexual needs; and 3. manifestation and satisfaction of sexual needs. Conclusions: The findings showed that nursing homes’ residents have different sexual needs, but there are many organizational, educational, and cultural barriers and negative attitudes of healthcare personnel. Supporting nursing home residents to express their sexual needs is a challenge for the healthcare professionals and managers of nursing homes. Full article

Background/Objectives: International guidelines recommend the combined use of the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI) to support early and accurate diagnosis of cerebral palsy (CP). However, their implementation remains inconsistent. This study aimed to map their reported global use and identify associated enablers and barriers. Methods: A scoping review was conducted following JBI and PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Cochrane, PEDro, ProQuest, Web of Science, and Scopus. Eligible studies were charted and thematically analyzed, focusing on tools use and implementation factors at individual, organizational, and system levels. Results: Fourteen articles (seven surveys, seven implementation studies) from seven countries met the inclusion criteria. While awareness of GMA, HINE, and MRI was generally high, routine clinical use was limited—particularly outside structured implementation initiatives. Major barriers emerged at the system level (e.g., limited training access, time constraints, lack of standardized referral pathways) and social level (e.g., unclear leadership and coordination). Conclusions: The limited integration of GMA, HINE, and MRI into routine practice reflects a persistent “know–do” gap in early CP detection. Since implementation is shaped by the dynamic interplay of capability, opportunity, and motivation, bridging this gap demands sustained and equitable action—by addressing system-wide barriers, supporting professional development, and embedding early detection within national care pathways. Full article

Workaholism and perfectionism have increasingly been identified as significant obstacles to effective lifelong learning and skills development, ultimately undermining long-term career adaptability and organizational resilience. This study explores the predictive role of perfectionism and professional workaholism, with a particular focus on their implications for continuous education and occupational sustainability—defined as employees’ ability to remain adaptable and resilient over time. Using a cross-sectional quantitative design, data were collected from 105 participants (54 IT professionals and 51 nurses) who completed standardized measures of perfectionism and workaholism and reported their cognitive–emotional readiness for further training. Four regression models were employed to assess the impact of the three perfectionism dimensions and profession on overall workaholism and its subcomponents (excessive work, compulsive work, supplementary work). Socially prescribed perfectionism emerged as a strong predictor, accounting for over one-third of the variance in workaholism (β = 0.37; R²_adj = 0.368; p < 0.001), while self-oriented perfectionism significantly predicted excessive work (β = 0.25; p = 0.015). Professional domain had no significant effect, indicating the trans-professional nature of these psychological barriers. Additionally, workaholism was associated with reduced cognitive–emotional availability for ongoing training, highlighting its detrimental effects on lifelong learning. Limitations include the cross-sectional design and reliance on convenience sampling. From a practical perspective, the findings support interventions targeting maladaptive perfectionism, aiming to enhance engagement in continuous professional education and foster sustainable work environments, in line with the United Nations Sustainable Development Goals (SDG 4 and SDG 8). Full article

Long-acting (LA) antiretroviral therapies for human immunodeficiency virus (HIV), such as injectable formulations of cabotegravir and rilpivirine (CAB+RPV LA), are now available. Considering the limited data on the out-of-hospital administration of this combination, evaluating the implementation strategies needed is essential to support future clinical efforts. To gather data on barriers and facilitators of implementation for CAB+RPV LA in alternative outpatient facilities, this study used qualitative interviews informed by the Consolidated Framework for Implementation Research (CFIR), with 13 staff participating in the HOLA study (NCT06185452). Data analysis followed qualitative descriptive methods, assisted by Atlas.ti software version 22. The study adhered to the COREQ guidelines. Findings reveal five main factors to consider for implementation: operational and infrastructure adaptations, integrated management of human and organizational resources, need for coordination and follow-up, professional attitudes and work environment, and patient experience and patients’ needs perceived by professionals. This study emphasizes the comprehensive operational and infrastructure adaptations, adequate staff training, and supportive professional environment required for the successful implementation of CAB+RPV LA, while considering patients’ needs throughout the externalization process (trial registration number: NCT06643897). Full article

Background/Objectives: Evidence-based practice (EBP) has been widely adopted in clinical nursing practice, with nursing education efforts consistently emphasizing its importance in strengthening implementation efforts. Despite these efforts to promote translational research, the level of implementation of evidence-based practice (EBP) in clinical nursing practice remains unsatisfactory. This study aimed to identify specific organizational, individual, and research-related barriers to the utilization of research in clinical practice among nurses in Sabah, Malaysia, to determine factors associated with these perceived barriers and to assess nurses’ awareness and understanding of the implementation of evidence-based practice. Methods: A cross-sectional study was conducted in 2019 using the BARRIERS scale, a validated tool that measures perceived barriers to the utilization of research across four domains: organizational barriers, nurses’ research awareness and values, quality of research, and research communication. This study involved nurses from five tertiary hospitals in Sabah, Malaysia. Results: A total of 562 nurses participated in the study, with a mean age of 34.3 years (SD = 7.96) and mean duration of clinical practice of 10.0 years (SD = 7.58). While 66.5% of the nurses had heard of EBP, only 7.3% reported understanding it very well. The top three barriers to the utilization of research were ‘the nurse does not feel she/he has enough authority to change patient care procedures’ (35.9%), ‘the nurse does not have time to read research’ (27.8%), and ‘research reports/articles are not published fast enough’ (25.8%). Among the four domains, organizational barriers scored highest (mean = 2.7, SD = 0.72), followed by research communication (mean = 2.6, SD = 0.73). Conclusions: The study findings emphasize the challenges nurses encounter in integrating research into clinical practice and highlight the need for ongoing efforts to promote the utilization of evidence-based practice and research among nurses in Sabah, while addressing the identified gaps. Full article

Background: Pneumococcal vaccination rates in the United States (US) remain suboptimal, especially for adults aged 19 to 64 with high-risk medical conditions. Community-pharmacy-based immunization services increase vaccine access, particularly in rural areas. This study describes the provision of pneumococcal immunization services, assesses the processes used to identify and confirm patient eligibility, and determines barriers to immunization services in rural community pharmacies. Methods: A cross-sectional survey was emailed to members of the Rural Research Alliance of Community Pharmacies, located in the southeastern US. The survey assessed which pneumococcal vaccines were offered, age groups, prescription requirements, and how patient eligibility was determined. In addition, participants were asked to rate a series of patient-related and organizational barriers to pneumococcal vaccination. Results: Ninety-four pharmacies completed the survey, with most (96.8%) offering pneumococcal vaccines, most commonly PCV20 (95.6%). Most pharmacies vaccinated patients upon request (98.9%) or when patients presented with a prescription (82.4%), but few proactively contacted patients to schedule the vaccination (17.6%). Pharmacists most often administered pneumococcal vaccines to patients aged 65 and older and used patient age and immunization information systems to identify eligible patients. The most common patient-related barrier was the patient’s belief that they do not need the vaccine. The most common organizational barriers were inadequate reimbursements for vaccine administration and vaccine products. Conclusions: Pneumococcal vaccinations are commonly offered in rural community pharmacies, which play an important role in immunization access. With recent guideline changes to the age-based recommendation, there is an opportunity to optimize strategies to increase vaccine uptake. Full article