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This introductory chapter provides an overview of the land rights movement, drawing from the experience of the Yolngu peoples in northern Australia. This chapter identifies the different ways that land rights may be recognized. Each of these mechanisms has strengths and weaknesses, with a constitution being the most robust form of protection for land rights. However, the biggest challenge is in the implementation of land rights. Despite the challenges, Indigenous Peoples have successfully protected and reclaimed their lands under the ongoing force of dispossession, employing strategies such as direct action and litigation. Drawing from the contexts presented in this edited book, this chapter identifies the barriers to advancing land rights; the strategies to overcome these barriers and to support the reclamation of land; and identifies some of the opportunities to strengthen land rights moving forward.
This study examines multilevel barriers to women’s participation and contribution to the process manufacturing industry in an emerging economy. We employed an exploratory multiple-case study approach, and 24 semi-structured interviews were conducted with senior corporate managers. Drawing on the behavioral reasoning theory, intellectual capital-based view, and institutional theory-based view, the findings highlighted several individual, organizational, sociocultural, infrastructure, and institutional barriers at micro, meso, and macro levels that inhibited female participation in the manufacturing sector. This study is one of the early empirical investigations to examine the obstacles hindering women’s contributions to the process manufacturing industry in an emerging country, applying three theoretical lenses – behavioral reasoning theory, intellectual capital-based view, and institutional theory-based view. Furthermore, the insights gained from the study contribute to the literature on diversity, equity, and inclusion in the operations management domain by developing a multilevel integrative model of barriers to women’s participation in the manufacturing sector.
A person-centered outcomes-based quality improvement program is lacking within palliative care in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality.
Objectives
This study aimed to explore the barriers and facilitators perceived by healthcare providers to integrating the PCOC model in a Chinese hospital-based palliative care unit.
Methods
A qualitative descriptive study was conducted using semi-structured focus group and individual interviews. A rapid deductive analysis approach was selected for data analysis. The Consolidated Framework for Implementation Research framework was used to guide the study design, data collection, analysis, and interpretation.
Results
Eighteen healthcare professionals participated in this study, four focus group interviews and five individual interviews were completed. Barriers to the PCOC integration included clinical application and workload concerns (patients in terminal stage, patients’ dialects, workload concerns, and staff shortages); attitudinal barriers (negative attitudes toward PCOC); psychological barriers (numbness to their work) and barriers related to knowledge and self-efficacy (lack of knowledge, capacity, and self-efficacy in palliative care). Facilitators included adapting the program to local contexts, ongoing education and feedback, effective PCOC data use, a supportive work and clinical environment and staff’s perceived advantages of the model across clinical, research and process domains.
Significance of Results
The successful integration of the PCOC program hinges on local adaptation, improved data utilization, education, and IT support. In regions with less developed palliative care, enhancing professionals’ knowledge and self-efficacy is crucial. Incorporating assessment and clinical response protocols into technology can accelerate palliative care development and implementation.
Clinical and translational research (CTR) plays a vital role in improving health outcomes, but its success relies heavily on institutional support, infrastructure, and workforce capacity. This study aimed to explore the barriers, needs, and facilitators to conducting CTR in Oklahoma, highlighting both the strengths and gaps within the research ecosystem.
Methods:
A sequential, descriptive mixed-methods design was employed, combining survey data (n = 164) with four qualitative focus groups (n = 23 total participants). The survey assessed research infrastructure, funding, and workforce needs, while the focus groups explored researchers’ lived experiences and institutional challenges. Mixed-methods meta-inference approaches, such as convergence, complementarity, and explanatory integration, were used to identify overlapping and distinct patterns across data strands.
Results:
Key barriers included lack of protected research time (23.9%), limited pilot funding (15.3%), and administrative hurdles such as IRB delays. Researchers expressed a strong need for centralized tools to support networking, scientific writing, and data access. Qualitative findings revealed additional needs, such as bridge funding and mentorship, not fully captured in the survey. Facilitators included Oklahoma Shared Clinical and Translational Resources (OSCTR)-supported professional development and mentoring programs, though participants noted a heavy reliance on OSCTR as the primary support source, with few decentralized alternatives.
Conclusions:
While CTR infrastructure in Oklahoma has expanded, critical gaps remain in mentorship, data access, and institutional support. To build a more resilient and inclusive research environment, stakeholders should consider investing in decentralized systems, bridge funding, structured mentorship, and collaborative tools tailored to the state’s rural, tribal, and academic diversity. These findings may inform policy and strategic planning in Oklahoma and other underserved regions aiming to strengthen CTR capacity.
CJ experienced mental health problems and trauma during childhood and adolescence. This was treated effectively with psychotherapy. He remembers being exuberant and outgoing. Then, at the age of twenty-one, he developed a severe depressive episode, feeling numb and emotionless, unable to taste anything. Due to the previous history, a diagnosis of personality disorder was suggested, resulting in a delay in starting ECT whilst an inpatient. Relapses followed, the first one in Brazil, where he was quickly offered ECT. Back in the UK, CJ found pervasive barriers to getting treated with ECT, especially maintenance ECT, which he asked for several times, having seen the effect of the acute courses. He had to first try various drug treatments. There was also hesitancy in receiving psychotherapy because it was felt that ECT may affect his ability to engage in therapy. CJ feels that the community team had been inadequately resourced, equipped and educated about ECT to properly support him as an outpatient. CJ finishes the story with a description of his ‘life on maintenance’, which did not stop him from starting studies on a degree and working part-time as a research assistant.
People with severe mental illness (SMI) are at greater risk of obesity, cardiovascular disease and diabetes than the general population, due to a higher prevalence of health risk behaviours. Research is needed to inform tailored interventions to improve the health behaviours (diet, physical activity and sleep) of people with SMI in South Asia as these behaviours are closely linked to obesity. The study aimed to explore the barriers and facilitators to healthy diet, physical activity and good sleep among individuals with SMI. A qualitative design was employed using photovoice, semi-structured interviews and focus group discussions. Participants included 16 people with SMI, 16 caregivers and 17 health professionals in Bangladesh and Pakistan. Data were analysed thematically, informed by the socio-ecological framework. A complex interplay of individual, familial and societal factors influenced these health behaviours. Individual factors include knowledge, beliefs and mental health limitations. Caregivers play a crucial role in influencing behaviour. At the societal level, gender expectations, financial constraints and religious influences significantly impact these behaviours. The insights from this research can inform tailored interventions for this vulnerable group and highlight the need for integrated services, financial support and improved urban planning.
What next for autistics in the academy? In this chapter participants reflect on their career aspirations: the roles they aspire to and their expectations as to whether they will achieve their career goals. For those goals that seem out of reach, this chapter tries to answer the question of whether the barriers are intrinsic to being autistic or are systemic and structural.
This chapter explores the bi-directional challenges of autistics in the academy. Many of the challenges experienced by autistic people in academia are similar to those experienced in other aspects of our lives – dealing with sensory challenges, different processing styles, social interaction, and communication. Other challenges that are inherent to academia include the breadth of activity, the performance and competitive aspects of the role, and complicated institutional politics.
This study aimed to explore health professionals’ use, barriers, confidence, and preferences for technology and smartphone apps to assist clients with self-managing low back pain (LBP).
Methods:
Prospective observational cross-sectional survey of registered Australian health professionals that managed clients with LBP.
Results:
In total, 52 survey responses were included (mean age 43 ±13.8 years). Most did not personally use healthy lifestyle apps (60%) and did not recommend apps due to a lack of knowledge of app effectiveness (93%). The largest barrier to recommending apps was the potential for apps to be misused as a substitute to health professional diagnosis. Fifteen recommended smartphone apps (mean age 36 ±10.6 years) and were at least moderately confident in choosing/recommending apps (94%) and assessing app quality (80%). Those more likely to recommend apps personally used apps for healthy lifestyle behaviours (odds ratio (OR) 5.1 (p = 0.009)) were physiotherapists (OR 0.13 (p = 0.035) c/f chiropractors in their profession for <10 years (OR 8.6 (p = 0.015)) c/f >30 years. Increasing age decreased the odds (OR 0.94 (p = 0.013)) of recommending apps.
Conclusions:
Health professionals do not recommend LBP self-management apps due to a lack of knowledge of their effectiveness. Those that do recommend apps are confident with app choice, recommendation, and app quality assessment. Physiotherapists with <10 years’ experience were most likely to recommend apps.
This chapter documents our experiences of pivoting research on sexual and gender minority youth towards an online protocol using digital methods. Digital diaries presented an opportunity to conduct virtual longitudinal qualitative research on how youth describe their experiences of living through the COVID-19 pandemic in Vancouver, Canada. Our digital diary process, supplemented with remote interviews, allowed us to capture shifting health-related patterns and trends, establish capacity to identify and explore unanticipated areas of inquiry, and evaluate participants’ impressions of the method itself. While going digital allowed us to overcome some immediate constraints to participation, it also introduced new uncertainties, including equity concerns and issues around consistent, secure and safe digital access for research participants. We describe how features of young people’s lives remain important factors associated with their ability to participate in digital and remote research. We offer solutions to the challenges and conclude that to counteract the inequities arising from the shift to digital methods, we need flexible, adaptive and population-tailored digital and remote approaches to data collection.
This cross-sectional study examined the barriers and facilitators that influence vegetarian menu choices in a university cafeteria in Geneva, Switzerland. As a first step, an online survey developed by the authors based on the Capability, Opportunity, and Motivation Behaviour (COM-B) model was e-mailed to all university students and staff. In the second step, focus groups (FG) were held to complete the survey responses and identify what needed to be changed to promote the choice of the vegetarian menu in the cafeteria. Data from 304 participants collected through the survey was analysed. The main mentioned barriers were lack of vegetarian options, tastelessness and insufficient satiation. The facilitators that emerged from the survey were the price of the vegetarian menu for students and health and environmental benefits. Thirteen people participated in four FG sessions, which were analysed using thematic analysis. Five themes were identified: spontaneous menu selection, predefined menu selection, influence of opportunity on menu selection, influence of environmental sensitivity on menu selection, and threat to identity in menu selection. The choice of a vegetarian menu in a university cafeteria was mainly influenced by the attractiveness and taste of the plate. Future strategies to reduce food-related greenhouse gas emissions should (a) ensure the quality and attractiveness of the vegetarian menu, especially to appeal to the more resistant, such as men and omnivores, and (b) inform consumers about the guarantee of balanced nutrient intake of the vegetarian menu offered in the cafeteria, and about health and environmental benefits.
Academic psychiatry is essential for advancing mental health understanding and treatments. However, women encounter more obstacles hindering their progress in academia than men. This Editorial aims to highlight these obstacles and propose strategies to address them, advocating for a more supportive environment for women psychiatrists’ ongoing growth and development. The importance of supportive environments, fair access to opportunities and structural changes, including initiatives for mentorship, funding and flexible work arrangements, are crucial. Collaboration among governments, institutions and organisations is needed to enhance research infrastructure and promote gender equality. Encouraging and recognising women's contributions in research fosters inclusivity and innovation. Prioritising these efforts is vital for the existence, well-being and success of women in academic psychiatry.
To understand young women’s views of cervical screening, what obstacles they face, and what encourages them when considering attending their cervical screening.
Background:
Cervical screening figures have been steadily decreasing in the United Kingdom (UK). There is limited research on this trend, especially around views and knowledge of young women, aged 20–24 years, have before they are eligible for cervical screening.
Methods:
This qualitative study conducted 15 semi-structured Zoom in-depth interviews to discuss young women’s knowledge and perceptions of cervical screening in 2022. Participants were based in the UK. Thematic analysis was used to systematically manage, analyse, and identify themes including cervical screening knowledge; perceptions of cervical screening; barriers to cervical screening; and facilitators of cervical screening.
Findings:
The findings demonstrate significant gaps in knowledge and negative perceptions of cervical screening. Barriers to attending cervical screening were perceived pain and embarrassment. Facilitators suggested to promote attendance were ensuring access to appointments, creating pop-up clinics, and utilising incentives. The level of knowledge demonstrated by the participants, their negatively framed perceptions; and the vast number of barriers identified present substantial factors that could affect future attendance to cervical screening. Overall, action needs to be taken to prevent decreasing cervical screening attendance rates and eradicate any barriers women may experience.
Maternity outcomes for women from certain ethnic groups are notably poor, partly owing to their not receiving treatment from services.
Aims
To explore barriers to access among Black and south Asian women with perinatal mental health problems who did not access perinatal mental health services and suggestions for improvements, and to map findings on to the perinatal care pathway.
Method
Semi-structured interviews were conducted in 2020 and 2021 in the UK. Data were analysed using the framework method.
Results
Twenty-three women were interviewed, and various barriers were identified, including limited awareness of services, fear of child removal, stigma and unresponsiveness of perinatal mental health services. Whereas most barriers were related to access, fear of child removal, remote appointments and mask-wearing during COVID-19 affected the whole pathway. Recommendations include service promotion, screening and enhanced cultural understanding.
Conclusions
Women in this study, an underrepresented population in published literature, face societal, cultural, organisational and individual barriers that affect different aspects of the perinatal pathway.
Non-specialist mental health interventions serve as a potential solution to reduce the mental healthcare gap in low- and middle-income countries, such as Sri Lanka. However, contextual factors often influence their effective implementation, reflecting a research-to-practice gap. This study, using a qualitative, participatory approach with local mental health workers (n = 9) and potential service users (n = 11), identifies anticipated barriers and facilitators to implementing these interventions while also exploring alternative strategies for reducing the mental healthcare gap in this context. Perceived barriers include concerns about effectiveness, acceptance and feasibility in the implementation of non-specialist mental health interventions (theme 1). The participants’ overall perception that these interventions are a beneficial strategy for reducing the mental healthcare gap was identified as a facilitating factor for implementation (theme 2). Further facilitators relate to important non-specialist characteristics (theme 3), including desirable traits and occupational backgrounds that may aid in increasing the acceptance of this cadre. Other suggestions relate to facilitating the reach, intervention acceptance and feasibility (theme 4). This study offers valuable insights to enhance the implementation process of non-specialist mental health interventions in low-and middle-income countries such as Sri Lanka.
Barriers to innovation (e.g., obstacles causing not to innovate) are another critical concept that may affect the implementation of innovation. Innovation in the public sector has traditionally been viewed as something of an oxymoron. Burdened by a slow and stubborn bureaucracy, this traditional view concluded that innovation was essentially anathema to the public sector. More recently, however, careful research has subjected public sector innovation to scrutiny, and concluded that the perception of impervious barriers inhibiting innovative activity in the public sector is a mischaracterization. This chapter explains the differences between the public and private sectors and how this distinction is essential to understand barriers to innovation. Then, it explains the overall barriers to innovation in the public sector. After this explanation, the chapter provides more discussion based on the levels of analysis. Then, it discusses a relatively recent and novel concept: whether barriers to innovations are deterring or revealed. Finally, it provides strategies to policymakers about how to reduce barriers in the public sector.
Legume and pulse consumption is currently recommended for health and sustainability purposes, but barriers to consumption can include low enjoyment and poor sensory properties. This work aimed to investigate the relative importance of a number of barriers and facilitators towards legume, including pulse, consumption with a specific focus on enjoyment, sensory properties and a possible role for perceived cooking abilities in these relationships.
Design:
A cross-sectional questionnaire study assessed legume and pulse consumption, agreement and disagreement with statements relating to enjoyment, sensory properties, cooking abilities, practical aspects, healthiness, upbringing, social influences and quality issues, and four demographic characteristics. Complete responses were gained from 633 respondents with a mix of genders, ages, usual cooking responsibilities and usual eating habits.
Setting:
UK, March 2021 – September 2022.
Participants:
General UK adult population.
Results:
Using multiple regression analyses, enjoyment and cooking abilities were found to be important for both legume and pulse consumption (smallest beta = 0·165, P < 0·01), and the sensory properties of these foods were also important for the consumption of pulses (beta = 0·099, P = 0·04). Perceived cooking abilities also reduced the importance of enjoyment and sensory properties for consumption, mitigated effects due to upbringing and practical aspects and increased the value of perceived health benefits (smallest beta = 0·094, P = 0·04).
Conclusions:
These findings demonstrate a clear role for enjoyment, sensory properties and perceived cooking abilities in legume and pulse consumption and suggest benefits for increasing cooking abilities for improved legume and pulse consumption, as result of both direct and indirect effects.
In the United Kingdom (UK), racially-minoritised (non-White) people are more likely to have poorer health outcomes and greater difficulties with accessing healthcare (Dyer, 2019). People face individual and societal adversity that can affect their physical and mental wellbeing (Gibbons et al., 2012). There are clear mental health needs for racially-minoritised people, and we must go further in understanding the barriers to help to adequately meet the needs of diverse communities. The aim of this systematic review was to understand the barriers to accessing formal mental health support for racially-minoritised people within the UK. Qualitative empirical studies published between January 1970 to December 2020 were searched for using two databases: PsycINFO and Web of Science. Studies were searched for written in English, using a clinical or non-clinical population of adults with qualitative data collection and analysis methods. Database searches and reference mining gave a total of 283 studies, with 31 duplicates removed. Considering inclusion and exclusion criteria there were 15 final studies. A second researcher (S.O’H.) was used throughout, when selecting papers, quality assessment using the Critical Appraisal Skills Programme (CASP) checklist, coding and developing themes using thematic synthesis. The final four themes are ‘internal and external stigma’, ‘understanding of distress and coping’, ‘competence of professionals and services’ and ‘perception and accessibility’. There are various barriers making it harder for racially-minoritised people to access mental health support. Further research is needed with individual communities and action must be taken by commissioners, services, CBT practitioners, and others to eliminate barriers and improve mental health care.
Key learning aims
(1) To better understand the barriers to accessing mental health services, including Talking Therapies, for racially-minoritised communities.
(2) Low and high intensity CBT practitioners to better understand the factors that impact the wellbeing of racially-minoritised communities and how to better support different communities.
(3) Consider how to address these barriers to accessing support such as Talking Therapies services, with implications for practice and policy development.
The long-term impermeability of clay barriers in waste disposal facilities and hydraulic structures is of critical importance to environmental, agricultural, and industrial concerns. Changes in the oxidation state of Fe in the constituent clays of compacted clay barriers may degrade the hydraulic conductivity of these structures because other properties related to hydraulic conductivity, such as swelling, gel microstructure, and particle size, are greatly altered by the oxidation state. Two Na-saturated smectites (SWa-1 and API 25) were reduced by sodium dithionite (Na2S2O4), both in suspension and in situ after consolidation, to examine the effects of structural Fe reduction on hydraulic conductivity. Results indicated that the hydraulic conductivity depended on both the oxidation state and the consolidation history of the clay. The hydraulic conductivity of clay reduced in suspension before consolidation was lower than that of oxidized clay. Initially reduced smectite, thus, may be compactable to a less-permeable material with higher bulk density. But reduction of smectite in situ after consolidation increased the hydraulic conductivity and its variability. The oxidized state of clay liners should, therefore, be preserved.