Background: Since 2012, nurse practitioners (NPs) in Ontario have the professional capacity to assume the role of the most responsible provider (MRP) in hospitals; however, few have implemented this model. Aim: To explore the barriers and facilitators to the integration of the NP as MRP model of care in a hospital setting. Methods: A qualitative descriptive design with secondary data collected from a larger study, was used with principles from integrated knowledge translation. Findings: Thirteen barriers and eleven facilitators were found, such as: (i) challenges with off hour coverage; (ii) funding and remuneration; (iii) discrepancies in the employment standards regulations; and (iv) lack of a critical mass. Facilitators included the plan for role implementation, establishment of trust and leadership from the team. Conclusion: Many barriers, predominantly at the healthcare system-level, make it difficult to integrate the NP as MRP model of care in hospitals.

Identifying factors that influence physical activity (PA) among individuals with Down syndrome (DS) is essential for PA promotion. Insight can be gained from guardians and health professionals. The purpose was to compare guardians and health professional perspectives on facilitators and barriers of PA in individuals with DS. Interviews were conducted with 11 guardians (5 mothers, 4 fathers, 2 legal guardians) and 11 professionals (4 PA specialists, 3 physical therapists, 4 occupational therapists). Grounded Theory was applied to data analysis. Barriers and facilitators fit the levels of the Ecological Model of Health Behavior: (a) Intrapersonal (perceived rewards); (b) Interpersonal (interaction); (c) Community (availability of programs); (d) Organizational (school systems); (e) Policy (education). Guardians and professionals agreed on the importance of enjoyment, interaction, and programs to promote PA. Differences were found among organizational and policy levels. PA in persons with DS is influenced by interactions between individual and environmental factors.

The Human Immunodeficiency Virus (HIV) epidemic remains a major global public health problem, with sub-Saharan Africa (SSA) at its epicentre. Despite the use of antiretroviral therapy (ART) to reduce new infections and deaths, SSA reports the highest HIV incidence, constituting two-thirds of global new infections. Cameroon is one of SSA countries where HIV care decentralization is enforced as a national policy but follow up of people living with HIV (PLWH) is provider-oriented, with limited patient involvement in clinical monitoring. The purpose of this dissertation was to explore predominant barriers and facilitators influencing ART adherence and identify effective interventions enhancing ART adherence across SSA. Furthermore, we sought to assess the prevalence and predictors of ART non-adherence among PLWH, and factors influencing non-adherence among PLWH who have experienced ART non-adherence in Cameroon. We conducted a comprehensive systematic review and meta-analysis on studies examining barriers to ART adherence and interventions boosting adherence. Forty-five studies were selected (30 for narrative synthesis and 15 for meta-analysis). Identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Adherence-enhancing interventions encompassed counselling, incentives, mobile phone short message service, peer delivered behavioral intervention, community ART delivery, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between intervention and control groups (pooled OR=1.56, 95%CI:1.35 - 1.80, p=<0.01). Using a cross-sectional study of adult PLWH in HIV treatment centres in Cameroon, we explored the prevalence and predictors of ART non-adherence. A total of 451 participants with mean age 43.42 years (SD: 10.42), were enrolled. Overall, ART non-adherence was 37.78%. Reasons for missing ART include forgetfulness, business and traveling without drugs. Significant factors associated with ART non-adherence include age, education, and alcohol consumption. In a qualitative study of 43 adult PLWH who had experienced ART non-adherence, adherence barriers included those related to patient, medication, health service, stigma, use of alternative treatment, resource limitation, environmental/social, and political instability. Adherence facilitators included social support, aligning treatment with patient’s daily routines, use of reminders, health sector/caregiver support, and awareness of HIV status/ART knowledge. To harness full potential of ART and mitigate HIV burden in SSA countries, stakeholders engaged in HIV management must recognize and integrate barriers, facilitators, and adherence-enhancing interventions when formulating policies or crafting treatment strategies. Continuous information provision and unflinching support both from patients’ families and caregivers are needed to improve adherence. Future studies focusing on specific underrepresented demographics - HIV-infected children, adolescents, and pregnant women in SSA are needed to uncover appropriate barriers, facilitators and interventions tailored to each group’s unique needs. Other studies focusing on assessing long-term non-adherence trends and determinants using larger samples of PLWH in many regions are necessary. Also, studies using both in-depth and focused group discussions, and quantitative approaches are required to uncover the ART non-adherence-related burden.

The purpose of this study was to explore and describe the experiences of teachers fulfilling the role of facilitators of the STAR intervention with fellow teachers at two neighbouring schools. The study constituted part of a broader research project that commenced in 2003, at a primary school in the Eastern Cape. At the time of the current study, seven of the ten teachers who participated in the initial study were replicating the initial study’s strategy in two neighbouring schools in an attempt to assist the teachers in providing psychosocial support. In an attempt to explore the experiences of the teacher-facilitators I observed a STAR intervention session (November, 2008), that involved four participants facilitating a STAR intervention session at the neighbouring school. Following my observation of the intervention session, I co-facilitated a focus group, exploring the teacher-facilitators’ experiences in fulfilling the role of peer-facilitators. Two days after the first focus group, I co-facilitated a follow-up focus group for the purpose of member-checking. In addition, I relied on field notes and visual data as data sources. Based on the data analysis that followed, three main themes emerged. Firstly, the teachers seemed to ascribe meaning on a personal level in terms of their experiences as facilitators of STAR. They experienced joy in sharing knowledge and enabling others, feelings of self-worth and self-confidence, personal development and growth, as well as confirmed commitment and motivation. Secondly, they experienced a shared voice in the community, in response to the peer-facilitation of STAR, referring to appreciation and trust that inspired enthusiasm for participation in various school-community systems and a sense of community as outcome of facilitation. Thirdly, participants identified aspects related to being a peer-facilitator, in terms of overcoming feelings of uncertainty and concern, working as a team, relying on creative problem solving when dealing with potential challenges, and extending the scope of facilitation. Based on the findings of the study I concluded that the participating teachers experienced the facilitation of STAR in a positive manner on both a personal and professional level. As a result of their positive experiences, they seemed to become even more committed and motivated than initially, to support their community through the facilitation of STAR. Their positive experiences seemingly influenced their perceived development in terms of self-efficacy beliefs and actualisation, which in turn enhanced their personal and professional growth, thereby forming a cycle of improved positive experiences on various levels. / Dissertation (MEd)--University of Pretoria, 2010. / Educational Psychology / unrestricted

Not participating in physical activities is considered to be a risk factor for the health and well-being of children, especially children with physical disabilities. Nonetheless, children with physical disabilities tend to participate less in physical activities than children without disabilities. The aim of this study was to identify what individual and contextual facilitators are suggested to support the participation of children aged 6 to 18 with physical disabilities in physical activities. A systematic literature review was conducted in four databases. The search was limited to articles written in English, peer reviewed and published between January 2006 and March 2016. A qualitative content analysis with focus on a deductive manifest approach was used to analyze the data. Seven articles were selected for data analysis. Results show that facilitators on an individual level include awareness of health benefits, being motivated, having fun, and social aspects such as meeting friends. Facilitators on a contextual level include support from people in the child’s environment, accessibility, adaptive equipment, modifiable activities, positive attitudes from others, available information, knowledgeable instructors, financial support, and transportation. Occupational therapists need to be aware of the facilitators identified on both individual and contextual level when planning interventions. More research with younger children is needed.

Purpose: The aim of the research is to investigate what successful booksellers provide in store that increase interaction and thereby enhance perceived value for the customers. Approach: The study is based on a combination of using both quantitative and qualitative data, collected through questionnaire and through face-to-face interviews. A deductive approach has constituted the paper as the theoretical framework was constructed upon already existing theories. Findings: The investigated booksellers are working with all of the three interaction facilitators; servicescape, shopping event as well as employee competence to create interaction in store that thereafter through relating, communicating and knowing increase the customer perceived value. The success behind the booksellers is based on their niche and personal approach that is thoroughly implemented in their offerings, which will create a community feeling. The personal relationship with the customers gives a structural support for the communication that in the end increase the knowledge. However, the knowledge renewal was more vital for the employees in order to provide personal service. Practical implications: Brick-and-mortar stores should fully acknowledge the importance of interacting with customers, by implementing servicescape, shopping event and employee competence with a personal touch. It is important to be as physical as possible and use the store as a social meeting place. The store should create a unique atmosphere, where like-minded customers socialize. The employee competence is vital for the brick-and-mortar stores in order to provide personal service. Theoretical implications: Grönroos and Voima’s (2012) Value creation sphere-model was extended by integrating Ballantyne and Varey’s (2006) triangulated value-enable-model into the joint sphere of Grönroos and Voima’s (2012) model. Since both of the models were tested empirically the paper supplies empirical evidence for both of the theoretical models.

The aim of the current study was to determine whether academic burnout/engagement mediated the relationship between academic obstacles/facilitators and academic performance within a South African university context. Participants received a web link to an online survey host in which a questionnaire was presented. The questionnaire included a selfdeveloped demographic questionnaire, an adapted version of the Student Stress Scale (Da Coste Leite & Israel, 2011), an adapted version of the Factors of Academic Facilitators Scale (Salanova, Schaufeli, Martinez, & Breso, 2010), the Maslach Burnout Inventory-Student Scale (Schaufeli, Salanova, Gonzalez-Roma, & Bakker, 2002) and the Utrecht Work Engagement Scale-Student (Schaufeli, Salanova, et al., 2002). The final sample (n=351) consisted of both full-time and part-time first year psychology students. The results of the current study demonstrated that academic obstacles were positively related to academic burnout while academic burnout was negatively related to academic performance. Academic facilitators were also negatively related to academic burnout and positively related to academic engagement. Academic burnout was also found to mediate the relationship between academic obstacles/facilitators and academic performance. The results of the study also demonstrated some non-hypothesised, but not unexpected, findings. Academic burnout, for one, was found to be negatively related to academic engagement. In addition, the indirect effect between academic obstacles and engagement was negative while the indirect effect between academic facilitators and engagement was positive. The results of the current study further demonstrated a novel finding whereby academic performance was positively related to burnout. Furthermore, the indirect effect between academic burnout and engagement was positive while the indirect effects between academic burnout and burnout, academic performance and engagement, and academic performance and performance, were negative. These findings were supported by previous research within both the work and student context. The results of the current study demonstrated, however, that academic engagement was not significantly related to academic performance and therefore was not a mediator in the relationship between academic obstacles/facilitators and academic performance. These results were unexpected given the literature available, however, may have been due to the way in which academic performance was operationalised within the current study. The implications of the results and the limitations of the current study were discussed, and suggestions for further research were made.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

The impact of the physical environment on communication for residents of long-term care (LTC) facilities has not been examined in depth. No study currently exists which explores environmental influences on communication within the long-term care setting. Investigation of such facilities is important because of the a large impact environmental features have on the quality of life of residents due to the often restricted nature of daily routines and reduced level of cognitive and/or physical function of residents. A definition of environment is needed in order to create a methodology for assessment and treatment of residents in LTC facilities. This study investigates what factors contribute to a positive communication environment in long-term care facilities and how the physical environment should be assessed. Observational data was obtained for three LTC residents with different types of physical and communicative impairments to determine what environmental factors inhibit or support communication. Barriers and facilitators to communication are identified, and recommendations for assessment of the long-term care environment are made. Contributions from the fields of aphasiology, environmental gerontology, and environmental psychology are described in order to contribute to the understanding of what contributes to a positive communication environment. Study results included support for: participant observation as a component of resident assessment, assessment of multiple environments, the importance considering individual needs during assessment, and assessment of resident perception of environment. Furthermore, this study presents a checklist to be used to guide observational assessments. / text