Protocol for ACCESS: a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia

Introduction The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia. Methods and analysis Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 women's health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers. Ethics and dissemination The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee.

Cross-sector surveys assessing perceptions of key stakeholders towards barriers, concerns and facilitators to the appropriate use of adaptive designs in confirmatory trials

Background Appropriately conducted adaptive designs (ADs) offer many potential advantages over conventional trials. They make better use of accruing data, potentially saving time, trial participants, and limited resources compared to conventional, fixed sample size designs. However, one can argue that ADs are not implemented as often as they should be, particularly in publicly funded confirmatory trials. This study explored barriers, concerns, and potential facilitators to the appropriate use of ADs in confirmatory trials among key stakeholders. Methods We conducted three cross-sectional, online parallel surveys between November 2014 and January 2015. The surveys were based upon findings drawn from in-depth interviews of key research stakeholders, predominantly in the UK, and targeted Clinical Trials Units (CTUs), public funders, and private sector organisations. Response rates were as follows: 30(55 %) UK CTUs, 17(68 %) private sector, and 86(41 %) public funders. A Rating Scale Model was used to rank barriers and concerns in order of perceived importance for prioritisation. Results Top-ranked barriers included the lack of bridge funding accessible to UK CTUs to support the design of ADs, limited practical implementation knowledge, preference for traditional mainstream designs, difficulties in marketing ADs to key stakeholders, time constraints to support ADs relative to competing priorities, lack of applied training, and insufficient access to case studies of undertaken ADs to facilitate practical learning and successful implementation. Associated practical complexities and inadequate data management infrastructure to support ADs were reported as more pronounced in the private sector. For funders of public research, the inadequate description of the rationale, scope, and decision-making criteria to guide the planned AD in grant proposals by researchers were all viewed as major obstacles. Conclusions There are still persistent and important perceptions of individual and organisational obstacles hampering the use of ADs in confirmatory trials research. Stakeholder perceptions about barriers are largely consistent across sectors, with a few exceptions that reflect differences in organisations’ funding structures, experiences and characterisation of study interventions. Most barriers appear connected to a lack of practical implementation knowledge and applied training, and limited access to case studies to facilitate practical learning. Keywords: Adaptive designs; flexible designs; barriers; surveys; confirmatory trials; Phase 3; clinical trials; early stopping; interim analyses

The effects of minimal tillage, contour cultivation, in-field vegetative barriers and crop residues on phosphorus and sediment yields

Runoff, sediment, total phosphorus and total dissolved phosphorus losses in overland flow were measured for two years on unbounded plots cropped with wheat and oats. Half of the field was cultivated with minimum tillage (shallow tillage with a tine cultivator) and half was conventionally ploughed. Within each cultivation treatment there were different treatment areas (TAs). In the first year of the experiment, one TA was cultivated up and down the slope, one TA was cultivated on the contour, with a beetle bank acting as a vegetative barrier partway up the slope, and one had a mixed direction cultivation treatment, with cultivation and drilling conducted up and down the slope and all subsequent operations conducted on the contour. In the second year, this mixed treatment was replaced with contour cultivation. Results showed no significant reduction in runoff, sediment losses or total phosphorus losses from minimum tillage when compared to the conventional plough treatment, but there were increased losses of total dissolved phosphorus with minimum tillage. The mixed direction cultivation treatment increased surface runoff and losses of sediment and phosphorus. Increasing surface roughness with contour cultivation reduced surface runoff compared to up and down slope cultivation in both the plough and minimum tillage treatment areas, but this trend was not significant. Sediment and phosphorus losses in the contour cultivation treatment followed a very similar pattern to runoff. Combining contour cultivation with a vegetative barrier in the form of a beetle bank to reduce slope length resulted in a non-significant reduction in surface runoff, sediment and total phosphorus when compared to up and down slope cultivation, but there was a clear trend towards reduced losses. However, the addition of a beetle bank did not provide a significant reduction in runoff, sediment losses or total phosphorus losses when compared to contour cultivation, suggesting only a marginal additional benefit. The economic implications for farmers of the different treatment options are investigated in order to assess their suitability for implementation at a field scale.

Knowledge transfer processes in PFI: identification of barriers and enablers

Increasingly, the UK’s Private Finance Initiative has created a demand for construction companies to transfer knowledge from one organization or project to another. Knowledge transfer processes in such contexts face many challenges, due to the many resulting discontinuities in the involvement of organisations, personnel and information flow. This paper empirically identifies the barriers and enablers that hinder or enhance the transfer of knowledge in PFI contexts, drawing upon a questionnaire survey of construction firms. The main findings show that knowledge transfer processes in PFIs are hindered by time constraints, lack of trust, and policies, procedures, rules and regulations attached to the projects. Nevertheless, the processes of knowledge transfer are enhanced by emphasising the value and importance of a supportive leadership, participation/commitment from the relevant parties, and good communication between the relevant parties. The findings have considerable relevance to understanding the mechanism of knowledge transfer between organizations, projects and individuals within the PFI contexts in overcoming the barriers and enhancing the enablers. Furthermore, practitioners and managers can use the findings to efficiently design knowledge transfer frameworks that can be used to overcome the barriers encountered while enhancing the enablers to improve knowledge transfer processes.

Barriers and commitment of facilities management profession to the sustainability agenda

The practice of sustainable facilities management (FM) is rapidly evolving with the increasing interest in the discourse of sustainable development. This paper examines a recent survey of the experiences of facilities managers in the rapidly growing and evolving industry in regard to the barriers and their commitment to the sustainability agenda. The survey results show that time constraints, lack of knowledge and lack of senior management commitment are the main barriers for the implementation of consistent and comprehensive sustainable FM policy and practice. The paper concludes that the diversity of the FM role and the traditional undervaluation of the contribution it makes to the success of organisations are partially responsible for lack of success in achieving sustainable facilities. The overwhelming barrier for sustainable FM practice is the lack of understanding, focus and commitment of senior executives in appreciating the opportunities, threats and need for strategic leadership and direction in driving essential change, and hence further the sustainability agenda.

Identifying barriers and opportunities for transitions towards more sustainable agriculture through system analysis: the case of Vereda La Hoya, Colombia

The paper presents the results of studies which investigated farmers’ reasoning and behaviour with regards to the mis‐use of personal protective equipment and pesticide among smallholders in Colombia. First, the research approach is described. In particular, the structured mental models approach and the integrative agent‐centred framework are presented. These approaches permit to understand the farmers’ reasoning and behaviour in a system perspective. Second, the results are summarized. The methods adopted allowed not only for identifying the factors, but also the social dynamics influencing farmers. Finally, suggestions for interventions are provided, which are not limited to a technical fix, but address the underlying social causes of the problem.

Using HIT to deliver integrated care for the frail elderly in the UK: current barriers and future challenges

In this paper we briefly describe the results of a 3 year project examining the use of Health Information Technologies (e.g., electronic patient record systems) to deliver integrated care. In particular, we focus on one group of patient (the frail elderly) and efforts to design an e-health supported healthcare pathway (the frail elderly pathway – FEP). The aim of FEP is to bring together clinicians and staff from health and social care and allow them to share patient information. Our findings show that progress in delivering a fully-supported and working FEP has been slow, not least because of the difficulties experienced by healthcare staff in using current IT systems. In addition, there are many strategic and technical issues which remain unresolved (e.g., systems interoperability).

UK innovation systems for new and renewable energy technologies: drivers, barriers and systems failures

A better understanding of the systemic processes by which innovation occurs is useful, both conceptually and to inform policymaking in support of innovation in more sustainable technologies. This paper analyses current innovation systems in the UK for a range of new and renewable energy technologies, and generates policy recommendations for improving the effectiveness of these innovation systems. Although incentives are in place in the UK to encourage innovation in these technologies, system failures—or ‘gaps’—are identified in moving technologies along the innovation chain, preventing their successful commercialisation. Sustained investment will be needed for these technologies to achieve their potential. It is argued that a stable and consistent policy framework is required to help create the conditions for this. In particular, such a framework should be aimed at improving risk/reward ratios for demonstration and pre-commercial stage technologies. This would enhance positive expectations, stimulate learning effects leading to cost reductions, and increase the likelihood of successful commercialisation.

Lessons from real estate partnerships in the UK: Drivers, barriers and critical success factors

Purpose – This paper seeks to summarise the main research findings from a detailed, qualitative set of structured interviews and case studies of Real Estate Partnership (REP) schemes in the UK, which involve the construction of built facilities. The research, which was funded by the Foundation for the Built Environment, examines the evolution of REPs in the UK and in Europe. The paper also aims to analyse best practice, critical factors for success, and lessons for the future. Design/methodology/approach – The research in this paper is based around ten semi-structured interviews conducted with senior representatives from corporate occupiers, property consultants, legal practices and REP service providers. Findings – The research in the paper demonstrates that REPs are particularly suited to the UK, where lease lengths are relatively long, and the level of corporate real estate owner-occupation is often higher than elsewhere. It also shows that further research is needed to examine the future shape and form of the UK REP market. Research limitations/implications – The paper is based on a limited number of in-depth case study interviews. The paper shows that further research is needed to find better ways to examine REPs empirically. Practical implications – The paper is important in highlighting a number of main issues in developing REPs: identifying with occupier's objectives; risk transfer and size of contract; and developing appropriate innovation and skills. Originality/value – The paper examines the drivers, barriers and critical success factors (at strategic and operational levels) for REPs in the UK in detail and will be of value to property managers, facilities managers, investors, financiers, and others involved in the REP process.

Consulting young children about barriers and supports to learning

From consideration of children's rights in general and equal opportunities for disabled children in particular, it is important to consult children about barriers and supports to learning and participation. Finding appropriate and feasible ways, however, to incorporate this into educational programmes for younger children can present challenges. Here we report on what happened when teachers from reception classes in England for children aged 4–5 years implemented activities designed to access pupils' views about what helps or hinders at school. Teachers evaluated the feasibility and usefulness of the activities and, together with a small sample of children's responses, this showed that young children could indeed identify aspects of school life they like or dislike, laying the foundations for identifying barriers and supports to learning. Teachers' responses highlighted the importance of careful choice of activity to meet the needs of young children, particularly those with communication difficulties and/or low self-confidence, with staff in some cases adapting and merging activities to suit pupils' needs. Sensitive issues emerged concerning the introduction of consultation activities early in children's school careers. The implications of a compliant rather than collaborative approach by teachers are discussed in the context of children's right to have their views heard, and their developing understanding of difference.

Missing out? Challenges to hearing the views of all children on the barriers and supports to learning

Children's views are essential to enabling schools to fulfil their duties under the Special Educational Needs and Disability Act 2001 and create inclusive learning environments. Arguably children are the best source of information about the ways in which schools support their learning and what barriers they encounter. Accessing this requires a deeper level of reflection than simply asking what children find difficult. It is also a challenge to ensure that the views of all children contribute including those who find communication difficult. Development work in five schools is drawn on to analyse the ways in which teachers used suggestions for three interview activities. The data reveals the strengths and limitations of different ways of supporting the communication process.

The effect of environmental change on human migration

The influence of the environment and environmental change is largely unrepresented in standard theories of migration, whilst recent debates on climate change and migration focus almost entirely on displacement and perceive migration to be a problem. Drawing on an increasing evidence base that has assessed elements of the influence of the environment on migration, this paper presents a new framework for understanding the effect of environmental change on migration. The framework identifies five families of drivers which affect migration decisions: economic, political, social, demographic and environmental drivers. The environment drives migration through mechanisms characterised as the availability and reliability of ecosystem services and exposure to hazard. Individual migration decisions and flows are affected by these drivers operating in combination, and the effect of the environment is therefore highly dependent on economic, political, social and demographic context. Environmental change has the potential to affect directly the hazardousness of place. Environmental change also affects migration indirectly, in particular through economic drivers, by changing livelihoods for example, and political drivers, through affecting conflicts over resources, for example. The proposed framework, applicable to both international and internal migration, emphasises the role of human agency in migration decisions, in particular the linked role of family and household characteristics on the one hand, and barriers and facilitators to movement on the other in translating drivers into actions. The framework can be used to guide new research, assist with the evaluation of policy options, and provide a context for the development of scenarios representing a range of plausible migration futures.