Exploring the barriers and enablers to attendance at rural cardiac rehabilitation programs

Objective: The objectives of this study were to: (i) identify local barriers and enablers to the uptake of hospital-based cardiac rehabilitation (CR) programs, and (ii) identify preferred alternatives for the delivery of CR.

Design: A questionnaire administered by local CR coordinators and focus groups facilitated by the research team.

Setting: Six regional hospitals in south-west Victoria offering hospital-based CR programs.

Participants: Patients and their carers referred to and eligible for local CR programs; health professionals working within local CR programs.

Main outcomes measures: CR attendees and decliners demographics, patient and health professional perceived factors which contribute to enabling hospital-based CR attendance, patient and health professional perceived barriers to CR attendance, and receptiveness and preferences for alternative modes of CR delivery.

Results: This study identified distance to travel to hospital-based CR programs the only statistically significant factor in determining uptake of CR. Easy access to transport (63%) and to a lesser extent family support (49%) and work flexibility (43%) were the primary enablers to attendance. Of the 97 study participants, 38% were receptive to alternative CR methods such as programs in outlying communities, evening facility-based programs, home and GP based programs, telephone support and a patient manual/workbook.

Conclusions: The results of this study provide valuable information for designing strategies to increase utilisation and improve patient acceptability of existing hospital-based CR programs. It provides a basis for pilot testing alternative modes of CR program delivery for cardiac patients in rural areas unable to access hospital-based CR.

Understanding barriers to attendance and non-attendance at Arts and Cultural Institutions: A Conceptual Framework

This paper draws together themes from within the leisure, arts and other literature related to why people might not attend cultural institutions and identifies eight barriers: 1) Physical; 2) Personal Access; 3) Cost; 4) Time and Timing; 5) Product; 6) Personal Interest; 7) Socialisation/Understanding; and 8) Information. Many of these barriers appear to be interrelated and as such strategies to address non-visitation will most likely need to be complex to allow the full range of barriers to be addressed.

Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation

Objective: To evaluate the clinical effectiveness and implementation of a falls prevention exercise programme for preventing falls in the subacute hospital setting.

Design: Randomized controlled trial, subgroup analysis.

Participants: Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a falls prevention exercise programme when enrolled in a larger randomized controlled trial of a falls prevention programme.

Methods: Participants in both the control and intervention groups who were recommended for the exercise programme intervention were followed for the duration of their hospital stay to determine if falls occurred. Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge. Participation rates in the exercise programme were also recorded.

Results: Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident.

Conclusion: This exercise programme provided in addition to usual care may assist in the prevention of falls in the subacute hospital setting.

Barriers to care for depressed older people : perceptions of aged care among medical professionals

The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. The implications of these findings for training programs for professional carers are discussed.

Motivational readiness for active commuting by university students : incentives and barriers

Issue addressed: Walking for transport can contribute significantly to health enhancing physical activity. We examined the associations of stages of motivational readiness for active transport with perceived barriers and incentives to walking to and from university among students. Methods: Mail-back surveys were completed by 781 students in a regional university in southeast Queensland. They identified one of eight options on motivational readiness for active commuting, which were then classified as: pre-contemplation; contemplation-preparation; or, action-maintenance. Open-ended questions were used to identify relevant barriers and incentives. Logistic regressions were used to examine the barriers and incentives that distinguished between those at different stages of motivational readiness. Results: Barriers most frequently reported were long travel distances, inconvenience and time constraints. Incentives most frequently reported were shorter travel distance, having more time, supportive infrastructure and better security. Those not considering active commuting (pre-contemplation) were significantly more likely to report shorter travel distance as an incentive compared to those in contemplation-preparation. Those in contemplation-preparation were significantly more likely to report lack of motivation, inadequate infrastructure, shorter travel distance and inconvenience as barriers; and, having more time, supportive infrastructure, social support and incentive programs as encouragement. Conclusions: Different barriers and incentives to walking to or from university exist for students in the different stages of motivational readiness for active commuting. Interventions targeted specifically to stage of motivational readiness may be potentially helpful in increasing activity levels, through active transport.

Marketing cultural attractions : understanding non-attendance and visitation barriers

Purpose – The purpose of this paper is to draw together the previous academic and industry research on non-attendance of cultural attractions, followed by qualitative in-depth interviews to identify commonalities or gaps in the previous research on barriers, constraints and inhibitors, as well as to propose linkages between these.

Design/methodology/approach – A multi-method approach is used – where barriers, constraints and inhibitors are identified by means of thematic content analysis of the literature. A set of probing questions is developed based on these themes and is then examined in in-depth interviews with individuals that had not visited cultural attractions in the past two years, in an attempt to triangulate data, as well as to identify connections between barriers.

Findings – From the literature, eight interconnected barriers to visitation are identified: physical access; personal access; cost; time and timing; product; personal interest and peer group; socialisation and understanding; and information. The in-depth interviews generally support these, although it is also identified that there are complex interrelationships between the issues.

Originality/value – This paper addresses the neglected question of why people do not attend cultural attractions by triangulating thematic findings from the content analysis of diverse literature with in-depth interview responses from one non-visitor segment. This results in an interconnected model of barriers that can be used to assist managers to develop strategies addressing low visitation rates within targeted segments.

Barriers to learners' successful completion of VET flexible delivery programs

In the early 1990s, Australian policymakers began explicitly promoting increased use of flexible delivery in vocational education and training (VET). Some researchers argued that many students lack the learning skills required to deal with the unique demands of flexible delivery. Concerns were also raised about the VET sector's capacity to help students develop needed cognitive and metacognitive skills. A review of the literature revealed wide agreement that students' success in flexible delivery and open and distance education in Australia and elsewhere is generally determined by a complex interplay of factors, including the following: readiness for self-directed learning; ability to balance the time demands of study with other commitments such as family and work; level of literacy; ability to understand and deal with assessment requirements; level of motivation; and previous educational experiences. Two case studies based on the actual experiences of two of six students interviewed about their experiences in flexible VET delivery were reviewed. Both students decided to withdraw from their VET course because of several interconnected factors that built up over time. Both cases illustrated that some problems that can be addressed quickly in face-to-face learning environments are much more difficult to resolve when students are off campus.

Online delivery and learning in regional Australia : benefits and barriers

The potential for online learning to enhance learning opportunities of those living in regional Australia cannot be over-emphasised. This chapter* describes a study where online delivery was mapped to determine ‘what’ is happening and ‘why’. This enabled the benefits, barriers and ‘promoters’ of online learning to be identified. However, an important conclusion of this study is that there is a lack of consistent, comparable enrolment data relating to online learning, which obviously affects funding allocation decisions. To ensure high-quality learning experiences and appropriate support for students and staff, institutions require adequate funding and resources based on models which reflect the reality of online delivery and learning.

A preliminary analysis of barriers, intentions, and attitudes towards moderate physical activity in women who are overweight

Physical activity is important for the health of all individuals, however, the determinants of physical activity behaviour for women who are overweight remain largely unexplored. The purpose of this investigation was to explore a range of factors that influence participation in physical activity for a group of women who are overweight. Participants were 30 women, aged 25–71 years, with a mean age of 46.8 years (+12.95) and an average BMI of 31.2 kg/m2 (+5.6). Self-reported level of physical activity, perceived barriers and facilitators of physical activity, attitudes, intentions and perceived behavioural control to physical activity were measured. Seventeen participants were generally active, with self-reported moderate physical activity of 218.53 min (±113.82) in the last 7 days; whereas 13 participants were reportedly less active 43.46 (±42.98) min. Active participants were more likely to identify social reasons for participating in physical activity, while inactive participants perceived that their laziness prevented them from being physically active. There were no significant differences between active and inactive overweight women for attitude, intention or subjective norm for moderate-intensity physical activity. There was a significant difference between these women in perceived behavioural control (p = .014) for moderate-intensity physical activity, as women who felt more in control of their physical activity behaviour were more likely to engage in physical activity than inactive women. Future research should investigate interventions to increase behavioural control of moderate-intensity physical activity in women who are overweight.

Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

The structural and behaviourial barriers to sustainable real estate development

Sustainable real estate development appears, on literal translation of both terms, to be an oxymoron - however it is a concept that the real estate profession needs to embrace knowledgably. On one hand it can be argued that real estate development is required for continued economic growth and the adoption of sustainability measures is required to mitigate climate change and global warming. Over the last few years there has been growth in the number of sustainability tools available to designers and operators of buildings. For example, in the US the LEED scheme enables designers to assess the environmental impact of their design and to benchmark the sustainability of the design against industry recognised criteria. LEED follows a similar format to the UK’s Building Research Establishment Environmental Assessment Method (BREEAM) introduced in 1990 and the Australian ‘GreenStar’ introduced in 2004. Even though there are an increasing number of sustainability tools available to designers, it still remains that the degree of uptake of the tools has been sporadic. This paper discusses the barriers to sustainable real estate development. Firstly it identifies the barriers to uptake and secondly it establishes the structural barriers in the market which prevent the wider uptake of tools.