BMC Health Services Research最新文献

{"title":"Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China.","authors":"Xiaoyu Dong, Huaizhi Cheng, Ruotong Tian, Lingxiao Gao, Wenpei Lyu, Jiaqi Zhang, Doudou Huang, Bin Guo","doi":"10.1186/s12913-025-12631-x","DOIUrl":"10.1186/s12913-025-12631-x","url":null,"abstract":"<p><strong>Background: </strong>Globally, Out-of-pocket (OOP) payments as a share of Total Health Expenditure (THE) has always been a focus of attention in the field of health economics, which affects the economic burden of medical treatment for residents. At present, countries around the world have widely used spatial econometric models to conduct in-depth discussions and analyses of their own OOP, exploring the spatial distribution characteristics and influencing factors of OOP in different regions. However, in China, research in this area is relatively scarce, and few studies have been conducted from a macro perspective and space-time dimension.</p><p><strong>Methods: </strong>Based on the panel data of 31 provinces in China, the spatiotemporal distribution characteristics of the proportion of OOP payments in China from 2013 to 2022 were analyzed using spatial autocorrelation. The spatial Durbin model (SDM) was employed to explore the factors influencing OOP payments as a share of THE in China.</p><p><strong>Results: </strong>The results indicate that the proportion of OOP in China shows a decreasing trend, and there is a significant spatial positive correlation. The change in spatial agglomeration is relatively stable, and only some provinces have a slight change. SDM shows that the main factors affecting the inter-provincial differences in the OOP proportion in China include the elderly dependency ratio (direct effect - 0.181, indirect effect - 0.585), the child dependency ratio (direct effect 0.292, indirect effect 0.686), per capita GDP(direct effect 11.235), and the proportion of government health expenditure to fiscal expenditure (direct effect - 0.254, indirect effect - 0.994), the average number of medical visits per year (direct effect - 0.444), the expenditure of basic medical insurance (direct effect - 1.519, indirect effect - 3.940), and the average medical cost of outpatients (direct effect 3.142, indirect effect - 10.064). These factors collectively influence the spatial variation in OOP payments across provinces in China.</p><p><strong>Conclusion: </strong>The spatial distribution difference of OOP proportion in China is obvious. Factors such as demographics, economics, policy, and health service utilization can all significantly influence OOP. The government should further implement differentiated medical security policies, optimize the allocation structure of health resources, enhance the capacity of primary medical services, promote cross-provincial medical cooperation, and ensure that local residents can enjoy equal access to high-quality medical services and reduce their medical burden.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"471"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting managerial decisions: a comparison of new robotic platforms through time-driven activity-based costing within a value-based healthcare framework.","authors":"Stefano Landi, Gianluca Maistri, Luca Piubello Orsini, Chiara Leardini, Sarah Malandra, Alessandro Antonelli","doi":"10.1186/s12913-025-12598-9","DOIUrl":"10.1186/s12913-025-12598-9","url":null,"abstract":"<p><strong>Background: </strong>The advent of novel robotic platforms requires that managers base their decisions on the value these platforms generate. This study showcases how micro-costing methodologies can assist managers in the decision-making process regarding the implementation of new robotic platforms within the value-based healthcare (VBHC) framework.</p><p><strong>Methods: </strong>We applied time-driven activity-based costing (TDABC) to evaluate cost disparities between the da Vinci and Hugo robotic systems for robot-assisted radical prostatectomy (RARP). Data were collected from consecutively enrolled patients with organ-confined prostate cancer. Basic cost information was gathered from Azienda Universitaria Integrata di Verona's finance and pharmacy departments. We conducted cost and sensitivity analyses to evaluate the most cost-sensitive parameters.</p><p><strong>Results: </strong>The da Vinci system incurred higher total costs for RARP than the Hugo system (€4,97.21 vs. € 3,511.73, p-value < 0.001) However, excluding surgical kit costs, the da Vinci platform proved less expensive (€1,481.18 vs. €1,926.18, p-value < 0.001). Sensitivity analyses identified surgical kit costs as the most influential parameter, followed by surgical duration and platform costs.</p><p><strong>Conclusions: </strong>This study highlights the importance of micro-costing practices in supporting managerial decisions within a VBHC framework. When clinical outcomes are equivalent, the value of robotic platforms is related to cost savings. By using TDABC and sensitivity analyses, managers can pinpoint critical activities and parameters to optimize the effective adoption of new platforms.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"470"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying risk factors for burnout-driven turnover in Canadian healthcare workers during the Covid-19 pandemic.","authors":"Taylor Orr, Ellie Cheung, Monidipa Saha, Temilola Balogun, Cindy Feng, Marwa Farag","doi":"10.1186/s12913-025-12522-1","DOIUrl":"10.1186/s12913-025-12522-1","url":null,"abstract":"<p><strong>Background/objectives: </strong>The COVID-19 pandemic has tested health systems worldwide, exposing significant weaknesses and vulnerabilities, particularly its toll on healthcare workers (HCWs). This study aimed to identify risk factors leading Canadian HCWs to consider leaving their positions due to stress or burnout during the pandemic.</p><p><strong>Methods: </strong>Data from the 2022 Survey on Healthcare Workers' Experiences During the Pandemic (SHCWEP) were analyzed using the Shanafelt and Noseworthy (2017) framework. We hypothesized that factors such as workload, work-life balance, resource availability, social and community support at work, and job environment-including organizational culture, values, and flexibility-could influence HCWs' intentions to leave due to stress or burnout. Multivariable logistic regression models were employed to identify significant risk factors for each HCW group.</p><p><strong>Results: </strong>The SHCWEP survey had a 54.9% response rate, with 12,139 HCWs participating. Of these, 3,034 HCWs (25%) expressed an intention to leave their current job, and within this group, 1,350 cited stress or burnout as their reason, representing 11% of the total participants and 44% of those intending to leave. Factors associated with HCWs considering leaving due to stress and burnout included being younger to middle-age, increased workload, longer working hours, financial difficulties, conflicts with colleagues or management, non-adherence to PPE/IPC protocols, and lack of professional emotional support.</p><p><strong>Conclusion: </strong>The findings underscore systemic issues exacerbated by the pandemic, highlighting the need for targeted interventions to address workload, organizational culture, and emotional support to mitigate stress and burnout and improve healthcare worker retention.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"469"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the COVID-19 pandemic on the surgical care continuum in Ethiopia: a national survey.","authors":"Amare Hailekiros Gebregzi, Berhane Redae Meshesha, Hassen Mohammed Beshir, Desalegn Bekele Taye, Fitalew Dagnew, Manuel K Sibhatu, Amanuel Sisay Endeshaw, Fantahun Tarekegn Kumie","doi":"10.1186/s12913-025-12602-2","DOIUrl":"10.1186/s12913-025-12602-2","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic severely affected social welfare, the economy, and global health, making delivering even the essential health service impossible. Surgical and anesthetic care was one of the essential parts of the health system that the COVID-19 pandemic greatly affected. This study aimed to assess the impact of COVID-19 on surgical care provision and the effectiveness of recovery measures in Ethiopia.</p><p><strong>Methods: </strong>An analysis of trends in a subcategory of surgical procedures performed in the years before COVID-19 and after the COVID-19 pandemic, which was designated as phases 0, 1, and 3, was conducted for public hospitals in Ethiopia that provided surgical services for three consecutive years, from January 2019 to March 2021. There were 24 general hospitals, 24 referral hospitals, and 91 primary hospitals. The indicators for assessing the impact of COVID-19 on the surgical care continuum were surgical volume, delay for surgical admission, cesarean section rate, and surgical site infection rate. The national District Health Information System (DHIS-2) of the Ministry of Health of Ethiopia was used to retrieve selected surgical services performance indicators.</p><p><strong>Results: </strong>Comparing the first COVID-19 pandemic year to the year prior to the pandemic, the mean surgical volume in primary hospitals grew while the surgical volume at referral hospitals decreased. The average reported rate of cesarean sections during the epidemic years was 23.7%. When compared to the pre-pandemic (phase 0), the pandemic year 2020 (phase 1), the mean caesarian section rate increased for referral, general, and primary hospitals. During the post-pandemic year, there is a clinically significant delay in surgical admission for referral, general and primary hospitals.</p><p><strong>Conclusion and recommendation: </strong>Compared to the pre-pandemic period, COVID-19 significantly impacted the Ethiopian surgical care continuum, indicated by decreased surgical volume and increased surgical admission delays. To build a more resilient health system and meet community surgical service demand during public health emergencies, strengthening surgical service at primary health care units, such as primary hospitals and health centers with operation theatre blocks, should be prioritized.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"468"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workplace mistreatment of Swedish health care professionals: prevalence and perpetrators across profession, sex, and birth country.","authors":"Britta E Gynning, Elinor Forsheden Sidoli, Katrina J Blindow, Emma Cedstrand, Erika L Sabbath, Emma Brulin","doi":"10.1186/s12913-025-12620-0","DOIUrl":"https://doi.org/10.1186/s12913-025-12620-0","url":null,"abstract":"<p><strong>Background: </strong>This study explores the prevalence and co-occurrence of workplace mistreatment of nurses and physicians and their perpetrators. We explore the distribution of incivility and identity-based harassment (ethnicity-, gender-based, and/or sexual harassment), combined with sex and birth country in these two professional groups.</p><p><strong>Methods: </strong>This cross-sectional study draws on survey data, including an analytical sample of 141,237 Swedish nurses and physicians in 2022.</p><p><strong>Results: </strong>Incivility was the most prevalent mistreatment type, ranging from 28.2% among male physicians to 59.5% among nurses born outside Europe. Identity-based harassment ranged from 18.1% among male physicians to 57.8% among nurses born outside Europe. Incivility stemmed most commonly from internal perpetrators (co-workers), and harassment was more commonly experienced by patients or their relatives.</p><p><strong>Conclusions: </strong>The mistreatment of healthcare professionals was widespread. Different types of mistreatment often co-occur, but prevalence varies substantially. The protective effect of professional status was dependent on social structures.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"465"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could a hand-held, visual electrophysiology device theoretically reduce diagnostic waiting times for complex eye conditions in the NHS? A Discrete Event Simulation (DES) modelling study.","authors":"Steffen Bayer, Daniel Garillo, Marion Penn, Maria Chorozoglou, Sally Brailsford, Eloise Keeling, Fatima Shawkat, Perry Carter, Helena Lee, Jay E Self","doi":"10.1186/s12913-025-12551-w","DOIUrl":"https://doi.org/10.1186/s12913-025-12551-w","url":null,"abstract":"<p><strong>Background/objectives: </strong>Visual Electro-Diagnostic Testing (EDTs) are a highly specialised service in the NHS. The high cost of tests and a paucity of trained visual electrophysiologists has resulted in very few services across the UK and, when combined with increasing patient backlogs, has caused significant travel burden and variable waiting times. Here, we study the potential for impact on patients and services by adding a screening step to traditional referral pathways using an Electroretinogram (ERG) test from a relatively inexpensive, portable, hand-held EDT device; the RETeval^® (LKC technologies, Gaithersburg, MD, USA).</p><p><strong>Subjects/methods: </strong>We model a large regional-referral EDT service using Discrete Event Simulation (DES) modelling based on retrospective patient data and published best evidence for the device. We evaluate the potential impact that adding the screening step in referral pathways could have on patient waiting times should the device prove to be safe and useable in clinical practice.</p><p><strong>Results: </strong>We demonstrate that should the RETeval^® ERG be safe and useable in real-world clinical practice, it has the potential to significantly reduce patient waiting times by avoiding lab-based EDT assessment for up to 45% of patients. We also show that the impact on services and patients is likely to be resilient to realistic changes in referral numbers, sensitivity/specificity of the device and changes in clinical capacity.</p><p><strong>Conclusions: </strong>This work demonstrates that a RETeval^® ERG screening step, performed at the point of referral, has the potential to result in significantly reduced EDT waiting lists through fewer patients requiring lab-based EDT assessment and that DES modelling is a useful tool in making this assessment. However, many questions remain about using the device in the real-world setting for this purpose. Future studies are needed to assess its sensitivity/specificity, test/retest variability, changes in referral patterns due to the device, useability, acceptability to patients and importantly, the consequences of screening errors. Our work, using only retrospective data and a DES model, shows that using the device as an ERG screening tool warrants further investigation due to the potential impact on both patients and clinical services.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"461"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ninety-one years of midwifery continuity of care in low and middle-income countries: a scoping review.","authors":"Qorinah Estiningtyas Sakilah Adnani, Ela Nurfitriyani, Yunri Merida, Siti Khuzaiyah, Giyawati Yulilania Okinarum, Ari Indra Susanti, Victor Abiola Adepoju, Sarena Haji Hashim","doi":"10.1186/s12913-025-12612-0","DOIUrl":"https://doi.org/10.1186/s12913-025-12612-0","url":null,"abstract":"<p><strong>Background: </strong>Midwifery continuity of care during pregnancy, childbirth, and postpartum is essential for improving maternal and neonatal health outcomes. In low- and middle-income countries (LMICs), however, challenges such as healthcare worker shortages, limited infrastructure, poor healthcare access, and cultural barriers often hinder the effective provision of midwifery services. These issues contribute to unsustainable and inadequate care, adversely affecting maternal and newborn health. This study examines the impact of these challenges on the midwifery continuity of care and its subsequent effect on maternal and neonatal outcomes.</p><p><strong>Methods: </strong>A scoping review was conducted following Arksey and O'Malley's framework. We analyzed 43 articles published between 1932 and 2023 across four databases. Included studies were conducted in LMICs, focused on continuous care models, and published in English. The review aimed to capture the varied impacts of midwifery care on health outcomes.</p><p><strong>Results: </strong>The review found that midwifery continuity of care in LMICs significantly improves maternal and newborn health by reducing medical interventions, increasing physiological births, and enhancing maternal satisfaction and breastfeeding rates. The approach also lowers newborn mortality and morbidity. Success factors include community acceptance, midwives' cultural competence, and collaboration with traditional birth attendants. Barriers such as insufficient funding and resistance to change persist. Midwife-led continuity of care (MLCC) was associated with a 16% reduction in neonatal loss and a 24% reduction in pre-term births. Also, MLCC decreases newborn mortality by 10-20% and increases breastfeeding rates by up to 30%. Effective implementation requires integrating midwifery services into existing health systems, securing funding, expanding training, and strengthening community partnerships.</p><p><strong>Conclusions: </strong>Midwifery continuity of care enhances maternal and neonatal health in LMICs by minimizing unnecessary medical interventions and improving maternal satisfaction and breastfeeding outcomes. However, cultural and socioeconomic factors influence its acceptance. Further research is needed to integrate traditional birth attendants into formal health systems, overcome resistance to change, and develop strategies for effective collaboration between traditional and professional care providers.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"463"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance indicators on long-term care for older people in 43 high- and middle-income countries: literature review, web search and expert consultation.","authors":"Mircha Poldrugovac, Joost D Wammes, Véronique L L C Bos, Erica Barbazza, Damir Ivanković, Hanneke Merten, Janet L MacNeil Vroomen, Niek S Klazinga, Dionne S Kringos","doi":"10.1186/s12913-025-12573-4","DOIUrl":"10.1186/s12913-025-12573-4","url":null,"abstract":"<p><strong>Background: </strong>Long-term care (LTC) for older people is an area of focus for many health and social policies in high- and middle-income countries. Performance Indicators are used to provide national and subnational jurisdictions with insights to ensure quality of the provided LTC services for older people. Although LTC systems vary across jurisdictions, there is demand for internationally comparable indicators to support countries in monitoring LTC and facilitate mutual learning. The aim of this study was to provide an overview of indicators currently employed to monitor the performance of LTC systems and services in high- and middle- income countries and describe their key characteristics.</p><p><strong>Methods: </strong>A review of the literature in six scientific databases (literature review) and web searches of relevant sites across 43 selected countries (web search) was conducted. We asked country representatives from the Working Party on Health Care Quality and Outcomes of the Organization for Economic Cooperation and Development, where most of these countries are represented, to cross-validate the sources of information found (expert consultation). We then extracted and analysed the data from all obtained sources based on a predetermined set of characteristics.</p><p><strong>Results: </strong>The search of scientific databases yielded 12,960 records, from which forty papers were selected for inclusion. The scientific literature findings were complemented by 34 grey literature sources. In total, we identified performance indicators being used to monitor LTC systems and services across 29 national and subnational jurisdictions in 24 out of 43 countries. In total, 620 indicators were identified. All jurisdictions used indicators related to institutional LTC and 16 also used indicators on home care. The most frequently monitored structures, processes, and results were pressure ulcers, falls, use of restraints and pain management.</p><p><strong>Conclusions: </strong>We identified LTC performance indicators currently being monitored in 29 jurisdictions across 24 countries. Many jurisdictions are monitoring similar structures, processes, and results. This presents an opportunity to develop internationally comparable LTC performance indicators based on existing efforts across countries.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"460"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a new clinical service - what's your elevator pitch?","authors":"Ashvene Sureshkumar, Jillian Scandiffio, Dorothy Luong, Sarah Munce, Nanette Lai, Gregory Feng, Mark Bayley, Jiwon Oh, Monika Kastner, Andrea D Furlan, Abhimanyu Sud, Anthony Feinstein, Robert Simpson","doi":"10.1186/s12913-025-12633-9","DOIUrl":"https://doi.org/10.1186/s12913-025-12633-9","url":null,"abstract":"<p><strong>Background: </strong>People with multiple sclerosis (PwMS) identify emotional well-being as a key unmet care need. Mindfulness-based interventions (MBI) can improve emotional well-being in PwMS; however, there is a lack of information on their implementation in routine care. Healthcare policy influencers may provide critical insight as to the implementation process. The aim of this study was to explore the needs and priorities of healthcare policy influencers for implementing MBIs for PwMS in Canada.</p><p><strong>Methods: </strong>A qualitative descriptive approach was adopted using semi-structured interviews with an inductive thematic analysis. Healthcare policy influencers (e.g., senior clinical leaders, provisional health service commissioners, healthcare policymakers) in various settings across Ontario were recruited.</p><p><strong>Results: </strong>Twelve individuals with an average age of 51.1 ± 8.9 years participated in the semi-structured interviews. Interviews ranged from 12 to 60 min. Four themes were identified in thematic analysis: (1) Need for evidence with a personal connection is foundational; (2) People Power: Need for Implementation champions; (3) Finding its place: Need for embedding interventions into existing systems; and (4) Sustainability: Need for focus on long-term impact.</p><p><strong>Conclusion: </strong>Our study provides novel insight into complex factors which affect implementation of new interventions, such as MBIs for PwMS, into the healthcare landscape in Ontario. Six key steps were identified for implementors to consider when seeking to implement a new intervention: (1) identify the problem and the need for intervention, (2) establish evidence highlighting evidence of effectiveness for an intervention, (3) build a team of implementation champions, (4) pilot the novel intervention to establish proof of concept, feasibility, and ecological integration within current landscape, (5) identify decision makers for intervention implementation, and (6) develop an 'elevator pitch' for decision makers. The implementation process is convoluted and can lack clarity. This is a major challenge for implementers. We have identified six key steps for implementers to consider, making this process more transparent and hopefully more successful. Future research should explore, test, and bridge the gaps in the implementation pathway we have identified, as this may be critical in closing the gaps that exist in our healthcare systems.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"462"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of the implementation of the HIV workplace policy in Akwa Ibom State: a cross-sectional descriptive study.","authors":"Helen M Idiong, Anyiekere M Ekanem, Esther Nwanja, Prince E Idiong, Emilia A Udofia","doi":"10.1186/s12913-025-12586-z","DOIUrl":"10.1186/s12913-025-12586-z","url":null,"abstract":"<p><strong>Background: </strong>Eliminating AIDS by 2030 will remain a mirage if obstacles to achieving zero new HIV infections and viral suppression, like stigma and discrimination against people living with HIV (PLHIV) are not eliminated. Several strategies and policies are targeted at this issue but it remains a huge challenge globally. Like other countries, Nigeria adopted the HIV in the Workplace policy (HIV WPP) in 2013, aimed at protecting the rights of PLHIV in the workplace. Akwa Ibom State (AKS), Nigeria, adopted this policy in 2014. However, since its adoption, its implementation has not been assessed. This study aimed to evaluate the availability and implementation of the HIV WPP in the state.</p><p><strong>Methods: </strong>A cross-sectional study using a mixed methods research approach was conducted for 591 consecutively recruited employees and 43 employers/ decision-makers across 23 organizations. Data was collected from October 2022 to February 2023. Seven criteria based on the Policy Implementation Assessment Tool were used to assess policy implementation. Scores above 70% were categorized as optimal policy implementation. The chi-square test was used to determine the factors associated with the level of implementation of the policy. Results were analyzed using STATA 15.1 for quantitative and NVivo 10 for qualitative data.</p><p><strong>Results: </strong>A total of 591 employees provided completed responses, the majority were females (59.7%) and 60.2% worked in government establishments. Of the employers, 55.6% were < 45 years old, 59.1% were males, 72.7% had a university education and the median duration working as a manager was 5.5 years. Of the 22 assessed establishments, the policy was available in 1 (4.5%) organization and 95% had a suboptimal implementation of the policy. The unavailability of the policy and resources for implementation were deterrents to the level of implementation of the policy.</p><p><strong>Conclusion: </strong>The level of implementation of the Akwa Ibom HIV in the workplace was suboptimal across both private and public sectors in the State. This was attributed to the unavailability of the policy and other resources for implementation. The State Agency for the Control of AIDS should consider improving access to the policy and strengthening implementation structures.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"459"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}