Barreras y facilitadores para la búsqueda de ayuda profesional en salud mental, desde la perspectiva de adolescentes con depresión / Barriers and facilitators to mental health help-seeking, from the perspective of adolescents with depression

La prevalencia de depresión en adolescentes es aproximadamente 7% en Chile. Sólo entre 18% y 34% de jóvenes con depresión accede a ayuda profesional. Objetivo: El objetivo de esta investigación fue analizar barreras y facilitadores para la búsqueda de ayuda profesional en salud mental, desde la perspectiva de adolescentes entre 15 y 17 años con depresión en Santiago de Chile. Método: Se llevó a cabo un estudio cualitativo exploratorio y descriptivo desde el enfoque fenomenológico. Se realizaron diez entrevistas semi estructuradas a adolescentes, que fueron analizadas con teoría fundamentada. Resultados: Las principales barreras fueron estigma, minimización de síntomas y preocupación por confidencialidad. Los principales facilitadores fueron contar con red de apoyo, reconocimiento de síntomas e intervenciones escolares que favorecen la detección de síntomas. Conclusiones: Se debe trabajar de manera conjunta con adolescentes, sus familias, pares y sistema escolar brindando información sobre la depresión y su tratamiento.

The prevalence of depression in adolescents is approximately 7% in Chile. Only between 18% and 34% of young people with depression access professional help. Objective: The aim of this research was to analyze the barriers and facilitators for seeking professional help in mental health, from the perspective of adolescents between 15 and 17 years of age with depression in Santiago, Chile. Methodology: An exploratory and descriptive qualitative study was carried out from the phenomenological approach. Ten semi-structured interviews were conducted with adolescents and analyzed with grounded theory. Results: The main barriers were stigma, minimization of symptoms, and concerns about confidentiality. The main facilitators were having a support network, symptom recognition, and school interventions that favor symptom detection. Conclusions: Joint work should be done with adolescents, their families, peers, and school system providing information about depression and its treatment.

Barriers and Facilitators Factors to Uptake of Cervical Cancer Screening Among Women in Low- and Middle-income Countries: A Narrative Review

@#Cervical cancer is a worldwide health issue. Each year, it kills hundreds of thousands of women worldwide. Despite the availability of screening tests, the incidence of cervical cancer remains high in low and middle-income countries. In this review, we survey the current literature on factors affecting cervical cancer screening uptake among women in low and middle-income countries. It also highlights potential strategies for improving screening uptake and suggests directions for future research. Knowledge about cervical cancer and its screening, socio-demographic factors, personal and behavioural factors, cultural factors and beliefs, and health service factors are considered the main barriers and facilitators to cervical cancer screening uptake among women in low and middle-income countries. Understanding the facilitators and barriers to cervical cancer screening encountered by women in low and middle-income countries can improve screening uptake by overcoming inequalities in resource and information access. Culturally sensitive screening programs, improvement of the health system, and health education interventions to raise awareness of screening and its benefits can be effective strategies to improve screening uptake among women in low and middle-income countries.

Barreras y facilitadores para la práctica de actividad física en niños y jóvenes con parálisis cerebral: una revisión sistemática / Barriers and facilitators for the practice of physical activity in children and young people with cerebral paralysis: a systematic review / Barreiras e facilitadores para a prática de atividade física em crianças e jovens com paralisia cerebral: uma revisão sistemática

Objetivo: describir los principales facilitadores y barreras presentados en la población con parálisis cerebral (PC) y cómo estos ayudan o dificultan la práctica de actividad física. Metodología: se realizó una revisión sistemática de los últimos 10 años siguiendo lo expuesto en la declaración PRISMA, para lo que se utilizaron las bases de datos Web of Science, Scopus y PubMed. La estrategia de búsqueda arrojó un total de 99 documentos de los que finalmente fueron seleccionados 11 estudios. Resultados: los estudios establecen que existe una variedad de factores fisiológicos, psicológicos, sociales y macro ambientales que actúan tanto para promover como inhibir la participación en el deporte y el ejercicio en adolescentes con PC. Por otro lado, los facilitadores que más se dan a conocer, son la familia como foco principal, acompañada de su entorno y la estimulación temprana realizada desde que son pequeños. Conclusión: las barreras son un aspecto modificable y que pueden ser disminuidas con el objetivo de potenciar los facilitadores para aumentar la práctica de actividad física siendo duradera en el tiempo. Las principales barreras son la falta de acceso, los cambios en su cuerpo respecto a la práctica de actividad física, factores medioambientales, falta de profesionales que estén relacionados con el área, y el acceso a la actividad física en ambientes y espacios seguros. La familia juega un rol fundamental desde edades tempranas para incentivar a los niños, niñas o adolescentes con PC a realizar actividades físicas y/o deportivas.

Objective: To describe the main facilitators and barriers presented in population with cerebral palsy (PC) and how they help or hinder the practice of physical activity. Methods: A systematic review of the last 10 years was carried out, following what was stated in the PRISMA declaration, for which the Web of Science, Scopus and PubMed databases were used. The search strategy yielded a total of 99 documents where 11 studies were finally selected. Results: Studies have established that there are a variety of macro physiological, psychological, social, and environmental factors that both promote and inhibit participation in sport and exercise in adolescents with PC. On the other hand, the most common facilitators in the research are the family as the main focus, accompanied by their environment and the early stimulation that they get from an early age. Conclusion: Barriers are a modifiable aspect which can be reduced to empower facilitators that increase the practice of physical activity, being sustainable over time. The main barriers are lack of access, changes in the body regarding the practice of physical activity, environmental factors, lack of professionals who are related to the field, and access to physical activity in safe environments and spaces. Family plays a fundamental role from an early age in encouraging children or adolescents with CP to carry out physical and/or sports activities.

Objetivo: Descrever os principais facilitadores e barreiras que ocorrem na população com paralisia cerebral (PC) e como eles auxiliam ou dificultam a prática de atividade física. Metodologia: Realizou-se uma revisão sistemática dos últimos 10 anos seguindo o estabelecido na declaração PRISMA, para a qual foram utilizadas as bases de dados Web of Science, Scopus e PubMed. A estratégia de busca lançou um total de 99 documentos dos quais 11 estudos foram finalmente selecionados. Resultados: Os estudos estabeleceram que há uma variedade de fatores fisiológicos, psicológicos, sociais e macroambientais que atuam tanto para promover quanto para inibir a participação em esportes e exercícios em adolescentes com PC. Por outro lado, os facilitadores mais conhecidos na variedade de estudos têm como eixo principal a família, acompanhada de seu ambiente e da estimulação precoce que desenvolveram desde a infância. Conclusão: As barreiras são um aspecto modificável que pode ser reduzido com o objetivo de capacitar os facilitadores para aumentar a prática de atividade física de forma duradoura. As principais barreiras são a falta de acesso, as alterações em seus corpos devido à prática de atividade física, fatores ambientais, a falta de profissionais relacionados à área e o acesso à atividade física em ambientes e espaços seguros. A família desempenha desde cedo um papel fundamental para estimular as crianças e adolescentes com PC a realizarem atividades físicas e/ou esportivas.

Facilitators And Barriers to Hypertension Control, Fol-lowing the Implementation of India Hypertension Con-trol Initiative (IHCI) In Thiruvananthapuram District – A Qualitative Study

Background: India Hypertension Control Initiative (IHCI) was launched in 2017 to improve the control rate of hypertensive patients on treatment. Thiruvananthapuram was one of the 26 districts in the coun-try where the programme was initially rolled out. Methods: A qualitative cross-sectional study was conducted among stakeholders involved in the imple-mentation of IHCI of Thiruvananthapuram district. Purposive sampling method was used for the selec-tion of samples. A total of 25 in-depth interviews were carried out. Results: The major facilitators which propelled hypertension control were uniformity in drug prescrip-tion, proper documentation of patient data along with indicators for measuring control rates and a de-faulter tracking mechanism. Clinical inertia among doctors, increased workload and sending of bystand-ers for monthly follow-up are the major barriers that affected hypertension control. Conclusions: Replication of good practices performed under IHCI into similar health settings or pro-grammes can be encouraged. Apart from the few barriers seen at the programme level, the already exist-ing barriers at the health system level need to be addressed immediately through efforts such as e-Health incorporation and trainings.

Barreras y facilitadores en la atención primaria de salud en personas con discapacidad física / Barriers and facilitators in primary health care for people with physical disabilities

Introducción: La discapacidad se considera un problema de salud a nivel mundial. Las personas con discapacidad física son susceptibles de padecer distintos problemas de salud. A pesar de ser un grupo priorizado, el acceso a los servicios de salud es menor que el de la población en general, debido a barreras de distintos tipos. Objetivo: Describir las barreras y facilitadores de acceso a la atención primaria de salud en personas con discapacidad física. Métodos: Se realizó una revisión bibliográfica cuya metodología estuvo basada en la búsqueda, selección, revisión, interpretación y síntesis de la evidencia científica relacionada con el problema de investigación. Se utilizó como fuente de literatura científica primaria la publicada en las bases de datos Scielo, Redalyc, Latindex y PudMed en los últimos 5 años, con los términos de búsqueda MeSH en idoma español, inglés y portugués. Desarrollo: Se identificó un total de 67 documentos de los cuales se empleó 46 en la investigación realizada. Los restantes 21 manuscritos fueron excluidos por presentar deficiencias metodológicas que limitaban su utilización. Las principales barreras son las condiciones físicas de las unidades de salud; el funcionamiento del Sistema de Salud; el acceso de las personas con discapacidad a la atención primaria de salud; y las características del paciente y su entorno familiar. El principal facilitador es el relacionado con el Sistema de Salud. Conclusiones: El acceso de las personas con discapacidad física a los servicios de salud está condicionado por situaciones que se interpretan como barreras o facilitadores. En este sentido los factores relacionados con el sistema de salud nacional y con las características y el entorno de la persona con discapacidad pueden comportarse como barrera o como facilitador, en dependencia de su expresión(AU)

Introduction: Disability is considered a health problem worldwide. People with physical disabilities are susceptible to different health problems. Despite being a prioritized group, access to health services is lower than that of the general population, conditioned by the presence of different types of barriers. Objective: To describe the barriers and facilitators of access to primary health care in people with physical disabilities. Methods: A bibliographic review was carried out whose methodology was based on the search, selection, review, interpretation and synthesis of the scientific evidence related to the research problem. It was used as a source of primary scientific literature published in the databases Scielo, Redalyc, Latindex and PudMed in the last 5 years, with the MeSH search terms in Spanish, English and Portuguese. Results: A total of 67 documents were identified, of which 46 were used in the research carried out. The remaining 21 manuscripts were excluded due to methodological deficiencies that limited their use. Conclusions: The access of people with physical disabilities to health services is conditioned by situations that are interpreted as barriers or facilitators. In this sense, the factors related to the national health system and the characteristics and environment of the person with a disability can act as a barrier or as a facilitator, depending on their expression(AU)

Barreras y facilitadores para la formulación de políticas públicas que regulan los ambientes alimentarios obesogénicos: revisión de la literatura / Barriers and facilitators to policymaking public policies that regulate obesogenic food environments: review of the literature

INTRODUCCIÓN: Los ambientes alimentarios determinan en gran medida el comportamiento alimentario de la población, por lo que se asocian a la epidemia de obesidad. Es responsabilidad de los Estados formular e implementar políticas para intervenir los ambientes alimentarios obesogénicos. El éxito de las políticas dependerá de factores que actúan como barreras o facilitadores. OBJETIVO: Identificar las barreras y facilitadores que se presentan al formular e implementar políticas públicas que aborden los ambientes alimentarios obesogénicos. MATERIAL Y MÉTODO: Estudio secundario en base a revisión narrativa. La identificación, tamizaje y selección de los artículos publicados se guio por el diagrama PRISMA. Para la identificación se recurrió a las bases de datos electrónicas PubMed, Scielo, Scopus y Web of Science (WOS), ingresando campos de búsqueda y palabras clave. En el tamizaje se eliminaron los duplicados y se aplicaron criterios de inclusión. La calidad metodológica de los estudios elegibles se evaluó con el protocolo CASPe. RESULTADOS: Se revisaron estudios cualitativos que usaron entrevistas a actores claves. Las barreras identificadas para el proceso de formulación de políticas de ambientes alimentarios obesogénicos son el impacto económico negativo, falta de evidencia científica sobre la efectividad de las políticas, influencia de la industria alimentaria, debilidades de coordinación y cooperación técnica. Los facilitadores identificados son el compromiso político de los Estados con las agencias internacionales, enfoque de trabajo conjunto con la industria alimentaria y el apoyo académico. CONCLUSIÓN: La formulación de políticas para intervenir ambientes alimentarios obesogénicos está especialmente limitada por la industria alimentaria. Es relevante generar evidencia científica del impacto que, las regulaciones implementadas, han tenido en los factores económicos y sobre la salud de la población. La colaboración entre gobiernos e industria alimentaria, podría derivar políticas que, además de impactar positivamente la salud de la población, sean una oportunidad para el sector privado y la generación de empleo.

INTRODUCTION: Food environments largely determine the eating behavior of the population, which is why they are associated with the obesity epidemic. It is the responsibility of States to formulate and implement policies to intervene in obesogenic food environments. The success of the policies will depend on factors that act as barriers or facilitators. OBJECTIVE: To identify the barriers and facilitators for the formulation and implementation of public policies that address obesogenic food environments. MATERIAL AND METHOD: Secondary study based on narrative review. The identification, screening and selection of published articles was guided by the PRISMA diagram. For the identification, the electronic databases PubMed, Scielo, Scopus and Web of Science (WOS) were used, entering search fields and keywords. In the screening, duplicates were eliminated and inclusion criteria were applied. The methodological quality of eligible studies was assessed using the CASPe protocol. RESULTS: Qualitative studies that used interviews with key actors were reviewed. The barriers identified for the process of formulating policies on obesogenic food environments are the negative economic impact, lack of scientific evidence on the effectiveness of policies, influence of the food industry, weaknesses in coordination and technical cooperation. The identified facilitators are the political commitment of the States with international agencies, a joint work approach with the food industry and academic support. CONCLUSION: Policymaking to intervene in obesogenic food environments is especially limited by the food industry. It is relevant to generate scientific evidence of the impact that the implemented regulations have had on economic factors and on the health of the population. Collaboration between governments and the food industry could derive policies that, in addition to having a positive impact on the health of the population, would mean an opportunity for the private sector and the generation of employment.

Facilitators and barriers of patient involvement in hospital services: integrative review / Facilitadores y barreras para la participación del paciente en los servicios hospitalarios: revisión integrativa / Facilitadores e barreiras do envolvimento do paciente nos serviços hospitalares: revisão integrativa

ABSTRACT Objective to identify the facilitating factors and barriers that influence patient involvement in hospital services. Method integrative review; search of articles published between January 2011 and December 2020, in the electronic databases PubMed, Web of Science, Cinahl, Lilacs and Scopus, using descriptors related to "patient involvement", Barriers, Facilitators, in English, Spanish and Portuguese. Data collection was performed from May to June 2021, identifying 32 publications that met the inclusion criteria. Results the analysis resulted in three categories of facilitating factors and barriers: communication, actors of involvement and organizational culture, allowing the elaboration of a theoretical model of patient involvement. This model shows that in the centrality of the process are the actors involved, that is, patients and professionals, inserted in an organizational context, being influenced by leadership, culture, environment, available resources and processes, where communication permeates as a basis for involvement. Conclusion the facilitating factors and barriers identified in this review, synthesized in a theoretical model, allow transcending theoretical knowledge for practice. The complexity to operationalize this model requires patients, professionals, health services and society join forces to make this theoretical proposition a practice incorporated by the services.

RESUMEN Objetivo incidir en los factores y barreras de la implicación del paciente en los servicios hospitalarios. Método revisión integradora; búsqueda de artículos publicados entre enero de 2011 y diciembre de 2020, en las bases de datos electrónicas PubMed, Web of Science, Cinahl, Lilacs y Scopus, utilizando descriptores relacionados con "involucramiento del paciente", Barreras, Facilitadores, en inglés, español y portugués. La recolección de datos se realizó de mayo a junio de 2021, identificándose 32 publicaciones que cumplieron con los criterios de inclusión. Resultados el análisis resultó en las tres categorías de facilitadores y barreras: comunicación, factores de involucramiento y cultura organizacional, permitiendo la elaboración de un modelo teórico de involucramiento. Este modelo muestra que en la centralidad del proceso están los actores involucrados, es decir, pacientes y profesionales, insertos en un contexto organizacional, siendo influenciados por el liderazgo, la cultura, el ambiente, los recursos disponibles y los procesos, donde la comunicación permea como base para el involucramiento. Conclusión los factores y barreras identificados en esta revisión sintetizados en un modelo teórico, permiten trascender el conocimiento teórico para la práctica. La complejidad para operacionalizar este modelo requiere que los pacientes, los profesionales, los servicios de salud y la sociedad se unan para hacer de esta propuesta teórica una práctica incorporada por los servicios.

RESUMO Objetivo identificar os fatores facilitadores e as barreiras que influenciam no envolvimento do paciente nos serviços hospitalares. Método revisão integrativa; realizada busca de artigos publicados entre janeiro de 2011 e dezembro de 2020, nas bases eletrônicas PubMed, Web of Science, Cinahl, Lilacs e Scopus, utilizando descritores relacionados a "patient involvement", Barriers, Facilitators, nos idiomas inglês, espanhol e português. Coleta de dados realizada de maio a junho de 2021, identificando-se 32 publicações que atenderam aos critérios de inclusão. Resultados a análise resultou em três categorias de fatores facilitadores e barreiras: comunicação, atores do envolvimento e cultura organizacional, permitindo a elaboração de um modelo teórico de envolvimento do paciente. Esse modelo mostra que na centralidade do processo estão os atores envolvidos, ou seja, pacientes e profissionais, inseridos em um contexto organizacional, sendo influenciados pela liderança, cultura, ambiente, recursos disponíveis e processos, onde a comunicação perpassa como base para o envolvimento. Conclusão os fatores facilitadores e as barreiras identificadas nesta revisão, sintetizados num modelo teórico, permitem transcender o conhecimento teórico para a prática. A complexidade para operacionalizar esse modelo requer que pacientes, profissionais, serviços de saúde e sociedade unam os esforços para tornar esta proposição teórica em uma prática incorporada pelos serviços.

The Barriers and Facilitators of Family-Witnessed Resuscitation (FWR) in Adult Patients in the Emergency Department (EDS): A Systematic Review

@#Aims: Aims: When attending family members, the procedure for the resuscitation of cardiac arrest patients remains controversial. There have been conflicts on why healthcare professionals, should include the family during resuscitation. This systematic review seeks to identify the barriers and facilitators related to the FWR of adult patients at Emergency Department. Design: A systematic review was conducted on ten studies. This review utilized a clearly formulated research question then the data was gathered and analysed from the included studies. Data Source: Studies on the barriers and facilitators related to allowing family members to attend were included during January 2020 to May 2020. Methods: A systematic review of studies that investigate the barriers and facilitators of the FWR of adult patients at emergency department. All studies evaluated the barriers and facilitators related to allowing family members to attend cardiopulmonary resuscitation. This systematic review was registered in PROSPERO with the registration number CRD42020169383. Results: This review has demonstrated that the facilitators reduce conflict and provide a supportive presence that builds the emotional adequacy and closure related to the resuscitation. These policies can eliminate barriers, such as conflicts in EDs and negative attitudes, and expedite the accommodation of the professional as well as individual staff’s needs during witnessed resuscitation.

The Tele-Evaluation Facilitators Model

@#Telehealth has become an alternative service delivery of different healthcare professionals, including occupational therapists, upon the onset of the COVID-19 pandemic. Occupational therapists have adapted to this platform to deliver service in response to the global crisis. This conceptual framework explores the facilitators of occupational therapy evaluation provided via telehealth. It aims to provide insights to clinicians and clients in engaging tele-evaluation. It also aims to establish primary considerations to ensure a thorough evaluation process. The Tele-Evaluation Facilitators Model (TFM) describes the occupational therapy evaluation in the therapy setting. It outlines the OT evaluation process, adapting it to the telehealth setting. The process emphasizes the importance of client-caregiver interaction in creating and achieving occupational therapy goals. Moreover, surrounding the tele-evaluation process, the model highlights the facilitators of tele-evaluation, enabling a comprehensive evaluation process despite the challenges and barriers of this alternative service delivery. Across practice settings, the COVID-19 pandemic necessitated a shift in service delivery to telehealth, and occupational therapists adapted accordingly. Evaluation frameworks exist for telehealth services, but none are unique to occupational therapy evaluation. As a result, an occupational therapy framework that highlights the facilitators of telehealth evaluation will benefit occupational therapy. TFM consists of three domain areas: (1) Family Involvement, (2) Accessibility, (3) Professional Development. This framework promotes telehealth evaluation to clinicians and clients who have hesitations and difficulties in this service delivery model.

Barriers and facilitators to adherence for antiretroviral therapy the perspectives of patients from a wellness center in the Mpumalanga Province, South Africa

Introduction. Patients' non-adherence to antiretroviral treatment remains a public health concern in many developing countries, especially in South Africa. Objectives: The objective of the study was to explore the barriers and facilitators of patients' ART adherence in one health care facility in Mpumalanga Province, South Africa. Methods: A qualitative, exploratory, and descriptive design was employed to collect data using a semi-structured interview guide through individual in-depth interviews among twenty (20) purposively selected patients. The thematic analysis approach was used to generate themes from the data. Results: A majority of the participants were female (n=12, 60%), married (n=13, 65%), and employed (n=12, 60%). Barriers to ART adherence include insufficient medical staff at the health center and waiting time being too long. Facilitators included service providers' positive attitude, clear instructions for taking medication, benefits of adhering to ART, and dangers of defaulting treatment. Conclusion: Barriers and facilitators for adherence included several factors related to the health system, health care workers, and the patients. Achievement of optimal adherence to ART requires the commitment of both patients and providers

Enfermeria basada en la evidencia: revisión de alcance

RESUMEN Objetivos: Identificar la evidencia científica sobre el concepto, desarrollo y función, de la Enfermería Basada en la Evidencia (EBE) y analizar críticamente esta herramienta, sus elementos facilitadores y barreras para su implementación. Material y Método: Revisión de alcance según propuesta del Joanna Briggs Institute. Se consideró el rango de tiempo entre 1997 y 2019 para recuperar artículos y revisiones en inglés, portugués y español. Se utilizaron descriptores del tesauro Medical Subject Headings y términos booleanos para aplicar las estrategias de búsqueda en 4 bases de datos: PubMed, EBSCOhost, Scopus y Science Direct. Se complementó la búsqueda con la técnica de bola de nieve aplicada a la lista de referencias de los artículos relevantes seleccionados. Para evaluar la validez y el impacto de los resultados de los artículos de revisión y cualitativos se aplicó el Critical Appraisal Skills Programme Español (CASPE), y para estudios observacionales el Strengthening the Reporting of Observational studies in Epidemiology (STROBE). Para establecer los niveles de evidencia se utilizó Canadian Task Force on Preventive Health Care (CTPFCHC). Resultados: De 163.074 manuscritos iniciales, fueron seleccionados 44 para análisis y extraer datos referentes a: Historia de la EBE; Concepto y función de EBE; Etapas, barreras y facilitadores. Conclusiones: El concepto de EBE pone de manifiesto la necesidad de utilizar esta herramienta para planificar los cuidados mediante el uso del pensamiento crítico y reflexivo; la importancia de realizar el cuidado a la cabecera del paciente y cultivar un cuidado basado en la mejor evidencia, enmarcado, todo ello, en un contexto de humanización, así como considerar las barreras y facilitadores de esta herramienta.

ABSTRACT Objective: To identify the scientific evidence on the concept, development and function of Evidence-Based Nursing (EBN) and to critically analyze this tool, its facilitating elements and barriers for implementation. Material and Method: Scoping review according to the proposal of the Joanna Briggs Institute. The period between 1997 and 2019 was considered to retrieve articles and reviews in English, Portuguese and Spanish. Medical Subject Headings thesaurus descriptors and Boolean operators were used to apply search strategies in 4 databases: Pubmed, EBSCOhost, Scopus, Science Direct. The search was complemented with the snowball technique applied to the reference list of the relevant selected articles. The Critical Appraisal Skills Programme Español (CASPE) was used to assess the validity and impact of the articles review and qualitative results, and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) was used for the observational studies. To establish the levels of evidence, The Canadian Task Force on Preventive Health Care (CTPFCHC) was used. Results: Out of 163,074 initial manuscripts, 44 were selected for analysis and data extraction regarding history of EBN; concept and function of EBN; stages, barriers and facilitators. Conclusions: The concept of EBN highlights the need to use this tool to plan nursing care through critical and reflective thinking; the importance of providing direct patient care and promoting care based on the best evidence, in a context of humanization and considering the tool's barriers and facilitators.

RESUMO Objetivo: Identificar as evidências científicas sobre o conceito, desenvolvimento e função da Enfermagem Baseada em Evidências (EBE) e analisar criticamente esta ferramenta, seus elementos facilitadores e as barreiras para sua implementação. Material e Método: Revisão do escopo de acordo com a proposta do Instituto Joanna Briggs. Considerou-se o período entre 1997 e 2019 para recuperar artigos e revisões em inglês, português e español. Foram utilizados descritores do tesauro Medical Subject Headings e operadores booleanos para aplicar estratégias de pesquisa en 4 bancos de dados diferentes: Pubmed, EBSCOhost, Scopus, Science Direct. A pesquisa foi complementada com a técnica de bola de neve aplicada à lista de referência dos artigos selecionados relevantes. O Critical Appraisal Skills Programme Español (CASPE) foi usado para avaliar a validade e o impacto da revisão dos artigos e os resultados qualitativos, e para os estudos de observação utilizou-se o Strengthening the Reporting of Observational studies in Epidemiology (STROBE). A Canadian Task Force on Preventive Health Care (CTPFCHC) foi utilizada para establecer os níveis de evidência. Resultados: Dos 163.074 manuscritos iniciais, 44 foram selecionados para análise e extração de dados referentes à história da EBN; conceito e função da EBN; etapas, barreiras e facilitadores. Conclusões: O conceito de EBN destaca a necessidade de utilizar esta ferramenta de planejamento de cuidado, através do uso do pensamento crítico e reflexivo; a importância de realizar o cuidado à beira do leito do paciente e promover cuidados baseados nas melhores evidências, em um contexto de humanização e considerando as barreiras e facilitadores desta ferramenta.

Facilitators and barriers to implementation of the Pharmacy DOTS Initiative in selected project sites in the Philippines

@#<p style="text-align: justify;"><strong>Objectives:</strong> The Pharmacy DOTS Initiative (PDI) was relaunched on a larger scale in 2014 through the Innovations and Multi-Sectoral Partnerships to Achieve Control of Tuberculosis (IMPACT) project. This paper aimed to assess the PDI program through IMPACT by identifying the facilitating and hindering factors in its implementation. The identified factors are classified as to the affected stakeholders or processes.</p><p style="text-align: justify;"><strong>Methods:</strong> Semi-structured interviews were conducted with the PDI Program Manager and four NTP coordinators from selected project sites. Thematic analysis was done to determine the recurring facilitating and hindering factors as identified by the key informants.</p><p style="text-align: justify;"><strong>Results:</strong> Facilitating factors identified include cooperation of the stakeholders, capability-building and a good referral system. The barriers to the implementation were grouped into patient-related, pharmacy-related, health center-related, program-related as well as external factors.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The referral system created through PDI facilitated the flow of referrals starting from the pharmacy. This enabled presumptive patients to have access to health facilities for TB. Hindering factors contributed to the inability of the engaged pharmacies to sustain their consistency and commitment in conducting the PDI interventions.</p><p style="text-align: justify;"><strong>Key Words:</strong> barriers, facilitators, tuberculosis, directly observed therapy, program evaluation, pharmacy</p>

Evaluación de una intervención educativa para mejorar el consumo de frutas, vegetales y la actividad física de docentes en tres centros educativos públicos en Costa Rica / Evaluation of an educational intervention to improve teachers' fruit and vegetable intake and physical activity practice in three public schools in Costa Rica

Resumen: Introducción: El modelo Póngale Vida ® para la prevención de la obesidad infantil reconoce a docentes de las escuelas como actores clave para esta labor, pero para ello se requiere fortalecer los conocimientos y las prácticas para la promoción de la alimentación saludable y la actividad física de los escolares. Objetivo: Evaluar los resultados de la intervención educativa para mejorar la autoeficacia en consumo de frutas y vegetales y en actividad física en docentes de tres centros educativos públicos urbanos de Costa Rica. Metodología: Se aplicó y evaluó la propuesta educativa de Jara y Rivera (2011) con 70 docentes. Hubo evaluaciones antes y después de la aplicación de la intervención. Las variables evaluadas fueron demográficas, de estilo de vida y medición de la autoeficacia para actividad física y consumo de frutas y vegetales, valoraciones bioquímicas y antropométricas. A través de grupos focales, se identificó tanto facilitadores como barreras a nivel personal, familiar y laboral. Resultados: Posterior a la intervención, casi 25 % de docentes incrementó la práctica de actividad física y la autoeficacia para las prácticas de actividad física y consumo de frutas y vegetales. Las barreras identificadas fueron la doble carga de trabajo asociada al rol de género femenino, creencias limitantes y la falta de urgencia para la prevención de enfermedades. Conclusiones: La propuesta educativa favoreció el aumento de la autoeficacia en el consumo de frutas y vegetales, así como la práctica de actividad física de la población docente.

Abstract: Introduction: The Póngale Vida ® model for the prevention of childhood obesity recognizes schoolteachers as key actors in this work, but this requires strengthening their knowledge and practices to promote healthy eating and physical activity for school children. Objective: To evaluate an educational intervention to increase teacher's self-efficacy for fruit and vegetable consumption and physical activity, within three public schools in Costa Rica. Methods: Jara and Rivera's educational proposal for intervention (2011) was implemented and evaluated with 70 teachers. There were evaluations before and after the intervention, it had demographic characteristics, lifestyle variables, self-efficacy measurements for physical activity and fruit and vegetables consumption; also, biochemical and anthropometric measures. Focus groups were used to identify facilitators and barriers at personal, family and work levels. Results: After the intervention, almost 25% of teachers increased their physical activity practices, as well as self efficacy for physical activity practice and fruits and vegetables consumption. The main barriers were a double work burden linked with feminine gender roles, limiting beliefs, and, lack of urgency in preventing diseases. Conclusions: The educational intervention contributed in increasing self-efficacy regarding eating fruit and vegetables and the practice of physical activity of participating teachers.

Navegando por los servicios de salud públicos: experiencias de mujeres de sectores populares en la periferia de Buenos Aires / Navigating the public health services: the experiences of women who live in the periphery of Buenos Aires city

Resumen Con base en datos cualitativos de seis grupos focalizados, realizados durante los años 2015 y 2016, con mujeres de 18 a 60 años residentes en un barrio de sectores populares del conurbano norte bonaerense, analizamos las lógicas de utilización y sus experiencias con los servicios de salud públicos. Nos centramos en las barreras que las participantes identifican para acceder a la infraestructura sanitaria pública del barrio (Centro de Salud y postas sanitarias) y en los establecimientos hospitalarios de la localidad, considerando las necesidades, expectativas y demandas de cuidado médico, no sólo curativo, sino también preventivo y de salud mental. Observamos las consecuencias de las barreras en el acceso a la atención, cómo reaccionan frente a ellas y los recursos que algunas mujeres y sus grupos familiares movilizan para sortearlas (contar con medios para desplazarse a otras localidades, el pago de bolsillo para consultas y tratamientos privados, contar con cobertura de obra social, etc.).

Abstract Based on the qualitative data gathered from six focus groups conducted between 2015 and 2016 with women aged from 18 to 60, it is analyzed how they utilize public health services. Focusing on the barriers of access to local (the community health center and primary health posts) and to nearby hospitals, it is considered their health needs, expectations and demands to both preventive and curative care. Access to mental health care is also addressed. We observe how women and their families respond when facing these barriers and the resources they can mobilize to overcome them (spatial mobility, relative financial capacity, access to social security and private health coverage etc.). Also, the negative consequences of organizational barriers and deficiencies of the public services network on neighbors' health are shown.

A reinserção social na perspectiva de egressos de penitenciárias e profissionais das Centrais de Atenção ao Egresso e Família / The social reintegration in the perspective of egresses of penitentiaries and professionals of the "Centrais de Atenção ao Egresso e Família" (Centers of Attention to the Egresses and Family

A reinserção social é um processo contínuo que pressupõe o anterior pertencimento de uma pessoa a uma sociedade, pessoa esta que, após privação dessa vida social, retornará ao seu convívio por meio de "reeducação", "reintegração" e "ressocialização". Entende-se que o processo de reinserção social do egresso do sistema penitenciário tem seu início desde o momento de aprisionamento e se estende no contexto de liberdade. Tal processo tem encontrado entraves em seu desenvolvimento, constatados no alto índice de reincidência prisional. O presente trabalho pretendeu compreender o processo de reinserção social, seus entraves e facilitadores na visão de egressos do sistema penitenciário e de técnicos das Centrais de Atenção ao Egresso e Família (CAEFs) da região noroeste do estado de São Paulo. O trabalho adotou o método de estudo qualitativo exploratório-descritivo de campo, realizado com 9 técnicos das CAEFs e 13 egressos do sistema prisional. Os dados foram coletados por meio de entrevista semiestruturada, nos meses de março, abril e maio de 2018 e analisados de acordo com a técnica de análise temática indutiva. A análise foi realizada sob o referencial teórico de Urie Bronfenbrenner (teoria bioecológica). Os resultados da análise temática indutiva dos egressos constituíram três categorias: 1) Os reveses da reinserção social no contexto de encarceramento na visão dos egressos; 2) Os reveses da reinserção social no contexto de liberdade na visão dos egressos; 3) Facilitadores da reinserção social na visão dos egressos. Os principais reveses em contexto de encarceramento apontados foram: abuso de poder, falta de estrutura física e humana, negligência, alianças negativas e efeitos do tempo no contexto de encarceramento. No contexto de liberdade, os reveses apontados foram: falta de direitos, de trabalho e rede social. Como facilitadores aparecem: família, religião e características pessoais. Os resultados da análise temática indutiva dos técnicos constituíram outras três categorias: 1) Os reveses da reinserção social no contexto de encarceramento na visão dos técnicos; 2) Os reveses da reinserção social no contexto de liberdade na visão dos técnicos; 3) Facilitadores da reinserção social na visão dos técnicos. Como principais achados no contexto de encarceramento, mencionaram-se os reveses: falta de recursos físicos, humanos e falta de projetos. No contexto de liberdade: A sociedade (macrossistema) produtora de violência estrutural e mantenedora do preconceito e estigma, falta de recursos físicos e humanos nos CAEFs para o desenvolvimento do trabalho. Como facilitadores, foram apontados a família e o CAEF, este como um lugar em desenvolvimento. Consideramos, a partir das análises, que o processo da reinserção social não pode ser compreendido apenas em uma perspectiva, ele é multifatorial. A reinserção não acontece apenas por um microssistema - trabalho, religião ou família. Estes são facilitadores, mas a reinserção social parte de uma mudança macrossistêmica, um guarda-chuva maior que resguarda todos os outros contextos em interação

Social reintegration is a continuous process that presupposes a person's previous belonging to a society, a person who, after being deprived of that social life, will return to his or her life through "reeducation", "reintegration" and "resocialization". It is understood that the process of social reinsertion of the egress from the penitentiary system has its beginning from the moment of imprisonment and extends in the context of freedom. This process has found obstacles in its development, verified in the high rate of prison recidivism. The present work aimed to understand the process of social reintegration, its obstacles and facilitators in the view of prisoners from the penitentiary system and technicians of the Centers of Attention to the Egress and Family (CAEF) in the northwest region of the state of São Paulo. The study adopted the qualitative exploratory-descriptive field study method, carried out with 9 technicians from CAEFs and 13 graduates from the prison system. The data were collected through a semistructured interview in the months of March, April and May of 2018 and analyzed according to the technique of thematic inductive analysis. The analysis was carried out under the theoretical reference of Urie Bronfenbrenner (bioecological theory). The results of the inductive thematic analysis of the egresses constituted three categories: 1) The setbacks of social reintegration in the context of imprisonment in the view of the egresses; 2) The setbacks of social reintegration in the context of freedom in the view of the egresses; 3) Facilitators of social reintegration in the view of the egresses. The main setbacks identified were: abuse of power, lack of physical and human structure, neglect, negative alliances and the effects of time in the context of incarceration. In the context of freedom, the setbacks were: lack of rights, work and social network. As facilitators appear: family, religion and personal characteristics. The results of the inductive thematic analysis of the technicians constituted three other categories: 1) The setbacks of social reintegration in the context of imprisonment in the view of technicians; 2) The setbacks of social reintegration in the context of freedom in the view of technicians; 3) Facilitators of social reintegration in the view of technicians. The main findings in the context of incarceration were the setbacks: lack of physical resources, human resources, and lack of projects. In the context of freedom: The society (macrosystem) that produces structural violence and maintains the prejudice and stigma, lack of physical and human resources in the CAEFs for the development of the work. As facilitators, the family and the CAEF were named as a place of development. We consider, from the analysis, that the process of social reintegration cannot be understood only in one perspective, it is multifactorial. Reinsertion does not happen only through a microsystem - work, religion or family. These are facilitators, but social reinsertion is part of a macrosystemic shift, a larger umbrella that shelters all other contexts in interaction

Perspectives of adolescents, parents, and teachers on barriers and facilitators of physical activity among school-age adolescents: a qualitative analysis

BACKGROUND@#Physical activity levels are low among adolescents in Morocco; however, the influences on physical activity behavior of adolescents have not yet been explored in a qualitative study. Here, we explored potential social-ecological barriers and facilitators of physical activity in Moroccan adolescents with the goal of developing a successful intervention program aimed at improving their physical activity level.@*METHODS@#For this study, we conducted 17 focus group discussions (100 participants, composed of 56 adolescents, 26 parents, and 18 teachers from two middle schools in Taza city, Morocco). Discussions during focus groups were facilitated by a semi-structured interview guide. Guide questions were underpinned by the social-ecological model as a theoretical framework. Data analysis was carried out by two coders using thematic analysis.@*RESULTS@#We found that barriers and facilitators of physical activity in adolescents are organized into six themes that belong to different levels of the social-ecological model. Three themes belonged to the intrapersonal level (perceived motivating and limiting factors, physical activity awareness, and time constraints), two themes were classified into the interpersonal/cultural level (social support and gender and cultural norms), and one theme belonged to the environmental level (access to opportunities). Most of the themes were at the individual level, with each theme including both barriers and facilitators.@*CONCLUSIONS@#Adolescent participation in physical activity can be facilitated or hampered by many factors. Results from the focus group discussions showed that these factors belonged to different levels of the social-ecological model, but most were at the individual level. Our findings have several implications. First, they may offer suggestions for a tailored intervention program aimed at improving adolescent physical activity. Second, they can improve quantitative research by enriching the battery of questions of physical activity instruments (e.g., a question related to physical disability). Third, the proposed thematic map can contribute to understanding interactions and causal pathways in the social-ecological model.

Psychosocial triggers or facilitators and burnout syndrome in workers of grocery stores in Guadalajara, Mexico / Desencadenantes o facilitadores psicosociales y síndrome de burnout en trabajadores de tiendas de abarrotes en Guadalajara, México

Abstract Objective: To analyze the relationship among the triggers and facilitators variables of the influential psychosocial type with Burnout Syndrome in grocery store workers, in Guadalajara, Mexico. Material and methods: The study was cross-sectional and applied to 321 people working in grocery stores located in the municipality of Guadalajara, Jalisco. A sociodemographic and labor data questionnaire was applied for the evaluation of psychosocial variables and the Maslach Burnout Inventory scale (MBI-HSS) for the presence of Burnout Syndrome. Both descriptive and inferential analysis were included. Under informed consent the respondents accepted their participation voluntarily. Results: 64.2% of the population presented Burnout Syndrome. Emotional exhaustion was the most affected (59.9%). Several triggers and / or facilitators were associated with more than one burned dimension, specifically with the Emotional exhaustion dimension. Conclusions: Grocery stores are usually a family business. The people who work in them, depend on them to survive. They are a source of employment, tranquility and protection. Thus, working safely affirms a better life quality and customer service.

Resumen Objetivo: Analizar la relación entre las variables desencadenantes y facilitadores del tipo psicosocial influyente con el síndrome de Burnout en los trabajadores de las tiendas de abarrotes en Guadalajara, México. Material y métodos: El estudio fue transversal y aplicado a 321 personas que trabajaban en supermercados ubicados en el municipio de Guadalajara, Jalisco. Se aplicó un cuestionario sociodemográfico y de datos laborales para la evaluación de variables psicosociales y la escala de inventario de Maslach Burnout (MBI-HSS) para la presencia de síndrome de Burnout. Se incluyeron análisis tanto descriptivos como inferenciales. Bajo consentimiento informado los encuestados aceptaron su participación voluntariamente. Resultados: 64,2% de la población presentó síndrome de Burnout. El agotamiento emocional fue el más afectado (59,9%). Varios disparadores y/o facilitadores se asociaron con más de una dimensión quemada, específicamente con la dimensión de agotamiento emocional. Conclusión: Las tiendas de abarrotes suelen ser una empresa familiar. Las personas que trabajan en ellas dependen de ellos para sobrevivir. Son una fuente de empleo, tranquilidad y protección. Por lo tanto, trabajar con seguridad afirma una mejor calidad de vida y servicio al cliente.

Barreras y facilitadores para la práctica de lactancia materna exclusiva en un grupo de madres de la ciudad de méxico / Barriers and facilitators of exclusive breastfeeding practice in mothers from mexico city

La lactancia materna exclusiva (LME) representa beneficios para la madre y bebé. Sin embargo, México no logra las cifras esperadas, debido a que influyen factores de la madre y su entorno. El objetivo del estudio fue analizar las principales barreras y facilitadores para la práctica de LME en un grupo de madres de la Ciudad de México. Se realizó un estudio transversal analítico en una Universidad. Participaron 500 madres trabajadoras y sus conocidas, de 19 a 45 años, clínicamente sanas, que su último hijo tuviera 6-24 meses de edad. Respondieron encuestas sobre principales barreras y facilitadores para LME y su autopercepción de la lactancia. Se compararon frecuencias de principales barreras y facilitadores de LME y se realizaron modelos de regresión logística con la no práctica de LME como variable dependiente. Los principales facilitadores fueron: buen acomodo del bebé (54%, n=270), paciencia-perseverancia (46%, n=230). Las variables asociadas a no practicar LME fueron: autopercepción negativa de LME (RM:7,48; IC95%:3,78-14,98), ser principal proveedora de ingreso (RM:2,42; IC95%:1,25-4,68) ser madre soltera (RM:1,92; IC95%:1,13-3,25), sentir que no sale leche (RM:2,31; IC 95%:1,27-4,20) y falta de información (RM:1,91; IC95%:1,01-2,98). Existe necesidad de contar con programas de educación pre y posnatal sobre la LME, así como de la extracción y conservación de leche oportuna en todos los grupos de madres, pero enespecial a aquellas que trabajan fuera del hogar(AU)

Exclusive breastfeeding (EBF) brings benefits for both mother and child. Nevertheless, Mexico has low number of EBF, due to different factors related to mother and her environment. The objective of this study was to identify barriers and facilitators of EBF in a sample of mothers from Mexico City. A cross-sectional study was performed in a University, including 500 healthy female mothers and their acquaintances, aged 19-45 y, whom their last child was 6-24 months of age. They responded a questionnaire to obtain information about the main barriers and facilitators for EBF and self-perception of EBF practice. Frequencies were calculated to identify main barriers and facilitators. A logistic regression model was performed using non-EBF as outcome. Main facilitators for EBF were good baby's position (54%, n=270), patience and perseverance (46% n=230). Main barriers were negative self-perception of EBF (OR:7.48; CI95%:3.78-14.98), being the main provider at home (OR:2.42; CI95%:1.25-4.68), being single mother (OR:1.92; CI95%:1.13-3.25), the sensation of no having milk (OR: 2.31; CI95%:1.27-4.20), and the lack of information regarding breastfeeding (OR: 1.91; CI 95%:1.01-2.98). There is a need to develop pre and postnatal educational programs about EBF, timely milk extraction and conservation and the strengthening of facilitators in every lactating mother, specifically those who have to work outside home(AU)

Barreiras e facilitadores para a atividade física em pessoas com déficit intelectual / Barriers and facilitators to physical activity people with intellectual disability

O objetivo deste estudo foi descrever as barreiras e os facilitadores da prática de atividade física (AF) no tempo livre e sua associação com essa prática em pessoas maiores de seis anos de ambos os sexos com déficit intelectual (DI) inseridas nas Associações de Pais e Amigos dos Excepcionais (APAES). A amostra foi composta por 1.191 pessoas com DI representadas pelos seus responsáveis. As barreiras e facilitadores para a prática de AF foram identificadas com questões fechadas em que o responsável respondia se o fator influenciava sempre (1), influenciava às vezes (2) ou não influenciava (3) na prática de AF. As questões foram separadas em três dimensões que correspondiam a onze fatores de ordem pessoal, sete de ordem ambiental e dez de ordem social. Verificou-se no aspecto pessoal sete facilitadores e duas barreiras, nos quais destaca-se o fato de sentir-se capaz como facilitador associado com a prática de AF e não possuir dinheiro como barreira; no aspecto ambiental seis facilitadores e uma barreira, sendo a companhia de pessoas próximas o principal facilitador pela associação com a prática de AF e a ausência de projetos sociais como barreira; e no aspecto social cinco facilitadores e uma barreira, no qual encontram-se a existência de locais próximos de casa e os profissionais estarem preparados para trabalhar com pessoas com DI os principais facilitadores e a falta de companhia como barreira. Conclui-se que as barreiras e facilitadores de AF para as pessoas com DI podem estar ligados ao estímulo que recebem, pois a companhia de outra pessoa foi o principal facilitador associado com a prática, isto pode ocorrer devido às limitações que a maioria possui no aspecto social. Oferta de locais com qualidade para prática de AF também facilitam a prática de AF, o que pode ser amenizado com o investimento em políticas públicas e projetos sociais de qualidade.

The objective of this study was to describe the barriers and facilitators of free time physical activity (PA), their influence both in this practice of people with intellectual deficit (ID) inserted in APAES / RS. The sample consisted of 1191 ID individuals represented by their legal representatives. The barriers and facilitators for the practice of PA were identified with closed questions in which the respondent answered whether the factor always influences (1), so-metimes influences (2) or does not influence (3) the practice of PA. The issues were separated into three dimensions: personal, environmental and social. As a result, seven facilitators and two barriers were observed in the personal aspect, in which the fact that they feel capable as a facilitator associated with the practice of PA and lack of money as a barrier; In the environmental aspect, six facilitators and a barrier, the company of close people being the main facilitator by the association with the practice of PA and non-existence of social projects as a barrier; And in the social aspect five facilitators and a barrier in which the existence of places close to their homes and professionals prepared to work with people with ID appear as the main facilitators and lack of companion as a barrier. It is concluded that some barriers and facilitators are linked to the stimulus that the people receive, since they can arouse the taste for PA if there is company, providing conditions for the practice due to the limitations that the majority has in the social aspect. Offering quality PA sites also facilitate, which can be provided by the investment in public policies and social projects.

Actividad física y discapacidad: un estudio cualitativo con mujeres en un gimnasio adaptado / Atividade física e incapacidade: um estudo qualitativo com mulheres em um ginásio adaptado / Physical activity and disability: a qualitative study on women at an adapted gym

Este estudio explora cómo un grupo de mujeres con discapacidad (n=6) experimentan y perciben la práctica de actividad física en un gimnasio adaptado. Se utilizaron entrevistas semiestructuradas como instrumento de recogida de datos cualitativos y se realizó un análisis temático inductivo. Los resultados se agruparon en torno a cuatro categorías temáticas emergentes: condición física y autonomía personal; papel paliativo del ejercicio; bienestar psicológico; relación social y apoyo. Destaca la experiencia satisfactoria de las participantes, en la que predomina una valoración positiva de procesos autorregulativos, la concepción social-relacional de la actividad física y la relevancia del gimnasio adaptado como facilitador ambiental y social. (AU)

Este estudo explora como um grupo de mulheres com incapacidade (n = 6) experimenta e percebe a prática da atividade física em um ginásio adaptado. Foram realizadas entrevistas semiestruturadas como instrumento de coleta de dados qualitativos e uma análise temática indutiva. Os resultados foram agrupados em torno de quatro emergentes categorias temáticas: aptidão e autonomia pessoal; papel paliativo de exercício; bem-estar psicológico; relação social e apoio. Ele destaca a experiência bem sucedida dos participantes, que é dominada por uma avaliação positiva dos processos de autorregulação, concepção social-relacional da atividade física e a relevância do ginásio adaptado como facilitador ambiental e social. (AU)

This study explores how a group of disabled women (n=6) experience and perceive physical activity practice in an adapted gym. Semi-structured interviews were used to collect qualitative data, and a thematic inductive analysis was carried out. Results were grouped under four emergent thematic categories: physical fitness and personal autonomy; the palliative role of exercise; psychological wellbeing; social relation and support. Participants' satisfaction with the experience is highlighted, predominating positive appraisal of self-regulation processes, social-relational conception of physical activity, as well as the relevance of the adapted gym as an environmental and social facilitator. (AU)