Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects.

BACKGROUND: Neural tube defects continue to be one of the main congenital malformations affecting the development of the nervous system and a significant cause of disability and disease burden to individuals living with these conditions. Mandatory food fortification with folic acid is, by far, one of the most efficacious, safe, and cost-effective interventions to prevent neural tube defects. However, most countries fail to effectively fortify staple foods with folic acid, impacting public health and healthcare systems and generating dismal disparities. AIM: This article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide. METHODS: A comprehensive review of the scientific literature allowed the identification of the determinant factors acting as barriers or facilitators for the reach, adoption, implementation, and scaling up of mandatory food fortification with folic acid as an evidence-based policy. RESULTS: We identified eight barriers and seven facilitators as determinant factors for food fortification policies. The identified factors were classified as individual, contextual, and external, inspired by the Consolidated Framework for Implementation of Research (CFIR). We discuss mechanisms to overcome obstacles and seize the opportunities to approach this public health intervention safely and effectively. CONCLUSIONS: Several determinant factors acting as barriers or facilitators influence the implementation of mandatory food fortification as an evidence-based policy worldwide. Notoriously, policymakers in many countries may lack knowledge of the benefits of scaling up their policies to prevent folic acid-sensitive neural tube defects, improve the health status of their communities, and promote the protection of many children from these disabling but preventable conditions. Not addressing this problem negatively affects four levels: public health, society, family, and individuals. Science-driven advocacy and partnerships with essential stakeholders can help overcome the barriers and leverage the facilitators for safe and effective food fortification.

Strategic Planning and Doctor Of Nursing Practice Education: Developing Today's and Tomorrow's Leaders.

Strategic planning and thinking skills are essential for today's nurse leaders. Doctor of nursing practice (DNP) programs provide an opportunity for developing effective nurse strategists. A well-designed strategy course can stimulate intellectual growth at all levels of Bloom's Taxonomy. Discussion forums in online education provide new opportunities for rich interaction among peers en route to development of well-informed strategic plans. An interprofessional perspective adds a rich and vital aspect to doctoral nursing education and it serves to inform strategic plan development. A roadmap for teaching strategic planning to current and future nursing leaders will guide the integration of essential content into DNP programs.

Integrating executive coaching and simulation to promote interprofessional education of health care students.

This study used executive coaching and simulation to enhance interprofessional teamwork by promoting collaboration and leadership capacity in health professional students attending undergraduate programs. A mixed methods approach to program evaluation was used. A statistically significant (p<0.05) increase was noted pre- and post-program on the Team Assessment Inventory. Qualitative analysis of reflective essays and focus group interviews revealed that students participated as a career-building opportunity and because they wanted to gain a better appreciation for the roles and contributions of other health care providers. The themes that emerged related to aspects of the process students found helpful, lessons learned about professional roles, and the meaning of leadership in the context of interprofessional teams. Students also provided recommendations for future studies. Findings suggest that integrating executive coaching and simulation in interprofessional education may have the potential to create meaningful experiences for health professional students. While more empirical research is needed to investigate this potential, in terms of how executive coaching and simulation may increase professional collaborative care and improve the quality of health care delivery, the initial insights seem promising.