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Policy Points Rural communities have more limited access to medical care and worse health outcomes. Existing federal and state policies largely fall short in addressing rural access disparities. Rural health woes require increased government funding for providers and the embrace of alternative health delivery mechanisms, as well as expanded public-private/nonprofit partnerships to overcome access barriers. Rural and urban areas have diverged significantly in health care access and health outcomes over the last four decades. Federal and state policies have played important roles in shaping these trends. I qualitatively review previous and existing federal and state policies that have shaped contemporary rural-urban health disparities. I review academic literature on recent policy enactments that have shown promise for alleviating some rural health struggles as well as scholarship on how the politics of rural health have stymied better policymaking. Large scale federal investments (e.g., the Hill-Burton Act) were required to bring modern health care to rural communities in the first place, but inadequate and nonuniversal policies enacted since the 1970s and the increasing corporatization of health care over the last decades have led to withering rural health care access. The recent "One Big Beautiful Bill Act" will likely make these matters worse. Policies that have expanded telehealth and mobile health access, as well as subsidized rural transportation services and changes to public payer reimbursement policies, have provided some optimism. However, the broader politics of rural health limit policy opportunities. Rural health has suffered, in part, due to state and federal policy failures. While some incremental changes have certainly shown evidence of potential improvements, a more radical policy agenda may be needed to maintain or improve health care access in rural communities. There is mixed-to-negative evidence regarding whether the political environment will allow for sufficient policy improvements.

Computational psychiatry has advanced formal accounts of individual prediction, affect regulation, and maladaptive rigidity, but it still has fewer clinically interpretable tools for representing social and institutional processes under collective stress. This Hypothesis and Theory article proposes a theory-driven candidate annotation architecture for this purpose. It defines five collective-process variables-defensive closure (DEF-C), collective anxiety load (ANX-C), integrative progression (PRO-C), punitive superegoic regulation (SUP-C), and moral frame rigidity (FRAME-C)-as theory-guided interpretive indicators for trained human annotation and later formal modeling. Drawing on Active Inference, PAD-S/CSA, Conceptual Metaphor Theory, Moral Politics, social defense theory, and threat-rigidity research, the framework specifies how historically or institutionally situated material can be parsed through explicit coding units, evidence spans, ordinal ratings, confidence markers, adjudication rules, variable-overlap handling, and prospective disconfirmation criteria. Early modern Iberia serves as a worked coding demonstration, with an internal contrast between layered plurality under constraint in al-Andalus and later confessional/inquisitorial consolidation; the Dutch Republic is added as a brief contrastive horizon. Because the framework is applied to historically mediated material, it treats anachronism, narrative uncertainty, interpretive plurality, and temporal delimitation as methodological constraints rather than residual problems. The article does not claim validated measurement status and does not report inter-coder reliability, fitted state-space estimation, or predictive performance. Its contribution is pre-validational and methodological: it provides an intermediate representation layer designed to make clinically interpretable collective-process hypotheses explicit, open to critical inspection, and suitable for future reliability testing, comparative coding, baseline comparison, and human-in-the-loop computational modeling.

Low-value care remains pervasive across healthcare systems and consumes scarce resources while exposing patients to avoidable harms. De-implementation, the purposeful process of reducing, restricting, replacing, or discontinuing low-value practices, has gained momentum, yet the field still lacks clear methodological guidance grounded in theory. De-implementation is often treated as "reverse implementation", despite accumulating evidence that stopping practices can activate distinct mechanisms and constraints. In this paper, we synthesize and contrast theories, process models, and frameworks relevant to de-implementation of low-value care to generate actionable methodological guidance. Drawing on a theory-informed narrative review and constant-comparative synthesis, we identify where de-implementation converges with implementation (e.g., staged processes; multilevel determinants; use of established determinant, strategy, and outcome frameworks) and where it diverges in ways that matter for design and evaluation. Across sources, three recurring lenses structure these divergences: (i) the psychology of stopping (habit disruption, loss aversion, cognitive biases, professional identity threats), (ii) multi-level constraints and politics (incentives, regulation, professional norms, stakeholder interests), and (iii) the nature of the low-value practice and endpoint (reduction vs. restriction vs. elimination; replacement vs. disenchantment discontinuance). We translate these contrasts into ten streamlined methodological recommendations that specify what investigators should state and report in practice, including configuration (stand-alone vs. embedded/paired), low-value classification, explicit determinant-to-strategy-to-mechanism logic, inclusion of patient experience and unintended consequences, and dual-trajectory evaluation when substitution is involved. De-implementation is not simply implementation in reverse. Methodological rigor in de-implementation research requires explicitly specifying configuration and endpoint, aligning strategies with stopping-specific mechanisms and multilevel constraints, and evaluating beyond utilization to include mechanisms, patient experience, equity-relevant impacts, and unintended consequences. This paper provides a practical, theory-grounded set of recommendations to strengthen the design, evaluation, and reporting of future de-implementation studies.

A core challenge of inclusive education lies in the difficulty teachers face in effectively identifying and responding to the diverse behavioral manifestations of students with special educational needs (SEN) in mainstream classrooms. Traditional observation methods are time-consuming, labor-intensive, and highly subjective. This paper explores the application potential of computer vision (CV) technology in this field, aiming to construct an objective and automated framework for classroom behavior analysis. We propose a multimodal fusion method based on pose estimation and spatiotemporal modeling, capturing students' nonverbal behaviors in the classroom (such as body posture, head orientation, and activity level) using an RGB camera and combining this with simple audio features (vocal activity) for comprehensive analysis. We collected a dataset containing behavioral patterns of typical SEN students (such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD)) in a simulated inclusive education classroom environment and validated the proposed method. Experimental results show that the system achieves high accuracy (average 85.2%) in identifying key behavioral indicators (such as "attention," "social interaction," and "Atypical sports pattern"), significantly outperforming baseline methods that rely solely on manual observation. This study demonstrates the effectiveness of computer vision technology as a professional support tool for teachers, providing a new technological approach for achieving precise and personalized inclusive educational interventions.

Exam anxiety is a specific form of performance anxiety in which students experience intense worry, physical arousal, and unhelpful behavior around exam situations. Exam anxiety is common in higher education and is associated with poor academic performance. Additional political and economic strain may increase anxiety and threaten achievement at Palestinian universities. This study aimed to investigates exam anxiety and associated factors, such as lifestyle and socio-demographic factors, among Palestinian university students. This cross-sectional descriptive study was conducted among students from three institutions in Palestine (Al-Quds University, Hebron University, and An-Najah National University), with 1,519 participants completing the survey. Data were collected using self-administered questionnaire; Westside Test Anxiety Scale (WTAS) was used to assess exam anxiety. Descriptive statistics and general linear model were performed to identify factors associated with exam anxiety. Among the 1,519 participants, a significant majority (61.8%) reported elevated exam anxiety levels, with nearly one-third (32.5%) categorized as experiencing "extremely high" anxiety. In contrast, only 38.2% of respondents fell within the lower end of the anxiety spectrum (from low to high normal). Student anxiety arises from a complex interplay of sociodemographic, academic, and lifestyle factors, with the overall model accounting for 21.2% of the variance. The most significant predictors of high anxiety include intense academic overload, lower family income (below $1,140), smoking, and physical illness. Conversely, strong family support and high academic performance (GPA of 80 or above) serve as essential protective factors. Additionally, lifestyle choices are influential, as students who exercise only 1 to 2 days per week report higher anxiety levels compared to those who engage in more frequent exercise. Furthermore, institutional differences are evident, with students from Al-Quds University exhibiting higher exam anxiety levels than those from An-Najah University. The high prevalence of exam anxiety among Palestinian university students highlights the need for systemic institutional support. Universities should implement regular mental health screenings and offer specialized counseling, especially for those in high-stress academic fields. Additionally, reforming assessment methods to reduce academic overload and promoting consistent physical activity are essential evidence-based strategies for alleviating distress. These measures can contribute to a more balanced academic environment and enhance students' overall well-being.

Stakeholder analysis (SHA) is a well-established approach for studying health policy development through mapping policy actors' power, positions, interests and influence on policy processes. There is growing interest in the influence of policy participation on policy change processes. However, there is little empirical evidence on how policy participation could affect the potential roles of policy actors in a prospective health policy process. Health Technology Assessment (HTA) is a multidisciplinary process for assessing the value of health technologies and supporting evidence-based decision-making in health systems. Given its technical and political complexity, institutionalising HTA remains a significant health policy challenge that requires diligent analysis and planning. This study aims to provide a thorough SHA on the United Arab Emirates (UAE) journey toward HTA establishment, to provide insights into how to optimise policy participation during the policy development process. Data were collected from document reviews and semi-structured interviews, then analysed using the thematic analysis technique. The perspectives of 34 experts and leaders shed new light on the different forms of stakeholders' power, and on the bidirectional relationship between policy participation and their capacity to contribute to HTA's development process. This study extends the analytical knowledge of the SHA's applications by integrating policy participation as a critical new dimension for successful HTA policy development.

The Gansu-Qinghai (GQ) region is a critical Eurasian contact zone with exceptional linguistic and genetic diversity. However, genomic studies integrating genetic and linguistic evidence in areas with intensive language mixing remain limited. We conducted fine-scale genomic analyses on 153 new samples from four linguistically mixing or mixed regions: Linxia and Xiahe in Gansu, and Gan'gou and Wutun in Qinghai. Our findings reveal three primary ancestral components: Yellow River, western Eurasian steppe, and Tibetan Plateau (TP)-related lineages. While non-Han populations show pronounced genetic heterogeneity and varying patterns of language maintenance, Han populations exhibit asymmetric convergence. Specifically, the Wutun Han show concordant genetic and linguistic shifts, whereas other Han groups exhibit linguistic structural convergence without corresponding gene flow. Widespread east-west admixture was detected in both Han Chinese and non-Han populations from the GQ region, primarily dating to the Tang/Song and Yuan Dynasties. Together, our interdisciplinary genetic-linguistic framework reveals complex and asymmetric processes underlying population interaction and language evolution in the GQ contact zone.

Nigeria's health reforms aim to accelerate progress toward Universal Health Coverage (UHC). In alignment with these efforts, Gombe State has leveraged national policy frameworks to implement health sector reforms that have improved maternal, newborn, and child health outcomes. To consolidate gains and define future priorities, the State convened the Maiden Gombe State Health Summit in October 2025. The Summit was a two-day hybrid event with over 500 participants from government, development partners, civil society, academia, and the private sector. Data were drawn from rapporteur reports, recordings, presentations, session transcripts, keynote speeches, and policy documents. A thematic analysis approach was used to synthesize key discussions and outcomes. The Summit highlighted strong political commitment, revitalization of 228 primary health centres, upgrades to secondary facilities, expanded immunization coverage, and strengthened disease surveillance. Health workforce reforms, including Human Resources for Health (HRH) governance structures, biometric attendance tracking, training programmes, and welfare improvements, enhanced accountability and productivity. Financial protection was strengthened through the Gombe State Contributory Health Insurance Scheme, covering over 380,000 residents. Implementation of the Sector Wide Approach (SWAp) improved coordination of partner investments. These reforms contributed to measurable reductions in under-five, infant, and child mortality between 2018 and 2023. Gombe State's experience demonstrates how subnational governments can advance UHC through political leadership, alignment with national reforms, primary healthcare strengthening, health workforce investment, sustainable financing, and inclusive stakeholder engagement. The lessons from the Summit provide actionable insights for sustaining reform momentum and strengthening health systems in similar settings.

This paper examines how Western Balkans' EU accession process and associated reforms influence investments by regional and non-regional firms, and how these investment flows affect sustainable regional economic growth. Using cross-border and domestic firm transactions involving Western Balkan companies between 2000 and 2024, we find that regional investments rose after 2010, when all five Western Balkan countries intensified reforms required by the EU accession process. We also find that regional firm investments drive more sustainable economic growth than non-regional investments in sectors prioritised by EU Green Agenda indicating that regional firms leverage EU initiatives more effectively. Our results show that both regional and non-regional investment effectiveness improves with control of corruption, political stability, and government effectiveness. However, after 2010, the influence of corruption control diminishes as EU accession expectations increasingly subsume investor concerns, while government effectiveness emerges as a central mediating mechanism, particularly for regional investors. We also find that excessive regulatory quality and voice and accountability constrain investment effectiveness, underscoring the need for targeted policy reforms in these areas.

Human migration is a fundamental driver of global demographic change, shaping population structure, labour markets and social policy across countries1-3. Although long-term migration patterns are often linked to economic development4, they can shift rapidly in response to shocks such as conflict, environmental crises and political change5. Despite its importance, migration remains difficult to measure consistently: existing data are sparse, concentrated in high-income settings and are fragmented across incompatible definitions, temporal resolutions and data types6-8. Past efforts have relied on partial datasets, including flow records, stock estimates and model-based reconstructions with limited coverage9-14. A central challenge is therefore to construct a globally consistent, high-resolution account of migration flows over time. Here we present a new dataset of annual origin-destination migration across 230 countries and regions from 1990 to the present, integrating diverse data sources into a unified modelling framework. By combining official statistics, census-based stocks, net migration estimates and past flow reconstructions, our approach produces temporally detailed and spatially comprehensive estimates that substantially extend existing resources. Using an ensemble of deep recurrent neural networks informed by geographic, economic, cultural and political covariates, we capture both persistent trends and short-term responses to changing conditions-all while propagating uncertainty to generate confidence bounds. Our results outperform existing five-year flow estimates on held-out data and provide finer temporal resolution, revealing previously obscured dynamics in global migration patterns. This framework highlights regions in which uncertainty remains high and data collection is most urgently needed. By releasing all data, code and trained models, we provide a transparent and reproducible foundation for future work. These advances enable a more timely and detailed understanding of human mobility, with implications for research and policy in an increasingly dynamic global system.

The Use of Research Evidence (URE) and Youth Participatory Action Research (YPAR) fields have developed in parallel. YPAR grapples with challenges of timeliness, 'traction', and sustained impact: Where does YPAR evidence go, who hears it, and what happens after youth present their findings? URE frameworks developed primarily with professional research in mind, leaving unexamined the use of evidence generated by students within the systems youth seek to change. Cross-pollination of YPAR and URE strengthens both fields and requires intentionality. URE concepts such as absorptive capacity and brokering illuminate pathways and barriers to YPAR impact, yet must center internal knowledge generated by youth, address power dynamics, and resist reducing YPAR to a transmission model of evidence delivery. Drawing on our UC-Berkeley-SFUSD Research-Practice Partnership focused on promoting student engagement and reducing chronic absenteeism, we examine how URE concepts sharpened our questions about organizational learning and decision-making. Districts must expand absorptive capacity to include YPAR as legitimate internal knowledge. Brokering must account for power differentials when youth critique the institutions that serve them. Political and symbolic uses of YPAR risk tokenizing youth input when decision-makers fail to act - or act in ways that contradict youth goals. Advancing authentic YPAR integration into system routines requires strategic advance planning, structures connecting evidence to decision-makers, and intentional space for multiple interest holders to shape questions and actions. We call for large-scale empirical investigation of YPAR URE, comparative designs to assess the value-add of YPAR, and systems mapping to clarify pathways to impact.

Inclusive governance ensures that institutions, policies, and practices allow marginalized and underserved groups to participate meaningfully in decision-making at all levels. It is defined by equitable participation, transparency, accountability, responsiveness, and effectiveness. Historically, women, youth, ethnic minorities, persons with disabilities, and low-income rural and urban populations have faced exclusion due to structural inequalities and weak institutions, resulting in poverty, disempowerment, and social unrest. However, inclusive governance fosters peace, empowerment, and economic growth. In sub-Saharan Africa, it is a key priority in Sustainable Development Goals (SDG) 16 and Agenda 2063, although interventions have yielded mixed results. Therefore, it is essential to enhance the discoverability of research on these interventions. To map evidence on inclusive governance interventions for underserved populations in sub-Saharan Africa. In 2024, the following databases were searched, limited to English language results: CAB Abstract, Web of Science, Dimensions, and Scopus. Additionally, gray literature sources, including organizational databases, Google Scholar, and registries, were utilized. Two reviewers independently screened the titles, abstracts, and full texts of potentially eligible articles for inclusion based on the outlined eligibility criteria. We developed and pilot-tested a data extraction tool in EPPI-Reviewer, where data was extracted and coded individually. We did not assess the quality of the reviews, as there were none available, nor did we evaluate the quality of the primary studies. A total of 88 articles (all primary studies) were included in this Evidence and Gap Map which assessed the interventions for underserved populations aimed at inclusive governance. Most studies looked at CSO's advocacy, and public policy and government agencies interventions. Civic participation, and movement and coalitions, & CSO's activities and achievement were the most studies outcomes leading to inclusive governance. Most research was conducted in Eastern Africa, particularly in Kenya and Uganda. Major gaps were identified in access to information and capacity building initiatives interventions, in addition to use of key government information as an outcome that address inclusive governance. Most of the evidence relies on non-experimental studies, and we could not identify any experimental or systematic review studies, highlighting a significant gap for future research. The Evidence and Gap Map (EGM) consolidates and enhances the visibility of research on inclusive governance interventions, providing a single, accessible resource for policymakers, researchers, and funders. It primarily draws from impact and summative evaluations, encompassing over two decades of studies across 48 sub-Saharan African countries, particularly in Kenya, South Africa, Uganda, and Ghana. The findings indicate evidence concerning civic participation, movements, coalitions, and civil society organization (CSO) activities, while areas such as the use of government information remain under-researched. Furthermore, regional imbalances persist, with Eastern Africa dominating the research landscape. Overall, the EGM identifies evidence clusters, highlights significant gaps, and offers guidance for future evaluations and policy planning. This Evidence and Gap Map on interventions aimed at promoting inclusive governance for underserved populations found the evidence is distributed disproportionately and lacks comprehensive systematic reviews. This EGM reviews and discusses the available evidence on interventions aimed at underserved populations to promote inclusive governance in SSA. Sub-Saharan Africa has a significant number of underserved populations, with notable challenges in service delivery and in government accountability to its citizens. By concentrating on this region, the EGM identifies context-specific interventions and evidence in areas where enhancing inclusive governance is essential for promoting equity, participation, and sustainable development. It highlights that much of the evidence focuses on the advocacy efforts of civil society organizations (CSOs) and their initiatives to achieve inclusive governance outcomes, particularly in civic participation. Most of this evidence originates from countries in Eastern Africa. What is this EGM about? Due to structural inequalities, weak institutional capacity, and a lack of transparency, many underserved populations are often excluded from political, economic, and social decision-making processes. Inclusive governance interventions can help these marginalized groups have their voices heard and empower them. Policymakers increasingly seek to identify effective interventions that promote equitable and non-discriminatory participation, accountability, transparency, responsiveness, and overall effectiveness in inclusive governance. This EGM addresses that need by systematically identifying and organizing research on inclusive governance interventions for underserved populations in sub-Saharan Africa. What is the aim of this EGM? To present evidence from studies on interventions that promote inclusive governance for underserved populations in sub-Saharan Africa. What studies are included? The EGM comprised 88 articles, all of which were primary studies evaluating interventions aimed at achieving inclusive governance. These studies specifically focused on interventions designed for underserved populations in sub-Saharan Africa. What are the main findings of this gap map? The evidence presented in this EGM highlights the role of Civil Society Organizations (CSOs) in advocacy, particularly in public policy, government agency engagement, and grassroots movements that promote inclusive governance. Specifically, there are clusters of evidence focusing on alliance building, advocacy and lobbying efforts, and the active participation of women and youth in CSO advocacy. Additionally, multiple studies have examined the development and strengthening of grassroots movements through collective actions and campaigns. Most of the evidence originates from Eastern African countries, including Kenya, Uganda, and Tanzania, with no systematic reviews included in the mapping. Over 35% of the studies reported outcomes related to civic participation. Furthermore, there were 7 and 8 studies assessing interventions aimed at enhancing the use of key government information and influencing policy and policymakers, respectively. While all regions of sub-Saharan Africa were represented, the majority of studies came from Eastern Africa (44.9%), with only a small proportion from Central Africa (4.1%). Most interventions in Eastern and Western Africa focused on CSO advocacy, with fewer studies addressing access to information and capacity-building initiatives. What do the findings of the map mean? This EGM aims to identify effective interventions for achieving inclusive governance among underserved populations. While there is limited evidence available, much of the research is concentrated in Eastern Africa, although Western and Southern Africa also have a significant number of studies, albeit without comprehensive reviews. This map helps build an evidence base in the field, enabling funders and researchers to identify existing gaps and prioritize future research efforts. How up-to-date is this EGM? We conducted a search for relevant studies up to September 17, 2024.

This is the protocol for a Campbell evidence and gap map. The objectives are as follows: to identify and describe the available evidence on interventions designed to improve financial literacy, digital financial skills, financial decision-making, and resilience to fraud and abuse among older adults; map the scope and focus of existing research, including the type of interventions implemented, target populations, delivery modalities, and contextual factors; assess the quality of the types of evidence available, including randomised and non-randomised controlled trials, as well as qualitative studies exploring the effectiveness and acceptability of financial literacy interventions; identify evidence clusters where sufficient studies exist to support further synthesis (e.g., systematic reviews or meta-analyses) and highlight evidence gaps where additional primary research is most needed, and; provide a structured and accessible resource for policymakers, practitioners, researchers, and advocacy groups to inform the design, adaptation, and implementation of financial literacy programmes for older adults.

The COVID-19 pandemic drove the implementation of vaccine mandates to protect spaces and/or increase vaccine uptake, though their design, timing, and scope varied across jurisdictions. This study examines the associations of vaccine mandate announcements and removals with COVID-19 vaccine uptake in France, Italy, and California (USA). We employed interrupted time series (ITS) analysis using aggregated data from Our World in Data and the Oxford COVID-19 Government Response Tracker. The primary outcomes were the weekly number of first and booster doses per 100,000 people. We estimated changes in the rate and trend of vaccine uptake following policy announcements and removals, adjusting for COVID-19 cases, deaths, and temporal autocorrelation to account for other influencing factors. Initial mandate announcements were associated with immediate increases in vaccine uptake: 113% (95% CI: 63 to 178%) in Italy, 195% (95% CI: 113 to 308%) in France, and 32% (95% CI: 16 to 51%) in California. However, these associations attenuated in more fully adjusted models, especially in France, where the initial association was no longer statistically significant after controlling for epidemiological conditions and temporal autocorrelation. Mandate removals were more consistently associated with declines in booster uptake in Italy and France, including declines of 62% (95% CI: -74 to -45%) and 70% (95% CI: -79 to -57%), respectively, while partial removal in California coincided with increased booster uptake. Vaccine mandate announcements were associated with short-term increases in vaccine uptake during key periods of the pandemic. Their removal was often associated with a slowing in uptake, highlighting the need for coordinated communication strategies to sustain coverage. Future policy responses should consider timing, mandate design, and transition planning in contexts where such policies are used.

Introduction: Research results are often not effectively communicated to study participants or others with relevant lived experience. Effective communication of research results would help study participants understand their contribution to research and could improve trust in research and likelihood of research participation. We aim to conduct a living (i.e., regularly updated) systematic review to assess the comparative effectiveness of communication tools for disseminating research results to study participants or others with relevant lived experience. Our primary objectives are to evaluate (1) overall satisfaction with the communication of study results, defined as how well the tool met participants' expectations and needs; (2) understanding of the study results, assessed through self-reported (e.g., perceived understanding) or objective measures (e.g., multiple-choice questions about study findings); and (3) ease of use, including clarity of language and navigability of the tool. Secondary objectives, including subgroup analyses will also be undertaken. Methods: Eligible studies will be randomized controlled trials (RCTs) that compare 2 or more communication tools for disseminating research results to people who participate in health research studies or others with relevant lived experience. Eligible tools will include, but will not be limited to, plain-language or lay summaries, infographics, visual abstracts, news articles or newsletters, comics, podcasts, study-specific websites, brochures, summary sheets, videos, leaflets, cartoons, and reports. Eligible comparators will include tools not specifically designed for study participants or others with relevant lived experience (e.g., scientific article, abstract) or another eligible tool. We will search MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Central. Automated searches will be set for monthly updates. Two independent reviewers screen, extract, and assess risk in identified studies. Meta-analyses will be considered if ≥ 2 eligible RCTs assess the effectiveness of similar tools and report comparable outcomes in similar populations. Discussion: Findings will inform decisions on how to most effectively share research results with study participants and others with relevant lived experience. Registration: PROSPERO (CRD42024463844).

Despite the growing relevance of Agriculture 4.0 technologies for enhancing productivity, decision-making, and sustainability in agri-food systems, their adoption remains uneven in developing-country contexts. This study aims to analyze the perceived severity and co-occurrence structure of barriers to Agriculture 4.0 adoption in the agri-food system of Rio Grande do Sul (RS), Brazil, using an exploratory quantitative design grounded in a barrier co-occurrence perspective rather than a causal or actor-centered network interpretation. An online survey conducted in 2024 with farmers in RS evaluated 25 literature-validated barriers spanning technological, economic, political, social, and environmental dimensions. The analysis combined a Barrier Severity Index (BSI), reliability testing, Principal Component Analysis (PCA), K-means clustering, ANOVA by farm size, and proximity-based co-occurrence networks constructed from highly rated barriers. The results show that economic barriers remain the most severe overall, particularly the lack of affordable solutions, high maintenance costs, and limited infrastructure. At the same time, farm-size-stratified networks reveal distinct association structures: small farms display a more segmented pattern linking affordability and technical access to institutional and capability constraints; medium farms show the most globally integrated co-occurrence structure; and large farms exhibit a dense but more differentiated configuration combining cost, interoperability, skills, and governance-related barriers. These findings are interpreted descriptively, as the networks capture patterns of co-reporting rather than causal interdependence. The study contributes a network-analytic representation of perceived barrier configurations and highlights the need for scale-sensitive policy mixes that address bundles of constraints rather than isolated obstacles.