76 FR 34087 - Broad Stakeholder Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-10

... DEPARTMENT OF HOMELAND SECURITY [Docket No. DHS-2011-0027] Broad Stakeholder Survey AGENCY... Survey. DATES: Comments are encouraged and will be accepted until August 9, 2011. This process is... Stakeholder Survey is designed to gather stakeholder feedback on the effectiveness of OEC services and to...

77 FR 50144 - Broad Stakeholder Survey

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-20

... DEPARTMENT OF HOMELAND SECURITY [Docket No. DHS-2012-0042] Broad Stakeholder Survey AGENCY... Survey. DATES: Comments are encouraged and will be accepted until October 19, 2012. This process is.... The Broad Stakeholder Survey is designed to gather stakeholder feedback on the effectiveness of OEC...

Stakeholders' resistance to telemedicine with focus on physicians: utilizing the Delphi technique.

PubMed

Choi, Woo Seok; Park, Joowoong; Choi, Jin Young Brian; Yang, Jae-Suk

2018-01-01

Introduction Sufficient infrastructure for information and communications technology (ICT) and a well-established policy are necessary factors for smooth implementation of telemedicine. However, despite these necessary conditions being met, there are situations where telemedicine still fails to be accepted as a system due to the low receptivity of stakeholders. In this study, we analyse stakeholders' resistance to an organization's implementation of telemedicine. Focusing on the physicians' interests, we propose a strategy to minimize conflicts and improve acceptance. Methods The Delphi study involved 190 telemedicine professionals who were recommended by 485 telemedicine-related personnel in South Korea. Results Out of 190 professionals, 60% of enrolled participants completed the final questionnaires. The stakeholders were categorized into four groups: policy-making officials, physicians, patients, and industrialists. Among these, the physicians were most opposed to the adoption of telemedicine. The main causes of such opposition were found to be the lack of a medical services delivery system and the threat of disruption for primary care clinics. Very little consensus was observed among the stakeholders, except on the following points: the need for expansion of the national health insurance budget by the government, and the need for enhancement of physicians' professional autonomy to facilitate smooth agreements. Discussion Our analysis on the causes of the resistance to telemedicine, carried out with the groups mentioned above, has important implications for policy-makers deriving strategies to achieve an appropriate consensus.

Distribution Grid Integration Costs Under High PV Penetrations Workshop |

Science.gov Websites

grids. These distribution grid integration costs are one component of a complete cost-benefit analysis . Engaging stakeholders to coalesce around transparent and mutually acceptable frameworks for cost-benefit -voltage only). In particular, there was be a focus on methods most appropriate for cost-benefit analysis

Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program.

PubMed

Gouin, Marie-Michelle; Coutu, Marie-France; Durand, Marie-José

2017-11-12

Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders. This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively. The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders' concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers' diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker's capacities were essential for return-to-work success. These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions. Implications for rehabilitation Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker's capacities, is important for return-to-work success. Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities. Rehabilitation professionals should also be constantly watching for workers' and employers' return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

The Mutable Nature of Risk and Acceptability: A Hybrid Risk Governance Framework.

PubMed

Wong, Catherine Mei Ling

2015-11-01

This article focuses on the fluid nature of risk problems and the challenges it presents to establishing acceptability in risk governance. It introduces an actor-network theory (ANT) perspective as a way to deal with the mutable nature of risk controversies and the configuration of stakeholders. To translate this into a practicable framework, the article proposes a hybrid risk governance framework that combines ANT with integrative risk governance, deliberative democracy, and responsive regulation. This addresses a number of the limitations in existing risk governance models, including: (1) the lack of more substantive public participation throughout the lifecycle of a project; (2) hijacking of deliberative forums by particular groups; and (3) the treatment of risk problems and their associated stakeholders as immutable entities. The framework constitutes a five-stage process of co-selection, co-design, co-planning, and co-regulation to facilitate the co-production of collective interests and knowledge, build capacities, and strengthen accountability in the process. The aims of this article are twofold: conceptually, it introduces a framework of risk governance that accounts for the mutable nature of risk problems and configuration of stakeholders. In practice, this article offers risk managers and practitioners of risk governance a set of procedures with which to operationalize this conceptual approach to risk and stakeholder engagement. © 2015 Society for Risk Analysis.

Key stakeholders' perceptions of the acceptability and usefulness of a tablet-based tool to improve communication and shared decision making in ICUs.

PubMed

Ernecoff, Natalie C; Witteman, Holly O; Chon, Kristen; Chen, Yanquan Iris; Buddadhumaruk, Praewpannarai; Chiarchiaro, Jared; Shotsberger, Kaitlin J; Shields, Anne-Marie; Myers, Brad A; Hough, Catherine L; Carson, Shannon S; Lo, Bernard; Matthay, Michael A; Anderson, Wendy G; Peterson, Michael W; Steingrub, Jay S; Arnold, Robert M; White, Douglas B

2016-06-01

Although barriers to shared decision making in intensive care units are well documented, there are currently no easily scaled interventions to overcome these problems. We sought to assess stakeholders' perceptions of the acceptability, usefulness, and design suggestions for a tablet-based tool to support communication and shared decision making in ICUs. We conducted in-depth semi-structured interviews with 58 key stakeholders (30 surrogates and 28 ICU care providers). Interviews explored stakeholders' perceptions about the acceptability of a tablet-based tool to support communication and shared decision making, including the usefulness of modules focused on orienting families to the ICU, educating them about the surrogate's role, completing a question prompt list, eliciting patient values, educating about treatment options, eliciting perceptions about prognosis, and providing psychosocial support resources. The interviewer also elicited stakeholders' design suggestions for such a tool. We used constant comparative methods to identify key themes that arose during the interviews. Overall, 95% (55/58) of participants perceived the proposed tool to be acceptable, with 98% (57/58) of interviewees finding six or more of the seven content domains acceptable. Stakeholders identified several potential benefits of the tool including that it would help families prepare for the surrogate role and for family meetings as well as give surrogates time and a framework to think about the patient's values and treatment options. Key design suggestions included: conceptualize the tool as a supplement to rather than a substitute for surrogate-clinician communication; make the tool flexible with respect to how, where, and when surrogates can access the tool; incorporate interactive exercises; use video and narration to minimize the cognitive load of the intervention; and build an extremely simple user interface to maximize usefulness for individuals with low computer literacy. There is broad support among stakeholders for the use of a tablet-based tool to improve communication and shared decision making in ICUs. Eliciting the perspectives of key stakeholders early in the design process yielded important insights to create a tool tailored to the needs of surrogates and care providers in ICUs. Copyright © 2016 Elsevier Inc. All rights reserved.

Using social network and stakeholder analysis to help evaluate infectious waste management: A step towards a holistic assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caniato, Marco, E-mail: marcocaniato@gmail.com; Vaccari, Mentore, E-mail: mentore.vaccari@unibs.it; Visvanathan, Chettiyappan, E-mail: visu@ait.ac.th

Highlights: • Assessment of infectious waste management in Bangkok, in particular incineration. • Integration of social network and stakeholder analysis assessment methods. • Assessment of stakeholder characteristics, role, interaction and communication. • Interviewees self-evaluate their own characteristics and the system. • Non-technical aspects are important for system acceptability, and sustainability. - Abstract: Assessing the strengths and weaknesses of a solid waste management scheme requires an accurate analysis and integration of several determining features. In addition to the technical aspects, any such system shows a complex interaction of actors with varying stakes, decision-making power and influence, as well as a favourablemore » or disabling environment. When capitalizing on the knowledge and experience from a specific case, it is also crucial that experts do not “forget” or underestimate the importance of such social determinants and that they are familiar with the methods and tools to assess them. Social network analysis (SNA) and stakeholder analysis (SA) methods can be successfully applied to better understand actors’ role and actions, analyse driving forces and existing coordination among stakeholders, as well as identify bottlenecks in communication which affect daily operations or strategic planning for the future way forward. SNA and SA, appropriately adjusted for a certain system, can provide a useful integration to methods by assessing other aspects to ensure a comprehensive picture of the situation. This paper describes how to integrate SNA and SA in order to survey a solid waste management system. This paper presents the results of an analysis of On-Nuch infectious waste incinerator in Bangkok, Thailand. Stakeholders were interviewed and asked to prioritize characteristics and relationships which they consider particularly important for system development and success of the scheme. In such a way, a large quantity of information about organization, communication between stakeholders and their perception about operation, environmental and health impact, and potential alternatives for the system was collected in a systematic way. The survey results suggest that stakeholders are generally satisfied with the system operation, though communication should be improved. Moreover, stakeholders should be strategically more involved in system development planning, according to their characteristics, to prevent negative reactions.« less

Patient and provider perspectives on the design and implementation of an electronic consultation system for kidney care delivery in Canada: a focus group study.

PubMed

Bello, Aminu K; Molzahn, Anita E; Girard, Louis P; Osman, Mohamed A; Okpechi, Ikechi G; Glassford, Jodi; Thompson, Stephanie; Keely, Erin; Liddy, Clare; Manns, Braden; Jinda, Kailash; Klarenbach, Scott; Hemmelgarn, Brenda; Tonelli, Marcello

2017-03-02

We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery. This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers). The e-Consult system was generally acceptable across all stakeholder groups. The key barriers identified were length of time required for referring physicians to complete the e-Consult due to lack of integration with current electronic medical records, and concerns that increased numbers of requests might overwhelm nephrologists and lead to a delayed response or an unsustainable system. The key facilitators identified were potential improvement of care coordination, dissemination of best practice through an educational platform, comprehensive data to make decisions without the need for face-to-face consultation, timely feedback to primary care providers, timeliness/reduced delays for patients' rapid triage and identification of cases needing urgent care and improved access to information to facilitate decision-making in patient care. Stakeholder perceptions regarding the e-Consult system were favourable, and the key barriers and facilitators identified will be considered in design and implementation of an acceptable and sustainable electronic consultation system for kidney care delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

May Stakeholders be Involved in Design Without Informed Consent? The Case of Hidden Design.

PubMed

Pols, A J K

2017-06-01

Stakeholder involvement in design is desirable from both a practical and an ethical point of view. It is difficult to do well, however, and some problems recur again and again, both of a practical nature, e.g. stakeholders acting strategically rather than openly, and of an ethical nature, e.g. power imbalances unduly affecting the outcome of the process. Hidden Design has been proposed as a method to deal with the practical problems of stakeholder involvement. It aims to do so by taking the observation of stakeholder actions, rather than the outcomes of a deliberative process, as its input. Furthermore, it hides from stakeholders the fact that a design process is taking place so that they will not behave differently than they otherwise would. Both aspects of Hidden Design have raised ethical worries. In this paper I make an ethical analysis of what it means for a design process to leave participants uninformed or deceived rather than acquiring their informed consent beforehand, and to use observation of actions rather than deliberation as input for design, using Hidden Design as a case study. This analysis is based on two sets of normative guidelines: the ethical guidelines for psychological research involving deception or uninformed participants from two professional psychological organisations, and Habermasian norms for a fair and just (deliberative) process. It supports the conclusion that stakeholder involvement in design organised in this way can be ethically acceptable, though under a number of conditions and constraints.

Impacts of the Interim Federal Health Program reforms: A stakeholder analysis of barriers to health care access and provision for refugees.

PubMed

Antonipillai, Valentina; Baumann, Andrea; Hunter, Andrea; Wahoush, Olive; O'Shea, Timothy

2017-11-09

Changes to the Interim Federal Health Program (IFHP) in 2012 reduced health care access for refugees and refugee claimants, generating concerns among key stakeholders. In 2014, a new IFHP temporarily reinstated access to some health services; however, little is known about these changes, and more information is needed to map the IFHP's impact. This study explores barriers occurring during the time period of the IFHP reforms to health care access and provision for refugees. A stakeholder analysis, using 23 semi-structured interviews, was conducted to obtain insight into stakeholder perceptions of the 2014 reforms, as well as stakeholders' position and their influence to assess the acceptability of the IFHP changes. The majority of stakeholders expressed concerns about the 2014 IFHP changes as a result of the continuing barriers posed by the 2012 retrenchments and the emergence of new barriers to health care access and provision for refugees. Key barriers identified included lack of communication and awareness, lack of continuity and comprehensive care, negative political discourse and increased costs. A few stakeholders supported the reforms as they represented some, but limited, access to health care. Overall, the reforms to the IFHP in 2014 generated barriers to health care access and provision that contributed to confusion among stakeholders, the transfer of refugee health responsibility to provincial authorities and the likelihood of increased health outcome disparities, as refugees and refugee claimants chose to delay seeking health care. The study recommends that policy-makers engage with refugee health stakeholders to formulate a policy that improves health care provision and access for refugee populations.

In acceptance we trust? Conceptualising acceptance as a viable approach to NGO security management.

PubMed

Fast, Larissa A; Freeman, C Faith; O'Neill, Michael; Rowley, Elizabeth

2013-04-01

This paper documents current understanding of acceptance as a security management approach and explores issues and challenges non-governmental organisations (NGOs) confront when implementing an acceptance approach to security management. It argues that the failure of organisations to systematise and clearly articulate acceptance as a distinct security management approach and a lack of organisational policies and procedures concerning acceptance hinder its efficacy as a security management approach. The paper identifies key and cross-cutting components of acceptance that are critical to its effective implementation in order to advance a comprehensive and systematic concept of acceptance. The key components of acceptance illustrate how organisational and staff functions affect positively or negatively an organisation's acceptance, and include: an organisation's principles and mission, communications, negotiation, programming, relationships and networks, stakeholder and context analysis, staffing, and image. The paper contends that acceptance is linked not only to good programming, but also to overall organisational management and structures. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

Bridging the Gap between Social Acceptance and Ethical Acceptability.

PubMed

Taebi, Behnam

2017-10-01

New technology brings great benefits, but it can also create new and significant risks. When evaluating those risks in policymaking, there is a tendency to focus on social acceptance. By solely focusing on social acceptance, we could, however, overlook important ethical aspects of technological risk, particularly when we evaluate technologies with transnational and intergenerational risks. I argue that good governance of risky technology requires analyzing both social acceptance and ethical acceptability. Conceptually, these two notions are mostly complementary. Social acceptance studies are not capable of sufficiently capturing all the morally relevant features of risky technologies; ethical analyses do not typically include stakeholders' opinions, and they therefore lack the relevant empirical input for a thorough ethical evaluation. Only when carried out in conjunction are these two types of analysis relevant to national and international governance of risky technology. I discuss the Rawlsian wide reflective equilibrium as a method for marrying social acceptance and ethical acceptability. Although the rationale of my argument is broadly applicable, I will examine the case of multinational nuclear waste repositories in particular. This example will show how ethical issues may be overlooked if we focus only on social acceptance, and will provide a test case for demonstrating how the wide reflective equilibrium can help to bridge the proverbial acceptance-acceptability gap. © 2016 The Authors Risk Analysis published by Wiley Periodicals, Inc. on behalf of Society for Risk Analysis.

A model for selecting bioindicators to monitor radionuclide concentrations using Amchitka Island in the Aleutians as a case study.

PubMed

Burger, Joanna

2007-11-01

World War II and the Cold War have left the Unites States, and other Nations, with massive cleanup and remediation tasks for radioactive and other legacy hazardous wastes. While some sites can be cleaned up to acceptable residential risk levels, others will continue to hold hazardous wastes, which must be contained and monitored to protect human health and the environment. While media (soil, sediment, groundwater) monitoring is the usual norm at many radiological waste sites, for some situations (both biological and societal), biomonitoring may provide the necessary information to assure greater peace of mind for local and regional residents, and to protect ecologically valuable buffer lands or waters. In most cases, indicators are selected using scientific expertise and a literature review, but not all selected indicators will seem relevant to stakeholders. In this paper, I provide a model for the inclusion of stakeholders in the development of bioindicators for assessing radionuclide levels of biota in the marine environment around Amchitka Island, in the Aleutian Chain of Alaska. Amchitka was the site of three underground nuclear tests from 1965 to 1971. The process was stakeholder-initiated, stakeholder-driven, and included stakeholders during each phase. Phases included conceptualization, initial selection of biota and radionuclides, refinement of biota and radionuclide target lists, collection of biota, selection of biota and radionuclides for analysis, and selection of biota, tissues, and radionuclides for bioindicators. The process produced site-specific information on biota availability and on radionuclide levels that led to selection of site-appropriate bioindicators. I suggest that the lengthy, iterative, stakeholder-driven process described in this paper results in selection of bioindicators that are accepted by biologists, public health personnel, public-policy makers, resource agencies, regulatory agencies, subsistence hunters/fishers, and a wide range of other stakeholders. The process is applicable to other sites with ecologically important buffer lands or waters, or where contamination issues are contentious.

Feasibility and acceptability of interventions to delay gun access in VA mental health settings.

PubMed

Walters, Heather; Kulkarni, Madhur; Forman, Jane; Roeder, Kathryn; Travis, Jamie; Valenstein, Marcia

2012-01-01

The majority of VA patient suicides are completed with firearms. Interventions that delay patients' gun access during high-risk periods may reduce suicide, but may not be acceptable to VA stakeholders or may be challenging to implement. Using qualitative methods, stakeholders' perceptions about gun safety and interventions to delay gun access during high-risk periods were explored. Ten focus groups and four individual interviews were conducted with key stakeholders, including VA mental health patients, mental health clinicians, family members and VA facility leaders (N=60). Transcripts were consensus-coded by two independent coders, and structured summaries were developed and reviewed using a consensus process. All stakeholder groups indicated that VA health system providers had a role in increasing patient safety and emphasized the need for providers to address gun access with their at-risk patients. However, VA mental health patients and clinicians reported limited discussion regarding gun access in VA mental health settings during routine care. Most, although not all, patients and clinicians indicated that routine screening for gun access was acceptable, with several noting that it was more acceptable for mental health patients. Most participants suggested that family and friends be involved in reducing gun access, but expressed concerns about potential family member safety. Participants generally found distribution of trigger locks acceptable, but were skeptical about its effectiveness. Involving Veteran Service Organizations or other individuals in temporarily holding guns during high-risk periods was acceptable to many participants but only with numerous caveats. Patients, clinicians and family members consider the VA health system to have a legitimate role in addressing gun safety. Several measures to delay gun access during high-risk periods for suicide were seen as acceptable and feasible if implemented thoughtfully. Published by Elsevier Inc.

Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico.

PubMed

Philbin, Morgan M; Mantsios, Andrea; Lozada, Remedios; Case, Patricia; Pollini, Robin A; Alvelais, Jorge; Latkin, Carl A; Magis-Rodriguez, Carlos; Strathdee, Steffanie A

2009-07-01

Injection drug use is a growing public health crisis along the U.S.-Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. We explored the acceptability and feasibility of such interventions in Tijuana, a city adjacent to San Diego, California. Using in-depth qualitative interviews conducted from August 2006-March 2007 with 40 key stakeholders - pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel - we explored the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included barriers, structural limitations, and suggestions for implementation. Topics included acceptance and feasibility of needle exchange programmes (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. Of these interventions, NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding. Increasing HIV infection rates among injection drug users in Tijuana have prompted interest in public health responses. Our results may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana.

Prospective political analysis for policy design: enhancing the political viability of single-payer health reform in Vermont.

PubMed

Blanchet, Nathan J; Fox, Ashley M

2013-06-01

In 2011 the state of Vermont adopted legislation that aims to create the nation's first state-level single-payer health care system, a system that would go well beyond national reform efforts. To conduct a prospective, institutional stakeholder analysis to guide development of a politically viable, universal health care reform proposal, as commissioned by Vermont's legislature in July 2010. A total of 64 semi-structured stakeholder interviews with nearly 120 individuals, representing 60 different groups/institutions, were conducted between July and December 2010. Interviews probed stakeholders regarding five major design components: financing options, decoupling insurance from employment, organization/governance, comprehensiveness of benefits, and payment reform. There was a range of opposition and support across stakeholder groups and components, and more remarkably a diversity of views within groups often believed to be unwavering supporters or detractors of comprehensive health reform. Given the balance of conflicting views, relative power, and acceptable trade-offs, the research team proposed a single-payer health care system financed through payroll taxes, decoupled from employment, with a generous benefit package, governed by a public-private intermediary. Prospective political analysis can assist in choosing among a range of technically sound policy options to create a more politically viable health reform package. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Multi-stakeholder perspectives in defining health-services quality in cataract care.

PubMed

Stolk-Vos, Aline C; van de Klundert, Joris J; Maijers, Niels; Zijlmans, Bart L M; Busschbach, Jan J V

2017-08-01

To develop a method to define a multi-stakeholder perspective on health-service quality that enables the expression of differences in systematically identified stakeholders' perspectives, and to pilot the approach for cataract care. Mixed-method study between 2014 and 2015. Cataract care in the Netherlands. Stakeholder representatives. We first identified and classified stakeholders using stakeholder theory. Participants established a multi-stakeholder perspective on quality of cataract care using concept mapping, this yielded a cluster map based on multivariate statistical analyses. Consensus-based quality dimensions were subsequently defined in a plenary stakeholder session. Stakeholders and multi-stakeholder perspective on health-service quality. Our analysis identified seven definitive stakeholders, as follows: the Dutch Ophthalmology Society, ophthalmologists, general practitioners, optometrists, health insurers, hospitals and private clinics. Patients, as dependent stakeholders, were considered to lack power by other stakeholders; hence, they were not classified as definitive stakeholders. Overall, 18 stakeholders representing ophthalmologists, general practitioners, optometrists, health insurers, hospitals, private clinics, patients, patient federations and the Dutch Healthcare Institute sorted 125 systematically collected indicators into the seven following clusters: patient centeredness and accessibility, interpersonal conduct and expectations, experienced outcome, clinical outcome, process and structure, medical technical acting and safety. Importance scores from stakeholders directly involved in the cataract service delivery process correlated strongly, as did scores from stakeholders not directly involved in this process. Using a case study on cataract care, the proposed methods enable different views among stakeholders concerning quality dimensions to be systematically revealed, and the stakeholders jointly agreed on these dimensions. The methods helped to unify different quality definitions and facilitated operationalisation of quality measurement in a way that was accepted by relevant stakeholders. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Does Joint Fact-finding work for Water-energy-food Nexus Issues? A Role of Scientific Evidence in Policy Process

NASA Astrophysics Data System (ADS)

Baba, K.

2014-12-01

A quite famous phrase in risk management "How safe is enough safe?" implies there exists a framing gap among experts, the general public and stakeholders. Scientific evidence that experts provide usually contains uncertainty, while the public tends to have the other type of qualitative local knowledge. As there is no zero-risk society, we have to build consensus on acceptable level of risk and trade-offs of risks based on expert knowledge and local knowledge. Therefore having a dialogue among them in the early stage of the policy process such as problem definition and agenda setting is essential to cultivate trust and to integrate their knowledge. To this end, we especially pay attention to Joint Fact-finding (JFF). The tentative definition of JFF is that a promising strategy for experts, decision makers, and key public rights-holders and stakeholders from opposing sides of an issue to work together to resolve or narrow factual disputes over public policy issues. JFF process usually begins with identifying stakeholders and holding interviews with them to determine their interests. We call this step stakeholder analysis. Then we define the scope of the study including the required scientific evidence and the preliminary list of experts. After that, stakeholders jointly select experts to participate in the study, then they work together on what they would like to clear about scientific evidence. They finally get the common understanding and findings through these collaboration. We applied the stakeholder analysis to the issue of groundwater in Obama City and the issues of hot spring water and geothermal power in Beppu City in Japan. We drew conclusions from these case studies to some extent but at the same time we found that the analysis method has a limitation in applying it to multiple nexus issues because the method based on stakeholders' cognition. For example, in Obama case, we identified a lack of cooperation among stakeholders that especially agricultural sector who should have positive relationship with groundwater in nature is not involved in groundwater issue thoroughly. However, we could not enough furnish stakeholders with the framing of trade-offs between resources. Accordingly we need to raise awareness of stakeholders with scientific evidence of experts on the way of the stakeholder analysis.

TREATMENT SWITCHING: STATISTICAL AND DECISION-MAKING CHALLENGES AND APPROACHES.

PubMed

Latimer, Nicholas R; Henshall, Chris; Siebert, Uwe; Bell, Helen

2016-01-01

Treatment switching refers to the situation in a randomized controlled trial where patients switch from their randomly assigned treatment onto an alternative. Often, switching is from the control group onto the experimental treatment. In this instance, a standard intention-to-treat analysis does not identify the true comparative effectiveness of the treatments under investigation. We aim to describe statistical methods for adjusting for treatment switching in a comprehensible way for nonstatisticians, and to summarize views on these methods expressed by stakeholders at the 2014 Adelaide International Workshop on Treatment Switching in Clinical Trials. We describe three statistical methods used to adjust for treatment switching: marginal structural models, two-stage adjustment, and rank preserving structural failure time models. We draw upon discussion heard at the Adelaide International Workshop to explore the views of stakeholders on the acceptability of these methods. Stakeholders noted that adjustment methods are based on assumptions, the validity of which may often be questionable. There was disagreement on the acceptability of adjustment methods, but consensus that when these are used, they should be justified rigorously. The utility of adjustment methods depends upon the decision being made and the processes used by the decision-maker. Treatment switching makes estimating the true comparative effect of a new treatment challenging. However, many decision-makers have reservations with adjustment methods. These, and how they affect the utility of adjustment methods, require further exploration. Further technical work is required to develop adjustment methods to meet real world needs, to enhance their acceptability to decision-makers.

Stakeholders' Perceptions of IELTS as an Entry Requirement for Higher Education in the UK

ERIC Educational Resources Information Center

Hyatt, David

2013-01-01

This project explores stakeholders' perceptions of the role of the International English Language Testing System (IELTS) in the admissions processes of UK higher education (HE) institutions. The term "stakeholders" here refers to HE academic and administrative staff responsible for the acceptance of students whose first language is not…

Sensitivity Analysis in Sequential Decision Models.

PubMed

Chen, Qiushi; Ayer, Turgay; Chhatwal, Jagpreet

2017-02-01

Sequential decision problems are frequently encountered in medical decision making, which are commonly solved using Markov decision processes (MDPs). Modeling guidelines recommend conducting sensitivity analyses in decision-analytic models to assess the robustness of the model results against the uncertainty in model parameters. However, standard methods of conducting sensitivity analyses cannot be directly applied to sequential decision problems because this would require evaluating all possible decision sequences, typically in the order of trillions, which is not practically feasible. As a result, most MDP-based modeling studies do not examine confidence in their recommended policies. In this study, we provide an approach to estimate uncertainty and confidence in the results of sequential decision models. First, we provide a probabilistic univariate method to identify the most sensitive parameters in MDPs. Second, we present a probabilistic multivariate approach to estimate the overall confidence in the recommended optimal policy considering joint uncertainty in the model parameters. We provide a graphical representation, which we call a policy acceptability curve, to summarize the confidence in the optimal policy by incorporating stakeholders' willingness to accept the base case policy. For a cost-effectiveness analysis, we provide an approach to construct a cost-effectiveness acceptability frontier, which shows the most cost-effective policy as well as the confidence in that for a given willingness to pay threshold. We demonstrate our approach using a simple MDP case study. We developed a method to conduct sensitivity analysis in sequential decision models, which could increase the credibility of these models among stakeholders.

Local perceptions of intermittent screening and treatment for malaria in school children on the south coast of Kenya

PubMed Central

2012-01-01

Background The intermittent screening and treatment (IST) of school children for malaria is one possible intervention strategy that could help reduce the burden of malaria among school children. Future implementation of IST will not only depend on its efficacy and cost-effectiveness but also on its acceptability to parents of the children who receive IST, as well as those responsible for its delivery. This study was conducted alongside a cluster-randomized trial to investigate local perceptions of school-based IST among parents and other stakeholders on the Kenyan south coast. Methods Six out of the 51 schools receiving the IST intervention were purposively sampled, based on the prevalence of Plasmodium infection, to participate in the qualitative study. Twenty-two focus group discussions and 17 in-depth interviews were conducted with parents and other key stakeholders involved in the implementation of school health programmes in the district. Data analysis was guided by the framework analysis method. Results High knowledge of the burden of clinical malaria on school children, the perceived benefits of preventing clinical disease through IST and previous positive experiences and interactions with other school health programmes facilitated the acceptability of IST. However, lack of understanding of the consequences of asymptomatic parasitaemia for apparently healthy school children could potentially contribute to non-adherence to treatment, and use of alternative anti-malarial drugs with simpler regimens was generally preferred. The general consensus of stakeholders was that health workers were best placed to undertake the screening and provide treatment, and although teachers’ involvement in the programme is critical, most participants were opposed to teachers taking finger-prick blood samples from children. There was also a strong demand for the distribution of mosquito nets to augment IST. Conclusion School-based malaria control through IST was acceptable to most parents and other stakeholders, but careful consideration of the various roles of teachers, community health workers, and health workers, and the use of anti-malarial drugs with simpler regimens are critical to its future implementation. PMID:22681850

Acceptability and Perceived Benefits and Risks of Public and Patient Involvement in Health Care Policy: A Delphi Survey in Belgian Stakeholders.

PubMed

Cleemput, Irina; Christiaens, Wendy; Kohn, Laurence; Léonard, Christian; Daue, François; Denis, Alain

2015-06-01

In systems with public health insurance, coverage decisions should reflect social values. Deliberation among stakeholders could achieve this goal, but rarely involves patients and citizens directly. This study aimed at evaluating the acceptability, and the perceived benefits and risks, of public and patient involvement (PPI) in coverage decision making to Belgian stakeholders. A two-round Delphi survey was conducted among all stakeholder groups. The survey was constructed on the basis of interviews with 10 key stakeholders and a review of the literature on participation models. Consensus was defined as 65% or more of the respondents agreeing with a statement and less than 15% disagreeing. Eighty stakeholders participated in both rounds. They were defined as the Delphi panel. Belgian stakeholders are open toward PPI in coverage decision processes. Benefits are expected to exceed risks. The preferred model for involvement is to consult citizens or patients, within the existing decision-making structures and at specific milestones in the process. Consulting citizens and patients is a higher level of involvement than merely informing them and a lower level than letting them participate actively. Consultation involves asking nonbinding advice on (parts of) the decision problem. According to the Delphi panel, the benefits of PPI could be increasing awareness among members of the general public and patients about the challenges and costs of health care, and enriched decision processes with expertise by experience from patients. Potential risks include subjectivity, insufficient resources to participate and weigh on the process, difficulties in finding effective ways to express a collective opinion, the risk of manipulation, and lobbying or power games of other stakeholders. PPI in coverage decision-making processes is acceptable to Belgian stakeholders, be it in different ways for different types of decisions. Benefits are expected to outweigh risks. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Ethical perspectives on emerging assistive technologies: insights from focus groups with stakeholders in long-term care facilities.

PubMed

Dorsten, Aimee-Marie; Sifford, K Susan; Bharucha, Ashok; Mecca, Laurel Person; Wactlar, Howard

2009-03-01

ASSISTIVE TECHNOLOGIES ARE RELATIVELY novel tools for research and daily care in long-term care (LTC) facilities that are faced with the burgeoning of the older adult population and dwindling staffing resources. The degree to which stakeholders in LTC facilities are receptive to the use of these technologies is poorly understood. Eighteen semi-structured focus groups and one interview were conducted with relevant groups of stakeholders at seven LTC facilities in southwestern Pennsylvania. Common themes identified across all focus groups centered on concerns for privacy, autonomy, cost, and safety associated with implementation of novel technologies. The relative importance of each theme varied by stakeholder group as well as the perceived severity of cognitive and/or physical disability. Our findings suggest that ethical issues are critical to acceptance of novel technologies by their end users, and that stakeholder groups are interdependent and require shared communication about the acceptance of these emerging technologies.

If We Build It, Will They Come? A Qualitative Study of Key Stakeholder Opinions on the Implementation of a Videogame Intervention for Risk Reduction in Adolescents.

PubMed

Pendergrass, Tyra M; Hieftje, Kimberly; Crusto, Cindy A; Montanaro, Erika; Fiellin, Lynn E

2016-08-01

Serious games are emerging as important tools that offer an innovative approach to teach adolescents behavioral skills to avoid risky situations. PlayForward: Elm City Stories, an interactive videogame targeting risk reduction, is currently undergoing evaluation. Collecting stakeholder data on its acceptability and real-life implementation strategies is critical for successful dissemination. We collected interview data from four stakeholder groups regarding incorporating PlayForward into settings with adolescents. Transcripts were coded, creating a comprehensive code structure for each stakeholder group. We conducted 40 semi-structured interviews that included 14 adolescents (aged 12-15 years; 10 boys), eight parents/guardians (all women), 12 after-school/school coordinators (nine women), and 14 community partners (13 women). We identified four themes that reflected stakeholders' perceptions about how the videogame might be implemented in real-world settings. (1) Stakeholder groups expressed that the topics of sex, alcohol, and drugs were not being taught in an educational setting. (2) Stakeholder groups saw a videogame as a viable option to teach about sex, alcohol, and drugs. (3) Stakeholder groups thought that the videogame would fit well into other settings, such as after-school programs or community organizations. (4) Some stakeholder groups highlighted additional tools that could help with implementation, such as manuals, homework assignments, and group discussion questions. Stakeholder groups supported the game as a delivery vehicle for targeted content, indicating high acceptability but highlighting additional tools that would aid in implementation.

A qualitative study assessing the acceptability and adoption of implementing a results based financing intervention to improve maternal and neonatal health in Malawi.

PubMed

Wilhelm, Danielle J; Brenner, Stephan; Muula, Adamson S; De Allegri, Manuela

2016-08-17

Results Based Financing (RBF) interventions have recently gained significant momentum, especially in sub-Saharan Africa. However, most of the research has focused on the evaluation of the impacts of this approach, providing little insight into how the contextual circumstances surrounding the implementation have contributed to its success or failure. This study aims to fill a void in the current literature on RBF by focusing explicitly on the process of implementing a RBF intervention rather than on its impact. Specifically, this study focuses on the acceptability and adoption of the RBF intervention's implementation among local and international key stakeholders with the aim to inform further implementation. The Results Based Financing for Maternal and Neonatal Health (RBF4MNH) Initiative is currently being implemented in Malawi. Our study employed an exploratory cross-sectional qualitative design to explore the factors affecting the acceptability and adoption of the intervention's implementation. Purposeful sampling techniques were used to identify each key stakeholder who participated in all or parts of the implementation process. In-depth interviews were conducted and analyzed using a deductive open coding approach. The final interpretation of the findings emerged through active discussion among the co-authors. Despite encountering several challenges, such as delay in procurement of equipment and difficulties in arranging local bank accounts, all stakeholders responded positively to the RBF4MNH Initiative. Stakeholders' acceptance of the RBF4MNH Initiative grew stronger over time as understanding of the intervention improved and was supported by early inclusion during the design and implementation process. In addition, stakeholders took on functions not directly incentivized by the intervention, suggesting that they turned adoption into actual ownership. All stakeholders raised concerns that the intervention may not be sustainable after its initial program phase would end, which contributed to hesitancy in fully accepting the intervention. Based on the results of this study, we recommend the inclusion of local stakeholders into the intervention's implementation process at the earliest stages. We also recommend setting up continuous feedback mechanisms to tackle challenges encountered during the implementation process. The sustainability of the intervention and its incorporation into national budgets should be addressed from the earliest stages.

Using concept mapping to mobilize a Black faith community to address HIV

PubMed Central

Szaflarski, Magdalena; Vaughn, Lisa M; McLinden, Daniel; Wess, Yolanda; Ruffner, Andrew

2017-01-01

Research that partners with community stakeholders increases contextual relevance and community buy-in and maximizes the chance for intervention success. Within a framework of an academic-community partnership, this project assessed a Black faith-community’s needs and opportunities to address HIV. We used concept mapping to identify/prioritize specific HIV-related strategies that would be acceptable to congregations. Ninety stakeholders brainstormed strategies to address HIV; 21 sorted strategies into groups and rated their importance and feasibility. Multidimensional scaling and cluster analysis were applied to the sorting to produce maps that illustrated the stakeholders’ conceptual thinking about HIV interventions. Of 278 responses, 93 were used in the sorting task. The visual maps represented eight clusters: church acceptance of people living with HIV; education (most feasible); mobilization and communication; church/leaders’ empowerment; church involvement/collaboration; safety/HIV prevention; media outreach; and, stigma (most important). Concept mapping clarified multifaceted issues of HIV in the Black faith community. The results will guide HIV programming in congregations. PMID:28239439

The stakeholder preference for best management practices in the Three Gorges Reservoir Region.

PubMed

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived (P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

Exploring stakeholder perceptions of acceptability and feasibility of needle exchange programmes, syringe vending machines and safer injection facilities in Tijuana, Mexico

PubMed Central

Philbin, Morgan M.; Mantsios, Andrea; Lozada, Remedios; Case, Patricia; Pollini, Robin A.; Alvelais, Jorge; Latkin, Carl A.; Magis-Rodriguez, Carlos; Strathdee, Steffanie A.

2009-01-01

Background Injection drug use is a growing public health crisis along the U.S.–Mexican border and rising rates of blood-borne infections highlight the pressing need for harm reduction interventions. We explored the acceptability and feasibility of such interventions in Tijuana, a city adjacent to San Diego, California. Methods Using in-depth qualitative interviews conducted from August 2006–March 2007 with 40 key stakeholders – pharmacists, legal professionals, health officials, religious officials, drug treatment providers, and law enforcement personnel – we explored the acceptability and feasibility of interventions to reduce drug-related harm in Tijuana, Mexico. Interviews were taped with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included barriers, structural limitations, and suggestions for implementation. Results Topics included acceptance and feasibility of needle exchange programmes (NEPs), syringe vending machines, and safer injection facilities (SIFs), structural barriers and suggestions for implementation. Of these interventions, NEPs were deemed the most acceptable (75%); however, only half believed these could be feasibly implemented, citing barriers involving religion, police, and lack of political will, public awareness, and funding. Conclusions Increasing HIV infection rates among injection drug users in Tijuana have prompted interest in public health responses. Our results may assist policy strategists in implementing social-structural interventions that will help create enabling environments that facilitate the scale-up and implementation of harm reduction in Tijuana. PMID:18963906

The Stakeholder Preference for Best Management Practices in the Three Gorges Reservoir Region

NASA Astrophysics Data System (ADS)

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived ( P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

If We Build It, Will They Come? A Qualitative Study of Key Stakeholder Opinions on the Implementation of a Videogame Intervention for Risk Reduction in Adolescents

PubMed Central

Hieftje, Kimberly; Crusto, Cindy A.; Montanaro, Erika; Fiellin, Lynn E.

2016-01-01

Abstract Objective: Serious games are emerging as important tools that offer an innovative approach to teach adolescents behavioral skills to avoid risky situations. PlayForward: Elm City Stories, an interactive videogame targeting risk reduction, is currently undergoing evaluation. Collecting stakeholder data on its acceptability and real-life implementation strategies is critical for successful dissemination. Materials and Methods: We collected interview data from four stakeholder groups regarding incorporating PlayForward into settings with adolescents. Transcripts were coded, creating a comprehensive code structure for each stakeholder group. Results: We conducted 40 semi-structured interviews that included 14 adolescents (aged 12–15 years; 10 boys), eight parents/guardians (all women), 12 after-school/school coordinators (nine women), and 14 community partners (13 women). We identified four themes that reflected stakeholders' perceptions about how the videogame might be implemented in real-world settings. (1) Stakeholder groups expressed that the topics of sex, alcohol, and drugs were not being taught in an educational setting. (2) Stakeholder groups saw a videogame as a viable option to teach about sex, alcohol, and drugs. (3) Stakeholder groups thought that the videogame would fit well into other settings, such as after-school programs or community organizations. (4) Some stakeholder groups highlighted additional tools that could help with implementation, such as manuals, homework assignments, and group discussion questions. Conclusion: Stakeholder groups supported the game as a delivery vehicle for targeted content, indicating high acceptability but highlighting additional tools that would aid in implementation. PMID:27336205

Lessons learned from stakeholder-driven sustainability analysis of six national HIV programmes.

PubMed

Katz, Itamar; Glandon, Douglas; Wong, Wendy; Kargbo, Brima; Ombam, Regina; Singh, Shanti; Ramsammy, Leslie; Tal-Dia, Anta; Seck, Ibrahima; Osika, John S

2014-05-01

In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis. During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article. The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed. Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.

Translating reference doses into allergen management practice: challenges for stakeholders.

PubMed

Crevel, René W R; Baumert, Joseph L; Luccioli, Stefano; Baka, Athanasia; Hattersley, Sue; Hourihane, Jonathan O'B; Ronsmans, Stefan; Timmermans, Frans; Ward, Rachel; Chung, Yong-joo

2014-05-01

Risk assessment describes the impact of a particular hazard as a function of dose and exposure. It forms the foundation of risk management and contributes to the overall decision-making process, but is not its endpoint. This paper outlines a risk analysis framework to underpin decision-making in the area of allergen cross-contact. Specifically, it identifies challenges relevant to each component of the risk analysis: risk assessment (data gaps and output interpretation); risk management (clear and realistic objectives); and risk communication (clear articulation of risk and benefit). Translation of the outputs from risk assessment models into risk management measures must be informed by a clear understanding of the model outputs and their limitations. This will lead to feasible and achievable risk management objectives, grounded in a level of risk accepted by the different stakeholders, thereby avoiding potential unintended detrimental consequences. Clear, consistent and trustworthy communications actively involving all stakeholders underpin these objectives. The conclusions, integrating the perspectives of different stakeholders, offer a vision where clear, science-based benchmarks form the basis of allergen management and labelling, cutting through the current confusion and uncertainty. Finally, the paper recognises that the proposed framework must be adaptable to new and emerging evidence. Copyright © 2014 ILSI Europe. Published by Elsevier Ltd.. All rights reserved.

Attitudes and perceptions towards novel objective measures of ARV-based vaginal ring use: Results from a global stakeholder survey

PubMed Central

Tharaldson, Jenae; Owen, Derek H.; Okumu, Eunice; Moench, Thomas; Mack, Natasha; Tolley, Elizabeth E.; MacQueen, Kathleen M.

2017-01-01

Results of recent microbicide and pre-exposure prophylaxis clinical trials have shown adherence to be a significant challenge with new HIV prevention technologies. As the vaginal ring containing dapivirine moves into two open label follow-on studies (HOPE/MTN-025 and DREAM) and other antiretroviral-based and multi-purpose prevention technology ring products advance through the development pipeline, there is a need for more accurate and reliable measures of adherence to microbicide ring products. We previously conducted a comprehensive landscape analysis to identify new technologies that could be applied to adherence measurement of vaginal rings containing antiretrovirals. To explore attitudes and perceptions towards the approaches that we identified, we conducted a survey of stakeholders with experience and expertise in microbicide and HIV prevention clinical trials. From May to July 2015 an electronic survey was distributed via email to 894 stakeholders; a total of 206 eligible individuals responded to at least one question and were included in the data analysis. Survey respondents were presented with various objective measures and asked about their perceived acceptability to trial participants, feasibility of implementation by study staff, usefulness for measuring adherence and ethical concerns. Methods that require no additional input from the participant and require no modifications to the existing ring product (i.e., measurement of residual drug or excipient, or a vaginal analyte that enters the ring) were viewed as being more acceptable to trial participants and more feasible to implement in the field. Respondents saw value in using objective measures to provide real-time feedback on adherence. However, approaches that involve unannounced home visits for sample collection or spot checks of ring use, which could provide significant value to adherence feedback efforts, were met with skepticism. Additional research on the acceptability of these methods to potential trial participants and trial staff is recommended. PMID:28708847

Attitudes and perceptions towards novel objective measures of ARV-based vaginal ring use: Results from a global stakeholder survey.

PubMed

Stalter, Randy M; Tharaldson, Jenae; Owen, Derek H; Okumu, Eunice; Moench, Thomas; Mack, Natasha; Tolley, Elizabeth E; MacQueen, Kathleen M

2017-01-01

Results of recent microbicide and pre-exposure prophylaxis clinical trials have shown adherence to be a significant challenge with new HIV prevention technologies. As the vaginal ring containing dapivirine moves into two open label follow-on studies (HOPE/MTN-025 and DREAM) and other antiretroviral-based and multi-purpose prevention technology ring products advance through the development pipeline, there is a need for more accurate and reliable measures of adherence to microbicide ring products. We previously conducted a comprehensive landscape analysis to identify new technologies that could be applied to adherence measurement of vaginal rings containing antiretrovirals. To explore attitudes and perceptions towards the approaches that we identified, we conducted a survey of stakeholders with experience and expertise in microbicide and HIV prevention clinical trials. From May to July 2015 an electronic survey was distributed via email to 894 stakeholders; a total of 206 eligible individuals responded to at least one question and were included in the data analysis. Survey respondents were presented with various objective measures and asked about their perceived acceptability to trial participants, feasibility of implementation by study staff, usefulness for measuring adherence and ethical concerns. Methods that require no additional input from the participant and require no modifications to the existing ring product (i.e., measurement of residual drug or excipient, or a vaginal analyte that enters the ring) were viewed as being more acceptable to trial participants and more feasible to implement in the field. Respondents saw value in using objective measures to provide real-time feedback on adherence. However, approaches that involve unannounced home visits for sample collection or spot checks of ring use, which could provide significant value to adherence feedback efforts, were met with skepticism. Additional research on the acceptability of these methods to potential trial participants and trial staff is recommended.

Formative research and stakeholder participation in intervention development.

PubMed

Vastine, Amy; Gittelsohn, Joel; Ethelbah, Becky; Anliker, Jean; Caballero, Benjamin

2005-01-01

To present a model for using formative research and stakeholder participation to develop a community-based dietary intervention targeting American Indians. Formative research included interviews, assessment of food- purchasing frequency and preparation methods, and dietary recalls. Stakeholders contributed to intervention development through formative research, a program planning workshop, group feedback, and implementation training. Foods high in fat and sugar are commonly consumed. Barriers to healthy eating include low availability, perceived high cost, and poor flavor. Stakeholder participation contributed to the development of a culturally appropriate intervention. This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program.

Ethical Issues in E-Learning: Insights from the Application of Stakeholder Analysis in Three E-Learning Cases.

ERIC Educational Resources Information Center

Chozos, Polyneikis; Lytras, Miltos; Pouloudi, Nancy

The application of emerging digital technologies such as e-mail, the World Wide Web and the Internet in the educational setting has received wide acceptance all over the world. Both corporate and academic agendas have recognized the potential advantages of e-learning; however, as a new field, e-learning courses comes with important issues that…

Contract Source Selection: An Analysis of Lowest Price Technically Acceptable and Tradeoff Strategies

DTIC Science & Technology

2016-06-15

selection strategy is key to minimizing risk and ensuring best value for all stakeholders. On the basis of thorough market research , acquisition...administrative lead-time, Contractor Performance Assessment Reporting System ratings, and earned value management assessments) and source selection strategy ...Postgraduate School A. PURPOSE This research analyzes LPTA and tradeoff source selection strategies and contract outcomes to determine if a relationship

Clinical imaging guidelines part 4: challenges in identifying, engaging and collaborating with stakeholders.

PubMed

Bettmann, Michael A; Oikarinen, Helja; Rehani, Madan; Holmberg, Ola; del Rosario Perez, Maria; Naidoo, Anusha; Do, Kyung-Hyun; Dreyer, Keith; Ebdon-Jackson, Steve

2015-04-01

The effective development and use of clinical imaging guidelines requires an understanding of who the stakeholders are, what their interests in the process are, and what roles they should play. If the appropriate stakeholders are not engaged in the right roles, it is unlikely that clinical imaging guidelines will be successfully developed, relied on, and actually used. Some stakeholders are obvious: for the development of clinical imaging guidelines, both imagers and those who request examinations, such as general practitioners, internists, and medical specialists, must be involved. To gain acceptance, other relevant groups are stakeholders, including medical societies, other health care professionals, insurers, health IT experts and vendors, and patients. The role of stakeholders must be dictated by their specific interest. For some, involvement in the creation of guidelines is the right role. For others, such as regulators or insurers, reviews or invitations to comment are required, and for others, such as medical educators, it is probably sufficient to provide information and create awareness. Only through a careful consideration of who the stakeholders are and what are their interests are the successful development, acceptance, and use of clinical imaging guidelines likely to occur. Future efforts must focus on collaboration, particularly among groups that create clinical imaging guidelines and those that can support their use, and on regulatory roles and mandates. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[How to prevent hazards and to reduce risk in clinical trials?].

PubMed

Czarkowski, Marek

2008-12-01

Different stakeholders involved in clinical trials are exposed to hazards related with this biomedical research. Beside clinical trials participants other important stakeholders are: investigators, sponsors, centers and clinical research organizations. Hazard prevention needs effective methods of hazard disclosure and analysis. A reduction of risks related with clinical trials is possible due to education, training, inspections, research discipline and penalties. Effective ways of hazard elimination or hazard reduction should be developed as well. Education and training should be offered to all stakeholders but their forms and contents should be adapted to different types of stakeholders. Direct control of the clinical trials should be held by stakeholders conducting clinical trials and outside inspections should be done by other institutions like clinical research organizations, research ethics committees and The Office for Registration of Medicinal Products, Medical Devices and Biocidal Products. Serious oversight is an absence of any independent inspection during a phase of publication of clinical trial results. We should not accept any exception from the golden rule that results of all clinical trials must be published. Indemnity for damages is a popular way of compensation for clinical trials participants. Investigators, sponsors and centers should have valid liability insurance. Drastic measures for reduction of risks in clinical trials are different kinds of penalties. They should prevent participation of unreliable stakeholders and promote those who respect regulations and high ethical standards.

Engagement strategies that foster community self-determination in participatory research: Insider ownership through outsider championship.

PubMed

Salsberg, Jon; Macridis, Soultana; Garcia Bengoechea, Enrique; Macaulay, Ann C; Moore, Spencer

2017-06-01

In order to maximize the benefits of community-based participatory research, effective ownership over the research process must be at least equally in the hands of the community. A previous social network analysis documented that the participatory research process shifted ownership from academic to community partners, but did not show what actions and strategies fostered this shift. This study follows the trajectory of a community-academic partnership and asks, from the perspective of the project stakeholders, which actions and strategies over the lifespan of the research led to the observed shift in ownership and decision-making from the original external academics to the community stakeholders? Qualitative description using inductive thematic analysis. One academic and five community stakeholders identified as central in a previous social network analysis, participated in retrospective, semi-structured interviews. Actions deemed to have fostered the observed shift in ownership included: existence of a strong champion; stimulating 'outside' ideas; emergence of core people; alignment of project goals with stakeholders' professional roles; involving the right people; personal qualities of the champion; trust-building; and active use of participatory engagement strategies. Although communities must take ownership over the research process to assure sustained action and change, a strong, trusted and accepted outside champion who actively enacts participatory engagement strategies can facilitate the participatory process and provide community stakeholders the time and support they need to achieve meaningful and sustained leadership roles. These findings have implications for how partnership research is designed and implemented, both in community and in clinical organisational settings. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Public acceptance of management methods under different human-wildlife conflict scenarios.

PubMed

Liordos, Vasilios; Kontsiotis, Vasileios J; Georgari, Marina; Baltzi, Kerasia; Baltzi, Ioanna

2017-02-01

Wildlife management seeks to minimise public controversy for successful application of wildlife control methods. Human dimensions research in wildlife seeks a better understanding of public preferences for effective human-wildlife conflict resolution. In face to face interviews, 630 adults in Greece were asked to rate on a 5-point Likert-like scale their acceptance of 3 management methods, i.e., do nothing, non-lethal control, and lethal control, in the context of 5 human-wildlife conflict scenarios: 1) corvids damage crops; 2) starlings damage crops; 3) starlings foul urban structures; 4) coypus damage crops; and 5) coypus transfer disease. Univariate GLMs determined occupation, hunting membership and their interaction as the stronger predictors of public acceptance, generating 4 stakeholder groups: the general public, farmers, hunters, and farmers-hunters. Differences in acceptance and consensus among stakeholder groups were assessed using the Potential for Conflict Index 2 (PCI 2 ). All 4 stakeholder groups agreed that doing nothing was unacceptable and non-lethal control acceptable in all 5 scenarios, with generally high consensus within and between groups. The lethal control method was more controversial and became increasingly more acceptable as the severity of scenarios was increased and between non-native and native species. Lethal control was unacceptable for the general public in all scenarios. Farmers accepted lethal methods in the corvids and starlings scenarios, were neutral in the coypus damage crops scenario, whereas they accepted lethal control when coypus transfer disease. Hunters' opinion was neutral in the corvids, starlings and coypus damage crops and starlings foul urban structures scenarios, but they accepted lethal methods in the coypus transfer disease scenario. Farmers-hunters considered lethal control acceptable in all 5 scenarios. Implications from this study could be used for designing a socio-ecological approach which incorporates wildlife management with public interests. The studied species have a wide distribution, therefore present findings might also prove useful elsewhere. Copyright © 2016 Elsevier B.V. All rights reserved.

Stakeholders' attitude to genetically modified foods and medicine.

PubMed

Amin, Latifah; Jahi, Jamaluddin Md; Nor, Abd Rahim Md

2013-01-01

Public acceptance of genetically modified (GM) foods has to be adequately addressed in order for their potential economic and social benefits to be realized. The objective of this paper is to assess the attitude of the Malaysian public toward GM foods (GM soybean and GM palm oil) and GM medicine (GM insulin). A survey was carried out using self-constructed multidimensional instrument measuring attitudes towards GM products. The respondents (n = 1017) were stratified according to stakeholders' groups in the Klang Valley region. Results of the survey show that the overall attitude of the Malaysian stakeholders towards GM products was cautious. Although they acknowledged the presence of moderate perceived benefits associated with GM products surveyed and were moderately encouraging of them, they were also moderately concerned about the risks and moral aspects of the three GM products as well as moderately accepting the risks. Attitudes towards GM products among the stakeholders were found to vary not according to the type of all GM applications but rather depend on the intricate relationships between the attitudinal factors and the type of gene transfers involved. Analyses of variance showed significant differences in the six dimensions of attitude towards GM products across stakeholders' groups.

Stakeholders' Attitude to Genetically Modified Foods and Medicine

PubMed Central

Md Jahi, Jamaluddin; Md Nor, Abd Rahim

2013-01-01

Public acceptance of genetically modified (GM) foods has to be adequately addressed in order for their potential economic and social benefits to be realized. The objective of this paper is to assess the attitude of the Malaysian public toward GM foods (GM soybean and GM palm oil) and GM medicine (GM insulin). A survey was carried out using self-constructed multidimensional instrument measuring attitudes towards GM products. The respondents (n = 1017) were stratified according to stakeholders' groups in the Klang Valley region. Results of the survey show that the overall attitude of the Malaysian stakeholders towards GM products was cautious. Although they acknowledged the presence of moderate perceived benefits associated with GM products surveyed and were moderately encouraging of them, they were also moderately concerned about the risks and moral aspects of the three GM products as well as moderately accepting the risks. Attitudes towards GM products among the stakeholders were found to vary not according to the type of all GM applications but rather depend on the intricate relationships between the attitudinal factors and the type of gene transfers involved. Analyses of variance showed significant differences in the six dimensions of attitude towards GM products across stakeholders' groups. PMID:24381520

User testing and stakeholder feedback contributed to the development of understandable and useful Summary of Findings tables for Cochrane reviews.

PubMed

Rosenbaum, Sarah E; Glenton, Claire; Nylund, Hilde Kari; Oxman, Andrew D

2010-06-01

To develop a Summary of Findings (SoF) table for use in Cochrane reviews that is understandable and useful for health professionals, acceptable to Cochrane Collaboration stakeholders, and feasible to implement. We gathered stakeholder feedback on the format and content of an SoF table from an advisory group of more than 50 participants and their constituencies through e-mail consultations. We conducted user tests using a think-aloud protocol method, collecting feedback from 21 health professionals and researchers in Norway and the UK. We analyzed the feedback, defined problem areas, and generated new solutions in brainstorming workshops. Stakeholders were concerned about precision in the data representation and about production feasibility. User testing revealed unexpected comprehension problems, mainly confusion about what the different numbers referred to (class reference). Resolving the tension between achieving table precision and table simplicity became the main focus of the working group. User testing led to a table more useful and understandable for clinical audiences. We arrived at an SoF table that was acceptable to the stakeholders and in principle feasible to implement technically. Some challenges remain, including presenting continuous outcomes and technical/editorial implementation.

Contract Source Selection: An Analysis of Lowest Price Technically Acceptable and Tradeoff Strategies

DTIC Science & Technology

2016-06-01

thorough market research, acquisition professionals must decide at an early stage which source selection strategy (lowest price technically...minimizing risk and ensuring best value for all stakeholders. On the basis of thorough market research, acquisition professionals must decide at an early...price-based, market -driven environment from requirements development through properly disposal. Source selection must be 8 made on a ‘best value

Stakeholder views of rural community-based medical education: a narrative review of the international literature.

PubMed

Somporn, Praphun; Ash, Julie; Walters, Lucie

2018-03-30

Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders.

PubMed

Schandelmaier, Stefan; Leibold, Andrea; Fischer, Katrin; Mager, Ralph; Hoffmann-Richter, Ulrike; Bachmann, Monica Susanne; Kedzia, Sarah; Busse, Jason Walter; Guyatt, Gordon Henry; Jeger, Joerg; Marelli, Renato; De Boer, Wout Ernst Lodewijk; Kunz, Regina

2015-01-01

In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation. Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts' findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts' delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable. Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.

Obesity Prevention Opinions of School Stakeholders: A Qualitative Study

ERIC Educational Resources Information Center

Della Torre, Sophie Bucher; Akre, Christina; Suris, Joan-Carles

2010-01-01

Background: In general, schools are an important setting to implement current recommendations for obesity prevention in children because the vast majority of children attend school. This study investigated the opinions of different school stakeholders on the feasibility and acceptability of current obesity prevention strategies that could be…

Public acceptability of forest management practices at Morgan-Monroe State Forest

Treesearch

Shannon C. Rogers; William L. Hoover; Shorna B. Allred

2013-01-01

Forest management practices on public forests are controversial with many organizational and individual stakeholders. Forest managers' understanding of the attitudes of stakeholders is necessary to honor statutory requirements and the social contract under which they operate. The human dimension component of the Hardwood Ecosystem Experiment (HEE) in Indiana...

An Exploration of Edible Palm Weevil Larvae (Akokono) as a Source of Nutrition and Livelihood: Perspectives From Ghanaian Stakeholders.

PubMed

Laar, Amos; Kotoh, Agnes; Parker, Megan; Milani, Peiman; Tawiah, Charlotte; Soor, Shobhita; Anankware, Jacob P; Kalra, Nikhila; Manu, Grace; Tandoh, Akua; Zobrist, Stephanie; Engmann, Cyril; Pelto, Gretel

2017-12-01

Meeting the nutritive needs of infants and young children is a challenge in Ghana. Alternative animal source foods, including insects, could enhance infant and young child dietary quality while also improving livelihoods. To investigate the perspectives of Ghanaian stakeholders on the acceptability of the palm weevil larvae ( akokono) as a food source and the feasibility of micro-farming this local edible insect as a complementary food for infants and young children. We conducted an ethnographic study in the Brong-Ahafo Region of Ghana. First, 48 caregivers were asked questions about feeding and care practices, including attitudes toward production and consumption of akokono. Then, a selection of previously interviewed respondents joined 1 of 8 focus group discussions to provide further insight on key themes that emerged from earlier interviews. Concurrently, interviews with 25 other key local stakeholders were conducted. Respondents generally had favorable perceptions of akokono as a nutritious food. A small minority would not consume akokono for religious reasons. Key factors positively influencing the acceptability of akokono as a complementary food were familiarity with the consumption of akokono by the primary caregiver and health worker endorsement of akokono. Stakeholders consider the larvae farmable and were open to its domestication. Anticipated barriers to scaling up akokono micro-farming include a need for greater familiarity with and acceptance of the insect as food for infants and young children and creation of a sustainable market. Engagement with stakeholders, including health workers, will facilitate use of akokono as a complementary food.

Application of discrete choice experiments to enhance stakeholder engagement as a strategy for advancing implementation: a systematic review.

PubMed

Salloum, Ramzi G; Shenkman, Elizabeth A; Louviere, Jordan J; Chambers, David A

2017-11-23

One of the key strategies to successful implementation of effective health-related interventions is targeting improvements in stakeholder engagement. The discrete choice experiment (DCE) is a stated preference technique for eliciting individual preferences over hypothetical alternative scenarios that is increasingly being used in health-related applications. DCEs are a dynamic approach to systematically measure health preferences which can be applied in enhancing stakeholder engagement. However, a knowledge gap exists in characterizing the extent to which DCEs are used in implementation science. We conducted a systematic literature search (up to December 2016) of the English literature to identify and describe the use of DCEs in engaging stakeholders as an implementation strategy. We searched the following electronic databases: MEDLINE, Econlit, PsychINFO, and the CINAHL using mesh terms. Studies were categorized according to application type, stakeholder(s), healthcare setting, and implementation outcome. Seventy-five publications were selected for analysis in this systematic review. Studies were categorized by application type: (1) characterizing demand for therapies and treatment technologies (n = 32), (2) comparing implementation strategies (n = 22), (3) incentivizing workforce participation (n = 11), and (4) prioritizing interventions (n = 10). Stakeholders included providers (n = 27), patients (n = 25), caregivers (n = 5), and administrators (n = 2). The remaining studies (n = 16) engaged multiple stakeholders (i.e., combination of patients, caregivers, providers, and/or administrators). The following implementation outcomes were discussed: acceptability (n = 75), appropriateness (n = 34), adoption (n = 19), feasibility (n = 16), and fidelity (n = 3). The number of DCE studies engaging stakeholders as an implementation strategy has been increasing over the past decade. As DCEs are more widely used as a healthcare assessment tool, there is a wide range of applications for them in stakeholder engagement. The DCE approach could serve as a tool for engaging stakeholders in implementation science.

Obesity prevention advocacy in Australia: an analysis of policy impact on autonomy.

PubMed

Haynes, Emily; Hughes, Roger; Reidlinger, Dianne P

2017-06-01

To explore obesity policy options recommended by stakeholders and identify their impact on individual autotomy. Qualitative and quantitative methods were used. A content analysis of submissions to the Australian Government's Inquiry into Obesity was conducted. Each recommendation was categorised by its impact on autonomy, according to existing frameworks. Chi-square test for independence was used to explore the association between autonomy and stakeholder support defined as frequency of recommendation. The extent of support for a policy option was significantly associated with impact on autonomy (p<0.001). Options that reduce autonomy were least frequently recommended in every setting; but more likely in schools (27%) than other settings (<1%). Recommendations to provide incentives (9%) were more common than disincentives (2%) or restrictions (3%), and those that enhance autonomy were most widely recommended (46%). Stakeholders advocated policy options that enhance individual autonomy to a greater extent than those that diminish autonomy. Implications for public health: Targeting obesity policy options that enhance rather than diminish autonomy may be more politically acceptable across most settings, with the exception of schools where more restrictive policy options are appropriate. Re-framing options accordingly may improve leadership by government in obesity policy. © 2017 The Authors.

A Qualitative Stakeholder Analysis of Avian Influenza Policy in Bangladesh.

PubMed

Chattopadhyay, Kaushik; Fournié, Guillaume; Abul Kalam, Md; Biswas, Paritosh K; Hoque, Ahasanul; Debnath, Nitish C; Rahman, Mahmudur; Pfeiffer, Dirk U; Harper, David; Heymann, David L

2017-11-13

Avian influenza is a major animal and public health concern in Bangladesh. A decade after development and implementation of the first national avian influenza and human pandemic influenza preparedness and response plan in Bangladesh, a two-stage qualitative stakeholder analysis was performed in relation to the policy development process and the actual policy. This study specifically aimed to identify the future policy options to prevent and control avian influenza and other poultry-related zoonotic diseases in Bangladesh. It was recommended that the policy should be based on the One Health concept, be evidence-based, sustainable, reviewed and updated as necessary. The future policy environment that is suitable for developing and implementing these policies should take into account the following points: the need to formally engage multiple sectors, the need for clear and acceptable leadership, roles and responsibilities and the need for a common pool of resources and provision for transferring resources. Most of these recommendations are directed towards the Government of Bangladesh. However, other sectors, including research and poultry production stakeholders, also have a major role to play to inform policy making and actively participate in the multi-sectoral approach.

Childhood pneumonia diagnostics: community health workers' and national stakeholders' differing perspectives of new and existing aids.

PubMed

Spence, Hollie; Baker, Kevin; Wharton-Smith, Alexandra; Mucunguzi, Akasiima; Matata, Lena; Habte, Tedila; Nanyumba, Diana; Sebsibe, Anteneh; Thany, Thol; Källander, Karin

2017-01-01

Pneumonia heavily contributes to global under-five mortality. Many countries use community case management to detect and treat childhood pneumonia. Community health workers (CHWs) have limited tools to help them assess signs of pneumonia. New respiratory rate (RR) counting devices and pulse oximeters are being considered for this purpose. To explore perspectives of CHWs and national stakeholders regarding the potential usability and scalability of seven devices to aid community assessment of pneumonia signs. Pile sorting was conducted to rate the usability and scalability of 7 different RR counting aids and pulse oximeters amongst 16 groups of participants. Following each pile-sorting session, a focus group discussion (FGD) explored participants' sorting rationale. Purposive sampling was used to select CHWs and national stakeholders with experience in childhood pneumonia and integrated community case management (iCCM) in Cambodia, Ethiopia, Uganda and South Sudan. Pile-sorting data were aggregated for countries and participant groups. FGDs were audio recorded and transcribed verbatim. Translated FGDs transcripts were coded in NVivo 10 and analysed using thematic content analysis. Comparative analysis was performed between countries and groups to identify thematic patterns. CHWs and national stakeholders across the four countries perceived the acute respiratory infection (ARI) timer and fingertip pulse oximeter as highly scalable and easy for CHWs to use. National stakeholders were less receptive to new technologies. CHWs placed greater priority on device acceptability to caregivers and children. Both groups felt that heavy reliance on electricity reduced potential scalability and usability in rural areas. Device simplicity, affordability and sustainability were universally valued. CHWs and national stakeholders prioritise different device characteristics according to their specific focus of work. The views of all relevant stakeholders, including health workers, policy makers, children and parents, should be considered in future policy decisions, research and development regarding suitable pneumonia diagnostic aids for community use.

Evaluating use and outcomes of mobility technology: a multiple stakeholder analysis.

PubMed

Hammel, Joy; Southall, Kenneth; Jutai, Jeffrey; Finlayson, Marcia; Kashindi, Gabriel; Fok, Daniel

2013-07-01

This qualitative, multi-site study compared and contrasted the outcomes of mobility technology (MT) and the factors influencing these outcomes from the perspective of MT users, caregivers, and professionals involved in MT service delivery. Qualitative focus groups were held in the USA and Canada with multiple stakeholder groups (consumer: n = 45, caregiver: n = 10, service provider: n = 10). Data were analyzed thematically. MT outcomes were conceptualized by participants as a match between expectations for MT and the actual outcomes experienced. Several factors influenced the match including a) MT features, b) environmental factors (e.g. built/physical environment, societal context of acceptance, MT delivery systems/policies), and c) the ability to self-manage the interaction across person, technology and environment, which involved constant negotiation and strategizing. Stakeholders identified MT outcomes that corresponded to ICF levels including body structure and function, activity, and participation across environments; however, varied on their importance and influence on MT impact. The conceptual fit model and factors related to self-management of MT represent new knowledge and provide a framework for stakeholder-based evaluation of MT outcomes. Implications for MT assessment, service delivery, outcomes research, and interventions are discussed.

Techniques for assessing extramarket values

Treesearch

Donald F. Dennis

1995-01-01

Central to effective policy development and management of natural resources is an understanding of the trade-offs stakeholders are willing to accept and the values they hold. Although market prices reflect society's preferences to some degree, they clearly do not encompass all values or costs. Conjoint techniques offer a means to estimate and analyze stakeholder...

Investigating Stakeholder Attitudes and Opinions on School-Based Human Papillomavirus Vaccination Programs

ERIC Educational Resources Information Center

Nodulman, Jessica A.; Starling, Randall; Kong, Alberta S.; Buller, David B.; Wheeler, Cosette M.; Woodall, W. Gill

2015-01-01

Background: In several countries worldwide, school-based human papillomavirus (HPV) vaccination programs have been successful; however, little research has explored US stakeholders' acceptance toward school-based HPV vaccination programs. Methods: A total of 13 focus groups and 12 key informant interviews (N?=?117; 85% females; 66% racial/ethnic…

Stakeholders' views on the routine use of n-of-1 trials to improve clinical care and to make resource allocation decisions for drug use.

PubMed

Nikles, Jane; Mitchell, Geoffrey K; Clavarino, Alexandra; Yelland, Michael J; Del Mar, Christopher B

2010-03-01

N-of-1 trials are empirical formal tests using a within-patient randomised, double-blind, cross-over comparison of drug and placebo (or another drug), which we adapted to study individual patients' responses as a clinical tool to guide clinical management. We administered semi-structured interviews to gauge stakeholder perspectives on the possibility of using routine n-of-1 trials for this purpose. Stakeholders included government and non-government health care sector, and patient, clinician and consumer, organisations. Stakeholders supported more widespread implementation of n-of-1 trials, in a targeted fashion, with some caveats. Barriers to their widespread implementation included constraints on doctors' time, doctors' acceptance, drug company acceptance, patient willingness, and cost. Strategies for overcoming barriers included conditional Pharmaceutical Benefits Scheme listing if cost-effective. There was little consensus on which model of n-of-1 trial implementation would be most effective. We discuss different approaches to addressing the several concerns raised to enable widespread introduction of n-of-1 trials into routine clinical practice as a decision tool.

Appetite for health-related food taxes: New Zealand stakeholder views.

PubMed

Signal, Louise N; Watts, Carolyn; Murphy, Celia; Eyles, Helen; Ni Mhurchu, Cliona

2017-05-05

There is increasing discussion globally of the value of health-related food taxes and subsidies to address obesity and noncommunicable diseases. In order for such policies to be successful it is important to understand the positions of key stakeholders. This research investigated New Zealand (NZ) stakeholders' views on the feasibility and acceptability of selected health-related food taxes and subsidies over the next 5 to 10 years. Twenty semi-structured interviews were undertaken by telephone from November 2014 to May 2015. The purposive sample of key stakeholders included politicians, bureaucrats, public health experts, food industry leaders and consumer representatives. Prior to interviews participants were sent summary information on the estimated impacts of a range of health-related food taxes and subsidies on dietary intake and mortality. According to key stakeholders there appears to be little appetite for taxes on foods high in saturated fat or salt in NZ. Stakeholders largely agreed that a tax on sugar-sweetened beverages (SSBs) and a subsidy on fruit and vegetables were both feasible and likely acceptable. There was strong support for starting with a SSBs tax, possibly framed around protecting children and dental health. Addressing obesity and noncommunicable diseases is a multidimensional challenge. A tax on SSBs and a subsidy on fruit and vegetables, possibly in tandem, could be part of the solution in NZ. There is growing interest in, and evidence for, health-related taxes and subsidies internationally. Given the critical role of stakeholder support for such policies similar research on stakeholders' views may assist the implementation of health-related food taxes and subsidies in other jurisdictions. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Limits of acceptable change as tool for tourism development sustainability in Pangandaran West Java

NASA Astrophysics Data System (ADS)

Komsary, K. C.; Tarigan, W. P.; Wiyana, T.

2018-03-01

Pangandaran since 2006 has become a model of sustainable tourism development. A program aimed to empower local communities to prepare work plans and activities to enrich the various potential development of sustainable tourism. By empowering local community, business competition has led to the undesired development of the tourism sector. This becomes the concern of the negative impact of physical changes in the area. This study aims to identify and measure the acceptable changes (limits of acceptable change-LAC) of tourism development in Pangandaran to remain adaptable as a tourist attraction. This study considers how to determine acceptable levels of impact that occurs in the Pangandaran area. This method involves stakeholders in determining the values, issues, and concerns the acceptable levels of impact for this region. The result of acceptance rate then compared with the effects of the current state. Through review and analysis methods used in this study, the LAC situation in Pangandaran outlined. Results from this study are expected to identify indicators of sustainable development of tourism sector through LAC approach.

In the eye of the stakeholder: The challenges of governing social forest values.

PubMed

Sténs, Anna; Bjärstig, Therese; Nordström, Eva-Maria; Sandström, Camilla; Fries, Clas; Johansson, Johanna

2016-02-01

This study examines which kinds of social benefits derived from forests are emphasised by Swedish stakeholders and what governance modes and management tools they accept. Our study shows that there exists a great variety among stakeholders' perceptions of forests' social values, where tourism and recreation is the most common reference. There are also differences in preferred governance modes and management where biomass and bioenergy sectors advocate business as usual (i.e. framework regulations and voluntarism) and other stakeholders demand rigid tools (i.e. coercion and targeting) and improved landscape planning. This divide will have implications for future policy orientations and require deliberative policy processes and improved dialogue among stakeholders and authorities. We suggest that there is a potential for these improvements, since actors from almost all stakeholder groups support local influence on governance and management, acknowledged and maintained either by the authorities, i.e. targeting, or by the stakeholders themselves, i.e. voluntarism.

Multicriteria mapping of stakeholder preferences in regulating nanotechnology

NASA Astrophysics Data System (ADS)

Hansen, Steffen Foss

2010-08-01

In order to facilitate stakeholder discussions on how to regulate nanotechnology, the opensource program multicriteria mapping (MCM) was used to structure 26 interviews with stakeholders in the USA. MCM offers a systematic part quantitative, part qualitative approach to clarify why some regulatory options (bans, moratoriums, voluntary measures, etc.) were deemed to be acceptable/unacceptable by various stakeholders and which criteria stakeholders used to evaluate the different regulatory options. Adopting an incremental approach and implementing a new regulatory framework was evaluated as the best options whereas a complete ban and no additional regulation of nanotechnology were found to be the least favorable. Criteria applied differed substantially among stakeholders and included social, ethical, regulatory, environmental, and health issues. Opinions on future regulation seem far less polarized than expected and it seems that stakeholders would welcome a combination of voluntary measures, an incremental approach and forming of a new regulatory framework.

A stakeholder-driven approach to improve the informed consent process for palliative chemotherapy.

PubMed

Enzinger, Andrea C; Wind, Jennifer K; Frank, Elizabeth; McCleary, Nadine J; Porter, Laura; Cushing, Heather; Abbott, Caroline; Cronin, Christine; Enzinger, Peter C; Meropol, Neal J; Schrag, Deborah

2017-08-01

Patients often anticipate cure from palliative chemotherapy. Better resources are needed to convey its risks and benefits. We describe the stakeholder-driven development and acceptability testing of a prototype video and companion booklet supporting informed consent (IC) for a common palliative chemotherapy regimen. Our multidisciplinary team (researchers, advocates, clinicians) employed a multistep process of content development, production, critical evaluation, and iterative revisions. Patient/clinician stakeholders were engaged throughout using stakeholder advisory panels, featuring their voices within the intervention, conducting surveys and qualitative interviews. A national panel of 57 patient advocates, and 25 oncologists from nine US practices critiqued the intervention and rated its clarity, accuracy, balance, tone, and utility. Participants also reported satisfaction with existing chemotherapy IC materials. Few oncologists (5/25, 20%) or advocates (10/22, 45%) were satisfied with existing IC materials. In contrast, most rated our intervention highly, with 89-96% agreeing it would be useful and promote informed decisions. Patient voices were considered a key strength. Every oncologist indicated they would use the intervention regularly. Our intervention was acceptable to advocates and oncologists. A randomized trial is evaluating its impact on the chemotherapy IC process. Stakeholder-driven methods can be valuable for developing patient educational interventions. Copyright © 2017 Elsevier B.V. All rights reserved.

Survey of the perceptions of key stakeholders on the attributes of the South African Notifiable Diseases Surveillance System.

PubMed

Benson, F G; Musekiwa, A; Blumberg, L; Rispel, L C

2016-10-25

An effective and efficient notifiable diseases surveillance system (NDSS) is essential for a rapid response to disease outbreaks, and the identification of priority diseases that may cause national, regional or public health emergencies of international concern (PHEICs). Regular assessments of country-based surveillance system are needed to enable countries to respond to outbreaks before they become PHEICs. As part of a broader evaluation of the NDSS in South Africa, the aim of the study was to determine the perceptions of key stakeholders on the national NDSS attributes of acceptability, flexibility, simplicity, timeliness and usefulness. During 2015, we conducted a nationally representative cross-sectional survey of communicable diseases coordinators and surveillance officers, as well as members of NDSS committees. Individuals with less than 1 year experience of the NDSS were excluded. Consenting participants completed a self-administered questionnaire. The questionnaire elicited information on demographic information and perceptions of the NDSS attributes. Data were analysed using descriptive statistics and the unconditional logistic regression model. Most stakeholders interviewed (53 %, 60/114) were involved in disease control and response. The median number of years of experience with the NDSS was 11 years (inter-quartile range (IQR): 5 to 20 years). Regarding the NDSS attributes, 25 % of the stakeholders perceived the system to be acceptable, 51 % to be flexible, 45 % to be timely, 61 % to be useful, and 74 % to be simple. Health management stakeholders perceived the system to be more useful and timely compared to the other stakeholders. Those with more years of experience were less likely to perceive the NDSS system as acceptable (OR 0.91, 95 % CI: 0.84-1.00, p = 0.041); those in disease detection were less likely to perceive it as timely (OR 0.10, 95 % CI: 0.01-0.96, p = 0.046) and those participating in National Outbreak Response Team were less likely to perceive it as useful (OR 0.38, 95 % CI: 0.16-0.93, p = 0.034). The overall poor perceptions of key stakeholder on the system attributes are a cause for concern. The study findings should inform the revitalisation and reform of the NDSS in South Africa, done in consultation and partnership with the key stakeholders.

Participatory research for chronic disease prevention in Inuit communities.

PubMed

Gittelsohn, Joel; Roache, Cindy; Kratzmann, Meredith; Reid, Rhonda; Ogina, Julia; Sharma, Sangita

2010-01-01

To develop a community-based chronic disease prevention program for Inuit in Nunavut, Canada. Stake-holders contributed to intervention development through formative research (in-depth interviews (n = 45), dietary recalls (n = 42)), community workshops, group feedback and implementation training. Key cultural themes included the perceived healthiness of country foods, food sharing, and importance of family. During community workshops, key problem foods for intervention were identified as well as healthier culturally and economically acceptable alternatives for these foods. Behaviors for promotion were identified and prioritized. This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program in stores, worksites, and other community venues.

Advanced Combat Helmet Technical Assessment

DTIC Science & Technology

2013-05-29

Lastly, we assessed the participation of various stakeholders and industry experts such as active ACH manufacturers and test facilities. Findings... industrially accepted American National Standards Institute (ANSI Z1.4-2008, Sampling Visit us on the web at www.dodig.mil Results in Brief Advanced...statistically principled approach and the lot acceptance test protocol adopts a widely established and industrially accepted sampling procedure. We

Integrated community case management of malaria, pneumonia and diarrhoea across three African countries: A qualitative study exploring lessons learnt and implications for further scale up

PubMed Central

Strachan, Clare; Wharton–Smith, Alexandra; Sinyangwe, Chomba; Mubiru, Denis; Ssekitooleko, James; Meier, Joslyn; Gbanya, Miatta; Tibenderana, James K.; Counihan, Helen

2014-01-01

Numerous studies highlight the effectiveness of an integrated approach for the management of malaria, pneumonia and diarrhoea at the community level. There has however been little study on lessons learnt from implementation in practice and stakeholder experiences which could inform future programmatic planning and evaluation frameworks. A participatory, qualitative evaluation was conducted in the three varied settings of South Sudan, Uganda and Zambia, which have seen the scale up of integrated community case management (iCCM) over the last five years. All key in–country stakeholders were consulted on study design, with a particular focus on scope and methodology. Data collection methods included stakeholder consultations (key informant interviews, focus group discussions), and a review of project and Ministry of Health documentation. Data analysis followed the Framework Approach. Results suggest that iCCM implementation generally followed national pre–agreed guidelines. Overarching key programmatic recommendations included: collaboration with implementing partners in planning stages to positively impact on community acceptance and ownership; adoption of participatory training methods adapted to low literacy populations; development of alternative support supervision methods such as peer support groups; full integration of community level data into the health management information system and emphasizing data analysis, use and feedback at all levels; strengthened supply chains through improved quantification and procurement of commodities in conjunction with the national distribution network; community engagement to establish a support system for community health workers to increase their motivation; enhanced sensitisation and behaviour change communication to raise awareness and usage of appropriate health services; and advocacy at the national level for funding and logistical support for the continuation and integration of iCCM. This qualitative study is a valuable contribution in understanding the ‘hows’ of iCCM implementation with key insights for improved feasibility and acceptability. Main findings show how community support to iCCM and community health workers is necessary for sustained health benefits coupled with a focus on strengthening and ‘enabling’ the public health system. The participatory study design and methodologies used enabled the scope of the research enquiry to effectively capture various stakeholder perspectives. PMID:25520794

User fees for public health care services in Hungary: expectations, experience, and acceptability from the perspectives of different stakeholders.

PubMed

Baji, Petra; Pavlova, Milena; Gulácsi, László; Groot, Wim

2011-10-01

The introduction of user fees for health care services is a new phenomenon in Central-Eastern European Countries. In Hungary, user fees were first introduced in 2007, but abolished one year later after a referendum. The aim of our study is to describe the experiences and expectations of health system stakeholders in Hungary related to user fees as well as their approval of such fees. For our analysis we use both qualitative and quantitative data from focus-group discussions with health care consumers and physicians, and in-depth interviews with policy makers and health insurance representatives. Our findings suggest that the reasons behind the unpopularity of user fees might be (a) the rejection of the objectives of user fees defined by the government, (b) negative personal experiences with user fees, and (c) the general mistrust of the Hungarian population when it comes to the utilization of public resources. Successful policy implementation of user fees requires social consensus on the policy objectives, also there should be real improvements in health care provision noticeable for consumers, to assure the fees acceptance. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Canadian 24-hour movement guidelines for the early years (0-4 years): exploring the perceptions of stakeholders and end users regarding their acceptability, barriers to uptake, and dissemination.

PubMed

Riazi, Negin; Ramanathan, Subha; O'Neill, Meghan; Tremblay, Mark S; Faulkner, Guy

2017-11-20

It is important to engage stakeholders and end users in the development of guidelines for knowledge translation purposes. The aim of this study was to examine stakeholders' (experts in pediatric and family medicine, physical activity knowledge translation, and research) and end users' (parents and early childhood educators) perceptions of the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years). Stakeholders (n = 10) engaged in telephone interviews and end users (n = 92) participated in focus groups (n = 14) to discuss perceived clarity and need for the guidelines, potential barriers to implementation, identification of credible messengers, and methods for dissemination of the guidelines. A thematic analysis was conducted. The proposed guidelines were very well received by both stakeholders and end users. A clear need for such guidelines was identified, and most believed the guidelines were achievable. Stakeholders and end users identified several potential barriers to uptake, including low awareness of current guidelines; 'daily challenges' such as allure of screen time, lack of time, and competing priorities; and challenges in the context of shifting social norms. A range of methods and messengers of dissemination were identified. Medical and child care settings were the most frequently cited places for dissemination, and physicians and early childhood educators were the most common suggestions for messengers. There was consistent support for the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) from both stakeholders and end users. Moving forward, it is important to dedicate appropriate support and funding toward dissemination efforts in order to reach end users, particularly parents and early childhood educators.

Energy justice: Participation promotes acceptance

NASA Astrophysics Data System (ADS)

Baxter, Jamie

2017-08-01

Wind turbines have been a go-to technology for addressing climate change, but they are increasingly a source of frustration for all stakeholders. While community ownership is often lauded as a panacea for maximizing turbine acceptance, a new study suggests that decision-making involvement — procedural fairness — matters most.

Fuzzy cognitive mapping in support of integrated ecosystem assessments: Developing a shared conceptual model among stakeholders.

PubMed

Vasslides, James M; Jensen, Olaf P

2016-01-15

Ecosystem-based approaches, including integrated ecosystem assessments, are a popular methodology being used to holistically address management issues in social-ecological systems worldwide. In this study we utilized fuzzy logic cognitive mapping to develop conceptual models of a complex estuarine system among four stakeholder groups. The average number of categories in an individual map was not significantly different among groups, and there were no significant differences between the groups in the average complexity or density indices of the individual maps. When ordered by their complexity scores, eight categories contributed to the top four rankings of the stakeholder groups, with six of the categories shared by at least half of the groups. While non-metric multidimensional scaling (nMDS) analysis displayed a high degree of overlap between the individual models across groups, there was also diversity within each stakeholder group. These findings suggest that while all of the stakeholders interviewed perceive the subject ecosystem as a complex series of social and ecological interconnections, there are a core set of components that are present in most of the groups' models that are crucial in managing the system towards some desired outcome. However, the variability in the connections between these core components and the rest of the categories influences the exact nature of these outcomes. Understanding the reasons behind these differences will be critical to developing a shared conceptual model that will be acceptable to all stakeholder groups and can serve as the basis for an integrated ecosystem assessment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Different shades of green: a case study of support for wind farms in the rural midwest.

PubMed

Mulvaney, Kate K; Woodson, Patrick; Prokopy, Linda Stalker

2013-05-01

Benton County, in north-central Indiana, USA has successfully sited more than 500 turbines. To understand Benton County's acceptance of wind farms, a holistic case study was conducted that included a document review, a survey of local residents and interviews with key stakeholders. Survey questionnaires were sent to 750 residents asking questions about attitudes toward the wind farms, perceived benefits and impacts from the wind farms, environmental attitudes, and demographic information. Key stakeholders were also interviewed for a deeper understanding of the historical timeline and community acceptance of the wind farm development. While there is limited opposition to the turbines, on the whole the community presents a front of acceptance. Financial, rather than environmental, benefits are the main reason for the acceptance. Although significant in other case studies, transparency and participation do not play a large role in Benton County's acceptance. Most residents are not concerned with either visual impacts or noise from the wind turbines. More concrete benefits to the community, such as reduced energy bills for county residents, could help to extend acceptance even further within the community. Although there are concerns about the acceptance of wind farms and the impacts of those farms on local residents in both peer-reviewed literature and popular media, we found little evidence of those concerns in Benton County. Instead, we found Benton County to be a community largely accepting of wind farms.

Different Shades of Green: A Case Study of Support for Wind Farms in the Rural Midwest

NASA Astrophysics Data System (ADS)

Mulvaney, Kate K.; Woodson, Patrick; Prokopy, Linda Stalker

2013-05-01

Benton County, in north-central Indiana, USA has successfully sited more than 500 turbines. To understand Benton County's acceptance of wind farms, a holistic case study was conducted that included a document review, a survey of local residents and interviews with key stakeholders. Survey questionnaires were sent to 750 residents asking questions about attitudes toward the wind farms, perceived benefits and impacts from the wind farms, environmental attitudes, and demographic information. Key stakeholders were also interviewed for a deeper understanding of the historical timeline and community acceptance of the wind farm development. While there is limited opposition to the turbines, on the whole the community presents a front of acceptance. Financial, rather than environmental, benefits are the main reason for the acceptance. Although significant in other case studies, transparency and participation do not play a large role in Benton County's acceptance. Most residents are not concerned with either visual impacts or noise from the wind turbines. More concrete benefits to the community, such as reduced energy bills for county residents, could help to extend acceptance even further within the community. Although there are concerns about the acceptance of wind farms and the impacts of those farms on local residents in both peer-reviewed literature and popular media, we found little evidence of those concerns in Benton County. Instead, we found Benton County to be a community largely accepting of wind farms.

Acceptability of financial incentives for health behaviour change to public health policymakers: a qualitative study.

PubMed

Giles, Emma L; Sniehotta, Falko F; McColl, Elaine; Adams, Jean

2016-09-15

Providing financial incentives contingent on healthy behaviours is one way to encourage healthy behaviours. However, there remains substantial concerns with the acceptability of health promoting financial incentives (HPFI). Previous research has studied acceptability of HPFI to the public, recipients and practitioners. We are not aware of any previous work that has focused particularly on the views of public health policymakers. Our aim was to explore the views of public health policymakers on whether or not HPFI are acceptable; and what, if anything, could be done to maximise acceptability of HPFI. We recruited 21 local, regional and national policymakers working in England via gatekeepers and snowballing. We conducted semi-structured in-depth interviews with participants exploring experiences of, and attitudes towards, HPFI. We analysed data using the Framework approach. Public health policymakers working in England acknowledged that HPFI could be a useful behaviour change tool, but were not overwhelmingly supportive of them. In particular, they raised concerns about effectiveness and cost-effectiveness, potential 'gaming', and whether or not HPFI address the underlying causes of unhealthy behaviours. Shopping voucher rewards, of smaller value, targeted at deprived groups were particularly acceptable to policymakers. Participants were particularly concerned about the response of other stakeholders to HPFI - including the public, potential recipients, politicians and the media. Overall, the interviews reflected three tensions. Firstly, a tension between wanting to trust individuals and promote responsibility; and distrust around the potential for 'gaming the system'. Secondly, a tension between participants' own views about HPFI; and their concerns about the possible views of other stakeholders. Thirdly, a tension between participants' personal distaste of HPFI; and their professional view that they could be a valuable behaviour change tool. There are aspects of design that influence acceptability of financial incentive interventions to public health policymakers. However, it is not clear that even interventions designed to maximise acceptability would be acceptable enough to be recommended for implementation. Further work may be required to help policymakers understand the potential responses of other stakeholder groups to financial incentive interventions.

Requirement Generation for Space Infrastructure Systems

NASA Astrophysics Data System (ADS)

Hempsell, M.

Despite heavy investment, in the half-century period between 1970 and 2020 there will almost no progress in the capability provided by the space infrastructure. It is argued that this is due to a failure during the requirement generation phase of the infrastructure's elements, a failure that is primarily due to following the accepted good practice of involving stakeholders while establishing a mission based set of technical requirements. This argument is supported by both a consideration of the history of the requirement generation phase of past space infrastructure projects, in particular the Space Shuttle, and an analysis of the interactions of the stakeholders during this phase. Traditional stakeholder involvement only works well in mature infrastructures where investment aims to make minor improvements, whereas space activity is still in the early experimental stages and is open to major new initiatives that aim to radically change the way we work in space. A new approach to requirement generation is proposed, which is more appropriate to these current circumstances. This uses a methodology centred on the basic functions the system is intended to perform rather than its expected missions.

Information analytics for healthcare service discovery.

PubMed

Sun, Lily; Yamin, Mohammad; Mushi, Cleopa; Liu, Kecheng; Alsaigh, Mohammed; Chen, Fabian

2014-01-01

The concept of being 'patient-centric' is a challenge to many existing healthcare service provision practices. This paper focuses on the issue of referrals, where multiple stakeholders, such as General Practitioners (GPs) and patients, are encouraged to make a consensual decision based on patients' needs. In this paper, we present an ontology-enabled healthcare service provision, which facilitates both patients and GPs in jointly deciding upon the referral decision. In the healthcare service provision model, we define three types of profiles which represent different stakeholders' requirements. This model also comprises a set of healthcare service discovery processes: articulating a service need, matching the need with the healthcare service offerings, and deciding on a best-fit service for acceptance. As a result, the healthcare service provision can carry out coherent analysis using personalised information and iterative processes that deal with requirements which change over time.

Multicriteria mapping of stakeholder preferences in regulating nanotechnology.

PubMed

Hansen, Steffen Foss

2010-08-01

In order to facilitate stakeholder discussions on how to regulate nanotechnology, the opensource program multicriteria mapping (MCM) was used to structure 26 interviews with stakeholders in the USA. MCM offers a systematic part quantitative, part qualitative approach to clarify why some regulatory options (bans, moratoriums, voluntary measures, etc.) were deemed to be acceptable/unacceptable by various stakeholders and which criteria stakeholders used to evaluate the different regulatory options. Adopting an incremental approach and implementing a new regulatory framework was evaluated as the best options whereas a complete ban and no additional regulation of nanotechnology were found to be the least favorable. Criteria applied differed substantially among stakeholders and included social, ethical, regulatory, environmental, and health issues. Opinions on future regulation seem far less polarized than expected and it seems that stakeholders would welcome a combination of voluntary measures, an incremental approach and forming of a new regulatory framework. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11051-010-0006-3) contains supplementary material, which is available to authorized users.

Modelling with stakeholders - Next generation

USGS Publications Warehouse

Voinov, Alexey; Kolagani, Nagesh; McCall, Michael K; Glynn, Pierre D.; Kragt, Marit E; Ostermann, Frank O; Pierce, Suzanne A; Ramu, Palaniappan

2016-01-01

This paper updates and builds on ‘Modelling with Stakeholders’ Voinov and Bousquet, 2010 which demonstrated the importance of, and demand for, stakeholder participation in resource and environmental modelling. This position paper returns to the concepts of that publication and reviews the progress made since 2010. A new development is the wide introduction and acceptance of social media and web applications, which dramatically changes the context and scale of stakeholder interactions and participation. Technology advances make it easier to incorporate information in interactive formats via visualization and games to augment participatory experiences. Citizens as stakeholders are increasingly demanding to be engaged in planning decisions that affect them and their communities, at scales from local to global. How people interact with and access models and data is rapidly evolving. In turn, this requires changes in how models are built, packaged, and disseminated: citizens are less in awe of experts and external authorities, and they are increasingly aware of their own capabilities to provide inputs to planning processes, including models. The continued acceleration of environmental degradation and natural resource depletion accompanies these societal changes, even as there is a growing acceptance of the need to transition to alternative, possibly very different, life styles. Substantive transitions cannot occur without significant changes in human behaviour and perceptions. The important and diverse roles that models can play in guiding human behaviour, and in disseminating and increasing societal knowledge, are a feature of stakeholder processes today.

A Survey of Expectations About the Role of Robots in Robot-Assisted Therapy for Children with ASD: Ethical Acceptability, Trust, Sociability, Appearance, and Attachment.

PubMed

Coeckelbergh, Mark; Pop, Cristina; Simut, Ramona; Peca, Andreea; Pintea, Sebastian; David, Daniel; Vanderborght, Bram

2016-02-01

The use of robots in therapy for children with autism spectrum disorder (ASD) raises issues concerning the ethical and social acceptability of this technology and, more generally, about human-robot interaction. However, usually philosophical papers on the ethics of human-robot-interaction do not take into account stakeholders' views; yet it is important to involve stakeholders in order to render the research responsive to concerns within the autism and autism therapy community. To support responsible research and innovation in this field, this paper identifies a range of ethical, social and therapeutic concerns, and presents and discusses the results of an exploratory survey that investigated these issues and explored stakeholders' expectations about this kind of therapy. We conclude that although in general stakeholders approve of using robots in therapy for children with ASD, it is wise to avoid replacing therapists by robots and to develop and use robots that have what we call supervised autonomy. This is likely to create more trust among stakeholders and improve the quality of the therapy. Moreover, our research suggests that issues concerning the appearance of the robot need to be adequately dealt with by the researchers and therapists. For instance, our survey suggests that zoomorphic robots may be less problematic than robots that look too much like humans.

Stakeholder Definition for Indonesian Integrated Agriculture Information System (IAIS)

NASA Astrophysics Data System (ADS)

Budi Santoso, Halim; Delima, Rosa

2017-03-01

Stakeholders plays an important roles to determine the system requirements. Stakeholders are people or organizations that has an interest to the enterprise. Timely and effective consultation of relevant stakeholders is a paramount importance in the requirements engineering process. From the research and analysis of system stakeholder finds that there are four stakeholder groups in IAIS. Stakeholder analysis is being implemented by identifying stakeholder, stakeholder category, and analysis interaction between stakeholders.

Educational Data Mining Acceptance among Undergraduate Students

ERIC Educational Resources Information Center

Wook, Muslihah; Yusof, Zawiyah M.; Nazri, Mohd Zakree Ahmad

2017-01-01

The acceptance of Educational Data Mining (EDM) technology is on the rise due to, its ability to extract new knowledge from large amounts of students' data. This knowledge is important for educational stakeholders, such as policy makers, educators, and students themselves to enhance efficiency and achievements. However, previous studies on EDM…

Biomarker Qualification: Toward a Multiple Stakeholder Framework for Biomarker Development, Regulatory Acceptance, and Utilization.

PubMed

Amur, S; LaVange, L; Zineh, I; Buckman-Garner, S; Woodcock, J

2015-07-01

The discovery, development, and use of biomarkers for a variety of drug development purposes are areas of tremendous interest and need. Biomarkers can become accepted for use through submission of biomarker data during the drug approval process. Another emerging pathway for acceptance of biomarkers is via the biomarker qualification program developed by the Center for Drug Evaluation and Research (CDER, US Food and Drug Administration). Evidentiary standards are needed to develop and evaluate various types of biomarkers for their intended use and multiple stakeholders, including academia, industry, government, and consortia must work together to help develop this evidence. The article describes various types of biomarkers that can be useful in drug development and evidentiary considerations that are important for qualification. A path forward for coordinating efforts to identify and explore needed biomarkers is proposed for consideration. © 2015 American Society for Clinical Pharmacology and Therapeutics.

Looking beyond borders: integrating best practices in benefit-risk analysis into the field of food and nutrition.

PubMed

Tijhuis, M J; Pohjola, M V; Gunnlaugsdóttir, H; Kalogeras, N; Leino, O; Luteijn, J M; Magnússon, S H; Odekerken-Schröder, G; Poto, M; Tuomisto, J T; Ueland, O; White, B C; Holm, F; Verhagen, H

2012-01-01

An integrated benefit-risk analysis aims to give guidance in decision situations where benefits do not clearly prevail over risks, and explicit weighing of benefits and risks is thus indicated. The BEPRARIBEAN project aims to advance benefit-risk analysis in the area of food and nutrition by learning from other fields. This paper constitutes the final stage of the project, in which commonalities and differences in benefit-risk analysis are identified between the Food and Nutrition field and other fields, namely Medicines, Food Microbiology, Environmental Health, Economics and Marketing-Finance, and Consumer Perception. From this, ways forward are characterized for benefit-risk analysis in Food and Nutrition. Integrated benefit-risk analysis in Food and Nutrition may advance in the following ways: Increased engagement and communication between assessors, managers, and stakeholders; more pragmatic problem-oriented framing of assessment; accepting some risk; pre- and post-market analysis; explicit communication of the assessment purpose, input and output; more human (dose-response) data and more efficient use of human data; segmenting populations based on physiology; explicit consideration of value judgments in assessment; integration of multiple benefits and risks from multiple domains; explicit recognition of the impact of consumer beliefs, opinions, views, perceptions, and attitudes on behaviour; and segmenting populations based on behaviour; the opportunities proposed here do not provide ultimate solutions; rather, they define a collection of issues to be taken account of in developing methods, tools, practices and policies, as well as refining the regulatory context, for benefit-risk analysis in Food and Nutrition and other fields. Thus, these opportunities will now need to be explored further and incorporated into benefit-risk practice and policy. If accepted, incorporation of these opportunities will also involve a paradigm shift in Food and Nutrition benefit-risk analysis towards conceiving the analysis as a process of creating shared knowledge among all stakeholders. Copyright © 2011 Elsevier Ltd. All rights reserved.

Some considerations on the attractiveness of participatory processes for researchers from natural science

NASA Astrophysics Data System (ADS)

Barthel, Roland

2013-04-01

Participatory modeling and participatory scenario development have become an essential part of environmental impact assessment and planning in the field of water resources management. But even if most people agree that participation is required to solve environmental problems in a way that satisfies both the environmental and societal needs, success stories are relatively rare, while many attempts to include stakeholders in the development of models are still reported to have failed. This paper proposes the hypothesis, that the lack of success in participatory modeling can partly be attributed to a lack of attractiveness of participatory approaches for researchers from natural sciences (subsequently called 'modelers'). It has to be pointed out that this discussion is mainly concerned with natural scientists in academia and not with modelers who develop models for commercial purposes or modelers employed by public agencies. The involvement of modelers and stakeholders in participatory modeling has been intensively studied during recent years. However, such analysis is rarely made from the viewpoint of the modelers themselves. Modelers usually don't see participatory modeling and scenario development as scientific targets as such, because the theoretical foundations of such processes usually lie far outside their own area of expertise. Thus, participatory processes are seen mainly as a means to attract funding or to facilitate the access to data or (relatively rarely) as a way to develop a research model into a commercial product. The majority of modelers very likely do not spend too much time on reflecting whether or not their new tools are helpful to solve real world problems or if the results are understandable and acceptable for stakeholders. They consider their task completed when the model they developed satisfies the 'scientific requirements', which are essentially different from the requirements to satisfy a group of stakeholders. Funding often stops before a newly developed model can actually be tested in a stakeholder process. Therefore the gap between stakeholders and modelers persists or is even growing. A main reason for this probably lies in the way that the work of scientists (modelers) is evaluated. What counts is the number of journal articles produced, while applicability or societal impact is still not a measure of scientific success. A good journal article on a model requires an exemplary validation but only very rarely would a reviewer ask if a model was accepted by stakeholders. So why should a scientist go through a tedious stakeholder process? The stakeholder process might be a requirement of the research grant, but whether this is taken seriously, can be questioned, as long as stakeholder dialogues do not lead to quantifiable scientific success. In particular for researchers in early career stages who undergo typical, publication-based evaluation processes, participatory research is hardly beneficial. The discussion in this contribution is based on three pillars: (i) a comprehensive evaluation of the literature published on participatory modeling and scenario development, (ii) a case study involving the development of an integrated model for water and land use management including an intensive stakeholder process and (iii) unstructured, personal communication - with mainly young scientists - about the attractiveness of multidisciplinary, applied research.

Development and psychometric testing of the clinical networks engagement tool

PubMed Central

Hecker, Kent G.; Rabatach, Leora; Noseworthy, Tom W.; White, Deborah E.

2017-01-01

Background Clinical networks are being used widely to facilitate large system transformation in healthcare, by engagement of stakeholders throughout the health system. However, there are no available instruments that measure engagement in these networks. Methods The study purpose was to develop and assess the measurement properties of a multiprofessional tool to measure engagement in clinical network initiatives. Based on components of the International Association of Public Participation Spectrum and expert panel review, we developed 40 items for testing. The draft instrument was distributed to 1,668 network stakeholders across different governance levels (leaders, members, support, frontline stakeholders) in 9 strategic clinical networks in Alberta (January to July 2014). With data from 424 completed surveys (25.4% response rate), descriptive statistics, exploratory and confirmatory factor analysis, Pearson correlations, linear regression, multivariate analysis, and Cronbach alpha were conducted to assess reliability and validity of the scores. Results Sixteen items were retained in the instrument. Exploratory factor analysis indicated a four-factor solution and accounted for 85.7% of the total variance in engagement with clinical network initiatives: global engagement, inform (provided with information), involve (worked together to address concerns), and empower (given final decision-making authority). All subscales demonstrated acceptable reliability (Cronbach alpha 0.87 to 0.99). Both the confirmatory factor analysis and regression analysis confirmed that inform, involve, and empower were all significant predictors of global engagement, with involve as the strongest predictor. Leaders had higher mean scores than frontline stakeholders, while members and support staff did not differ in mean scores. Conclusions This study provided foundational evidence for the use of this tool for assessing engagement in clinical networks. Further work is necessary to evaluate engagement in broader network functions and activities; to assess barriers and facilitators of engagement; and, to elucidate how the maturity of networks and other factors influence engagement. PMID:28350834

Acceptance of the Use of HIV Surveillance Data for Care Engagement: National and Local Community Perspectives

PubMed Central

Evans, David; Van Gorder, Dana; Morin, Stephen F.; Steward, Wayne T.; Gaffney, Stuart; Charlebois, Edwin D.

2015-01-01

Background Use of surveillance data including laboratory results (e.g. CD4 and HIV RNA) by public health departments to facilitate linkage, retention, and re-engagement of HIV-infected individuals in health care is on the rise. This is part of the goal of increasing the proportion of infected persons achieving virologic suppression. However, this use of surveillance data is not without controversy, particularly among some providers and people living with HIV. Methods We conducted informal discussions with key stakeholders and a literature search, and held a national think tank in November 2012, bringing together 31 representatives of the federal government, county and state officials, health care providers, and community-based organizations. A follow-up community consultation specific to San Francisco was held January 24, 2014, with 10 participants. Notes from these activities were used as data for this analysis. Results The think tank identified three strategies utilizing HIV surveillance data to aid in care engagement: 1) provider-mediated – where health department staff work with the provider of record on re-engagement, 2) electronic linkages between surveillance databases and medical records databases, and 3) direct outreach – where trained health department staff reach out to persons out of care. Participants also developed recommendations for minimizing harm, guidance on meaningful stakeholder involvement, and a consensus statement in support of the use of HIV surveillance data in care engagement. Conclusions Acceptance of the use of surveillance data for HIV care linkage, retention, and re-engagement is achievable, particularly if stakeholders have been engaged in the design, conduct, and evaluation of programs. PMID:25867776

CONTRIBUTION OF STAKEHOLDER ENGAGEMENT TO THE IMPACT OF A HEALTH TECHNOLOGY ASSESSMENT: AN IRISH CASE STUDY.

PubMed

Ryan, Máirín; Moran, Patrick S; Harrington, Patricia; Murphy, Linda; O'Neill, Michelle; Whelan, Marty; Teljeur, Conor

2017-01-01

The aim of this study was to illustrate the contribution of stakeholder engagement to the impact of health technology assessment (HTA) using an Irish HTA of a national public access defibrillation (PAD) program. In response to draft legislation that proposed a PAD program, the Minister for Health requested that Health Information and Quality Authority undertake an HTA to inform the design and implementation of a national PAD program and the necessary underpinning legislation. The draft legislation outlined a program requiring widespread installation and maintenance of automatic external defibrillators in specified premises. Stakeholder engagement to optimize the impact of the HTA included one-to-one interviews with politicians, engagement with an Expert Advisory Group, public and targeted consultation, and positive media management. The HTA quantified the clinical benefits of the proposed PAD program as modest, identified that substantial costs would fall on small/medium businesses at a time of economic recession, and that none of the programs modeled were cost-effective. The Senator who proposed the Bill actively publicized the HTA process and its findings and encouraged participation in the public consultation. Participation of key stakeholders was important for the quality and acceptability of the HTA findings and advice. Media management promoted public engagement and understanding. The Bill did not progress. The HTA informed the decision not to progress with legislation for a national PAD program. Engagement was tailored to ensure that key stakeholders including politicians and the public were informed of the HTA process, the findings, and the advice, thereby maximizing acceptance. Appropriate stakeholder engagement optimizes the impact of HTA.

Attitude of a group of Belgian stakeholders towards proposed agricultural countermeasures after a radioactive contamination: synthesis of the discussions within the Belgian EC-FARMING group.

PubMed

Vandecasteele, C M; Hardeman, F; Pauwels, O; Bernaerts, M; Carlé, B; Sombré, L

2005-01-01

In the case of radioactive contamination of the environment with an impact on the food chain, the remediation strategy will not only be based on scientific knowledge and technical experience, but will also be dictated by peculiarities of the country. These characteristics include the agro-industrial structure, the local and international economical contexts and the political configuration including the distribution of responsibilities and competencies. This paper identifies and illustrates the most relevant characteristics of the Belgian agricultural system and political environment; it also describes the past experience with food chain contamination, which is expected to influence the attitude of Belgian stakeholders, who would be involved in the setting up of countermeasure strategies for maintaining agricultural production and food safety. The picture drawn explains why several countermeasures aiming to reduce the contamination in food products, although scientifically sound and technically feasible, are hardly acceptable or even not acceptable at all, to the stakeholders.

Toward criteria for pragmatic measurement in implementation research and practice: a stakeholder-driven approach using concept mapping.

PubMed

Powell, Byron J; Stanick, Cameo F; Halko, Heather M; Dorsey, Caitlin N; Weiner, Bryan J; Barwick, Melanie A; Damschroder, Laura J; Wensing, Michel; Wolfenden, Luke; Lewis, Cara C

2017-10-03

Advancing implementation research and practice requires valid and reliable measures of implementation determinants, mechanisms, processes, strategies, and outcomes. However, researchers and implementation stakeholders are unlikely to use measures if they are not also pragmatic. The purpose of this study was to establish a stakeholder-driven conceptualization of the domains that comprise the pragmatic measure construct. It built upon a systematic review of the literature and semi-structured stakeholder interviews that generated 47 criteria for pragmatic measures, and aimed to further refine that set of criteria by identifying conceptually distinct categories of the pragmatic measure construct and providing quantitative ratings of the criteria's clarity and importance. Twenty-four stakeholders with expertise in implementation practice completed a concept mapping activity wherein they organized the initial list of 47 criteria into conceptually distinct categories and rated their clarity and importance. Multidimensional scaling, hierarchical cluster analysis, and descriptive statistics were used to analyze the data. The 47 criteria were meaningfully grouped into four distinct categories: (1) acceptable, (2) compatible, (3) easy, and (4) useful. Average ratings of clarity and importance at the category and individual criteria level will be presented. This study advances the field of implementation science and practice by providing clear and conceptually distinct domains of the pragmatic measure construct. Next steps will include a Delphi process to develop consensus on the most important criteria and the development of quantifiable pragmatic rating criteria that can be used to assess measures.

Speech-language pathology telehealth in rural and remote schools: the experience of school executive and therapy assistants.

PubMed

Fairweather, Glenn C; Lincoln, Michelle A; Ramsden, Robyn

2017-01-01

Difficulties in accessing allied health services, especially in rural and remote areas, appear to be driving the use of telehealth services to children in schools. The objectives of this study were to investigate the experiences and views of school executive staff and therapy assistants regarding the feasibility and acceptability of a speech-language pathology telehealth program for children attending schools in rural and remote New South Wales, Australia. The program, called Come N See, provided therapy interventions remotely via low-bandwidth videoconferencing, with email follow-up. Over a 12-week period, children were offered therapy blocks of six fortnightly sessions, each lasting a maximum of 30 minutes. School executives (n=5) and therapy assistants (n=6) described factors that promoted or threatened the program's feasibility and acceptability, during semistructured interviews. Thematic content analysis with constant comparison was applied to the transcribed interviews to identify relationships in the data. Emergent themes related to (a) unmet speech pathology needs, (b) building relationships, (c) telehealth's advantages, (d) telehealth's disadvantages, (e) anxiety replaced by joy and confidence in growing skills, and (f) supports. School executive staff and therapy assistants verified that the delivery of the school-based telehealth service was feasible and acceptable. However, the participants saw significant opportunities to enhance this acceptability through building into the program stronger working relationships and supports for stakeholders. These findings are important for the future development of allied health telehealth programs that are sustainable as well as effective and fit the needs of all crucial stakeholders. The results have significant implications for speech pathology clinical practice relating to technology, program planning and teamwork within telehealth programs.

A qualitative study on acceptable levels of risk for pregnant women in clinical research.

PubMed

van der Zande, Indira S E; van der Graaf, Rieke; Oudijk, Martijn A; van Delden, Johannes J M

2017-05-15

There is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as a case-study. We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members (RECs) and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands. Three themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals' individual perception of risk may influence recruitment. Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women.

Attracting and retaining GPs: a stakeholder survey of priorities.

PubMed

Lorant, Vincent; Geerts, Charlotte; Duchesnes, Christiane; Goedhuys, Jo; Ryssaert, Lynn; Remmen, Roy; D'hoore, William

2011-07-01

Despite being a key player in the healthcare system, training and practising general practice has become less attractive in many countries and is in need of reform. To identify political priorities for improving GPs' attraction to the profession and their retention within it. Stakeholder face-to-face survey in Belgium, 2008. A total of 102 key stakeholders were recruited from policymakers, professional groups, academia, GP leaders, and the media. All interviewees were asked to score 23 policies on four criteria: effectiveness in attracting and retaining GPs, cost to society, acceptance by other health professionals, and accessibility of care. An overall performance score was computed (from -3 to +3) for each type of policy - training, financing, work-life balance, practice organisation, and governance - and for innovative versus conservative policies. Practice organisation policies and training policies received the highest scores (mean score ≥ 1.11). Financing policies, governance, and work-life balance policies scored poorly (mean score ≤ 0.65) because they had negative effects, particularly in relation to cost, acceptance, and accessibility of care. Stakeholders were keen on moving GPs towards team work, improving their role as care coordinator, and helping them to offload administrative tasks (score ≥ 1.4). They also favoured moves to increase the early and integrated exposure of all medical students to general practice. Overall, conservative policies were better scored than innovative ones (beta = -0.16, 95% confidence interval = -0.28 to -0.03). The reforming of general practice is made difficult by the small-step approach, as well as the importance of decision criteria related to cost, acceptance, and access.

Key stakeholder perceptions about consent to participate in acute illness research: a rapid, systematic review to inform epi/pandemic research preparedness.

PubMed

Gobat, Nina H; Gal, Micaela; Francis, Nick A; Hood, Kerenza; Watkins, Angela; Turner, Jill; Moore, Ronald; Webb, Steve A R; Butler, Christopher C; Nichol, Alistair

2015-12-29

A rigorous research response is required to inform clinical and public health decision-making during an epi/pandemic. However, the ethical conduct of such research, which often involves critically ill patients, may be complicated by the diminished capacity to consent and an imperative to initiate trial therapies within short time frames. Alternative approaches to taking prospective informed consent may therefore be used. We aimed to rapidly review evidence on key stakeholder (patients, their proxy decision-makers, clinicians and regulators) views concerning the acceptability of various approaches for obtaining consent relevant to pandemic-related acute illness research. We conducted a rapid evidence review, using the Internet, database and hand-searching for English language empirical publications from 1996 to 2014 on stakeholder opinions of consent models (prospective informed, third-party, deferred, or waived) used in acute illness research. We excluded research on consent to treatment, screening, or other such procedures, non-emergency research and secondary studies. Papers were categorised, and data summarised using narrative synthesis. We screened 689 citations, reviewed 104 full-text articles and included 52. Just one paper related specifically to pandemic research. In other emergency research contexts potential research participants, clinicians and research staff found third-party, deferred, and waived consent to be acceptable as a means to feasibly conduct such research. Acceptability to potential participants was motivated by altruism, trust in the medical community, and perceived value in medical research and decreased as the perceived risks associated with participation increased. Discrepancies were observed in the acceptability of the concept and application or experience of alternative consent models. Patients accepted clinicians acting as proxy-decision makers, with preference for two decision makers as invasiveness of interventions increased. Research regulators were more cautious when approving studies conducted with alternative consent models; however, their views were generally under-represented. Third-party, deferred, and waived consent models are broadly acceptable to potential participants, clinicians and/or researchers for emergency research. Further consultation with key stakeholders, particularly with regulators, and studies focused specifically on epi/pandemic research, are required. We highlight gaps and recommendations to inform set-up and protocol development for pandemic research and institutional review board processes. CRD42014014000.

A qualitative assessment of stakeholder perceptions and socio-cultural influences on the acceptability of harm reduction programs in Tijuana, Mexico

PubMed Central

Philbin, Morgan M; Lozada, Remedios; Zúñiga, María Luisa; Mantsios, Andrea; Case, Patricia; Magis-Rodriguez, Carlos; Latkin, Carl A; Strathdee, Steffanie A

2008-01-01

Background The Mexico-U.S. border region is experiencing rising rates of blood-borne infections among injection drug users (IDUs), emphasizing the need for harm reduction interventions. Methods We assessed the religious and cultural factors affecting the acceptability and feasibility of three harm reduction interventions – Needle exchange programs (NEPs), syringe vending machines, and safer injection facilities (SIFs) – in Tijuana, Mexico. In-depth qualitative interviews were conducted with 40 community stakeholders to explore cultural and societal-related themes. Results Themes that emerged included Tijuana's location as a border city, family values, and culture as a mediator of social stigma and empathy towards IDUs. Perception of low levels of both awareness and socio-cultural readiness for harm reduction interventions was noted. Religious culture emerged as a theme, highlighting the important role religious leaders play in determining community responses to harm reduction and rehabilitation strategies for IDUs. The influence of religious culture on stakeholders' opinions concerning harm reduction interventions was evidenced by discussions of family and social values, stigma, and resulting policies. Conclusion Religion and politics were described as both a perceived benefit and deterrent, highlighting the need to further explore the overall influences of culture on the acceptability and implementation of harm reduction programs for drug users. PMID:19021899

An Exploratory Use of the Stakeholder Approach to Defining and Measuring Quality: The Case of a Cypriot Higher Education Institution

ERIC Educational Resources Information Center

Iacovidou, Melpo; Gibbs, Paul; Zopiatis, Anastasios

2009-01-01

Cyprus has recently adopted laws to allow for the provision of private higher education. This case study concerns one such institution that is developing its understanding of quality through the eyes of two of its key stakeholders, staff and students. This empirical study is nested within the literature that advocates community-wide acceptance of…

Who's in and why? A typology of stakeholder analysis methods for natural resource management.

PubMed

Reed, Mark S; Graves, Anil; Dandy, Norman; Posthumus, Helena; Hubacek, Klaus; Morris, Joe; Prell, Christina; Quinn, Claire H; Stringer, Lindsay C

2009-04-01

Stakeholder analysis means many things to different people. Various methods and approaches have been developed in different fields for different purposes, leading to confusion over the concept and practice of stakeholder analysis. This paper asks how and why stakeholder analysis should be conducted for participatory natural resource management research. This is achieved by reviewing the development of stakeholder analysis in business management, development and natural resource management. The normative and instrumental theoretical basis for stakeholder analysis is discussed, and a stakeholder analysis typology is proposed. This consists of methods for: i) identifying stakeholders; ii) differentiating between and categorising stakeholders; and iii) investigating relationships between stakeholders. The range of methods that can be used to carry out each type of analysis is reviewed. These methods and approaches are then illustrated through a series of case studies funded through the Rural Economy and Land Use (RELU) programme. These case studies show the wide range of participatory and non-participatory methods that can be used, and discuss some of the challenges and limitations of existing methods for stakeholder analysis. The case studies also propose new tools and combinations of methods that can more effectively identify and categorise stakeholders and help understand their inter-relationships.

Multiple Stakeholder Perspectives on Teletherapy Delivery of Speech Pathology Services in Rural Schools: A Preliminary, Qualitative Investigation

PubMed Central

LINCOLN, MICHELLE; HINES, MONIQUE; FAIRWEATHER, CRAIG; RAMSDEN, ROBYN; MARTINOVICH, JULIA

2015-01-01

The objective of this study was to investigate stakeholders’ views on the feasibility and acceptability of a pilot speech pathology teletherapy program for children attending schools in rural New South Wales, Australia. Nine children received speech pathology sessions delivered via Adobe Connect® web-conferencing software. During semi-structured interviews, school principals (n = 3), therapy facilitators (n = 7), and parents (n = 6) described factors that promoted or threatened the program’s feasibility and acceptability. Themes were categorized according to whether they related to (a) the use of technology; (b) the school-based nature of the program; or (c) the combination of using technology with a school-based program. Despite frequent reports of difficulties with technology, teletherapy delivery of speech pathology services in schools was highly acceptable to stakeholders. However, the use of technology within a school environment increased the complexities of service delivery. Service providers should pay careful attention to planning processes and lines of communication in order to promote efficiency and acceptability of teletherapy programs. PMID:25945230

Assessing Interventions to Manage West Nile Virus Using Multi-Criteria Decision Analysis with Risk Scenarios

PubMed Central

Hongoh, Valerie; Campagna, Céline; Panic, Mirna; Samuel, Onil; Gosselin, Pierre; Waaub, Jean-Philippe; Ravel, André; Samoura, Karim; Michel, Pascal

2016-01-01

The recent emergence of West Nile virus (WNV) in North America highlights vulnerability to climate sensitive diseases and stresses the importance of preventive efforts to reduce their public health impact. Effective prevention involves reducing environmental risk of exposure and increasing adoption of preventive behaviours, both of which depend on knowledge and acceptance of such measures. When making operational decisions about disease prevention and control, public health must take into account a wide range of operational, environmental, social and economic considerations in addition to intervention effectiveness. The current study aimed to identify, assess and rank possible risk reduction measures taking into account a broad set of criteria and perspectives applicable to the management of WNV in Quebec under increasing transmission risk scenarios, some of which may be related to ongoing warming in higher-latitude regions. A participatory approach was used to collect information on categories of concern to relevant stakeholders with respect to WNV prevention and control. Multi-criteria decision analysis was applied to examine stakeholder perspectives and their effect on strategy rankings under increasing transmission risk scenarios. Twenty-three preventive interventions were retained for evaluation using eighteen criteria identified by stakeholders. Combined evaluations revealed that, at an individual-level, inspecting window screen integrity, wearing light colored, long clothing, eliminating peridomestic larval sites and reducing outdoor activities at peak times were top interventions under six WNV transmission scenarios. At a regional-level, the use of larvicides was a preferred strategy in five out of six scenarios, while use of adulticides and dissemination of sterile male mosquitoes were found to be among the least favoured interventions in almost all scenarios. Our findings suggest that continued public health efforts aimed at reinforcing individual-level preventive behaviours combined with the application of larvicides to manage the risk of WNV infection are the interventions most acceptable and effective at reaching current management objectives now and under future theoretical transmission risk. PMID:27494136

A Multiple Streams analysis of the decisions to fund gender-neutral HPV vaccination in Canada.

PubMed

Shapiro, Gilla K; Guichon, Juliet; Prue, Gillian; Perez, Samara; Rosberger, Zeev

2017-07-01

In Canada, the human papillomavirus (HPV) vaccine is licensed and recommended for females and males. Although all Canadian jurisdictions fund school-based HPV vaccine programs for girls, only six jurisdictions fund school-based HPV vaccination for boys. The research aimed to analyze the factors that underpin government decisions to fund HPV vaccine for boys using a theoretical policy model, Kingdon's Multiple Streams framework. This approach assesses policy development by examining three concurrent, but independent, streams that guide analysis: Problem Stream, Policy Stream, and Politics Stream. Analysis from the Problem Stream highlights that males are affected by HPV-related diseases and are involved in transmitting HPV infection to their sexual partners. Policy Stream analysis makes clear that while the inclusion of males in HPV vaccine programs is suitable, equitable, and acceptable; there is debate regarding cost-effectiveness. Politics Stream analysis identifies the perspectives of six different stakeholder groups and highlights the contribution of government officials at the provincial and territorial level. Kingdon's Multiple Streams framework helps clarify the opportunities and barriers for HPV vaccine policy change. This analysis identified that the interpretation of cost-effectiveness models and advocacy of stakeholders such as citizen-advocates and HPV-affected politicians have been particularly important in galvanizing policy change. Copyright © 2017 Elsevier Inc. All rights reserved.

Engaging stakeholders and target groups in prioritising a public health intervention: the Creating Active School Environments (CASE) online Delphi study.

PubMed

Morton, Katie L; Atkin, Andrew J; Corder, Kirsten; Suhrcke, Marc; Turner, David; van Sluijs, Esther M F

2017-01-13

Stakeholder engagement and public involvement are considered as integral to developing effective public health interventions and is encouraged across all phases of the research cycle. However, limited guidelines and appropriate tools exist to facilitate stakeholder engagement-especially during the intervention prioritisation phase. We present the findings of an online 'Delphi' study that engaged stakeholders (including young people) in the process of prioritising secondary school environment-focused interventions that aim to increase physical activity. Web-based data collection using an online Delphi tool enabling participation of geographically diverse stakeholders. 37 stakeholders participated, including young people (age 13-16 years), parents, teachers, public health practitioners, academics and commissioners; 33 participants completed both rounds. Participants were asked to prioritise a (short-listed) selection of school environment-focused interventions (eg, standing desks, outdoor design changes) based on the criteria of 'reach', 'equality', 'acceptability', 'feasibility', 'effectiveness' and 'cost'. Participants were also asked to rank the criteria and the effectiveness outcomes (eg, physical activity, academic achievement, school enjoyment) from most to least important. Following feedback along with any new information provided, participants completed round 2 4 weeks later. The intervention prioritisation process was feasible to conduct and comments from participants indicated satisfaction with the process. Consensus regarding intervention strategies was achieved among the varied groups of stakeholders, with 'active lessons' being the favoured approach. Participants ranked 'mental health and well-being' as the most important outcome followed by 'enjoyment of school'. The most important criteria was 'effectiveness', followed by 'feasibility'. This novel approach to engaging a wide variety of stakeholders in the research process was feasible to conduct and acceptable to participants. It also provided insightful information relating to how stakeholders prioritise interventions. The approach could be extended beyond the specific project to be a useful tool for researchers and practitioners. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Stakeholder perceptions of a nurse led walk-in centre.

PubMed

Parker, Rhian M; Desborough, Jane L; Forrest, Laura E

2012-11-05

As many countries face primary care medical workforce shortages and find it difficult to provide timely and affordable care they seek to find new ways of delivering first point of contact health care through developing new service models. In common with other areas of rural and regional Australia, the Australian Capital Territory (ACT) is currently experiencing a general practitioner (GP) workforce shortage which impacts significantly on the ability of patients to access GP led primary care services. The introduction of a nurse led primary care Walk-in Centre in the ACT aimed to fulfill an unmet health care need in the community and meet projected demand for health care services as well as relieve pressure on the hospital system. Stakeholders have the potential to influence health service planning and policy, to advise on the potential of services to meet population health needs and to assess how acceptable health service innovation is to key stakeholder groups. This study aimed to ascertain the views of key stakeholders about the Walk-in Centre. Stakeholders were purposively selected through the identification of individuals and organisations which had organisational or professional contact with the Walk-in Centre. Semi structured interviews around key themes were conducted with seventeen stakeholders. Stakeholders were generally supportive of the Walk-in Centre but identified key areas which they considered needed to be addressed. These included the service's systems, full utilisation of the nurse practitioner role and adequate education and training. It was also suggested that a doctor could be available to the Centre as a source of referral for patients who fall outside the nurses' scope of practice. The location of the Centre was seen to impact on patient flows to the Emergency Department. Nurse led Walk-in Centres are one response to addressing primary health care medical workforce shortages. Whilst some stakeholders have reservations about the model others are supportive and see the potential the model has to provide accessible primary health care. Any further developments of nurse-led Walk-in Centres need to take into account the views of key stakeholders so as to ensure that the model is acceptable and sustainable.

Educational Needs on Palliative Care for Cancer Patients in Iran: A SWOT Analysis.

PubMed

Ansari, Mojgan; Rassouli, Maryam; Akbari, Mohamad Esmaiel; Abbaszadeh, Abbas; Akbari Sari, Ali

2018-04-01

By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder's educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran. This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes. A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included: "academic education planning", "workforce education", "public awareness", and "patient and caregiver empowerment" that contained our subcategories as follows: "strengths", "weaknesses", "opportunities" and "threats" (SWOT). Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced.

The greater snow goose Anser caerulescens atlanticus: Managing an overabundant population.

PubMed

Lefebvre, Josée; Gauthier, Gilles; Giroux, Jean-François; Reed, Austin; Reed, Eric T; Bélanger, Luc

2017-03-01

Between the early 1900s and the 1990s, the greater snow goose Anser caerulescens atlanticus population grew from 3000 individuals to more than 700 000. Because of concerns about Arctic degradation of natural habitats through overgrazing, a working group recommended the stabilization of the population. Declared overabundant in 1998, special management actions were then implemented in Canada and the United States. Meanwhile, a cost-benefit socioeconomic analysis was performed to set a target population size. Discussions aiming towards attaining a common vision were undertaken with stakeholders at multiple levels. The implemented measures have had varying success; but population size has been generally stable since 1999. To be effective and meet social acceptance, management actions must have a scientific basis, result from a consensus among stakeholders, and include an efficient monitoring programme. In this paper, historical changes in population size and management decisions along with past and current challenges encountered are discussed.

Use and perceived benefits and barriers of QSAR models for REACH: findings from a questionnaire to stakeholders

PubMed Central

2012-01-01

The ORCHESTRA online questionnaire on “benefits and barriers to the use of QSAR methods” addressed the academic, consultant, regulatory and industry communities potentially interested by QSAR methods in the context of REACH. Replies from more than 60 stakeholders produced some insights on the actual application of QSAR methods, and how to improve their use. Respondents state in majority that they have used QSAR methods. All have some future plans to test or use QSAR methods in accordance with their stakeholder role. The stakeholder respondents cited a total of 28 models, methods or software that they have actually applied. The three most frequently cited suites, used moreover by all the stakeholder categories, are the OECD Toolbox, EPISuite and CAESAR; all are free tools. Results suggest that stereotyped assumptions about the barriers to application of QSAR may be incorrect. Economic costs (including potential delays) are not found to be a major barrier. And only one respondent “prefers” traditional, well-known and accepted toxicological assessment methods. Information and guidance may be the keys to reinforcing use of QSAR models. Regulators appear most interested in obtaining clear explanation of the basis of the models, to provide a solid basis for decisions. Scientists appear most interested in the exploration of the scientific capabilities of the QSAR approach. Industry shows interest in obtaining reassurance that appropriate uses of QSAR will be accepted by regulators. PMID:23244245

Appraising the Corporate Sustainability Reports - Text Mining and Multi-Discriminatory Analysis

NASA Astrophysics Data System (ADS)

Modapothala, J. R.; Issac, B.; Jayamani, E.

The voluntary disclosure of the sustainability reports by the companies attracts wider stakeholder groups. Diversity in these reports poses challenge to the users of information and regulators. This study appraises the corporate sustainability reports as per GRI (Global Reporting Initiative) guidelines (the most widely accepted and used) across all industrial sectors. Text mining is adopted to carry out the initial analysis with a large sample size of 2650 reports. Statistical analyses were performed for further investigation. The results indicate that the disclosures made by the companies differ across the industrial sectors. Multivariate Discriminant Analysis (MDA) shows that the environmental variable is a greater significant contributing factor towards explanation of sustainability report.

Planning that works: Empowerment through stakeholder focused interactive planning (SFIP)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beck, J.E.; Ison, S.A.

1994-12-31

This paper describes a powerful planning tool that can enable government, private industries, and public interest organizations to actualize their visions through sound decision making. The stakeholder focused interactive planning model is designed to integrate and ultimately gain stakeholder investment in the success of attainment of their vision. The only concessions required of the planning organization using this process is the acceptance of the premise that sustained vision success requires the support of both internal and external stakeholders and that each step in the process must be used as a validation of the previous step and essential to the completionmore » of the next step. What is stakeholder/public involvement? It is the process in which the stakeholders (both internal and external) values, interests and expectations are included in decision-making processes. The primary goal of public involvement efforts is to include all those who have a stake in the decision, whether or not they have already been identified. Stakeholders are individuals, contractors, clients, suppliers, public organizations, state and local governments, Indian tribes, federal agencies, and other parties affected by decisions.« less

Value Frameworks in Oncology: Comparative Analysis and Implications to the Pharmaceutical Industry.

PubMed

Slomiany, Mark; Madhavan, Priya; Kuehn, Michael; Richardson, Sasha

2017-07-01

As the cost of oncology care continues to rise, composite value models that variably capture the diverse concerns of patients, physicians, payers, policymakers, and the pharmaceutical industry have begun to take shape. To review the capabilities and limitations of 5 of the most notable value frameworks in oncology that have emerged in recent years and to compare their relative value and application among the intended stakeholders. We compared the methodology of the American Society of Clinical Oncology (ASCO) Value Framework (version 2.0), the National Comprehensive Cancer Network Evidence Blocks, Memorial Sloan Kettering Cancer Center DrugAbacus, the Institute for Clinical and Economic Review Value Assessment Framework, and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale, using a side-by-side comparative approach in terms of the input, scoring methodology, and output of each framework. In addition, we gleaned stakeholder insights about these frameworks and their potential real-world applications through dialogues with physicians and payers, as well as through secondary research and an aggregate analysis of previously published survey results. The analysis identified several framework-specific themes in their respective focus on clinical trial elements, breadth of evidence, evidence weighting, scoring methodology, and value to stakeholders. Our dialogues with physicians and our aggregate analysis of previous surveys revealed a varying level of awareness of, and use of, each of the value frameworks in clinical practice. For example, although the ASCO Value Framework appears nascent in clinical practice, physicians believe that the frameworks will be more useful in practice in the future as they become more established and as their outputs are more widely accepted. Along with patients and payers, who bear the burden of treatment costs, physicians and policymakers have waded into the discussion of defining value in oncology care, as well as pharmaceutical companies that seek to understand the impact of these value frameworks on each stakeholder, as they model the value and financial threshold of innovative, high-cost drugs.

Multi-criteria assessment of community-based fluoride-removal technologies for rural Ethiopia.

PubMed

Osterwalder, Lars; Johnson, C Annette; Yang, Hong; Johnston, Richard B

2014-08-01

Elevated concentrations of naturally-occurring fluoride in groundwater pose a serious health risk to millions of people living in the Ethiopian Rift Valley. In the absence of low-fluoride water resources of sufficient capacity, fluoride removal from drinking water is the accepted mitigation option. To date, five different community-level fluoride-removal technologies have been implemented in Ethiopia, although only a few units have been found in a functional state in the field. Which technology should be promoted and up-scaled is the subject of controversial debate amongst key stakeholders. This paper describes a multi-criteria decision analysis exercise, which was conducted with the participation of stakeholders in Ethiopia during a one-day workshop, to assess in an objective and transparent manner the available technology options. Criteria for technology comparison were selected and weighted, thus enabling the participants to assess the advantages and disadvantages of the different technologies and hear the views of other stakeholders. It was shown that there is no single most-preferable, technical solution for fluoride removal in Ethiopia. Selection of the most suitable solution depends on location-specific parameters and on the relative importance given to different criteria by the stakeholders involved. The data presented in this paper can be used as reference values for Ethiopia. © 2013. Published by Elsevier B.V. All rights reserved.

Evaluating the value and impact of the Victorian Audit of Surgical Mortality.

PubMed

Retegan, Claudia; Russell, Colin; Harris, Darren; Andrianopoulos, Nick; Beiles, C Barry

2013-10-01

Since the Victorian Audit of Surgical Mortality (VASM) commenced in 2007, 95% of Victorian Fellows have agreed to participate and have provided data on the deaths of patients receiving surgical care. All public, and the majority of private, hospitals involved in the delivery of surgical services in Victoria have been submitting data on deaths associated with surgery. De-identified reports on this data are distributed in regular annual reports and case note review booklets. Although informal feedback on the perceived value of the audit was encouraging, a formal review of all aspects of the audit was felt necessary. An independent formal review of VASM governance, documentation, datasets and data analysis was performed, in addition to a survey of 257 individuals (surgeons and other stakeholders) on the perceived impact of VASM. The review confirmed increasing participation and acceptance by surgeons since the inception of the project. Governance mechanisms were found to be effective and acknowledged by stakeholders and collaborators. Robust participation rates have been achieved, and stakeholders were generally satisfied with the quality of feedback. Suggestions for improvement were provided by some surgeons and hospitals. External review of VASM processes and procedures confirmed that the audit was operating effectively, with robust quality control and achieving the trust of stakeholders. The educational value of the audit to the surgical community was acknowledged and areas for future improvement have been identified. © 2013 Royal Australasian College of Surgeons.

Feasibility and acceptability of a volunteer-mediated diversional therapy program for older patients with cognitive impairment.

PubMed

Wong Shee, Anna; Phillips, Bev; Hill, Keith; Dodd, Karen

2014-01-01

Understanding the perceptions of stakeholders is critical for determining acceptability and feasibility of volunteer-mediated programs. This study evaluated the feasibility and acceptability for staff, volunteers, patients and their carers, of a volunteer diversional therapy program for patients with cognitive impairment undergoing inpatient rehabilitation. Post-program structured interviews were conducted with the volunteers (n = 10), patients (n = 30) and their carers (n = 3); and nursing staff (n = 6) participated in a focus group. Thematic analysis identified five themes (values, attitudes, knowledge, purpose, support) in two dimensions (personal, team culture). Overall, patients, carers, staff and volunteers were satisfied with the volunteer program and perceived benefits for quality of care. Recommendations for improvements to the program related to staff engagement with the program and the volunteers' education and training. The volunteer diversional therapy pilot program for patients with cognitive impairment on a sub-acute ward was acceptable and feasible for patients, carers, staff and volunteers. Copyright © 2014 Mosby, Inc. All rights reserved.

Attracting and retaining GPs: a stakeholder survey of priorities

PubMed Central

Lorant, Vincent; Geerts, Charlotte; Duchesnes, Christiane; Goedhuys, Jo; Ryssaert, Lynn; Remmen, Roy; D'hoore, William

2011-01-01

Background Despite being a key player in the healthcare system, training and practising general practice has become less attractive in many countries and is in need of reform. Aim To identify political priorities for improving GPs' attraction to the profession and their retention within it. Design and setting Stakeholder face-to-face survey in Belgium, 2008. Method A total of 102 key stakeholders were recruited from policymakers, professional groups, academia, GP leaders, and the media. All interviewees were asked to score 23 policies on four criteria: effectiveness in attracting and retaining GPs, cost to society, acceptance by other health professionals, and accessibility of care. An overall performance score was computed (from –3 to +3) for each type of policy — training, financing, work–life balance, practice organisation, and governance — and for innovative versus conservative policies. Results Practice organisation policies and training policies received the highest scores (mean score ≥1.11). Financing policies, governance, and work–life balance policies scored poorly (mean score ≤0.65) because they had negative effects, particularly in relation to cost, acceptance, and accessibility of care. Stakeholders were keen on moving GPs towards team work, improving their role as care coordinator, and helping them to offload administrative tasks (score ≥1.4). They also favoured moves to increase the early and integrated exposure of all medical students to general practice. Overall, conservative policies were better scored than innovative ones (beta = –0.16, 95% confidence interval = –0.28 to –0.03). Conclusion The reforming of general practice is made difficult by the small-step approach, as well as the importance of decision criteria related to cost, acceptance, and access. PMID:21722449

The Missing Stakeholder Group: Why Patients Should be Involved in Health Economic Modelling.

PubMed

van Voorn, George A K; Vemer, Pepijn; Hamerlijnck, Dominique; Ramos, Isaac Corro; Teunissen, Geertruida J; Al, Maiwenn; Feenstra, Talitha L

2016-04-01

Evaluations of healthcare interventions, e.g. new drugs or other new treatment strategies, commonly include a cost-effectiveness analysis (CEA) that is based on the application of health economic (HE) models. As end users, patients are important stakeholders regarding the outcomes of CEAs, yet their knowledge of HE model development and application, or their involvement therein, is absent. This paper considers possible benefits and risks of patient involvement in HE model development and application for modellers and patients. An exploratory review of the literature has been performed on stakeholder-involved modelling in various disciplines. In addition, Dutch patient experts have been interviewed about their experience in, and opinion about, the application of HE models. Patients have little to no knowledge of HE models and are seldom involved in HE model development and application. Benefits of becoming involved would include a greater understanding and possible acceptance by patients of HE model application, improved model validation, and a more direct infusion of patient expertise. Risks would include patient bias and increased costs of modelling. Patient involvement in HE modelling seems to carry several benefits as well as risks. We claim that the benefits may outweigh the risks and that patients should become involved.

The Path Toward Universal Health Coverage.

PubMed

Yassoub, Rami; Alameddine, Mohamad; Saleh, Shadi

2017-04-01

Lebanon is a middle-income country with a market-maximized healthcare system that provides limited social protection for its citizens. Estimates reveal that half of the population lacks sufficient health coverage and resorts to out-of-pocket payments. This study triangulated data from a comprehensive review of health packages of countries similar to Lebanon, the Ministry of Public Health statistics, and services suggested by the World Health Organization for inclusion in a health benefits package (HBP). To determine the acceptability and viability of implementing the HBP, a stakeholder analysis was conducted to identify the knowledge, positions, and available resources for the package. The results revealed that the private health sector, having the most resources, is least in favor of implementing the package, whereas the political and civil society sectors support implementation. The main divergence in opinions among stakeholders was on the abolishment of out-of-pocket payments, mainly attributed to the potential abuse of the HBP's services by users. The study's findings encourage health decision makers to capitalize on the current political readiness by proposing the HBP for implementation in the path toward universal health coverage. This requires a consultative process, involving all stakeholders, in devising the strategy and implementation framework of a HBP.

Public acceptance of wildlife trapping in Colorado

USGS Publications Warehouse

Manfredo, M.J.; Pierce, C.L.; Fulton, D.; Pate, J.; Gill, B.R.

1999-01-01

In November 1994, the Colorado Division of Wildlife (CDOW) initiated a stakeholder process to develop trapping regulations that would seek to achieve compromise among divergent interests. A telephone survey was conducted to provide stakeholders with information about the Colorado public's acceptance of trapping. A random sample of 900 residents, stratified by geographic region, indicated that the public would vote to ban trapping and that they believed the ban would eliminate a cruel activity and help to preserve endangered wildlife. Most, however, agreed that trapping was acceptable to prevent spread of disease and to protect livestock, but unacceptable on the basis of providing recreation or making money. Beliefs about trapping were found to be rooted in a protection versus use value orientation about wildlife. The regulations subsequently adopted by the CDOW were consistent with survey findings; however, the regulatory process was bypassed by legislative action, giving trapping authority to the Colorado Department of Agriculture. In response, citizen activists succeeded in placing a ballot initiative before voters. In 1996, the ballot initiative passed, banning trapping in Colorado.

Social validity of randomised controlled trials in health services research and intellectual disabilities: a qualitative exploration of stakeholder views

PubMed Central

2011-01-01

Background Randomised controlled trials (RCTs) are the gold standard of evidence-based practice in medicine but they have had limited influence in the field of intellectual disabilities. Previous literature suggests that participants and professionals have limited tolerance for this type of research methodology. However, it is not known how well service users, carers and other health professionals understand and accept the need for RCTs, and why it is important for individuals with intellectual disabilities to be included in this kind of research. Methods We examined individual perceptions of RCTs in 51 participants (18 carers, 6 service users and 27 professionals) using semi-structured interviews. A framework approach was adopted in the analysis of data. Results We found that participants had concerns about capacity and resource allocation but held positive views towards this type of research methodology. Understanding of the principles behind RCTs was poor amongst service users and a minority of carers, but mediated by previous exposure to research for professionals. Conclusions The social validity of RCTs in intellectual disabilities may be compromised by lack of understanding of the design and the on-going concerns about obtaining informed consent especially in incapacitated adults. However, the overall finding that the need for this form of research was seen in a positive light suggests that there is a turning point in the perceptions of stakeholders working in intellectual disabilities services. We recommend that researchers include on-going education on RCT design during trials, tailoring it to all stakeholders with emphasis on strong service user and care involvement. This could be a pivotal element in improving acceptability of, and recruitment to RCTs. PMID:21658215

A novel framework for analysing stakeholder interest in healthy foods: A case study on iodine biofortification.

PubMed

Mogendi, Joseph Birundu; De Steur, Hans; Gellynck, Xavier; Makokha, Anselimo

2016-01-01

Despite the availability of novel strategies to prevent micronutrient malnutrition, such as biofortification, limited understanding of stakeholders often hampers their success. We build upon the existing literature on protection motivations (PMT) and technology acceptance (TAM) to develop an integrated PMTAM model for analyzing stakeholders' reactions, on both the supply and demand sides. Regarding the latter, the case of the iodine biofortified food chain is used to evaluate African households' interest. All model constructs, and threat appraisal in particular, are decisive in determining the uptake of biofortification, while also social demographics and own nutrition status play an important role.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Conover, David R.

This report acquaints stakeholders and interested parties involved in the development and/or deployment of energy storage systems (ESS) with the subject of safety-related codes, standards and regulations (CSRs). It is hoped that users of this document gain a more in depth and uniform understanding of safety-related CSR development and deployment that can foster improved communications among all ESS stakeholders and the collaboration needed to realize more timely acceptance and approval of safe ESS technology through appropriate CSR.

Mind the gap! Lessons from science-based stakeholder dialogue in climate-adapted management of wetlands.

PubMed

Grygoruk, Mateusz; Rannow, Sven

2017-01-15

Effective stakeholder involvement is crucial for the management of protected areas, especially when new challenges like adaptation to climate change need to be addressed. Under these circumstances, science-based stakeholder involvement is required. However, there is often a gap between the information produced by science and the need for information from stakeholders. Along with the design and implementation of adaptive management strategies and policies, efforts must be taken to adjust messages about conservation and adaptation issues, to make them easier to understand, relevant and acceptable for stakeholders. In this paper, the experience of closing the gap between scientific information and the user needs of stakeholders in the Biebrza Valley is documented. The requirements of efficient stakeholder dialogue and the raising of awareness are then indicated. We conclude that many attempts to raise awareness of environmental conservation require improvements. Messages often need to be adjusted for different stakeholders and their various perception levels to efficiently anticipate the potential impacts of the changing climate on ecosystem management. We also revealed that the autonomous adaptation measures implemented by stakeholders to mitigate impacts of climatic change often contradict adaptive management planned and implemented by environmental authorities. We conclude that there is a demand for boundary spanners that can build a bridge between complex scientific outputs and stakeholder needs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Implementing an organised cervical screening programme in the Republic of Moldova-Stakeholder identification and engagement.

PubMed

Davies, Philip; Valuta, Diana; Cojohari, Natalia; Sancho-Garnier, Helene

2017-10-01

Successfully implementing cervical screening programmes requires them to be adapted to the local context and have broad stakeholder support. This can be achieved by actively engaging local stakeholders in planning as well as implementing the programmes. The Moldovan government started implementing an organised cervical screening programme in 2010 with the first step being stakeholder identification and engagement. This process started by contacting easily identified stakeholders with each asked to recommend others and the process continued until no new ones were identified. Stakeholders were then involved in a series of individual and group meetings over a 2-year period to build confidence and encourage progressively greater engagement. In total, 87 individuals from 46 organisations were identified. Over the 2-year process, the individual and group meetings facilitated a change in stakeholder attitudes from disinterest, to acceptance and finally to active cooperation in designing the screening programme and preparing an implementation plan that were both well adapted to the Moldovan context. Developing the broad support needed to implement cervical screening programmes required ongoing interaction with stakeholders over an extended period. This interaction allowed stakeholder concerns to be identified and addressed, progress to be demonstrated, and stakeholders to be educated about organised screening programmes so they had the knowledge to progressively take greater responsibility and ownership. Copyright © 2017 Elsevier Ltd. All rights reserved.

Issues and approaches for ensuring effective communication on acceptable daily exposure (ADE) values applied to pharmaceutical cleaning.

PubMed

Olson, Michael J; Faria, Ellen C; Hayes, Eileen P; Jolly, Robert A; Barle, Ester Lovsin; Molnar, Lance R; Naumann, Bruce D; Pecquet, Alison M; Shipp, Bryan K; Sussman, Robert G; Weideman, Patricia A

2016-08-01

This manuscript centers on communication with key stakeholders of the concepts and program goals involved in the application of health-based pharmaceutical cleaning limits. Implementation of health-based cleaning limits, as distinct from other standards such as 1/1000th of the lowest clinical dose, is a concept recently introduced into regulatory domains. While there is a great deal of technical detail in the written framework underpinning the use of Acceptable Daily Exposures (ADEs) in cleaning (for example ISPE, 2010; Sargent et al., 2013), little is available to explain how to practically create a program which meets regulatory needs while also fulfilling good manufacturing practice (GMP) and other expectations. The lack of a harmonized approach for program implementation and communication across stakeholders can ultimately foster inappropriate application of these concepts. Thus, this period in time (2014-2017) could be considered transitional with respect to influencing best practice related to establishing health-based cleaning limits. Suggestions offered in this manuscript are intended to encourage full and accurate communication regarding both scientific and administrative elements of health-based ADE values used in pharmaceutical cleaning practice. This is a large and complex effort that requires: 1) clearly explaining key terms and definitions, 2) identification of stakeholders, 3) assessment of stakeholders' subject matter knowledge, 4) formulation of key messages fit to stakeholder needs, 5) identification of effective and timely means for communication, and 6) allocation of time, energy, and motivation for initiating and carrying through with communications. Copyright © 2016 Elsevier Inc. All rights reserved.

'Well, It's the Risk of the Unknown… Right?': A Qualitative Study of Perceived Risks and Benefits of HIV Cure Research in the United States.

PubMed

Dubé, Karine; Taylor, Jeff; Sylla, Laurie; Evans, David; Dee, Lynda; Burton, Alasdair; Willenberg, Loreen; Rennie, Stuart; Skinner, Asheley; Tucker, Joseph D; Weiner, Bryan J; Greene, Sandra B

2017-01-01

Biomedical research towards an HIV cure is advancing in the United States and elsewhere, yet little is known about perceptions of risks and benefits among potential study participants and other stakeholders. We conducted a qualitative study to explore perceived risks and benefits of investigational HIV cure research among people living with HIV (PLWHIV), biomedical HIV cure researchers, policy-makers and bioethicists. We conducted a qualitative research study using in-depth interviews with a purposive sample of PLWHIV, biomedical HIV cure researchers, policy-makers and bioethicists in 2015-2016. We analysed interview transcripts using thematic analysis anchored in grounded theory. We conducted and analyzed 36 key informant interviews. Qualitative analysis revealed four main findings. 1) Potential HIV cure study volunteers noted needing more information and education about the potential risks of HIV cure research. 2) Biomedical HIV cure researchers, policy-makers and bioethicists showed less awareness of social and financial risks of HIV cure research than PLWHIV. 3) Most respondents across the different categories of informants identified some risks that were too great to be acceptable in HIV cure research, although a subset of PLWHIV did not place an upper limit on acceptable risk. 4) PLWHIV showed a better awareness of potential psychological benefits of participating in HIV cure research than other groups of stakeholders. Our research suggests that PLWHIV have a variable understanding of the individual risks, sometimes substantial, associated with participating in biomedical HIV cure research studies. Community engagement and increased research literacy may help improve community understanding. Intensive informed consent procedures will be necessary for ethical study implementation. The current state of HIV cure research offers greater potential benefits to society than to participants. There is likely to be disagreement among regulators, researchers, clinicians, and potential participants about what constitutes acceptable risk for HIV cure studies.

'Well, It's the Risk of the Unknown… Right?': A Qualitative Study of Perceived Risks and Benefits of HIV Cure Research in the United States

PubMed Central

Dubé, Karine; Taylor, Jeff; Sylla, Laurie; Evans, David; Dee, Lynda; Burton, Alasdair; Willenberg, Loreen; Rennie, Stuart; Skinner, Asheley; Tucker, Joseph D.; Weiner, Bryan J.; Greene, Sandra B.

2017-01-01

Introduction Biomedical research towards an HIV cure is advancing in the United States and elsewhere, yet little is known about perceptions of risks and benefits among potential study participants and other stakeholders. We conducted a qualitative study to explore perceived risks and benefits of investigational HIV cure research among people living with HIV (PLWHIV), biomedical HIV cure researchers, policy-makers and bioethicists. Methods We conducted a qualitative research study using in-depth interviews with a purposive sample of PLWHIV, biomedical HIV cure researchers, policy-makers and bioethicists in 2015–2016. We analysed interview transcripts using thematic analysis anchored in grounded theory. Results We conducted and analyzed 36 key informant interviews. Qualitative analysis revealed four main findings. 1) Potential HIV cure study volunteers noted needing more information and education about the potential risks of HIV cure research. 2) Biomedical HIV cure researchers, policy-makers and bioethicists showed less awareness of social and financial risks of HIV cure research than PLWHIV. 3) Most respondents across the different categories of informants identified some risks that were too great to be acceptable in HIV cure research, although a subset of PLWHIV did not place an upper limit on acceptable risk. 4) PLWHIV showed a better awareness of potential psychological benefits of participating in HIV cure research than other groups of stakeholders. Conclusion Our research suggests that PLWHIV have a variable understanding of the individual risks, sometimes substantial, associated with participating in biomedical HIV cure research studies. Community engagement and increased research literacy may help improve community understanding. Intensive informed consent procedures will be necessary for ethical study implementation. The current state of HIV cure research offers greater potential benefits to society than to participants. There is likely to be disagreement among regulators, researchers, clinicians, and potential participants about what constitutes acceptable risk for HIV cure studies. PMID:28122027

Using stakeholder engagement to develop a patient-centered pediatric asthma intervention.

PubMed

Shelef, Deborah Q; Rand, Cynthia; Streisand, Randi; Horn, Ivor B; Yadav, Kabir; Stewart, Lisa; Fousheé, Naja; Waters, Damian; Teach, Stephen J

2016-12-01

Stakeholder engagement has the potential to develop research interventions that are responsive to patient and provider preferences. This approach contrasts with traditional models of clinical research in which researchers determine the study's design. This article describes the effect of stakeholder engagement on the design of a randomized trial of an intervention designed to improve child asthma outcomes by reducing parental stress. The study team developed and implemented a stakeholder engagement process that provided iterative feedback regarding the study design, patient-centered outcomes, and intervention. Stakeholder engagement incorporated the perspectives of parents of children with asthma; local providers of community-based medical, legal, and social services; and national experts in asthma research methodology and implementation. Through a year-long process of multidimensional stakeholder engagement, the research team successfully refined and implemented a patient-centered study protocol. Key stakeholder contributions included selection of patient-centered outcome measures, refinement of intervention content and format, and language framing the study in a culturally appropriate manner. Stakeholder engagement was a useful framework for developing an intervention that was acceptable and relevant to our target population. This approach might have unique benefits in underserved populations, leading to sustainable improvement in health outcomes and reduced disparities. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Development of a Web-Based Intervention for Addressing Distress in Caregivers of Patients Receiving Stem Cell Transplants: Formative Evaluation With Qualitative Interviews and Focus Groups

PubMed

Pensak, Nicole Amoyal; Joshi, Tanisha; Simoneau, Teresa; Kilbourn, Kristin; Carr, Alaina; Kutner, Jean; Laudenslager, Mark L

2017-06-22

Caregivers of cancer patients experience significant burden and distress including depression and anxiety. We previously demonstrated the efficacy of an eight session, in-person, one-on-one stress management intervention to reduce distress in caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT). The objective of this study was to adapt and enhance the in-person caregiver stress management intervention to a mobilized website (eg, tablet, smartphone, or computer-based) for self-delivery in order to enhance dissemination to caregiver populations most in need. We used an established approach for development of a mhealth intervention, completing the first two research and evaluation steps: Step One: Formative Research (eg, expert and stakeholder review from patients, caregivers, and palliative care experts) and Step Two: Pretesting (eg, Focus Groups and Individual Interviews with caregivers of patients with autologous HSCT (auto-HSCT). Step one included feedback elicited for a mock-up version of Pep-Pal session one from caregiver, patients and clinician stakeholders from a multidisciplinary palliative care team (N=9 caregivers and patient stakeholders and N=20 palliative care experts). Step two included two focus groups (N=6 caregivers) and individual interviews (N=9 caregivers) regarding Pep-Pal's look and feel, content, acceptability, and potential usability/feasibility. Focus groups and individual interviews were audio-recorded. In addition, individual interviews were transcribed, and applied thematic analysis was conducted in order to gain an in-depth understanding to inform the development and refinement of the mobilized caregiver stress management intervention, Pep-Pal (PsychoEducation and skills for Patient caregivers). Overall, results were favorable. Pep-Pal was deemed acceptable for caregivers of patients receiving an auto-HSCT. The refined Pep-Pal program consisted of 9 sessions (Introduction to Stress, Stress and the Mind Body Connection, How Thoughts Can Lead to Stress, Coping with Stress, Strategies for Maintaining Energy and Stamina, Coping with Uncertainty, Managing Changing Relationships and Communicating Needs, Getting the Support You Need, and Improving Intimacy) delivered via video instruction through a mobilized website. Feedback from stakeholder groups, focus groups, and individual interviews provided valuable feedback in key areas that was integrated into the development of Pep-Pal with the goal of enhancing dissemination, engagement, acceptability, and usability. ©Nicole Amoyal Pensak, Tanisha Joshi, Teresa Simoneau, Kristin Kilbourn, Alaina Carr, Jean Kutner, Mark L. Laudenslager. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 22.06.2017.

Public Hearing or `Hearing Public'? An Evaluation of the Participation of Local Stakeholders in Environmental Impact Assessment of Ghana's Jubilee Oil Fields

NASA Astrophysics Data System (ADS)

Bawole, Justice Nyigmah

2013-08-01

This article investigates the involvement of local stakeholders in the environmental impact assessment (EIA) processes of Ghana's first off-shore oil fields (the Jubilee fields). Adopting key informants interviews and documentary reviews, the article argues that the public hearings and the other stakeholder engagement processes were cosmetic and rhetoric with the view to meeting legal requirements rather than a purposeful interest in eliciting inputs from local stakeholders. It further argues that the operators appear to lack the social legitimacy and social license that will make them acceptable in the project communities. A rigorous community engagement along with a commitment to actively involving local stakeholders in the corporate social responsibility (CSR) programmes of the partners may enhance the image of the partners and improve their social legitimacy. Local government agencies should be capacitated to actively engage project organisers; and government must mitigate the impact of the oil projects through well-structured social support programmes.

Public hearing or 'hearing public'? an evaluation of the participation of local stakeholders in environmental impact assessment of Ghana's Jubilee oil fields.

PubMed

Bawole, Justice Nyigmah

2013-08-01

This article investigates the involvement of local stakeholders in the environmental impact assessment (EIA) processes of Ghana's first off-shore oil fields (the Jubilee fields). Adopting key informants interviews and documentary reviews, the article argues that the public hearings and the other stakeholder engagement processes were cosmetic and rhetoric with the view to meeting legal requirements rather than a purposeful interest in eliciting inputs from local stakeholders. It further argues that the operators appear to lack the social legitimacy and social license that will make them acceptable in the project communities. A rigorous community engagement along with a commitment to actively involving local stakeholders in the corporate social responsibility (CSR) programmes of the partners may enhance the image of the partners and improve their social legitimacy. Local government agencies should be capacitated to actively engage project organisers; and government must mitigate the impact of the oil projects through well-structured social support programmes.

A Study of Crisis Management Based on Stakeholders Analysis Model

NASA Astrophysics Data System (ADS)

Qingchun, Yue

2017-11-01

From the view of stakeholder theory, not only the enterprises should provide services to shareholders, but also take care of the demands of stakeholders. Stakeholders for the enterprise crisis are the organizations and individuals, which cause crisis, respond to the crisis and affected by the enterprise crisis. In this paper, first of all, to comb the development of stakeholder theory systematically; secondly, with the help of the enterprise crisis stakeholder analysis model, analyze the concept of stakeholders for the enterprise crisis and membership, and with the example of Shuanghui Group for further analysis; finally, we put forward relevant proposals for the enterprise crisis from the view of stakeholders.

Advancing complementary and alternative medicine through social network analysis and agent-based modeling.

PubMed

Frantz, Terrill L

2012-01-01

This paper introduces the contemporary perspectives and techniques of social network analysis (SNA) and agent-based modeling (ABM) and advocates applying them to advance various aspects of complementary and alternative medicine (CAM). SNA and ABM are invaluable methods for representing, analyzing and projecting complex, relational, social phenomena; they provide both an insightful vantage point and a set of analytic tools that can be useful in a wide range of contexts. Applying these methods in the CAM context can aid the ongoing advances in the CAM field, in both its scientific aspects and in developing broader acceptance in associated stakeholder communities. Copyright © 2012 S. Karger AG, Basel.

Community Engagement Studios: A Structured Approach to Obtaining Meaningful Input From Stakeholders to Inform Research.

PubMed

Joosten, Yvonne A; Israel, Tiffany L; Williams, Neely A; Boone, Leslie R; Schlundt, David G; Mouton, Charles P; Dittus, Robert S; Bernard, Gordon R; Wilkins, Consuelo H

2015-12-01

Engaging communities in research increases its relevance and may speed the translation of discoveries into improved health outcomes. Many researchers lack training to effectively engage stakeholders, whereas academic institutions lack infrastructure to support community engagement. In 2009, the Meharry-Vanderbilt Community-Engaged Research Core began testing new approaches for community engagement, which led to the development of the Community Engagement Studio (CE Studio). This structured program facilitates project-specific input from community and patient stakeholders to enhance research design, implementation, and dissemination. Developers used a team approach to recruit and train stakeholders, prepare researchers to engage with stakeholders, and facilitate an in-person meeting with both. The research core has implemented 28 CE Studios that engaged 152 community stakeholders. Participating researchers, representing a broad range of faculty ranks and disciplines, reported that input from stakeholders was valuable and that the CE Studio helped determine project feasibility and enhanced research design and implementation. Stakeholders found the CE Studio to be an acceptable method of engagement and reported a better understanding of research in general. A tool kit was developed to replicate this model and to disseminate this approach. The research core will collect data to better understand the impact of CE Studios on research proposal submissions, funding, research outcomes, patient and stakeholder engagement in projects, and dissemination of results. They will also collect data to determine whether CE Studios increase patient-centered approaches in research and whether stakeholders who participate have more trust and willingness to participate in research.

What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders.

PubMed

Peek, Sebastiaan Theodorus Michaël; Wouters, Eveline J M; Luijkx, Katrien G; Vrijhoef, Hubertus J M

2016-05-03

There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis. Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults' needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying differences emerged, for example, with regard to who should pay for the technology. Additionally, each stakeholder group mentioned specific steps that need to be taken to achieve successful implementation. Collectively, stakeholders felt that they need to take the leap (ie, change attitudes, change policies, and collaborate with other organizations); bridge the gap (ie, match technology with individuals and stimulate interdisciplinary education); facilitate technology for the masses (ie, work on products and research that support large-scale rollouts and train target groups on how to use technology); and take time to reflect (ie, evaluate use and outcomes). Stakeholders largely agree on the direction in which they should be heading; however, they have different perspectives with regard to the technologies that can be employed and the work that is needed to implement them. Central to these issues seems to be the tailoring of technology or technologies to the specific needs of each community-dwelling older adult and the work that is needed by stakeholders to support this type of service delivery on a large scale.

What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders

PubMed Central

Wouters, Eveline JM; Luijkx, Katrien G; Vrijhoef, Hubertus JM

2016-01-01

Background There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. Objective To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Methods Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis. Results Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults’ needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying differences emerged, for example, with regard to who should pay for the technology. Additionally, each stakeholder group mentioned specific steps that need to be taken to achieve successful implementation. Collectively, stakeholders felt that they need to take the leap (ie, change attitudes, change policies, and collaborate with other organizations); bridge the gap (ie, match technology with individuals and stimulate interdisciplinary education); facilitate technology for the masses (ie, work on products and research that support large-scale rollouts and train target groups on how to use technology); and take time to reflect (ie, evaluate use and outcomes). Conclusions Stakeholders largely agree on the direction in which they should be heading; however, they have different perspectives with regard to the technologies that can be employed and the work that is needed to implement them. Central to these issues seems to be the tailoring of technology or technologies to the specific needs of each community-dwelling older adult and the work that is needed by stakeholders to support this type of service delivery on a large scale. PMID:27143097

Developing biodiversity indicators on a stakeholders' opinions basis: the gypsum industry Key Performance Indicators framework.

PubMed

Pitz, Carline; Mahy, Grégory; Vermeulen, Cédric; Marlet, Christine; Séleck, Maxime

2016-07-01

This study aims to establish a common Key Performance Indicators (KPIs) framework for reporting about the gypsum industry biodiversity at the European level. In order to integrate different opinions and to reach a consensus framework, an original participatory process approach has been developed among different stakeholder groups: Eurogypsum, European and regional authorities, university scientists, consulting offices, European and regional associations for the conservation of nature, and the extractive industry. The strategy is developed around four main steps: (1) building of a maximum set of indicators to be submitted to stakeholders based on the literature (Focus Group method); (2) evaluating the consensus about indicators through a policy Delphi survey aiming at the prioritization of indicator classes using the Analytic Hierarchy Process method (AHP) and of individual indicators; (3) testing acceptability and feasibility through analysis of Environmental Impact Assessments (EIAs) and visits to three European quarries; (4) Eurogypsum final decision and communication. The resulting framework contains a set of 11 indicators considered the most suitable for all the stakeholders. Our KPIs respond to European legislation and strategies for biodiversity. The framework aims at improving sustainability in quarries and at helping to manage biodiversity as well as to allow the creation of coherent reporting systems. The final goal is to allow for the definition of the actual biodiversity status of gypsum quarries and allow for enhancing it. The framework is adaptable to the local context of each gypsum quarry.

Expert opinions on the acceptance of alternative methods in food safety evaluations: Formulating recommendations to increase acceptance of non-animal methods for kinetics.

PubMed

Punt, Ans; Bouwmeester, Hans; Schiffelers, Marie-Jeanne W A; Peijnenburg, Ad A C M

2018-02-01

Inclusion of alternative methods that replace, reduce, or refine (3R) animal testing within regulatory safety evaluations of chemicals generally faces many hurdles. The goal of the current work is to i) collect responses from key stakeholders involved in food safety evaluations on what they consider the most relevant factors that influence the acceptance and use of 3R methods and to ii) use these responses to formulate activities needed to increase the acceptance and use of 3R methods, particularly for kinetics. The stakeholders were contacted by e-mail for their opinions, asking the respondents to write down three barriers and/or drivers and scoring these by distributing 5 points over the three factors. The main barriers that obtained the highest aggregated scores were i) uncertain predictability 3R methods/lack of validation, ii) insufficient guidance regulators/industry and iii) insufficient harmonization of legislation. The major driver identified was the possibility of 3R methods to provide more mechanistic information. Based on the results, recommendations are given to enhance the acceptance and application of 3R toxicokinetic methods in food safety evaluations. These include steering of regulatory data requirements as well as creating (funding) opportunities for development and validation of alternative methods for kinetics and development of guidances. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Risk Assessment and Risk Governance of Liquefied Natural Gas Development in Gladstone, Australia.

PubMed

van der Vegt, R G

2018-02-26

This article is a retrospective analysis of liquefied natural gas development (LNG) in Gladstone, Australia by using the structure of the risk governance framework developed by the International Risk Governance Council (IRGC). Since 2010 the port of Gladstone has undergone extensive expansion to facilitate the increasing coal export as well as the new development of three recently completed LNG facilities. Significant environmental and socio-economic impacts and concerns have occurred as a result of these developments. The overall aim of the article, therefore, is to identify the risk governance deficits that arose and to formulate processes capable of improving similar decision-making problems in the future. The structure of the IRGC framework is followed because it represents a broad analytical approach for considering risk assessment and risk governance in Gladstone in ways that include, but also go beyond, the risk approach of the ISO 31000:2009 standard that was employed at the time. The IRGC risk framework is argued to be a consistent and comprehensive risk governance framework that integrates scientific, economic, social, and cultural aspects and advocates the notion of inclusive risk governance through stakeholder communication and involvement. Key aspects related to risk preassessment, risk appraisal, risk tolerability and acceptability, risk management, and stakeholder communication and involvement are considered. The results indicate that the risk governance deficits include aspects related to (i) the risk matrix methodology, (ii) reflecting uncertainties, (iii) cumulative risks, (iv) the regulatory process, and (v) stakeholder communication and involvement. © 2018 Society for Risk Analysis.

Science in the public process of ecosystem management: lessons from Hawaii, Southeast Asia, Africa and the US Mainland.

PubMed

Gutrich, John; Donovan, Deanna; Finucane, Melissa; Focht, Will; Hitzhusen, Fred; Manopimoke, Supachit; McCauley, David; Norton, Bryan; Sabatier, Paul; Salzman, Jim; Sasmitawidjaja, Virza

2005-08-01

Partnerships and co-operative environmental management are increasing worldwide as is the call for scientific input in the public process of ecosystem management. In Hawaii, private landowners, non-governmental organizations, and state and federal agencies have formed watershed partnerships to conserve and better manage upland forested watersheds. In this paper, findings of an international workshop convened in Hawaii to explore the strengths of approaches used to assess stakeholder values of environmental resources and foster consensus in the public process of ecosystem management are presented. Authors draw upon field experience in projects throughout Hawaii, Southeast Asia, Africa and the US mainland to derive a set of lessons learned that can be applied to Hawaiian and other watershed partnerships in an effort to promote consensus and sustainable ecosystem management. Interdisciplinary science-based models can serve as effective tools to identify areas of potential consensus in the process of ecosystem management. Effective integration of scientific input in co-operative ecosystem management depends on the role of science, the stakeholders and decision-makers involved, and the common language utilized to compare tradeoffs. Trust is essential to consensus building and the integration of scientific input must be transparent and inclusive of public feedback. Consideration of all relevant stakeholders and the actual benefits and costs of management activities to each stakeholder is essential. Perceptions and intuitive responses of people can be as influential as analytical processes in decision-making and must be addressed. Deliberative, dynamic and iterative decision-making processes all influence the level of stakeholder achievement of consensus. In Hawaii, application of lessons learned can promote more informed and democratic decision processes, quality scientific analysis that is relevant, and legitimacy and public acceptance of ecosystem management.

Performance Measures for Evaluating Public Participation Activities in the Office of Environmental Management (DOE)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carnes, S.A.

2001-02-15

Public participation in Office of Environmental Management (EM) activities throughout the DOE complex is a critical component of the overall success of remediation and waste management efforts. The challenges facing EM and its stakeholders over the next decade or more are daunting (Nuclear Waste News 1996). Achieving a mission composed of such challenges will require innovation, dedication, and a significant degree of good will among all stakeholders. EM's efforts to date, including obtaining and using inputs offered by EM stakeholders, have been notable. Public participation specialists have accepted and met challenges and have consistently tried to improve their performance. Theymore » have reported their experiences both formally and informally (e.g., at professional conferences and EM Public Participation Network Workshops, other internal meetings of DOE and contractor public participation specialists, and one-on-one consultations) in order to advance the state of their practice. Our research, and our field research in particular (including our interactions with many representatives of numerous stakeholder groups at nine DOE sites with diverse EM problems), have shown that it, is possible to develop coherent results even in a problem domain as complex as that of EM. We conclude that performance-based evaluations of public participation appear possible, and we have recommended an approach, based on combined and integrated multi-stakeholder views on the attributes of successful public participation and associated performance indicators, that seems workable and should be acceptable to diverse stakeholders. Of course, as an untested recommendation, our approach needs the validation that can only be achieved by application (perhaps at a few DOE sites with ongoing EM activities). Such an application would serve to refine the proposed approach in terms of its clarity, its workability, and its potential for full-scale use by EM and, potentially, other government agencies and private sector concerns.« less

A systematic review of stakeholder views of selection methods for medical schools admission.

PubMed

Kelly, M E; Patterson, F; O'Flynn, S; Mulligan, J; Murphy, A W

2018-06-15

The purpose of this paper is to systematically review the literature with respect to stakeholder views of selection methods for medical school admissions. An electronic search of nine databases was conducted between January 2000-July 2014. Two reviewers independently assessed all titles (n = 1017) and retained abstracts (n = 233) for relevance. Methodological quality of quantitative papers was assessed using the MERSQI instrument. The overall quality of evidence in this field was low. Evidence was synthesised in a narrative review. Applicants support interviews, and multiple mini interviews (MMIs). There is emerging evidence that situational judgement tests (SJTs) and selection centres (SCs) are also well regarded, but aptitude tests less so. Selectors endorse the use of interviews in general and in particular MMIs judging them to be fair, relevant and appropriate, with emerging evidence of similarly positive reactions to SCs. Aptitude tests and academic records were valued in decisions of whom to call to interview. Medical students prefer interviews based selection to cognitive aptitude tests. They are unconvinced about the transparency and veracity of written applications. Perceptions of organisational justice, which describe views of fairness in organisational processes, appear to be highly influential on stakeholders' views of the acceptability of selection methods. In particular procedural justice (perceived fairness of selection tools in terms of job relevance and characteristics of the test) and distributive justice (perceived fairness of selection outcomes in terms of equal opportunity and equity), appear to be important considerations when deciding on acceptability of selection methods. There were significant gaps with respect to both key stakeholder groups and the range of selection tools assessed. Notwithstanding the observed limitations in the quality of research in this field, there appears to be broad concordance of views on the various selection methods, across the diverse stakeholders groups. This review highlights the need for better standards, more appropriate methodologies and for broadening the scope of stakeholder research.

Management of change in health care organisations and human resource role.

PubMed

Carignani, V

2000-01-01

The paper is focused on the analysis of the most relevant factors necessary to manage change in health care organisations. The approach suggested is the Stakeholder one. According to this approach, the hospital's managers seem to be successful if they are able to satisfy people (internal and external stakeholders) that have a stake in the health care institution. The attention of the author is mainly focused on the internal forces that make the health care sector competitive and successful. In order to motivate internal human resources to accept change and to achieve the organisational targets two main methods can be suggested. The former is based on tangible variables and in particular on a fair reward system; the latter is built on intangible elements e.g. communication, negotiation, contracting, and organisational values sharing. Moreover, in order to cope with change it is important to develop the information technology management and to reengineer delivery processes, taking into consideration both the costs and benefits of these kinds of innovations.

Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights.

PubMed

Kwan, Bethany M; Jortberg, Bonnie; Warman, Meredith K; Kane, Ilima; Wearner, Robyn; Koren, Romona; Carrigan, Thomas; Martinez, Vincent; Nease, Donald E

2017-06-01

Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices. To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR). Twenty-seven diabetes care stakeholders, including patients and providers from a local network of federally qualified health centres participated. Stakeholders met in-person and by conference call over the course of 8 months. Subject matter experts provided education on the diabetes SMS evidence. Facilitators engaged the group in discussions about barriers to self-management and opportunities for improving delivery of SMS. BCT participants identified lack of social support, personal resources, trust, knowledge and confidence as barriers to diabetes self-management. Intervention opportunities emphasized peer support, use of multidisciplinary care teams and centralized systems for sharing information about community and practice resources. BCT informed new services and a PCOR study proposal. Patients and family engaged in diabetes care research value peer support, group visits, and multidisciplinary care teams as key features of SMS models. SMS should be tailored to an individual patient's health literacy. BCT can be used to engage multiple stakeholders in translation of evidence into practice and to inform PCOR. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Stakeholder involvement in agri-environmental policy making--learning from a local- and a state-level approach in Germany.

PubMed

Prager, Katrin; Freese, Jan

2009-02-01

Recent European regulations for rural development emphasise the requirement to involve stakeholder groups and other appropriate bodies in the policy-making process. This paper presents two cases involving stakeholder participation in agri-environmental development and policy making, targeted at different policy-making levels. One study was undertaken in Lower Saxony where a local partnership developed and tested an agri-environmental prescription, which was later included in the state's menu of agri-environmental schemes. In Sachsen-Anhalt, state-facilitated stakeholder workshops including a mathematical model were used to optimise the programme planning and budget allocation at the state level. Both studies aimed at improving the acceptance of agri-environmental schemes. The authors gauge the effectiveness of the two approaches and discuss what lessons can be learned. The experience suggests that the approaches can complement one another and could also be applied to rural policy making.

How much does participatory flood management contribute to stakeholders' social capacity building? Empirical findings based on a triangulation of three evaluation approaches

NASA Astrophysics Data System (ADS)

Buchecker, M.; Menzel, S.; Home, R.

2013-06-01

Recent literature suggests that dialogic forms of risk communication are more effective to build stakeholders' hazard-related social capacities. In spite of the high theoretical expectations, there is a lack of univocal empirical evidence on the relevance of these effects. This is mainly due to the methodological limitations of the existing evaluation approaches. In our paper we aim at eliciting the contribution of participatory river revitalisation projects on stakeholders' social capacity building by triangulating the findings of three evaluation studies that were based on different approaches: a field-experimental, a qualitative long-term ex-post and a cross-sectional household survey approach. The results revealed that social learning and avoiding the loss of trust were more relevant benefits of participatory flood management than acceptance building. The results suggest that stakeholder involvements should be more explicitly designed as tools for long-term social learning.

Stakeholder Analysis of an Executable Achitecture Systems Engineering (EASE) Tool

DTIC Science & Technology

2013-06-21

The FCR tables and stakeholder feedback are then used as the foundation of a Strengths, Weaknesses, Opportunities, and Threats ( SWOT ) analysis . Finally...the SWOT analysis and stakeholder feedback arc translated into an EASE future development strategy; a series of recommendations regarding...and Threats ( SWOT ) analysis . Finally, the SWOT analysis and stakeholder feedback are translated into an EASE future development strategy; a series

Healthcare professionals and the ethics of healthcare marketing.

PubMed

Hammond, Kevin L; Jurkus, Anthony F

1993-01-01

The article explores marketing ethics considerations in the application of marketing to healthcare. While we realize that acceptance of healthcare marketing by all stakeholders is important for successful marketing, we emphasize its level of acceptance by healthcare professionals. The high levels of resistance to advertising and other forms of healthcare marketing by healthcare professionals has been largely based on the grounds that the practices are unethical. The nature of the resistance thus invites this exploration of healthcare marketing (and the marketing concept), marketing ethics, and the acceptance (rejection) by healthcare professionals of healthcare marketing.

Stakeholder engagement opportunities in systematic reviews: knowledge transfer for policy and practice.

PubMed

Keown, Kiera; Van Eerd, Dwayne; Irvin, Emma

2008-01-01

Knowledge transfer and exchange is the process of increasing the awareness and use of research evidence in policy or practice decision making by nonresearch audiences or stakeholders. One way to accomplish this end is through ongoing interaction between researchers and interested nonresearch audiences, which provides an opportunity for the two groups to learn more about one another. The purpose of this article is to describe and discuss various stakeholder engagement opportunities that we employ throughout the stages of conducting a systematic review, to increase knowledge utilization within these audiences. Systematic reviews of the literature on a particular topic can provide an unbiased overview of the state of the literature. The engagement opportunities we have identified are topic consultation, feedback meetings during the review, member of review team, and involvement in dissemination. The potential benefits of including stakeholders in the process of a systematic review include increased relevance, clarity, and awareness of systematic review findings. A further benefit is the potential for increased dissemination of the findings. Challenges that researchers face are that stakeholder interactions can be time- and resource-intensive, it can be difficult balancing stakeholder desires with scientific rigor, and stakeholders may have difficulties accepting findings with which they do not agree. Despite these challenges we have included stakeholder involvement as a permanent step in the procedure of conducting a systematic review.

Stakeholder attitudes towards cumulative and aggregate exposure assessment of pesticides.

PubMed

Verbeke, Wim; Van Loo, Ellen J; Vanhonacker, Filiep; Delcour, Ilse; Spanoghe, Pieter; van Klaveren, Jacob D

2015-05-01

This study evaluates the attitudes and perspectives of different stakeholder groups (agricultural producers, pesticide manufacturers, trading companies, retailers, regulators, food safety authorities, scientists and NGOs) towards the concepts of cumulative and aggregate exposure assessment of pesticides by means of qualitative in-depth interviews (n = 15) and a quantitative stakeholder survey (n = 65). The stakeholders involved generally agreed that the use of chemical pesticides is needed, primarily for meeting the need of feeding the growing world population, while clearly acknowledging the problematic nature of human exposure to pesticide residues. Current monitoring was generally perceived to be adequate, but the timeliness and consistency of monitoring practices across countries were questioned. The concept of cumulative exposure assessment was better understood by stakeholders than the concept of aggregate exposure assessment. Identified pitfalls were data availability, data limitations, sources and ways of dealing with uncertainties, as well as information and training needs. Regulators and food safety authorities were perceived as the stakeholder groups for whom cumulative and aggregate pesticide exposure assessment methods and tools would be most useful and acceptable. Insights obtained from this exploratory study have been integrated in the development of targeted and stakeholder-tailored dissemination and training programmes that were implemented within the EU-FP7 project ACROPOLIS. Copyright © 2014 Elsevier Ltd. All rights reserved.

Clinician-Stakeholders' Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results.

PubMed

Korngiebel, Diane M; West, Kathleen M; Burke, Wylie

2018-04-01

Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record's patient portal may increase the efficiency of returning results and could activate patient follow-up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow-up and providing resources to notify at-risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.

Application fuzzy multi-attribute decision analysis method to prioritize project success criteria

NASA Astrophysics Data System (ADS)

Phong, Nguyen Thanh; Quyen, Nguyen Le Hoang Thuy To

2017-11-01

Project success is a foundation for project owner to manage and control not only for the current project but also for future potential projects in construction companies. However, identifying the key success criteria for evaluating a particular project in real practice is a challenging task. Normally, it depends on a lot of factors, such as the expectation of the project owner and stakeholders, triple constraints of the project (cost, time, quality), and company's mission, vision, and objectives. Traditional decision-making methods for measuring the project success are usually based on subjective opinions of panel experts, resulting in irrational and inappropriate decisions. Therefore, this paper introduces a multi-attribute decision analysis method (MADAM) for weighting project success criteria by using fuzzy Analytical Hierarchy Process approach. It is found that this method is useful when dealing with imprecise and uncertain human judgments in evaluating project success criteria. Moreover, this research also suggests that although cost, time, and quality are three project success criteria projects, the satisfaction of project owner and acceptance of project stakeholders with the completed project criteria is the most important criteria for project success evaluation in Vietnam.

Community Engagement Studios: A Structured Approach to Obtaining Meaningful Input From Stakeholders to Inform Research

PubMed Central

Joosten, Yvonne A.; Israel, Tiffany L.; Williams, Neely A.; Boone, Leslie R.; Schlundt, David G.; Mouton, Charles P.; Dittus, Robert S.; Bernard, Gordon R.

2015-01-01

Problem Engaging communities in research increases its relevance and may speed the translation of discoveries into improved health outcomes. Many researchers lack training to effectively engage stakeholders, whereas academic institutions lack infrastructure to support community engagement. Approach In 2009, the Meharry-Vanderbilt Community-Engaged Research Core began testing new approaches for community engagement, which led to the development of the Community Engagement Studio (CE Studio). This structured program facilitates project-specific input from community and patient stakeholders to enhance research design, implementation, and dissemination. Developers used a team approach to recruit and train stakeholders, prepare researchers to engage with stakeholders, and facilitate an in-person meeting with both. Outcomes The research core has implemented 28 CE Studios that engaged 152 community stakeholders. Participating researchers, representing a broad range of faculty ranks and disciplines, reported that input from stakeholders was valuable and that the CE Studio helped determine project feasibility and enhanced research design and implementation. Stakeholders found the CE Studio to be an acceptable method of engagement and reported a better understanding of research in general. A tool kit was developed to replicate this model and to disseminate this approach. Next Steps The research core will collect data to better understand the impact of CE Studios on research proposal submissions, funding, research outcomes, patient and stakeholder engagement in projects, and dissemination of results. They will also collect data to determine whether CE Studios increase patient-centered approaches in research and whether stakeholders who participate have more trust and willingness to participate in research. PMID:26107879

Promoting excellence in end-of-life care: a report on innovative models of palliative care.

PubMed

Byock, Ira; Twohig, Jeanne Sheils; Merriman, Melanie; Collins, Karyn

2006-02-01

Promoting Excellence in End-of Life Care, a national program of The Robert Wood Johnson Foundation, funded 22 demonstration projects representing a wide range of health care settings and patient populations to develop innovative models for delivering palliative care that addressed documented deficiencies in the care of patients and families facing the final stage of life. To determine the practicality (feasibility of development and operation as well as acceptance by stakeholders) of new models of care and to determine the impact of the models on access to, quality of and financing for palliative care. The program cannot report scientifically rigorous outcomes, but the grant-funded projects used a variety of methods and measures to assess acceptance of new models and their impact from the perspectives of various stakeholders, including patients and their families, clinicians, administrators and payers. While it is not possible to aggregate data across projects, the data reported to the Promoting Excellence national program office were used to describe program impact with respect to the practicality of palliative care service integration into existing clinical care settings (feasibility and acceptance by stakeholders), the availability and use of palliative care services (access), quality of care (conformance to patient expectations and accepted clinical standards) and costs of care. The 22 projects provided services in urban as well as rural settings, in integrated health systems, hospitals, outpatient clinics, cancer centers, nursing homes, renal dialysis clinics, inner city public health and safety net systems and prisons. Populations served included prison inmates, military veterans, renal dialysis patients, Native Americans, Native Alaskans, and African American patients, inner-city medically underserved patients, pediatric patients, and persons with serious mental illness patients. Hosting or adopting institutions sustained or expanded twenty of the 22 models, and feedback from all stakeholders was positive. Project sites developed and utilized new palliative care services and addressed quality through implementation of new standards and clinical protocols. Costs of care, where they could be assessed, were unaffected or decreased for project patients versus historical or concurrent controls. The 22 Promoting Excellence in End-of Life Care projects demonstrated that by individualizing patient and family assessment, effectively employing existing resources and aligning services with specific patient and family needs, it is possible to expand access to palliative services and improve quality of care in ways that are financially feasible and acceptable to patients, families, clinicians, administrators, and payers.

[Current status on storage, processing and risk communication of medical radioactive waste in Japan].

PubMed

Watanabe, Hiroshi; Yamaguchi, Ichiro; Kida, Tetsuo; Hiraki, Hitoshi; Fujibuchi, Toshioh; Maehara, Yoshiaki; Tsukamoto, Atsuko; Koizumi, Mitsue; Kimura, Yumi; Horitsugi, Genki

2013-03-01

Decay-in-storage for radioactive waste including that of nuclear medicine has not been implemented in Japan. Therefore, all medical radioactive waste is collected and stored at the Japan Radioisotope Association Takizawa laboratory, even if the radioactivity has already decayed out. To clarify the current situation between Takizawa village and Takizawa laboratory, we investigated the radiation management status and risk communication activities at the laboratory via a questionnaire and site visiting survey in June 2010. Takizawa laboratory continues to maintain an interactive relationship with local residents. As a result, Takizawa village permitted the acceptance of new medical radioactive waste containing Sr-89 and Y-90. However, the village did not accept any non-medical radioactive waste such as waste from research laboratories. To implement decay-in-storage in Japan, it is important to obtain agreement with all stakeholders. We must continue to exert sincere efforts to acquire the trust of all stakeholders.

Feasibility of Providing Web-Based Information to Breast Cancer Patients Prior to a Surgical Consult.

PubMed

Bruce, Jordan G; Tucholka, Jennifer L; Steffens, Nicole M; Mahoney, Jane E; Neuman, Heather B

2017-03-30

Patients facing decisions for breast cancer surgery commonly search the internet. Directing patients to high-quality websites prior to the surgeon consultation may be one way of supporting patients' informational needs. The objective was to test an approach for delivering web-based information to breast cancer patients. The implementation strategy was developed using the Replicating Effective Programs framework. Pilot testing measured the proportion that accepted the web-based information. A pre-consultation survey assessed whether the information was reviewed and the acceptability to stakeholders. Reasons for declining guided refinement to the implementation package. Eighty-two percent (309/377) accepted the web-based information. Of the 309 that accepted, 244 completed the pre-consultation survey. Participants were a median 59 years, white (98%), and highly educated (>50% with a college degree). Most patients who completed the questionnaire reported reviewing the website (85%), and nearly all found it helpful. Surgeons thought implementation increased visit efficiency (5/6) and would result in patients making more informed decisions (6/6). The most common reasons patients declined information were limited internet comfort or access (n = 36), emotional distress (n = 14), and preference to receive information directly from the surgeon (n = 7). Routine delivery of web-based information to breast cancer patients prior to the surgeon consultation is feasible. High stakeholder acceptability combined with the low implementation burden means that these findings have immediate relevance for improving care quality.

Report On Stakeholders Analysis Fast-Trac Phase Iii Deliverables, #5 One Set Of Stakeholder Readings, #6. Final Version Of The Stakeholders? Questionnaire, #7. Stakeholders? Analysis Report

DOT National Transportation Integrated Search

1996-12-10

THIS STUDY WAS UNDERTAKEN TO IDENTIFY AND EVALUATE CRITERIA BY WHICH THE PUBLIC, AND CERTAIN STAKEHOLDER GROUPS WITHIN THE PUBLIC, WILL JUDGE THE MERITS OF THE FAST-TRAC SYSTEM. OVER A PERIOD OF TWO YEARS, THREE SURVEYS WERE CONDUCTED TO OBTAIN SPECI...

Modeling and management of water in the Klamath River Basin: overcoming politics and conflicts

USGS Publications Warehouse

Flug, Marshall; Scott, John F.; Abt, Steven R.; Young-Pezeshk, Jayne; Watson, Chester C.

1998-01-01

The network flow model MODSIM, which was designed as a water quantity mass balance model for evaluating and selecting water management alternatives, has been applied to the Klamath River basin. A background of conflicting issues in the basin is presented. The complexity of water quantity model development, while satisfying the many stakeholders and involved special interest groups is discussed, as well as the efforts taken to have the technical model accepted and used, and overcome stakeholder criticism, skepticism, and mistrust of the government.

The challenge of a ban on animal testing for the development of a regulated legal market for new psychoactive substances (NPS) ('legal highs') in New Zealand: Issues and options for resolution.

PubMed

Rychert, Marta; Wilkins, Chris

2015-12-01

In mid-July 2013, New Zealand passed the Psychoactive Substances Act (PSA), which allowed 'low risk' psychoactive products ('legal highs') to be approved for legal sale. In early May 2014, following public protest, the Psychoactive Substances Amendment Act (PSAA) was passed banning animal testing of psychoactive products, potentially making the new regime unworkable. To investigate strategies to overcome the impasse created by the animal testing ban. Solutions to the impasse were investigated using 'scenario' and 'stakeholder' analysis. Legislation, parliamentary debates, and regulatory statements related to the PSA and animal testing were reviewed. Strategies to resolve the impasse were discussed with stakeholders including the Psychoactive Substances Regulatory Authority (PSRA) officials, health officials, a legal high industry lawyer, and a leading legal highs manufacturer. This process generated six possible scenarios and five decision-making criteria of key importance to major stakeholders. Scenarios were then evaluated based on feedback from the industry and regulators. The six scenarios were: (1) pragmatic modification of the animal testing ban; (2) waiting until new non-animal test models are internationally accepted; (3) use of non-validated replacement test methods; (4) judicial challenge of the animal testing ban; (5) 'creative compliance' by only presenting human clinical trial results; and (6) philosophical re-conceptualisation of the 'benefits' from psychoactive products. Options 1 and 5 appear to be the most attractive overall solutions. However, both rely on a new political consensus and astute framing of the issues by political communicators. Political decision makers may be happy to accept Scenario 2 which would impose significant delays. A 'failed' pharmaceutical product with psychoactive effects may have the test data required to be approved under Scenarios 1 and 5. Ultimately, the pleasurable benefits from psychoactive products may need to be included in the debate. Copyright © 2015 Elsevier B.V. All rights reserved.

Pharmacy clients' attitudes to expanded pharmacist prescribing and the role of agency theory on involved stakeholders.

PubMed

Hoti, Kreshnik; Hughes, Jeffery; Sunderland, Bruce

2011-02-01

To examine the views of regular pharmacy clients on pharmacist prescribing and employ agency theory in considering the relationship between the stakeholders involved. Computer assisted telephone interviews were conducted with 400 pharmacy clients recruited around Australia. Potential respondents were identified using a random number generation function in Microsoft Excel. Data were analysed with SPSS version 17 using one-way analysis of variance, principal component analysis and linear regression. The relationships between the main stakeholders involved were explored using agency theory. A total of 1153 answered calls recruited 400 consenting pharmacy clients. Most respondents (71%) trusted pharmacists adopting an expanded role in prescribing, however the majority (66%) supported this only after a diagnosis had been made by a doctor. Those who accepted pharmacist diagnosing and prescribing preferred that this was limited to pain management and antibiotics. Most respondents (64%) considered that expanded pharmacist prescribing would improve their access to prescription medicines, although those over 65 years of age were less supportive than younger respondents. Factors which contributed positively to clients' perception of trust in an expanded prescribing role for pharmacists were identified, and improved access to medicines was found to be the strongest predictor (P < 0.0001). Most pharmacy clients trusted pharmacists adopting an expanded prescribing role, but preferred that this was limited to doctors performing the initial diagnosis. Agency theory would conceptualize the introduction of pharmacist prescribers, as disrupting the principal (patient) agent (doctor) relationship. Its introduction would best be facilitated by careful change management. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

Voice, perceived fairness, agency trust, and acceptance of management decisions among Minnesota anglers

USGS Publications Warehouse

Schroeder, Susan A.; Fulton, David C.

2017-01-01

Although researchers agree that public participation in natural resource decision making is critical to institutional acceptance by stakeholders and the general public, the processes to gain public perceptions of fairness, agency trust, and acceptance of management decisions are not clear. Using results from a mail survey of Minnesota resident anglers, we used structural equation modeling to examine how instrumental versus symbolic motives related to anglers’ perceptions of agency fairness, trustworthiness, and ultimately acceptance of fisheries management decisions. We applied laboratory research on relationships among procedural fairness, trust, and management acceptance, and then tested models incorporating anglers’ perceptions of voice for anglers and nonanglers in management decisions. Results suggested that trust fully mediated the relationship between procedural fairness and management acceptance. Angler perceptions of angler and nonangler voice both related to views of procedural fairness, but angler voice was more strongly related and was also significantly related to acceptance of management decisions.

Stakeholder perspectives on workplace-based performance assessment: towards a better understanding of assessor behaviour.

PubMed

de Jonge, Laury P J W M; Timmerman, Angelique A; Govaerts, Marjan J B; Muris, Jean W M; Muijtjens, Arno M M; Kramer, Anneke W M; van der Vleuten, Cees P M

2017-12-01

Workplace-Based Assessment (WBA) plays a pivotal role in present-day competency-based medical curricula. Validity in WBA mainly depends on how stakeholders (e.g. clinical supervisors and learners) use the assessments-rather than on the intrinsic qualities of instruments and methods. Current research on assessment in clinical contexts seems to imply that variable behaviours during performance assessment of both assessors and learners may well reflect their respective beliefs and perspectives towards WBA. We therefore performed a Q methodological study to explore perspectives underlying stakeholders' behaviours in WBA in a postgraduate medical training program. Five different perspectives on performance assessment were extracted: Agency, Mutuality, Objectivity, Adaptivity and Accountability. These perspectives reflect both differences and similarities in stakeholder perceptions and preferences regarding the utility of WBA. In comparing and contrasting the various perspectives, we identified two key areas of disagreement, specifically 'the locus of regulation of learning' (i.e., self-regulated versus externally regulated learning) and 'the extent to which assessment should be standardised' (i.e., tailored versus standardised assessment). Differing perspectives may variously affect stakeholders' acceptance, use-and, consequently, the effectiveness-of assessment programmes. Continuous interaction between all stakeholders is essential to monitor, adapt and improve assessment practices and to stimulate the development of a shared mental model. Better understanding of underlying stakeholder perspectives could be an important step in bridging the gap between psychometric and socio-constructivist approaches in WBA.

Involving migrants in the development of guidelines for communication in cross-cultural general practice consultations: a participatory learning and action research project

PubMed Central

O'Reilly-de Brún, Mary; MacFarlane, Anne; de Brún, Tomas; Okonkwo, Ekaterina; Bonsenge Bokanga, Jean Samuel; Manuela De Almeida Silva, Maria; Ogbebor, Florence; Mierzejewska, Aga; Nnadi, Lovina; van den Muijsenbergh, Maria; van Weel-Baumgarten, Evelyn; van Weel, Chris

2015-01-01

Objective The aim of this research was to involve migrants and other key stakeholders in a participatory dialogue to develop a guideline for enhancing communication in cross-cultural general practice consultations. In this paper, we focus on findings about the use of formal versus informal interpreters because dialogues about these issues emerged as central to the identification of recommendations for best practice. Design This qualitative case study involved a Participatory Learning and Action (PLA) research methodology. Participants The sample comprised 80 stakeholders: 51 from migrant communities; 15 general practitioners (GPs) and general practice staff; 7 established migrants as peer researchers; 5 formal, trained interpreters; and 2 service planners from the national health authority. Setting Galway, Ireland. Results There was 100% consensus across stakeholder groups that while informal interpreters have uses for migrants and general practice staff, they are not considered acceptable as best practice. There was also 100% consensus that formal interpreters who are trained and working as per a professional code of practice are acceptable as best practice. Conclusions Policymakers and service planners need to work in partnership with service providers and migrants to progress the implementation of professional, trained interpreters as a routine way of working in general practice. PMID:26391628

Stakeholder analysis in the management of irrigation in Kampili area

NASA Astrophysics Data System (ADS)

Jumiati; Ali, M. S. S.; Fahmid, I. M.; Mahyuddin

2018-05-01

Irrigation has appreciable contribution in building food security, particularly rice crops. This study aims to analyze the role of stakeholders involved in distributing of irrigation water. The study was conducted in the Kampili Irrigation Area in South Sulawesi Province Indonesia, the data were obtained through observation and interviews with stakeholders involved, and analysed by stakeholder analysis, based on the interests and power held by the actors. This analysis is intended to provide an optimal picture of the expected role of each stakeholder in the management of irrigation resources. The results show that there were many stakeholders involved in irrigation management. In the arrangement of irrigation distribution there was overlapping authority of the stakeholders to its management, every stakeholder had different interests and power between each other. The existence have given positive and negative values in distributing irrigation water management, then in the stakeholder collaboration there was contestation between them. This contestation took place between the agriculture department, PSDA province, the Jeneberang River Region Hall, the Farmers Group and the P3A.

'I just wanted someone to tell me it wasn't all in my mind and do something for me': Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain.

PubMed

Goldthorpe, J; Peters, S; Lovell, K; McGowan, L; Aggarwal, V

2016-05-13

Introduction Evidence suggests that psychosocial management may produce improved outcomes for patients suffering from chronic orofacial pain (COFP), when symptoms cannot be attributed to pathology. A complex intervention, based on cognitive behavioural therapy (CBT) was developed by a multi-disciplinary team, using evidence synthesis. An important element of developing and evaluating complex interventions is to establish acceptability to stakeholders; therefore qualitative interviews with patients were carried out.Objectives To explore levels of acceptability of a complex intervention to manage COFP.Method Semi-structured interviews were carried out with 17 participants who had been referred to the intervention. Thematic analysis was used to identify emerging issues and themes from the data.Results Themes relating to processes of engagement with the intervention emerged. Important processes were: identification with the intervention; feeling believed and understood; obtaining a plausible explanation for symptoms; degree of perceived effort required to engage; acceptance of having a long-term condition; and receiving demonstrative, positive feedback.Conclusion Patients presenting with unexplained COFP in a secondary care setting are able to accept a CBT based intervention to manage their condition. Findings may offer guidance for dentists who are not used to referring patients to psychosocial interventions and inform the way dentists communicate the nature of unexplained symptoms to patients.

75 FR 8339 - Difenzoquat; Product Cancellation Order for Certain Pesticide Registrations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-24

... stakeholders including environmental, human health, and agricultural advocates; the chemical industry... Cancellation Order for Certain Pesticide Registrations AGENCY: Environmental Protection Agency (EPA). ACTION... registrant and accepted by the Agency, of products containing the pesticide difenzoquat, pursuant to section...

Stakeholder Analysis Worksheet

EPA Pesticide Factsheets

Stakeholder Analysis WorksheetA worksheet that can be used to document potential stakeholder groups, the information or expertise they hold, the role that they can play, their interests or concerns about the HIA

Towards a stakeholders' consensus on patient payment policy: the views of health-care consumers, providers, insurers and policy makers in six Central and Eastern European countries.

PubMed

Tambor, Marzena; Pavlova, Milena; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

2015-08-01

Although patient charges for health-care services may contribute to a more sustainable health-care financing, they often raise public opposition, which impedes their introduction. Thus, a consensus among the main stakeholders on the presence and role of patient charges should be worked out to assure their successful implementation. To analyse the acceptability of formal patient charges for health-care services in a basic package among different health-care system stakeholders in six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). Qualitative data were collected in 2009 via focus group discussions and in-depth interviews with health-care consumers, providers, policy makers and insurers. The same participants were asked to fill in a self-administrative questionnaire. Qualitative and quantitative data are analysed separately to outline similarities and differences in the opinions between the stakeholder groups and across countries. There is a rather weak consensus on patient charges in the countries. Health policy makers and insurers strongly advocate patient charges. Health-care providers overall support charges but their financial profits from the system strongly affects their approval. Consumers are against paying for services, mostly due to poor quality and access to health-care services and inability to pay. To build consensus on patient charges, the payment policy should be responsive to consumers' needs with regard to quality and equity. Transparency and accountability in the health-care system should be improved to enhance public trust and acceptance of patient payments. © 2012 John Wiley & Sons Ltd.

What's holding back abuse-deterrent opioid formulations? Considering 12 U.S. stakeholders.

PubMed

Pergolizzi, Joseph V; Taylor, Robert; LeQuang, Jo Ann; Raffa, Robert B

2018-06-01

There is no greater public health threat at this time in America than the opioid abuse crisis, and a systematic, level-headed, coherent, and unified approach is needed. Among the many things that have been proposed to help reduce opioid abuse is the development of opioid analgesic products in abuse-deterrent formulations (ADFs). This seems to make perfect sense. Areas covered: In this article, the viewpoints of 12 stakeholders (physicians, pain patients, payers, manufacturers, regulators, law enforcement, hospitals, first responders, elected officials, rehabilitation centers, opioid addicts, and the general public) were considered in terms of how ADF opioids are regarded and might contribute potential impediments to more widespread use. This is a narrative review based on the literature. Stakeholders were not surveyed directly. Expert opinion: Although abuse-deterrent technology for opioid analgesics has been available for several years, ADFs have not gained widespread acceptance. ADF products serve an important but limited purpose, but their incremental costs may serve as a 'mixed message' for many of the stakeholders concerned about cost containment.

Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia.

PubMed

Bunzli, Samantha; Singh, Nabita; Mazza, Danielle; Collie, Alex; Kosny, Agnieszka; Ruseckaite, Rasa; Brijnath, Bianca

2017-04-11

Return to work (RTW) is important for recovery post-injury. Fear of (re)injury is a strong predictor of delayed RTW, and therefore much attention has been given to addressing injured workers' fear beliefs. However, RTW is a socially-negotiated process and it may be important to consider the wider social context of the injured worker, including the beliefs of the key people involved in their RTW journey. This paper involves data collected as part of a wider study in which semi-structured interviews explored RTW from the perspectives of 93 key stakeholders: injured workers, GPs, employers and insurance case managers in Victoria, Australia. Inductive analysis of interview transcripts identified fear of (re)injury as a salient theme across all stakeholder groups. This presented an opportunity to analyse how the wider social context of the injured worker may influence fear and avoidance behaviour. Two co-authors performed inductive analysis of the theme 'fear of (re)injury'. Codes identified in the data were grouped into five categories. Between and within category analysis revealed three themes describing the contextual factors that may influence fear avoidance and RTW behaviour. Theme one described how injured workers engaged in a process of weighing up the risk of (re)injury in the workplace against the perceived benefits of RTW. Theme two described how workplace factors could influence an injured workers' perception of the risk of (re)injury in the workplace, including confidence that the source of the injury had been addressed, the availability and suitability of alternative duties. Theme three described other stakeholders' reluctance to accept injured workers back at work because of the fear that they might reinjure themselves. Our findings illustrate the need for a contextualised perspective of fear avoidance and RTW behaviour that includes the beliefs of other important people surrounding the injured worker (e.g. employers, family members, GPs). Existing models of health behaviour such as The Health Beliefs Model may provide useful frameworks for interventions targeting the affective, cognitive, social, organisational and policy factors that can influence fear avoidance or facilitate RTW following injury.

Engaging Gatekeeper-Stakeholders in Development of a Mobile Health Intervention to Improve Medication Adherence Among African American and Pacific Islander Elderly Patients With Hypertension

PubMed Central

Bazargan, Mohsen; Jones, Loretta; Vawer, May; Seto, Todd B; Farooq, Summer; Taira, Deborah A

2016-01-01

Background Approximately 70 million people in the United States have hypertension. Although antihypertensive therapy can reduce the morbidity and mortality associated with hypertension, often patients do not take their medication as prescribed. Objective The goal of this study was to better understand issues affecting the acceptability and usability of mobile health technology (mHealth) to improve medication adherence for elderly African American and Native Hawaiian and Pacific Islander patients with hypertension. Methods In-depth interviews were conducted with 20 gatekeeper-stakeholders using targeted open-ended questions. Interviews were deidentified, transcribed, organized, and coded manually by two independent coders. Analysis of patient interviews used largely a deductive approach because the targeted open-ended interview questions were designed to explore issues specific to the design and acceptability of a mHealth intervention for seniors. Results A number of similar themes regarding elements of a successful intervention emerged from our two groups of African American and Native Hawaiian and Pacific Islander gatekeeper-stakeholders. First was the need to teach participants both about the importance of adherence to antihypertensive medications. Second, was the use of mobile phones for messaging and patients need to be able to access ongoing technical support. Third, messaging needs to be short and simple, but personalized, and to come from someone the participant trusts and with whom they have a connection. There were some differences between groups. For instance, there was a strong sentiment among the African American group that the church be involved and that the intervention begin with group workshops, whereas the Native Hawaiian and Pacific Islander group seemed to believe that the teaching could occur on a one-to-one basis with the health care provider. Conclusions Information from our gatekeeper-stakeholder (key informant) interviews suggests that the design of a mHealth intervention to improve adherence to antihypertensives among the elderly could be very similar for African Americans and Native Hawaiian and Pacific Islanders. The main difference might be in the way in which the program is initiated (possibly through church-based workshops for African Americans and by individual providers for Native Hawaiian and Pacific Islanders). Another difference might be who sends the messages with African Americans wanting someone outside the health care system, but Native Hawaiian and Pacific Islanders preferring a provider. PMID:27784651

Identifying and reconciling stakeholder perspectives in deploying automated speed enforcement : final report.

DOT National Transportation Integrated Search

2017-05-01

Speeding is a public-health crisis, making up approximately a third of roadway deaths each year in the United : States. One countermeasure with clearly documented efficacy to reduce speed is automated speed enforcement : (ASE). Public acceptance of A...

Pharmaceutical companies' role in state vaccination policymaking: the case of human papillomavirus vaccination.

PubMed

Mello, Michelle M; Abiola, Sara; Colgrove, James

2012-05-01

We sought to investigate roles that Merck & Co Inc played in state human papillomavirus (HPV) immunization policymaking, to elicit key stakeholders' perceptions of the appropriateness of these activities, and to explore implications for relationships between health policymakers and industry. We used a series of state case studies combining data from key informant interviews with analysis of media reports and archival materials. We interviewed 73 key informants in 6 states that were actively engaged in HPV vaccine policy deliberations. Merck promoted school-entry mandate legislation by serving as an information resource, lobbying legislators, drafting legislation, mobilizing female legislators and physician organizations, conducting consumer marketing campaigns, and filling gaps in access to the vaccine. Legislators relied heavily on Merck for scientific information. Most stakeholders found lobbying by vaccine manufacturers acceptable in principle, but perceived that Merck had acted too aggressively and nontransparently in this case. Although policymakers acknowledge the utility of manufacturers' involvement in vaccination policymaking, industry lobbying that is overly aggressive, not fully transparent, or not divorced from financial contributions to lawmakers risks undermining the prospects for legislation to foster uptake of new vaccines.

Mud, models, and managers: Reaching consensus on a watershed strategy for sediment load reduction

NASA Astrophysics Data System (ADS)

Wilcock, P. R.; Cho, S. J.; Gran, K.; Belmont, P.; Hobbs, B. F.; Heitkamp, B.; Marr, J. D.

2017-12-01

Agricultural nonpoint source sediment pollution is a leading cause of impairment of U.S. waters. Sediment sources are often on private land, such that solutions require not only considerable investment, but broad acceptance among landowners. We present the story of a participatory modeling exercise whose goal was to develop a consensus strategy for reducing sediment loading from the Greater Blue Earth River Basin, a large (9,200 km2) watershed in southern Minnesota dominated by row crop agriculture. The Collaborative for Sediment Source Reduction was a stakeholder group of farmers, industry representatives, conservation groups, and regulatory agencies. We used a participatory modeling approach to promote understanding of the problem, to define the scope of solutions acceptable to farmers, to develop confidence in a watershed model, and to reach consensus on a watershed strategy. We found that no existing watershed model could provide a reliable estimate of sediment response to management actions and developed a purpose-built model that could provide reliable, transparent, and fast answers. Because increased stream flow was identified as an important driver of sediment loading, the model and solutions included both hydrologic and sediment transport components. The model was based on an annual sediment budget with management actions serving to proportionally reduce both sediment sources and sediment delivery. Importantly, the model was developed in collaboration with stakeholders, such that a shared understanding emerged regarding of the modeling challenges and the reliability of information used to strongly constrain model output. The simplicity of the modeling approach supported stakeholder engagement and understanding, thereby lowering the social barrier between expert modeler and concerned stakeholder. The consensus strategy focused on water storage higher in the watershed in order to reduce river discharge and the large supply of sediment from near-channel sources. Because water storage must occur largely on private farmland, this strategy was initially opposed by some stakeholders, such that model simplicity and transparency was essential in reaching a consensus strategy.

Social Acceptance of Wind Energy: Managing and Evaluating Its Market Impacts (Presentation)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baring-Gould, I.

2012-06-01

As with any industrial-scale technology, wind power has impacts. As wind technology deployment becomes more widespread, a defined opposition will form as a result of fear of change and competing energy technologies. As the easy-to-deploy sites are developed, the costs of developing at sites with deployment barriers will increase, therefore increasing the total cost of power. This presentation provides an overview of wind development stakeholders and related stakeholder engagement questions, Energy Department activities that provide wind project deployment information, and the quantification of deployment barriers and costs in the continental United States.

The promise of acceptance as an NGO security management approach.

PubMed

Fast, Larissa; Freeman, Faith; O'Neill, Michael; Rowley, Elizabeth

2015-04-01

This paper explores three questions related to acceptance as a security management approach. Acceptance draws upon relationships with community members, authorities, belligerents and other stakeholders to provide consent for the presence and activities of a non-governmental organisation (NGO), thereby reducing threats from these actors. Little is documented about how NGOs gain and maintain acceptance, how they assess and monitor the presence and degree of acceptance, or how they determine whether acceptance is effective in a particular context. Based on field research conducted in April 2011 in Kenya, South Sudan and Uganda, we address each of these three issues and argue that acceptance must be actively sought as both a programme and a security management strategy. In the paper we delineate elements common to all three contexts as well as missed opportunities, which identify areas that NGOs can and should address as part of an acceptance approach. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

Business Modeling to Implement an eHealth Portal for Infection Control: A Reflection on Co-Creation With Stakeholders.

PubMed

van Limburg, Maarten; Wentzel, Jobke; Sanderman, Robbert; van Gemert-Pijnen, Lisette

2015-08-13

It is acknowledged that the success and uptake of eHealth improve with the involvement of users and stakeholders to make technology reflect their needs. Involving stakeholders in implementation research is thus a crucial element in developing eHealth technology. Business modeling is an approach to guide implementation research for eHealth. Stakeholders are involved in business modeling by identifying relevant stakeholders, conducting value co-creation dialogs, and co-creating a business model. Because implementation activities are often underestimated as a crucial step while developing eHealth, comprehensive and applicable approaches geared toward business modeling in eHealth are scarce. This paper demonstrates the potential of several stakeholder-oriented analysis methods and their practical application was demonstrated using Infectionmanager as an example case. In this paper, we aim to demonstrate how business modeling, with the focus on stakeholder involvement, is used to co-create an eHealth implementation. We divided business modeling in 4 main research steps. As part of stakeholder identification, we performed literature scans, expert recommendations, and snowball sampling (Step 1). For stakeholder analyzes, we performed "basic stakeholder analysis," stakeholder salience, and ranking/analytic hierarchy process (Step 2). For value co-creation dialogs, we performed a process analysis and stakeholder interviews based on the business model canvas (Step 3). Finally, for business model generation, we combined all findings into the business model canvas (Step 4). Based on the applied methods, we synthesized a step-by-step guide for business modeling with stakeholder-oriented analysis methods that we consider suitable for implementing eHealth. The step-by-step guide for business modeling with stakeholder involvement enables eHealth researchers to apply a systematic and multidisciplinary, co-creative approach for implementing eHealth. Business modeling becomes an active part in the entire development process of eHealth and starts an early focus on implementation, in which stakeholders help to co-create the basis necessary for a satisfying success and uptake of the eHealth technology.

Identifying the institutional decision process to introduce decentralized sanitation in the city of Kunming (China).

PubMed

Medilanski, Edi; Chuan, Liang; Mosler, Hans-Joachim; Schertenleib, Roland; Larsen, Tove A

2007-05-01

We conducted a study of the institutional barriers to introducing urine source separation in the urban area of Kunming, China. On the basis of a stakeholder analysis, we constructed stakeholder diagrams showing the relative importance of decision-making power and (positive) interest in the topic. A hypothetical decision-making process for the urban case was derived based on a successful pilot project in a periurban area. All our results were evaluated by the stakeholders. We concluded that although a number of primary stakeholders have a large interest in testing urine source separation also in an urban context, most of the key stakeholders would be reluctant to this idea. However, the success in the periurban area showed that even a single, well-received pilot project can trigger the process of broad dissemination of new technologies. Whereas the institutional setting for such a pilot project is favorable in Kunming, a major challenge will be to adapt the technology to the demands of an urban population. Methodologically, we developed an approach to corroborate a stakeholder analysis with the perception of the stakeholders themselves. This is important not only in order to validate the analysis but also to bridge the theoretical gap between stakeholder analysis and stakeholder involvement. We also show that in disagreement with the assumption of most policy theories, local stakeholders consider informal decision pathways to be of great importance in actual policy-making.

Identifying the Institutional Decision Process to Introduce Decentralized Sanitation in the City of Kunming (China)

NASA Astrophysics Data System (ADS)

Medilanski, Edi; Chuan, Liang; Mosler, Hans-Joachim; Schertenleib, Roland; Larsen, Tove A.

2007-05-01

We conducted a study of the institutional barriers to introducing urine source separation in the urban area of Kunming, China. On the basis of a stakeholder analysis, we constructed stakeholder diagrams showing the relative importance of decision-making power and (positive) interest in the topic. A hypothetical decision-making process for the urban case was derived based on a successful pilot project in a periurban area. All our results were evaluated by the stakeholders. We concluded that although a number of primary stakeholders have a large interest in testing urine source separation also in an urban context, most of the key stakeholders would be reluctant to this idea. However, the success in the periurban area showed that even a single, well-received pilot project can trigger the process of broad dissemination of new technologies. Whereas the institutional setting for such a pilot project is favorable in Kunming, a major challenge will be to adapt the technology to the demands of an urban population. Methodologically, we developed an approach to corroborate a stakeholder analysis with the perception of the stakeholders themselves. This is important not only in order to validate the analysis but also to bridge the theoretical gap between stakeholder analysis and stakeholder involvement. We also show that in disagreement with the assumption of most policy theories, local stakeholders consider informal decision pathways to be of great importance in actual policy-making.

Modified Policy-Delphi study for exploring obesity prevention priorities

PubMed Central

Haynes, Emily; Palermo, Claire; Reidlinger, Dianne P

2016-01-01

Introduction Until now, industry and government stakeholders have dominated public discourse about policy options for obesity. While consumer involvement in health service delivery and research has been embraced, methods which engage consumers in health policy development are lacking. Conflicting priorities have generated ethical concern around obesity policy. The concept of ‘intrusiveness’ has been applied to policy decisions in the UK, whereby ethical implications are considered through level of intrusiveness to choice; however, the concept has also been used to avert government regulation to address obesity. The concept of intrusiveness has not been explored from a stakeholder's perspective. The aim is to investigate the relevance of intrusiveness and autonomy to health policy development, and to explore consensus on obesity policy priorities of under-represented stakeholders. Methods and analysis The Policy-Delphi technique will be modified using the James Lind Alliance approach to collaborative priority setting. A total of 60 participants will be recruited to represent three stakeholder groups in the Australian context: consumers, public health practitioners and policymakers. A three-round online Policy-Delphi survey will be undertaken. Participants will prioritise options informed by submissions to the 2009 Australian Government Inquiry into Obesity, and rate the intrusiveness of those proposed. An additional round will use qualitative methods in a face-to-face discussion group to explore stakeholder perceptions of the intrusiveness of options. The novelty of this methodology will redress the balance by bringing the consumer voice forward to identify ethically acceptable obesity policy options. Ethics and dissemination Ethical approval was granted by the Bond University Health Research Ethics Committee. The findings will inform development of a conceptual framework for analysing and prioritising obesity policy options, which will be relevant internationally and to ethical considerations of wider public health issues. The findings will be disseminated through peer-reviewed publications, conference presentations and collaborative platforms of policy and science. PMID:27601495

Stakeholder analysis and social-biophysical interdependencies for common pool resource management: La Brava Wetland (Argentina) as a case study.

PubMed

Romanelli, Asunción; Massone, Héctor E; Escalante, Alicia H

2011-09-01

This article gives an account of the implementation of a stakeholder analysis framework at La Brava Wetland Basin, Argentina, in a common-pool resource (CPR) management context. Firstly, the context in which the stakeholder framework was implemented is described. Secondly, a four-step methodology is applied: (1) stakeholder identification, (2) stakeholder differentiation-categorization, (3) investigation of stakeholders' relationships, and (4) analysis of social-biophysical interdependencies. This methodology classifies stakeholders according to their level of influence on the system and their potential in the conservation of natural resources. The main influential stakeholders are La Brava Village residents and tourism-related entrepreneurs who are empowered to make the more important decisions within the planning process of the ecosystem. While these key players are seen as facilitators of change, there are other groups (residents of the inner basin and fishermen) which are seen mainly as key blockers. The applied methodology for the Stakeholder Analysis and the evaluation of social-biophysical interdependencies carried out in this article can be seen as an encouraging example for other experts in natural sciences to learn and use these methods developed in social sciences. Major difficulties and some recommendations of applying this method in the practice by non-experts are discussed.

Stakeholder analysis: a useful tool for biobank planning.

PubMed

Bjugn, Roger; Casati, Bettina

2012-06-01

Stakeholders are individuals, groups, or organizations that are affected by or can affect a particular action undertaken by others. Biobanks relate to a number of donors, researchers, research institutions, regulatory bodies, funders, and others. These stakeholders can potentially have a strong influence upon the organization and operation of a biobank. A sound strategy for stakeholder engagement is considered essential in project management and organization theory. In this article, we review relevant stakeholder theory and demonstrate how a stakeholder analysis was undertaken in the early stage of a planned research biobank at a public hospital in Norway.

Stakeholder analysis methodologies resource book

DOE Office of Scientific and Technical Information (OSTI.GOV)

Babiuch, W.M.; Farhar, B.C.

1994-03-01

Stakeholder analysis allows analysts to identify how parties might be affected by government projects. This process involves identifying the likely impacts of a proposed action and stakeholder groups affected by that action. Additionally, the process involves assessing how these groups might be affected and suggesting measures to mitigate any adverse effects. Evidence suggests that the efficiency and effectiveness of government actions can be increased and adverse social impacts mitigated when officials understand how a proposed action might affect stakeholders. This report discusses how to conduct useful stakeholder analyses for government officials making decisions on energy-efficiency and renewable-energy technologies and theirmore » commercialization. It discusses methodological issues that may affect the validity and reliability of findings, including sampling, generalizability, validity, ``uncooperative`` stakeholder groups, using social indicators, and the effect of government regulations. The Appendix contains resource directories and a list of specialists in stakeholder analysis and involvement.« less

Contribution of the Multi-attribute Value Theory to conflict resolution in groundwater management. Application to the Mancha Oriental system (Spain)

NASA Astrophysics Data System (ADS)

Apperl, B.; Pulido-Velazquez, M.; Andreu, J.; Llopis-Albert, C.

2012-04-01

The implementation of the EU Water Framework Directive, with consideration of environmental, economic and social objectives, claims for participatory water resource management methods. To deal with different conflicting objectives it is necessary to apply a method for clarifying stakeholders' positions (identifying values and opinions of stakeholders, and quantifying their valuations), improving transparency with respect to outcomes of alternatives, and moving the discussion from alternatives towards fundamental objectives (value-thinking approach) and valuing trade-offs, facilitating negotiation. The method allows the incorporation of stakeholders in the planning process, which should guarantee a higher acceptance of the policies to be implemented. This research has been conducted in the Mancha Oriental groundwater system Spain, subject to an intensive use of groundwater for irrigation. The main goals according to the WFD are: a good qualitative and quantitative status of the aquifer and a good quantitative and ecological status of related surface water resources (mainly the Jucar river and dependent ecosystems). The aim is to analyze the contribution of the MAVT for conflict resolution and a sustainable groundwater management, involving the stakeholders in the valuation process. A complex set of objectives and attributes has been defined. The alternatives have been evaluated according to the compliance of ecological, economic and social interests. Results show that the acceptation of alternatives depends strongly on the combination of measures and the implementation status. A high conflict potential is expected from alternatives consisting of one unique measure. Uncertainties of the results are notable, but do not influence heavily on the alternative ranking. Different future scenarios also influence on the preference of alternatives. For instance, an expected reduction of future groundwater resources by climate change increases the conflict potential, with two observed reactions: acceptance of more rigorous measures, on one hand, and a tendency to soft measures with the same cost, as a reaction to the decreased effectiveness of the alternatives. The implementation of the method to a very complex case study, with many conflicting objectives and alternatives and uncertain outcomes, including future scenarios (climate change) illustrate the potential of the method for supporting management decisions.

Development of a comprehensive model for stakeholder management in mental healthcare.

PubMed

Bierbooms, Joyce; Van Oers, Hans; Rijkers, Jeroen; Bongers, Inge

2016-06-20

Purpose - Stakeholder management is not yet incorporated into the standard practice of most healthcare providers. The purpose of this paper is to assess the applicability of a comprehensive model for stakeholder management in mental healthcare organization for more evidence-based (stakeholder) management. Design/methodology/approach - The assessment was performed in two research parts: the steps described in the model were executed in a single case study at a mental healthcare organization in the Netherlands; and a process and effect evaluation was done to find the supporting and impeding factors with regard to the applicability of the model. Interviews were held with managers and directors to evaluate the effectiveness of the model with a view to stakeholder management. Findings - The stakeholder analysis resulted in the identification of eight stakeholder groups. Different expectations were identified for each of these groups. The analysis on performance gaps revealed that stakeholders generally find the collaboration with a mental healthcare provider "sufficient." Finally a prioritization showed that five stakeholder groups were seen as "definite" stakeholders by the organization. Practical implications - The assessment of the model showed that it generated useful knowledge for more evidence-based (stakeholder) management. Adaptation of the model is needed to increase its feasibility in practice. Originality/value - Provided that the model is properly adapted for the specific field, the analysis can provide more knowledge on stakeholders and can help integrate stakeholder management as a comprehensive process in policy planning.

Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan.

PubMed

Hussain, Syed S; Khan, Murad; Gul, Raisa; Asad, Nargis

2018-05-03

In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC). This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Cognitive mapping tools: review and risk management needs.

PubMed

Wood, Matthew D; Bostrom, Ann; Bridges, Todd; Linkov, Igor

2012-08-01

Risk managers are increasingly interested in incorporating stakeholder beliefs and other human factors into the planning process. Effective risk assessment and management requires understanding perceptions and beliefs of involved stakeholders, and how these beliefs give rise to actions that influence risk management decisions. Formal analyses of risk manager and stakeholder cognitions represent an important first step. Techniques for diagramming stakeholder mental models provide one tool for risk managers to better understand stakeholder beliefs and perceptions concerning risk, and to leverage this new understanding in developing risk management strategies. This article reviews three methodologies for assessing and diagramming stakeholder mental models--decision-analysis-based mental modeling, concept mapping, and semantic web analysis--and assesses them with regard to their ability to address risk manager needs. © 2012 Society for Risk Analysis.

Changing stakeholder relationships in nature reserve management: a case study on Snake Island-Laotie Mountain National Nature Reserve, Liaoning, China.

PubMed

Zhou, Dan; Wang, Ziyan; Lassoie, James; Wang, Xiaoping; Sun, Lixin

2014-12-15

The number and total area of nature reserves in China has increased rapidly over the past couple of decades; however, the ability to effectively manage these reserves has not kept pace and conflicts between conservation efforts and economic development have emerged. The Snake Island-Laotie Mountain National Nature Reserve (SILMNNR) currently is experiencing the challenges of balancing conservation with local community development. This paper uses components analysis of human ecosystems (HEC) to examine conflicts arising from the management of the nature reserve and uses a stakeholder analysis to identify and better understand stakeholder inter-relationships in the SILMNNR-HEC. The goal of this study is to identify critical factors influencing stakeholder relationships in order to find ways of relieving conflicts between the reserve management and development. The stakeholder analysis revealed that the key stakeholders in the SILMNNR-HEC are natural resources, the Liaoning SILMNNR Authority, local residents, and enterprise developers; however, there was unequal power among stakeholders in the decision making process affecting the nature reserve. The paper evaluated the conditions and processes of SILMNNR-HEC through a framework of stakeholder relationships where critical factors, such as policy, finance, technology, and labor, and their respective strengths and feedbacks among stakeholders, were assessed and showed unequal flows of power among stakeholders. Two approaches are provided for transforming the unbalanced relationships into a stable and sustainable framework to sustainably manage the nature reserve: the first is by changing stakeholder relationships from opposition to cooperation; and the second by enhancing feedbacks and dynamics among stakeholders. The analysis used in this paper can be used as a model to assess conflicts around other protected areas in China and elsewhere. Copyright © 2014 Elsevier Ltd. All rights reserved.

Stakeholder analysis of perceived relevance of connectivity - the implication to your research

NASA Astrophysics Data System (ADS)

Smetanova, Anna; Müller, Eva Nora Nora; Fernández-Getino, Ana Patricia; José Marqués, María; Vericat, Damià; Dugodan, Recep; Kapovic, Marijana; Ljusa, Melisa; Ferreira, Carla Sofia; Cavalli, Marco; Marttila, Hannu; Broja, Manuel Esteban Lucas; Święchowicz, Jolanta; Zumr, David

2016-04-01

Effectively communicated connectivity research is inevitable for targeting the real world connectivity issues, the land and water managers - stakeholders, deal with every day. The understanding of stakeholder's perception of connectivity and the usage of the connectivity concept in their work (both theoretically and practically), are the pre-requisites for successful dialogue between scientist and the end-users of the scientific advancements, that is one of the goals of the COST Action ES1306: Connecting European connectivity research (Connecteur). The contribution presents the results of a questionnaire survey on stakeholders perception of connectivity from 20 European countries. Potential stakeholders on local/ regional and national level, in agriculture, water and land management, or cross-sectoral management authorities, were identified and interviewed in their native language by 29 members of the Connecteur network. Semi-structured interviews consisted of mix of 20 opened, multiple-choice and closed questions. They focused on the context the stakeholders' work, the management issues they deal with, the sources and type of data their use, their collaborative network in relation to management, understanding of connectivity and their expectation on connectivity research. Semi-qualitative analysis was applied to the final datasets of 85 questionnaires in order to (i) understand the stakeholders mental models and perception of connectivity,(ii) to identify the management issues where immediate scientific cooperation is required and / or demanded, and (iii) to identify the tools to represent connectivity that would accepted and implemented by the practitioners. Direct implications for the experts in different domains of the connectivity research, including (i) its theoretical conceptualisation, (ii) measurements, (iii) modelling, (iv) connectivity indices and (v)communication, are presented. Following members of the Connecteur expert team are acknowledged for conducting interview with a stakeholder: Charles Bielders (Catholic University Louvain, Belgium), Frédéric Darboux (Department of Soil Science Orléans, INRA, France), Dragana Dordevic (Centre of Chemistry, University of Belgrade, Serbia), Tobias Heckmann (Catholic University of Eichstätt-Ingolstadt, Germany), Anna Kidová (Institute of Geography, Slovak Academy of Sciences, Slovakia), Tobias Krüger (Integrative Research Institute on Transformations of Human-Environment Systems, Humboldt University, Germany), Carly Maynard (Department of Geography and the Lived Environment, University of Edinburgh, UK), Eva Mockler, (School of Civil, Structural and Environmental Engineering , University College Dublin, Ireland), Tony Parsons, (Department of Geography, University Sheffield, UK), Thorunn Petursdottir (RECARE, Soil Conservation Service of Iceland, Iceland), Ronald Pöppel (Institute of Geography and Regional Research, University Vienna, Austria), Jerzy Rejman (Institute of Agronomy, Polish Academy of Sciences, Poland), Jose López-Tarazón (Institute of Earth and Environmental Sciences, University of Potsdam, Germany), Sophie Tindale (Department of Geography, University, Durham, UK), Brigitta Tóth (Department of Crop Production and Soil Sciences, Pannonian University, Hungary) and Marco Vainu (Institute of Ecology, Tallinn University, Estonia). The project was supported by COST-STSM-ECOST-STSM-ES1306-011215-063624.

Stakeholder analysis for the development of a community pharmacy service aimed at preventing cardiovascular disease.

PubMed

Franco-Trigo, L; Hossain, L N; Durks, D; Fam, D; Inglis, S C; Benrimoj, S I; Sabater-Hernández, D

Participatory approaches involving stakeholders across the health care system can help enhance the development, implementation and evaluation of health services. These approaches may be particularly useful in planning community pharmacy services and so overcome challenges in their implementation into practice. Conducting a stakeholder analysis is a key first step since it allows relevant stakeholders to be identified, as well as providing planners a better understanding of the complexity of the health care system. The main aim of this study was to conduct a stakeholder analysis to identify those individuals and organizations that could be part of a leading planning group for the development of a community pharmacy service (CPS) to prevent cardiovascular disease (CVD) in Australia. An experienced facilitator conducted a workshop with 8 key informants of the Australian health care system. Two structured activities were undertaken. The first explored current needs and gaps in cardiovascular care and the role of community pharmacists. The second was a stakeholder analysis, using both ex-ante and ad-hoc approaches. Identified stakeholders were then classified into three groups according to their relative influence on the development of the pharmacy service. The information gathered was analyzed using qualitative content analysis. The key informants identified 46 stakeholders, including (1) patient/consumers and their representative organizations, (2) health care providers and their professional organizations and (3) institutions and organizations that do not directly interact with patients but organize and manage the health care system, develop and implement health policies, pay for health care, influence funding for health service research or promote new health initiatives. From the 46 stakeholders, a core group of 12 stakeholders was defined. These were considered crucial to the service's development because they held positions that could drive or inhibit progress. Secondary results of the workshop included: a list of needs and gaps in cardiovascular care (n = 6), a list of roles for community pharmacists in cardiovascular prevention (n = 12) and a list of potential factors (n = 7) that can hinder the integration of community pharmacy services into practice. This stakeholder analysis provided a detailed picture of the wide range of stakeholders across the entire health care system that have a stake in the development of a community pharmacy service aimed at preventing CVD. Of these, a core group of key stakeholders, with complementary roles, can then be approached for further planning of the service. The results of this analysis highlight the relevance of establishing multilevel stakeholder groups for CPS planning. Copyright © 2016 Elsevier Inc. All rights reserved.

Stakeholder analysis: a review.

PubMed

Brugha, R; Varvasovszky, Z

2000-09-01

The growing popularity of stakeholder analysis reflects an increasing recognition of how the characteristics of stakeholders--individuals, groups and organizations--influence decision-making processes. This paper reviews the origins and uses of stakeholder analysis, as described in the policy, health care management and development literature. Its roots are in the political and policy sciences, and in management theory where it has evolved into a systematic tool with clearly defined steps and applications for scanning the current and future organizational environment. Stakeholder analysis can be used to generate knowledge about the relevant actors so as to understand their behaviour, intentions, interrelations, agendas, interests, and the influence or resources they have brought--or could bring--to bear on decision-making processes. This information can then be used to develop strategies for managing these stakeholders, to facilitate the implementation of specific decisions or organizational objectives, or to understand the policy context and assess the feasibility of future policy directions. Policy development is a complex process which frequently takes place in an unstable and rapidly changing context, subject to unpredictable internal and external factors. As a cross-sectional view of an evolving picture, the utility of stakeholder analysis for predicting and managing the future is time-limited and it should be complemented by other policy analysis approaches.

Acceptability and perceived barriers and facilitators to creating a national research register to enable ’direct to patient’ enrolment into research: the Scottish Health Research Register (SHARE)

PubMed Central

2013-01-01

Background Difficulties with recruitment pose a major, increasingly recognised challenge to the viability of research. We sought to explore whether a register of volunteers interested in research participation, with data linkage to electronic health records to identify suitable research participants, would prove acceptable to healthcare staff, patients and researchers. Methods We undertook a qualitative study in which a maximum variation sampling approach was adopted. Focus groups and interviews were conducted with patients, general practitioners (GP), practice managers and health service researchers in two Scottish health boards. Analysis was primarily thematic to identify a range of issues and concerns for all stakeholder groups. Results The concept of a national research register was, in general, acceptable to all stakeholder groups and was widely regarded as beneficial for research and for society. Patients, however, highlighted a number of conditions which should be met in the design of a register to expedite confidence and facilitate recruitment. They also gave their perceptions on how a register should operate and be promoted, favouring a range of media. GPs and practice managers were primarily concerned with the security and confidentiality of patient data and the impact a register may have on their workload. Researchers were supportive of the initiative seeing advantages in more rapid access to a wider pool of patients. They did raise concerns that GPs may be able to block access to personal patient data held in general practice clinical systems and that the register may not be representative of the whole population. Conclusions This work suggests that patients, healthcare staff and researchers have a favourable view of the potential benefits of a national register to identify people who are potentially eligible and willing to participate in health related research. It has highlighted a number of issues for the developers to incorporate in the design of research registers. PMID:24139174

Acceptability and perceived barriers and facilitators to creating a national research register to enable 'direct to patient' enrolment into research: the Scottish Health Research Register (SHARE).

PubMed

Grant, Aileen; Ure, Jenny; Nicolson, Donald J; Hanley, Janet; Sheikh, Aziz; McKinstry, Brian; Sullivan, Frank

2013-10-18

Difficulties with recruitment pose a major, increasingly recognised challenge to the viability of research. We sought to explore whether a register of volunteers interested in research participation, with data linkage to electronic health records to identify suitable research participants, would prove acceptable to healthcare staff, patients and researchers. We undertook a qualitative study in which a maximum variation sampling approach was adopted. Focus groups and interviews were conducted with patients, general practitioners (GP), practice managers and health service researchers in two Scottish health boards. Analysis was primarily thematic to identify a range of issues and concerns for all stakeholder groups. The concept of a national research register was, in general, acceptable to all stakeholder groups and was widely regarded as beneficial for research and for society. Patients, however, highlighted a number of conditions which should be met in the design of a register to expedite confidence and facilitate recruitment. They also gave their perceptions on how a register should operate and be promoted, favouring a range of media. GPs and practice managers were primarily concerned with the security and confidentiality of patient data and the impact a register may have on their workload. Researchers were supportive of the initiative seeing advantages in more rapid access to a wider pool of patients. They did raise concerns that GPs may be able to block access to personal patient data held in general practice clinical systems and that the register may not be representative of the whole population. This work suggests that patients, healthcare staff and researchers have a favourable view of the potential benefits of a national register to identify people who are potentially eligible and willing to participate in health related research. It has highlighted a number of issues for the developers to incorporate in the design of research registers.

Developing a community driven sustainable model of maternity waiting homes for rural Zambia.

PubMed

Lori, Jody R; Munro-Kramer, Michelle L; Mdluli, Eden Ahmed; Musonda Mrs, Gertrude K; Boyd, Carol J

2016-10-01

maternity waiting homes (MWHs) are residential dwellings located near health facilities where women in the late stages of pregnancy stay to await childbirth and receive immediate postpartum services. These shelters help overcome distance and transportation barriers that prevent women from receiving timely skilled obstetric care. the purpose of this study was to explore Zambian stakeholders' beliefs regarding the acceptability, feasibility, and sustainability of maternity waiting homes (MWHs) to inform a model for rural Zambia. a qualitative design using a semi-structured interview guide for data collection was used. two rural districts in the Eastern province of Zambia. individual interviews were conducted with community leaders (n=46). Focus groups were held with Safe Motherhood Action Groups, husbands, and women of childbearing age in two rural districts in Zambia (n=500). latent content analysis was used to analyze the data. participants were overwhelmingly in support of MWHs as a way to improve access to facility-based childbirth and address the barrier of distance. Data suggest that participants can describe features of high quality care, and the type of care they expect from a MWH. Stakeholders acknowledged the need to contribute to the maintenance of the MWH, and that community involvement was crucial to MWH sustainability. access to facility childbirth remains particularly challenging in rural Zambia and delays in seeking care exist. Maternity waiting homes offer a feasible and acceptable intervention to reduce delays in seeking care, thereby holding the potential to improve maternal outcomes. this study joins a growing literature on the acceptability, feasibility, and sustainability of MWHs. It is believed that MWHs, by addressing the distance and transportation barriers, will increase the use of skilled birth attendants, thereby reducing maternal and neonatal morbidity and mortality in rural, low resource areas of Zambia. We recommend that any initiative, such as MWHs, seeking to increase facility-based births with a skilled birth attendant also concurrently addresses any local deficiencies in quality of care. Copyright © 2016 Elsevier Ltd. All rights reserved.

Stakeholders and public involvement in river management: heterogeneous acceptance of participatory processes among Swiss institutions.

NASA Astrophysics Data System (ADS)

Buletti, Nora; Utz, Stephan; Ejderyan, Olivier; Graefe, Olivier; Lane, Stuart; Reynard, Emmanuel

2014-05-01

This research explores participatory processes in the domain of river management in Switzerland. The main objective is to better understand how participatory processes are incorporated into river management practice. Switzerland being a federal state, river management is a cantonal (regional) responsibility, under the supervision (and co-funding) of the State (a Confederation). The federal funding includes the opportunity to fund additional participatory activities to aid river management, not least because the federal authorities consider the involvement of wider stakeholders and the public in decision-making as a means of aiding the progression of projects. This is a particularly important goal in a Swiss setting where direct democracy (the possibility of calling the decision of any level of government into question through a popular vote) means that a reasonable level of project acceptance is a necessary element of project progression. River management in Switzerland now includes both flood protection and river restoration objectives, which has served to increase its controversy: river corridors contain competing interests with different objectives (e.g. ecological enhancement, protection of agricultural land, flood risk reduction). We were asked by the Confederation to evaluate participatory processes it sponsored and one element of this evaluation aimed to develop a typology of stakeholder participation. We conducted interviews with the 26 cantonal officers in charge of river management. These interviews were based upon thematically structured open ended questions, with the responses analyzed qualitatively. We have identified significant divergence in the implementation of participatory processes between the cantons. These appear to be related to two factors: (1) the canton's historical experience of river management; and (2) the methods used to select stakeholders for inclusion in the decisional process. Cantons that refer to guidelines or pre-established handbooks for the selection of stakeholders often conduct instrumental participation, limited to information dissemination. On the other hand, in some cantons participatory processes characterized by normative rationales take place. Here the goals of participatory processes are not limited to outcomes (e.g. acceptance of the project), but value the process of participation in itself. In these cantons actors are selected via social connections and the claimed 'common sense' of cantonal project officers. Here, the opportunity of public debate opens up, the inclusion of actors often start earlier in the decision-making processes and objectives are defined publicly and collectively. Cantonal authorities involved in river management do not all consider participatory processes as important. The acknowledgment of participatory processes is less related to an authority's recognition of the importance of participation and more to specific local experience.

Prioritizing comparative effectiveness research for cancer diagnostics using a regional stakeholder approach.

PubMed

Klein, Gregory; Gold, Laura S; Sullivan, Sean D; Buist, Diana S M; Ramsey, Scott; Kreizenbeck, Karma; Snell, Kyle; Loggers, Elizabeth Trice; Gifford, Joseph; Watkins, John B; Kessler, Larry

2012-05-01

This paper describes our process to engage regional stakeholders for prioritizing comparative effectiveness research (CER) in cancer diagnostics. We also describe a novel methodology for incorporating stakeholder data and input to inform the objectives of selected CER studies. As an integrated component to establishing the infrastructure for community-based CER on diagnostic technologies, we have assembled a regional stakeholder group composed of local payers, clinicians and state healthcare representatives to not only identify and prioritize CER topics most important to the western Washington State region, but also to inform the study design of selected research areas. A landscape analysis process combining literature searches, expert consultations and stakeholder discussions was used to identify possible CER topics in cancer diagnostics. Stakeholders prioritized the top topics using a modified Delphi/group-nominal method and a standardized evaluation criteria framework to determine a final selected CER study area. Implementation of the selected study was immediate due to a unique American Recovery and Reinvestment Act funding structure involving the same researchers and stakeholders in both the prioritization and execution phases of the project. Stakeholder engagement was enhanced after study selection via a rapid analysis of a subset of payers' internal claims, coordinated by the research team, to obtain summary data of imaging patterns of use. Results of this preliminary analysis, which we termed an 'internal analysis,' were used to determine with the stakeholders the most important and feasible study objectives. Stakeholders identified PET and MRI in cancers including breast, lung, lymphoma and colorectal as top priorities. In an internal analysis of breast cancer imaging, summary data from three payers demonstrated utilization rates of advanced imaging increased between 2002 and 2009 in the study population, with a great deal of variability in use between different health plans. Assessing whether breast MRI affects treatment decisions was the top breast cancer study objective selected by the stakeholders. There were other high-priority research areas including whether MRI use improved survival that were not deemed feasible with the length of follow-up time following MRI adoption. Continuous stakeholder engagement greatly enhanced their enthusiasm for the project. We believe CER implementation will be more successful when undertaken by regional stakeholders.

Business Modeling to Implement an eHealth Portal for Infection Control: A Reflection on Co-Creation With Stakeholders

PubMed Central

Wentzel, Jobke; Sanderman, Robbert; van Gemert-Pijnen, Lisette

2015-01-01

Background It is acknowledged that the success and uptake of eHealth improve with the involvement of users and stakeholders to make technology reflect their needs. Involving stakeholders in implementation research is thus a crucial element in developing eHealth technology. Business modeling is an approach to guide implementation research for eHealth. Stakeholders are involved in business modeling by identifying relevant stakeholders, conducting value co-creation dialogs, and co-creating a business model. Because implementation activities are often underestimated as a crucial step while developing eHealth, comprehensive and applicable approaches geared toward business modeling in eHealth are scarce. Objective This paper demonstrates the potential of several stakeholder-oriented analysis methods and their practical application was demonstrated using Infectionmanager as an example case. In this paper, we aim to demonstrate how business modeling, with the focus on stakeholder involvement, is used to co-create an eHealth implementation. Methods We divided business modeling in 4 main research steps. As part of stakeholder identification, we performed literature scans, expert recommendations, and snowball sampling (Step 1). For stakeholder analyzes, we performed “basic stakeholder analysis,” stakeholder salience, and ranking/analytic hierarchy process (Step 2). For value co-creation dialogs, we performed a process analysis and stakeholder interviews based on the business model canvas (Step 3). Finally, for business model generation, we combined all findings into the business model canvas (Step 4). Results Based on the applied methods, we synthesized a step-by-step guide for business modeling with stakeholder-oriented analysis methods that we consider suitable for implementing eHealth. Conclusions The step-by-step guide for business modeling with stakeholder involvement enables eHealth researchers to apply a systematic and multidisciplinary, co-creative approach for implementing eHealth. Business modeling becomes an active part in the entire development process of eHealth and starts an early focus on implementation, in which stakeholders help to co-create the basis necessary for a satisfying success and uptake of the eHealth technology. PMID:26272510

Exploring Stakeholder Relationships in a University Internship Program: A Qualitative Study

ERIC Educational Resources Information Center

Hoyle, Jeffrey A.

2013-01-01

This study explores stakeholder relationships between the key stakeholders of a public university, private employers, and university students in a marketing undergraduate internship program. By exploring these relationships through the process of stakeholder analysis a deeper understanding of the power dynamics between key stakeholders emerged.…

Feasibility of a clearing house for improved cooperation between telemedicine networks delivering humanitarian services: acceptability to network coordinators.

PubMed

Wootton, Richard; Bonnardot, Laurent; Geissbuhler, Antoine; Jethwani, Kamal; Kovarik, Carrie; McGoey, Suzanne; Person, Donald A; Vladzymyrskyy, Anton; Zolfo, Maria

2012-10-09

Telemedicine networks, which deliver humanitarian services, sometimes need to share expertise to find particular experts in other networks. It has been suggested that a mechanism for sharing expertise between networks (a 'clearing house') might be useful. To propose a mechanism for implementing the clearing house concept for sharing expertise, and to confirm its feasibility in terms of acceptability to the relevant networks. We conducted a needs analysis among eight telemedicine networks delivering humanitarian services. A small proportion of consultations (5-10%) suggested that networks may experience difficulties in finding the right specialists from within their own resources. With the assistance of key stakeholders, many of whom were network coordinators, various methods of implementing a clearing house were considered. One simple solution is to establish a central database holding information about consultants who have agreed to provide help to other networks; this database could be made available to network coordinators who need a specialist when none was available in their own network. The proposed solution was examined in a desktop simulation exercise, which confirmed its feasibility and probable value. This analysis informs full-scale implementation of a clearing house, and an associated examination of its costs and benefits.

A Doctor is in the House: Stakeholder Focus Groups About Expanded Scope of Practice of Community Psychiatrists.

PubMed

Mangurian, Christina; Modlin, Chelsea; Williams, Lindsey; Essock, Susan; Riano, Nicholas S; Shumway, Martha; Newcomer, John W; Dilley, James W; Schillinger, Dean

2017-11-28

We sought to understand stakeholder perspectives on barriers to metabolic screening for people with severe mental illness. We additionally assessed the feasibility of expanding psychiatrists' scope of practice to include treatment of cardiometabolic abnormalities. We conducted four focus groups among patients with severe mental illness, community psychiatrists, primary care providers, and public health administrators. Focus group transcripts were thematically analyzed. Three domains emerged: challenges with patient navigation of the complex health care system, problem list prioritization difficulties, and concern that treatment of cardiometabolic abnormalities were beyond the scope of practice of psychiatrists. Stakeholders agreed that navigating the health care system was challenging for this population and led to undertreatment of cardiometabolic risk factors. Expansion of psychiatrists' scope of practice within community mental health appears acceptable to patients and may be a mechanism to improve cardiometabolic care among people with severe mental illness.

International University Freshmen's Perceptions on Culturally Diverse Community and Internal Stakeholders' Tactics

ERIC Educational Resources Information Center

Atabekova, Anastasia A.; Belousov, Alexander A.; Yastrebov, Oleg A.

2016-01-01

The paper explores first-year students' feelings about international university campus. Increasing globalisation of education raises a number of issues related not only to internationally accepted standards of qualifications and degrees, curriculum development, faculty competences, but also to domestic and international students' tolerance,…

SOVA: Design of a stakeholder informed social media website for depressed adolescents and their parents.

PubMed

Radovic, Ana; DeMand, Alexandra L; Gmelin, Theresa; Stein, Bradley D; Miller, Elizabeth

2018-01-01

Two moderated social media websites were designed for increasing likelihood for mental health treatment engagement for depressed adolescents (sova.pitt.edu) and for parents (wisesova.pitt.edu). This paper describes iterative stakeholder interviews conducted with adolescents, young adults, parents, advocates, and clinicians and use of human computer interaction techniques to inform major design changes which: (1) underscored the role of online interaction to provide emotional support and information; (2) importance of anonymity; (3) desire to share positive media; and (4) need for frequent moderation. Future studies will examine acceptability and effectiveness of revised websites in helping depressed adolescents and their parents engage with treatment.

A Multi-Level Approach to Outreach for Geologic Sequestration Projects

USGS Publications Warehouse

Greenberg, S.E.; Leetaru, H.E.; Krapac, I.G.; Hnottavange-Telleen, K.; Finley, R.J.

2009-01-01

Public perception of carbon capture and sequestration (CCS) projects represents a potential barrier to commercialization. Outreach to stakeholders at the local, regional, and national level is needed to create familiarity with and potential acceptance of CCS projects. This paper highlights the Midwest Geological Sequestration Consortium (MGSC) multi-level outreach approach which interacts with multiple stakeholders. The MGSC approach focuses on external and internal communication. External communication has resulted in building regional public understanding of CCS. Internal communication, through a project Risk Assessment process, has resulted in enhanced team communication and preparation of team members for outreach roles. ?? 2009 Elsevier Ltd. All rights reserved.

Patient-centric Care and Chronic Disease Management: A Stakeholder Perspective.

PubMed

Stroetmann, Karl A

2015-01-01

By taking a stakeholder perspective, the paper explores reasons why the political commitment to patient-centric integrated care, facilitated by eHealth applications, is so difficult to meet. In spite of hundreds of pilots, still today there is a dearth of evidence on how to indeed successfully organise such services. Outcomes from a variety of implementation projects supported by the European Union were analysed, focusing on benefits and costs for the diverse stakeholder groups involved or impacted. The re-engineering of the services may result in a considerable shift in these variables between groups. Rendering both positive clinical impacts and a positive (overall) socio-economic return is not sufficient to assure wide acceptance and long-term sustainability. However motivated stakeholders may be, few will operate against their economic interests. Successfully establishing modern eHealth facilitated services is not so much a technical, but a social, organisational, and business innovation. We need to better understand in detail the benefits and costs, or the new 'business models' that go with integrated care for each involved stakeholder group, and the likely impacts for each of them, with a focus on how to best assure a win-win situation for all. Health policy has to respond to this, and a promising approach would be to promote organisational integration with shared budgets and outcome targets.

Investigating Stakeholder Attitudes and Opinions on School-Based Human Papillomavirus Vaccination Programs

PubMed Central

Nodulman, Jessica A.; Starling, Randall; Kong, Alberta S.; Buller, David B.; Wheeler, Cosette M.; Woodall, W. Gill

2015-01-01

BACKGROUND In several countries worldwide, school-based human papillomavirus (HPV) vaccination programs have been successful; however, little research has explored US stakeholders’ acceptance toward school-based HPV vaccination programs. METHODS A total of 13 focus groups and 12 key informant interviews (N = 117; 85% females; 66% racial/ethnic minority) were conducted with 5 groups of stakeholders: parents of adolescent girls, parents of adolescent boys, adolescent girls, middle school nurses, and middle school administrators throughout the 5 public health regions of New Mexico. RESULTS All groups of stakeholders lacked knowledge on HPV and HPV vaccines. Stakeholders were interested in—but apprehensive about—the benefits of HPV vaccination. Despite previous literature showing the benefits of using middle schools as an HPV vaccination site, stakeholders did not deem middle schools as a viable site for vaccination. Nurses reported that using the school as an HPV vaccination site had not occurred to them; parents and adolescents stated they were uncertain about using this type of program. School administrators indicated that they lacked implementation authority. CONCLUSIONS Our study uncovered barriers to using middle schools as a site of HPV vaccination. Resources should be directed toward increased support and education for middle school nurses who function as opinion leaders relevant to the uptake of HPV vaccination. PMID:25846308

National Laboratory Planning: Developing Sustainable Biocontainment Laboratories in Limited Resource Areas.

PubMed

Yeh, Kenneth B; Adams, Martin; Stamper, Paul D; Dasgupta, Debanjana; Hewson, Roger; Buck, Charles D; Richards, Allen L; Hay, John

2016-01-01

Strategic laboratory planning in limited resource areas is essential for addressing global health security issues. Establishing a national reference laboratory, especially one with BSL-3 or -4 biocontainment facilities, requires a heavy investment of resources, a multisectoral approach, and commitments from multiple stakeholders. We make the case for donor organizations and recipient partners to develop a comprehensive laboratory operations roadmap that addresses factors such as mission and roles, engaging national and political support, securing financial support, defining stakeholder involvement, fostering partnerships, and building trust. Successful development occurred with projects in African countries and in Azerbaijan, where strong leadership and a clear management framework have been key to success. A clearly identified and agreed management framework facilitate identifying the responsibility for developing laboratory capabilities and support services, including biosafety and biosecurity, quality assurance, equipment maintenance, supply chain establishment, staff certification and training, retention of human resources, and sustainable operating revenue. These capabilities and support services pose rate-limiting yet necessary challenges. Laboratory capabilities depend on mission and role, as determined by all stakeholders, and demonstrate the need for relevant metrics to monitor the success of the laboratory, including support for internal and external audits. Our analysis concludes that alternative frameworks for success exist for developing and implementing capabilities at regional and national levels in limited resource areas. Thus, achieving a balance for standardizing practices between local procedures and accepted international standards is a prerequisite for integrating new facilities into a country's existing public health infrastructure and into the overall international scientific community.

An Examination of Not-For-Profit Stakeholder Networks for Relationship Management: A Small-Scale Analysis on Social Media.

PubMed

Wyllie, Jessica; Lucas, Benjamin; Carlson, Jamie; Kitchens, Brent; Kozary, Ben; Zaki, Mohamed

2016-01-01

Using a small-scale descriptive network analysis approach, this study highlights the importance of stakeholder networks for identifying valuable stakeholders and the management of existing stakeholders in the context of mental health not-for-profit services. We extract network data from the social media brand pages of three health service organizations from the U.S., U.K., and Australia, to visually map networks of 579 social media brand pages (represented by nodes), connected by 5,600 edges. This network data is analyzed using a collection of popular graph analysis techniques to assess the differences in the way each of the service organizations manage stakeholder networks. We also compare node meta-information against basic topology measures to emphasize the importance of effectively managing relationships with stakeholders who have large external audiences. Implications and future research directions are also discussed.

An Examination of Not-For-Profit Stakeholder Networks for Relationship Management: A Small-Scale Analysis on Social Media

PubMed Central

Carlson, Jamie; Kitchens, Brent; Kozary, Ben; Zaki, Mohamed

2016-01-01

Using a small-scale descriptive network analysis approach, this study highlights the importance of stakeholder networks for identifying valuable stakeholders and the management of existing stakeholders in the context of mental health not-for-profit services. We extract network data from the social media brand pages of three health service organizations from the U.S., U.K., and Australia, to visually map networks of 579 social media brand pages (represented by nodes), connected by 5,600 edges. This network data is analyzed using a collection of popular graph analysis techniques to assess the differences in the way each of the service organizations manage stakeholder networks. We also compare node meta-information against basic topology measures to emphasize the importance of effectively managing relationships with stakeholders who have large external audiences. Implications and future research directions are also discussed. PMID:27711236

Value flow mapping: Using networks to inform stakeholder analysis

NASA Astrophysics Data System (ADS)

Cameron, Bruce G.; Crawley, Edward F.; Loureiro, Geilson; Rebentisch, Eric S.

2008-02-01

Stakeholder theory has garnered significant interest from the corporate community, but has proved difficult to apply to large government programs. A detailed value flow exercise was conducted to identify the value delivery mechanisms among stakeholders for the current Vision for Space Exploration. We propose a method for capturing stakeholder needs that explicitly recognizes the outcomes required of the value creating organization. The captured stakeholder needs are then translated into input-output models for each stakeholder, which are then aggregated into a network model. Analysis of this network suggests that benefits are infrequently linked to the root provider of value. Furthermore, it is noted that requirements should not only be written to influence the organization's outputs, but also to influence the propagation of benefit further along the value chain. A number of future applications of this model to systems architecture and requirement analysis are discussed.

Tradespace investigation of strategic design factors for large space telescopes

NASA Astrophysics Data System (ADS)

Karlow, Brandon; Jewison, Christopher; Sternberg, David; Hall, Sherrie; Golkar, Alessandro

2015-04-01

Future large telescope arrays require careful balancing of satisfaction across the stakeholders' community. Development programs usually cannot afford to explicitly address all stakeholder tradeoffs during the conceptual design stage, but rather confine the analysis to performance, cost, and schedule discussions, treating policy and budget as constraints defining the envelope of the investigation. Thus, it is of interest to develop an integrated stakeholder analysis approach to explicitly address the impact of all stakeholder interactions on the design of large telescope arrays to address future science and exploration needs. This paper offers a quantitative approach for modeling some of the stakeholder influences relevant to large telescope array designs-the linkages between a given mission and the wider NASA community. The main goal of the analysis is to explore the tradespace of large telescope designs and understand the effects of different design decisions in the stakeholders' network. Proposed architectures that offer benefits to existing constellations of systems, institutions, and mission plans are expected to yield political and engineering benefits for NASA stakeholders' wider objectives. If such synergistic architectures are privileged in subsequent analysis, regions of the tradespace that better meet the needs of the wider NASA community can be selected for further development.

The Data Party: Involving Stakeholders in Meaningful Data Analysis

ERIC Educational Resources Information Center

Franz, Nancy K.

2013-01-01

A hallmark of Extension includes the involvement of stakeholders in research and program needs assessment, design, implementation, evaluation, and reporting. A data party can be used to enhance this stakeholder involvement specifically in data analysis. This type of event can not only increase client participation in Extension programming and…

Designing and evaluating an electronic patient falls reporting system: perspectives for the implementation of health information technology in long-term residential care facilities.

PubMed

Mei, Yi You; Marquard, Jenna; Jacelon, Cynthia; DeFeo, Audrey L

2013-11-01

Patient falls are the leading cause of unintentional injury and death among older adults. In 2000, falls resulted in over 10,300 elderly deaths, costing the United States approximately $179 million in incidence and medical costs. Furthermore, non-fatal injuries caused by falls cost the United States $19 billion annually. Health information technology (IT) applications, specifically electronic falls reporting systems, can aid quality improvement efforts to prevent patient falls. Yet, long-term residential care facilities (LTRCFs) often do not have the financial resources to implement health IT, and workers in these settings are often not ready to adopt such systems. Additionally, most health IT evaluations are conducted in large acute-care settings, so LTRCF administrators currently lack evidence to support the value of health IT. In this paper, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a LTRCF using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders' perspectives: (1) System-level benefits and costs, (2) system usability, via scenario-based use cases, (3) a holistic assessment of users' physical, cognitive, and marcoergonomic (work system) challenges in using the system, and (4) user technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder. The electronic falls reporting system was successfully implemented, with 100% reporting at 3-months post-implementation. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings. The usability analysis revealed several fixable design flaws and demonstrated the importance of scenario-based user training. The technology acceptance model showed that users perceived the reporting system to be useful and easy to use, even more so after implementation. Finally, the holistic human factors evaluation identified challenges encountered when nurses used the system as a part of their daily work, guiding further system redesign. The four-pronged evaluation framework accounted for varied stakeholder perspectives and goals and is a highly scalable framework that can be easily applied to health IT implementations in other LTRCFs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Improving Management of Green Retrofits from a Stakeholder Perspective: A Case Study in China.

PubMed

Liang, Xin; Shen, Geoffrey Qiping; Guo, Li

2015-10-28

Green retrofits, which improve the environment and energy efficiency of buildings, are considered a potential solution for reducing energy consumption as well as improving human health and productivity. They represent some of the riskiest, most complex, and most uncertain projects to manage. As the foundation of project management, critical success factors (CSFs) have been emphasized by previous research. However, most studies identified and prioritized CSFs independently of stakeholders. This differs from the reality, where the success of green retrofits is tightly interrelated to the stakeholders of projects. To improve the analysis from a stakeholder perspective, the present study proposed an innovative method based on a two-mode social network analysis to integrate CSF analysis with stakeholders. The results of this method can provide further understanding of the interactions between stakeholders and CSFs, and the underlying relationship among CSFs through stakeholders. A pilot study was conducted to apply the proposed method and assess the CSFs for green retrofits in China. The five most significant CSFs are identified in the management of green retrofit. Furthermore, the interrelations between stakeholders and CSFs, coefficient and clusters of CSFs are likewise discussed.

Improving Management of Green Retrofits from a Stakeholder Perspective: A Case Study in China

PubMed Central

Liang, Xin; Shen, Geoffrey Qiping; Guo, Li

2015-01-01

Green retrofits, which improve the environment and energy efficiency of buildings, are considered a potential solution for reducing energy consumption as well as improving human health and productivity. They represent some of the riskiest, most complex, and most uncertain projects to manage. As the foundation of project management, critical success factors (CSFs) have been emphasized by previous research. However, most studies identified and prioritized CSFs independently of stakeholders. This differs from the reality, where the success of green retrofits is tightly interrelated to the stakeholders of projects. To improve the analysis from a stakeholder perspective, the present study proposed an innovative method based on a two-mode social network analysis to integrate CSF analysis with stakeholders. The results of this method can provide further understanding of the interactions between stakeholders and CSFs, and the underlying relationship among CSFs through stakeholders. A pilot study was conducted to apply the proposed method and assess the CSFs for green retrofits in China. The five most significant CSFs are identified in the management of green retrofit. Furthermore, the interrelations between stakeholders and CSFs, coefficient and clusters of CSFs are likewise discussed. PMID:26516897

Improving district level health planning and priority setting in Tanzania through implementing accountability for reasonableness framework: Perceptions of stakeholders.

PubMed

Maluka, Stephen; Kamuzora, Peter; San Sebastián, Miguel; Byskov, Jens; Ndawi, Benedict; Hurtig, Anna-Karin

2010-12-01

In 2006, researchers and decision-makers launched a five-year project - Response to Accountable Priority Setting for Trust in Health Systems (REACT) - to improve planning and priority-setting through implementing the Accountability for Reasonableness framework in Mbarali District, Tanzania. The objective of this paper is to explore the acceptability of Accountability for Reasonableness from the perspectives of the Council Health Management Team, local government officials, health workforce and members of user boards and committees. Individual interviews were carried out with different categories of actors and stakeholders in the district. The interview guide consisted of a series of questions, asking respondents to describe their perceptions regarding each condition of the Accountability for Reasonableness framework in terms of priority setting. Interviews were analysed using thematic framework analysis. Documentary data were used to support, verify and highlight the key issues that emerged. Almost all stakeholders viewed Accountability for Reasonableness as an important and feasible approach for improving priority-setting and health service delivery in their context. However, a few aspects of Accountability for Reasonableness were seen as too difficult to implement given the socio-political conditions and traditions in Tanzania. Respondents mentioned: budget ceilings and guidelines, low level of public awareness, unreliable and untimely funding, as well as the limited capacity of the district to generate local resources as the major contextual factors that hampered the full implementation of the framework in their context. This study was one of the first assessments of the applicability of Accountability for Reasonableness in health care priority-setting in Tanzania. The analysis, overall, suggests that the Accountability for Reasonableness framework could be an important tool for improving priority-setting processes in the contexts of resource-poor settings. However, the full implementation of Accountability for Reasonableness would require a proper capacity-building plan, involving all relevant stakeholders, particularly members of the community since public accountability is the ultimate aim, and it is the community that will live with the consequences of priority-setting decisions.

Using stakeholder analysis to support moves towards universal coverage: lessons from the SHIELD project.

PubMed

Gilson, Lucy; Erasmus, Ermin; Borghi, Jo; Macha, Janet; Kamuzora, Peter; Mtei, Gemini

2012-03-01

Stakeholder analysis is widely recommended as a tool for gathering insights on policy actor interests in, positions on, and power to influence, health policy issues. Such information is recognized to be critical in developing viable health policy proposals, and is particularly important for new health care financing proposals that aim to secure universal coverage (UC). However, there remain surprisingly few published accounts of the use of stakeholder analysis in health policy development generally, and health financing specifically, and even fewer that draw lessons from experience about how to do and how to use such analysis. This paper, therefore, aims to support those developing or researching UC reforms to think both about how to conduct stakeholder analysis, and how to use it to support evidence-informed pro-poor health policy development. It presents practical lessons and ideas drawn from experience of doing stakeholder analysis around UC reforms in South Africa and Tanzania, combined with insights from other relevant material. The paper has two parts. The first presents lessons of experience for conducting a stakeholder analysis, and the second, ideas about how to use the analysis to support policy design and the development of actor and broader political management strategies. Comparison of experience across South Africa and Tanzania shows that there are some commonalities concerning which stakeholders have general interests in UC reform. However, differences in context and in reform proposals generate differences in the particular interests of stakeholders and their likely positioning on reform proposals, as well as in their relative balance of power. It is, therefore, difficult to draw cross-national policy comparisons around these specific issues. Nonetheless, the paper shows that cross-national policy learning is possible around the approach to analysis, the factors influencing judgements and the implications for, and possible approaches to, management of policy processes. Such learning does not entail generalization about which UC reform package offers most gain in any setting, but rather about how to manage the reform process within a particular context.

Prioritizing comparative effectiveness research for cancer diagnostics using a regional stakeholder approach

PubMed Central

Klein, Gregory; Gold, Laura S; Sullivan, Sean D; Buist, Diana SM; Ramsey, Scott; Kreizenbeck, Karma; Snell, Kyle; Loggers, Elizabeth Trice; Gifford, Joseph; Watkins, John B; Kessler, Larry

2012-01-01

Aims This paper describes our process to engage regional stakeholders for prioritizing comparative effectiveness research (CER) in cancer diagnostics. We also describe a novel methodology for incorporating stakeholder data and input to inform the objectives of selected CER studies. Materials & methods As an integrated component to establishing the infrastructure for community-based CER on diagnostic technologies, we have assembled a regional stakeholder group composed of local payers, clinicians and state healthcare representatives to not only identify and prioritize CER topics most important to the western Washington State region, but also to inform the study design of selected research areas. A landscape analysis process combining literature searches, expert consultations and stakeholder discussions was used to identify possible CER topics in cancer diagnostics. Stakeholders prioritized the top topics using a modified Delphi/group-nominal method and a standardized evaluation criteria framework to determine a final selected CER study area. Implementation of the selected study was immediate due to a unique American Recovery and Reinvestment Act funding structure involving the same researchers and stakeholders in both the prioritization and execution phases of the project. Stakeholder engagement was enhanced after study selection via a rapid analysis of a subset of payers’ internal claims, coordinated by the research team, to obtain summary data of imaging patterns of use. Results of this preliminary analysis, which we termed an ‘internal analysis,’ were used to determine with the stakeholders the most important and feasible study objectives. Results Stakeholders identified PET and MRI in cancers including breast, lung, lymphoma and colorectal as top priorities. In an internal analysis of breast cancer imaging, summary data from three payers demonstrated utilization rates of advanced imaging increased between 2002 and 2009 in the study population, with a great deal of variability in use between different health plans. Assessing whether breast MRI affects treatment decisions was the top breast cancer study objective selected by the stakeholders. There were other high-priority research areas including whether MRI use improved survival that were not deemed feasible with the length of follow-up time following MRI adoption. Conclusion Continuous stakeholder engagement greatly enhanced their enthusiasm for the project. We believe CER implementation will be more successful when undertaken by regional stakeholders. PMID:23105966

Stakeholder opinions on the assessment of MPA effectiveness and their interests to participate at Pacific Rim National Park Reserve, Canada.

PubMed

Heck, Nadine; Dearden, Philip; McDonald, Adrian; Carver, Steve

2011-04-01

As the number of marine protected areas (MPAs) is globally increasing, information is needed on the effectiveness of existing sites. Many protected area agencies however have limited resources and are unable to evaluate MPA effectiveness. An evaluation conducted entirely by the managing agency may also lack credibility. Long-term monitoring and evaluation programs should ideally offer opportunities for participation of diverse groups in the selection of evaluation indicators and their assessment. A participatory approach has the potential to enhance evaluation capacity, to increase credibility and acceptance of results, to strengthen relationships between managers and local stakeholders, and to address more locally relevant information. Using a case study approach, this paper investigates diverse stakeholder groups' opinions on the design of an evaluation and their interest to participate in an assessment. Respondents were most interested in the assessment of MPA achievements and outcome indicators. Most groups identified a range of government agencies and stakeholders that should participate in an assessment but only half of all respondents were interested to participate in monitoring activities. Most frequently mentioned limitations for more participation were a lack of time and money, but also governance shortcomings such as limited participation possibilities and not paying enough credit to stakeholders' input. Participation interest was also influenced by occupation, place of residency, and familiarity with the marine environment. Differences exist among stakeholders about suitable evaluators and preferred monitoring partners, which could affect the credibility of evaluation results and affect monitoring activities.

Participatory Evaluation of Monitoring and Modeling of Sustainable Land Management Technologies in Areas Prone to Land Degradation

NASA Astrophysics Data System (ADS)

Stringer, L. C.; Fleskens, L.; Reed, M. S.; de Vente, J.; Zengin, M.

2014-11-01

Examples of sustainable land management (SLM) exist throughout the world. In many cases, SLM has largely evolved through local traditional practices and incremental experimentation rather than being adopted on the basis of scientific evidence. This means that SLM technologies are often only adopted across small areas. The DESIRE (DESertIfication mitigation and REmediation of degraded land) project combined local traditional knowledge on SLM with empirical evaluation of SLM technologies. The purpose of this was to evaluate and select options for dissemination in 16 sites across 12 countries. It involved (i) an initial workshop to evaluate stakeholder priorities (reported elsewhere), (ii) field trials/empirical modeling, and then, (iii) further stakeholder evaluation workshops. This paper focuses on workshops in which stakeholders evaluated the performance of SLM technologies based on the scientific monitoring and modeling results from 15 study sites. It analyses workshop outcomes to evaluate how scientific results affected stakeholders' perceptions of local SLM technologies. It also assessed the potential of this participatory approach in facilitating wider acceptance and implementation of SLM. In several sites, stakeholder preferences for SLM technologies changed as a consequence of empirical measurements and modeling assessments of each technology. Two workshop examples are presented in depth to: (a) explore the scientific results that triggered stakeholders to change their views; and (b) discuss stakeholders' suggestions on how the adoption of SLM technologies could be up-scaled. The overall multi-stakeholder participatory approach taken is then evaluated. It is concluded that to facilitate broad-scale adoption of SLM technologies, de-contextualized, scientific generalisations must be given local context; scientific findings must be viewed alongside traditional beliefs and both scrutinized with equal rigor; and the knowledge of all kinds of experts must be recognised and considered in decision-making about SLM, whether it has been formally codified or not. The approach presented in this paper provided this opportunity and received positive feedback from stakeholders.

Engaging stakeholders and target groups in prioritising a public health intervention: the Creating Active School Environments (CASE) online Delphi study

PubMed Central

Morton, Katie L; Atkin, Andrew J; Corder, Kirsten; Suhrcke, Marc; Turner, David; van Sluijs, Esther M F

2017-01-01

Objectives Stakeholder engagement and public involvement are considered as integral to developing effective public health interventions and is encouraged across all phases of the research cycle. However, limited guidelines and appropriate tools exist to facilitate stakeholder engagement—especially during the intervention prioritisation phase. We present the findings of an online ‘Delphi’ study that engaged stakeholders (including young people) in the process of prioritising secondary school environment-focused interventions that aim to increase physical activity. Setting Web-based data collection using an online Delphi tool enabling participation of geographically diverse stakeholders. Participants 37 stakeholders participated, including young people (age 13–16 years), parents, teachers, public health practitioners, academics and commissioners; 33 participants completed both rounds. Primary and secondary outcome measures Participants were asked to prioritise a (short-listed) selection of school environment-focused interventions (eg, standing desks, outdoor design changes) based on the criteria of ‘reach’, ‘equality’, ‘acceptability’, ‘feasibility’, ‘effectiveness’ and ‘cost’. Participants were also asked to rank the criteria and the effectiveness outcomes (eg, physical activity, academic achievement, school enjoyment) from most to least important. Following feedback along with any new information provided, participants completed round 2 4 weeks later. Results The intervention prioritisation process was feasible to conduct and comments from participants indicated satisfaction with the process. Consensus regarding intervention strategies was achieved among the varied groups of stakeholders, with ‘active lessons’ being the favoured approach. Participants ranked ‘mental health and well-being’ as the most important outcome followed by ‘enjoyment of school’. The most important criteria was ‘effectiveness’, followed by ‘feasibility’. Conclusions This novel approach to engaging a wide variety of stakeholders in the research process was feasible to conduct and acceptable to participants. It also provided insightful information relating to how stakeholders prioritise interventions. The approach could be extended beyond the specific project to be a useful tool for researchers and practitioners. PMID:28087549

Unravelling networks in local public health policymaking in three European countries - a systems analysis.

PubMed

Spitters, Hilde P E M; Lau, Cathrine J; Sandu, Petru; Quanjel, Marcel; Dulf, Diana; Glümer, Charlotte; van Oers, Hans A M; van de Goor, Ien A M

2017-02-03

Facilitating and enhancing interaction between stakeholders involved in the policymaking process to stimulate collaboration and use of evidence, is important to foster the development of effective Health Enhancing Physical Activity (HEPA) policies. Performing an analysis of real-world policymaking processes will help reveal the complexity of a network of stakeholders. Therefore, the main objectives were to unravel the stakeholder network in the policy process by conducting three systems analyses, and to increase insight into the similarities and differences in the policy processes of these European country cases. A systems analysis of the local HEPA policymaking process was performed in three European countries involved in the 'REsearch into POlicy to enhance Physical Activity' (REPOPA) project, resulting in three schematic models showing the main stakeholders and their relationships. The models were used to compare the systems, focusing on implications with respect to collaboration and use of evidence in local HEPA policymaking. Policy documents and relevant webpages were examined and main stakeholders were interviewed. The systems analysis in each country identified the main stakeholders involved and their position and relations in the policymaking process. The Netherlands and Denmark were the most similar and both differed most from Romania, especially at the level of accountability of the local public authorities for local HEPA policymaking. The categories of driving forces underlying the relations between stakeholders were formal relations, informal interaction and knowledge exchange. A systems analysis providing detailed descriptions of positions and relations in the stakeholder network in local level HEPA policymaking is rather unique in this area. The analyses are useful when a need arises for increased interaction, collaboration and use of knowledge between stakeholders in the local HEPA network, as they provide an overview of the stakeholders involved and their mutual relations. This information can be an important starting point to enhance the uptake of evidence and build more effective public health policies.

STAR--people-powered prioritization: a 21st-century solution to allocation headaches.

PubMed

Airoldi, Mara; Morton, Alec; Smith, Jenifer A E; Bevan, Gwyn

2014-11-01

The aim of cost effectiveness analysis (CEA) is to inform the allocation of scarce resources. CEA is routinely used in assessing the cost-effectiveness of specific health technologies by agencies such as the National Institute for Health and Clinical Excellence (NICE) in England and Wales. But there is extensive evidence that because of barriers of accessibility and acceptability, CEA has not been used by local health planners in their annual task of allocating fixed budgets to a wide range of types of health care. This paper argues that these planners can use Socio Technical Allocation of Resources (STAR) for that task. STAR builds on the principles of CEA and the practice of program budgeting and marginal analysis. STAR uses requisite models to assess the cost-effectiveness of all interventions considered for resource reallocation by explicitly applying the theory of health economics to evidence of scale, costs, and benefits, with deliberation facilitated through an interactive social process of engaging key stakeholders. In that social process, the stakeholders generate missing estimates of scale, costs, and benefits of the interventions; develop visual models of their relative cost-effectiveness; and interpret the results. We demonstrate the feasibility of STAR by showing how it was used by a local health planning agency of the English National Health Service, the Isle of Wight Primary Care Trust, to allocate a fixed budget in 2008 and 2009. © The Author(s) 2014.

From the day they are born: a qualitative study exploring violence against children with disabilities in West Africa.

PubMed

Njelesani, Janet; Hashemi, Goli; Cameron, Cathy; Cameron, Deb; Richard, Danielle; Parnes, Penny

2018-01-17

Despite the building evidence on violence against children globally, almost nothing is known about the violence children with disabilities in low and middle-income countries (LMICs) experience. The prevalence of violence against children with disabilities can be expected to be higher in LMICs where there are greater stigmas associated with having a child with a disability, less resources for families who have children with disabilities, and wider acceptance of the use of corporal punishment to discipline children. This study explores violence experienced by children with disabilities based on data collected from four countries in West Africa- Guinea, Niger, Sierra Leone, and Togo. A qualitative study design guided data generation with a total of 419 children, community members, and disability stakeholders. Participants were selected using purposive sampling. Stakeholders shared their observations of or experiences of violence against children with disabilities in their community in interviews and focus groups. Thematic analysis guided data analysis and identified patterns of meaning among participants' experiences. Results illuminate that children with disabilities experience violence more than non-disabled children, episodes of violence start at birth, and that how children with disabilities participate in their communities contributes to their different experiences of violence. The study recommends policy-oriented actions and prevention programs that include children and their families in strategizing ways to address violence.

How does the context and design of participatory decision-making processes affect their outcomes? Evidence from sustainable land management in global drylands.

NASA Astrophysics Data System (ADS)

de Vente, Joris; Reed, Mark; Stringer, Lindsay; Valente, Sandra; Newig, Jens

2014-05-01

It is widely accepted that the design of participatory processes in environmental management needs to be adapted to local contexts. Yet, it is not clear which elements of process design are universal, making it difficult to design processes that deliver beneficial outcomes across different contexts. We used empirical evidence to analyse the extent to which context and process design can enable or impede stakeholder participation and facilitate beneficial environmental and social outcomes in a range of decision-making contexts where stakeholders are engaged in environmental management. To explore the role of national-scale context on the outcomes of participatory processes, we interviewed facilitators from a process that was replicated across 13 dryland study sites around the world, which focussed on selecting Sustainable Land Management (SLM) options in close collaboration with stakeholders. To explore the role of process design and local context, we interviewed participants and facilitators in 11 case studies in Spain and Portugal in which different process designs were used. Interview data were analysed using a combination of quantitative and qualitative approaches to characterise relationships between process design, context and process outcomes. The similarity of outcomes across the 13 international study sites suggested that the national socio-cultural context in which a participatory process is conducted has little impact on its outcomes. However, analysis of cases from Spain and Portugal showed that some aspects of local context may affect outcomes. Having said this, factors associated with process design and participant selection played a more significant role in influencing outcomes in both countries. Processes that led to more beneficial outcomes for the environment and/or participants were likely to include: the legitimate representation of stakeholders; professional facilitation including structured methods for eliciting and aggregating information and balancing power dynamics between participants; and the provision of information and decision-making power to all participants. Participatory processes initiated or facilitated by government bodies led to significantly less trust, information gain, learning, and flexible solutions. However, in these processes, decisions were more acceptable to and likely to be implemented by governments and by those who had to apply them on the ground. These findings provide a solid empirical basis for best practice in the design of participatory processes in SLM in a number of contexts internationally, which if followed, increase the likelihood of providing beneficial environmental and social outcomes for those involved.

Challenges in Incorporating Climate Change Adaptation into Integrated Water Resources Management

NASA Astrophysics Data System (ADS)

Kirshen, P. H.; Cardwell, H.; Kartez, J.; Merrill, S.

2011-12-01

Over the last few decades, integrated water resources management (IWRM), under various names, has become the accepted philosophy for water management in the USA. While much is still to be learned about how to actually carry it out, implementation is slowly moving forward - spurred by both legislation and the demands of stakeholders. New challenges to IWRM have arisen because of climate change. Climate change has placed increased demands on the creativities of planners and engineers because they now must design systems that will function over decades of hydrologic uncertainties that dwarf any previous hydrologic or other uncertainties. Climate and socio-economic monitoring systems must also now be established to determine when the future climate has changed sufficiently to warrant undertaking adaptation. The requirements for taking some actions now and preserving options for future actions as well as the increased risk of social inequities in climate change impacts and adaptation are challenging experts in stakeholder participation. To meet these challenges, an integrated methodology is essential that builds upon scenario analysis, risk assessment, statistical decision theory, participatory planning, and consensus building. This integration will create cross-disciplinary boundaries for these disciplines to overcome.

Facing Up to the Challenge: Why Is It so Hard to Develop Graduate Attributes?

ERIC Educational Resources Information Center

Green, Wendy; Hammer, Sarah; Star, Cassandra

2009-01-01

Debate continues regarding the nature and desirability of graduate attributes, driven partly by stakeholder expectations that universities will prepare employees for the knowledge economy and partly by higher education academics and learning specialists. While universities appear to have accepted their new vocational role, there is considerable…

Getting Growers to Go Digital: The Power of a Positive User Experience

ERIC Educational Resources Information Center

McCornack, Brian P.; Johnson, Wendy A.

2016-01-01

Using web-based applications is an innovative approach for delivery of Extension resources. For example, myFields.info is a mobile-friendly application focused on directing stakeholders to information at the field level. Acceptance and diffusion of such applications depends on initial experiences resulting from traditional face-to-face…

Global view of remote sensing of rangelands: Evolution, applications, future pathways [Chapter 10

Treesearch

Matt Reeves; Robert A. Washington-Allen; Jay Angerer; E. Raymond Hunt; Ranjani Wasantha Kulawardhana; Lalit Kumar; Tatiana Loboda; Thomas Loveland; Graciela Metternicht; R. Douglas Ramsey

2015-01-01

The term "rangeland" is rather nebulous, and there is no single definition of rangeland that is universally accepted by land managers, scientists, or international bodies (Lund, 2007; Reeves and Mitchell, 2011). Dozens and possibly hundreds (Lund, 2007) of definitions and ideologies exist because various stakeholders often have unique objectives...

Participatory Plant Breeding with Traders and Farmers for White Pea Bean in Ethiopia

ERIC Educational Resources Information Center

Assefa, T.; Sperling, L.; Dagne, B.; Argaw, W.; Tessema, D.; Beebe, S.

2014-01-01

Purpose: This research, conducted in Ethiopia, involved select stakeholders in the variety evaluation process early: to identify a greater number of acceptable varieties and to shorten a lengthy research and release process. Design/methodology/approach: A Participatory Plant Breeding (PPB) approach was used in both on-station and community-based…

77 FR 50082 - Notice of Opportunity To Submit Content Request for the 2013 Census of Aquaculture

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-20

...The National Agricultural Statistics Service (NASS is currently accepting stakeholder feedback in the form of content requests for the 2013 Census of Aquaculture. This census is required by law under the ``Census of Agriculture Act of 1997,'' Public Law 105-113 (7 U.S.C. 2204g).

From Learning Organization to Practically Wise Organization

ERIC Educational Resources Information Center

Rowley, Jennifer; Gibbs, Paul

2008-01-01

Purpose: Although the notion of wisdom confronts the economic rationale of business organizations, this paper aims to argue that organizations are coming under increasing pressure not only to learn, change and adapt, but also to take actions that are ethically acceptable and respond to the expectations of multiple stakeholders, or in other words…

Implementing Innovation in Primary EFL: A Case Study in Greece

ERIC Educational Resources Information Center

Karavas, Evdokia

2014-01-01

The purpose of this article is to highlight and discuss the strategies used to diffuse and manage a primary ELT innovation in Greece, strategies that proved essential for developing stakeholders' acceptance and ownership of the innovation, thereby facilitating its further development and sustainability. The PEAP Programme, launched in 2010,…

Buffering Negative Impacts of Divorce on Children: Evaluating Impact of Divorce Education

ERIC Educational Resources Information Center

Crawford, Jennifer K.; Riffe, Jane; Trevisan, Dominic A.; Adesope, Olusola O.

2014-01-01

Following the call for more stringent evaluation methodology and recently documented national Extension presence in the field of divorce education for parents and children, the study reported here describes a local multi-level evaluation to capture program impact of a stakeholder-accepted divorce education program. Using a post-then-pre…

Using patient engagement in the design and rationale of a trial for women with depression in obstetrics and gynecology practices.

PubMed

Poleshuck, Ellen; Wittink, Marsha; Crean, Hugh; Gellasch, Tara; Sandler, Mardy; Bell, Elaine; Juskiewicz, Iwona; Cerulli, Catherine

2015-07-01

Significant health disparities exist among socioeconomically disadvantaged women, who experience elevated rates of depression and increased risk for poor depression treatment engagement and outcomes. We aimed to use stakeholder input to develop innovative methods for a comparative effectiveness trial to address the needs of socioeconomically disadvantaged women with depression in women's health practices. Using a community advisory board, focus groups, and individual patient input, we determined the feasibility and acceptability of an electronic psychosocial screening and referral tool; developed and finalized a prioritization tool for women with depression; and piloted the prioritization tool. Two intervention approaches, enhanced screening and referral using an electronic psychosocial screening, and mentoring using the prioritization tool, were developed as intervention options for socioeconomically disadvantaged women attending women's health practices. We describe the developmental steps and the final design for the comparative effectiveness trial evaluating both intervention approaches. Stakeholder input allowed us to develop an acceptable clinical trial of two patient-centered interventions with patient-driven outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Female respondent acceptance of computer-assisted personal interviewing (CAPI) for maternal, newborn and child health coverage surveys in rural Uganda.

PubMed

Mercader, Hannah Faye G; Kabakyenga, Jerome; Katuruba, David Tumusiime; Hobbs, Amy J; Brenner, Jennifer L

2017-02-01

High maternal and child mortality continues in low- and middle-income countries (LMIC). Measurement of maternal, newborn and child health (MNCH) coverage indicators often involves an expensive, complex, and lengthy household data collection process that is especially difficult in less-resourced settings. Computer-assisted personal interviewing (CAPI) has been proposed as a cost-effective and efficient alternative to traditional paper-and-pencil interviewing (PAPI). However, the literature on respondent-level acceptance of CAPI in LMIC has reported mixed outcomes. This is the first study to prospectively examine female respondent acceptance of CAPI and its influencing factors for MNCH data collection in rural Southwest Uganda. Eighteen women aged 15-49 years were randomly selected from 3 rural villages to participate. Each respondent was administered a Women's Questionnaire with half of the survey questions asked using PAPI techniques and the other half using CAPI. Following this PAPI/CAPI exposure, semi-structured focus group discussions (FGDs) assessed respondent attitudes towards PAPI versus CAPI. FGD data analysis involved an immersion/crystallization method (thematic narrative analysis). The sixteen FGD respondents had a median age of 27 (interquartile range: 24.8, 32.3) years old. The majority (62.5%) had only primary level education. Most respondents (68.8%) owned or regularly used a mobile phone or computer. Few respondents (31.3%) had previously seen but not used a tablet computer. Overall, FGDs revealed CAPI acceptance and the factors influencing CAPI acceptability were 'familiarity', 'data confidentiality and security', 'data accuracy', and 'modernization and development'. Female survey respondents in our rural Southwest Ugandan setting found CAPI to be acceptable. Global health planners and implementers considering CAPI for health coverage survey data collection should accommodate influencing factors during survey planning in order to maximize and facilitate acceptance and support by local stakeholders and community participants. Further research is needed to generate best practices for CAPI implementation and LMIC; higher quality, timely, streamlined and budget-friendly collection of MNCH indicators could help direct and improve programming to save lives of mothers and children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Engaging stakeholders for adaptive management using structured decision analysis

USGS Publications Warehouse

Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett

2009-01-01

Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.

Stakeholder Analysis in Utilizing of Environmental Services and Natural Attractions in Tuk Semuncar Utilization Zone of Gunung Merbabu National Park: A literature review

NASA Astrophysics Data System (ADS)

Setiawan, Muhammad Arif; Muhammad, Fuad

2018-02-01

Many stakeholders in the utilizing of environmental services and natural attraction of Tuk Semuncar Utilization Zone needs to get the attention of the Gunung Merbabu National Park Officer. The existence of natural resources has an important role for the life of the community, making the complexity of the relationship between various parties who have interests in natural resource management. The existence of stakeholders and their interests should receive attention and be considered to be accommodated as an effort to prevent the occurrence of losses to the conservation area of Gunung Merbabu National Park. Every stakeholder's interest can have a positive and negative impact on other stakeholders. Stakeholder analysis can help in understanding the conflict on the utilizing of environmental services and natural attraction that is happening, as well as input strategy in involving stakeholders for the achievement of goals.

The stakeholder approach: a new perspective on developing and marketing clinical trials.

PubMed

Droms, Courtney M; Ferguson, Michael; Giuliano, Karen

2014-01-01

The use of evidence-based medical practice has become the standard for health care decision-making. Thus, it has become increasingly important for medical device manufactures to provide evidence for the efficacy of their products. As new products, services, and solutions are developed, it is important to perform a stakeholder analysis to assess clinical evidence needs. As evidenced by the variety of stakeholders in clinical trials, we expect that each has different interests in how clinical trials are developed, conducted, and promoted to the general public. This analysis of the stakeholders' concerns provides recommendations for marketing professionals on meeting the needs of these stakeholders.

Support amongst UK pig farmers and agricultural stakeholders for the use of food losses in animal feed

PubMed Central

Kelly, Moira; Bladon, Eleanor; Salemdeeb, Ramy; Balmford, Andrew

2018-01-01

While food losses (foods which were intended for human consumption, but which ultimately are not directly eaten by people) have been included in animal feed for millennia, the practice is all but banned in the European Union. Amid recent calls to promote a circular economy, we conducted a survey of pig farmers (n = 82) and other agricultural stakeholders (n = 81) at a UK agricultural trade fair on their attitudes toward the use of food losses in pig feed, and the potential relegalisation of swill (the use of cooked food losses as feed). While most respondents found the use of feeds containing animal by-products or with the potential for intra-species recycling (i.e. pigs eating pork products) to be less acceptable than feeds without, we found strong support (>75%) for the relegalisation of swill among both pig farmers and other stakeholders. We fit multi-hierarchical Bayesian models to understand people’s position on the relegalisation of swill, finding that respondents who were concerned about disease control and the perception of the pork industry supported relegalisation less, while people who were concerned with farm financial performance and efficiency or who thought that swill would benefit the environment and reduce trade-deficits, were more supportive. Our results provide a baseline estimate of support amongst the large-scale pig industry for the relegalisation of swill, and suggest that proponents for its relegalisation must address concerns about disease control and the consumer acceptance of swill-fed pork. PMID:29689078

Support amongst UK pig farmers and agricultural stakeholders for the use of food losses in animal feed.

PubMed

Zu Ermgassen, Erasmus K H J; Kelly, Moira; Bladon, Eleanor; Salemdeeb, Ramy; Balmford, Andrew

2018-01-01

While food losses (foods which were intended for human consumption, but which ultimately are not directly eaten by people) have been included in animal feed for millennia, the practice is all but banned in the European Union. Amid recent calls to promote a circular economy, we conducted a survey of pig farmers (n = 82) and other agricultural stakeholders (n = 81) at a UK agricultural trade fair on their attitudes toward the use of food losses in pig feed, and the potential relegalisation of swill (the use of cooked food losses as feed). While most respondents found the use of feeds containing animal by-products or with the potential for intra-species recycling (i.e. pigs eating pork products) to be less acceptable than feeds without, we found strong support (>75%) for the relegalisation of swill among both pig farmers and other stakeholders. We fit multi-hierarchical Bayesian models to understand people's position on the relegalisation of swill, finding that respondents who were concerned about disease control and the perception of the pork industry supported relegalisation less, while people who were concerned with farm financial performance and efficiency or who thought that swill would benefit the environment and reduce trade-deficits, were more supportive. Our results provide a baseline estimate of support amongst the large-scale pig industry for the relegalisation of swill, and suggest that proponents for its relegalisation must address concerns about disease control and the consumer acceptance of swill-fed pork.

Stakeholders Analysis

ERIC Educational Resources Information Center

Delrio, Claudio; Ami, Zvi Ben; de Groot, Reuma; Drachmann, Raul; Ilomaki, Liisa

2008-01-01

The aim of this report is, first of all, to present the KP-Lab approach toward stakeholders in the wider framework of European policies. Secondly, the KP-Lab definition of stakeholders and the strategy to address different stakeholders needs, concerns and expectations is presented in the following paragraphs. The second chapter presents concrete…

SOVA: Design of a stakeholder informed social media website for depressed adolescents and their parents

PubMed Central

Radovic, Ana; DeMand, Alexandra L.; Gmelin, Theresa; Stein, Bradley D.; Miller, Elizabeth

2018-01-01

Two moderated social media websites were designed for increasing likelihood for mental health treatment engagement for depressed adolescents (sova.pitt.edu) and for parents (wisesova.pitt.edu). This paper describes iterative stakeholder interviews conducted with adolescents, young adults, parents, advocates, and clinicians and use of human computer interaction techniques to inform major design changes which: (1) underscored the role of online interaction to provide emotional support and information; (2) importance of anonymity; (3) desire to share positive media; and (4) need for frequent moderation. Future studies will examine acceptability and effectiveness of revised websites in helping depressed adolescents and their parents engage with treatment. PMID:29743822

Explaining variation in Down's syndrome screening uptake: comparing the Netherlands with England and Denmark using documentary analysis and expert stakeholder interviews.

PubMed

Crombag, Neeltje M T H; Vellinga, Ynke E; Kluijfhout, Sandra A; Bryant, Louise D; Ward, Pat A; Iedema-Kuiper, Rita; Schielen, Peter C J I; Bensing, Jozien M; Visser, Gerard H A; Tabor, Ann; Hirst, Janet

2014-09-25

The offer of prenatal Down's syndrome screening is part of routine antenatal care in most of Europe; however screening uptake varies significantly across countries. Although a decision to accept or reject screening is a personal choice, it is unlikely that the widely differing uptake rates across countries can be explained by variation in individual values alone.The aim of this study was to compare Down's syndrome screening policies and programmes in the Netherlands, where uptake is relatively low (<30%) with England and Denmark where uptake is higher (74 and > 90% respectively), in an attempt to explain the observed variation in national uptake rates. We used a mixed methods approach with an embedded design: a) documentary analysis and b) expert stakeholder analysis. National central statistical offices and legal documents were studied first to gain insight in demographic characteristics, cultural background, organization and structure of healthcare followed by documentary analysis of primary and secondary sources on relevant documents on DSS policies and programme. To enhance interpretation of these findings we performed in-depth interviews with relevant expert stakeholders. There were many similarities in the demographics, healthcare systems, government abortion legislation and Down's syndrome screening policy across the studied countries. However, the additional cost for Down's syndrome screening over and above standard antenatal care in the Netherlands and an emphasis on the 'right not to know' about screening in this country were identified as potential explanations for the 'low' uptake rates of Down's syndrome screening in the Netherlands. The social context and positive framing of the offer at the service delivery level may play a role in the relatively high uptake rates in Denmark. This paper makes an important contribution to understanding how macro-level demographic, social and healthcare delivery factors may have an impact on national uptake rates for Down's syndrome screening. It has suggested a number of policy level and system characteristics that may go some way to explaining the relatively low uptake rates of Down's syndrome screening in the Netherlands when compared to England and Denmark.

Assessing Cost-Effectiveness in Obesity (ACE-Obesity): an overview of the ACE approach, economic methods and cost results

PubMed Central

2009-01-01

Background The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study. Methods The Assessing Cost Effectiveness (ACE) approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'. Results The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum) and when expressed as a 'cost per child' estimate (from

In search of common ground among diverse forest stakeholders: A contextual content analysis of online text

Treesearch

Jennifer A. Cuff; David N. Bengston; Donald G. McTavish

2000-01-01

Managing public forest collaboratively requires an understanding of differences between and similarities among diverse stakeholder groups. The Minnesota Contextual Content Analysis (MCCA) computer program was used to analyze text obtained from World Wide Web sites expressing the views of seven diverse stakeholder groups involved in forest planning and managemnet....

Developing the Storyline for an Advance Care Planning Video for Surgery Patients: Patient-Centered Outcomes Research Engagement from Stakeholder Summit to State Fair.

PubMed

Aslakson, Rebecca A; Schuster, Anne L R; Lynch, Thomas J; Weiss, Matthew J; Gregg, Lydia; Miller, Judith; Isenberg, Sarina R; Crossnohere, Norah L; Conca-Cheng, Alison M; Volandes, Angelo E; Smith, Thomas J; Bridges, John F P

2018-01-01

Patient-centered outcomes research (PCOR) methods and social learning theory (SLT) require intensive interaction between researchers and stakeholders. Advance care planning (ACP) is valuable before major surgery, but a systematic review found no extant perioperative ACP tools. Consequently, PCOR methods and SLT can inform the development of an ACP educational video for patients and families preparing for major surgery. The objective is to develop and test acceptability of an ACP video storyline. The design is a stakeholder-guided development of the ACP video storyline. Design-thinking methods explored and prioritized stakeholder perspectives. Patients and family members evaluated storyboards containing the proposed storyline. The study was conducted at hospital outpatient surgical clinics, in-person stakeholder summit, and the 2014 Maryland State Fair. Measurements are done through stakeholder engagement and deidentified survey. Stakeholders evaluated and prioritized evidence from an environmental scan. A surgeon, family member, and palliative care physician team iteratively developed a script featuring 12 core themes and worked with a medical graphic designer to translate the script into storyboards. For 10 days, 359 attendees of the 2014 Maryland State Fair evaluated the storyboards and 87% noted that they would be "very comfortable" or "comfortable" seeing the storyboard before major surgery, 89% considered the storyboards "very helpful" or "helpful," and 89% would "definitely recommend" or "recommend" this story to others preparing for major surgery. Through an iterative process utilizing diverse PCOR engagement methods and informed by SLT, storyboards were developed for an ACP video. Field testing revealed the storyline to be highly meaningful for surgery patients and family members.

Engaging Stakeholders in the Development of an eHealth Intervention for Cancer Symptom Management for Rural Residents.

PubMed

Gilbertson-White, Stephanie; Yeung, Chi W; Saeidzadeh, Seyedehtanaz; Tykol, Hannah; Vikas, Praveen; Cannon, Ashley

2018-04-25

Late-stage cancer diagnoses disproportionately occur in rural residents, frequently resulting in increased need for symptom management support with minimal access to these services. Oncology Associated Symptoms and Individualized Strategies (OASIS) is an eHealth symptom self-management intervention that was developed to provide cancer symptom self-management support and address this disparity. To engage stakeholders about the symptom management needs and concerns of patients with advanced cancer living in rural areas. A 3-phased, mixed-methods design was used to (1) assess stakeholder needs and opinions; (2) develop a symptom self-management website; and (3) obtain usability feedback from potential users. Interviews with stakeholders (patients and clinic staff) from rural areas using a descriptive qualitative approach were analyzed; cross-cutting themes were identified; a symptom management web application was developed; and stakeholders completed a 12-item usability survey about the web application. Patients (n = 16) and clinical staff (n = 10) participated in phase 1. Three major themes were identified: "symptom experience," "symptom management," and "technology." Through an iterative process using these results and evidence from the literature, the OASIS web application was developed. Usability testing with N = 126 stakeholders demonstrated that the web application is easy to use, contains relevant content, and has pleasing graphics. No differences were found among patients, family/friends, and staff. Both frequent and infrequent internet users positively evaluated the web application.  CONCLUSIONS: Rural stakeholders report significant symptom management needs, are interested in eHealth technologies, and perceived OASIS positively. Future research is needed to evaluate the feasibility, acceptability, and efficacy of OASIS. © 2018 National Rural Health Association.

Higher Education and Its Communities: Interconnections, Interdependencies and a Research Agenda

ERIC Educational Resources Information Center

Jongbloed, Ben; Enders, Jurgen; Salerno, Carlo

2008-01-01

Universities everywhere are being forced to carefully reconsider their role in society and to evaluate the relationships with their various constituencies, stakeholders, and communities. In this article, "stakeholder analysis" is put forward as a tool to assist universities in classifying stakeholders and determining stakeholder salience.…

Working with Evaluation Stakeholders: A Rationale, Step-Wise Approach and Toolkit

ERIC Educational Resources Information Center

Bryson, John M.; Patton, Michael Quinn; Bowman, Ruth A.

2011-01-01

In the broad field of evaluation, the importance of stakeholders is often acknowledged and different categories of stakeholders are identified. Far less frequent is careful attention to analysis of stakeholders' interests, needs, concerns, power, priorities, and perspectives and subsequent application of that knowledge to the design of…

Regulatory withdrawal of medicines marketed with uncertain benefits: the bevacizumab case study.

PubMed

Vitry, Agnes; Nguyen, Tuan; Entwistle, Vikky; Roughead, Elizabeth

2015-01-01

Withdrawal of conditional regulatory approval or subsidization of new medicines when subsequent evidence does not confirm early trial results may not be well understood or accepted by the public. We present a case study of the US Food and Drug Administration (FDA)'s decision to withdraw the indication of bevacizumab for the treatment of advanced breast cancer and include an analysis of the reactions of stakeholders with a view to identifying opportunities for improving risk management for new medicines with conditional approval or funding. We drew on a range of information sources, including FDA documents, medical journals and media reports, to describe the evidentiary basis of the FDA decisions. We analysed the reactions and perspectives of the stakeholders. In 2008 bevacizumab was granted conditional approval for treatment of advanced breast cancer by the FDA pending submission of supplementary satisfactory evidence. In 2011 the FDA decision to withdraw the indication was met with a hostile reaction from many clinicians and cancer survivors. There were different interpretations of the therapeutic value of bevacizumab with strong beliefs among cancer survivors that the medicine was effective and potential harm was manageable. High expectations of the public may have been encouraged by overly positive media reports and limited understanding by the public of the complexity of the scientific evaluation of new medicines and of the regulatory processes. Improving understanding and acceptance of approval or coverage schemes conditional to evidence development may require the development of risk management plans by regulatory and funding institutions. They may include a range of strategies such as requirements for formal patient acknowledgment of the conditional availability of the medicine, 'black-triangle' equivalent labels that identify full approval is based on pending evidence, and ongoing communication with the media, public and health professionals.

Hospital food service: a comparative analysis of systems and introducing the 'Steamplicity' concept.

PubMed

Edwards, J S A; Hartwell, H J

2006-12-01

Patient meals are an integral part of treatment hence the provision and consumption of a balanced diet, essential to aid recovery. A number of food service systems are used to provide meals and the Steamplicity concept has recently been introduced. This seeks, through the application of a static, extended choice menu, revised patient ordering procedures, new cooking processes and individual patient food heated/cooked at ward level, to address some of the current hospital food service concerns. The aim of this small-scale study, therefore, was to compare a cook-chill food service operation against Steamplicity. Specifically, the goals were to measure food intake and wastage at ward level; 'stakeholders' (i.e. patients, staff, etc.) satisfaction with both systems; and patients' acceptability of the food provided. The study used both quantitative (self-completed patient questionnaires, n = 52) and qualitative methods (semi-structured interviews, n = 16) with appropriate stakeholders including medical and food service staff, patients and their visitors. Patients preferred the Steamplicity system overall and in particular in terms of food choice, ordering, delivery and food quality. Wastage was considerably less with the Steamplicity system, although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, at lunch, the mean intake with the cook-chill system was 202 g whilst that for the Steamplicity system was 282 g and for the evening meal, 226 g compared with 310 g. The results of this small study suggest that Steamplicity is more acceptable to patients and encourages the consumption of larger portions. Further evaluation of the Steamplicity system is warranted.

Health promotion in schools: a multi-method evaluation of an Australian School Youth Health Nurse Program.

PubMed

Banfield, Michelle; McGorm, Kelly; Sargent, Ginny

2015-01-01

Health promotion provides a key opportunity to empower young people to make informed choices regarding key health-related behaviours such as tobacco and alcohol use, sexual practices, dietary choices and physical activity. This paper describes the evaluation of a pilot School Youth Health Nurse (SYHN) Program, which aims to integrate a Registered Nurse into school communities to deliver health promotion through group education and individual sessions. The evaluation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. The objectives were to explore: 1) whether the Program was accessible to the high school students; 2) the impacts of the Program on key stakeholders; 3) which factors affected adoption of the Program; 4) whether implementation was consistent with the Program intent; and 5) the long-term sustainability of the Program. Research included retrospective analysis of Program records, administration of a survey of student experiences and interviews with 38 stakeholders. This evaluation provided evidence that the SYHN Program is reaching students in need, is effective, has been adopted successfully in schools, is being implemented as intended and could be maintained with sustained funding. The nurses deliver an accessible and acceptable primary health care service, focused on health promotion, prevention and early intervention. After some initial uncertainty about the scope and nature of the role, the nurses are a respected source of health information in the schools, consulted on curriculum development and contributing to whole-of-school health activities. Findings demonstrate that the SYHN model is feasible and acceptable to the students and schools involved in the pilot. The Program provides health promotion and accessible primary health care in the school setting, consistent with the Health Promoting Schools framework.

Conceptual Modeling for Adaptive Environmental Assessment and Management in the Barycz Valley, Lower Silesia, Poland

PubMed Central

Magnuszewski, Piotr; Sendzimir, Jan; Kronenberg, Jakub

2005-01-01

The complexity of interactions in socio-ecological systems makes it very difficult to plan and implement policies successfully. Traditional environmental management and assessment techniques produce unsatisfactory results because they often ignore facets of system structure that underlie complexity: delays, feedbacks, and non-linearities. Assuming that causes are linked in a linear chain, they concentrate on technological developments (“hard path”) as the only solutions to environmental problems. Adaptive Management is recognized as a promising alternative approach directly addressing links between social and ecological systems and involving stakeholders in the analysis and decision process. This “soft path” requires special tools to facilitate collaboration between “experts” and stakeholders in analyzing complex situations and prioritizing policies and actions. We have applied conceptual modeling to increase communication, understanding and commitment in the project of seven NGOs “Sustainable Regional Development in the Odra Catchment”. The main goal was to help our NGO partners to facilitate their efforts related to developing sustainable policies and practices to respond to large-scale challenges (EU accession, global changes in climate and economy) to their natural, economic and socio-cultural heritages. Among the variety of sustainability issues explored by these NGOs, two (extensive agricultural practices and “green” local products) were examined by using Adaptive Management (AM) as a framework that would link analysis, discussion, research, actions and monitoring. Within the AM framework the project coordinators used tools of systems analysis (Mental Model Mapping) to facilitate discussions in which NGO professionals and local stakeholders could graphically diagram and study their understanding of what factors interacted and how they affect the region’s sustainability. These discussions produced larger-scale Regional Sustainability Models as well as more detailed sub-models of particular factors, processes, and feedback loops that appear critical to a sustainable future. The Regional Sustainability Model was used to identify a subset of key interacting factors (variables). For each variable, several sustainability indicators were suggested. The growing understanding and acceptance of the AM framework and systems analysis created a momentum both locally and within the region, which makes continued successful use of these indicators quite likely. In contrast to expert-driven projects that inject outside knowledge into a local context, this project established a broad basis for stakeholder-driven discussion that is articulated into goals, objectives, conceptual models, and indicators. The ability to learn and adapt in the AM framework increases the capacity to innovate and find policies and practices that enhance resilience and sustainability in a world in transition. PMID:16705818

The acceptance of in silico models for REACH: Requirements, barriers, and perspectives

PubMed Central

2011-01-01

In silico models have prompted considerable interest and debate because of their potential value in predicting the properties of chemical substances for regulatory purposes. The European REACH legislation promotes innovation and encourages the use of alternative methods, but in practice the use of in silico models is still very limited. There are many stakeholders influencing the regulatory trajectory of quantitative structure-activity relationships (QSAR) models, including regulators, industry, model developers and consultants. Here we outline some of the issues and challenges involved in the acceptance of these methods for regulatory purposes. PMID:21982269

Stakeholder analysis and mapping as targeted communication strategy.

PubMed

Shirey, Maria R

2012-09-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author highlights the importance of stakeholder theory and discusses how to apply the theory to conduct a stakeholder analysis. This article also provides an explanation of how to use related stakeholder mapping techniques with targeted communication strategies.

Stakeholder Engagement in Sustainability Reporting in Higher Education: An Analysis of Key Internal Stakeholders' Expectations

ERIC Educational Resources Information Center

Ferrero-Ferrero, Idoya; Fernández-Izquierdo, María Ángeles; Muñoz-Torres, María Jesús; Bellés-Colomer, Lucía

2018-01-01

Purpose: The purpose of this study is to improve the understanding of stakeholder engagement in the context of sustainability reporting (SR) for higher education institutions (HEIs), together with the materiality principle and stakeholder expectations. Design/methodology/approach: This research uses an exploratory approach based on content…

Preferences on policy options for ensuring the financial sustainability of health care services in the future: results of a stakeholder survey.

PubMed

Tordrup, David; Angelis, Aris; Kanavos, Panos

2013-12-01

Universal access to health care in most western European countries has been a given for many decades; however, macroeconomic developments and increased pressure on health care budgets could mean the status quo cannot be maintained. As populations age, a declining proportion of economically active citizens are being required to support a larger burden of health and social care, while increasing availability of novel technologies for extending and improving life continues to push health care costs upwards. With health expenditure continuing to rise as a proportion of national income, concerns are raised about the current and future financial sustainability of Organisation for Economic Co-Operation and Development (OECD) health care systems. Against this backdrop, a discussion about options to fund health care in the future, including whether to raise additional health care finance (and the ways to do so), reallocate resources and/or ration services becomes very pertinent. This study elicits preferences among a group of key stakeholders (payers, providers, government, academia and health-related industry) on the issue of health care financial sustainability and the future funding of health care services, with a view to understanding the different degrees of acceptability between policy interventions and future funding options as well as their feasibility. We invited 842 individuals from academia, other research organisations (eg. think tanks), national health services, providers, health insurance organisations, government representatives and health-related industry and related advisory stakeholders to participate in an online survey collecting preferences on a variety of revenue-generating mechanisms and cost/demand reducing policies. Respondents represented the 28 EU member states as well as Norway, Iceland, Switzerland, Australia, Russian Federation, Canada and New Zealand. We received 494 responses to our survey from all stakeholder groups. Across all groups, the highest preference was for policies to modify lifestyle and implement more extensive screening within risk groups for high burden illnesses. There was a broad consensus not to reallocate resources from social security/education. Between stakeholders, there were differences of opinion between industry/advisory and a range of other groups, with industry being generally more in favour of market-based interventions and an increased role for the private sector in health care financing/delivery. Conversely, stakeholders from academia, government, national health services and insurance were relatively more in favour of more restrictive purchasing of new and expensive technologies, and (to varying extent) of higher income/corporate taxes. Taxes on cigarettes/alcohol were by far considered the most politically feasible option. According to this study, policy options that are broadly acceptable across stakeholder groups with different inherent interests exist but are limited to lifestyle modification, screening interventions and excise taxes on harmful products. Representatives from the private sector tend to view solutions rooted in the private sector as both effective and politically feasible options, while stakeholders from academia and the public sector seem to place more emphasis on solutions that do not disproportionately impact certain population groups.

Effect of culture on acceptance of telemedicine in Middle Eastern countries: case study of Jordan and Syria.

PubMed

Alajlani, Mohannad; Clarke, Malcolm

2013-04-01

We investigated issues that affect the use and adoption of telemedicine in Middle Eastern countries, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as case studies. Our study is based on interviews with key stakeholders (including doctors, technicians, engineers, and decision makers) and questionnaires administered to key stakeholders (including patients), ensuring opinion was gained from people from a full range of backgrounds and roles in the healthcare system. We found doctor and patient resistance was a major issue preventing the adoption of telemedicine in both countries, followed by poor infrastructure, lack of funding, and lack of information technology training. Our research identifies that culture is a greater issue than technical matters for the adoption of telemedicine in Middle Eastern countries. Based on our preliminary results we developed a guideline framework for each country that might be applied to telemedicine projects at the pre-implementation phase. The proposed guideline framework was validated through a return visit to the stakeholders and seeking further opinion.

Evaluating the Social Validity of the Early Start Denver Model: A Convergent Mixed Methods Study

ERIC Educational Resources Information Center

Ogilvie, Emily; McCrudden, Matthew T.

2017-01-01

An intervention has social validity to the extent that it is socially acceptable to participants and stakeholders. This pilot convergent mixed methods study evaluated parents' perceptions of the social validity of the Early Start Denver Model (ESDM), a naturalistic behavioral intervention for children with autism. It focused on whether the parents…

Natural and induced variation in tomato fruit: an assessment of substantial equivalence relative to stakeholder acceptable chemical diversity

USDA-ARS?s Scientific Manuscript database

Unintended effects to food quality and composition occur no matter the method of plant improvement. The existence of unintended effects is perhaps not the most important point within the discussion, but rather the identity and significance of the compositional changes observed. Here we report the ex...

78 FR 58987 - Approval of Air Quality Implementation Plans; Navajo Nation; Regional Haze Requirements for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... hold five public hearings to accept written and oral comment on our proposed BART determination for NGS. On July 26, 2013, a group of stakeholders, known as the Technical Work Group (TWG), submitted its... included as part of the public comment. If EPA cannot read your comment due to technical difficulties and...

Sustainability Indices as Measures of Service Delivery in Open and Distance Learning Institutions in Nigeria

ERIC Educational Resources Information Center

Salawu, I. O.; Adeoye, F. A.; Ojo, Olugbenga David; Olakulehin, Felix Kayode

2010-01-01

Open and Distance Education if well organized, is an adequate alternative to conventional education. For acceptability of this assertion, the public, governments, employers of labour and other stakeholders need to be convinced that ODL institutions are not providing half-baked education. Also, for the public and other shareholders enthusiasm and…

A Construal of the Understanding Level of Quality Assurance by Internal Stakeholders in Two Malaysian Universities

ERIC Educational Resources Information Center

Njie, Baboucarr; Asimiran, Soaib

2016-01-01

The "understanding" in terms of interpretation of quality assurance is essential for the acceptance, theorizing and the practical application of the methods proposed by it. A great deal of research papers have often pointed to the lack of understanding, among others, as the reason behind the inadequate nature of implementing quality…

Factors influencing stakeholders attitudes toward genetically modified aedes mosquito.

PubMed

Amin, Latifah; Hashim, Hasrizul

2015-06-01

Dengue fever is a debilitating and infectious disease that could be life-threatening. It is caused by the dengue virus which affects millions of people in the tropical area. Currently, there is no cure for the disease as there is no vaccine available. Thus, prevention of the vector population using conventional methods is by far the main strategy but has been found ineffective. A genetically modified (GM) mosquito is among the favoured alternatives to curb dengue fever in Malaysia. Past studies have shown that development and diffusion of gene technology products depends heavily upon public acceptance. The purpose of this study is to identify the relevant factors influencing stakeholders' attitudes toward the GM Aedes mosquito and to analyse the relationships between all the factors using the structural equation model. A survey was carried out on 509 respondents from various stakeholder groups in the Klang Valley region of Malaysia. Results of the survey have confirmed that public perception towards complex issues such as gene technology should be seen as a multi-faceted process. The perceived benefit-perceived risk balance is very important in determining the most predominant predictor of attitudes toward a GM mosquito. In this study the stakeholders perceived the benefit of the GM mosquito as outweighing its risk, translating perceived benefit as the most important direct predictor of attitudes toward the GM mosquito. Trust in key players has a direct influence on attitudes toward the GM mosquito while moral concern exhibited an indirect influence through perceived benefits. Other factors such as attitudes toward technology and nature were also indirect predictors of attitudes toward the GM mosquito while religiosity and engagement did not exhibited any significant roles. The research findings serve as a useful database to understand public acceptance and the social construct of public attitudes towards the GM mosquito to combat dengue.

Community Engagement in a complex intervention to improve access to primary mental health care for hard-to-reach groups.

PubMed

Lamb, Jonathan; Dowrick, Christopher; Burroughs, Heather; Beatty, Susan; Edwards, Suzanne; Bristow, Kate; Clarke, Pam; Hammond, Jonathan; Waheed, Waquas; Gabbay, Mark; Gask, Linda

2015-12-01

Despite the availability of effective evidence-based treatments for depression and anxiety, many 'harder-to-reach' social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement. To develop and evaluate a model for community engagement component of the complex intervention. This paper focuses on the development of relationships between stakeholders, their engagement with the issue of access to mental health and with the programme through the CE model. Our evaluation draws on process data, qualitative interviews and focus groups, brought together through framework analysis to evaluate the issues and challenges encountered. A case study of the South Asian community project carried out in Longsight in Greater Manchester, United Kingdom. Complex problems require multiple local stakeholders to work in concert. Assets based approaches implicitly make demands on scarce time and resources. Community development approaches have many benefits, but perceptions of open-ended investment are a barrier. The time-limited nature of a CE intervention provides an impetus to 'do it now', allowing stakeholders to negotiate their investment over time and accommodating their wider commitments. Both tangible outcomes and recognition of process benefits were vital in maintaining involvement. CE interventions can play a key role in improving accessibility and acceptability by engaging patients, the public and practitioners in research and in the local service ecology. © 2014 John Wiley & Sons Ltd.

National Laboratory Planning: Developing Sustainable Biocontainment Laboratories in Limited Resource Areas

PubMed Central

Adams, Martin; Stamper, Paul D.; Dasgupta, Debanjana; Hewson, Roger; Buck, Charles D.; Richards, Allen L.; Hay, John

2016-01-01

Strategic laboratory planning in limited resource areas is essential for addressing global health security issues. Establishing a national reference laboratory, especially one with BSL-3 or -4 biocontainment facilities, requires a heavy investment of resources, a multisectoral approach, and commitments from multiple stakeholders. We make the case for donor organizations and recipient partners to develop a comprehensive laboratory operations roadmap that addresses factors such as mission and roles, engaging national and political support, securing financial support, defining stakeholder involvement, fostering partnerships, and building trust. Successful development occurred with projects in African countries and in Azerbaijan, where strong leadership and a clear management framework have been key to success. A clearly identified and agreed management framework facilitate identifying the responsibility for developing laboratory capabilities and support services, including biosafety and biosecurity, quality assurance, equipment maintenance, supply chain establishment, staff certification and training, retention of human resources, and sustainable operating revenue. These capabilities and support services pose rate-limiting yet necessary challenges. Laboratory capabilities depend on mission and role, as determined by all stakeholders, and demonstrate the need for relevant metrics to monitor the success of the laboratory, including support for internal and external audits. Our analysis concludes that alternative frameworks for success exist for developing and implementing capabilities at regional and national levels in limited resource areas. Thus, achieving a balance for standardizing practices between local procedures and accepted international standards is a prerequisite for integrating new facilities into a country's existing public health infrastructure and into the overall international scientific community. PMID:27559843

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda

PubMed Central

Nabyonga-Orem, Juliet; Mijumbi, Rhona

2015-01-01

Background: Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors’ views regarding what evidence they deemed appropriate to guide health policy development. Methods: Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Results: Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. Conclusion: What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. PMID:25905479

Stakeholder influence in public sector information systems strategy implementation-The case of public hospitals in South Africa.

PubMed

Hwabamungu, Boroto; Brown, Irwin; Williams, Quentin

2018-01-01

Recent literature on organisational strategy has called for greater emphasis on individuals (stakeholders) and what they do in the process of strategizing. Public sector organisations have to engage with an array of heterogeneous stakeholders in fulfilling their mandate. The public health sector in particular needs to engage with a diversity of stakeholders at local, regional and national levels when strategising. The purpose of this study is to investigate the influence of stakeholder relations on the implementation of Information Systems (IS) strategy in public hospitals in South Africa. An interpretive approach using two provinces was employed. The Activity Analysis and Development (ActAD) framework, an enhanced form of activity theory, was used as the theoretical framework. Data was collected using semi-structured interviews, meetings, documents analysis, physical artefacts and observation. The collected data was analysed using thematic analysis. Findings reveal that IS strategy implementation in public hospitals involves a large and complex network of stakeholder groups at different levels, and over different time periods. These stakeholder groups act in accordance with formal and informal roles, rules and modalities. Various contextual conditions together with the actions of, and interactions between stakeholder groups give rise to the situationality of stakeholder relations dynamics and strategy implementation. The multiple actions and interactions over time lead to the realisation of some aspects of the IS strategy in public hospitals. Given the complexity and dynamism of the context there are also certain unplanned implementations as well. These relationships are captured in a Stakeholder Relations Influence (SRI) framework. The SRI framework can be assistive in the assessment and mapping of stakeholders and stakeholder relations, and the assessment of the implications of these relations for effective IS strategy implementation in public hospitals. The framework can also provide the basis for the development of appropriate corrective measures in the implementation of strategies and policies in public institutions such as public hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

Participative approach to elicit water quality monitoring needs from stakeholder groups - An application of integrated watershed management.

PubMed

Behmel, S; Damour, M; Ludwig, R; Rodriguez, M J

2018-07-15

Water quality monitoring programs (WQMPs) must be based on monitoring objectives originating from the real knowledge needs of all stakeholders in a watershed and users of the resource. This paper proposes a participative approach to elicit knowledge needs and preferred modes of communication from citizens and representatives of organized stakeholders (ROS) on water quality and quantity issues. The participative approach includes six steps and is adaptable and transferable to different types of watersheds. These steps are: (1) perform a stakeholder analysis; (2) conduct an adaptable survey accompanied by a user-friendly public participation geographical information system (PPGIS); (3) hold workshops to meet with ROS to inform them of the results of the survey and PPGIS; discuss attainment of past monitoring objectives; exchange views on new knowledge needs and concerns on water quality and quantity; (4) meet with citizens to obtain the same type of input (as from ROS); (5) analyze the data and information collected to identify new knowledge needs and modes of communication and (6) identify, in collaboration with the individuals in charge of the WQMPs, the short-, medium- and long-term monitoring objectives and communication strategies to be pursued. The participative approach was tested on two distinct watersheds in the province of Quebec, Canada. It resulted in a series of optimization objectives of the existing WQMPs, new monitoring objectives and recommendations regarding communication strategies of the WQMPs' results. The results of this study show that the proposed methodology is appreciated by all parties and that the outcomes and monitoring objectives are acceptable. We also conclude that successful integrated watershed management is a question of scale, and that every aspect of integrated watershed management needs to be adapted to the surface watershed, the groundwater watershed (aquifers) and the human catchment area. Copyright © 2018 Elsevier Ltd. All rights reserved.

Educational Needs on Palliative Care for Cancer Patients in Iran: A SWOT Analysis

PubMed Central

Ansari, Mojgan; Rassouli, Maryam; Akbari, Mohamad Esmaiel; Abbaszadeh, Abbas; Akbari Sari, Ali

2018-01-01

ABSTRACT Background: By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder’s educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran. Methods: This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes. Result: A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included: ”academic education planning”, “workforce education”, “public awareness”, and “patient and caregiver empowerment” that contained our subcategories as follows: “strengths”, “weaknesses”, “opportunities” and “threats” (SWOT). Conclusion: Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced. PMID:29607340

Comparative analysis of sustainable value distribution for stakeholders in the mining industry

NASA Astrophysics Data System (ADS)

Lorenc, Sylwia; Kustra, Arkadiusz

2018-01-01

The objective of this article is the analysis and comparison of the value distribution process that takes place in enterprises for stakeholders. The following coal mining enterprises are subject of this work: JSW S.A., KGHM S.A., and LW Bogdanka S.A, for which the directions of value distribution in the years 2011-2016 were presented. The article defines the main groups of the partnerships' stakeholders, such as the owners, staff, suppliers, equity providers, the country budget and the local governments' budgets. The sustainable value benchmark was defined as the benefits received by the stakeholders through the allocation of financial surplus. The value defined for the abovementioned stakeholders was assessed according to the Free Cash Flow (FCF) methodology.

Detecting Initiation or Risk for Initiation of Substance Use before High School during Pediatric Well-Child Check-Ups

PubMed Central

Ridenour, Ty A.; Willis, David; Bogen, Debra L.; Novak, Scott; Scherer, Jennifer; Reynolds, Maureen D.; Zhai, Zu Wei; Tarter, Ralph E.

2015-01-01

Background Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index© (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups. Design A high-risk longitudinal design with two cross-sectional replication samples, ages 9–13 was used. Analyses included receiver operating characteristics and regression analyses. Participants A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool. Results YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratio=7.44 CI=4.3–13.0) and conduct problems (odds ratios=7.33 CI=3.9–13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service. Conclusions Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI’s association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders. PMID:25765481

Multicriteria decision analysis: Overview and implications for environmental decision making

USGS Publications Warehouse

Hermans, Caroline M.; Erickson, Jon D.; Erickson, Jon D.; Messner, Frank; Ring, Irene

2007-01-01

Environmental decision making involving multiple stakeholders can benefit from the use of a formal process to structure stakeholder interactions, leading to more successful outcomes than traditional discursive decision processes. There are many tools available to handle complex decision making. Here we illustrate the use of a multicriteria decision analysis (MCDA) outranking tool (PROMETHEE) to facilitate decision making at the watershed scale, involving multiple stakeholders, multiple criteria, and multiple objectives. We compare various MCDA methods and their theoretical underpinnings, examining methods that most realistically model complex decision problems in ways that are understandable and transparent to stakeholders.

Engaging Community Stakeholders to Evaluate the Design, Usability, and Acceptability of a Chronic Obstructive Pulmonary Disease Social Media Resource Center

PubMed Central

Chaney, Beth; Chaney, Don; Paige, Samantha; Payne-Purvis, Caroline; Tennant, Bethany; Walsh-Childers, Kim; Sriram, PS; Alber, Julia

2015-01-01

Background Patients with chronic obstructive pulmonary disease (COPD) often report inadequate access to comprehensive patient education resources. Objective The purpose of this study was to incorporate community-engagement principles within a mixed-method research design to evaluate the usability and acceptability of a self-tailored social media resource center for medically underserved patients with COPD. Methods A multiphase sequential design (qual → QUANT → quant + QUAL) was incorporated into the current study, whereby a small-scale qualitative (qual) study informed the design of a social media website prototype that was tested with patients during a computer-based usability study (QUANT). To identify usability violations and determine whether or not patients found the website prototype acceptable for use, each patient was asked to complete an 18-item website usability and acceptability questionnaire, as well as a retrospective, in-depth, semistructured interview (quant + QUAL). Results The majority of medically underserved patients with COPD (n=8, mean 56 years, SD 7) found the social media website prototype to be easy to navigate and relevant to their self-management information needs. Mean responses on the 18-item website usability and acceptability questionnaire were very high on a scale of 1 (strongly disagree) to 5 (strongly agree) (mean 4.72, SD 0.33). However, the majority of patients identified several usability violations related to the prototype’s information design, interactive capabilities, and navigational structure. Specifically, 6 out of 8 (75%) patients struggled to create a log-in account to access the prototype, and 7 out of 8 patients (88%) experienced difficulty posting and replying to comments on an interactive discussion forum. Conclusions Patient perceptions of most social media website prototype features (eg, clickable picture-based screenshots of videos, comment tools) were largely positive. Mixed-method stakeholder feedback was used to make design recommendations, categorize usability violations, and prioritize potential solutions for improving the usability of a social media resource center for COPD patient education. PMID:25630449

Heartland Alliance for Regional Transmission

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jackson, Nancy

2017-03-15

The Heartland Alliance for Regional Transmission (HART) will foster a candid, productive conversation among stakeholders that identifies challenges to and benefits from a massive build out of wind generation and transmission across the Southwest Power Pool. Based on the outcomes of those deliberations, HART will develop and deliver an ambitious, coordinated, peer-to-peer outreach effort that spans the SPP to improve market acceptance for wind.

Getting on the Same Page: Identifying Goals for Technology Use in Early Childhood Education. Policy Brief

ERIC Educational Resources Information Center

Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

2014-01-01

Technology use among young children is increasingly a fact of life, and establishing a clear set of goals that are broadly accepted by stakeholders is critical to planning for the successful integration of technology into early childhood education (ECE). However, debates about the role of technology in ECE settings are ongoing, with some…

The NATO Unmanned Aircraft System Human Systems Integration Guidebook

DTIC Science & Technology

2012-11-01

Stakeholders HSI Management Activity Goals Project SMEs HCR Acceptance Methods & Criteria Figure 2. Overarching HSI Goal Structure ...88ABW Clear 10/21/2013; 88ABW-2013-4442 55 N NATO North Atlantic Treaty Organisation NTSB National Transportation Safety Board S SME Subject...support the organisation Personnel trained to support safety Operational Concepts HSI Technical Activity Goals Allocation of Functions

Financing strategic plans for not-for-profits.

PubMed

Wong-Hammond, Laca; Damon, Lorie

2013-07-01

To succeed in today's complex economic environment, a not-for-profit health system requires an effective strategic capital planning process that harmonizes three elements: The organization's long-term business plan and mission. Existing financial resources and finance options available to support the organization's business plan. Financial risk and return on equity to the organization's stakeholders (within acceptable parameters for business risk).

Determinants of public attitudes to genetically modified salmon.

PubMed

Amin, Latifah; Azad, Md Abul Kalam; Gausmian, Mohd Hanafy; Zulkifli, Faizah

2014-01-01

The objective of this paper is to assess the attitude of Malaysian stakeholders to genetically modified (GM) salmon and to identify the factors that influence their acceptance of GM salmon using a structural equation model. A survey was carried out on 434 representatives from various stakeholder groups in the Klang Valley region of Malaysia. Public attitude towards GM salmon was measured using self-developed questionnaires with seven-point Likert scales. The findings of this study have confirmed that public attitudes towards GM salmon is a complex issue and should be seen as a multi-faceted process. The most important direct predictors for the encouragement of GM salmon are the specific application-linked perceptions about religious acceptability of GM salmon followed by perceived risks and benefits, familiarity, and general promise of modern biotechnology. Encouragement of GM salmon also involves the interplay among other factors such as general concerns of biotechnology, threatening the natural order of things, the need for labeling, the need for patenting, confidence in regulation, and societal values. The research findings can serve as a database that will be useful for understanding the social construct of public attitude towards GM foods in a developing country.

Determinants of Public Attitudes to Genetically Modified Salmon

PubMed Central

Amin, Latifah; Azad, Md. Abul Kalam; Gausmian, Mohd Hanafy; Zulkifli, Faizah

2014-01-01

The objective of this paper is to assess the attitude of Malaysian stakeholders to genetically modified (GM) salmon and to identify the factors that influence their acceptance of GM salmon using a structural equation model. A survey was carried out on 434 representatives from various stakeholder groups in the Klang Valley region of Malaysia. Public attitude towards GM salmon was measured using self-developed questionnaires with seven-point Likert scales. The findings of this study have confirmed that public attitudes towards GM salmon is a complex issue and should be seen as a multi-faceted process. The most important direct predictors for the encouragement of GM salmon are the specific application-linked perceptions about religious acceptability of GM salmon followed by perceived risks and benefits, familiarity, and general promise of modern biotechnology. Encouragement of GM salmon also involves the interplay among other factors such as general concerns of biotechnology, threatening the natural order of things, the need for labeling, the need for patenting, confidence in regulation, and societal values. The research findings can serve as a database that will be useful for understanding the social construct of public attitude towards GM foods in a developing country. PMID:24489695

Stakeholder appraisal of policy options for responding to obesity in Hungary.

PubMed

Horváth, Z; Pankotai, M G; Szabolcs, I

2007-05-01

Overweight and obesity increases risks for many diseases, while treating them is expensive. Trends in the prevalence of overweight and obesity over the last two decades indicate the need for urgent interventions. Several different kinds of interventions could modify the obesogenic environment. The aim of this study was to map which policy options will be acceptable and effective in Hungary. Interviews were conducted with 21 stakeholders representing a wide range of viewpoints to evaluate seven core and 13 discretionary policy options under different criteria. The 21 Hungarian participants used 92 appraisal criteria covering a wide range of issues. Efficacy, practical feasibility, social acceptability and societal benefits were widely judged more important than the costs of measures. Significant additional social and health benefits were anticipated from changes in transport and planning policies, but the cost to the public sector was considered high and the implementation difficult. There was broad support for changes in patterns of food consumption and levels of physical activity. There was a consensus that without developing the attitudes of individuals to be more responsible for their health, environmental changes alone would not be enough to reverse the trend of the growing prevalence of obesity.

Framework for Architecture Trade Study Using MBSE and Performance Simulation

NASA Technical Reports Server (NTRS)

Ryan, Jessica; Sarkani, Shahram; Mazzuchim, Thomas

2012-01-01

Increasing complexity in modern systems as well as cost and schedule constraints require a new paradigm of system engineering to fulfill stakeholder needs. Challenges facing efficient trade studies include poor tool interoperability, lack of simulation coordination (design parameters) and requirements flowdown. A recent trend toward Model Based System Engineering (MBSE) includes flexible architecture definition, program documentation, requirements traceability and system engineering reuse. As a new domain MBSE still lacks governing standards and commonly accepted frameworks. This paper proposes a framework for efficient architecture definition using MBSE in conjunction with Domain Specific simulation to evaluate trade studies. A general framework is provided followed with a specific example including a method for designing a trade study, defining candidate architectures, planning simulations to fulfill requirements and finally a weighted decision analysis to optimize system objectives.

Negotiating designs of multi-purpose reservoir systems in international basins

NASA Astrophysics Data System (ADS)

Geressu, Robel; Harou, Julien

2016-04-01

Given increasing agricultural and energy demands, coordinated management of multi-reservoir systems could help increase production without further stressing available water resources. However, regional or international disputes about water-use rights pose a challenge to efficient expansion and management of many large reservoir systems. Even when projects are likely to benefit all stakeholders, agreeing on the design, operation, financing, and benefit sharing can be challenging. This is due to the difficulty of considering multiple stakeholder interests in the design of projects and understanding the benefit trade-offs that designs imply. Incommensurate performance metrics, incomplete knowledge on system requirements, lack of objectivity in managing conflict and difficulty to communicate complex issue exacerbate the problem. This work proposes a multi-step hybrid multi-objective optimization and multi-criteria ranking approach for supporting negotiation in water resource systems. The approach uses many-objective optimization to generate alternative efficient designs and reveal the trade-offs between conflicting objectives. This enables informed elicitation of criteria weights for further multi-criteria ranking of alternatives. An ideal design would be ranked as best by all stakeholders. Resource-sharing mechanisms such as power-trade and/or cost sharing may help competing stakeholders arrive at designs acceptable to all. Many-objective optimization helps suggests efficient designs (reservoir site, its storage size and operating rule) and coordination levels considering the perspectives of multiple stakeholders simultaneously. We apply the proposed approach to a proof-of-concept study of the expansion of the Blue Nile transboundary reservoir system.

Diagnosis of sustainable collaboration in health promotion – a case study

PubMed Central

Leurs, Mariken TW; Mur-Veeman, Ingrid M; van der Sar, Rosalie; Schaalma, Herman P; de Vries, Nanne K

2008-01-01

Background Collaborations are important to health promotion in addressing multi-party problems. Interest in collaborative processes in health promotion is rising, but still lacks monitoring instruments. The authors developed the DIagnosis of Sustainable Collaboration (DISC) model to enable comprehensive monitoring of public health collaboratives. The model focuses on opportunities and impediments for collaborative change, based on evidence from interorganizational collaboration, organizational behavior and planned organizational change. To illustrate and assess the DISC-model, the 2003/2004 application of the model to the Dutch whole-school health promotion collaboration is described. Methods The study combined quantitative research, using a cross-sectional survey, with qualitative research using the personal interview methodology and document analysis. A DISC-based survey was sent to 55 stakeholders in whole-school health promotion in one Dutch region. The survey consisted of 22 scales with 3 to 8 items. Only scales with a reliability score of 0.60 were accepted. The analysis provided for comparisons between stakeholders from education, public service and public health. The survey was followed by approaching 14 stakeholders for a semi-structured DISC-based interview. As the interviews were timed after the survey, the interviews were used to clarify unexpected and unclear outcomes of the survey as well. Additionally, a DISC-based document analysis was conducted including minutes of meetings, project descriptions and correspondence with schools and municipalities. Results Response of the survey was 77% and of the interviews 86%. Significant differences between respondents of different domains were found for the following scales: organizational characteristics scale, the change strategies, network development, project management, willingness to commit and innovative actions and adaptations. The interviews provided a more specific picture of the state of the art of the studied collaboration regarding the DISC-constructs. Conclusion The DISC-model is more than just the sum of the different parameters provided in the literature on interorganizational collaboration, organization change, networking and setting-approaches. Monitoring a collaboration based on the DISC-model yields insight into windows of opportunity and current impediments for collaborative change. DISC-based monitoring is a promising strategy enabling project managers and social entrepreneurs to plan change management strategies systematically. PMID:18992132

Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing.

PubMed

Maguire, Erin; Hong, Paul; Ritchie, Krista; Meier, Jeremy; Archibald, Karen; Chorney, Jill

2016-11-04

To describe the process involved in developing a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. A paper-based decision aid prototype was developed using the framework proposed by the International Patient Decision Aids Standards Collaborative. The decision aid focused on two main treatment options: watchful waiting and adenotonsillectomy. Usability was assessed with parents of pediatric patients and providers with qualitative content analysis of semi-structured interviews, which included open-ended user feedback. A steering committee composed of key stakeholders was assembled. A needs assessment was then performed, which confirmed the need for a decision support tool. A decision aid prototype was developed and modified based on semi-structured qualitative interviews and a scoping literature review. The prototype provided information on the condition, risk and benefits of treatments, and values clarification. The prototype underwent three cycles of accessibility, feasibility, and comprehensibility testing, incorporating feedback from all stakeholders to develop the final decision aid prototype. A standardized, iterative methodology was used to develop a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. The decision aid prototype appeared feasible, acceptable and comprehensible, and may serve as an effective means of improving shared decision-making.

The Essential Elements of a Risk Governance Framework for Current and Future Nanotechnologies.

PubMed

Stone, Vicki; Führ, Martin; Feindt, Peter H; Bouwmeester, Hans; Linkov, Igor; Sabella, Stefania; Murphy, Finbarr; Bizer, Kilian; Tran, Lang; Ågerstrand, Marlene; Fito, Carlos; Andersen, Torben; Anderson, Diana; Bergamaschi, Enrico; Cherrie, John W; Cowan, Sue; Dalemcourt, Jean-Francois; Faure, Michael; Gabbert, Silke; Gajewicz, Agnieszka; Fernandes, Teresa F; Hristozov, Danail; Johnston, Helinor J; Lansdown, Terry C; Linder, Stefan; Marvin, Hans J P; Mullins, Martin; Purnhagen, Kai; Puzyn, Tomasz; Sanchez Jimenez, Araceli; Scott-Fordsmand, Janeck J; Streftaris, George; van Tongeren, Martie; Voelcker, Nicolas H; Voyiatzis, George; Yannopoulos, Spyros N; Poortvliet, P Marijn

2017-12-14

Societies worldwide are investing considerable resources into the safe development and use of nanomaterials. Although each of these protective efforts is crucial for governing the risks of nanomaterials, they are insufficient in isolation. What is missing is a more integrative governance approach that goes beyond legislation. Development of this approach must be evidence based and involve key stakeholders to ensure acceptance by end users. The challenge is to develop a framework that coordinates the variety of actors involved in nanotechnology and civil society to facilitate consideration of the complex issues that occur in this rapidly evolving research and development area. Here, we propose three sets of essential elements required to generate an effective risk governance framework for nanomaterials. (1) Advanced tools to facilitate risk-based decision making, including an assessment of the needs of users regarding risk assessment, mitigation, and transfer. (2) An integrated model of predicted human behavior and decision making concerning nanomaterial risks. (3) Legal and other (nano-specific and general) regulatory requirements to ensure compliance and to stimulate proactive approaches to safety. The implementation of such an approach should facilitate and motivate good practice for the various stakeholders to allow the safe and sustainable future development of nanotechnology. © 2017 Society for Risk Analysis.

Addressing Mental Health Needs: Perspectives from African Americans Living in the Rural South

PubMed Central

Haynes, Tiffany F.; Cheney, Ann; Sullivan, Greer; Bryant, Keneshia; Curran, Geoffrey; Olson, Mary; Cottoms, Naomi; Reaves, Christina

2017-01-01

OBJECTIVE Rural African Americans are disproportionately impacted by social stressors that place them at risk of developing psychiatric disorders. This study aims to understand mental health from the perspective of rural African American residents and other stakeholders in order to devise culturally acceptable treatment approaches. METHODS Seven focus groups (N=50) were conducted with four stakeholder groups. A semi-structured interview guide was used to elicit perspectives of mental health, mental health treatment, and ways to improve mental health within rural African American communities. Inductive analysis was used to identify emergent themes and develop a conceptual model grounded in the textual data. RESULTS Stressful living environments (e.g. impoverished communities) and broader community held beliefs (e.g. religious beliefs and mental health stigma) impacted not only perceptions of mental health but also contributed to barriers that impede mental health seeking. Participants also identified community level strategies that can be utilized to improve emotional wellness in rural African American communities. CONCLUSION Rural African Americans experience several barriers that impede treatment use. Strategies that include conceptualizing mental illness as a normal reaction to stressful living environments, the use of community-based mental health services, and providing mental health education to the general public may improve use of services in this population. PMID:28142389

Occupational Physicians’ Reasoning about Recommending Early Return to Work with Work Modifications

PubMed Central

Horppu, Ritva; Martimo, Kari-Pekka; Viikari-Juntura, Eira; Lallukka, Tea; MacEachen, Ellen

2016-01-01

Previous research indicates that work modifications can effectively enhance return to work (RTW) at an early stage of work disability. We aimed to examine how occupational physicians (OPs) reason about recommending early return to work (RTW) with work modifications. Pre-defined propositions regarding the use of work modifications in promoting early RTW were discussed in four focus groups with altogether 11 Finnish OPs. Discussions were audio recorded, and the transcribed data were analyzed using qualitative content analysis. Five different rationales for supporting early RTW were identified: to manage medical conditions, to enhance employee well-being, to help workplace stakeholders, to reduce costs to society, and to enhance OP’s own professional fulfillment. However, OPs identified situations and conditions in which early RTW may not be suitable. In addition, there were differences between the OPs in the interpretation of the rationales, suggesting variation in clinical practice. In conclusion, encouraging early RTW with work modifications was perceived by OPs as a meaningful task and, to a large extent, beneficial for employees and several stakeholders. However, this practice was not accepted without consideration to the RTW situation and context. If early RTW and work modifications are to be promoted, OPs should be offered education that addresses their views regarding this practice. PMID:27367908

A tall order on a tight timeframe: stakeholder perspectives on comparative effectiveness research using electronic clinical data.

PubMed

Holve, Erin; Lopez, Marianne Hamilton; Scott, Lisa; Segal, Courtney

2012-09-01

BACKGROUND & SIGNIFICANCE: The AcademyHealth Electronic Data Methods Forum aims to advance the national dialogue on the use of electronic clinical data (ECD) for comparative effectiveness research (CER), patient-centered outcomes research, and quality improvement by facilitating exchange and collaboration among eleven research projects and external stakeholders. AcademyHealth conducted a mixed-method needs assessment with the Electronic Data Methods Forum's key stakeholders to assess: stakeholder views on developing new infrastructure for CER using ECD; current gaps in knowledge with respect to CER; and expectations for a learning health system. AcademyHealth conducted 50 stakeholder interviews between August 2011 and November 2011 with participants from the following seven stakeholder groups: government, business/payer, industry, healthcare delivery, patient/consumer, nonprofit/policy and research. With input from key collaborators, AcademyHealth designed a semi-structured interview guide and a short survey. Reviewers used the qualitative data analysis software NVivo to code the transcripts and to identify and manage complex concepts. Quantitative data from the questionnaire has been integrated with the final analysis as relevant. The analysis of recurring concepts in the interviews focus on five central themes: stakeholders have substantial expectations for CER using ECD, both with respect to addressing the limitations of traditional research studies, and generating meaningful evidence for decision-making and improving patient outcomes; stakeholders are aware of many challenges related to implementing CER with ECD, including the need to develop appropriate governance, assess and manage data quality, and develop methods to address confounding in observational data; stakeholders continue to struggle to define 'patient-centeredness' in CER using ECD, adding complexity to attaining this goal; stakeholders express that improving translation and dissemination of CER, and how research can be 'useful' at the point of care, can help mitigate negative perceptions of the CER 'brand'; and stakeholders perceive a need for a substantial 'culture shift' to facilitate collaborative science and new ways of conducting biomedical and outcomes research. Many stakeholders proposed approaches or solutions they felt might address the challenges identified.

In the public interest: assessing expert and stakeholder influence in public deliberation about biobanks.

PubMed

MacLean, Samantha; Burgess, Michael M

2010-07-01

Providing technical and experiential information without overwhelming participants' perspectives presents a major challenge to public involvement in policy decisions. This article reports the design and analysis of a case study on incorporating expert and stakeholder knowledge without including them as deliberators, while supporting deliberative participants' ability to introduce and critically assess different perspectives. Analysis of audio-recorded deliberations illustrates how expert and stakeholder knowledge was cited, criticized and incorporated into deliberations. In conclusion, separating experts and stakeholders from deliberations may be an important prima facie principle when the goal is to enhance citizen representation on technical issues and related policy.

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition

PubMed Central

O'Brien, Nicola; Heaven, Ben; Teal, Gemma; Evans, Elizabeth H; Cleland, Claire; Moffatt, Suzanne; Sniehotta, Falko F; White, Martin; Mathers, John C

2016-01-01

Background Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible. PMID:27489143

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition.

PubMed

O'Brien, Nicola; Heaven, Ben; Teal, Gemma; Evans, Elizabeth H; Cleland, Claire; Moffatt, Suzanne; Sniehotta, Falko F; White, Martin; Mathers, John C; Moynihan, Paula

2016-08-03

Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible.

Stakeholder management for conservation projects: a case study of Ream National Park, Cambodia.

PubMed

De Lopez, T T

2001-07-01

The paper gives an account of the development and implementation of a stakeholder management framework at Ream National Park, Cambodia. Firstly, the concept of stakeholder is reviewed in management and in conservation literatures. Secondly, the context in which the stakeholder framework was implemented is described. Thirdly, a five-step methodological framework is suggested: (1) stakeholder analysis, (2) stakeholder mapping, (3) development of generic strategies and workplan, (4) presentation of the workplan to stakeholders, and (5) implementation of the workplan. This framework classifies stakeholders according to their level of influence on the project and their potential for the conservation of natural resources. In a situation characterized by conflicting claims on natural resources, park authorities were able to successfully develop specific strategies for the management of stakeholders. The conclusion discusses the implications of the Ream experience and the generalization of the framework to other protected areas.

How stakeholder roles, power, and negotiation impact natural resource policy: A political economy view

USGS Publications Warehouse

Caughlan, L.

2002-01-01

Natural resource management decisions are complicated by multiple property rights, management objectives, and stakeholders with varying degrees of influence over the decision making process. In order to make efficient decisions, managers must incorporate the opinions and values of the involved stakeholders as well as understand the complex institutional constraints and opportunities that influence the decision-making process. Often this type of information is not understood until after a decision has been made, which can result in wasted time and effort.The purpose of my dissertation was to show how institutional frameworks and stakeholder involvement influence the various phases of the resource management decision-making process in a public choice framework. The intent was to assist decision makers and stakeholders by developing a methodology for formally incorporating stakeholders'' objectives and influence into the resource management planning process and to predict the potential success of rent-seeking activity based on stakeholder preferences and level of influence. Concepts from decision analysis, institutional analysis, and public choice economics were used in designing this interdisciplinary framework. The framework was then applied to an actual case study concerning elk and bison management on the National Elk Refuge and Grand Teton National Park near Jackson, Wyoming. The framework allowed for the prediction of the level of support and conflict for all relevant policy decisions, and the identification of each stakeholder''s level of support or opposition for each management decision.

Converting science to policy through stakeholder involvement: an analysis of the European Marine Strategy Directive.

PubMed

Fletcher, Stephen

2007-12-01

The Marine Strategy Directive requires European Union Member States to develop science-based marine strategies with the involvement of stakeholders, in order that Europe's marine environment reaches 'good environmental status' by 2021. The scientific requirements of marine strategies are clearly defined within the Directive, however, the requirements related to stakeholder involvement are not. This paper presents a critical analysis of the provisions for stakeholder involvement with in the Marine Strategy Directive. In particular, the paper is focused upon the definition of stakeholder, the sequencing of involvement, and the form and purpose of involvement. The critique is set within an evaluative framework that considers policy-making to be a social process, rather than a purely scientific one. It is concluded that the Marine Strategy Directive lacks coherency with respect to stakeholder involvement which may perpetuate the traditional tension between marine science and policy. This in turn may compromise the ability of the Directive to protect Europe's marine environment.

African stakeholders' views of research options to improve nutritional status in sub-Saharan Africa.

PubMed

Holdsworth, Michelle; Kruger, Annamarie; Nago, Eunice; Lachat, Carl; Mamiro, Peter; Smit, Karlien; Garimoi-Orach, Chris; Kameli, Yves; Roberfroid, Dominique; Kolsteren, Patrick

2015-09-01

Setting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders' views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years. Using Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa. Impact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries. Research funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective community nutrition interventions. Expanding research funding in behavioural and ecological nutrition was also valued and require multi-disciplinary collaborations between nutritionists, social scientists, agricultural and climate change scientists. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Criteria for the prioritization of public health interventions for climate-sensitive vector-borne diseases in Quebec.

PubMed

Hongoh, Valerie; Gosselin, Pierre; Michel, Pascal; Ravel, André; Waaub, Jean-Philippe; Campagna, Céline; Samoura, Karim

2017-01-01

Prioritizing resources for optimal responses to an ever growing list of existing and emerging infectious diseases represents an important challenge to public health. In the context of climate change, there is increasing anticipated variability in the occurrence of infectious diseases, notably climate-sensitive vector-borne diseases. An essential step in prioritizing efforts is to identify what considerations and concerns to take into account to guide decisions and thus set disease priorities. This study was designed to perform a comprehensive review of criteria for vector-borne disease prioritization, assess their applicability in a context of climate change with a diverse cross-section of stakeholders in order to produce a baseline list of considerations to use in this decision-making context. Differences in stakeholder choices were examined with regards to prioritization of these criteria for research, surveillance and disease prevention and control objectives. A preliminary list of criteria was identified following a review of the literature. Discussions with stakeholders were held to consolidate and validate this list of criteria and examine their effects on disease prioritization. After this validation phase, a total of 21 criteria were retained. A pilot vector-borne disease prioritization exercise was conducted using PROMETHEE to examine the effects of the retained criteria on prioritization in different intervention domains. Overall, concerns expressed by stakeholders for prioritization were well aligned with categories of criteria identified in previous prioritization studies. Weighting by category was consistent between stakeholders overall, though some significant differences were found between public health and non-public health stakeholders. From this exercise, a general model for climate-sensitive vector-borne disease prioritization has been developed that can be used as a starting point for further public health prioritization exercises relating to research, surveillance, and prevention and control interventions in a context of climate change. Multi-stakeholder engagement in prioritization can help broaden the range of criteria taken into account, offer opportunities for early identification of potential challenges and may facilitate acceptability of any resulting decisions.

Measuring biotechnology employees' ethical attitudes towards a controversial transgenic cattle project: the ethical valance matrix.

PubMed

Small, Bruce H; Fisher, Mark W

2005-01-01

What is the relationship between biotechnology employees' beliefs about the moral outcomes of a controversial transgenic research project and their attitudes of acceptance towards the project? To answer this question, employees (n=466) of a New Zealand company, AgResearch Ltd., were surveyed regarding a project to create transgenic cattle containing a synthetic copy of the human myelin basic protein gene (hMBP). Although diversity existed amongst employees' attitudes of acceptance, they were generally: in favor of the project, believed that it should be allowed to proceed to completion, and that it is acceptable to use transgenic cattle to produce medicines for humans. These three items were aggregated to form a project acceptance score. Scales were developed to measure respondents' beliefs about the moral outcomes of the project for identified stakeholders in terms of the four principles of common morality (benefit, non-harm, justice, and autonomy). These data were statistically aggregated into an Ethical Valence Matrix fo the project. The respondents' project Ethical Valence Scores correlated significantly with their project acceptance scores (r=0.64, p<0.001), accounting for 41% of the variance in respondents' acceptance attitudes. Of the four principles, non-harm had the strongest correlation with attitude to the project (r=0.59), followed by benefit and justice (both r=0.54), then autonomy (r=0.44). These results indicate that beliefs about the moral outcomes of a research project, in terms of the four principles approach, are strongly related to, and may be significant determinants of, attitudes to the research project. This suggests that, for employees of a biotechnology organization, ethical reasoning could be a central mechanism for the evaluation of the acceptability of a project. We propose that the Ethical Valence Matrix may be used as a tool to measure ethical attitudes towards controversial issues, providing a metric for comparison of perceived ethical consequences for multiple stakeholder groups and for the evaluation and comparison of the ethical consequences of competing alternative issues or projects. The tool could be used to measure both public and special interest groups' ethical attitudes and results used for the development of socially responsible policy or by science organizations as a democratizing decision aid to selection amongst projects competing for scarce research funds.

Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania.

PubMed

Mutero, Clifford M; Kramer, Randall A; Paul, Christopher; Lesser, Adriane; Miranda, Marie Lynn; Mboera, Leonard E G; Kiptui, Rebecca; Kabatereine, Narcis; Ameneshewa, Birkinesh

2014-08-08

Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST). Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate. Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides. Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.

PubMed

Stergiopoulos, Vicky; Saab, Dima; Francombe Pridham, Kate; Aery, Anjana; Nakhost, Arash

2018-01-24

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation. We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis. Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions. Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Evidence for informing health policy development in Low-income Countries (LICs): perspectives of policy actors in Uganda.

PubMed

Nabyonga-Orem, Juliet; Mijumbi, Rhona

2015-03-08

Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors' views regarding what evidence they deemed appropriate to guide health policy development. Using exploratory qualitative methods, we conducted interviews with 51 key informants using an in-depth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. What LICs like Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making. © 2015 by Kerman University of Medical Sciences.

A Model for Stakeholders' Influence on Internationalization: A Contribution from the Portuguese, Brazilian, and Dutch Cases

ERIC Educational Resources Information Center

Castro, Rita; Rosa, Maria João; Pinho, Carlos

2015-01-01

This article aims to discuss stakeholders' influence on higher education institutions' (HEIs) internationalization, through an analysis of the relationships established between stakeholders' importance and the institutions' rationales for internationalization, the strategies developed for internationalization, and the benefits from…

How acceptable is paternalism? A survey-based study of clinician and nonclinician opinions on paternalistic decision making.

PubMed

Bailoor, Kunal; Valley, Thomas; Perumalswami, Chithra; Shuman, Andrew G; DeVries, Raymond; Zahuranec, Darin B

2018-01-01

We conducted an empirical study to explore clinician and lay opinions on the acceptability of physician paternalism. Respondents read a vignette describing a patient with brain hemorrhage facing urgent surgery that would be lifesaving but would result in long-term severe disability. Cases were randomized to show either low or high surrogate distress and certain or uncertain prognosis, with respondents rating the acceptability of not offering brain surgery. Clinicians (N = 169) were more likely than nonclinicians (N = 649) to find the doctor withholding surgery acceptable (30.2% vs. 11.4%, p ≤ 0.001). Among clinicians, the doctor withholding surgery was more acceptable when prognosis was certain to be poor (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.04, 4.01). There was no effect of surrogate distress on clinician ratings. Responses among lay public were more variable. Given the differences in attitudes across clinicians and lay public, there is an ongoing need to engage stakeholders in the process of end-of-life decision making.

Coast Guard Proceedings. Volume 70, Number 3, Fall 2013

DTIC Science & Technology

2013-01-01

author. Beach areas support recreation, culture, tourism , and provide opportunities for the public to connect with the ocean. U.S. Coast Guard photo...involvement — including the public, tribal leaders, industry, nonprofit and private groups, energy, rec- reational and commercial fishing, tourism ...industry, tourism , and energy). for marine planning to succeed, stakeholders must accept the planning goals. Additionally, long-term goals and visions

The evolution of sustainable remediation in Australia and New Zealand: A storyline.

PubMed

Smith, Garry; Nadebaum, Peter

2016-12-15

This article describes the 'storyline' of the early and recent growth of sustainable remediation (SR) practice in Australia and New Zealand (ANZ), in order to inform and support other SR stakeholders, and to identify some lessons learned. Achievement of full acceptance and consistency across relevant ANZ regulatory jurisdictions and industry sectors will take time and will require publication of successful examples of SR application. The article describes the respective policy and regulatory contexts for sustainable remediation practice in Australia and in New Zealand; several milestone activities and events in the growth of SR in ANZ; and example SR methodologies and policies produced by stakeholders and remediation practitioners including the Sustainable Remediation Forum of Australia and New Zealand (SuRF ANZ). Copyright © 2016 Elsevier Ltd. All rights reserved.

Addressing the Need for Independence in the CSE Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abercrombie, Robert K; Ferragut, Erik M; Sheldon, Frederick T

2011-01-01

Abstract Information system security risk, defined as the product of the monetary losses associated with security incidents and the probability that they occur, is a suitable decision criterion when considering different information system architectures. Risk assessment is the widely accepted process used to understand, quantify, and document the effects of undesirable events on organizational objectives so that risk management, continuity of operations planning, and contingency planning can be performed. One technique, the Cyberspace Security Econometrics System (CSES), is a methodology for estimating security costs to stakeholders as a function of possible risk postures. In earlier works, we presented a computationalmore » infrastructure that allows an analyst to estimate the security of a system in terms of the loss that each stakeholder stands to sustain, as a result of security breakdowns. Additional work has applied CSES to specific business cases. The current state-of-the-art of CSES addresses independent events. In typical usage, analysts create matrices that capture their expert opinion, and then use those matrices to quantify costs to stakeholders. This expansion generalizes CSES to the common real-world case where events may be dependent.« less

The demonstration of a theory-based approach to the design of localized patient safety interventions

PubMed Central

2013-01-01

Background There is evidence of unsafe care in healthcare systems globally. Interventions to implement recommended practice often have modest and variable effects. Ideally, selecting and adapting interventions according to local contexts should enhance effects. However, the means by which this can happen is seldom systematic, based on theory, or made transparent. This work aimed to demonstrate the applicability, feasibility, and acceptability of a theoretical domains framework implementation (TDFI) approach for co-designing patient safety interventions. Methods We worked with three hospitals to support the implementation of evidence-based guidance to reduce the risk of feeding into misplaced nasogastric feeding tubes. Our stepped process, informed by the TDF and key principles from implementation literature, entailed: involving stakeholders; identifying target behaviors; identifying local factors (barriers and levers) affecting behavior change using a TDF-based questionnaire; working with stakeholders to generate specific local strategies to address key barriers; and supporting stakeholders to implement strategies. Exit interviews and audit data collection were undertaken to assess the feasibility and acceptability of this approach. Results Following audit and discussion, implementation teams for each Trust identified the process of checking the positioning of nasogastric tubes prior to feeding as the key behavior to target. Questionnaire results indicated differences in key barriers between organizations. Focus groups generated innovative, generalizable, and adaptable strategies for overcoming barriers, such as awareness events, screensavers, equipment modifications, and interactive learning resources. Exit interviews identified themes relating to the benefits, challenges, and sustainability of this approach. Time trend audit data were collected for 301 patients over an 18-month period for one Trust, suggesting clinically significant improved use of pH and documentation of practice following the intervention. Conclusions The TDF is a feasible and acceptable framework to guide the implementation of patient safety interventions. The stepped TDFI approach engages healthcare professionals and facilitates contextualization in identifying the target behavior, eliciting local barriers, and selecting strategies to address those barriers. This approach may be of use to implementation teams and policy makers, although our promising findings confirm the need for a more rigorous evaluation; a balanced block evaluation is currently underway. PMID:24131864

Speech-language pathology teletherapy in rural and remote educational settings: Decreasing service inequities.

PubMed

Fairweather, Glenn Craig; Lincoln, Michelle Ann; Ramsden, Robyn

2016-12-01

The objectives of this study were to investigate the efficacy of a speech-language pathology teletherapy program for children attending schools and early childcare settings in rural New South Wales, Australia, and their parents' views on the program's feasibility and acceptability. Nineteen children received speech-language pathology sessions delivered via Adobe Connect®, Facetime © or Skype © web-conferencing software. During semi-structured interviews, parents (n = 5) described factors that promoted or threatened the program's feasibility and acceptability. Participation in a speech-language pathology teletherapy program using low-bandwidth videoconferencing improved the speech and language skills of children in both early childhood settings and primary school. Emergent themes related to (a) practicality and convenience, (b) learning, (c) difficulties and (d) communication. Treatment outcome data and parental reports verified that the teletherapy service delivery was feasible and acceptable. However, it was also evident that regular discussion and communication between the various stakeholders involved in teletherapy programs may promote increased parental engagement and acceptability.

Investigating IT Faculty Resistance to Learning Management System Adoption Using Latent Variables in an Acceptance Technology Model.

PubMed

Bousbahi, Fatiha; Alrazgan, Muna Saleh

2015-01-01

To enhance instruction in higher education, many universities in the Middle East have chosen to introduce learning management systems (LMS) to their institutions. However, this new educational technology is not being used at its full potential and faces resistance from faculty members. To investigate this phenomenon, we conducted an empirical research study to uncover factors influencing faculty members' acceptance of LMS. Thus, in the Fall semester of 2014, Information Technology faculty members were surveyed to better understand their perceptions of the incorporation of LMS into their courses. The results showed that personal factors such as motivation, load anxiety, and organizational support play important roles in the perception of the usefulness of LMS among IT faculty members. These findings suggest adding these constructs in order to extend the Technology acceptance model (TAM) for LMS acceptance, which can help stakeholders of the university to implement the use of this system. This may assist in planning and evaluating the use of e-learning.

Investigating IT Faculty Resistance to Learning Management System Adoption Using Latent Variables in an Acceptance Technology Model

PubMed Central

Bousbahi, Fatiha; Alrazgan, Muna Saleh

2015-01-01

To enhance instruction in higher education, many universities in the Middle East have chosen to introduce learning management systems (LMS) to their institutions. However, this new educational technology is not being used at its full potential and faces resistance from faculty members. To investigate this phenomenon, we conducted an empirical research study to uncover factors influencing faculty members' acceptance of LMS. Thus, in the Fall semester of 2014, Information Technology faculty members were surveyed to better understand their perceptions of the incorporation of LMS into their courses. The results showed that personal factors such as motivation, load anxiety, and organizational support play important roles in the perception of the usefulness of LMS among IT faculty members. These findings suggest adding these constructs in order to extend the Technology acceptance model (TAM) for LMS acceptance, which can help stakeholders of the university to implement the use of this system. This may assist in planning and evaluating the use of e-learning. PMID:26491712

The impact of stakeholder involvement in hospital policy decision-making: a study of the hospital's business processes.

PubMed

Malfait, Simon; Van Hecke, Ann; Hellings, Johan; De Bodt, Griet; Eeckloo, Kristof

2017-02-01

In many health care systems, strategies are currently deployed to engage patients and other stakeholders in decisions affecting hospital services. In this paper, a model for stakeholder involvement is presented and evaluated in three Flemish hospitals. In the model, a stakeholder committee advises the hospital's board of directors on themes of strategic importance. To study the internal hospital's decision processes in order to identify the impact of a stakeholder involvement committee on strategic themes in the hospital decision processes. A retrospective analysis of the decision processes was conducted in three hospitals that implemented a stakeholder committee. The analysis consisted of process and outcome evaluation. Fifteen themes were discussed in the stakeholder committees, whereof 11 resulted in a considerable change. None of these were on a strategic level. The theoretical model was not applied as initially developed, but was altered by each hospital. Consequentially, the decision processes differed between the hospitals. Despite alternation of the model, the stakeholder committee showed a meaningful impact in all hospitals on the operational level. As a result of the differences in decision processes, three factors could be identified as facilitators for success: (1) a close interaction with the board of executives, (2) the inclusion of themes with a more practical and patient-oriented nature, and (3) the elaboration of decisions on lower echelons of the organization. To effectively influence the organization's public accountability, hospitals should involve stakeholders in the decision-making process of the organization. The model of a stakeholder committee was not applied as initially developed and did not affect the strategic decision-making processes in the involved hospitals. Results show only impact at the operational level in the participating hospitals. More research is needed connecting stakeholder involvement with hospital governance.

New Superintendents: Trust, Networking, and Social Capital

ERIC Educational Resources Information Center

Ripley, Joan; Mitchell, Roxanne M.; Richman, John A.

2013-01-01

This instrumental case study explored how five newly appointed superintendents identified key stakeholders and built trust and social capital with stakeholders in their districts. Stakeholder, trust, and social capital theory were the lenses that guided this study. We utilized a pragmatic research design and thematic data analysis to interpret our…

A Methodological Framework to Analyze Stakeholder Preferences and Propose Strategic Pathways for a Sustainable University

ERIC Educational Resources Information Center

Turan, Fikret Korhan; Cetinkaya, Saadet; Ustun, Ceyda

2016-01-01

Building sustainable universities calls for participative management and collaboration among stakeholders. Combining analytic hierarchy and network processes (AHP/ANP) with statistical analysis, this research proposes a framework that can be used in higher education institutions for integrating stakeholder preferences into strategic decisions. The…

Value of decision analysis in stakeholder interactions for the restoration and recovery from the Gulf of Mexico oil spill

EPA Science Inventory

The importance of stakeholder involvement in the management of watersheds is receiving greater recognition than in the past; however, interacting with stakeholders is frequently accomplished using informal procedures. It is essential to structure elicitations so that they can be ...

The Process, Outcomes, and Challenges of Feasibility Studies Conducted in Partnership With Stakeholders: A Health Intervention for Women Survivors of Intimate Partner Violence

PubMed Central

Wuest, Judith; Merritt-Gray, Marilyn; Dubé, Norma; Hodgins, Marilyn J; Malcolm, Jeannie; Majerovich, Jo Ann; Scott-Storey, Kelly; Ford-Gilboe, Marilyn; Varcoe, Colleen

2015-01-01

Feasibility studies play a crucial role in determining whether complex, community-based interventions should be subject to efficacy testing. Reports of such studies often focus on efficacy potential but less often examine other elements of feasibility, such as acceptance by clients and professionals, practicality, and system integration, which are critical to decisions for proceeding with controlled efficacy testing. Although stakeholder partnership in feasibility studies is widely suggested to facilitate the research process, strengthen relevance, and increase knowledge transfer, little is written about how this occurs or its consequences and outcomes. We began to address these gaps in knowledge in a feasibility study of a health intervention for women survivors of intimate partner violence (IPV) conducted in partnership with policy, community and practitioner stakeholders. We employed a mixed-method design, combining a single-group, pre-post intervention study with 52 survivors of IPV, of whom 42 completed data collection, with chart review data and interviews of 18 purposefully sampled participants and all 9 interventionists. We assessed intervention feasibility in terms of acceptability, demand, practicality, implementation, adaptation, integration, and efficacy potential. Our findings demonstrate the scope of knowledge attainable when diverse elements of feasibility are considered, as well as the benefits and challenges of partnership. The implications of diverse perspectives on knowledge transfer are discussed. Our findings show the importance of examining elements of feasibility for complex community-based health interventions as a basis for determining whether controlled intervention efficacy testing is justified and for refining both the intervention and the research design. © 2015 The Authors. Research in Nursing & Health published by Wiley Periodicals, Inc. PMID:25594917

Community-centred eco-bio-social approach to control dengue vectors: an intervention study from Myanmar

PubMed Central

Wai, Khin Thet; Htun, Pe Than; Oo, Tin; Myint, Hla; Lin, Zaw; Kroeger, Axel; Sommerfeld, Johannes; Petzold, Max

2012-01-01

Objectives To build up and analyse the feasibility, process, and effectiveness of a partnership-driven ecosystem management intervention in reducing dengue vector breeding and constructing sustainable partnerships among multiple stakeholders. Methods A community-based intervention study was conducted from May 2009 to January 2010 in Yangon city. Six high-risk and six low-risk clusters were randomized and allocated as intervention and routine service areas, respectively. For each cluster, 100 households were covered. Bi-monthly entomological evaluations (i.e. larval and pupal surveys) and household acceptability surveys at the end of 6-month intervention period were conducted, supplemented by qualitative evaluations. Intervention description The strategies included eco-friendly multi-stakeholder partner groups (Thingaha) and ward-based volunteers, informed decision-making of householders, followed by integrated vector management approach. Findings Pupae per person index (PPI) decreased at the last evaluation by 5.7% (0.35–0.33) in high-risk clusters. But in low-risk clusters, PPI remarkably decreased by 63.6% (0.33–0.12). In routine service area, PPI also decreased due to availability of Temephos after Cyclone Nargis. As for total number of pupae in all containers, when compared to evaluation 1, there was a reduction of 18.6% in evaluation 2 and 44.1% in evaluation 3 in intervention area. However, in routine service area, more reduction was observed. All intervention tools were found as acceptable, being feasible to implement by multi-stakeholder partner groups. Conclusions The efficacy of community-controlled partnership-driven interventions was found to be superior to the vertical approach in terms of sustainability and community empowerment. PMID:23318238

Community-centred eco-bio-social approach to control dengue vectors: an intervention study from Myanmar.

PubMed

Wai, Khin Thet; Htun, Pe Than; Oo, Tin; Myint, Hla; Lin, Zaw; Kroeger, Axel; Sommerfeld, Johannes; Petzold, Max

2012-12-01

To build up and analyse the feasibility, process, and effectiveness of a partnership-driven ecosystem management intervention in reducing dengue vector breeding and constructing sustainable partnerships among multiple stakeholders. A community-based intervention study was conducted from May 2009 to January 2010 in Yangon city. Six high-risk and six low-risk clusters were randomized and allocated as intervention and routine service areas, respectively. For each cluster, 100 households were covered. Bi-monthly entomological evaluations (i.e. larval and pupal surveys) and household acceptability surveys at the end of 6-month intervention period were conducted, supplemented by qualitative evaluations. Intervention description: The strategies included eco-friendly multi-stakeholder partner groups (Thingaha) and ward-based volunteers, informed decision-making of householders, followed by integrated vector management approach. Pupae per person index (PPI) decreased at the last evaluation by 5·7% (0·35-0·33) in high-risk clusters. But in low-risk clusters, PPI remarkably decreased by 63·6% (0·33-0·12). In routine service area, PPI also decreased due to availability of Temephos after Cyclone Nargis. As for total number of pupae in all containers, when compared to evaluation 1, there was a reduction of 18·6% in evaluation 2 and 44·1% in evaluation 3 in intervention area. However, in routine service area, more reduction was observed. All intervention tools were found as acceptable, being feasible to implement by multi-stakeholder partner groups. The efficacy of community-controlled partnership-driven interventions was found to be superior to the vertical approach in terms of sustainability and community empowerment.

Uncertainty in Bioenergy Scenarios for California: Lessons Learned in Communicating with Different Stakeholder Groups

NASA Astrophysics Data System (ADS)

Youngs, H.

2013-12-01

Projecting future bioenergy use involves incorporating several critical inter-related parameters with high uncertainty. Among these are: technology adoption, infrastructure and capacity building, investment, political will, and public acceptance. How, when, where, and to what extent the various bioenergy options are implemented has profound effects on the environmental impacts incurred. California serves as an interesting case study for bioenergy implementation because it has very strong competing forces that can influence these critical factors. The state has aggressive greenhouse gas reduction goals, which will require some biofuels, and has invested accordingly on new technology. At the same time, political will and public acceptance of bioenergy has wavered, seriously stalling bioenergy expansion efforts. We have constructed scenarios for bioenergy implementation in California to 2050, in conjunction with efforts to reach AB32 GHG reduction goals of 80% below 1990 emissions. The state has the potential to produce 3 to 10 TJ of biofuels and electricity; however, this potential will be severely limited in some scenarios. This work examines sources of uncertainty in bioenergy implementation, how uncertainty is or is not incorporated into future bioenergy scenarios, and what this means for assessing environmental impacts. How uncertainty is communicated and perceived also affects future scenarios. Often, there is a disconnect between scenarios for widespread implementation and the actual development of individual projects, resulting in "artificial uncertainty" with very real impacts. Bringing stakeholders to the table is only the first step. Strategies to tailor and stage discussions of uncertainty to stakeholder groups is equally important. Lessons learned in the process of communicating the Calfornia's Energy Future biofuels assessment will be discussed.

Prioritization in comparative effectiveness research: the CANCERGEN Experience.

PubMed

Thariani, Rahber; Wong, William; Carlson, Josh J; Garrison, Louis; Ramsey, Scott; Deverka, Patricia A; Esmail, Laura; Rangarao, Sneha; Hoban, Carolyn J; Baker, Laurence H; Veenstra, David L

2012-05-01

Systematic approaches to stakeholder-informed research prioritization are a central focus of comparative effectiveness research. Genomic testing in cancer is an ideal area to refine such approaches given rapid innovation and potentially significant impacts on patient outcomes. To develop and pilot test a stakeholder-informed approach to prioritizing genomic tests for future study in collaboration with the cancer clinical trials consortium SWOG. We conducted a landscape analysis to identify genomic tests in oncology using a systematic search of published and unpublished studies, and expert consultation. Clinically valid tests suitable for evaluation in a comparative study were presented to an external stakeholder group. Domains to guide the prioritization process were identified with stakeholder input, and stakeholders ranked tests using multiple voting rounds. A stakeholder group was created including representatives from patient-advocacy groups, payers, test developers, regulators, policy makers, and community-based oncologists. We identified 9 domains for research prioritization with stakeholder feedback: population impact; current standard of care, strength of association; potential clinical benefits, potential clinical harms, economic impacts, evidence of need, trial feasibility, and market factors. The landscape analysis identified 635 studies; of 9 tests deemed to have sufficient clinical validity, 6 were presented to stakeholders. Two tests in lung cancer (ERCC1 and EGFR) and 1 test in breast cancer (CEA/CA15-3/CA27.29) were identified as top research priorities. Use of a diverse stakeholder group to inform research prioritization is feasible in a pragmatic and timely manner. Additional research is needed to optimize search strategies, stakeholder group composition, and integration with existing prioritization mechanisms.

Prioritization in Comparative Effectiveness Research: The CANCERGEN Experience in Cancer Genomics

PubMed Central

Thariani, Rahber; Wong, William; Carlson, Josh J; Garrison, Louis; Ramsey, Scott; Deverka, Patricia A; Esmail, Laura; Rangarao, Sneha; Hoban, Carolyn J; Baker, Laurence H; Veenstra, David L

2012-01-01

Background Systematic approaches to stakeholder-informed research prioritization are a central focus of comparative effectiveness research. Genomic testing in cancer is an ideal area to refine such approaches given rapid innovation and potentially significant impacts on patient outcomes. Objective To develop and pilot-test a stakeholder-informed approach to prioritizing genomic tests for future study in collaboration with the cancer clinical trials consortium SWOG. Methods We conducted a landscape-analysis to identify genomic tests in oncology using a systematic search of published and unpublished studies, and expert consultation. Clinically valid tests suitable for evaluation in a comparative study were presented to an external stakeholder group. Domains to guide the prioritization process were identified with stakeholder input, and stakeholders ranked tests using multiple voting rounds. Results A stakeholder group was created including representatives from patient-advocacy groups, payers, test developers, regulators, policy-makers, and community-based oncologists. We identified nine domains for research prioritization with stakeholder feedback: population impact; current standard of care, strength of association; potential clinical benefits, potential clinical harms, economic impacts, evidence of need, trial feasibility, and market factors. The landscape-analysis identified 635 studies; of 9 tests deemed to have sufficient clinical validity, 6 were presented to stakeholders. Two tests in lung cancer (ERCC1 and EGFR) and one test in breast cancer (CEA/CA15-3/CA27.29) were identified as top research priorities. Conclusions Use of a diverse stakeholder group to inform research prioritization is feasible in a pragmatic and timely manner. Additional research is needed to optimize search strategies, stakeholder group composition and integration with existing prioritization mechanisms. PMID:22274803

Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector.

PubMed

Buhagiar, Mark A; Naylor, Justine M; Simpson, Grahame; Harris, Ian A; Kohler, Friedbert

2017-06-19

To understand private consumer and clinician preferences towards different rehabilitation modes following knee or hip arthroplasty, and identify factors which influence the chosen rehabilitation pathway. Mixed methods cross-sectional study involving 95 semi-structured interviews of consumers (patients and carers) and clinicians (arthroplasty surgeons, physiotherapists and rehabilitation physicians) in Sydney, Australia, during 2014-2015. Participants were asked about the acceptability of different modes of rehabilitation provision, and factors influencing their chosen rehabilitation pathway. Interviews were in person or via the telephone. Qualitative analysis software was used to electronically manage qualitative data. An analytical approach guided data analysis. Pre-operative preferences strongly influenced the type of rehabilitation chosen by consumers. Key factors that influenced this were both intrinsic and extrinsic, including; the previous experience of self or known others, the perceived benefits of the chosen mode, a sense of entitlement, the role of orthopaedic surgeons and influence of patient preference, a patient's clinical status post-surgery, the private hospital business model and insurance provider involvement. The acceptability of rehabilitation modes varied between clinician groups. No one rehabilitation mode provided following arthroplasty is singularly preferred by stakeholders. Factors other than the belief that a particular mode was more effective than another appear to dominate the pathway followed by private arthroplasty consumers, indicating evidence-based policies around rehabilitation provision may have limited appeal in the private sector.

Stakeholders' perspectives on social participation in preschool children with Autism Spectrum Disorder.

PubMed

Germani, Tamara; Zwaigenbaum, Lonnie; Magill-Evans, Joyce; Hodgetts, Sandy; Ball, Geoff

2017-11-01

To determine (a) the essential components of social participation for preschool children with Autism Spectrum Disorder (ASD) using stakeholders' perspectives and (b) the facilitators and barriers experienced in promoting social participation. A mixed-methods, web-based survey utilizing the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) taxonomy was circulated across Canada through purposeful snowball sampling. Frequency analysis of the combined responses of 74 stakeholders revealed the most essential components of social participation were: (a) behavior management, (b) social interactions, and (c) various types of play. Further, content analysis revealed that stakeholders used intrinsic motivation strategies and contingency management to facilitate social participation. Stakeholders reported that the purpose of social participation was to engage the child in fun, enjoyable social activities that developed relationships between the child and peers and created a sense of belonging in the community.

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery.

PubMed

Orlowski, Simone; Lawn, Sharon; Matthews, Ben; Venning, Anthony; Wyld, Kaisha; Jones, Gabrielle; Winsall, Megan; Antezana, Gaston; Schrader, Geoffrey; Bidargaddi, Niranjan

2016-10-10

Digital technologies show promise for reversing poor engagement of youth (16-24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. The literature in this field, however, fails to adequately capture the perspectives of the youth mental health workforce regarding utility and acceptability of technology for this purpose. This paper describes results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff (n = 4 focus groups; n = 8 interviews) and analysed via inductive thematic analysis. Results question the acceptability of technology to engage clients within youth mental health services. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy. These findings deepen the understanding of risks and challenges faced when adopting new technologies in mental healthcare. Recommendations for technology design and implementation in mental health services are made.

Integrated Reporting as a Tool for Communicating with Stakeholders - Advantages and Disadvantages

NASA Astrophysics Data System (ADS)

Matuszyk, Iwona; Rymkiewicz, Bartosz

2018-03-01

Financial and non-financial reporting from the beginning of its existence is the primary source of communication between the company and a wide range of stakeholders. Over the decades it has adapted to the needs of rapidly changing business and social environment. Currently, the final link in the evolution of organizational reporting, such as integrated reporting, assumes integration and mutual connectivity to both financial and non-financial data. The main interest in the concept of integrated reporting comes from the value it contributes to the organization. Undoubtedly, the concept of integrated reporting is a milestone in the evolution of organizational reporting. It is however important to consider whether it adequately addresses the information needs of a wide range of stakeholders, and whether it is a universal tool for communication between the company and its stakeholders. The aim of the paper is to discuss the advantages and disadvantages of the concept of integrated reporting as a tool for communication with stakeholders and to further directions of its development. The article uses the research methods such as literature analysis, the content analysis of the corporate publications and comparative analysis.

The potential role of taxes and subsidies on food in the prevention of obesity in Europe.

PubMed

González-Zapata, Laura Inés; Alvarez-Dardet, Carlos; Millstone, Erik; Clemente-Gómez, Vicente; Holdsworth, Michelle; Ortiz-Moncada, Rocio; Lobstein, Tim; Sarri, Katerina; De Marchi, Bruna; Horvath, Katalin Z

2010-08-01

Obesity implies costs not only for the individual but also for society. The authors explore the opinions of stakeholders on the potential of taxes or subsidies, as measures for tackling obesity in Europe. Structured interviews were conducted using Multicriteria Mapping, a computer-based, decision-support tool, with 189 interviewees drawn from 21 different stakeholder categories across nine members of the EU interviews, to appraise 20 predefined policy options aimed at reducing obesity, including 'taxing obesity-promoting foods' and 'subsidising healthy foods.' A four-step approach involved selecting options, defining criteria, scoring options quantitatively and weighting criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. Compared with other policy options appraised, taxation and subsidies were not favourably received, mainly because they were considered difficult to implement. Overall, trade unions rated both options more favourably than all other stakeholder groups. As anticipated, both options received their lowest scores from representatives of the farming, food processing and advertising industries. Nutritional/obesity advisory experts and public sector caterers gave the most positive ratings to subsidies overall. Along with public health professionals, large commercial retailers were most in favour of taxation. Taxation and subsidies were poorly appraised compared with other policy measures, with stakeholders expressing reservations mainly focussed on the practicalities and cost of introducing such measures. Although applying taxes/subsidies could be useful to combat obesity, the study suggests that most stakeholders still need to be convinced of their viability and acceptability when compared with other measures.

Stakeholder Participation in Freshwater Monitoring and Evaluation Programs: Applying Thresholds of Potential Concern within Environmental Flows

NASA Astrophysics Data System (ADS)

Conallin, John; McLoughlin, Craig A.; Campbell, Josh; Knight, Roger; Bright, Troy; Fisher, Ian

2018-03-01

The complex nature of freshwater systems provides challenges for incorporating evidence-based techniques into management. This paper investigates the potential of participatory evidence-based techniques to involve local stakeholders and make decisions based on different "knowledge" sources within adaptive management programs. It focuses on the application of thresholds of potential concern (TPC) within strategic adaptive management (SAM) for facilitating inclusive decision-making. The study is based on the case of the Edward-Wakool (E-W) "Fish and Flows" SAM project in the Murray-Darling River Basin, Australia. We demonstrate the application of TPCs for improving collaborative decision-making within the E-W, associated with environmental watering requirements, and other natural resource management programs such as fish stocking. The development of TPCs in the E-W fish and flows SAM project helped improve stakeholder involvement and understanding of the system, and also the effectiveness of the implemented management interventions. TPCs ultimately helped inform environmental flow management activities. The TPC process complemented monitoring that was already occurring in the system and provided a mechanism for linking formal and informal knowledge to form explicit and measurable endpoints from objectives. The TPC process faced challenges due to the perceived reduction in scientific rigor within initial TPC development and use. However, TPCs must remain tangible to managers and other stakeholders, in order to aid in the implementation of adaptive management. Once accepted by stakeholders, over time TPCs should be reviewed and refined in order to increase their scientific rigor, as new information is generated.

Influences on parental acceptance of HPV vaccination in demonstration projects in Uganda and Vietnam.

PubMed

Galagan, Sean R; Paul, Proma; Menezes, Lysander; LaMontagne, D Scott

2013-06-26

This study investigates the effect of communication strategies on human papillomavirus (HPV) vaccine uptake in HPV vaccine demonstration projects in Uganda and Vietnam. Secondary analysis was conducted on data from surveys of a representative sample of parents and guardians of girls eligible for HPV vaccine, measuring three-dose coverage achieved in demonstration projects in 2008-2010. Univariate and multivariate logistic regression analysis calculated the unadjusted and adjusted odds of receiving at least one dose of HPV vaccine depending on exposure to community influencers; information, education, and communication (IEC) channels; and demographic factors. This study found that exposure to community influencers was associated with HPV vaccine uptake in a multivariate model controlling for other factors. Exposure to non-interactive IEC channels was only marginally associated with HPV vaccine uptake. These results underscore the need of HPV vaccine programs in low- and middle-income countries to involve and utilize key community influencers and stakeholders to maximize HPV vaccine uptake. Copyright © 2013 Elsevier Ltd. All rights reserved.

Improving sustainability by technology assessment and systems analysis: the case of IWRM Indonesia

NASA Astrophysics Data System (ADS)

Nayono, S.; Lehmann, A.; Kopfmüller, J.; Lehn, H.

2016-09-01

To support the implementation of the IWRM-Indonesia process in a water scarce and sanitation poor region of Central Java (Indonesia), sustainability assessments of several technology options of water supply and sanitation were carried out based on the conceptual framework of the integrative sustainability concept of the German Helmholtz association. In the case of water supply, the assessment was based on the life-cycle analysis and life-cycle-costing approach. In the sanitation sector, the focus was set on developing an analytical tool to improve planning procedures in the area of investigation, which can be applied in general to developing and newly emerging countries. Because sanitation systems in particular can be regarded as socio-technical systems, their permanent operability is closely related to cultural or religious preferences which influence acceptability. Therefore, the design of the tool and the assessment of sanitation technologies took into account the views of relevant stakeholders. The key results of the analyses are presented in this article.

Using canonical correlation analysis to identify environmental attitude groups: considerations for national forest planning in the southwestern U.S.

PubMed

Prera, Alejandro J; Grimsrud, Kristine M; Thacher, Jennifer A; McCollum, Dan W; Berrens, Robert P

2014-10-01

As public land management agencies pursue region-specific resource management plans, with meaningful consideration of public attitudes and values, there is a need to characterize the complex mix of environmental attitudes in a diverse population. The contribution of this investigation is to make use of a unique household, mail/internet survey data set collected in 2007 in the Southwestern United States (Region 3 of the U.S. Forest Service). With over 5,800 survey responses to a set of 25 Public Land Value statements, canonical correlation analysis is able to identify 7 statistically distinct environmental attitudinal groups. We also examine the effect of expected changes in regional demographics on overall environmental attitudes, which may help guide in the development of socially acceptable long-term forest management policies. Results show significant support for conservationist management policies and passive environmental values, as well as a greater role for stakeholder groups in generating consensus for current and future forest management policies.

Home medication support for childhood cancer: family-centered design and testing.

PubMed

Walsh, Kathleen E; Biggins, Colleen; Blasko, Deb; Christiansen, Steven M; Fischer, Shira H; Keuker, Christopher; Klugman, Robert; Mazor, Kathleen M

2014-11-01

Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study. Copyright © 2014 by American Society of Clinical Oncology.

Dynamic simulation modelling of policy responses to reduce alcohol-related harms: rationale and procedure for a participatory approach.

PubMed

Atkinson, Jo-An; O'Donnell, Eloise; Wiggers, John; McDonnell, Geoff; Mitchell, Jo; Freebairn, Louise; Indig, Devon; Rychetnik, Lucie

2017-02-15

Development of effective policy responses to address complex public health problems can be challenged by a lack of clarity about the interaction of risk factors driving the problem, differing views of stakeholders on the most appropriate and effective intervention approaches, a lack of evidence to support commonly implemented and acceptable intervention approaches, and a lack of acceptance of effective interventions. Consequently, political considerations, community advocacy and industry lobbying can contribute to a hotly contested debate about the most appropriate course of action; this can hinder consensus and give rise to policy resistance. The problem of alcohol misuse and its associated harms in New South Wales (NSW), Australia, provides a relevant example of such challenges. Dynamic simulation modelling is increasingly being valued by the health sector as a robust tool to support decision making to address complex problems. It allows policy makers to ask 'what-if' questions and test the potential impacts of different policy scenarios over time, before solutions are implemented in the real world. Participatory approaches to modelling enable researchers, policy makers, program planners, practitioners and consumer representatives to collaborate with expert modellers to ensure that models are transparent, incorporate diverse evidence and perspectives, are better aligned to the decision-support needs of policy makers, and can facilitate consensus building for action. This paper outlines a procedure for embedding stakeholder engagement and consensus building in the development of dynamic simulation models that can guide the development of effective, coordinated and acceptable policy responses to complex public health problems, such as alcohol-related harms in NSW.

What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders' views.

PubMed

Pound, Pandora; Denford, Sarah; Shucksmith, Janet; Tanton, Clare; Johnson, Anne M; Owen, Jenny; Hutten, Rebecca; Mohan, Leanne; Bonell, Chris; Abraham, Charles; Campbell, Rona

2017-07-02

Sex and relationship education (SRE) is regarded as vital to improving young people's sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation. This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations. Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide. Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a 'life skills' approach and not focus on abstinence. Young people advocated a 'sex-positive' approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence. We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Counting the Homeless: A Previously Incalculable Tuberculosis Risk and Its Social Determinants

PubMed Central

Teeter, Larry D.; Musser, James M.; Graviss, Edward A.

2013-01-01

Tuberculosis (TB) surveillance among the homeless is not supported by the political will necessary for TB elimination. We merged the first stakeholder-accepted enumeration of homeless persons with existing surveillance data to assess TB risk among the homeless in Houston, Texas. The average incidence per 100 000 was 411 among homeless and 9.5 among housed persons. The homeless were more likely than the housed to be US-born, clustered, and in a larger-sized cluster. Multivariate analysis revealed that TB rates among the homeless were driven not by comorbidities but by social determinants. Homeless patients were hospitalized more days than the housed and required more follow-up time. Reporting of TB rates for populations with known health disparities could help reframe TB prevention and better target limited funds. PMID:23488504

Unfolding the values of work - therapists´ experience of addressing the return to work process in occupational rehabilitation based on Acceptance and Commitment Therapy.

PubMed

Klevanger, Nina E; Fimland, Marius S; Johnsen, Roar; Rise, Marit B

2018-04-27

Facilitating return to work can be challenging due to the complexity of work disability. Few studies have examined rehabilitation programs based on Acceptance and Commitment Therapy that intend to support return to work, and none have investigated therapists' experience with providing such programs. The aim of this study was therefore to explore therapists' experience of addressing the return to work process in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy. This was a qualitative interview study supported by participant observation. Therapists were interviewed regarding their experiences with addressing return to work in an inpatient occupational rehabilitation program based on Acceptance and Commitment Therapy. In addition, the rehabilitation program was investigated through participant observation. The interviews were analysed according to Interpretative Phenomenological Analysis and informed by an analysis of field notes from the participant observation. Acceptance and Commitment Therapy was experienced as a meaningful approach to facilitate return to work, as it allowed therapists to address all relevant aspects of the individual participant's life that might influence work participation. The therapists' twofold goal was to support participants in building both a meaningful life and sustainable work participation. To do so, they attempted to instil long-term and interrelated processes concerning ownership, causes of sick leave, relation to expectations, the values of work, and the scope of agency. Unfolding values connected to work participation might reconcile the tension between work and family life by integrating work with other areas of life. Providing work participation with personal meaning also seems especially commensurable with a context where economy presents a poor incentive for return to work. Therapists should, however, be attentive to the need to secure the prominence of return to work by relating participants' chosen themes explicitly to their return to work process. Therapists should also be aware of the dilemma that may arise when they attempt to refrain from providing advice while simultaneously encouraging actions they consider appropriate to facilitate sustainable work participation. In addition, having an individual-oriented approach to occupational rehabilitation may obscure the extent to which return to work is a multi-stakeholder process.

Understanding the perceptions, roles and interactions of stakeholder networks managing health-care waste: A case study of the Gaza Strip.

PubMed

Caniato, M; Tudor, T; Vaccari, M

2015-01-01

The sustainable management of waste requires a holistic approach involving a range of stakeholders. What can often be difficult is to understand the manner in which different types of stakeholder networks are composed and work, and how best to enhance their effectiveness. Using social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally while health-care facilities had a strong interest in waste management, they were generally poorly informed and had limited links to each other. The manner in which the networks operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. The lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management issues they were involved with, however segregation at the source was identified as a key requirement by most. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach served to raise interest and awareness at different levels (public authorities, health providers, supporting actors, others), stimulate the discussion about the adoption of specific policies, and identify the effective way forward. Copyright © 2014 Elsevier Ltd. All rights reserved.

Stakeholder engagement analysis - a bioethics dilemma in patient-targeted intervention: patients with temporomandibular joint disorders.

PubMed

Barkhordarian, Andre; Demerjian, Gary; Jan, Allison; Sama, Nateli; Nguyen, Mia; Du, Angela; Chiappelli, Francesco

2015-01-20

Modern health care in the field of Medicine, Dentistry and Nursing is grounded in fundamental philosophy and epistemology of translational science. Recently in the U.S major national initiatives have been implemented in the hope of closing the gaps that sometimes exist between the two fundamental components of translational science, the translational research and translational effectiveness. Subsequent to these initiatives, many improvements have been made; however, important bioethical issues and limitations do still exist that need to be addressed. One such issue is the stakeholder engagement and its assessment and validation. Federal, state and local organizations such as PCORI and AHRQ concur that the key to a better understanding of the relationship between translational research and translational effectiveness is the assessment of the extent to which stakeholders are actively engaged in the translational process of healthcare. The stakeholder engagement analysis identifies who the stakeholders are, maps their contribution and involvement, evaluates their priorities and opinions, and accesses their current knowledge base. This analysis however requires conceptualization and validation from the bioethics standpoint. Here, we examine the bioethical dilemma of stakeholder engagement analysis in the context of the person-environment fit (PE-fit) theoretical model. This model is an approach to quantifying stakeholder engagement analysis for the design of patient-targeted interventions. In our previous studies of Alzheimer patients, we have developed, validated and used a simple instrument based on the PE-fit model that can be adapted and utilized in a much less studied pathology as a clinical model that has a wide range of symptoms and manifestations, the temporomandibular joint disorders (TMD). The temporomandibular joint (TMJ) is the jaw joint endowed with sensory and motor innervations that project from within the central nervous system and its dysfunction can be manifested systemically in forms of movement disorders, and related pathological symptomatologies.Currently, there is limited reliable evidence available to fully understand the complexity of the various domains of translational effectiveness, particularly in the context of stakeholder engagement and its assessment, validation as well as the bioethical implications as they pertain to evidence-based, effectivness-focused and patient-centered care.

Players and processes behind the national health insurance scheme: a case study of Uganda

PubMed Central

2013-01-01

Background Uganda is the last East African country to adopt a National Health Insurance Scheme (NHIS). To lessen the inequitable burden of healthcare spending, health financing reform has focused on the establishment of national health insurance. The objective of this research is to depict how stakeholders and their power and interests have shaped the process of agenda setting and policy formulation for Uganda’s proposed NHIS. The study provides a contextual analysis of the development of NHIS policy within the context of national policies and processes. Methods The methodology is a single case study of agenda setting and policy formulation related to the proposed NHIS in Uganda. It involves an analysis of the real-life context, the content of proposals, the process, and a retrospective stakeholder analysis in terms of policy development. Data collection comprised a literature review of published documents, technical reports, policy briefs, and memos obtained from Uganda’s Ministry of Health and other unpublished sources. Formal discussions were held with ministry staff involved in the design of the scheme and some members of the task force to obtain clarification, verify events, and gain additional information. Results The process of developing the NHIS has been an incremental one, characterised by small-scale, gradual changes and repeated adjustments through various stakeholder engagements during the three phases of development: from 1995 to 1999; 2000 to 2005; and 2006 to 2011. Despite political will in the government, progress with the NHIS has been slow, and it has yet to be implemented. Stakeholders, notably the private sector, played an important role in influencing the pace of the development process and the currently proposed design of the scheme. Conclusions This study underscores the importance of stakeholder analysis in major health reforms. Early use of stakeholder analysis combined with an ongoing review and revision of NHIS policy proposals during stakeholder discussions would be an effective strategy for avoiding potential pitfalls and obstacles in policy implementation. Given the private sector’s influence on negotiations over health insurance design in Uganda, this paper also reviews the experience of two countries with similar stakeholder dynamics. PMID:24053551

Players and processes behind the national health insurance scheme: a case study of Uganda.

PubMed

Basaza, Robert K; O'Connell, Thomas S; Chapčáková, Ivana

2013-09-22

Uganda is the last East African country to adopt a National Health Insurance Scheme (NHIS). To lessen the inequitable burden of healthcare spending, health financing reform has focused on the establishment of national health insurance. The objective of this research is to depict how stakeholders and their power and interests have shaped the process of agenda setting and policy formulation for Uganda's proposed NHIS. The study provides a contextual analysis of the development of NHIS policy within the context of national policies and processes. The methodology is a single case study of agenda setting and policy formulation related to the proposed NHIS in Uganda. It involves an analysis of the real-life context, the content of proposals, the process, and a retrospective stakeholder analysis in terms of policy development. Data collection comprised a literature review of published documents, technical reports, policy briefs, and memos obtained from Uganda's Ministry of Health and other unpublished sources. Formal discussions were held with ministry staff involved in the design of the scheme and some members of the task force to obtain clarification, verify events, and gain additional information. The process of developing the NHIS has been an incremental one, characterised by small-scale, gradual changes and repeated adjustments through various stakeholder engagements during the three phases of development: from 1995 to 1999; 2000 to 2005; and 2006 to 2011. Despite political will in the government, progress with the NHIS has been slow, and it has yet to be implemented. Stakeholders, notably the private sector, played an important role in influencing the pace of the development process and the currently proposed design of the scheme. This study underscores the importance of stakeholder analysis in major health reforms. Early use of stakeholder analysis combined with an ongoing review and revision of NHIS policy proposals during stakeholder discussions would be an effective strategy for avoiding potential pitfalls and obstacles in policy implementation. Given the private sector's influence on negotiations over health insurance design in Uganda, this paper also reviews the experience of two countries with similar stakeholder dynamics.

Involvement of External Stakeholders in Local Health Policymaking Process: A Case Study from Odense Municipality, Denmark

ERIC Educational Resources Information Center

Karlsson, Leena Eklund; Jakobsen, Mette Winge; Winblad, Malin; Aro, Arja R.

2017-01-01

Collaboration between research and policy is an essential element for knowledge-based public health. However, only half of the Danish municipalities have experience with collaborating with researchers or other stakeholders. Through content analysis of interviews and policy documents the study explores the involvement of external stakeholders in…

Stakeholder Analysis in Higher Education: A Case Study of the University of Portsmouth

ERIC Educational Resources Information Center

Chapleo, Chris; Simms, Christopher

2010-01-01

The issue of stakeholder identification and management is relatively well understood in the literature for private sector organisations, and its importance is increasing across all developed countries. However, whilst stakeholder theory has been advanced in commercial arenas, there is less research in the public and non-profit areas, particularly…

Universal Health Insurance Coverage in Vietnam: A Stakeholder Analysis From Policy Proposal (1989) to Implementation (2014).

PubMed

Hoang, Chi K; Hill, Peter; Nguyen, Huong T

In 1989, health insurance (HI) was introduced in Vietnam and began to be implemented in 1992. There was limited progress until the 2014 Law on HI that was revised with the aim of universal health insurance coverage (UHIC) by 2020. This article explores stakeholder roles and positions from the initial introduction of HI to the implementation of the Master Plan accelerating UHIC. To better understand the influence of stakeholders in accelerating UHIC to achieve equity in health care. Using a qualitative study design, we conducted content analysis of HI-related documents and interviewed social security and health system key informants, government representatives, and community stakeholders to determine their positions and influence on UHIC. Our findings demonstrate different levels of support of stakeholders that influence in the HI formulation and implementation, from opposition when HI was first introduced in 1989 to collaboration of stakeholders from 2013 when the Master Plan for UHIC was implemented. Despite an initial failure to secure the support of the Parliament for a Law on HI, a subsequent series of alternative legislative strategies brought limited increases in HI coverage. With government financial subsidization, the involvement of multiple stakeholders, political commitment, and flexible working mechanisms among stakeholders have remained important, with an increasing recognition that HI is not only a technical aspect of the health system but also a broader socioeconomic and governance issue. The different levels of power and influence among stakeholders, together with their commercial and political interests and their different perceptions of HI, have influenced stakeholders' support or opposition to HI policies. Despite high-level policy support, stakeholders' positions may vary, depending on their perceptions of the policy implications. A shift in government stakeholder positions, especially at the provincial level, has been necessary to accelerate UHIC progress and build institutional capacity.

Trust build up and break down between stakeholders in water resource management

NASA Astrophysics Data System (ADS)

Carr, Gemma

2015-04-01

Trust is a word that is often heard in discussions about stakeholder participation in water management programmes and projects. A break down in trust between participants is often attributed to the failure of a project reaching its objectives. In contrast, the development of trust is often described as a success in itself, and is thought to lead to positive water management outcomes. To explore how trust impacts water management, this research explores the factors that led to trust development and break-down, and the implications of this, in a major stakeholder engagement project in water management in North America. A major review of the Lake Ontario and St Lawrence River water level operating system (the LOSL Study) was commissioned in 1999 by the International Joint Commission (IJC). The goal of the five-year LOSL Study was to produce an operating policy for the system that was acceptable to everyone impacted by the water levels and flows in the basin. Through public meetings and consultations, the Study aimed to bring together and combine public and scientist input to co-produce an operating policy that met the needs of all interest groups. Freely accessible documentation of the public involvement activities that took place is available, which is used to explore trust and mistrust development. Provisional findings show that some public/interest group representatives mistrusted the Study. This was related to concerns over data quality, whether appropriate indicators were selected by the researchers and whether the models used were producing accurate outputs. Scientist responses to questions at public meetings were able to address some of these concerns and therefore build trust in the methods, but could also lead to further mistrust if public concerns and questions were not addressed adequately (for example, simply dismissed as irrelevant by scientists without due explanation). The impacts of distrust between participants and scientists included apathy and low participant engagement and failure of some interest groups to accept the findings and recommendations produced by the study. An acceptable operating policy is yet to be identified by the IJC. Future work will explore how the empirical evidence from the LOSL study supports some of the theoretically expected benefits of trust (raised efficiency of cooperation because less time and resources are spent monitoring the actions of others, free and open dialogue that leads to more creative solutions, and greater acceptance of decisions and more efficient implementation of an agreed plan).

Identifying the causes, prevention and management of crises in dementia. An online survey of stakeholders.

PubMed

Ledgerd, Ritchard; Hoe, Juanita; Hoare, Zoë; Devine, Mike; Toot, Sandeep; Challis, David; Orrell, Martin

2016-06-01

Crisis situations in dementia can lead to hospital admission or institutionalisation. Offering immediate interventions may help avoid admission, whilst stabilising measures can help prevent future crises. Our objective was to identify the main causes of crisis and interventions to treat or prevent crisis in persons with dementia based on different stakeholder perspectives. An online questionnaire was developed to identify the causes of crisis and appropriate interventions in a crisis. Participants included people with dementia, family carers and staff working in health and social care, including emergency and voluntary sectors, and academia. The results ranked the main causes of crisis, interventions that can prevent a crisis and interventions that can be useful in a crisis. Wandering, falls and infection were highly rated as risk factors for crises across all stakeholder groups. Consumers rated aggression as less important but severity of memory impairment as much more important than the other groups did. Education and support for family carers and home care staff were highly valued for preventing crises. Well-trained home care staff, communication equipment, emergency contacts and access to respite were highly valued for managing crises. We identified triggers and interventions that different stakeholders see as important for crisis in dementia. Recognition of these may be critical to planning effective and accepted support and care for people with dementia. Copyright © 2015 John Wiley & Sons, Ltd.

Priority setting: what constitutes success? A conceptual framework for successful priority setting.

PubMed

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-03-05

The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts.

Using social network and stakeholder analysis to help evaluate infectious waste management: a step towards a holistic assessment.

PubMed

Caniato, Marco; Vaccari, Mentore; Visvanathan, Chettiyappan; Zurbrügg, Christian

2014-05-01

Assessing the strengths and weaknesses of a solid waste management scheme requires an accurate analysis and integration of several determining features. In addition to the technical aspects, any such system shows a complex interaction of actors with varying stakes, decision-making power and influence, as well as a favourable or disabling environment. When capitalizing on the knowledge and experience from a specific case, it is also crucial that experts do not "forget" or underestimate the importance of such social determinants and that they are familiar with the methods and tools to assess them. Social network analysis (SNA) and stakeholder analysis (SA) methods can be successfully applied to better understand actors' role and actions, analyse driving forces and existing coordination among stakeholders, as well as identify bottlenecks in communication which affect daily operations or strategic planning for the future way forward. SNA and SA, appropriately adjusted for a certain system, can provide a useful integration to methods by assessing other aspects to ensure a comprehensive picture of the situation. This paper describes how to integrate SNA and SA in order to survey a solid waste management system. This paper presents the results of an analysis of On-Nuch infectious waste incinerator in Bangkok, Thailand. Stakeholders were interviewed and asked to prioritize characteristics and relationships which they consider particularly important for system development and success of the scheme. In such a way, a large quantity of information about organization, communication between stakeholders and their perception about operation, environmental and health impact, and potential alternatives for the system was collected in a systematic way. The survey results suggest that stakeholders are generally satisfied with the system operation, though communication should be improved. Moreover, stakeholders should be strategically more involved in system development planning, according to their characteristics, to prevent negative reactions. Copyright © 2014 Elsevier Ltd. All rights reserved.

A total design and implementation of an intelligent mobile chemotherapy medication administration.

PubMed

Kuo, Ming-Chuan; Chang, Polun

2014-01-01

The chemotherapy medication administration is a process involved many stakeholders and efforts. Therefore, the information support system cannot be well designed if the entire process was not carefully examined and reengineered first. We, from a 805-teaching medical center, did a process reengineering and involved physicians, pharmacists and IT engineers to work together to design a mobile support solution. System was implemented in March to July, 2013. A 6" android handheld device with 1D BCR was used as the main hardware. 18 nurses were invited to evaluate their perceived acceptance of system based on Technology Acceptance Model for Mobile Service Model. Time saved was also calculated to measure the effectiveness of system. The results showed positive support from nurses. The estimated time saved every year was about 288 nursing days. We believe our mobile chemotherapy medication administration support system is successful in terms of acceptance and real impacts.

Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care.

PubMed

Ford, Cameron G; Manegold, Ellen M; Randall, Cameron L; Aballay, Ariel M; Duncan, Christina L

2018-06-01

Burn care often involves procedures that result in significant pain experiences for patients which, in turn, can lead to poorer physical and psychological health outcomes. Distraction and virtual reality (VR) are an effective adjunct to pharmacological interventions in reducing pain. Much of the research that has demonstrated efficacy for VR in burn care has involved expensive and extensive technology. Thus, identifying cost-effective, feasible, acceptable, and effective approaches to apply distraction within routine burn care is important. The objective of this mixed-methods study was to evaluate key stakeholder (i.e., patients, providers) perceptions of feasibility, acceptability, and effectiveness for the use of low-cost VR technology during routine burn care with adult patients. Ten adult patients used VR during burn care dressing changes in an outpatient clinic setting, after which they completed a satisfaction survey and individual qualitative interview. Providers also completed a satisfaction/perception survey after each participant's care. Quantitative and qualitative results from both patient and provider perspectives consistently supported the feasibility and utility of applying low-cost VR technology in this outpatient burn clinic setting. Special considerations (e.g., aspects to consider when choosing an apparatus or application) stemming from stakeholder feedback are discussed. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Stakeholders' analysis of the medical tourism industry: development strategies in Isfahan.

PubMed

Jabbari, Alireza; Ferdosi, Masoud; Keyvanara, Mahmoud; Agharahimi, Zahra

2013-01-01

Policy makers and decision makers must identify the stakeholders in medical tourism, who will be affected by and/or affect this industry, and determine their status for partnership. The aim of this study was to identify the main stakeholders in Isfahan's medical tourism, analyze them, and provide strategies for developing this industry. A qualitative study was conducted in 2011. At first, the key stakeholders in medical tourism were identified in accordance with the experts' idea and literature review. Then we interviewed the key stakeholders. Data analysis was conducted using the stakeholders' analyses, which helped in developing strategies. The result showed that the key stakeholders were made up of nine groups. They included the provincial governance of Isfahan, the Cultural Heritage and Tourism Organization of Isfahan, the Chamber of Commerce, the Medical Council, the Isfahan University of Medical Sciences, health service providers, tourism services providers, investors, and the Tosea Saderat Bank. The rate of knowledge of the Cultural Heritage and Tourism Organization of Isfahan, clinic and international relationship of Isfahan University of Medical Sciences from government policy about medical tourism were very much. Private Hospitals, the Medical Council, investors, and the University of Medical Sciences had great power. Private hospitals, clinics, the Cultural Heritage and Tourism Organization of Isfahan, and the University of Medical Sciences were in the supporter position. The effected strategies were the included strategies, focused on increasing power; increasing support, and on maintaining the position. There are different stakeholders in the medical tourism industry. Thus, policy makers can plan, make a policy and decision, and use effective strategies to develop medical tourism by designing a medical tourism stakeholders' network, a medical tourism provincial council, and clarify the roles and responsibilities of stakeholders.

Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia.

PubMed

Seale, Holly; Sitaresmi, Mei Neni; Atthobari, Jarir; Heywood, Anita E; Kaur, Rajneesh; MacIntyre, Raina C; Soenarto, Yati; Padmawati, Retna Siwi

2015-11-30

Rotavirus has been identified as the most common pathogen associated with severe diarrhoea. Two effective vaccines against the pathogen have been licensed. However, many countries including Indonesia have yet to introduce the vaccine into their national immunisation programs. This study aimed to examine the attitudes of healthcare providers (HCPs) and other health stakeholders towards the pathogen and the vaccine. Semi-structured in-depth interviews were undertaken in two districts of Yogyakarta Province, Indonesia with nurses, midwives, primary care providers, pediatricians and other health stakeholders. Thematic analysis was undertaken. Fourteen interviews were conducted between August and October 2013. We identified that while participants do not consider diarrhea to be an important problem in Indonesia, they do acknowledge that it can be serious if not properly treated. While the majority had some level of knowledge about rotavirus, not all participants knew that a vaccine was available. There were mixed feelings towards the need for the vaccine. Some felt that the vaccine is not ranked as a priority as it is not listed on the national program. However, others agreed there is a rationale for its use in Indonesia. The cost of the vaccine (when sold in the private sector) was perceived to be the primary barrier impacting on its use. The high cost and the low priority given to this vaccine by the public health authorities are the biggest obstacles impacting on the acceptance of this vaccine in Indonesia. HCPs need to be reminded of the burden of disease associated with rotavirus. In addition, reminding providers about the costs associated with treating severe cases versus the costs associated with prevention may assist with improving the acceptance of HCPs towards the vaccine. Promotion campaigns need to target the range of HCPs involved in the provision of care to infants and pregnant women.

Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa

PubMed Central

van Heerden, Alastair; Harris, Danielle M.; van Rooyen, Heidi; Barnabas, Ruanne V.; Ramanathan, Nithya; Ngcobo, Nkosinathi; Mpiyakhe, Zukiswa; Comulada, W. Scott

2017-01-01

mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such systems are critical to the successful extension of the health system from health facilities into people’s homes. PMID:28475904

Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: Qualitative findings from health officials, community health workers, and persons living with HIV in South Africa.

PubMed

van Heerden, Alastair; Harris, Danielle M; van Rooyen, Heidi; Barnabas, Ruanne V; Ramanathan, Nithya; Ngcobo, Nkosinathi; Mpiyakhe, Zukiswa; Comulada, W Scott

2017-06-01

mHealth has been proposed to address inefficiencies in the current South African healthcare system, including home-based HIV testing and counseling (HTC) programs. Yet wide-scale adoption of mHealth has not occurred. Even as infrastructure barriers decrease, a need to better understand perceived adoption barriers by stakeholders remains. We conducted focus group discussions (FGD) in South Africa in 2016 with 10 home-based HTC field staff, 12 community health workers (CHWs) and 10 persons living with HIV (PLH). Key informant (KI) interviews were conducted with five health officials. Perceptions about current home-based HTC practices, future mHealth systems and the use of biometrics for patient identification were discussed, recorded and transcribed for qualitative analysis. Themes were based on a conceptual model for perceived mHealth service quality. Stakeholders brought up a lack of communication in sharing patient health information between clinics, between clinics and CHWs, and between clinics and patients as major barriers to care that mHealth can address. CHWs need better patient information from clinics in terms of physical location and health status to plan visitation routes and address patient needs. CHWs perceive that communication barriers create distrust towards them by clinic staff. PLH want automated appointment and medication reminders. KI see mHealth as a way to improve health information transfer to government officials to better allocate healthcare resources. Stakeholders are also optimistic about the ability for biometrics to improve patient identification but disagreed as to which biometrics would be acceptable, especially in older patients. All stakeholders provided useful information towards the development of mHealth systems. Hospitals are adopting patient-centered approaches that solicit feedback from patients and incorporate them into decision-making processes. A similar approach is needed in the development of mHealth systems. Further, such systems are critical to the successful extension of the health system from health facilities into people's homes. Copyright © 2017 Elsevier Ltd. All rights reserved.

The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry

PubMed Central

2011-01-01

Background Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process. Methods Several qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey. Findings The Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted. Conclusion The state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged. PMID:21923945

The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry.

PubMed

Higashi, Hideki; Khuong, Tuan A; Ngo, Anh D; Hill, Peter S

2011-09-18

Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process. Several qualitative methods were employed for the study including: literature review and documentary analysis; key informant interview; focus groups discussion; and key stakeholders survey. The Ministry of Health, Ministry of Trade and Industry, and Ministry of Finance are key players in the tobacco control policy and legislation, representing competing bureaucratic interests over health, macro-economy and revenue. High-ranking officials, including the Communist Party and National Assembly members, take a rather relaxed position reflecting the low political stakes placed on tobacco issues. The state-owned tobacco industry is regarded as an important contributor to the government revenue and gross domestic product, and the relative weight on health and socioeconomic issues placed by stakeholders determine their positions on tobacco control. Overall, short-term economic interests have more immediate influence in setting policy directions, with the consequences of health gains perceived as relegated to a distant future. This was reflected in the position of tobacco control advocates, including MOH, that presented with reluctance in insisting on some tobacco control strategies revealing a mixture attitude of concessions to the socioeconomic uncertainties and a sense of bargaining to win the strategies that are more likely to be accepted. The state-ownership of tobacco industry poses a major paradox within the government that benefits from manufacturing of tobacco products and is also responsible for controlling tobacco consumption. The perceptions of negative implications on government revenue and the macro-economy, coupled with the reluctance to challenge these issues from health perspective too directly, means that tobacco control has yet to secure itself a place on the priority policy agenda. The overall policy environment will shift in favour of tobacco control only if the economic framing can be challenged.

An organizational analysis of road traffic crash prevention to explain the difficulties of a national program in a low income country.

PubMed

Vogel, Tania; Reinharz, Daniel; Gripenberg, Marissa; Barennes, Hubert

2015-09-28

Road traffic crashes (RTC), that daily kill 3400 people and leave 15,000 with a permanent disability could be prevented through the implementation of safety programs developed in partnership with governments and institutions. The relationship between key stakeholders can be a crucial determinant to the effectiveness of road safety programs. This issue has rarely been addressed. We conducted a detailed organizational analysis of the stakeholders involved in road safety programs in Lao People's Democratic Republic (Lao PDR). A case study was performed. The framework used was a snowball effect in which the characterization of all key stakeholders and the links between them, as well as the factors that led to these links, were determined. The effect of the relations between key stakeholders on the prevention of RTC was assessed through an analysis of the transactional, intangible and controlling factors that influence these relationships. The design and implementation of road safety programs in Lao PDR suffer from weak relationships between stakeholders and a poorly functional bicephal leadership between the Ministry of Public Works and Transport and the non-governmental organisation called Handicap International. This poor coordination between key stakeholders is evident, particularly in the area of collective action and is reinforced by a lack of interest from several different stakeholders. Most agencies do not prioritize road safety. Uneven distribution of funding is another contributing factor. Strengthening the leadership is crucial to the success of the program. Some organisations have skills, power the decision making and the allocation of resources in regards to road safety programs. Encouraging participation of these organizations through a more prominent position would thus result in a better collaboration. Non-monetary rewards would further help to strengthen collaborative work. The bicephal nature of the leadership of road safety programs proves detrimental, is associated with a weak coalition between stakeholders, and contributes to the declaimed poor effectiveness of the existing programs. The study has identified non-monetary and realistic means of strengthening the collaboration between key stakeholders. Stakeholders need to revise their interpretive schemes, in order to actively support the reinforcement of government leadership of road safety policies.

Framing K-12 partnerships in order to make a difference.

PubMed

Hamos, James E

2006-06-01

The Health Professions Partnership Initiative (HPPI) furthered the establishment of partnerships between academic health centers and K-12 school systems. The present article contends that partnerships in efforts such as the HPPI exist in varying degrees of depth with deeper partnerships being those based in a concept of mutuality even as partners continue to maintain institutional identity. In the context of K-12 schools, the article reinforces the view that K-12 students, teachers, and administrators can benefit through partnership contexts, but also suggests that institutions of higher education-including academic health centers-should enter into partnerships because they benefit when they commit as stakeholders in the outcomes, not principally as altruistic good neighbors to the schools. Partnerships can continue to grow when multiple stakeholders accept mutual dependence as a norm, with goals, processes, and outcomes impacting each partner.

Development and successful application of a "Community-First" communication model for community-based environmental health research.

PubMed

Emmett, Edward Anthony; Zhang, Hong; Shofer, Frances Susan; Rodway, Nancy; Desai, Chintan; Freeman, David; Hufford, Mary

2009-02-01

Effectively communicate results from a community exposure study to meet predetermined community priorities, maintaining ethical principles of autonomy, empowerment and justice. The community established principles for the communications and a plan to inform study participants, community and other stakeholders of results and recommendations in a novel sequence: the "Community-First" communication model. The communications resulted in positive actions including company sponsored free bottled water, accepted by 77.6% of eligible households. Over 95% of participants in a follow-up survey had made some change to residential water supplies. Serum perfluorooctanoate levels were reduced. Government agencies acted on the results. The unique communication approach generated workable solutions to the problem investigated, raised community awareness and modified behaviors. Information generated a "free market" of community-level solutions. Each major stakeholder voluntarily adopted a "precautionary principle."

Analysis of stakeholders networks of infant and young child nutrition programmes in Sri Lanka, India, Nepal, Bangladesh and Pakistan.

PubMed

Uddin, Shahadat; Mahmood, Hana; Senarath, Upul; Zahiruddin, Quazi; Karn, Sumit; Rasheed, Sabrina; Dibley, Michael

2017-06-13

Effective public policies are needed to support appropriate infant and young child feeding (IYCF) to ensure adequate child growth and development, especially in low and middle income countries. The aim of this study was to: (i) capture stakeholder networks in relation to funding and technical support for IYCF policy across five countries in South Asia (i.e. Sri Lanka, India, Nepal, Bangladesh and Pakistan); and (ii) understand how stakeholder networks differed between countries, and identify common actors and their patterns in network engagement across the region. The Net-Map method, which is an interview-based mapping technique to visualise and capture connections among different stakeholders that collaborate towards achieving a focused goal, has been used to map funding and technical support networks in all study sites. Our study was conducted at the national level in Bangladesh, India, Nepal, and Sri Lanka, as well as in selected states or provinces in India and Pakistan during 2013-2014. We analysed the network data using a social network analysis software (NodeXL). The number of stakeholders identified as providing technical support was higher than the number of stakeholders providing funding support, across all study sites. India (New Delhi site - national level) site had the highest number of influential stakeholders for both funding (43) and technical support (86) activities. Among all nine study sites, India (New Delhi - national level) and Sri Lanka had the highest number of participating government stakeholders (22) in their respective funding networks. Sri Lanka also had the highest number of participating government stakeholders for technical support (34) among all the study sites. Government stakeholders are more engaged in technical support activities compared with their involvement in funding activities. The United Nations Children's Emergency Fund (UNICEF) and the World Health Organization (WHO) were highly engaged stakeholders for both funding and technical support activities across all study sites. International stakeholders were highly involved in both the funding and technical support activities related to IYCF practices across these nine study sites. Government stakeholders received more support for funding and technical support activities from other stakeholders compared with the support that they offered. Stakeholders were, in general, more engaged for technical support activities compared with the funding activities.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cox, Sadie

This fact sheet overviews the benefits of using the RE Data Explorer tool to analyze and develop renewable energy zones. Renewable energy zones are developed through a transmission planning and approval process customized for renewable energy. RE Data Explorer analysis can feed into broader stakeholder discussions and allow stakeholders to easily visualize potential zones. Stakeholders can access pertinent data to inform transmission planning and enable investment.

A Community Stakeholder Analysis of Drug Resistance Strategies of Rural Native Hawaiian Youth

ERIC Educational Resources Information Center

Okamoto, Scott K.; Helm, Susana; Delp, Justin A.; Stone, Kristina; Dinson, Ay-Laina; Stetkiewicz, Jennifer

2011-01-01

This study examines and validates the drug resistance strategies identified by rural Hawaiian youth from prior research with a sample of community stakeholders on the Island of Hawai'i. One hundred thirty-eight stakeholders with a vested interest in reducing youth substance use (i.e., teachers, principals, social service agency providers, and…

Does a One-Size-Fits-All Cost-Sharing Approach Incentivize Appropriate Medication Use? A Roundtable on the Fairness and Ethics Associated with Variable Cost Sharing.

PubMed

Graff, Jennifer S; Shih, Chuck; Barker, Thomas; Dieguez, Gabriela; Larson, Cheryl; Sherman, Helen; Dubois, Robert W

2017-06-01

Tiered formularies, in which patients pay copays or coinsurance out-of-pocket (OOP), are used to manage costs and encourage more efficient health care resource use. Formulary tiers are typically based on the cost of treatment rather than the medical appropriateness for the patient. Cost sharing may have unintended consequences on treatment adherence and health outcomes. Use of higher-cost, higher-tier medications can be due to a variety of factors, including unsuccessful treatment because of lack of efficacy or side effects, patient clinical or genetic characteristics, patient preferences to avoid potential side effects, or patient preferences based on the route of administration. For example, patients with rheumatoid arthritis may be required to fail low-cost generic treatments before obtaining coverage for a higher-tier tumor necrosis factor alpha inhibitor for which they would have a larger financial burden. Little is known about stakeholders' views on the acceptability of greater patient cost sharing if the individual patient characteristics lead to the higher-cost treatments. To identify and discuss the trade-offs associated with variable cost sharing in pharmacy benefits. To discuss the trade-offs associated with variable cost sharing in pharmacy benefits, we convened an expert roundtable of patient, payer, and employer representatives (panelists). Panelists reviewed background white papers, including an ethics framework; actuarial analysis; legal review; and stakeholder perspectives representing health plan, employer, and patient views. Using case studies, panelists were asked to consider (a) when it would be more (or less) acceptable to require higher cost sharing; (b) the optimal distribution of financial burdens across patients, all plan members, and employers; and (c) the existing barriers and potential solutions to align OOP costs with medically appropriate treatments. Panelists felt it was least acceptable for patients to have greater OOP costs if the use of the higher-cost treatment was due to biological reasons such as step therapy (6 = unacceptable, 9 = neutral, 2 = acceptable) or diagnostic results (5 = unacceptable, 10 = neutral, and 2 = acceptable). In contrast, panelists felt it was more acceptable for patients to pay greater OOP costs when treatment choice was based on preferences to avoid a side-effect risk (1 = unacceptable, 3 = neutral, and 13 = acceptable) or the route/frequency of administration (1 = unacceptable, 1 = neutral, and 15 = acceptable). Five guiding principles emerged from the discussion: When patients have tried lower-cost therapies unsuccessfully, the benefits of higher-cost treatments were certain and significant, the cost difference between treatments was aligned with improved benefits, and penalties due to bad luck were mitigated, then cost-sharing differences should be minimized but not eliminated. Patient OOP costs can affect the use of both inappropriate and appropriate medications. This study identified 5 guiding principles to determine when it was more (or less) acceptable for patients with the same or similar conditions to have different OOP costs. Barriers that hinder the alignment of care and patient cost sharing exist. Policies that facilitate the alignment of patient cost sharing with appropriate care are needed. Funding for this roundtable was provided by the National Pharmaceutical Council (NPC). Graff and Dubois are employed by the NPC. Shih was employed by the NPC at the time of this study. Barker, Dieguez, Sherman, and Larson received consulting fees for participation in this study. Larson also reports receiving grants and other payment from multiple major pharmaceutical manufacturers outside of this study. The NPC employees developed the study design and chose the case studies in collaboration with the white paper authors. The roundtable was facilitated by Dubois, and the meeting summary and manuscript were written by Graff and Shih, with revisions by all roundtable participants. The abstract for this article was previously presented as a poster at the following meetings: Stakeholder perspectives on balancing patient-centeredness and drug costs in the design of pharmacy benefits. Presented at: Academy of Managed Care Pharmacy 27th Annual Meeting & Expo; San Diego, California; April 8, 2015. Considering efficiency and fairness in the design of prescription drug benefits: seeking a balanced approach to improve patient access to medically appropriate medication and manage drug costs. Presented at: AcademyHealth Annual Research Meeting; Minneapolis, Minnesota; June 15, 2015. Study concept and design were contributed by Shih, Dubois, and Graff, along with Barker and Dieguez. Barker and Dieguez took the lead in data collection, assisted by Graff, Shih, and Dubois. Data interpretation was performed by Shih, Larson, Sherman, and Graff, with assistance from Dubois. The manuscript was written and revised by Graff and Shih, with assistance from the other authors.

Cultural context of school communities in rural Hawaii to inform youth violence prevention.

PubMed

Affonso, Dyanne D; Mayberry, Linda; Shibuya, June Y; Archambeau, Olga G; Correa, Mary; Deliramich, Aimee N; Frueh, B Christopher

2010-03-01

Escalation of youth violence within a large geographic school-complex area in southeastern rural Hawaii became a major problem in 2006. How cultural forces impact the problem was an impetus to examine youth violence from perspectives of adults and children in rural communities. Gathering these data was an essential first step toward school-based youth violence prevention program development. Eight focus groups involving 86 community stakeholders included 51 adults (parent, teachers, school staff, community leaders) and 35 children aged 8-15 years old (3rd- to 10-th grade). Qualitative narrative analysis elicited major themes. Five themes emerged: (1) School-community violence takes on many forms that become entrenched in local culture. (2) Disintegration of community resources and a sense of learned helplessness underlie the escalation of youth violence. (3) Inadequate role modeling coupled with behavioral ambivalence among adults has sustained a climate of local cultural acceptance with youth violence. (4) Connection to cultural values has diminished, leading to a sense of loss in cultural identity among students. (5) Cultural values and practices are potential strategies for youth violence prevention. Cultural and community contextual factors contributed to youth violence in rural Hawaiian communities. Study implications include the need to further investigate the impact of vigilant, community involvement of stakeholders in school-based youth violence prevention program development. Cultural revitalization at family, school, and community levels may be critical success factors of such programs.

Analyzing the social factors that influence willingness to pay for invasive alien species management under two different strategies: eradication and prevention.

PubMed

García-Llorente, Marina; Martín-López, Berta; Nunes, Paulo A L D; González, José A; Alcorlo, Paloma; Montes, Carlos

2011-09-01

Biological invasions occur worldwide, and have been the object of ecological and socio-economic research for decades. However, the manner in which different stakeholder groups identify the problems associated with invasive species and confront invasive species management under different policies remains poorly understood. In this study, we conducted an econometric analysis of the social factors influencing willingness to pay for invasive alien species management under two different regimes: eradication and prevention in the Doñana Natural Protected Area (SW Spain). Controlling for the participation of local residents, tourists and conservationists, email and face-to-face questionnaires were conducted. Results indicated that respondents were more willing to pay for eradication than prevention; and public support for invasive alien species management was influenced by an individual's knowledge and perception of invasive alien species, active interest in nature, and socio-demographic attributes. We concluded that invasive alien species management research should confront the challenges to engage stakeholders and accept any tradeoffs necessary to modify different conservation policies to ensure effective management is implemented. Finally, our willingness to pay estimates suggest the Department of Environment of Andalusian Government has suitable social support to meet the budgetary expenditures required for invasive alien species plans and adequate resources to justify an increase in the invasive alien species management budget.

Analyzing the Social Factors That Influence Willingness to Pay for Invasive Alien Species Management Under Two Different Strategies: Eradication and Prevention

NASA Astrophysics Data System (ADS)

García-Llorente, Marina; Martín-López, Berta; Nunes, Paulo A. L. D.; González, José A.; Alcorlo, Paloma; Montes, Carlos

2011-09-01

Biological invasions occur worldwide, and have been the object of ecological and socio-economic research for decades. However, the manner in which different stakeholder groups identify the problems associated with invasive species and confront invasive species management under different policies remains poorly understood. In this study, we conducted an econometric analysis of the social factors influencing willingness to pay for invasive alien species management under two different regimes: eradication and prevention in the Doñana Natural Protected Area (SW Spain). Controlling for the participation of local residents, tourists and conservationists, email and face-to-face questionnaires were conducted. Results indicated that respondents were more willing to pay for eradication than prevention; and public support for invasive alien species management was influenced by an individual's knowledge and perception of invasive alien species, active interest in nature, and socio-demographic attributes. We concluded that invasive alien species management research should confront the challenges to engage stakeholders and accept any tradeoffs necessary to modify different conservation policies to ensure effective management is implemented. Finally, our willingness to pay estimates suggest the Department of Environment of Andalusian Government has suitable social support to meet the budgetary expenditures required for invasive alien species plans and adequate resources to justify an increase in the invasive alien species management budget.

Perspectives of key stakeholders and experts in infant feeding on the implementation of the Australian National Breastfeeding Strategy 2010-2015.

PubMed

Hull, Naomi S; Schubert, Lisa C; Smith, Julie P

2017-03-01

Breastfeeding is widely accepted as an important public health issue for babies and their mothers. Yet, despite this, Australia continues to struggle with reaching global targets for breastfeeding indicators. In 2007, the Best Start Parliamentary Inquiry Report was released and set the stage for the Australian National Breastfeeding Strategy [2010-2015), which was announced in November 2009, with the vision to increase Australia's breastfeeding rates of infants at 6 months of age and beyond. The aim of this research project was to explore the perspectives of key stakeholders in the field of infant feeding in Australia on the implementation of the strategy, barriers and enablers to its successful implementation and actions that were still needed. Using qualitative research methods of in-depth, semi-structured interviews and thematic analysis, this study identifies main themes of these perceptions about the strategy implementation and some recommendations for future strategies and further research. The main themes identified were initial opinions of the strategy as a blueprint for action, the strategy as a driver for action, lessons learned and recommendations for the future. For success in improving implementation of national breastfeeding strategies, it is recommended that Australia establish an independent breastfeeding/infant feeding committee, increase the political prioritisation of issues surrounding infant feeding and strengthen the regulation of the marketing of breastmilk substitutes.

Decision support system for the operating room rescheduling problem.

PubMed

van Essen, J Theresia; Hurink, Johann L; Hartholt, Woutske; van den Akker, Bernd J

2012-12-01

Due to surgery duration variability and arrivals of emergency surgeries, the planned Operating Room (OR) schedule is disrupted throughout the day which may lead to a change in the start time of the elective surgeries. These changes may result in undesirable situations for patients, wards or other involved departments, and therefore, the OR schedule has to be adjusted. In this paper, we develop a decision support system (DSS) which assists the OR manager in this decision by providing the three best adjusted OR schedules. The system considers the preferences of all involved stakeholders and only evaluates the OR schedules that satisfy the imposed resource constraints. The decision rules used for this system are based on a thorough analysis of the OR rescheduling problem. We model this problem as an Integer Linear Program (ILP) which objective is to minimize the deviation from the preferences of the considered stakeholders. By applying this ILP to instances from practice, we determined that the given preferences mainly lead to (i) shifting a surgery and (ii) scheduling a break between two surgeries. By using these changes in the DSS, the performed simulation study shows that less surgeries are canceled and patients and wards are more satisfied, but also that the perceived workload of several departments increases to compensate this. The system can also be used to judge the acceptability of a proposed initial OR schedule.

Issues for interpreting external stakeholder feedback on restructuring NCIC's research programs.

PubMed

Ashbury, F D; Iverson, D C; Shephard, P J

1995-03-01

The National Cancer Institute of Canada surveyed members of its stakeholder groups on a number of issues pertaining to restructuring research programs. While it was hoped that the survey would ensure input from its primary stakeholder groups and thereby facilitate decision-making on critical issues like distribution of funds and research awards, there is reason to believe this may not have occurred. Some of the stakeholder groups seemed to be over-represented in the respondent population and the effect of this on the results was therefore examined. Analysis revealed several important issues: 1) a clear definition of who constitutes a "stakeholder" needs to be developed when stakeholder input-gathering is being contemplated; 2) multi-faceted strategies need to be developed to gain input from stakeholders; 3) potential sources of bias can emerge from the various techniques used to gather feedback from stakeholders; and 4) a clear outline of how the feedback is to be used in the decision-making process needs to be determined.

Waiting room time: An opportunity for parental oral health education.

PubMed

Soussou, Randa; Aleksejūnienė, Jolanta; Harrison, Rosamund

2017-09-14

The UBC Children's Dental Program (CDP) has provided free dental treatments to underserved low-income children, but its preventive component needs to be enhanced. The study aims were: 1) to develop a "waiting-room based" dental education program engaging caregivers of these children, and 2) to assess the program's feasibility, acceptability and effectiveness. In preparation, a situational analysis (SA) included structured interviews with caregivers, and with various stakeholders (e.g., dental students, instructors, health authority) involved in the CDP program. Based on the SA, caregiver-centered education was designed using an interactive power point presentation; after the presentation, each caregiver set personalized goals for modifying his/her child's dental behaviours. Evaluation of the program was done with follow-up telephone calls; the program's effectiveness was assessed by comparing before/after proportions of caregivers brushing their child's teeth, children brushing teeth in the morning and evening, children eating sugar-containing snacks, and children drinking sugar-containing drinks. The program proved to be easy to implement (feasible) and the recruitment rate was 99% (acceptable). The follow-up rate was 81%. The SA identified that the caregivers' knowledge about caries etiology and prevention was limited. All recruited caregivers completed the educational session and set goals for their family. The evaluation demonstrated an increase in caregiver-reported short-term diet and oral self-care behaviours of their children. A dental education program engaging caregivers in the waiting room was a feasible, acceptable and promising strategy for improving short-term dental behaviours of children.

A Practical Approach to Address Uncertainty in Stakeholder Deliberations.

PubMed

Gregory, Robin; Keeney, Ralph L

2017-03-01

This article addresses the difficulties of incorporating uncertainty about consequence estimates as part of stakeholder deliberations involving multiple alternatives. Although every prediction of future consequences necessarily involves uncertainty, a large gap exists between common practices for addressing uncertainty in stakeholder deliberations and the procedures of prescriptive decision-aiding models advanced by risk and decision analysts. We review the treatment of uncertainty at four main phases of the deliberative process: with experts asked to describe possible consequences of competing alternatives, with stakeholders who function both as individuals and as members of coalitions, with the stakeholder committee composed of all stakeholders, and with decisionmakers. We develop and recommend a model that uses certainty equivalents as a theoretically robust and practical approach for helping diverse stakeholders to incorporate uncertainties when evaluating multiple-objective alternatives as part of public policy decisions. © 2017 Society for Risk Analysis.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

PubMed

Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

2017-01-08

Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

Stakeholder Dialogue as Deliberation for Decision Making in Health Policy and Systems: The Approach from Argumentation Theory.

PubMed

Rubinelli, Sara; von Groote, Per Maximilian

2017-02-01

The literature on knowledge translation and dissemination in health care highlights the value of the stakeholder dialogue, namely, a structured process where stakeholders interact to identify the best solution to a given problem. By analyzing the stakeholder dialogue as a form of deliberative argumentation, this article identifies those factors that may hinder or facilitate reaching agreement among stakeholders on options to target problems. Conceptual analysis based on the descriptive and evaluation methods of argumentation theory. When stakeholders have a difference of opinion, confrontation alone does not lead to agreement. A normative model of critical discussion is needed to facilitate stakeholders in reaching this agreement and to prevent barriers to it that can result from personal factors (e.g., attitude and beliefs) or communication moves. This type of dialogue requires a training of stakeholders about the preconditions of argumentation and its different stages. The figure of the moderator is crucial in ensuring that the dialogue fulfills standards of reasonableness. This article offers a reading of the stakeholder dialogue rooted in the tradition of critical thinking. It instructs on how to promote a collaborative exchange among stakeholders as a way to go beyond any expression of views.

Farmers' markets' uptake of food assistance programmes in East Tennessee, USA.

PubMed

Russomanno, Jennifer; Jabson, Jennifer M

2016-10-01

Limited acceptance of government food assistance programmes such as the US Department of Agriculture's (USDA) Supplemental Nutrition Assistance Program (SNAP) is a barrier that produces unequal access to market products for SNAP beneficiaries. There is a dearth of published evidence to explain the limited SNAP acceptance at farmers' markets. The current project aimed to fill this gap; to identify and describe the barriers to markets' acceptance of SNAP. Cross-sectional, semi-structured interviews were conducted. All interviews were conducted via telephone. Twelve East Tennessee area market managers, vendors and other key stakeholders. Multiple barriers exist for SNAP implementation at markets including administrative and time limitations, prejudice from market vendors against SNAP beneficiaries, and resistance to invasive and burdensome requirements of the USDA SNAP application required for farmers' markets. SNAP acceptance at farmers' markets is a complex issue, especially for small, rural markets. If farmers' markets are to serve as sustainable resources to increase food access, these issues must be addressed so that SNAP can be accepted. Successful implementation of SNAP at rural markets requires increased administrative support and vendor education about SNAP and its beneficiaries. A revised USDA SNAP application process for farmers' markets should also be considered.

Contribution of the Multi Attribute Value Theory to conflict resolution in groundwater management. Application to the Mancha Oriental groundwater system, Spain

NASA Astrophysics Data System (ADS)

Apperl, B.; Andreu, J.; Karjalainen, T. P.; Pulido-Velazquez, M.

2014-09-01

The implementation of the EU Water Framework Directive demands participatory water resource management approaches. Decision making in groundwater quantity and quality management is complex because of the existence of many independent actors, heterogeneous stakeholder interests, multiple objectives, different potential policies, and uncertain outcomes. Conflicting stakeholder interests have been often identified as an impediment to the realization and success of water regulations and policies. The management of complex groundwater systems requires clarifying stakeholders' positions (identifying stakeholders preferences and values), improving transparency with respect to outcomes of alternatives, and moving the discussion from the selection of alternatives towards definition of fundamental objectives (value-thinking approach), what facilitates negotiation. The aims of the study are to analyse the potential of the multi attribute value theory for conflict resolution in groundwater management and to evaluate the benefit of stakeholder incorporation in the different stages of the planning process to find an overall satisfying solution for groundwater management. The research was conducted in the Mancha Oriental groundwater system (Spain), subject to an intensive use of groundwater for irrigation. A complex set of objectives and attributes were defined, and the management alternatives were created by a combination of different fundamental actions, considering different implementation stages and future changes in water resources availability. Interviews were conducted with representative stakeholder groups using an interactive platform, showing simultaneously the consequences of changes of preferences to the alternative ranking. Results show that the acceptation of alternatives depends strongly on the combination of measures and the implementation stages. Uncertainties of the results were notable but did not influence heavily on the alternative ranking. The expected reduction of future groundwater resources by climate change increases the conflict potential. The implementation of the method to a very complex case study, with many conflicting objectives and alternatives and uncertain outcomes, including future scenarios under water limiting conditions, illustrate the potential of the method for supporting management decisions.

A challenge for land and risk managers: differents stakeholders, differents definitions of the risks

NASA Astrophysics Data System (ADS)

Fernandez, M.; Ruegg, J.

2012-04-01

In developing countries, mountain populations and territories are subject to multiple risks and vulnerabilities. In addition, they face even greater challenges than developed countries due to lack of knowledge, resources and technology. There are many different types of actors in society that manage risk at various scales and levels (i.e. engineers, geologists, administrators, land use planners, merchants and local indigenous and non-indigenous people). Because of limited resources and possibilities to reduce all types of risk, these different actors, or 'risk managers' have to choose and compete to prioritize which types of risks to address. This paper addresses a case study from San Cristobal Altaverapaz, Guatemala where a large landslide "Los Chorros", a catastrophic collapse of 6 millions cubic meters of rock, is affecting several communities and one of the country's main west-east access highways. In this case, the government established that the "primary" risk is the landslide, whereas other local stakeholders consider the primary risks to be economic This paper, situated at the cross section between political science, geography and disaster risk management, addresses the social conflict and competition for priorities and solutions for risk management, depending on the group of actors based on the on-going Los Chorros, Guatemala landslide mitigation process. This work is based on the analysis of practices, (Practical Science), policies and institutions in order to understand how the inclusion of multiple stakeholders in determining risk priorities can lead to more sustainable risk management in a given territory. The main objective of this investigation is first to identify and understand the juxtaposition of different readings of the risk equation, usually considered the interface between vulnerability, exposure and hazards. Secondly, it is to analyze the mechanisms of actions taken by various stakeholders, or risk managers. The analysis focuses on the various solutions proposed for reducing vulnerabilities (and consequentially their risks). To resolve a post-disaster situation, the actors prioritize one main type of vulnerability to address a set of vulnerabilities (in a multi-vulnerability context). With this choice, they define their own acceptable risk limits and the type of action that is most relevant. In doing so, they have to determine what elements can be changed and improved and which elements must be considered essential and preserved or the priority variables. These may include: equipment, production facilities, networks, services, modes of production and organizations, etc. or various economic and social capitals upon which individuals and groups rely for recovering from a post-disaster situation. Depending on the actor, certain factors will be will be emphasized over others and these may change over time. Linked with this political, institutional and geographical analysis of risk management, this work also questions who are the legitimate actors and the right criteria to prioritize risk reduction actions using public funds criteria and finally, which motivations are satisfied. In this sense, the challenge for managers of natural hazards is to move from risk management in the strict sense, which focuses mainly on hazards only, to a broader risks management, taking into consideration what is important for society and for the functioning of systems (what have not be vulnerable in a territorial system). In a context where risk and risk management is produced and managed by both formal and informal stakeholders, the main issue is how to engage the various stakeholders and evaluate different priorities of risk in order to determine which actions are best suited for a more balanced approach to risk management. This case study demonstrates that reducing landslide risk is subject to interpretation depending on the stakeholder and the result of priorities, providing on the role of each actor, their needs and range of action with a territory.

Protocol of a cluster randomised stepped-wedge trial of behavioural interventions targeting amphetamine-type stimulant use and sexual risk among female entertainment and sex workers in Cambodia

PubMed Central

Page, Kimberly; Stein, Ellen S; Carrico, Adam W; Evans, Jennifer L; Sokunny, Muth; Nil, Ean; Ngak, Song; Sophal, Chhit; McCulloch, Charles; Maher, Lisa

2016-01-01

Introduction HIV risk among female entertainment and sex workers (FESW) remains high and use of amphetamine-type stimulants (ATS) significantly increases this risk. We designed a cluster randomised stepped wedge trial (The Cambodia Integrated HIV and Drug Prevention Implementation (CIPI) study) to test sequentially delivered behavioural interventions targeting ATS use. Methods and analysis The trial combines a 12-week Conditional Cash Transfer (CCT) intervention with 4 weeks of cognitive-behavioural group aftercare (AC) among FESW who use ATS. The primary goal is to reduce ATS use and unprotected sex among FESW. The CCT+AC intervention is being implemented in 10 provinces where order of delivery was randomised. Outcome assessments (OEs) including biomarkers and self-reported measures of recent sexual and drug use behaviours are conducted prior to implementation, and at three 6-month intervals after completion. Consultation with multiple groups and stakeholders on implementation factors facilitated acceptance and operationalisation of the trial. Statistical power and sample size calculations were based on expected changes in ATS use and unprotected sex at the population level as well as within subjects. Ethics and dissemination Ethical approvals were granted by the Cambodia National Ethics Committee; University of New Mexico; University of California, San Francisco; and FHI360. The trial is registered with ClinicalTrials.gov. Dissemination of process indicators during the multiyear trial is carried out through annual in-country Stakeholder Meetings. Provincial ‘Close-Out’ forums are held at the conclusion of data collection in each province. When analysis is completed, dissemination meetings will be held in Cambodia with stakeholders, including community-based discussion sessions, policy briefs and results published and presented in the HIV prevention scientific journals and conferences. Conclusions CIPI is the first trial of an intervention to reduce ATS use and HIV risk among FESW in Cambodia. Results Will inform both CCT+AC implementation in low and middle-income countries and programmes designed to reach FESW. Trial registration number NCT01835574; Pre-results. PMID:27160844

Integrating Hydrology, Ecology, and Biogeochemistry in Stormwater Management: the Vermont Experience

NASA Astrophysics Data System (ADS)

Bowden, W. B.

2005-12-01

Although Vermont has had a stormwater management program since the 1970's, support for the program languished during a period intense suburban development in several counties in the state, most notably Chittenden County next to Lake Champlain. Beginning in 2000, the state renewed efforts to address concerns that stormwater runoff from suburban developments had significantly degraded streams in the area and threatened the health of the Lake. The state employs an extensive, EPA-approved biomonitoring program (based on macroinvertebrates and fish) to assess the health of streams. However, it is difficult to translate these data into targets for stormwater management or to predict how and especially when they will change as a result of future management practices. The challenge of managing stormwater in this area is further compounded by a complete lack of historical hydrologic monitoring data. Ultimately a stakeholder-driven process developed that has lead to an innovative partnership among state agencies, resource managers, NGO's, the US-EPA and scientists. Through this partnership a unique consensus evolved that management for hydrologic targets by themselves would address most of the stakeholders' concerns. The new regulations that are emerging are based on two components. The first component relies on flow-duration curves (FDC's) derived from a simple, widely-used stormwater model (P-8) for which adequate input data are available. The model was calibrated for streams in other areas for which long-term hydrologic data were available and then used to generate `synthetic' FDC's for the stormwater impaired and a suite of `attainment' (developing, but currently un-impaired) watersheds in Vermont. Statistical (cluster) analyses of synthetic FDC's provide watershed-wide targets for hydrologic reduction. Sub-watershed mapping linked to further multivariate analysis of the flow data identify specific locations to implement best management practices (BMP's) that will achieve these targets. This approach is firmly grounded in first principles of stormwater hydrology and recognition of the impacts of altered hydrology on stream ecology and biogeochemistry. Stakeholders have accepted the approach because it is objective, defensible, and subject to future, quantitative analysis and adjustment (adaptive management). This approach is not specific to Vermont and could be employed in any region.

Vegetative covers for waste containment.

PubMed

Rock, Steven A

2003-01-01

Disposal of municipal and hazardous waste in the United States is primarily accomplished by containment in lined and capped landfills. Evapotranspiration cover systems offer an alternative to conventional landfill cap systems. These covers work on completely different principles than traditional covers do, and that difference may slow understanding and acceptance by site owners, regulators, and stakeholders. This chapter provides an introduction to this alternative technique and explains some of the common concerns regarding its implementation.

Stakeholder analysis for a maternal and newborn health project in Eastern Uganda.

PubMed

Namazzi, Gertrude; N, Kiwanuka Suzanne; Peter, Waiswa; John, Bua; Olico, Okui; A, Allen Katharine; A, Hyder Adnan; Elizabeth, Ekirapa Kiracho

2013-03-04

Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders' interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up.

Generic medicines and generic substitution: contrasting perspectives of stakeholders in Ireland.

PubMed

O'Leary, A; Usher, C; Lynch, M; Hall, M; Hemeryk, L; Spillane, S; Gallagher, P; Barry, M

2015-12-15

The Health (Pricing and Supply of Medical Goods) Act 2013 passed into law in July 2013 and legislated for generic substitution in Ireland. The aim of the study was to ascertain the knowledge and perceptions of stakeholders i.e. patients, pharmacists and prescribers, of generic medicines and to generic substitution with the passing of legislation. Three stakeholder specific questionnaires were developed to assess knowledge of and perceptions to generic medicines and generic substitution. Purposive samples of patients, prescribers and pharmacists were analysed. Descriptive quantitative and qualitative analyses were undertaken. A total of 762 healthcare professionals and 353 patients were recruited. The study highlighted that over 84% of patients were familiar with generic medicines and are supportive of the concept of generic substitution. Approximately 74% of prescribers and 84% of pharmacists were supportive of generic substitution in most cases. The main areas of concern highlighted by the healthcare professionals that might impact on the successful implementation of the policy, were the issue of bioequivalence with generic medicines, the computer software systems used at present in general practitioner (GP) surgeries and the availability of branded generics. The findings from this study identify a high baseline rate of acceptance to generic medicines and generic substitution among patients, prescribers and pharmacists in the Irish setting. The concerns of the main stakeholders provide a valuable insight into the potential difficulties that may arise in its implementation, and the need for on-going reassurance and proactive dissemination of the impact of the generic substitution policy. The existing positive attitude to generic medicines and generic substitution among key stakeholders in Ireland to generic substitution, combined with appropriate support and collaboration should result in the desired increase in rates of prescribing, dispensing and use of generic medicines.

Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel.

PubMed

Khodyakov, Dmitry; Stockdale, Susan E; Smith, Nina; Booth, Marika; Altman, Lisa; Rubenstein, Lisa V

2017-02-01

There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens ™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Criteria for the prioritization of public health interventions for climate-sensitive vector-borne diseases in Quebec

PubMed Central

Gosselin, Pierre; Michel, Pascal; Ravel, André; Waaub, Jean-Philippe; Campagna, Céline; Samoura, Karim

2017-01-01

Prioritizing resources for optimal responses to an ever growing list of existing and emerging infectious diseases represents an important challenge to public health. In the context of climate change, there is increasing anticipated variability in the occurrence of infectious diseases, notably climate-sensitive vector-borne diseases. An essential step in prioritizing efforts is to identify what considerations and concerns to take into account to guide decisions and thus set disease priorities. This study was designed to perform a comprehensive review of criteria for vector-borne disease prioritization, assess their applicability in a context of climate change with a diverse cross-section of stakeholders in order to produce a baseline list of considerations to use in this decision-making context. Differences in stakeholder choices were examined with regards to prioritization of these criteria for research, surveillance and disease prevention and control objectives. A preliminary list of criteria was identified following a review of the literature. Discussions with stakeholders were held to consolidate and validate this list of criteria and examine their effects on disease prioritization. After this validation phase, a total of 21 criteria were retained. A pilot vector-borne disease prioritization exercise was conducted using PROMETHEE to examine the effects of the retained criteria on prioritization in different intervention domains. Overall, concerns expressed by stakeholders for prioritization were well aligned with categories of criteria identified in previous prioritization studies. Weighting by category was consistent between stakeholders overall, though some significant differences were found between public health and non-public health stakeholders. From this exercise, a general model for climate-sensitive vector-borne disease prioritization has been developed that can be used as a starting point for further public health prioritization exercises relating to research, surveillance, and prevention and control interventions in a context of climate change. Multi-stakeholder engagement in prioritization can help broaden the range of criteria taken into account, offer opportunities for early identification of potential challenges and may facilitate acceptability of any resulting decisions. PMID:29281726

AMCP Partnership Forum: Biosimilars--Ready, Set, Launch.

PubMed

2016-04-01

Through 2020, reference biologic products will lose patent protection that will be worth $54 billion to the U.S. economy. Consequently, interest in biosimilars is intensifying across the health care industry. Managed care organizations (MCOs) are depending on the savings opportunity that bio-similars promise. After the first FDA approval of a biosimilar in March 2015, the Academy of Managed Care Pharmacy (AMCP) convened a biosimilar Partnership Forum on June 10-11, 2015. The goal of this forum was to address current readiness of MCOs to optimize biosimilars; identify gaps, challenges, and opportunities with regard to biosimilars; and recommend education and training content to help AMCP best meet the needs of its members and stakeholders. The forum brought together multiple stakeholders from MCOs, pharmacy benefit managers, specialty pharmacies, integrated delivery networks, federal government and standards setting organizations, consumer advocacy groups, and the pharmaceutical industry. Through a series of 4 one-hour webinars and a 1.5-day live workgroup session, participants identified current challenges and readiness issues in addressing biosimilars. These challenges included lack of a consolidated educational strategy for incorporating biosimilars into the clinical decision-making process; deficiencies in current levels of federal (e.g., the FDA) or state (e.g., departments of insurance) guidance; limited intelligence on pricing strategies and consideration of stakeholder contracting alignment and risk sharing; and operational implementation issues. Participants identified necessary tactics for executing a successful bio-similar strategy. These tactics included creating a broad multiple stakeholder coalition to support educational efforts to gain public, provider, and other stakeholder acceptance; aligning utilization incentives through reimbursement policies and programs; encouraging benefit design and stakeholder collaboration; advancing the coding and technology infrastructure to support operations, contracting, billing, reimbursement, and reporting needs; and having appropriate active surveillance mechanisms to enable assessment of the clinical performance of biosimilars and their innovator products. Participants recommended guidance for AMCP to optimally support its membership and stakeholders with educational and training programs at multiple venues; a platform for regular communications and updates; and advocacy, community promotion, and education. The AMCP Partnership Forum entitled "Biosimilars-Ready, Set, Launch" and the development of this report were supported by Abbvie, Amgen, Apotex, Boehringer, Merck, Momenta, and Sandoz.

Voices of Informal Caregivers and Community Stakeholders: Whether and How to Develop an Informal Caregiver Training Program

PubMed Central

Phillips, Sara S.; Ragas, Daiva M.; Tom, Laura S.; Hajjar, Nadia; Dong, XinQi; Simon, Melissa A.

2015-01-01

Our primary objective was to gather pilot data from caregivers and stakeholders to guide the development of a training program to assist informal caregivers in re-entering the job market. The goal of the program would be to help caregivers rebound from their incurred economic burden by transitioning into a paid caregiving or other health-service role. The economic burden they bear often necessitates a return to the workforce following caregiving; yet the act of returning is complicated by an extended absence from the workforce and a lack of experience in other verifiably skilled and paid roles. We interviewed 37 stakeholders and 25 caregivers of a chronically or terminally ill family member or friend in a suburban collar county close to Chicago. The interview questions considered the economic impact of illness, as well as the feasibility, logistics, and options of a training program for caregivers. Our data gathered from caregivers and leaders within this community support the acceptability of such a training program for informal caregivers, and also provide practical advice for development and implementation related to training cost, length, content, and instructional practices. PMID:26607814

Voices of Informal Caregivers and Community Stakeholders: Whether and How to Develop an Informal Caregiver Training Program.

PubMed

Phillips, Sara S; Ragas, Daiva M; Tom, Laura S; Hajjar, Nadia; Dong, XinQi; Simon, Melissa A

2016-06-01

Our primary objective was to gather pilot data from caregivers and stakeholders to guide the development of a training program to assist informal caregivers in re-entering the job market. The goal of the program would be to help caregivers rebound from their incurred economic burden by transitioning into a paid caregiving or other health-service role. The economic burden they bear often necessitates a return to the workforce following caregiving; yet the act of returning is complicated by an extended absence from the workforce and a lack of experience in other verifiably skilled and paid roles. We interviewed 37 stakeholders and 25 caregivers of a chronically or terminally ill family member or friend in a suburban collar county close to Chicago. The interview questions considered the economic impact of illness, as well as the feasibility, logistics, and options of a training program for caregivers. Our data gathered from caregivers and leaders within this community support the acceptability of such a training program for informal caregivers, and also provide practical advice for development and implementation related to training cost, length, content, and instructional practices.

On risky ground: the water professional in politics.

PubMed

Holmes, P R

2004-01-01

Best practice in drainage basin management requires consultation and stakeholder engagement in the formulation and implementation of plans. The water management professional, engaging with the political world, is on risky ground, thanks to many stakeholders' accidental or chosen unwillingness to accept science-based advice. Technical specialists produce good advice, yet progress is inhibited because they do not connect effectively with politicians, administrators and managers. A series of short case studies from three countries in different but related fields provides evidence of the problems that are encountered. Professionals may be cut off from the political world within comfort zones defined by the cultural norms and behaviours of bureaucracy, their profession or their preferred communications style. The consequence of the professionals' lack of engagement in the political world can be that scarce money and effort is wasted on low priority issues, and the case for sound, sustainable environmental management is discredited. Stakeholder support is worth winning, because it can bring positive benefits in the effectiveness of environmental management programmes. Where outside help is needed to bring about this result, it should be provided by advisers who are sensitive to the culture, at the national, professional and organizational level, of the recipients.

Training needs analysis for engineering technicians in Oman

NASA Astrophysics Data System (ADS)

Al-Mughairi, Abdulkarim Sultan

This thesis examines the transition from the Omani Colleges of Technology (CT) to employment of its engineering graduates. It arises out of concerns that the transition to the labour market for engineering graduate is problematical. The research was carried out to identify the knowledge, skills, and abilities (KSA) of engineering technicians required in the Omani market place. The aim is to provide local curriculum designers in the Colleges of Technology with sufficient information about the required KSA in order to create and enhance the engineering curriculum so that it has greater capacity to meet the needs of a variety of stakeholders and of employers in particular. This in turn has the potential to bridge the gap between what is presently taught and what the workplace demands. Personnel psychologists identify views concerning the skills that are required for different jobs. One of these is based on the assumption that quite different skills are required in different jobs (SCANS, 1990). This view generates approaches within job analysis: the worker-oriented and the task-oriented approaches. This research uses Position Analysis Questionnaire (PAQ), which is a worker-oriented job analysis instrument, to investigate the KSA required to perform some of the engineering technician jobs in Omani industries. In addition, semi-structured interviews were used to investigate the factors that either hinder or entirely prevent the new graduates from Colleges of Technology from being accepted in the workforce pool. The major research findings concern the dimensions of knowledge, skills, and abilities of six engineering technician job titles and the major factors that hinder or (prevent) the technical college graduates from being accepted in the market place in Oman. These findings would definitely help design better transition route and bridge the gap between the CT technicians engineering programmes and the workplace demands.

Surrogate outcomes: experiences at the Common Drug Review

PubMed Central

2013-01-01

Background Surrogate outcomes are a significant challenge in drug evaluation for health technology assessment (HTA) agencies. The research objectives were to: identify factors associated with surrogate use and acceptability in Canada’s Common Drug Review (CDR) recommendations, and compare the CDR with other HTA or regulatory agencies regarding surrogate concerns. Methods Final recommendations were identified from CDR inception (September 2003) to December 31, 2010. Recommendations were classified by type of outcome (surrogate, final, other) and acceptability of surrogates (determined by the presence/absence of statements of concern regarding surrogates). Descriptive and statistical analyses examined factors related to surrogate use and acceptability. For thirteen surrogate-based submissions, recommendations from international HTA and regulatory agencies were reviewed for statements about surrogate acceptability. Results Of 156 final recommendations, 68 (44%) involved surrogates. The overall ‘do not list’ (DNL) rate was 48%; the DNL rate for surrogates was 41% (p = 0.175). The DNL rate was 64% for non-accepted surrogates (n = 28) versus 25% for accepted surrogates (odds ratio 5.4, p = 0.002). Clinical uncertainty, use of economic evidence over price alone, and a premium price were significantly associated with non-accepted surrogates. Surrogates were used most commonly for HIV, diabetes, rare diseases, cardiovascular disease and cancer. For the subset of drugs studied, other HTA agencies did not express concerns for most recommendations, while regulatory agencies frequently stated surrogate acceptance. Conclusions The majority of surrogates were accepted at the CDR. Non-accepted surrogates were significantly associated with clinical uncertainty and a DNL recommendation. There was inconsistency of surrogate acceptability across several international agencies. Stakeholders should consider collaboratively establishing guidelines on the use, validation, and acceptability of surrogates. PMID:24341379

A Value Analysis of Lean Processes in Target Value Design and Integrated Project Delivery.

PubMed

Nanda, Upali; K Rybkowski, Zofia; Pati, Sipra; Nejati, Adeleh

2017-04-01

To investigate what key stakeholders consider to be the advantages and the opportunities for improvement in using lean thinking and tools in the integrated project delivery (IPD) process. A detailed literature review was followed by case study of a Lean-IPD project. Interviews with members of the project leadership team, focus groups with the integrated team as well as the design team, and an online survey of all stakeholders were conducted. Statistical analysis and thematic content analysis were used to analyze the data, followed by a plus-delta analysis. (1) Learning is a large, implicit benefit of Lean-IPD that is not currently captured by any success metric; (2) the cardboard mock-up was the most successful lean strategy; (3) although a collaborative project, the level of influence of different stakeholder groups was perceived to be different by different stakeholders; (4) overall, Lean-IPD was rated as better than traditional design-bid-build methods; and (5) opportunities for improvement reported were increase in accurate cost estimating, more efficient use of time, perception of imbalance of control/influence, and need for facilitation (which represents different points of view). While lean tools and an IPD method are preferred to traditional design-bid-build methods, the perception of different stakeholders varies and more work needs to be done to allow a truly shared decision-making model. Learning was identified as one of the biggest advantages.

Supporting multi-stakeholder environmental decisions.

PubMed

Hajkowicz, Stefan A

2008-09-01

This paper examines how multiple criteria analysis (MCA) can be used to support multi-stakeholder environmental management decisions. It presents a study through which 48 stakeholders from environmental, primary production and community interest groups used MCA to prioritise 30 environmental management problems in the Mackay-Whitsunday region of Queensland, Australia. The MCA model, with procedures for aggregating multi-stakeholder output, was used to inform a final decision on the priority of the region's environmental management problems. The result was used in the region's environmental management plan as required under Australia's Natural Heritage Trust programme. The study shows how relatively simple MCA methods can help stakeholders make group decisions, even when they hold strongly conflicting preferences.

Promoting universal financial protection: a case study of new management of community health insurance in Tanzania.

PubMed

Borghi, Josephine; Maluka, Stephen; Kuwawenaruwa, August; Makawia, Suzan; Tantau, Juma; Mtei, Gemini; Ally, Mariam; Macha, Jane

2013-06-13

The National Health Insurance Fund (NHIF), a compulsory formal sector scheme took over the management of the Community Health Fund (CHF), a voluntary informal sector scheme, in 2009. This study assesses the origins of the reform, its effect on management and reporting structures, financial flow adequacy, reform communication and acceptability to key stakeholders, and initial progress towards universal coverage. The study relied on national data sources and an in-depth collective case study of a rural and an urban district to assess awareness and acceptability of the reform, and fund availability and use relative to need in a sample of facilities. The reform was driven by a national desire to expand coverage and increase access to services. Despite initial delays, the CHF has been embedded within the NHIF organisational structure, bringing more intensive and qualified supervision closer to the district. National CHF membership has more than doubled. However, awareness of the reform was limited below the district level due to the reform's top-down nature. The reform was generally acceptable to key stakeholders, who expected that benefits between schemes would be harmonised.The reform was unable to institute changes to the CHF design or district management structures because it has so far been unable to change CHF legislation which also limits facility capacity to use CHF revenue. Further, revenue generated is currently insufficient to offset treatment and administration costs, and the reform did not improve the revenue to cost ratio. Administrative costs are also likely to have increased as a result of the reform. Informal sector schemes can benefit from merger with formal sector schemes through improved data systems, supervision, and management support. However, effects will be maximised if legal frameworks can be harmonised early on and a reduction in administrative costs is not guaranteed.

Using electronic health records for clinical research: the case of the EHR4CR project.

PubMed

De Moor, Georges; Sundgren, Mats; Kalra, Dipak; Schmidt, Andreas; Dugas, Martin; Claerhout, Brecht; Karakoyun, Töresin; Ohmann, Christian; Lastic, Pierre-Yves; Ammour, Nadir; Kush, Rebecca; Dupont, Danielle; Cuggia, Marc; Daniel, Christel; Thienpont, Geert; Coorevits, Pascal

2015-02-01

To describe the IMI EHR4CR project which is designing and developing, and aims to demonstrate, a scalable, widely acceptable and efficient approach to interoperability between EHR systems and clinical research systems. The IMI EHR4CR project is combining and extending several previously isolated state-of-the-art technical components through a new approach to develop a platform for reusing EHR data to support medical research. This will be achieved through multiple but unified initiatives across different major disease areas (e.g. cardiovascular, cancer) and clinical research use cases (protocol feasibility, patient identification and recruitment, clinical trial execution and serious adverse event reporting), with various local and national stakeholders across several countries and therefore under various legal frameworks. An initial instance of the platform has been built, providing communication, security and terminology services to the eleven participating hospitals and ten pharmaceutical companies located in seven European countries. Proof-of-concept demonstrators have been built and evaluated for the protocol feasibility and patient recruitment scenarios. The specifications of the clinical trial execution and the adverse event reporting scenarios have been documented and reviewed. Through a combination of a consortium that brings collectively many years of experience from previous relevant EU projects and of the global conduct of clinical trials, of an approach to ethics that engages many important stakeholders across Europe to ensure acceptability, of a robust iterative design methodology for the platform services that is anchored on requirements of an underlying Service Oriented Architecture that has been designed to be scalable and adaptable, EHR4CR could be well placed to deliver a sound, useful and well accepted pan-European solution for the reuse of hospital EHR data to support clinical research studies. Copyright © 2014 Elsevier Inc. All rights reserved.

Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study.

PubMed

Frost, Rachael; Kharicha, Kalpa; Jovicic, Ana; Liljas, Ann E M; Iliffe, Steve; Manthorpe, Jill; Gardner, Benjamin; Avgerinou, Christina; Goodman, Claire; Drennan, Vari M; Walters, Kate

2018-05-01

Mild frailty is common in later life, increasing the risk of hospitalisation, loss of independence and premature death. Targeted health promotion services may reduce adverse outcomes and increase quality of life; however, effective, well-developed theory-based interventions are lacking. We aimed to explore perceptions of health promotion behaviours undertaken by older people with mild frailty, barriers and facilitators to engagement, and identify potential components for new home-based health promotion services. We carried out 17 semi-structured qualitative interviews and six focus groups with 53 stakeholders, including 14 mildly frail older people, 12 family carers, 19 community health and social care professionals, and 8 homecare workers, in one urban and one semi-rural area of England. Transcripts were thematically analysed. Older people with mild frailty reported engaging in a variety of lifestyle behaviours to promote health and well-being. Key barriers or facilitators to engaging in these included transport, knowledge of local services, social support and acceptance of personal limitations. Older people, carers and professionals agreed that any new service should address social networks and mobility and tailor other content to each individual. Services should aim to increase motivation through focussing on independence and facilitate older people to continue carrying out behaviours that improve their well-being, as well as provide information, motivation, psychological support and practical support. Stakeholders agreed services should be delivered over a sustained period by trained non-specialist workers. New services including these components are likely to be acceptable to older people with mild frailty. © 2017 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Feasibility study of a family- and school-based intervention for child behavior problems in Nepal.

PubMed

Adhikari, Ramesh P; Upadhaya, Nawaraj; Satinsky, Emily N; Burkey, Matthew D; Kohrt, Brandon A; Jordans, Mark J D

2018-01-01

This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal. Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6-15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale-Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews were conducted with community stakeholders, including teachers, parents, and community members, to assess stakeholders' perceptions of the intervention. The study found that children's behavior problems as assessed on the DBIS-N were significantly lower at follow-up (M = 13.0, SD = 6.4) than at baseline (M = 20.5, SD = 3.8), p < 0.001, CI [5.57, 9.35]. Similarly, children's ECBI Intensity scores were significantly lower at follow-up (M = 9.9, SD = 8.5) than at baseline (M = 14.8, SD = 7.7), p < 0.005, 95% CI [1.76, 8.14]. The intervention also significantly improved children's daily functioning. Parents and teachers involved in the intervention found it acceptable and feasible for delivery to their children and students. Parents and teachers reported improved behaviors among children and the implementation of new behavior management techniques both at home and in the classroom. Significant change in child outcome measures in this uncontrolled evaluation, alongside qualitative findings suggesting feasibility and acceptability, support moving toward a controlled trial to determine effectiveness.

Bridging clinical researcher perceptions and health IT realities: A case study of stakeholder creep.

PubMed

Panyard, Daniel J; Ramly, Edmond; Dean, Shannon M; Bartels, Christie M

2018-02-01

We present a case report detailing a challenge in health information technology (HIT) project implementations we term "stakeholder creep": not thoroughly identifying which stakeholders need to be involved and why before starting a project, consequently not understanding the true effort, skill sets, social capital, and time required to complete the project. A root cause analysis was performed post-implementation to understand what led to stakeholder creep. HIT project stakeholders were given a questionnaire to comment on these misconceptions and a proposed implementation tool to help mitigate stakeholder creep. Stakeholder creep contributed to an unexpected increase in time (3-month delayed go-live) and effort (68% over expected HIT work hours). Four main clinician/researcher misconceptions were identified that contributed to the development of stakeholder creep: 1) that EHR IT is a single group; 2) that all EHR IT members know the entire EHR functionality; 3) that changes to an EHR need the input of just a single EHR IT member; and 4) that the technological complexity of a project mirrors the clinical complexity. HIT project stakeholders similarly perceived clinicians/researchers to hold these misconceptions. The proposed stakeholder planning tool was perceived to be feasible and helpful. Stakeholder creep can negatively affect HIT project implementations. Projects may be susceptible to stakeholder creep when clinicians/researchers hold misconceptions related to HIT organization and processes. Implementation tools, such as the proposed stakeholder checklist, could be helpful in preempting and mitigating the effect of stakeholder creep. Copyright © 2017 Elsevier B.V. All rights reserved.

Lay and professional stakeholder involvement in scoping palliative care issues: Methods used in seven European countries.

PubMed

Brereton, Louise; Ingleton, Christine; Gardiner, Clare; Goyder, Elizabeth; Mozygemba, Kati; Lysdahl, Kristin Bakke; Tummers, Marcia; Sacchini, Dario; Leppert, Wojciech; Blaževičienė, Aurelija; van der Wilt, Gert Jan; Refolo, Pietro; De Nicola, Martina; Chilcott, James; Oortwijn, Wija

2017-02-01

Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ⩾18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development.

Association football and the representation of homosexuality by the print media: a case study of Anton Hysén.

PubMed

Cleland, Jamie

2014-01-01

In March 2011, Anton Hysén (a semiprofessional footballer currently playing in the Swedish fourth division) became only the second association football (soccer) player of any professional disposition to publicly declare his homosexuality while still playing the game. This article provides a textual analysis of the print media's reaction to Hysén coming out and examines whether, in 2011, they portray more inclusive notions toward homosexuality than they did in 1990 when British footballer Justin Fashanu came out. The results advance inclusive masculinity theory as a number of print media sources (mostly British) interview Hysén in the weeks immediately after he came out and publish articles that challenge homophobia. Highlighting a change since 1990, a significant number of articles stress the need for the key stakeholders in football (players, fans, clubs, agents, the authorities, and the media) to accept gay players.

“Are we ready for robots that care for us?” Attitudes and opinions of older adults toward socially assistive robots

PubMed Central

Pino, Maribel; Boulay, Mélodie; Jouen, François; Rigaud, Anne-Sophie

2015-01-01

Socially Assistive Robots (SAR) may help improve care delivery at home for older adults with cognitive impairment and reduce the burden of informal caregivers. Examining the views of these stakeholders on SAR is fundamental in order to conceive acceptable and useful SAR for dementia care. This study investigated SAR acceptance among three groups of older adults living in the community: persons with Mild Cognitive Impairment, informal caregivers of persons with dementia, and healthy older adults. Different technology acceptance questions related to the robot and user characteristics, potential applications, feelings about technology, ethical issues, and barriers and facilitators for SAR adoption, were addressed in a mixed-method study. Participants (n = 25) completed a survey and took part in a focus group (n = 7). A functional robot prototype, a multimedia presentation, and some use-case scenarios provided a base for the discussion. Content analysis was carried out based on recorded material from focus groups. Results indicated that an accurate insight of influential factors for SAR acceptance could be gained by combining quantitative and qualitative methods. Participants acknowledged the potential benefits of SAR for supporting care at home for individuals with cognitive impairment. In all the three groups, intention to use SAR was found to be lower for the present time than that anticipated for the future. However, caregivers and persons with MCI had a higher perceived usefulness and intention to use SAR, at the present time, than healthy older adults, confirming that current needs are strongly related to technology acceptance and should influence SAR design. A key theme that emerged in this study was the importance of customizing SAR appearance, services, and social capabilities. Mismatch between needs and solutions offered by the robot, usability factors, and lack of experience with technology, were seen as the most important barriers for SAR adoption. PMID:26257646

Diabetes self-management education: acceptability of using trained lay educators.

PubMed

Mandalia, P K; Stone, M A; Davies, M J; Khunti, K; Carey, M E

2014-11-01

The use of lay people to deliver education programmes for people with chronic conditions is a potential method of addressing healthcare staff capacity and increasing the cost efficiency of delivering education. This qualitative substudy is embedded within an equivalence trial (2008-2011 including development stage). In the qualitative substudy, we aimed to elicit the views of key stakeholders (patients, educators) about using lay people to deliver education to people recently diagnosed with type 2 diabetes, alongside a healthcare professional educator with an equal role. In this way, we sought to explore perceptions about acceptability and also contribute to understanding the reasons underlying positive or negative quantitative findings from main trial. We conducted 27 telephone interviews with a purposive sample of patients, lay educators and healthcare professional educators involved in the main trial. Thematic analysis of transcribed data was underpinned by the constant comparative approach and structured using Framework methodology. Overall, the data suggested that the use of lay educators was acceptable to educators and patients. Perceived difference in knowledge levels between lay and healthcare professional educators did not appear to have an impact on perceived acceptability or the effectiveness of the education received. Additional themes explored were related to peer status of educators and feasibility. Some concerns were raised about lay educators with diabetes, transferring personal issues and about the impact of healthcare professional time taken up by mentoring and supporting lay educators. Positive perceptions about the use of lay educators support the positive quantitative findings from the main trial. Acceptability is an important consideration in relation to implementation of the model of delivery studied. Concerns raised within the interviews should be considered in the design of training for lay educators. ISRCTN 99350009. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

"Are we ready for robots that care for us?" Attitudes and opinions of older adults toward socially assistive robots.

PubMed

Pino, Maribel; Boulay, Mélodie; Jouen, François; Rigaud, Anne-Sophie

2015-01-01

Socially Assistive Robots (SAR) may help improve care delivery at home for older adults with cognitive impairment and reduce the burden of informal caregivers. Examining the views of these stakeholders on SAR is fundamental in order to conceive acceptable and useful SAR for dementia care. This study investigated SAR acceptance among three groups of older adults living in the community: persons with Mild Cognitive Impairment, informal caregivers of persons with dementia, and healthy older adults. Different technology acceptance questions related to the robot and user characteristics, potential applications, feelings about technology, ethical issues, and barriers and facilitators for SAR adoption, were addressed in a mixed-method study. Participants (n = 25) completed a survey and took part in a focus group (n = 7). A functional robot prototype, a multimedia presentation, and some use-case scenarios provided a base for the discussion. Content analysis was carried out based on recorded material from focus groups. Results indicated that an accurate insight of influential factors for SAR acceptance could be gained by combining quantitative and qualitative methods. Participants acknowledged the potential benefits of SAR for supporting care at home for individuals with cognitive impairment. In all the three groups, intention to use SAR was found to be lower for the present time than that anticipated for the future. However, caregivers and persons with MCI had a higher perceived usefulness and intention to use SAR, at the present time, than healthy older adults, confirming that current needs are strongly related to technology acceptance and should influence SAR design. A key theme that emerged in this study was the importance of customizing SAR appearance, services, and social capabilities. Mismatch between needs and solutions offered by the robot, usability factors, and lack of experience with technology, were seen as the most important barriers for SAR adoption.

The Added-Value of Using Participatory Approaches to Assess the Acceptability of Surveillance Systems: The Case of Bovine Tuberculosis in Belgium

PubMed Central

Calba, Clémentine; Goutard, Flavie Luce; Vanholme, Luc; Antoine-Moussiaux, Nicolas; Hendrikx, Pascal; Saegerman, Claude

2016-01-01

Context and Objective Bovine tuberculosis (bTB) surveillance in Belgium is essential to maintain the officially free status and to preserve animal and public health. An evaluation of the system is thus needed to ascertain the surveillance provides a precise description of the current situation in the country. The evaluation should assess stakeholders’ perceptions and expectations about the system due to the fact that the acceptability has an influence on the levels of sensitivity and timeliness of the surveillance system. The objective of the study was to assess the acceptability of the bTB surveillance in Belgium, using participatory tools and the OASIS flash tool (‘analysis tool for surveillance systems’). Methods For the participatory process, focus group discussions and individual interviews were implemented with representatives involved with the system, both from cattle and wildlife part of the surveillance. Three main tools were used: (i) relational diagrams associated with smileys, (ii) flow diagrams associated with proportional piling, and (iii) impact diagrams associated with proportional piling. A total of six criteria were assessed, among which five were scored on a scale from -1 to +1. For the OASIS flash tool, one full day meeting with representatives from stakeholders involved with the surveillance was organised. A total of 19 criteria linked to acceptability were scored on a scale from 0 to 3. Results and Conclusion Both methods highlighted a medium acceptability of the bTB surveillance. The main elements having a negative influence were the consequences of official notification of a bTB suspect case in a farm, the low remuneration paid to private veterinarians for execution of intradermal tuberculin tests and the practical difficulties about the containment of the animals. Based on the two evaluation processes, relevant recommendations to improve the surveillance were made. Based on the comparison between the two evaluation processes, the added value of the participatory approach was highlighted. PMID:27462705

Acceptability of financial incentives or quasi-mandatory schemes to increase uptake of immunisations in preschool children in the United Kingdom: Qualitative study with parents and service delivery staff.

PubMed

McNaughton, Rebekah Jayne; Adams, Jean; Shucksmith, Janet

2016-04-27

Since the 1990 s strenuous attempts have been made to rebuild trust in childhood immunisations. This study aimed to understand if financial incentives (FI) or quasi-mandatory schemes (QMS), e.g. mandating immunisations for entry to universal services such as day care or school, might be acceptable interventions to increase immunisations uptake for preschool children. Parents and carers of preschool children (n=91); health and other professionals (n=18); and those responsible for developing and commissioning immunisation services (n=6) took part in the study. Qualitative methods were employed to explore the acceptability of FI/QMS with stakeholders. Framework analysis was used to develop a coding framework that was applied to the whole dataset. Interpretations of the emergent themes were verified between researchers and presented to the project's Parent Reference Group to ensure coherence and relevance. (1) FI: parents and professionals felt introducing FI was inappropriate. It was acknowledged FI may encourage families living in disadvantage to prioritise immunisation, but unintended consequences could outweigh any advantage. FI essentially changes behaviour into a cash transaction which many equated to bribery that could inadvertently create inequalities. (2) QMS: parents and professionals highlighted the positives of introducing QMS, stating it felt natural, fair and less likely to create inequality. Despite QMS' potential to positively impact on uptake there were concerns about the implementation and workability of such schemes. FI for preschool immunisation may not be acceptable, within a UK context. Introducing FI could have detrimental effects on uptake if it were associated with bribery and coercion. Quasi-mandatory schemes, mandating immunisation for universal service entry, was the most acceptable option and could contribute to the normalising of immunisation. Future work would be needed to assess how this could be successfully implemented and if it did indeed increase uptake. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Responding to a crisis: a stakeholder analysis of community health organizations.

PubMed

Savage, Grant T; Dunkin, Jeri W; Ford, David M

2004-01-01

On May 11, 2001, the Bureau of Primary Health Care notified West Alabama Health Services, doing business as Family HealthCare of Alabama, that it was terminating $6 million in grants due to non-compliance and amid allegations of financial mismanagement and fraud. West Alabama Health Services, a not-for-profit organization, operated 19 community health centers that provided preventive and primary care services for 17 counties in Alabama. This disruption of health services engendered considerable stakeholder debate. Within this context, the authors examine how a small, newly established rural health center and a well-established, federally qualified community health center responded to this crisis. The authors use a stakeholder analysis framework to highlight how key relationships with stakeholders may change with the perceived credibility of the organizational leaders and the legitimacy of their actions.

Exploring Stakeholder Definitions within the Aerospace Industry: A Qualitative Case Study

NASA Astrophysics Data System (ADS)

Hebert, Jonathan R.

A best practice in the discipline of project management is to identify all key project stakeholders prior to the execution of a project. When stakeholders are properly identified, they can be consulted to provide expert advice on project activities so that the project manager can ensure the project stays within the budget and schedule constraints. The problem addressed by this study is that managers fail to properly identify key project stakeholders when using stakeholder theory because there are multiple conflicting definitions for the term stakeholder. Poor stakeholder identification has been linked to multiple negative project outcomes such as budget and schedules overruns, and this problem is heightened in certain industries such as aerospace. The purpose of this qualitative study was to explore project managers' and project stakeholders' perceptions of how they define and use the term stakeholder within the aerospace industry. This qualitative exploratory single-case study had two embedded units of analysis: project managers and project stakeholders. Six aerospace project managers and five aerospace project stakeholders were purposively selected for this study. Data were collected through individual semi-structured interviews with both project managers and project stakeholders. All data were analyzed using Yin's (2011) five-phased cycle approach for qualitative research. The results indicated that the aerospace project managers and project stakeholder define the term stakeholder as "those who do the work of a company." The participants build upon this well-known concept by adding that, "a company should list specific job titles" that correspond to their company specific-stakeholder definition. Results also indicated that the definition of the term stakeholder is used when management is assigning human resources to a project to mitigate or control project risk. Results showed that project managers tended to include the customer in their stakeholder definitions while project stakeholders included a wider range of stakeholders from young employees to union workers. Practical application recommendations, based on the study's findings, include that companies start to develop company-specific definitions of the term stakeholder. Recommendations for future research should focus on exploring how CEOs, executive members, new hires, and hourly workers define and use the term stakeholder in the aerospace industry.

The Public Acceptance of Biofuels and Bioethanol from Straw- how does this affect Geoscience

NASA Astrophysics Data System (ADS)

Jäger, Alexander; Ortner, Tina; Kahr, Heike

2015-04-01

The Public Acceptance of Biofuels and Bioethanol from Straw- how does this affect Geoscience The successful use of bioethanol as a fuel requires its widespread acceptance by consumers. Due to the planned introduction of a 10 per cent proportion of bioethanol in petrol in Austria, the University of Applied Sciences Upper Austria carried out a representative opinion poll to collect information on the population's acceptance of biofuels. Based on this survey, interviews with important stakeholders were held to discuss the results and collect recommendations on how to increase the information level and acceptance. The results indicate that there is a lack of interest and information about biofuels, especially among young people and women. First generation bioethanol is strongly associated with the waste of food resources, but the acceptance of the second generation, produced from agricultural remnants like straw from wheat or corn, is considerably higher. The interviewees see more transparent, objective and less technical information about biofuels as an essential way to raise the information level and acceptance rate. As the production of bioethanol from straw is now economically feasible, there is one major scientific question to answer: In which way does the withdrawal of straw from the fields affect the formation of humus and, therefore, the quality of the soil? An interdisciplinary approach of researchers in the fields of bioethanol production, geoscience and agriculture in combination with political decision makers are required to make the technologies of renewable bioenergy acceptable to the population.

IMPORTANCE OF MULTIPLE CRITERIA FOR PRIORITY SETTING OF HIV/AIDS INTERVENTIONS.

PubMed

Tromp, Noor; Prawiranegara, Rozar; Siregar, Adiatma; Sunjaya, Deni; Baltussen, Rob

2015-01-01

This study describes the views of various stakeholders on the importance of different criteria for priority setting of HIV/AIDS interventions in Indonesia. Based on a general list of criteria and a focus group discussion with stakeholders (n = 6), a list was developed of thirty-two criteria that play a role in priority setting in HIV/AIDS control in West-Java province. Criteria were categorized according to the World Health Organization's health system goals and building block frameworks. People living with HIV/AIDS (n = 49), healthcare workers (HCW) (n = 41), the general population (n = 43), and policy makers (n = 22) rated the importance of thirty-two criteria on a 5-point Likert-scale. Thereafter, respondents ranked the highest rated criteria to express more detailed preferences. Stakeholders valued the following criteria as most important for the priority setting of HIV/AIDS interventions: an intervention's impact on the HIV/AIDS epidemic, reduction of stigma, quality of care, effectiveness on individual level, and feasibility in terms of current capacity of the health system (i.e., HCW, product, information, and service requirements), financial sustainability, and acceptance by donors. Overall, stakeholders' preferences for the importance of criteria are similar. Our study design outlines an approach for other settings to identify which criteria are important for priority setting of health interventions. For Indonesia, these study results may be used in priority setting processes for HIV/AIDS control and may contribute to more transparent and systematic allocation of resources.

Priority setting: what constitutes success? A conceptual framework for successful priority setting

PubMed Central

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-01-01

Background The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Methods Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). Results This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. Conclusion The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts. PMID:19265518

NREL: U.S. Life Cycle Inventory Database - User Poll

Science.gov Websites

User Poll In preparation for the 2009 U.S. Life Cycle Inventory (LCI) Data Stakeholder meeting, the interested in life cycle analysis. The results from that poll and information gathered from the stakeholders polling data and feedback from life cycle analysis supporters helped develop the U.S. Life Cycle Inventory

[Posthumous sperm procurement and use--ethical and legal dilemmas].

PubMed

Crha, I; Dostál, J; Ventruba, P; Kudela, M; Záková, J

2004-07-01

To present a review of bioethical discussion and recommendations concerning posthumous sperm procurement and postmortem parenthood. Review article. Department of Obstetrics and Gynecology, Masaryk University, Brno, Department of Obstetrics and Gynecology, Palacky University, Olomouc. Literature search in Database of Abstracts of Reviews of the Evidence (DARE) and MEDLINEplus. Posthumous sperm procurement and cryopreservation must be performed within 36 hours after death. To established appropriate medical practice, it is important to consider all stakeholders in the decision-making process: the deceased, the requesting party, the child, the physician and the society. There are only few legislative measures concerning postmortem parenthood and posthumous sperm procurement. The essential elements for postmortem reproduction are: judicial order, ethics committee approval, bereavement period of at least 6 month before use. Posthumous sperm procurement is fraught with ethical and legal implications. All stakeholder should be considered. Society for reproductive medicine should prepare acceptable standard protocol.

Mobile Phone–based Infectious Disease Surveillance System, Sri Lanka

PubMed Central

Sawford, Kate; Daniel, Samson L.A.; Nelson, Trisalyn A.; Stephen, Craig

2010-01-01

Because many infectious diseases are emerging in animals in low-income and middle-income countries, surveillance of animal health in these areas may be needed for forecasting disease risks to humans. We present an overview of a mobile phone–based frontline surveillance system developed and implemented in Sri Lanka. Field veterinarians reported animal health information by using mobile phones. Submissions increased steadily over 9 months, with ≈4,000 interactions between field veterinarians and reports on the animal population received by the system. Development of human resources and increased communication between local stakeholders (groups and persons whose actions are affected by emerging infectious diseases and animal health) were instrumental for successful implementation. The primary lesson learned was that mobile phone–based surveillance of animal populations is acceptable and feasible in lower-resource settings. However, any system implementation plan must consider the time needed to garner support for novel surveillance methods among users and stakeholders. PMID:20875276

Development and Successful Application of a “Community-First” Communication Model for Community-Based Environmental Health Research

PubMed Central

Emmett, Edward Anthony; Zhang, Hong; Shofer, Frances Susan; Rodway, Nancy; Desai, Chintan; Freeman, David; Hufford, Mary

2011-01-01

Objectives Effectively communicate results from a community exposure study to meet predetermined community priorities, maintaining ethical principles of autonomy, empowerment and justice. Methods The community established principles for the communications and a plan to inform study participants, community and other stakeholders of results and recommendations in a novel sequence: the “Community-First” communication model. Results The communications resulted in positive actions including company sponsored free bottled water, accepted by 77.6% of eligible households. Over 95% of participants in a follow-up survey had made some change to residential water supplies. Serum PFOA levels were reduced. Government agencies acted on the results. Conclusions The unique communication approach generated workable solutions to the problem investigated, raised community awareness and modified behaviors. Information generated a “free market” of community-level solutions. Each major stakeholder voluntarily adopted a “precautionary principle”. PMID:19209035

A Multi-Year Plan for Research, Development, and Prototype Testing of Standard Modular Hydropower Technology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Brennan T.; Welch, Tim; Witt, Adam M.

The Multi-Year Plan for Research, Development, and Prototype Testing of Standard Modular Hydropower Technology (MYRP) presents a strategy for specifying, designing, testing, and demonstrating the efficacy of standard modular hydropower (SMH) as an environmentally compatible and cost-optimized renewable electricity generation technology. The MYRP provides the context, background, and vision for testing the SMH hypothesis: if standardization, modularity, and preservation of stream functionality become essential and fully realized features of hydropower technology, project design, and regulatory processes, they will enable previously unrealized levels of new project development with increased acceptance, reduced costs, increased predictability of outcomes, and increased value to stakeholders.more » To achieve success in this effort, the MYRP outlines a framework of stakeholder-validated criteria, models, design tools, testing facilities, and assessment protocols that will facilitate the development of next-generation hydropower technologies.« less

Understanding the complex needs of automotive training at final assembly lines.

PubMed

Hermawati, Setia; Lawson, Glyn; D'Cruz, Mirabelle; Arlt, Frank; Apold, Judith; Andersson, Lina; Lövgren, Maria Gink; Malmsköld, Lennart

2015-01-01

Automobile final assembly operators must be highly skilled to succeed in a low automation environment where multiple variants must be assembled in quick succession. This paper presents formal user studies conducted at OPEL and VOLVO Group to identify assembly training needs and a subset of requirements; and to explore potential features of a hypothetical game-based virtual training system. Stakeholder analysis, timeline analysis, link analysis, Hierarchical Task Analysis and thematic content analysis were used to analyse the results of interviews with various stakeholders (17 and 28 participants at OPEL and VOLVO, respectively). The results show that there is a strong case for the implementation of virtual training for assembly tasks. However, it was also revealed that stakeholders would prefer to use a virtual training to complement, rather than replace, training on pre-series vehicles. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Multiple stakeholders in multi-criteria decision-making in the context of Municipal Solid Waste Management: A review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Soltani, Atousa; Hewage, Kasun; Reza, Bahareh

2015-01-15

Highlights: • We review Municipal Solid Waste Management studies with focus on multiple stakeholders. • We focus on studies with multi-criteria decision analysis methods and discover their trends. • Most studies do not offer solutions for situations where stakeholders compete for more benefits or have unequal voting powers. • Governments and experts are the most participated stakeholders and AHP is the most dominant method. - Abstract: Municipal Solid Waste Management (MSWM) is a complicated process that involves multiple environmental and socio-economic criteria. Decision-makers look for decision support frameworks that can guide in defining alternatives, relevant criteria and their weights, andmore » finding a suitable solution. In addition, decision-making in MSWM problems such as finding proper waste treatment locations or strategies often requires multiple stakeholders such as government, municipalities, industries, experts, and/or general public to get involved. Multi-criteria Decision Analysis (MCDA) is the most popular framework employed in previous studies on MSWM; MCDA methods help multiple stakeholders evaluate the often conflicting criteria, communicate their different preferences, and rank or prioritize MSWM strategies to finally agree on some elements of these strategies and make an applicable decision. This paper reviews and brings together research on the application of MCDA for solving MSWM problems with more focus on the studies that have considered multiple stakeholders and offers solutions for such problems. Results of this study show that AHP is the most common approach in consideration of multiple stakeholders and experts and governments/municipalities are the most common participants in these studies.« less

A stakeholder visioning exercise to enhance chronic care and the integration of community pharmacy services.

PubMed

Franco-Trigo, L; Tudball, J; Fam, D; Benrimoj, S I; Sabater-Hernández, D

2018-02-21

Collaboration between relevant stakeholders in health service planning enables service contextualization and facilitates its success and integration into practice. Although community pharmacy services (CPSs) aim to improve patients' health and quality of life, their integration in primary care is far from ideal. Key stakeholders for the development of a CPS intended at preventing cardiovascular disease were identified in a previous stakeholder analysis. Engaging these stakeholders to create a shared vision is the subsequent step to focus planning directions and lay sound foundations for future work. This study aims to develop a stakeholder-shared vision of a cardiovascular care model which integrates community pharmacists and to identify initiatives to achieve this vision. A participatory visioning exercise involving 13 stakeholders across the healthcare system was performed. A facilitated workshop, structured in three parts (i.e., introduction; developing the vision; defining the initiatives towards the vision), was designed. The Chronic Care Model inspired the questions that guided the development of the vision. Workshop transcripts, researchers' notes and materials produced by participants were analyzed using qualitative content analysis. Stakeholders broadened the objective of the vision to focus on the management of chronic diseases. Their vision yielded 7 principles for advanced chronic care: patient-centered care; multidisciplinary team approach; shared goals; long-term care relationships; evidence-based practice; ease of access to healthcare settings and services by patients; and good communication and coordination. Stakeholders also delineated six environmental factors that can influence their implementation. Twenty-four initiatives to achieve the developed vision were defined. The principles and factors identified as part of the stakeholder shared-vision were combined in a preliminary model for chronic care. This model and initiatives can guide policy makers as well as healthcare planners and researchers to develop and integrate chronic disease services, namely CPSs, in real-world settings. Copyright © 2018 Elsevier Inc. All rights reserved.

Stakeholder Engagement in HIV Cure Research: Lessons Learned from Other HIV Interventions and the Way Forward

PubMed Central

Chu, Carissa; Ananworanich, Jintanat; Excler, Jean-Louis; Tucker, Joseph D.

2015-01-01

Abstract Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of the implementation challenges. The treatment-related stakeholder engagement was strong and community-led from the onset and helped translation from research to implementation. We outline five steps to initiate and sustain stakeholder engagement in HIV cure research and conclude that stakeholder engagement represents a key investment in which stakeholders mutually agree to share knowledge, benefits, and risk of failure. Effective stakeholder engagement prevents misconceptions. As HIV cure research advances from early trials involving subjects with generally favorable prognosis to studies involving greater risk and uncertainty, success may depend on early and deliberate engagement of stakeholders. PMID:26061668

Stakeholder engagement in dredged material management decisions.

PubMed

Collier, Zachary A; Bates, Matthew E; Wood, Matthew D; Linkov, Igor

2014-10-15

Dredging and disposal issues often become controversial with local stakeholders because of their competing interests. These interests tend to manifest themselves in stakeholders holding onto entrenched positions, and deadlock can result without a methodology to move the stakeholder group past the status quo. However, these situations can be represented as multi-stakeholder, multi-criteria decision problems. In this paper, we describe a case study in which multi-criteria decision analysis was implemented in a multi-stakeholder setting in order to generate recommendations on dredged material placement for Long Island Sound's Dredged Material Management Plan. A working-group of representatives from various stakeholder organizations was formed and consulted to help prioritize sediment placement sites for each dredging center in the region by collaboratively building a multi-criteria decision model. The resulting model framed the problem as several alternatives, criteria, sub-criteria, and metrics relevant to stakeholder interests in the Long Island Sound region. An elicitation of values, represented as criteria weights, was then conducted. Results show that in general, stakeholders tended to agree that all criteria were at least somewhat important, and on average there was strong agreement on the order of preferences among the diverse groups of stakeholders. By developing the decision model iteratively with stakeholders as a group and soliciting their preferences, the process sought to increase stakeholder involvement at the front-end of the prioritization process and lead to increased knowledge and consensus regarding the importance of site-specific criteria. Published by Elsevier B.V.

Stakeholder Engagement in HIV Cure Research: Lessons Learned from Other HIV Interventions and the Way Forward.

PubMed

Lo, Ying-Ru; Chu, Carissa; Ananworanich, Jintanat; Excler, Jean-Louis; Tucker, Joseph D

2015-07-01

Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of the implementation challenges. The treatment-related stakeholder engagement was strong and community-led from the onset and helped translation from research to implementation. We outline five steps to initiate and sustain stakeholder engagement in HIV cure research and conclude that stakeholder engagement represents a key investment in which stakeholders mutually agree to share knowledge, benefits, and risk of failure. Effective stakeholder engagement prevents misconceptions. As HIV cure research advances from early trials involving subjects with generally favorable prognosis to studies involving greater risk and uncertainty, success may depend on early and deliberate engagement of stakeholders.

Stakeholder Perceptions of Risk in Construction.

PubMed

Zhao, Dong; McCoy, Andrew P; Kleiner, Brian M; Mills, Thomas H; Lingard, Helen

2016-02-01

Safety management in construction is an integral effort and its success requires inputs from all stakeholders across design and construction phases. Effective risk mitigation relies on the concordance of all stakeholders' risk perceptions. Many researchers have noticed the discordance of risk perceptions among critical stakeholders in safe construction work, however few have provided quantifiable evidence describing them. In an effort to fill this perception gap, this research performs an experiment that investigates stakeholder perceptions of risk in construction. Data analysis confirms the existence of such discordance, and indicates a trend in risk likelihood estimation. With risk perceptions from low to high, the stakeholders are architects, contractors/safety professionals, and engineers. Including prior studies, results also suggest that designers have improved their knowledge in building construction safety, but compared to builders they present more difficultly in reaching a consensus of perception. Findings of this research are intended to be used by risk management and decision makers to reassess stakeholders' varying judgments when considering injury prevention and hazard assessment.

Decontamination issues for chemical and biological warfare agents: how clean is clean enough?

PubMed

Raber, E; Jin, A; Noonan, K; McGuire, R; Kirvel, R D

2001-06-01

The objective of this assessment is to determine what level of cleanup will be required to meet regulatory and stakeholder needs in the case of a chemical and/or biological incident at a civilian facility. A literature review for selected, potential chemical and biological warfare agents shows that dose information is often lacking or controversial. Environmental regulatory limits or other industrial health guidelines that could be used to help establish cleanup concentration levels for such agents are generally unavailable or not applicable for a public setting. Although dose information, cleanup criteria, and decontamination protocols all present challenges to effective planning, several decontamination approaches are available. Such approaches should be combined with risk-informed decision making to establish reasonable cleanup goals for protecting health, property, and resources. Key issues during a risk assessment are to determine exactly what constitutes a safety hazard and whether decontamination is necessary or not for a particular scenario. An important conclusion is that cleanup criteria are site dependent and stakeholder specific. The results of a modeling exercise for two outdoor scenarios are presented to reinforce this conclusion. Public perception of risk to health, public acceptance of recommendations based on scientific criteria, political support, time constraints, and economic concerns must all be addressed in the context of a specific scenario to yield effective and acceptable decontamination.

A comparison of cat-related risk perceptions and tolerance for outdoor cats in Florida and Hawaii.

PubMed

Wald, Dara M; Lohr, Cheryl A; Lepczyk, Christopher A; Jacobson, Susan K; Cox, Linda J

2016-12-01

Risk perceptions and attitudes toward animals often explain tolerance for wildlife and management preferences. However, little is understood about how these relationships vary across different geographic regions and stakeholder groups. To address this gap in knowledge, we compared differences in acceptance capacity, risk perceptions, perceived enjoyment from outdoor cats, and experiences with outdoor cats among 3 groups (general public, conservation community, and animal-welfare community) in Hawaii and Florida, two states with large conservation challenges. We combined independently collected data from Florida and Hawaii, to determine how perception of the risks presented by outdoor cats, group membership, and state of residence influenced people's tolerance for outdoor cats. Florida respondents were significantly more tolerant of outdoor cats and less concerned about cat-related risks than Hawaii respondents (p < 0.05). In both states, animal-welfare group members reported greater enjoyment seeing cats and perceived a smaller increase in the cat population and lower levels of risk than other groups (p < 0.05). All groups exhibited similar relationships between acceptance capacity and enjoyment and the perceived increase in the cat population. Our results suggest public tolerance for cats varied due to the influence of local or geographical concerns, but that strongly held beliefs, risk perceptions, and feelings about cats explained more of the variance in stakeholder tolerance. © 2016 Society for Conservation Biology.

Barriers and enablers that influence sustainable interprofessional education: a literature review.

PubMed

Lawlis, Tanya Rechael; Anson, Judith; Greenfield, David

2014-07-01

The effective incorporation of interprofessional education (IPE) within health professional curricula requires the synchronised and systematic collaboration between and within the various stakeholders. Higher education institutions, as primary health education providers, have the capacity to advocate and facilitate this collaboration. However, due to the diversity of stakeholders, facilitating the pedagogical change can be challenging and complex, and brings a degree of uncertainty and resistance. This review, through an analysis of the barriers and enablers investigates the involvement of stakeholders in higher education IPE through three primary stakeholder levels: Government and Professional, Institutional and Individual. A review of eight primary databases using 21 search terms resulted in 40 papers for review. While the barriers to IPE are widely reported within the higher education IPE literature, little is documented about the enablers of IPE. Similarly, the specific identification and importance of enablers for IPE sustainability and the dual nature of some barriers and enablers have not been previously reported. An analysis of the barriers and enablers of IPE across the different stakeholder levels reveals five key "fundamental elements" critical to achieving sustainable IPE in higher education curricula.

Review of various approaches for assessing public health risks in regulatory decision making: choosing the right approach for the problem.

PubMed

Dearfield, Kerry L; Hoelzer, Karin; Kause, Janell R

2014-08-01

Stakeholders in the public health risk analysis community can possess differing opinions about what is meant by "conduct a risk assessment." In reality, there is no one-size-fits-all risk assessment that can address all public health issues, problems, and regulatory needs. Although several international and national organizations (e.g., Codex Alimentarius Commission, Office International des Epizooties, Food and Agricultural Organization, World Health Organization, National Research Council, and European Food Safety Authority) have addressed this issue, confusion remains. The type and complexity of a risk assessment must reflect the risk management needs to appropriately inform a regulatory or nonregulatory decision, i.e., a risk assessment is ideally "fit for purpose" and directly applicable to risk management issues of concern. Frequently however, there is a lack of understanding by those not completely familiar with risk assessment regarding the specific utility of different approaches for assessing public health risks. This unfamiliarity can unduly hamper the acceptance of risk assessment results by risk managers and may reduce the usefulness of such results for guiding public health policies, practices, and operations. Differences in interpretation of risk assessment terminology further complicate effective communication among risk assessors, risk managers, and stakeholders. This article provides an overview of the types of risk assessments commonly conducted, with examples primarily from the food and agricultural sectors, and a discussion of the utility and limitations of these specific approaches for assessing public health risks. Clarification of the risk management issues and corresponding risk assessment design needs during the formative stages of the risk analysis process is a key step for ensuring that the most appropriate assessment of risk is developed and used to guide risk management decisions.

Assisted suicide for prisoners? Stakeholder and prisoner perspectives.

PubMed

Shaw, David M; Elger, Bernice S

2016-09-01

For a wider project on aging in prison, the authors interviewed 35 older prisoners and 24 stakeholders (prison staff, prison healthcare professionals, and policy makers) about healthcare for prisoners. In all, 6 prisoners and 3 stakeholders spontaneously expressed their attitudes concerning assisted suicide. Some prisoners seek assisted suicide for medical reasons and others because they regard spending the rest of their lives in prison as undignified. However, stakeholders identified several ethical and practical challenges in providing assisted suicide to prisoners. This article presents these perspectives on assisted suicide in prison and provides an ethical analysis of the issues raised.

Strategic planning to reduce conflicts for offshore wind development in Taiwan: A social marketing perspective.

PubMed

Chen, Jyun-Long; Liu, Hsiang-Hsi; Chuang, Ching-Ta

2015-10-15

This study aims to improve the current inefficiency and ineffectiveness of communications among stakeholders when planning and constructing offshore wind farms (OWFs). An analysis using a social marketing approach with segmentation techniques is used to identify the target market based on stakeholders' perceptions. The empirical results identify three stakeholder segments: (1) impact-attend group; (2) comprehensive group; and (3) benefit-attend group. The results suggest that communication should be implemented to alter stakeholders' attitudes toward the construction of OWFs. Furthermore, based on the results of segmentation, target markets are identified to plan the communication strategies for reducing the conflicts among stakeholders of OWF construction. The results also indicated that in the planning phase of construction for OWFs, effective stakeholder participation and policy communication can enhance the perception of benefits to reduce conflict with local communities and ocean users. Copyright © 2015 Elsevier Ltd. All rights reserved.

Implementing a Nation-Wide Mental Health Care Reform: An Analysis of Stakeholders' Priorities.

PubMed

Lorant, Vincent; Grard, Adeline; Nicaise, Pablo

2016-04-01

Belgium has recently reformed its mental health care delivery system with the goals to strengthen the community-based supply of care, care integration, and the social rehabilitation of users and to reduce the resort to hospitals. We assessed whether these different reform goals were endorsed by stakeholders. One-hundred and twenty-two stakeholders ranked, online, eighteen goals of the reform according to their priorities. Stakeholders supported the goals of social rehabilitation of users and community care but were reluctant to reduce the resort to hospitals. Stakeholders were averse to changes in treatment processes, particularly in relation to the reduction of the resort to hospitals and mechanisms for more care integration. Goals heterogeneity and discrepancies between stakeholders' perspectives and policy priorities are likely to produce an uneven implementation of the reform process and, hence, reduce its capacity to achieve the social rehabilitation of users.

Rapid Development: A Content Analysis Comparison of Literature and Purposive Sampling of AFRL Rapid Reaction Projects

DTIC Science & Technology

2011-12-01

systems engineering technical and technical management processes. Technical Planning, Stakeholders Requirements Development, and Architecture Design were...Stakeholder Requirements Definition, Architecture Design and Technical Planning. A purposive sampling of AFRL rapid development program managers and engineers...emphasize one process over another however Architecture Design , Implementation scored higher among Technical Processes. Decision Analysis, Technical

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

PubMed Central

Mashamba-Thompson, Tivani P.; Jama, Ngcwalisa A.; Sartorius, Benn; Drain, Paul K.; Thompson, Rowan M.

2017-01-01

Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics. PMID:28075337

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China

PubMed Central

Richards, Esther; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources. PMID:29045434

Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia

PubMed Central

Mayston, Rosie; Alem, Atalay; Habtamu, Alehegn; Shibre, Teshome; Fekadu, Abebaw; Hanlon, Charlotte

2016-01-01

Little is understood about the feasibility and acceptability of primary care-based models of task-sharing care for people with severe mental disorders (SMDs) in low- and middle-income countries (LMICs). A participatory planning approach was adopted in preparation for the transition from hospital-delivered psychiatric care for SMD to a primary care-based, task-sharing model in a rural Ethiopian community. In this article, we present findings from community consultation meetings (n = 4), focus group discussions (n = 7) and in-depth interviews (n = 11) with key stakeholders (healthcare administrators and providers, caregivers, service-users and community leaders) which were carried out over a 2-year period in the context of ongoing dialogue with the community. The principle of local delivery of mental health services was agreed upon by all stakeholder groups. Key reasons for supporting local delivery were increased access for the majority due to proximity, reduced cost and reduced stress related to transportation. However, acceptance of the new service was qualified by concerns about the competence of staff to deliver a comprehensive and dependable service of equal quality to that currently provided at the hospital. Adequate training and support, as well as ensuring consistency of medication supply were identified as key components to ensure success. Encouragingly, our results suggest that there is significant support for the service change and an interest for the mobilization of community resources to support this. One of the study strengths was that we were able to present the different perspectives of multiple stakeholder groups. By nesting the study in an ongoing community-based cohort of people with SMD we were able to interview a more representative and empowered group of caregivers and service users than is often available in LMICs. Despite this, the extent to which service-users are able to express their opinions is likely limited by their marginalized role in rural Ethiopian society. PMID:26282860

Perceptions and acceptability of some stakeholders about the bovine tuberculosis surveillance system for wildlife (Sylvatub) in France

PubMed Central

2018-01-01

Bovine tuberculosis (bTB) is a common disease of cattle and wildlife, with economic repercussions and implications for animal and human health. The surveillance of bTB in wildlife is particularly important, to shed light on the epidemiological role of wild species and for the adaptation of control measures. In France, a bTB surveillance system for free-ranging wildlife, the Sylvatub system, was launched in 2011 on wild boars, red deer, roe deer and badgers. It relies on active and passive surveillance activities, constrained by practical difficulties, such as the accessibility of wild animals, and regulatory rules for the trapping of badgers, for example. We report here the first assessment of stakeholders’ perceptions of the Sylvatub system and its acceptability, based on 20 individual semi-structured interviews with three types of stakeholder (collectors, coordinators, officers) in areas with different rates of bTB infection. With the caveat that these findings cannot be assumed to be representative of the national situation, we found that the Sylvatub system was considered useful by all the stakeholders interviewed. Those from the world of hunting participate in surveillance mostly to help livestock farmers, who are not systematically involved in bTB surveillance in wildlife. Many practical and regulatory constraints were raised, which could be offset by recognition of the work done by the “hunting community”, to maintain the willingness of these individuals to participate. We also identified a need for improvements in communication and information. Qualitative information, such as that collected here, is essential to improve our understanding of the reasons favoring and disfavoring participation in surveillance, and should be taken into account in the evaluation process. These results are relevant to hunters and to veterinary authorities wishing to identify the determinants of participation in the Sylvatub system. They could provide support for decision-making processes to improve surveillance strategies. PMID:29543911

What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders’ views

PubMed Central

Pound, Pandora; Denford, Sarah; Shucksmith, Janet; Tanton, Clare; Johnson, Anne M; Owen, Jenny; Hutten, Rebecca; Mohan, Leanne; Bonell, Chris; Abraham, Charles; Campbell, Rona

2017-01-01

Objectives Sex and relationship education (SRE) is regarded as vital to improving young people’s sexual health, but a third of schools in England lacks good SRE and government guidance is outdated. We aimed to identify what makes SRE programmes effective, acceptable, sustainable and capable of faithful implementation. Design This is a synthesis of findings from five research packages that we conducted (practitioner interviews, case study investigation, National Survey of Sexual Attitudes and Lifestyles, review of reviews and qualitative synthesis). We also gained feedback on our research from stakeholder consultations. Settings Primary research and stakeholder consultations were conducted in the UK. Secondary research draws on studies worldwide. Results Our findings indicate that school-based SRE and school-linked sexual health services can be effective at improving sexual health. We found professional consensus that good programmes start in primary school. Professionals and young people agreed that good programmes are age-appropriate, interactive and take place in a safe environment. Some young women reported preferring single-sex classes, but young men appeared to want mixed classes. Young people and professionals agreed that SRE should take a ‘life skills’ approach and not focus on abstinence. Young people advocated a ‘sex-positive’ approach but reported this was lacking. Young people and professionals agreed that SRE should discuss risks, but young people indicated that approaches to risk need revising. Professionals felt teachers should be involved in SRE delivery, but many young people reported disliking having their teachers deliver SRE and we found that key messages could become lost when interpreted by teachers. The divergence between young people and professionals was echoed by stakeholders. We developed criteria for best practice based on the evidence. Conclusions We identified key features of effective and acceptable SRE. Our best practice criteria can be used to evaluate existing programmes, contribute to the development of new programmes and inform consultations around statutory SRE. PMID:28669970

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China.

PubMed

Jiang, Hong; Xu, Jieshuang; Richards, Esther; Qian, Xu; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers' perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces-Zhejiang, Hubei and Yunnan-were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources.

Branding water

PubMed Central

Dolnicar, Sara; Hurlimann, Anna; Grün, Bettina

2014-01-01

Branding is a key strategy widely used in commercial marketing to make products more attractive to consumers. With the exception of bottled water, branding has largely not been adopted in the water context although public acceptance is critical to the implementation of water augmentation projects. Based on responses from 6247 study participants collected between 2009 and 2012, this study shows that (1) different kinds of water – specifically recycled water, desalinated water, tap water and rainwater from personal rainwater tanks – are each perceived very differently by the public, (2) external events out of the control of water managers, such as serious droughts or floods, had a minimal effect on people's perceptions of water, (3) perceptions of water were stable over time, and (4) certain water attributes are anticipated to be more effective to use in public communication campaigns aiming at increasing public acceptance for drinking purposes. The results from this study can be used by a diverse range of water stakeholders to increase public acceptance and adoption of water from alternative sources. PMID:24742528

Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

PubMed

Kahan, Deborah; Leszcz, Molyn; O'Campo, Patricia; Hwang, Stephen W; Wasylenki, Donald A; Kurdyak, Paul; Wise Harris, Deborah; Gozdzik, Agnes; Stergiopoulos, Vicky

2016-04-27

Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis. Stakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations. A multi-organizational brief intervention is an acceptable model to support integration of hospital, primary and community care for frequent ED users. The study highlights the importance of early implementation evaluation to identify potential solutions to implementation barriers that may be applicable to many jurisdictions.

Using community-based evidence for decentralized health planning: insights from Maharashtra, India.

PubMed

Shukla, Abhay; Khanna, Renu; Jadhav, Nitin

2018-01-01

Health planning is generally considered a technical subject, primarily the domain of health officials with minimal involvement of community representatives. The National Rural Health Mission launched in India in 2005 recognized this gap and mandated mechanisms for decentralized health planning. However, since planning develops in the context of highly unequal power relations, formal spaces for participation are necessary but not sufficient. Hence a project on capacity building for decentralized health planning was implemented in selected districts of Maharashtra, India during 2010-13. This process developed on the platform of officially supported community-based monitoring and planning, a process for community feedback and participation towards health system change. A specific project on capacity building for decentralized planning included a structured learning course and workshops for major stakeholders. An evaluation of the project, including in-depth interviews of various participants and analysis of change in local health planning processes, revealed positive changes in intervention areas, including increased capacity of key stakeholders leading to preparation of evidence-based, innovative planning proposals, significant community oriented changes in utilization of health facility funds, and inclusion of community-based proposals in village, health facility-based block and district plans. Transparency related to planning increased along with responsiveness of health providers to community suggestions. A key lesson is that active facilitation of decentralized health planning and influencing the health system to expand participation, are essential to ensure changes in planning. Effective strategies included: identifying people's health service related priorities through community-based monitoring, capacity building of diverse stakeholders regarding local health planning, and advocacy to enable participation of community-based actors in the planning process. This combination of strategies draws upon the framework of 'empowered participatory governance' which necessitates combining a degree of 'countervailing power' and acceptance of participation by the system, for new forms of governance to emerge. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Implementation of a framework for multi-species, multi-objective adaptive management in Delaware Bay

USGS Publications Warehouse

McGowan, Conor P.; Smith, David R.; Nichols, James D.; Lyons, James E.; Sweka, John A.; Kalasz, Kevin; Niles, Lawrence J.; Wong, Richard; Brust, Jeffrey; Davis, Michelle C.; Spear, Braddock

2015-01-01

Decision analytic approaches have been widely recommended as well suited to solving disputed and ecologically complex natural resource management problems with multiple objectives and high uncertainty. However, the difference between theory and practice is substantial, as there are very few actual resource management programs that represent formal applications of decision analysis. We applied the process of structured decision making to Atlantic horseshoe crab harvest decisions in the Delaware Bay region to develop a multispecies adaptive management (AM) plan, which is currently being implemented. Horseshoe crab harvest has been a controversial management issue since the late 1990s. A largely unregulated horseshoe crab harvest caused a decline in crab spawning abundance. That decline coincided with a major decline in migratory shorebird populations that consume horseshoe crab eggs on the sandy beaches of Delaware Bay during spring migration. Our approach incorporated multiple stakeholders, including fishery and shorebird conservation advocates, to account for diverse management objectives and varied opinions on ecosystem function. Through consensus building, we devised an objective statement and quantitative objective function to evaluate alternative crab harvest policies. We developed a set of competing ecological models accounting for the leading hypotheses on the interaction between shorebirds and horseshoe crabs. The models were initially weighted based on stakeholder confidence in these hypotheses, but weights will be adjusted based on monitoring and Bayesian model weight updating. These models were used together to predict the effects of management actions on the crab and shorebird populations. Finally, we used a dynamic optimization routine to identify the state dependent optimal harvest policy for horseshoe crabs, given the possible actions, the stated objectives and our competing hypotheses about system function. The AM plan was reviewed, accepted and implemented by the Atlantic States Marine Fisheries Commission in 2012 and 2013. While disagreements among stakeholders persist, structured decision making enabled unprecedented progress towards a transparent and consensus driven management plan for crabs and shorebirds in Delaware Bay.

Content and factor validation of the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations.

PubMed

Friend, Mary Louanne; Sieloff, Christina Leibold; Murphy, Shannon; Leeper, James

2016-07-01

Nursing education programs have responsibilities to their stakeholders to prepare graduates who can provide safe, effective patient centered care while leading health care changes. Empowered nurses have been associated with low nurse turnover and higher patient satisfaction; however, less is currently known about group empowerment in nursing education. In order to examine group empowerment in schools of nursing, the Sieloff-King Assessment of Group Empowerment in Organizations (SKAGEO©) was adapted and tested for content validity and confirmatory factor analysis. The adapted instrument, the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations (SKFAGEEO) was first reviewed by nurse experts who provided quantitative and qualitative data regarding each item. A total of 320 nurse deans and faculty comprised the final sample for the second order confirmatory 8 factor analysis. Findings revealed factor loadings ranging from .455 to .960.The overall fit of the propose model was Chi Square=1383. 24, df=566, p<.001; GFI=.786, RMSEA=0.69. The study results indicated that the SKFAGEEO has acceptable psychometric properties. Copyright © 2016 Elsevier Ltd. All rights reserved.

Exploring methods the for selection and integration of stakeholder views in the development of core outcome sets: a case study in reconstructive breast surgery.

PubMed

Potter, Shelley; Brookes, Sara T; Holcombe, Christopher; Ward, Joseph A; Blazeby, Jane M

2016-09-23

The development and use of core outcome sets (COSs) in trials may improve data synthesis and reduce outcome reporting bias. The selection of outcomes in COSs is informed by views of key stakeholders, yet little is known about the role and influence of different stakeholders' views during COS development. We report an exploratory case study examining how stakeholder selection and incorporation of stakeholders' views may influence the selection of outcomes for a COS in reconstructive breast surgery (RBS). We also make recommendations for future considerations. Key stakeholder groups and subgroups were identified from the literature and expert opinion by the COS management group. They included health care professionals, subdivided by profession (breast and plastic surgeons, specialist nurses and psychologists) and patients, subdivided according to type of surgery received, timing of reconstruction, time since surgery and patient age. All participated in a survey in which they were asked to prioritise outcomes. Outcomes were prioritised using a 9-point scale from 1 (not important) to 9 (extremely important). The proportion of (1) all participants, ignoring stakeholder group (single heterogeneous panel analysis), (2) 'professional' and 'patient' groups separately (two heterogeneous panels), ignoring prespecified subgroups and (3) each participant subgroup separately (multiple homogeneous panel analysis) rating each item 'extremely important' was summarised and compared to explore how selection and integration of stakeholder views may influence outcome prioritisation. There were many overlaps between items rated as most important by all groups. Specific stakeholders, however, prioritised specific concerns and a broader range of outcomes were prioritised when the subgroups were considered separately. For example, two additional outcomes were prioritised when patient and professional groups were considered separately and eight additional outcomes were identified when the views of the individual subgroups were explored. In general, patient subgroups preferentially valued additional clinical outcomes, including unplanned surgery, whereas professional subgroups prioritised additional psychosocial issues including body image. Stakeholder groups value different outcomes. Selection of groups, therefore, is important. Our recommendations for robust and transparent stakeholder selection and integration of stakeholder views may aid future COS developers in the design and conduct of their studies and improve the validity and value of future COS.

Developing an Integrative Treatment Program for Cancer-Related Fatigue Using Stakeholder Engagement - A Qualitative Study.

PubMed

Canella, Claudia; Mikolasek, Michael; Rostock, Matthias; Beyer, Jörg; Guckenberger, Matthias; Jenewein, Josef; Linka, Esther; Six, Claudia; Stoll, Sarah; Stupp, Roger; Witt, Claudia M

2017-11-01

Although cancer-related fatigue (CRF) has gained increased attention in the past decade, it remains difficult to treat. An integrative approach combining conventional and complementary medicine interventions seems highly promising. Treatment programs are more likely to be effective if the needs and interests of the people involved are well represented. This can be achieved through stakeholder engagement. The aim of the study was to develop an integrative CRF treatment program using stakeholder engagement and to compare it to an expert version. In a qualitative study, a total of 22 stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5 nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a local Swiss Cancer League) were interviewed either face-to-face or in a focus group setting. For data analysis, qualitative content analysis was used. With stakeholder engagement, the integrative CRF treatment program was adapted to usual care using a prioritizing approach and allowing more patient choice. Unlike the expert version, in which all intervention options were on the same level, the stakeholder engagement process resulted in a program with 3 different levels. The first level includes mandatory nonpharmacological interventions, the second includes nonpharmacological choice-based interventions, and the third includes pharmacological interventions for severe CRF. The resulting stakeholder based integrative CRF treatment program was implemented as clinical practice guideline at our clinic (Institute for Complementary and Integrative Medicine, University Hospital Zurich). Through the stakeholder engagement approach, we integrated the needs and preferences of people who are directly affected by CRF. This resulted in an integrative CRF treatment program with graded recommendations for interventions and therefore potentially greater sustainability in a usual care setting.

An examination on the influence of small and medium enterprise (SME) stakeholder on green supply chain management practices

NASA Astrophysics Data System (ADS)

Shahlan, M. Z.; Sidek, A. A.; Suffian, S. A.; Hazza, M. H. F. A.; Daud, M. R. C.

2018-01-01

In this paper, climate change and global warming are the biggest current issues in the industrial sectors. The green supply chain managements (GSCM) is one of the crucial input to these issues. Effective GSCM can potentially secure the organization’s competitive advantage and improve the environmental performance of the network activities. In this study, the aim is to investigate and examine how a small and medium enterprises (SMEs) stakeholder pressure and top management influence green supply chain management practices. The study is further advance green supply chain management research in Malaysia focusing on SMEs manufacturing sector using structural equation modelling. Structural equation modelling is a multivariate statistical analysis technique used to examine structural relationship. It is the combination of factor analysis and multi regression analysis and used to analyse structural relationship between measure variable and latent factor. This research found that top management support and stakeholder pressure is the major influence for SMEs to adopt green supply chain management. The research also found that top management is fully mediate with the relationship between stakeholder pressure and monitoring supplier environmental performance.

Exploring the effectiveness of sustainable water management structures in the Upper Pungwe river basin

NASA Astrophysics Data System (ADS)

Nyikadzino, B.; Chibisa, P.; Makurira, H.

The study endeavoured to assess the effectiveness of stakeholder structures and their participation in sustainable water resources management in the Upper Pungwe river basin shared by Zimbabwe and Mozambique. The study sought to assess the level and effectiveness of stakeholder, gender and the vulnerable groups representation in sustainable water resources management as well as the whole stakeholder participation process. The study employed both qualitative and quantitative methods for data collection and analysis. Sampling data was obtained from 15 stakeholder representatives (councillors) constituting Pungwe Subcatchment Council, 30 water users ranging from small scale to large scale users and professionals in water resources management. Two different questionnaires and three structured interviews were administered during the study. Water permit database, financial reports and other source documents were also analysed. The study established that the sustainability and effectiveness of stakeholder structures and their participation in water resources management is being compromised by lack of stakeholder awareness. Water utilisation is very high in the subcatchment (99%) while women participation is still low (20%). The study therefore recommends the use of quotas for the participation of women in stakeholder structures. Stakeholder structures are encouraged to intensify stakeholder awareness on issues of river protection, efficient water use and pollution control. Further research is recommended to be carried out on the effectiveness of stakeholder structures in combating water pollution and enhancing river protection.

Input analysis for two public consultations on the EU Clinical Trials Regulation.

PubMed

Langhof, Holger; Lander, Jonas; Strech, Daniel

2016-09-17

The European Union's (EU) Clinical Trials Directive was replaced by an EU-Regulation as of 2016. The policy revision process was subject to a formal impact assessment exercised by the European Commission (EC) from 2008 to 2014. Following the EU principles of Good Governance, deliberation with stakeholders was an integral part of this impact assessment and the policy formulation process. Hence, two public consultations (PCs) were held by the EC in 2009 and 2011, respectively. Various stakeholders contributed and submitted their written input to the EC. Though often cited in the further revision process, the input gathered in the PC was not communicated with full transparency and it is unclear how and to what extent the input has been processed and used in the policy formulation. The objective of this study was an analysis of submissions to both PCs in order to systematically present what topics have been discussed and which possible policy options have been raised by the stakeholders. All written submissions publicly available were downloaded from the EC's homepage and assessed for stakeholder characteristics. Thematic text analysis was applied to assess the full text of a random sample of 33% of these submissions. A total of 198 different stakeholders from the EU and the United States of America contributed to one or both of the two PCs. In total, 44 various themes have been addressed that could be clustered under 24 main themes, including the articulation of problems as well as possible policy solutions to face these problems. The two PCs on the Clinical Trials Directive were highly appreciated by the various stakeholders and their input allowed an in-depth view on their particular interests. This input provided a rich source of information for all stakeholders in the field of clinical trials as well as to the EC's impact assessment. Although the EC obviously gathered a large quantity of expert knowledge on practical implications of trials legislation by consulting stakeholders, it remained unclear how this input was used in the development of the new regulation. For the sake of transparency, it is recommended that in future PCs the EC uses better standardized methods for a more transparent analysis and presentation of results.

A Stakeholder Analysis of the Navy’s Thirty-Year Shipbuilding Plan

DTIC Science & Technology

2007-12-01

new.items/d05183.pdf Mankiw , N. Gregory (2004). Principles of economics (3rd ed.). Mason, OH: Thomson South-Western. McCaffery, J.L. and Jones, L.R...Shipbuilding Association, 2007). 11 III. LITERATURE REVIEW AND THEORETICAL FRAMEWORK Stakeholder theory confronts the traditional economic model of the... Mankiw , 2004). By completing these steps, the manager attains answers to basic questions about the stakeholder (Freeman, 1984): Over the long run

Using Cartoons to Transfer Knowledge Concerning the Principles of Work Disability Prevention Among Stakeholders.

PubMed

Labrecque, Marie-Elise; Coutu, Marie-France; Durand, Marie-José; Fassier, Jean-Baptiste; Loisel, Patrick

2016-06-01

Purpose This study assesses how well two cartoons transfer knowledge of principles of work disability prevention among stakeholders, according to their level of experience. We also document stakeholders' perceptions of the usefulness of the cartoons. Method We performed a descriptive study. Two groups of stakeholders were recruited: (1) experienced (working for more than 2 years in work disability), (2) non-experienced (in training). A self-administered questionnaire with open-ended questions documented stakeholders' understanding of each cartoon box and their perception of the possible usefulness of the cartoons. We transformed qualitative responses into quantitative responses for descriptive purposes. We performed independent t tests to compare the groups' level of understanding, and content analysis for the perception of usefulness. Results Overall, 149 stakeholders (50 experienced and 99 non-experienced) participated and identified 79.4 and 61.4 % of all principles presented in each of the two cartoons respectively. Experienced stakeholders identified more principles compared to non-experienced stakeholders (p = 0.007). Both cartoons were perceived to be useful for knowledge transfer. Conclusions Principles were generally well identified in the cartoons by all participants. Cartoons can be used as an effective tool among stakeholders to achieve a common understanding in order to coordinate their actions.

Motivation of university and non-university stakeholders to change medical education in Vietnam.

PubMed

Luu, Ngoc Hoat; Nguyen, Lan Viet; van der Wilt, G J; Broerse, J; Ruitenberg, E J; Wright, E P

2009-07-24

Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders. Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders. Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors. The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.

Stakeholder Participation in System Change: A New Conceptual Model.

PubMed

O'Rourke, Tammy; Higuchi, Kathryn S; Hogg, William

2016-08-01

A recent change in Canada's primary care system led to the introduction of Nurse Practitioner-Led clinics. The literature suggests that stakeholders can influence system change initiatives. However, very little is known about healthcare stakeholder motivations, particularly stakeholders who are seen as resistors to change. To examine stakeholder participation in the system change process that led to the introduction of the first Nurse Practitioner-Led clinic in Ontario. This single case study included two site visits, semistructured individual tape-recorded interviews, and the examination of relevant public documents. Qualitative content analysis was used to analyze the data. Sixteen individuals from different healthcare sectors and professions participated in the interviews and 20 documents were reviewed. Six key themes emerged from the data. Linking Evidence to Action The findings from the study present a new perspective on stakeholder participation that includes both those who supported the proposed change and those who advocated for a different change. The findings identify stakeholder activities used to shape, share, and protect their visions for system change. The conceptual model presented in this study adds to the understanding of challenges and complexities involved in healthcare system change. Understanding why and how stakeholders participate in change can help healthcare leaders in planning activities to enhance stakeholder involvement in healthcare system change. © 2016 Sigma Theta Tau International.

Stakeholder analysis for a maternal and newborn health project in Eastern Uganda

PubMed Central

2013-01-01

Background Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. Methods A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. Results This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Conclusion Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up. PMID:23497057

Involvement of stakeholders in determining health priorities of adolescents in rural South Africa.

PubMed

Twine, Rhian; Kahn, Kathleen; Scholtz, Alexandra; Norris, Shane A

2016-01-01

When developing intervention research, it is important to explore issues from the community perspective. Interventions that promote adolescent health in South Africa are urgently needed, and Project Ntshembo ('hope') aims to improve the health of young women and their offspring in the Agincourt sub-district of rural northeast South Africa, actively using stakeholder involvement throughout the research process. This study aimed to determine adolescent health priorities according to key stakeholders, to align stakeholder and researcher priorities, and to form a stakeholder forum, which would be active throughout the intervention. Thirty-two stakeholders were purposefully identified as community members interested in the health of adolescents. An adapted Delphi incorporating face-to-face discussions, as well as participatory visualisation, was used in a series of three workshops. Consensus was determined through non-parametric analysis. Stakeholders and researchers agreed that peer pressure and lack of information, or having information but not acting on it, were the root causes of adolescent health problems. Pregnancy, HIV, school dropout, alcohol and drug abuse, not accessing health services, and unhealthy lifestyle (leading to obesity) were identified as priority adolescent health issues. A diagram was developed showing how these eight priorities relate to one another, which was useful in the development of the intervention. A stakeholder forum was founded, comprising 12 of the stakeholders involved in the stakeholder involvement process. The process brought researchers and stakeholders to consensus on the most important health issues facing adolescents, and a stakeholder forum was developed within which to address the issues. Stakeholder involvement as part of a research engagement strategy can be of mutual benefit to the researchers and the community in which the research is taking place.

Children, parents and pets exercising together (CPET): exploratory randomised controlled trial.

PubMed

Morrison, Ryan; Reilly, John J; Penpraze, Victoria; Westgarth, Carri; Ward, Dianne S; Mutrie, Nanette; Hutchison, Pippa; Young, David; McNicol, Lindsay; Calvert, Michael; Yam, Philippa S

2013-11-27

Levels of physical activity (PA) in UK children are much lower than recommended and novel approaches to its promotion are needed. The Children, Parents and Pets Exercising Together (CPET) study is the first exploratory randomised controlled trial (RCT) to develop and evaluate an intervention aimed at dog-based PA promotion in families. CPET aimed to assess the feasibility, acceptability and potential efficacy of a theory-driven, family-based, dog walking intervention for 9-11 year olds. Twenty-eight families were allocated randomly to either receive a 10-week dog based PA intervention or to a control group. Families in the intervention group were motivated and supported to increase the frequency, intensity and duration of dog walking using a number of behaviour change techniques. Parents in the intervention group were asked to complete a short study exit questionnaire. In addition, focus groups with parents and children in the intervention group, and with key stakeholders were undertaken. The primary outcome measure was 10 week change in total volume of PA using the mean accelerometer count per minute (cpm). Intervention and control groups were compared using analysis of covariance. Analysis was performed on an intention to treat basis. Twenty five families were retained at follow up (89%) and 97% of all outcome data were collected at baseline and follow up. Thirteen of 14 (93%) intervention group parents available at follow up completed the study exit questionnaire and noted that study outcome measures were acceptable. There was a mean difference in child total volume of PA of 27 cpm (95% CI -70, 123) and -3 cpm (95% CI -60, 54) for intervention and control group children, respectively. This was not statistically significant. Approximately 21% of dog walking time for parents and 39% of dog walking time for children was moderate-vigorous PA. The acceptability of the CPET intervention and outcome measures was high. Using pet dogs as the agent of lifestyle change in PA interventions in children and their parents is both feasible and acceptable, but did not result in a significant increase in child PA in this exploratory trial. ISRCTN85939423.

Children, parents and pets exercising together (CPET): exploratory randomised controlled trial

PubMed Central

2013-01-01

Background Levels of physical activity (PA) in UK children are much lower than recommended and novel approaches to its promotion are needed. The Children, Parents and Pets Exercising Together (CPET) study is the first exploratory randomised controlled trial (RCT) to develop and evaluate an intervention aimed at dog-based PA promotion in families. CPET aimed to assess the feasibility, acceptability and potential efficacy of a theory-driven, family-based, dog walking intervention for 9–11 year olds. Methods Twenty-eight families were allocated randomly to either receive a 10-week dog based PA intervention or to a control group. Families in the intervention group were motivated and supported to increase the frequency, intensity and duration of dog walking using a number of behaviour change techniques. Parents in the intervention group were asked to complete a short study exit questionnaire. In addition, focus groups with parents and children in the intervention group, and with key stakeholders were undertaken. The primary outcome measure was 10 week change in total volume of PA using the mean accelerometer count per minute (cpm). Intervention and control groups were compared using analysis of covariance. Analysis was performed on an intention to treat basis. Results Twenty five families were retained at follow up (89%) and 97% of all outcome data were collected at baseline and follow up. Thirteen of 14 (93%) intervention group parents available at follow up completed the study exit questionnaire and noted that study outcome measures were acceptable. There was a mean difference in child total volume of PA of 27 cpm (95% CI -70, 123) and -3 cpm (95% CI -60, 54) for intervention and control group children, respectively. This was not statistically significant. Approximately 21% of dog walking time for parents and 39% of dog walking time for children was moderate-vigorous PA. Conclusions The acceptability of the CPET intervention and outcome measures was high. Using pet dogs as the agent of lifestyle change in PA interventions in children and their parents is both feasible and acceptable, but did not result in a significant increase in child PA in this exploratory trial. Trial registration ISRCTN85939423 PMID:24279294

One Health stakeholder and institutional analysis in Kenya

PubMed Central

Kimani, Tabitha; Ngigi, Margaret; Schelling, Esther; Randolph, Tom

2016-01-01

Introduction One Health (OH) can be considered a complex emerging policy to resolve health issues at the animal–human and environmental interface. It is expected to drive system changes in terms of new formal and informal institutional and organisational arrangements. This study, using Rift Valley fever (RVF) as a zoonotic problem requiring an OH approach, sought to understand the institutionalisation process at national and subnational levels in an early adopting country, Kenya. Materials and methods Social network analysis methodologies were used. Stakeholder roles and relational data were collected at national and subnational levels in 2012. Key informants from stakeholder organisations were interviewed, guided by a checklist. Public sector animal and public health organisations were interviewed first to identify other stakeholders with whom they had financial, information sharing and joint cooperation relationships. Visualisation of the OH social network and relationships were shown in sociograms and mathematical (degree and centrality) characteristics of the network summarised. Results and discussion Thirty-two and 20 stakeholders relevant to OH were identified at national and subnational levels, respectively. Their roles spanned wildlife, livestock, and public health sectors as well as weather prediction. About 50% of national-level stakeholders had made significant progress on OH institutionalisation to an extent that formal coordination structures (zoonoses disease unit and a technical working group) had been created. However, the process had not trickled down to subnational levels although cross-sectoral and sectoral collaborations were identified. The overall binary social network density for the stakeholders showed that 35 and 21% of the possible ties between the RVF and OH stakeholders existed at national and subnational levels, respectively, while public health actors’ collaborations were identified at community/grassroots level. We recommend extending the OH network to include the other 50% stakeholders and fostering of the process at subnational-level building on available cross-sectoral platforms. PMID:27330042

Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom Management: A Protocol for Design and Development

PubMed Central

MacDonald, James John; Amoyal Pensak, Nicole; Jacobs, Jamie Michele; Flanagan, Clare; Jethwani, Kamal

2017-01-01

Background Oral chemotherapy is increasingly used in place of traditional intravenous chemotherapy to treat patients with cancer. While oral chemotherapy includes benefits such as ease of administration, convenience, and minimization of invasive infusions, patients receive less oversight, support, and symptom monitoring from clinicians. Additionally, adherence is a well-documented challenge for patients with cancer prescribed oral chemotherapy regimens. With the ever-growing presence of smartphones and potential for efficacious behavioral intervention technology, we created a mobile health intervention for medication and symptom management. Objective The objective of this study was to develop and evaluate the usability and acceptability of a smartphone app to support adherence to oral chemotherapy and symptom management in patients with cancer. Methods We used a 5-step development model to create a comprehensive mobile app with theoretically informed content. The research and technical development team worked together to develop and iteratively test the app. In addition to the research team, key stakeholders including patients and family members, oncology clinicians, health care representatives, and practice administrators contributed to the content refinement of the intervention. Patient and family members also participated in alpha and beta testing of the final prototype to assess usability and acceptability before we began the randomized controlled trial. Results We incorporated app components based on the stakeholder feedback we received in focus groups and alpha and beta testing. App components included medication reminders, self-reporting of medication adherence and symptoms, an education library including nutritional information, Fitbit integration, social networking resources, and individually tailored symptom management feedback. We are conducting a randomized controlled trial to determine the effectiveness of the app in improving adherence to oral chemotherapy, quality of life, and burden of symptoms and side effects. At every stage in this trial, we are engaging stakeholders to solicit feedback on our progress and next steps. Conclusions To our knowledge, we are the first to describe the development of an app designed for people taking oral chemotherapy. The app addresses many concerns with oral chemotherapy, such as medication adherence and symptom management. Soliciting feedback from stakeholders with broad perspectives and expertise ensured that the app was acceptable and potentially beneficial for patients, caregivers, and clinicians. In our development process, we instantiated 7 of the 8 best practices proposed in a recent review of mobile health app development. Our process demonstrated the importance of effective communication between research groups and technical teams, as well as meticulous planning of technical specifications before development begins. Future efforts should consider incorporating other proven strategies in software, such as gamification, to bolster the impact of mobile health apps. Forthcoming results from our randomized controlled trial will provide key data on the effectiveness of this app in improving medication adherence and symptom management. Trial Registration ClinicalTrials.gov NCT02157519; https://clinicaltrials.gov/ct2/show/NCT02157519 (Archived by WebCite at http://www.webcitation.org/6prj3xfKA) PMID:28428158

The Conceptualization of Value in the Value Proposition of New Health Technologies Comment on "Providing Value to New Health Technology: The Early Contribution of Entrepreneurs, Investors, and Regulatory Agencies".

PubMed

Buttigieg, Sandra C; Hoof, Joost van

2017-07-03

Lehoux et al provide a highly valid contribution in conceptualizing value in value propositions for new health technologies and developing an analytic framework that illustrates the interplay between health innovation supply-side logic (the logic of emergence) and demand-side logic (embedding in the healthcare system). This commentary brings forth several considerations on this article. First, a detailed stakeholder analysis provides the necessary premonition of potential hurdles in the development, implementation and dissemination of a new technology. This can be achieved by categorizing potential stakeholder groups on the basis of the potential impact of future technology. Secondly, the conceptualization of value in value propositions of new technologies should not only embrace business/economic and clinical values but also ethical, professional and cultural values, as well as factoring in the notion of usability and acceptance of new technology. As a final note, the commentary emphasises the point that technology should facilitate delivery of care without negatively affecting doctor-patient communications, physical examination skills, and development of clinical knowledge. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ensuring Disaster Risk Reduction via Sustainable Wetland Development

NASA Astrophysics Data System (ADS)

Lyon, S. W.; Lindborg, R.; Nyström, S.; Silengo, M.; Tumbo, M.; Koutsouris, A. J.

2015-12-01

Wetland ecosystems around the world are increasingly being targeted as land use development 'hotspots' under growing concerns of climate variability and food security. Anthropogenic encroachment on natural wetland ecosystems can have direct consequences locally through loss of biodiversity and regionally through increased disaster risks associated with, for example, flooding. We consider two regionally-relevant wetland ecosystems in eastern Africa, namely Zambia's Lukanga Swamps and Tanzania's Kilombero Valley, experiencing varying trajectories of development under climatic variations. These regions have been targeted for inclusive, multi-stakeholder initiatives that aim at developing agricultural potential through combinations of large and small scale irrigation schemes. Through our data-driven analysis we highlight the potential for shifts in hydrologic regime of each wetland ecosystem which can have significant regional impacts on disaster risks. In the case of the Lukanga Swamps, wetlands maintain water table fluctuations that help mitigate water cycling with implications for the downstream flooding impact of annual rains. With regards to Kilombero Valley, understanding seasonal changes in hydrological processes and storages provides the cornerstone for managing future water resource impacts/feedbacks under different scenarios of land management. This work emphasizes the need to tailor strategies towards sustainable uses of wetlands that reduce disaster risks regionally while contributing to improved community health and wellbeing. It remains an open (and fundamental) question of how to best define management recommendations and activities that not only achieve climate resiliency but also are acceptable for stakeholders without compromising the balance between ecosystem service supply and biodiversity conservation.

75 FR 34973 - Notice of Opportunity To Submit Content Request for the Agricultural Energy Program Surveys

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-21

...The National Agricultural Statistics Service (NASS) is currently conducting the 2009 On-farm Renewable Energy Production (OREP) survey as a follow-on to the 2007 Census of Agriculture. Respondents who answered that they generated energy or electricity in 2007 are eligible for the follow-on survey to determine types of selected energy produced and associated information. NASS is currently accepting stakeholder feedback on future energy related topics and questionnaire content for development of an annual agricultural energy survey.

Validation of Automated Scores of TOEFL iBT® Tasks against Nontest Indicators of Writing Ability. TOEFL iBT® Research Report. TOEFL iBT-15. ETS Research Report RR-11-24

ERIC Educational Resources Information Center

Weigle, Sara Cushing

2011-01-01

Automated scoring has the potential to dramatically reduce the time and costs associated with the assessment of complex skills such as writing, but its use must be validated against a variety of criteria for it to be accepted by test users and stakeholders. This study addresses two validity-related issues regarding the use of e-rater® with the…

Defining acceptable levels for ecological indicators: an approach for considering social values.

PubMed

Smyth, Robyn L; Watzin, Mary C; Manning, Robert E

2007-03-01

Ecological indicators can facilitate an adaptive management approach, but only if acceptable levels for those indicators have been defined so that the data collected can be interpreted. Because acceptable levels are an expression of the desired state of the ecosystem, the process of establishing acceptable levels should incorporate not just ecological understanding but also societal values. The goal of this research was to explore an approach for defining acceptable levels of ecological indicators that explicitly considers social perspectives and values. We used a set of eight indicators that were related to issues of concern in the Lake Champlain Basin. Our approach was based on normative theory. Using a stakeholder survey, we measured respondent normative evaluations of varying levels of our indicators. Aggregated social norm curves were used to determine the level at which indicator values shifted from acceptable to unacceptable conditions. For seven of the eight indicators, clear preferences were interpretable from these norm curves. For example, closures of public beaches because of bacterial contamination and days of intense algae bloom went from acceptable to unacceptable at 7-10 days in a summer season. Survey respondents also indicated that the number of fish caught from Lake Champlain that could be safely consumed each month was unacceptably low and the number of streams draining into the lake that were impaired by storm water was unacceptably high. If indicators that translate ecological conditions into social consequences are carefully selected, we believe the normative approach has considerable merit for defining acceptable levels of valued ecological system components.

Defining Acceptable Levels for Ecological Indicators: An Approach for Considering Social Values

NASA Astrophysics Data System (ADS)

Smyth, Robyn L.; Watzin, Mary C.; Manning, Robert E.

2007-03-01

Ecological indicators can facilitate an adaptive management approach, but only if acceptable levels for those indicators have been defined so that the data collected can be interpreted. Because acceptable levels are an expression of the desired state of the ecosystem, the process of establishing acceptable levels should incorporate not just ecological understanding but also societal values. The goal of this research was to explore an approach for defining acceptable levels of ecological indicators that explicitly considers social perspectives and values. We used a set of eight indicators that were related to issues of concern in the Lake Champlain Basin. Our approach was based on normative theory. Using a stakeholder survey, we measured respondent normative evaluations of varying levels of our indicators. Aggregated social norm curves were used to determine the level at which indicator values shifted from acceptable to unacceptable conditions. For seven of the eight indicators, clear preferences were interpretable from these norm curves. For example, closures of public beaches because of bacterial contamination and days of intense algae bloom went from acceptable to unacceptable at 7-10 days in a summer season. Survey respondents also indicated that the number of fish caught from Lake Champlain that could be safely consumed each month was unacceptably low and the number of streams draining into the lake that were impaired by storm water was unacceptably high. If indicators that translate ecological conditions into social consequences are carefully selected, we believe the normative approach has considerable merit for defining acceptable levels of valued ecological system components.

Dentists with extended skills: the challenge of innovation.

PubMed

Al-Haboubi, M; Eliyas, S; Briggs, P F A; Jones, E; Rayan, R R; Gallagher, J E

2014-08-01

The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided. A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists. Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice. This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed.

Implementing accountability for reasonableness--the case of pharmaceutical reimbursement in Sweden.

PubMed

Jansson, Sandra

2007-04-01

This paper aims to describe the priority-setting procedure for new original pharmaceuticals practiced by the Swedish Pharmaceutical Benefits Board (LFN), to analyse the outcome of the procedure in terms of decisions and the relative importance of ethical principles, and to examine the reactions of stakeholders. All the 'principally important' decisions made by the LFN during its first 33 months of operation were analysed. The study is theoretically anchored in the theory of fair and legitimate priority-setting procedures by Daniels and Sabin, and is based on public documents, media articles, and semi-structured interviews. Only nine cases resulted in a rejection of a subsidy by the LFN and 15 in a limited or conditional subsidy. Total rejections rather than limitations gave rise to actions by stakeholders. Primarily, the principle of cost-effectiveness was used when limiting/conditioning or totally rejecting a subsidy. This study suggests that implementing a priority-setting process that fulfils the conditions of accountability for reasonableness can result in a priority-setting process which is generally perceived as fair and legitimate by the major stakeholders and may increase social learning in terms of accepting the necessity of priority setting in health care. The principle of cost-effectiveness increased in importance when the demand for openness and transparency increased.

Developing Policy for Integrating Biomedicine and Traditional Chinese Medical Practice Using Focus Groups and the Delphi Technique

PubMed Central

Chung, Vincent C. H.; Ma, Polly H. X.; Lau, Chun Hong; Griffiths, Sian M.

2012-01-01

In Hong Kong, statutory regulation for traditional Chinese medicine (TCM) practitioners has been implemented in the past decade. Increasing use of TCM on top of biomedicine (BM) services by the population has been followed; but corresponding policy development to integrate their practices has not yet been discussed. Using focus group methodology, we explore policy ideas for integration by collating views from frontline BM (n = 50) and TCM clinicians (n = 50). Qualitative data were analyzed under the guidance of structuration model of collaboration, a theoretical model for understanding interprofessional collaboration. From focus group findings we generated 28 possible approaches, and subsequently their acceptability was assessed by a two round Delphi survey amongst BM and TCM policy stakeholders (n = 12). Consensus was reached only on 13 statements. Stakeholders agreed that clinicians from both paradigms should share common goals of providing patient-centered care, promoting the development of protocols for shared care and information exchange, as well as strengthening interprofessional connectivity and leadership for integration. On the other hand, attitudes amongst policy stakeholders were split on the possibility of fostering trust and mutual learning, as well as on enhancing innovation and governmental support. Future policy initiatives should focus on these controversial areas. PMID:22649469

Assisted-living spaces for end-users with complex needs: a proposed implementation and delivery model.

PubMed

Linskell, Jeremy; Bouamrane, Matt-Mouley

2012-09-01

An assisted living space (ALS) is a technology-enabled environment designed to allow people with complex health or social care needs to remain, and live independently, in their own home for longer. However, many challenges remain in order to deliver usable systems acceptable to a diverse range of stakeholders, including end-users, and their families and carers, as well as health and social care services. ALSs need to support activities of daily-living while allowing end-users to maintain important social connections. They must be dynamic, flexible and adaptable living environments. In this article, we provide an overview of the technological landscape of assisted-living technology (ALT) and recent policies to promote an increased adoption of ALT in Scotland. We discuss our experiences in implementing technology-supported ALSs and emphasise key lessons. Finally, we propose an iterative and pragmatic user-centred implementation model for delivering ALSs in complex-needs scenarios. This empirical model is derived from our past ALS implementations. The proposed model allows project stakeholders to identify requirements, allocate tasks and responsibilities, and identify appropriate technological solutions for the delivery of functional ALS systems. The model is generic and makes no assumptions on needs or technology solutions, nor on the technical knowledge, skills and experience of the stakeholders involved in the ALS design process.

Potential scenarios for broadening stakeholder involvement in the implementing geological disposal technology platform

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martell, Meritxell; Bergmans, Anne

This paper analyses the potential for the involvement of different types of stakeholders in the Implementing Geological Disposal Technology Platform (IGD-TP). This analysis was conducted as part of the InSOTEC project, a three-year (2011- 2014) collaborative research project funded under the 7. Euratom Framework Programme (Grant Agreement nr. 269906). In our analysis, we consider the extent to which the IGDTP's practice as regards to stakeholder involvement matches its discourse, and what potential for improvement exists given its structural organisation as a European Technology Platform (ETPs). Technology Platforms (TPs) can be understood as knowledge networks, deliberately set up to influence (research)more » policy in a specific domain. We therefore use knowledge networks as a conceptual approach and look at the IGD-TP as a complex network which includes actors, knowledge and practices across different countries, focusing on a very specific topic (i.e. implementing geological disposal). We compare the way different stakeholders are involved in the IGD-TP to the practice of other ETPs, and explore how the IGD-TP is viewed by its members and by outsiders to the platform Applying Callon's framework of knowledge co-production (1999) we come to define different degrees of interaction between science, society and policy in view of defining research and development (R and D) priorities [1]. Subsequently we describe how these interactions could be conceptualised and interpreted for the IGD-TP. The current approach of the IGDTP can be mainly understood as classical model involving mainly expert stakeholders and scientists. Where there seems to be a good representation among IGD-TP members of industry, research institutes, and some members of the academic community this is not the case for other types of stakeholders, such as public authorities or civil society. At this stage, the overall approach of the IGD-TP would seem to restrict the scope of stakeholder involvement, as it narrows participation down to uniquely technology experts, hindering socio-technical manifestations. Our analysis nevertheless shows that there is room for engaging with a broader range of stakeholders in the field of radioactive waste management, if this is the intention of the IGD-TP. However, this would require a commitment to developing a common knowledge base including other stakeholders through a process of mutual adjustment and negotiation. (authors)« less

Tackling wicked problems in infection prevention and control: a guideline for co-creation with stakeholders.

PubMed

van Woezik, Anne F G; Braakman-Jansen, Louise M A; Kulyk, Olga; Siemons, Liseth; van Gemert-Pijnen, Julia E W C

2016-01-01

Infection prevention and control can be seen as a wicked public health problem as there is no consensus regarding problem definition and solution, multiple stakeholders with different needs and values are involved, and there is no clear end-point of the problem-solving process. Co-creation with stakeholders has been proposed as a suitable strategy to tackle wicked problems, yet little information and no clear step-by-step guide exist on how to do this. The objectives of this study were to develop a guideline to assist developers in tackling wicked problems using co-creation with stakeholders, and to apply this guideline to practice with an example case in the field of infection prevention and control. A mixed-method approach consisting of the integration of both quantitative and qualitative research was used. Relevant stakeholders from the veterinary, human health, and public health sectors were identified using a literature scan, expert recommendations, and snowball sampling. The stakeholder salience approach was used to select key stakeholders based on 3 attributes: power, legitimacy, and urgency. Key values of stakeholders (N = 20) were derived by qualitative semi-structured interviews and quantitatively weighted and prioritized using an online survey. Our method showed that stakeholder identification and analysis are prerequisites for understanding the complex stakeholder network that characterizes wicked problems. A total of 73 stakeholders were identified of which 36 were selected as potential key stakeholders, and only one was seen as a definite stakeholder. In addition, deriving key stakeholder values is a necessity to gain insights into different problem definitions, solutions and needs stakeholders have regarding the wicked problem. Based on the methods used, we developed a step-by-step guideline for co-creation with stakeholders when tackling wicked problems. The mixed-methods guideline presented here provides a systematic, transparent method to identify, analyze, and co-create with stakeholders, and to recognize and prioritize their values, problem definitions, and solutions in the context of wicked problems. This guideline consists of a general framework and although it was applied in an eHealth context, may be relevant outside of eHealth as well.

Understanding the perceptions, roles and interactions of stakeholder networks managing health-care waste: A case study of the Gaza Strip

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caniato, M., E-mail: marcocaniato@gmail.com; Tudor, T.; Vaccari, M.

Highlights: • We systematically review scientific literature about health-care waste management. • We identify and discuss gaps, trends, efforts, and key-factors. • We suggest areas for improvement and best practices reported in literature. • We include recommendations for policy makers, practitioners and researchers. • We promote a holistic and harmonized approach to health-care waste management. - Abstract: The sustainable management of waste requires a holistic approach involving a range of stakeholders. What can often be difficult is to understand the manner in which different types of stakeholder networks are composed and work, and how best to enhance their effectiveness. Usingmore » social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally while health-care facilities had a strong interest in waste management, they were generally poorly informed and had limited links to each other. The manner in which the networks operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. The lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management issues they were involved with, however segregation at the source was identified as a key requirement by most. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach served to raise interest and awareness at different levels (public authorities, health providers, supporting actors, others), stimulate the discussion about the adoption of specific policies, and identify the effective way forward.« less

Recognizing nurse stakeholder dissonance as a critical determinant of patient safety in new healthcare information technologies.

PubMed

Samaras, Elizabeth A; Real, Sara D; Curtis, Amber M; Meunier, Tessa S

2012-01-01

Proper identification of all stakeholders and the comprehensive assessment of their evolving and often conflicting Needs, Wants, and Desires (NWDs) is a fundamental principle of human factors science and human-centered systems engineering; it is not yet a consistent element in development and deployment of new health information technologies (HIT). As the single largest group of healthcare professionals, nurses are critical stakeholders for these new technologies. Careful analysis can reveal nurse stakeholder dissonance (NSD) when integrating new technologies into the healthcare environment. Stakeholder dissonance is a term that describes the conflict between the NWDs of different stakeholders which, if left unresolved, can result in dissatisfaction, workarounds, errors, and threats to patient safety. Three case studies drawn from the authors' experience in a variety of acute-care settings where new HITs have been recently deployed are examined to illustrate the concept of NSD. Conflicting NWDs, other stakeholders, and possible root causes of the NSD are analyzed and mapped to threats to patient safety. Lessons learned, practical guidance for anticipating, identifying, and mitigating NSD, future research and implications for HFE and nursing practice are discussed.

Two-Sides of the Same Coin: Communicating Climate Change Science to Water Utilities and Stakeholders in Florida and Hawai'i

NASA Astrophysics Data System (ADS)

Keener, V. W.; Staal, L.

2011-12-01

The NOAA-funded Regional Integrated Sciences and Assessment (RISA) programs act as boundary organizations that both conduct and translate academic climate research in the physical and social sciences for a variety of stakeholder applications, including for local and state governments, natural resource managers, non-climate scientists, and community members. For the past six years, I have worked with two RISAs-one in the southeast United States, and recently in the Pacific region. In confronting the most immediate impacts of climate change, Florida and Hawai'i are both currently dealing with saltwater intrusion effects on infrastructure and water supply, sea level rise impacts on vulnerable coastlines, and expect the problems to worsen in the future. Both RISAs have focused on water resource sustainability as a topic of interest, and held workshops on climate variability and change impacts for water utilities and a wider range of relevant stakeholders. Methods that have been used to communicate climate science, projected impacts, and risk have included: working groups/collaborative learning, scientific presentations and presentations of relevant case studies, beach management planning, in-depth interviews, and educational radio spots. Despite the similarities in the types of issues being confronted, stakeholders in each location have responded with differing levels of acceptance, which has resulted in the usage of different methods of communication of the same types of climate science information. This talk will focus on the success of a variety of different methods in communicating similar information on comparable risks to different audiences.

Web-based social media for professional medical education: Perspectives of senior stakeholders in the nursing home sector.

PubMed

Kitching, Fiona; Winbolt, Margaret; MacPhail, Aleece; Ibrahim, Joseph E

2015-12-01

Participatory web-based platforms, including social media, have been recognised as valuable learning tools in healthcare education for over a decade. Use of these platforms is now widespread in tertiary education. It is less widely accepted as a tool for continuing professional education and development at the industry level. This study explores perspectives of senior stakeholders in the nursing home sector to explore perceived benefits, barriers and risks for use in professional education. Qualitative data were collected through semi-structured interviews of 'high level' clinical and executive staff from a cross section of nursing home stakeholder organisations. Established printed educational material (PEM) was used as a case study for adaptation to web-based social applications. Questions were designed to gather information about the interviewee's views on the potential to apply PEM to programs such as blogs, Twitter and YouTube to deliver education and aid communication in the sector. Twelve participants from eleven stakeholder organisations took part in the study. Most participants were cautious about the use of social media programs in continuing professional education. Participants described the benefits (contemporary information, delivered rapidly, varying formats) and barriers (credibility of information, potential misinterpretation, sector demographics, time constraints) to uptake of these programs. The majority of participants preferred formal e-learning programs to web-based social media applications. Reservations expressed about the use of social media, such as accuracy, legal and privacy risks to the organisation reflected those previously expressed by the broader medical community. Copyright © 2015 Elsevier Ltd. All rights reserved.

Assessing Patient-Centered Communication in Cancer Care: Stakeholder Perspectives

PubMed Central

Mazor, Kathleen M.; Gaglio, Bridget; Nekhlyudov, Larissa; Alexander, Gwen L.; Stark, Azadeh; Hornbrook, Mark C.; Walsh, Kathleen; Boggs, Jennifer; Lemay, Celeste A.; Firneno, Cassandra; Biggins, Colleen; Blosky, Mary Ann; Arora, Neeraj K.

2013-01-01

Purpose: Patient-centered communication is critical to quality cancer care. Effective communication can help patients and family members cope with cancer, make informed decisions, and effectively manage their care; suboptimal communication can contribute to care breakdowns and undermine clinician-patient relationships. The study purpose was to explore stakeholders' views on the feasibility and acceptability of collecting self-reported patient and family perceptions of communication experiences while receiving cancer care. The results were intended to inform the design, development, and implementation of a structured and generalizable patient-level reporting system. Methods: This was a formative, qualitative study that used semistructured interviews with cancer patients, family members, clinicians, and leaders of health care organizations. The constant comparative method was used to identify major themes in the interview transcripts. Results: A total of 106 stakeholders were interviewed. Thematic saturation was achieved. All stakeholders recognized the importance of communication and endorsed efforts to improve communication during cancer care. Patients, clinicians, and leaders expressed concerns about the potential consequences of reports of suboptimal communication experiences, such as damage to the clinician-patient relationship, and the need for effective improvement strategies. Patients and family members would report good communication experiences in order to encourage such practices. Practical and logistic issues were identified. Conclusion: Patient reports of their communication experiences during cancer care could increase understanding of the communication process, stimulate improvements, inform interventions, and provide a basis for evaluating changes in communication practices. This qualitative study provides a foundation for the design and pilot testing of such a patient reporting system. PMID:23943884

Evaluating taboo trade-offs in ecosystems services and human well-being.

PubMed

Daw, Tim M; Coulthard, Sarah; Cheung, William W L; Brown, Katrina; Abunge, Caroline; Galafassi, Diego; Peterson, Garry D; McClanahan, Tim R; Omukoto, Johnstone O; Munyi, Lydiah

2015-06-02

Managing ecosystems for multiple ecosystem services and balancing the well-being of diverse stakeholders involves different kinds of trade-offs. Often trade-offs involve noneconomic and difficult-to-evaluate values, such as cultural identity, employment, the well-being of poor people, or particular species or ecosystem structures. Although trade-offs need to be considered for successful environmental management, they are often overlooked in favor of win-wins. Management and policy decisions demand approaches that can explicitly acknowledge and evaluate diverse trade-offs. We identified a diversity of apparent trade-offs in a small-scale tropical fishery when ecological simulations were integrated with participatory assessments of social-ecological system structure and stakeholders' well-being. Despite an apparent win-win between conservation and profitability at the aggregate scale, food production, employment, and well-being of marginalized stakeholders were differentially influenced by management decisions leading to trade-offs. Some of these trade-offs were suggested to be "taboo" trade-offs between morally incommensurable values, such as between profits and the well-being of marginalized women. These were not previously recognized as management issues. Stakeholders explored and deliberated over trade-offs supported by an interactive "toy model" representing key system trade-offs, alongside qualitative narrative scenarios of the future. The concept of taboo trade-offs suggests that psychological bias and social sensitivity may exclude key issues from decision making, which can result in policies that are difficult to implement. Our participatory modeling and scenarios approach has the potential to increase awareness of such trade-offs, promote discussion of what is acceptable, and potentially identify and reduce obstacles to management compliance.

Building a picture: Prioritisation of exotic diseases for the pig industry in Australia using multi-criteria decision analysis.

PubMed

Brookes, V J; Hernández-Jover, M; Cowled, B; Holyoake, P K; Ward, M P

2014-01-01

Diseases that are exotic to the pig industry in Australia were prioritised using a multi-criteria decision analysis framework that incorporated weights of importance for a range of criteria important to industry stakeholders. Measurements were collected for each disease for nine criteria that described potential disease impacts. A total score was calculated for each disease using a weighted sum value function that aggregated the nine disease criterion measurements and weights of importance for the criteria that were previously elicited from two groups of industry stakeholders. One stakeholder group placed most value on the impacts of disease on livestock, and one group placed more value on the zoonotic impacts of diseases. Prioritisation lists ordered by disease score were produced for both of these groups. Vesicular diseases were found to have the highest priority for the group valuing disease impacts on livestock, followed by acute forms of African and classical swine fever, then highly pathogenic porcine reproductive and respiratory syndrome. The group who valued zoonotic disease impacts prioritised rabies, followed by Japanese encephalitis, Eastern equine encephalitis and Nipah virus, interspersed with vesicular diseases. The multi-criteria framework used in this study systematically prioritised diseases using a multi-attribute theory based technique that provided transparency and repeatability in the process. Flexibility of the framework was demonstrated by aggregating the criterion weights from more than one stakeholder group with the disease measurements for the criteria. This technique allowed industry stakeholders to be active in resource allocation for their industry without the need to be disease experts. We believe it is the first prioritisation of livestock diseases using values provided by industry stakeholders. The prioritisation lists will be used by industry stakeholders to identify diseases for further risk analysis and disease spread modelling to understand biosecurity risks to this industry. Copyright © 2013 Elsevier B.V. All rights reserved.

A Customizable Dashboarding System for Watershed Model Interpretation

NASA Astrophysics Data System (ADS)

Easton, Z. M.; Collick, A.; Wagena, M. B.; Sommerlot, A.; Fuka, D.

2017-12-01

Stakeholders, including policymakers, agricultural water managers, and small farm managers, can benefit from the outputs of commonly run watershed models. However, the information that each stakeholder needs is be different. While policy makers are often interested in the broader effects that small farm management may have on a watershed during extreme events or over long periods, farmers are often interested in field specific effects at daily or seasonal period. To provide stakeholders with the ability to analyze and interpret data from large scale watershed models, we have developed a framework that can support custom exploration of the large datasets produced. For the volume of data produced by these models, SQL-based data queries are not efficient; thus, we employ a "Not Only SQL" (NO-SQL) query language, which allows data to scale in both quantity and query volumes. We demonstrate a stakeholder customizable Dashboarding system that allows stakeholders to create custom `dashboards' to summarize model output specific to their needs. Dashboarding is a dynamic and purpose-based visual interface needed to display one-to-many database linkages so that the information can be presented for a single time period or dynamically monitored over time and allows a user to quickly define focus areas of interest for their analysis. We utilize a single watershed model that is run four times daily with a combined set of climate projections, which are then indexed, and added to an ElasticSearch datastore. ElasticSearch is a NO-SQL search engine built on top of Apache Lucene, a free and open-source information retrieval software library. Aligned with the ElasticSearch project is the open source visualization and analysis system, Kibana, which we utilize for custom stakeholder dashboarding. The dashboards create a visualization of the stakeholder selected analysis and can be extended to recommend robust strategies to support decision-making.

A strategic stakeholder approach for addressing further analysis requests in whole genome sequencing research.

PubMed

Thornock, Bradley Steven O

2016-01-01

Whole genome sequencing (WGS) can be a cost-effective and efficient means of diagnosis for some children, but it also raises a number of ethical concerns. One such concern is how researchers derive and communicate results from WGS, including future requests for further analysis of stored sequences. The purpose of this paper is to think about what is at stake, and for whom, in any solution that is developed to deal with such requests. To accomplish this task, this paper will utilize stakeholder theory, a common method used in business ethics. Several scenarios that connect stakeholder concerns and WGS will also posited and analyzed. This paper concludes by developing criteria composed of a series of questions that researchers can answer in order to more effectively address requests for further analysis of stored sequences.

Assessing stakeholder perceptions of the acceptability and feasibility of national scale-up for a dual HIV/syphilis rapid diagnostic test in Malawi.

PubMed

Maddox, Brandy L Peterson; Wright, Shauntā S; Namadingo, Hazel; Bowen, Virginia B; Chipungu, Geoffrey A; Kamb, Mary L

2017-12-01

The WHO recommends pregnant women receive both HIV and syphilis testing at their first antenatal care visit, as untreated maternal infections can lead to severe, adverse pregnancy outcomes. One strategy for increasing testing for both HIV and syphilis is the use of point-of-care (rapid) diagnostic tests that are simple, proven effective and inexpensive. In Malawi, pregnant women routinely receive HIV testing, but only 10% are tested for syphilis at their first antenatal care visit. This evaluation explores stakeholder perceptions of a novel, dual HIV/syphilis rapid diagnostic test and potential barriers to national scale-up of the dual test in Malawi. During June and July 2015, we conducted 15 semistructured interviews with 25 healthcare workers, laboratorians, Ministry of Health leaders and partner agency representatives working in prevention of mother-to-child transmission in Malawi. We asked stakeholders about the importance of a dual rapid diagnostic test, concerns using and procuring the dual test and recommendations for national expansion. Stakeholders viewed the test favourably, citing the importance of a dual rapid test in preventing missed opportunities for syphilis diagnosis and treatment, improving infant outcomes and increasing syphilis testing coverage. Primary technical concerns were about the additional procedural steps needed to perform the test, the possibility that testers may not adhere to required waiting times before interpreting results and difficulty reading and interpreting test results. Stakeholders thought national scale-up would require demonstration of cost-savings, uniform coordination, revisions to testing guidelines and algorithms, training of testers and a reliable supply chain. Stakeholders largely support implementation of a dual HIV/syphilis rapid diagnostic test as a feasible alternative to current antenatal testing. Scale-up will require addressing perceived barriers; negotiating changes to existing algorithms and guidelines; and Ministry of Health approval and funding to support training of staff and procurement of supplies. © Article author(s) (or their employer(s) unless otherwise stated in the text of thearticle) 2017. All rights reserved. No commercial use is permitted unless otherwiseexpressly granted.

A Decision Support Framework For Science-Based, Multi-Stakeholder Deliberation: A Coral Reef Example

EPA Science Inventory

We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environ...

Analysis of Stakeholder-Defined Needs in Northeast U.S. Coastal Communities to Determine Gaps in Research Informing Coastal Resilience Planning

NASA Astrophysics Data System (ADS)

Molino, G. D.; Kenney, M. A.; Sutton-Grier, A.; Penn, K.

2017-12-01

The impacts of climate change on our coastlines are increasing pressure on communities, ecosystems, infrastructure, and state-to-local economies in the northeastern United States (U.S.). As a result of current or imminent risk of acute and chronic hazards, local, state and regional entities have taken steps to identify and address vulnerabilities to climate change. Decisions to increase coastal infrastructure resilience and grey, green, and cultural infrastructure solutions requires physical, natural, and social science that is useful for decision-making and effective science translation mechanisms. Despite the desire to conduct or fund science that meets the needs of communities, there has been no comprehensive analysis to determine stakeholder-defined research needs. To address this gap, this study conducts a stakeholder needs analysis in northeast U.S. coastal communities to determine gaps in information and translation processes supporting coastal resilience planning. Documents were sourced from local, state, and regional organizations in both the public and private sectors, using the northeast region defined by the third National Climate Assessment. Modeled after Dilling et al. (2015), a deductive coding schema was developed that categorized documents using specific search terms such as "Location and condition of infrastructure" and "Proactive planning". A qualitative document analysis was then executed using NVivo to formally identify patterns and themes present in stakeholder surveys, workshop proceedings, and reports. Initial stakeholder priorities centered around incorporation of climate science into planning and decision making regarding vulnerabilities of infrastructure, enhanced emergency planning and response, and communication of key information.

"By slapping their laps, the patient will know that you truly care for her": A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria.

PubMed

Bohren, Meghan A; Vogel, Joshua P; Tunçalp, Özge; Fawole, Bukola; Titiloye, Musibau A; Olutayo, Akinpelu Olanrewaju; Oyeniran, Agnes A; Ogunlade, Modupe; Metiboba, Loveth; Osunsan, Olubunmi R; Idris, Hadiza A; Alu, Francis E; Oladapo, Olufemi T; Gülmezoglu, A Metin; Hindin, Michelle J

2016-12-01

Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth. Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth. Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's "disobedience" and "uncooperativeness" during labor for her experience of mistreatment. Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.

Return on Scientific Investment - RoSI: a PMO dynamical index proposal for scientific projects performance evaluation and management.

PubMed

Caous, Cristofer André; Machado, Birajara; Hors, Cora; Zeh, Andrea Kaufmann; Dias, Cleber Gustavo; Amaro Junior, Edson

2012-01-01

To propose a measure (index) of expected risks to evaluate and follow up the performance analysis of research projects involving financial and adequate structure parameters for its development. A ranking of acceptable results regarding research projects with complex variables was used as an index to gauge a project performance. In order to implement this method the ulcer index as the basic model to accommodate the following variables was applied: costs, high impact publication, fund raising, and patent registry. The proposed structured analysis, named here as RoSI (Return on Scientific Investment) comprises a pipeline of analysis to characterize the risk based on a modeling tool that comprises multiple variables interacting in semi-quantitatively environments. This method was tested with data from three different projects in our Institution (projects A, B and C). Different curves reflected the ulcer indexes identifying the project that may have a minor risk (project C) related to development and expected results according to initial or full investment. The results showed that this model contributes significantly to the analysis of risk and planning as well as to the definition of necessary investments that consider contingency actions with benefits to the different stakeholders: the investor or donor, the project manager and the researchers.

Robustness analysis of a green chemistry-based model for the ...

EPA Pesticide Factsheets

This paper proposes a robustness analysis based on Multiple Criteria Decision Aiding (MCDA). The ensuing model was used to assess the implementation of green chemistry principles in the synthesis of silver nanoparticles. Its recommendations were also compared to an earlier developed model for the same purpose to investigate concordance between the models and potential decision support synergies. A three-phase procedure was adopted to achieve the research objectives. Firstly, an ordinal ranking of the evaluation criteria used to characterize the implementation of green chemistry principles was identified through relative ranking analysis. Secondly, a structured selection process for an MCDA classification method was conducted, which ensued in the identification of Stochastic Multi-Criteria Acceptability Analysis (SMAA). Lastly, the agreement of the classifications by the two MCDA models and the resulting synergistic role of decision recommendations were studied. This comparison showed that the results of the two models agree between 76% and 93% of the simulation set-ups and it confirmed that different MCDA models provide a more inclusive and transparent set of recommendations. This integrative research confirmed the beneficial complementary use of MCDA methods to aid responsible development of nanosynthesis, by accounting for multiple objectives and helping communication of complex information in a comprehensive and traceable format, suitable for stakeholders and

Building partnerships towards strengthening Makerere University College of Health Sciences: a stakeholder and sustainability analysis

PubMed Central

2011-01-01

Background Partnerships and networking are important for an institution of higher learning like Makerere University College of Health Sciences (MakCHS) to be competitive and sustainable. Methods A stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of MakCHS to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes. Results The College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. Many stakeholders felt that the initiative for collaboration currently came more from the stakeholders than the College. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also identified the opportunity for MakCHS to embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. The need for MakCHS to be more vigorous in training to enhance professionalism and ethical conduct was also identified. Discussion As a constituent of a public university, MakCHS has relied on public funding, which has been inadequate to fulfill its mission. Broader networking, marketing to mobilize resources, and providing strong leadership and management support to inspire confidence among its current and potential stakeholders will be essential to MakCHS’ further growth. MakCHS’ relevance is hinged on generating research knowledge for solving the country’s contemporary health problems and starting relevant programs and embracing technologies. It should share new knowledge widely through publications and other forms of dissemination. Whether institutional leadership is best in the hands of academicians or professional managers is a debatable matter. Conclusions This study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance, and sustainability. Conducting stakeholder and sustainability analyses are instructive toward this end, and have provided information and perspectives on how to make long-range informed choices for success. PMID:21411001

Motivation of university and non-university stakeholders to change medical education in Vietnam

PubMed Central

Hoat, Luu Ngoc; Lan Viet, Nguyen; van der Wilt, GJ; Broerse, J; Ruitenberg, EJ; Wright, EP

2009-01-01

Background Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders. Methods Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders. Results Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors. Conclusion The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience. PMID:19630961

Conflict resolution efforts through stakeholder mapping in Labanan Research Forest, Berau, East Kalimantan, Indonesia

NASA Astrophysics Data System (ADS)

Wiati, C. B.; Indriyanti, S. Y.; Maharani, R.; Subarudi

2018-04-01

Conflict resolution in Labanan Research Forest (LRF) by the Dipterocarps Forest Ecosystem Research and Development Center (Balai Besar Penelitian dan Pengembangan Ekosistem Hutan Dipterokarpa – B2P2EHD) needs support from other parties that are also interested in such forest management. This paper aimed to presented conflict resolution in LRF through stakeholder mapping for its engagement. This research was conducted for seven months (June to December 2015) with interviews and literature study as its data collection. Collected data were analysed by a stakeholder analysis and matrix based on their interest and power levels. Two important findings were: (1) There are 19 parties having interests in the existence of LRF should be engaged; (2) Conflict resolution of LRF can be achieved: (a) ensuring key stakeholders which have high interest and high power level has same perception in existence and management of LRF, (b) establishing a partnership with primary stakeholders which have high interest and high power levels; (c) building partnerships between primary stakeholders which have high interest but low power levels, (d) building partnerships between key and secondary stakeholders which have low interest but high power levels and (e) gaining support from primary and secondary stakeholders which have low interest and low power levels. Stakeholder mapping is an important tool for tenure conflict resolution through mapping the power and interest of the conflicted parties and finding the proper parties to be approached.

Input from Key Stakeholders in the National Security Technology Incubator

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

This report documents the input from key stakeholders of the National Security Technology Incubator (NSTI) in developing a new technology incubator and related programs for southern New Mexico. The technology incubator is being developed as part of the National Security Preparedness Project (NSPP), funded by a Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant. This report includes identification of key stakeholders as well as a description and analysis of their input for the development of an incubator.

Integrated wetland management: an analysis with group model building based on system dynamics model.

PubMed

Chen, Hsin; Chang, Yang-Chi; Chen, Kung-Chen

2014-12-15

The wetland system possesses diverse functions such as preserving water sources, mediating flooding, providing habitats for wildlife and stabilizing coastlines. Nonetheless, rapid economic growth and the increasing population have significantly deteriorated the wetland environment. To secure the sustainability of the wetland, it is essential to introduce integrated and systematic management. This paper examines the resource management of the Jiading Wetland by applying group model building (GMB) and system dynamics (SD). We systematically identify local stakeholders' mental model regarding the impact brought by the yacht industry, and further establish a SD model to simulate the dynamic wetland environment. The GMB process improves the stakeholders' understanding about the interaction between the wetland environment and management policies. Differences between the stakeholders' perceptions and the behaviors shown by the SD model also suggest that our analysis would facilitate the stakeholders to broaden their horizons and achieve consensus on the wetland resource management. Copyright © 2014 Elsevier Ltd. All rights reserved.