A protocol for stakeholder engagement in deliver-EE: A pragmatic randomized comparative effectiveness trial evaluating effects of meal delivery on the ability of homebound older adults to remain in the community

BACKGROUND

Few clinical trials include a detailed protocol for stakeholder engagement in the design and execution of the clinical trial. Deliver-EE is a pragmatic clinical trial to assess how different types of home-delivered meals can affect older adults' health and well-being. We present the protocol for stakeholder engagement in this national, multi-site trial and initial findings from our efforts.

METHODS

Twenty-nine participants were recruited to two stakeholder advisory panels. The "Lived Experience Perspectives" panel is defined as the clients, caregivers, and meal delivery drivers with first-hand knowledge and lived experiences with meal delivery. The "System Perspectives" panel is defined as representatives from the larger financial, clinical, regulatory, and operational environments in which meal delivery to homebound older adults operate. Together, these two groups holistically represent interested parties that coordinate the interdependent elements of meal delivery to homebound older adults in order to: 1) inform our understanding of what matters most to older adults, their families, and the larger health and social care systems; 2) provide strategies to overcome challenges conducting the study; 3) enhance dissemination and uptake of study findings; and 4) identify opportunities for future research.

RESULTS

Although stakeholder partners share a common goal of using home-delivered meals as a method to improve outcomes for homebound older adults, individuals have different goals for participating as advisors in this research.

CONCLUSIONS

Understanding what individual stakeholders hope to gain from their participation is critical in designing an effective engagement protocol and critical for meaningful and rigorous stakeholder engagement in clinical trials.

Fuzzy cognitive mapping in participatory research and decision making: a practice review

BACKGROUND

Fuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023.

RESULTS

The methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases.

CONCLUSIONS

A strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings.

Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data

BACKGROUND

Successful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services.

METHODS

An implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals.

RESULTS

Landscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals.

CONCLUSION

Landscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.

Comparisons of stakeholders' influences, inter-relationships, and obstacles for circular economy implementation on existing building sectors

Buildings are energy- and resource-hungry: their construction and use account for around 39% of global carbon dioxide emissions; they consume around 40% of all the energy produced; they are responsible for over 35% of the EU's total waste generation; and account for about 50% of all extracted (fossil) materials. Therefore, they present a significant challenge to meeting national and international Net Zero targets of reducing greenhouse emissions and fossil resource use. The CircularB Project, is at the heart of this issue, which will underpin synergies of multi-scale circular perspectives (from materials, to components, to assets and built environments), digital transformation solutions, data-driven and complexity science, stakeholder behavioral science, and interdisciplinary capabilities towards achievable, affordable and marketable circular solutions for both new and existing buildings, for sustainable urban design, and for circular built environments across Europe. This paper contributes to the project by deriving new insights into the stakeholders' influences, inter-relationships, and obstacles in the implementation of circular economy concepts on existing building stocks in Europe, which represent over 90% of whole building assets. In order to identify and derive the insights, our study is rigorously based on (i) a robust critical literature review of key documentations such as articles, standards, policy reports, strategic roadmaps and white papers; and (ii) interviews with relevant stakeholders and decision makers. Uniquely, our work spans across all scales of CE implementation from materials, to products and components, to existing building stocks, and to living built environments. The findings point out the current challenges and obstacles required to be tackled. Inadequacies of financial incentives and governmental enforcement (via policy, legislation, or directive) are commonly found to be the most critical obstacles found throughout Europe. Circular economy is the global challenge and not just a single country can resolve the climate issue without the cooperation of other countries. The insights thus highlight the essential need for harmonized actions and tactical/pragmatic policies promoted and regulated by the European Commission, national and local governments who can dominate the influence, promote inter-relationship, and overcome the barriers towards circular economy much more effectively.

Using quality improvement approaches to increase emergency department provider engagement in research participant enrollment during COVID-19 and opioid overdose public health emergencies

PURPOSE

We utilized quality improvement (QI) approaches to increase emergency department (ED) provider engagement with research participant enrollment during the opioid crisis and coronavirus disease (COVID-19) pandemic. The context of this work is the Evaluating Microdosing in the Emergency Department (EMED) study, a randomized trial offering buprenorphine/naloxone to ED patients through randomization to standard or microdosing induction. Engaging providers is crucial for participant recruitment to our study. Anticipating challenges sustaining long-term engagement after a 63% decline in provider referrals four months into enrollments, we applied Plan-Do-Study-Act (PDSA) cycles to develop and implement an engagement strategy to increase and sustain provider engagement by 50% from baseline within 9 months.

METHODS

Our engagement strategy was centered on Coffee Carts rounds: 5-min study-related educational presentations for providers on shift; and a secondary initiative, a Suboxone Champions program, to engage interested providers as study-related peer educators. We used provider referrals to our team as a proxy for study engagement and report the percent change in mean weekly referrals across two PDSA cycles relative to our established referral baseline.

RESULTS

A QI approach afforded real-time review of interventions based on research and provider priorities, increasing engagement via mean weekly provider referrals by 14.5% and 49% across two PDSA cycles relative to baseline, respectively.

CONCLUSIONS

Our Coffee Carts and Suboxone Champions program are efficient, low-barrier, educational initiatives to convey study-related information to providers. This work supported our efforts to maximally engage providers, minimize burden, and provide life-saving buprenorphine/naloxone to patients at risk of fatal overdose.

Engaging patient and community stakeholders in the optimization of the Compassionate And Loving Mindset towards heart health risk (CALM Hearts) physical activity intervention: a description of initial work and protocol for future engagement activities

BACKGROUND

Participatory research approaches systematically integrate the perspectives of individuals, organizations, or communities that have a direct interest in a study's processes and outcomes (i.e., stakeholders) in research design and implementation. This supports interventions that are developed "by, not for" end-users, thereby increasing acceptability, uptake, and adherence. However, participatory approaches are relatively under-utilized in intervention development and behavioral change intervention research, in part, due to inadequate reporting of methodology. Therefore, to improve transparency in planning and reporting, we (a) describe how we engaged patients and community organizations (i.e., patient and community partners) in grant development for a self-compassion and physical activity behaviour change intervention for women with cardiovascular risk factors and (b) present a protocol for engaging patient and community partners in the optimization and implementation of the intervention moving forward.

METHODS

Our participatory research approach was guided by the Strategy for Patient-Oriented Research patient engagement framework and our prior stakeholder engagement work. Four patients and three community partners were engaged at the level of Involve, meaning their perspectives informed directions, processes, and decisions at major project milestones. Specifically, patient and community partners engaged in three separate meetings during grant development wherein they: (a) established a Terms of Reference to guide engagement activities and expectations; (b) shaped the grant through guided conversations about research priorities, outcomes, and intervention delivery components that could be targeted for optimization and (c) co-developed a protocol that specifies how relationships will be initiated with future patient partners, proposes engagement activities across the research cycle, and includes plans for formal evaluation of engagement processes.

CONCLUSIONS

Participatory research approaches provide valuable insights into the development of behavioural interventions, especially when stakeholders can partner early and have a meaningful impact. By detailing our engagement activities to date, we hope to model an approach to engaging stakeholders in behavioral intervention development and demonstrate the impacts of doing so.

Understanding Canadian stakeholders' views on measuring and valuing health for children and adolescents: a qualitative study

OBJECTIVE

Valuing child health is critical to assessing the value of healthcare interventions for children. However, there remain important methodological and normative issues. This qualitative study aimed to understand the views of Canadian stakeholders on these issues.

METHODS

Stakeholders from health technology assessment (HTA) agencies, pharmaceutical industry representatives, healthcare providers, and academic researchers/scholars were invited to attend an online interview. Semi-structured interviews were designed to focus on: (1) comparing the 3-level and 5-level versions of the EQ-5D-Y; (2) source of preferences for valuation (adults vs. children); (3) perspective of valuation tasks; and (4) methods for valuation (discrete choice experiment [DCE] and its variants versus time trade-off [TTO]). Participants were probed to consider HTA guidelines, cognitive capacity, and potential ethical concerns. All interviews were recorded and transcribed verbatim. Framework analysis with the incidence density method was used to analyze the data.

RESULTS

Fifteen interviews were conducted between May and September 2022. 66.7% (N = 10) of participants had experience with economic evaluations, and 86.7% (N = 13) were parents. Eleven participants preferred the EQ-5D-Y-5L. 12 participants suggested that adolescents should be directly involved in child health valuation from their own perspective. The participants were split on the ethical concerns. Eight participants did not think that there was ethical concern. 11 participants preferred DCE to TTO. Among the DCE variants, 6 participants preferred the DCE with duration to the DCE with death.

CONCLUSIONS

Most Canadian stakeholders supported eliciting the preferences of adolescents directly from their own perspective for child health valuation. DCE was preferred if adolescents are directly involved.

Engaging stakeholders to retrospectively discern implementation strategies to support program evaluation: Proposed method and case study

BACKGROUND

Availability of evidence-based practices (EBPs) is critical for improving health care outcomes, but diffusion can be challenging. Implementation activities increase the adoption of EBPs and support sustainability. However, when implementation activities are a part of quality improvement processes, evaluation of the time and cost associated with these activities is challenged by the need for a correct classification of these activities to a known taxonomy of implementation strategies by implementation actors.

DESIGN

Observational study of a four-stage, stakeholder-engaged process for identifying implementation activities and estimating the associated costs.

RESULTS

A national initiative in the Veterans Health Administration (VHA) to improve Advance Care Planning (ACP) via Group Visits (ACP-GV) for rural veterans identified 49 potential implementation activities. Evaluators translated and reduced these to 14 strategies used across three groups with the aid of implementation actors. Data were collected to determine the total implementation effort and applied cost estimates to estimate the budget impact of implementation for VHA.

LIMITATIONS

Recall bias may influence the identification of potential implementation activities.

CONCLUSIONS

This process improved understanding of the implementation effort and allowed estimation of ACP-GV 's budget impact.

IMPLICATIONS

A four-stage, stakeholder-engaged methodology can be applied to other initiatives when a pragmatic evaluation of implementation efforts is needed.

Perception of photovoltaic energy consumption in the Spanish primary sector. An environmentally profitable alternative

Agriculture and livestock farming are activities that depend on energy consumption. Photovoltaic self-consumption systems can reduce the production costs of these actors, especially in periods of high-energy price volatility. This work aimed to determine the degree of implementation of photovoltaic self-consumption systems, their relationship with the economic impact of the energy crisis, and the perception of producers to use renewable energy sources in the Spanish agricultural system as it is one of the most important at European level. For this purpose, a survey of the Spanish agricultural and livestock system, involving 396 primary producers, was carried out between December 2022 and March 2023. The results suggest that self-consumption systems are in place in 49.1% of all farms and that these have had a positive effect in alleviating the rising energy costs suffered by the Spanish primary sector. In summary, Spanish primary producers generally have a favorable perception of the use of renewable energies on their farms, especially photovoltaic. However, the cluster analysis shows the fact that there are two types of producers, active and passive, from an environmental point of view. The characterization of this type of producers can help the Spanish Administration to improve the efficiency of its energy strategy, and can be a source of inspiration for the governments of other countries.

The Renovation of Good Clinical Practice: A Framework for Key Components of ICH E8

The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use's (ICH) renovation of Good Clinical Practice (GCP) represents a philosophical shift in the conduct of clinical research away from a one-size-fits-all application to promoting a proactive, risk-based approach. The aim of this paper is to enhance the understanding of specific topics detailed in ICH E8 based on direct feedback from TransCelerate member companies who identified Quality by Design (QbD), Critical to Quality (CtQ), Fit for Purpose, and Stakeholder Engagement, as most changed and open to interpretation. The TransCelerate framework seeks to highlight and expand each of these central topics to support utilization and implementation of a strong foundation for quality in clinical development.

Lessons learned and recommendations in conducting solutions-driven environmental and public health research

Solutions-driven research is a transdisciplinary approach that incorporates diverse forms of expertise to identify solutions to stakeholder-identified environmental problems. This qualitative evaluation of early solutions-driven research projects provides transferable recommendations to improve researcher and stakeholder experiences and outcomes in transdisciplinary environmental research projects. Researchers with the U.S. Environmental Protection Agency (EPA) Office of Research and Development recently piloted a solutions-driven research approach in two parallel projects; one addressing nutrient management related to coastal waters and another studying wildland fire smoke impacts on indoor air quality. Studying the experiences of those involved with these pilots can enhance the integration of researcher and experiential expertise, improving solutions-driven research outcomes. Data collection included semi-structured interviews with 17 EPA researchers and 12 other stakeholders and reflective case narratives from the authors. We used conventional content analysis to qualitatively analyze perspectives on implementing innovative engagement and research approaches in a solutions-driven process. Findings that reflect common perspectives include the importance of continuous engagement, the challenges of differing timelines and priorities for researchers and stakeholders, and the need to define consistent markers of success across researchers and stakeholders. Key lessons to improve transdisciplinary research identified from the analysis are (1) improving clarity of roles and responsibilities; (2) planning to provide sufficient, continuous project funding over multiple years; (3) expecting research needs and plans to adapt to evolving circumstances; and (4) clearly defining the end of the project.

Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care

The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.

Designing explainable AI to improve human-AI team performance: A medical stakeholder-driven scoping review

The rise of complex AI systems in healthcare and other sectors has led to a growing area of research called Explainable AI (XAI) designed to increase transparency. In this area, quantitative and qualitative studies focus on improving user trust and task performance by providing system- and prediction-level XAI features. We analyze stakeholder engagement events (interviews and workshops) on the use of AI for kidney transplantation. From this we identify themes which we use to frame a scoping literature review on current XAI features. The stakeholder engagement process lasted over nine months covering three stakeholder group's workflows, determining where AI could intervene and assessing a mock XAI decision support system. Based on the stakeholder engagement, we identify four major themes relevant to designing XAI systems - 1) use of AI predictions, 2) information included in AI predictions, 3) personalization of AI predictions for individual differences, and 4) customizing AI predictions for specific cases. Using these themes, our scoping literature review finds that providing AI predictions before, during, or after decision-making could be beneficial depending on the complexity of the stakeholder's task. Additionally, expert stakeholders like surgeons prefer minimal to no XAI features, AI prediction, and uncertainty estimates for easy use cases. However, almost all stakeholders prefer to have optional XAI features to review when needed, especially in hard-to-predict cases. The literature also suggests that providing both system- and prediction-level information is necessary to build the user's mental model of the system appropriately. Although XAI features improve users' trust in the system, human-AI team performance is not always enhanced. Overall, stakeholders prefer to have agency over the XAI interface to control the level of information based on their needs and task complexity. We conclude with suggestions for future research, especially on customizing XAI features based on preferences and tasks.

Health system performance assessment: embedding resilience through performance intelligence

Health systems around the world are facing challenges in achieving their goals. In the wake of the coronavirus disease pandemic, the need for resilient health systems has become even more apparent. This article argues that embedding resilience into health system performance assessment (HSPA) frameworks can be a valuable approach for improving health system performance. This perspective examines key challenges threatening health systems and makes a case for the continued relevance of HSPA by embedding resilience-related performance intelligence.

Bridging the gap between science and food policy: nutrition as a driver of policy drawing on Scotland as a case study

Access to adequate food is one of the Human Rights set out in international law and hence its delivery (through policy) is the role of government. 'Food policy' cannot be the role of a single government department, however, since regulations must take care of public goods (e.g. public health and protecting the natural environment) while also creating an economic environment attractive to private sector participation. From the mid-20th century, much of food policy was driven by a need to encourage the production base, but more recently the importance of considering food policy through the lens of nutritional requirements is increasingly recognised, alongside the importance of minimising environmental damage. This review paper draws on experience of working with policymakers (in particular the Scottish Government) and of active participation in an EC-commissioned project. It highlights the need for the research community to invest time and resources in understanding what evidence policymakers are asking for and to consider that alongside evidence from those who will be impacted by the policy (stakeholders). Examples of effective ways of engaging stakeholders and policy communities simultaneously are outlined and the paper provides some thoughts on the boundaries between the science and policy communities and how to bridge them. The Case Study also highlights the importance of evidence to inform prioritisation and consultation at a local level when aiming to meet multiple policy goals nationally.

An integrated knowledge translation (iKT) approach to advancing community-based depression care in Vietnam: lessons from an ongoing research-policy collaboration

BACKGROUND

Evidence-based mental health policies are key to supporting the expansion of community-based mental health care and are increasingly being developed in low and middle-income countries (LMICs). Despite this, research on the process of mental health policy development in LMICs is limited. Engagement between researchers and policy makers via an integrated Knowledge Translation (iKT) approach can help to facilitate the process of evidence-based policy making. This paper provides a descriptive case study of a decade-long policy and research collaboration between partners in Vietnam, Canada and Australia to advance mental health policy for community-based depression care in Vietnam.

METHODS

This descriptive case study draws on qualitative data including team meeting minutes, a focus group discussion with research team leaders, and key informant interviews with two Vietnamese policy makers. Our analysis draws on Murphy et al.'s (2021) findings and recommendations related to stakeholder engagement in global mental health research.

RESULTS

Consistent with Murphy et al.'s findings, facilitating factors across three thematic categories were identified. Related to 'the importance of understanding context', engagement between researchers and policy partners from the formative research stage provided a foundation for engagement that aligned with local priorities. The COVID-19 pandemic acted as a catalyst to further advance the prioritization of mental heath by the Government of Vietnam. 'The nature of engagement' is also important, with findings demonstrating that long-term policy engagement was facilitated by continuous funding mechanisms that have enabled trust-building and allowed the research team to respond to local priorities over time. 'Communication and dissemination' are also crucial, with the research team supporting mental health awareness-raising among policy makers and the community, including via capacity building initiatives.

CONCLUSIONS

This case study identifies factors influencing policy engagement for mental health system strengthening in an LMIC setting. Sustained engagement with policy leaders helps to ensure alignment with local priorities, thus facilitating uptake and scale-up. Funding agencies can play a crucial role in supporting mental health system development through longer term funding mechanisms. Increased research related to the policy engagement process in global mental health will further support policy development and improvement in mental health care in LMICs.

The impact of MAMCA as a stakeholder engagement tool during the setup of an energy community

As they foster active participation in their daily operations, energy communities (ECs) are often regarded as important tools for the empowerment of civil stakeholders in the energy system. To ensure the incorporation of stakeholder needs, participation must also be guaranteed throughout the design phase of the EC. Despite a general consensus on the importance of stakeholder engagement in the setup of sustainability-fostering projects, the impact of engagement initiatives often goes unassessed. This makes it difficult to determine whether their application advances stakeholder interest. Therefore, we wanted to study the effects of a specific stakeholder engagement tool (Multi Actor Multi Criteria Analysis, MAMCA) that was used in the setup phase of eight different ECs. Through a survey with 102 participants, three core aspects are assessed: 1) the effect on participants' knowledge of ECs, 2) the effect on social learning, and 3) the extent to which the engagement goals and participant expectations are fulfilled. The study results show that stakeholder appreciation of the method is high and MAMCA has important value as a learning methodology, with 96% of participants indicating their knowledge was raised significantly and 94% marking increased awareness of other viewpoints. This led to a relevant rise in willingness to join an EC (from 75% of participants to 93%). The interactive aspect and expert assistance are seen as crucial elements in the MAMCA process. More attention to raising participants' technical knowledge and feedback on the follow-up of the engagement initiative results are identified points of improvement for future applications.

Engaging stakeholders to level up COPD care in LMICs: lessons learned from the "Breathe Well" programme in Brazil, China, Georgia, and North Macedonia

BACKGROUND

Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned.

MAIN BODY

Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice.

CONCLUSION

Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.

"It starts with a knock on the door": Caregiver and provider perspectives on healthcare communication for youth with intellectual and developmental disabilities

OBJECTIVES

Effective healthcare communication (HCC) is critical for youth with intellectual and developmental disabilities (IDD) who may have complex healthcare needs. The goal of this study was to gain family caregiver and provider perspectives on facilitators and challenges to effective HCC for youth with IDD.

METHODS

Caregivers of, and providers for youth with IDD were recruited from the community to participate in virtual focus group (FG) sessions. FGs were 60-90 min long and were facilitated by a research team consisting of caregivers and providers. The FGs were recorded, transcribed, and coded inductively for HCC themes.

RESULTS

Nineteen stakeholders participated in the FGs (caregivers: n = 14; providers: n = 5). Twenty-three themes were coded from the transcripts and were categorized by whether they focused on providers, caregivers, or healthcare systems.

CONCLUSIONS

Provider behaviors such as active listening and demonstrating humility were found to be critical for effective HCC. Fewer caregiver factors, such as advocacy, and systems factors such as visit format, emerged from the FG data. FG themes represent challenges that future interventions must address.

PRACTICE IMPLICATIONS

Efforts to improve HCC, and thus healthcare outcomes for youth with IDD, should address challenges identified by caregivers and providers.

The development of a novel decision support system for regional land use planning for brownfield land

Digital tools, particularly specialised decision support systems (DSSs), can be utilized to assist in the complex process of brownfield redevelopment. Existing brownfield DSSs typically focus on site-specific, late-stage applications, and socioeconomic factors are often overlooked. In this paper, we present a novel DSS aimed at providing support for early-stage, city region-scale brownfield land use planning and redevelopment. The proposed DSS is a prototype WebGIS application that enables land use planners and other brownfield regeneration professionals to examine a region and a set of sites during the initial planning phase for brownfield redevelopment. The DSS includes three bespoke modules comprising: (1) Land Use Potential (residential, commercial, and public open space), (2) risks posed by contamination and geotechnical hazards, (3) data pertinent to brownfield economic viability assessments. We outline a use case for this DSS, developed through comprehensive user-requirements gathering, and subsequently describe the techniques employed to construct the DSS modules and user interface. Finally, we present the results of user testing, wherein case-study stakeholders assessed the DSS. The feedback obtained during user testing aided in the identification of areas for improvement with regard to the functionality, usability, and effectiveness of the DSS in supporting decision-makers. The feedback was utilized to implement iterative improvements to the DSS and to plan future developments for the prototype DSS.

Effective Stakeholder Engagement for Collation, Analysis and Expansion of Antimicrobial Resistance (AMR) Data: A CAPTURA Experience

BACKGROUND

An effective implementation of antimicrobial resistance (AMR) surveillance projects requires sustainable and multidisciplinary engagement with stakeholders from various backgrounds, interests and aims. The "Capturing Data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) project, funded by the Fleming Fund, initially targeted 12 countries in South Asia (SA) and Southeast Asia (SEA) to "expand the volume of historical and current data on AMR and antimicrobial usage" and support local agencies through capacity building activities.

METHODS

In this article, we focus on early stakeholder engagement activities and present overall statistics on AMR data collated from 72 laboratories across seven countries. This included 2.3 million records of antimicrobial susceptibility testing (AST) data, which were curated, analyzed, and shared back to the facilities for informed decision making.

RESULTS

Approximately 98% of the data collated by CAPTURA originated from laboratories based in SA countries. Furthermore, country-wide data were analyzed to identify commonly reported pathogens in each country, followed by descriptions of AST practices and multidrug-resistant (MDR) pathogens. Overall, we found meager adherence to standard guidelines to perform and record AST results, and a significant number of MDR pathogens were reported.

CONCLUSIONS

We conclude that close collaboration with the existing national mechanisms for identifying AMR data sources was crucial for the project's success. Although we show a vast retrospective dataset on AMR is available for data sharing in Asia, there remain critical gaps in data generation/management practice and analysis capacity for AMR data at most facilities.

Stakeholder development of an implementation strategy for fall prevention in Norwegian home care - a qualitative co-creation approach

BACKGROUND

The uptake of fall prevention evidence has been slow and limited in home care services. Involving stakeholders in the implementation process is suggested as a method to successfully tailor implementation strategies. The aim of this study was to develop an implementation strategy for fall prevention, targeting healthcare providers working in home care services.

METHODS

This study used an explorative qualitative approach in a five-step co-creation process to involve researchers, service users, and healthcare providers. The first two steps consisted of workshops. This was followed by focus group interviews and individual interviews with key informants as steps three and four. Data from the first four steps were analyzed using reflexive thematic analysis. The fifth and final step was a workshop finalizing a strategy for implementing fall prevention evidence in home health services.

RESULTS

Overall, our findings, resulted in an implementation strategy for fall prevention with four components: (1) Empower leaders to facilitate implementation, operationalized through what managers pay attention to regularly, resource priorities, and time spent on fall prevention, (2) Establish implementation teams, consisting of multidisciplinary healthcare providers from different levels of the organization, with formalized responsibility for implementation, (3) Tailor dual competence improvement, reflecting the need for knowledge and skills for fall prevention and implementation among healthcare providers and users, and (4) Provide implementation support, representing guidance through the implementation process.

CONCLUSIONS

This study advances our understanding of implementation in home care services. Implementation of fall prevention requires an implementation strategy involving a blend of essential components targeting leaders, competent healthcare providers and users, and establishing structures enhancing the implementation process.

Environmental strategic performance of SMEs in developing countries: perspectives of environmental strategic capabilities, environmental strategic assessment, and stakeholder engagement

The purpose of this study is to empirically evaluate the model that explains the methods involved in the transformation of environmental strategic capabilities (ESC) into environmental strategic performance (ESP) of manufacturing SMEs in developing economies such as Pakistan. This study also analyzes the role of environmental strategic assessment (ESA) as a mediator as well as the contingent impacts of stakeholder engagement (SE). To evaluate the conceptual model, a cross-sectional design was employed in this study. Data from 489 owners, production managers, finance managers, and CEOs of 133 production units dealing in agriculture equipment (31 units), auto parts (18 units), electrical equipment (25 units), gas appliances (23 units), pharmaceutical instruments (15 units), and plastic products manufacturing (21 units) was gathered to validate the moderated mediation framework. The outcomes of the study support the notion that ESC and ESP are positively correlated. Furthermore, results also support the mediation role of ESA in the association between ESC and ESP. Additionally, the moderation of SE is validated, and this construct is portrayed as a catalyst in interaction of ESC and ESP. The current study contributes to strategic management literature by concentrating on intangible assets such as ESC and its key aspects. As a result, it introduces a new framework as well as a roadmap that will support the accomplishment of ESP. Through focusing on the mediating mechanism in which ESC may well be transformed to ESP of manufacturing SMEs by ESA, the study findings significantly contributed to the understanding of environmental dynamism in contemporary management era. The findings of the study also assist in clarifying the moderating impact of SE and how its interactions with ESC and ESP strengthen the influence that enterprises have on ESA.

From data to decisions: Empowering brownfield redevelopment with a novel decision support system

This research evaluates a novel decision support system (DSS) for planning brownfield redevelopment. The DSS is implemented within a web-based geographical information system that contains the spatial data informing three modules comprising land use suitability, economic viability, and ground risk. Using multi-criteria decision analysis, an evaluation was conducted on 31,942 ha of post-industrial land and around Liverpool, UK. The representativeness and credibility of the DSS outputs were evaluated through user trials with fifteen land-use planning and development stakeholders from the Liverpool City Region Comined Authority. The DSS was used to explore land use planning scenarios and it could be used to support decision making. Our research reveals that the DSS has the potential to positively inform the identification of brownfield redevelopment opportunities by offering a reliable, carefully curated, and user-driven digital evidence base. This expedites the traditionally manual process of conducting assessments of land suitability and viability. This research has important implications for assessing the impact of current and future planning policy and the potential for the use of digital tools for land use planning and sustainability in the UK and globally.

Exploring patient and caregiver perceptions of the meaning of the patient partner role: a qualitative study

BACKGROUND

The re-conceptualization of patients' and caregivers' roles in research from study participants to co-researchers ("patient partners") has led to growing pains within and outside the research community, such as how to effectively engage patients in research and as part of interdisciplinary teams. To support the growth of more successful research partnerships by developing a shared understanding of how patient partners conceptualize and contribute to their role, this study aimed to explore patient partners' motivations for engagement and understanding of their role.

METHODS

We conducted semi-structured interviews with participants (n = 13) of an online survey of activities and impacts of patient engagement in Strategy for Patient-Oriented Research projects. Eligibility criteria included being a patient partner that indicated interest in interview participation upon survey completion, the ability to read/write in English and provide informed consent. Data were analyzed thematically using an inductive, codebook thematic analysis.

RESULTS

Illuminating the lived/living patient and caregiver experience was central to how most patient partners conceptualized the role in terms of its definition, purpose, value, and responsibilities. Participants also identified four additional categories of motivations for becoming a patient partner and contributions that patient partners make to research that build upon and are in addition to sharing their lived/living experiences. Lastly, participants highlighted important connotations of the term patient partner, including temporal and context-specific considerations for the term "patient" and what "partner" may imply about the nature of the research relationship.

CONCLUSIONS

At the onset of partnership, academic researchers and patient partners must create the space necessary to discuss and understand each other's underlying motivations for partnering and their perspectives on the purpose, value, and responsibilities of the patient partner role. These early conversations should help unearth what research partners hope to get out of and feel that they are able to contribute to engaging, and in such contribute to the development of reciprocal relationships that work towards shared and valued goals. Trial registration Not applicable.

Partnering with social service staff to implement pragmatic clinical trials: an interim analysis of implementation strategies

BACKGROUND

With recent growth in the conduct of pragmatic clinical trials, the reliance on frontline staff to contribute to trial-related activities has grown as well. Active partnerships with staff members are often critical to pragmatic trial implementation, but rarely do research teams track and evaluate the specific "implementation strategies" used to support staff's involvement in trial procedures (e.g., participant recruitment). Accordingly, we adapted implementation science methodologies and conducted an interim analysis of the strategies deployed with social service staff involved in one multi-site pragmatic clinical trial.

METHODS

We used a naturalistic, observational study design to characterize strategies our research team deployed with staff during monthly, virtual meetings. Data were drawn from meeting notes and recordings from the trial's 4-month Preparation phase and 8-month Implementation phase. Strategies were mapped to the Expert Recommendations for Implementing Change taxonomy and categorized into nine implementation clusters. Survey data were also collected from staff to identify the most useful strategies the research team should deploy when onboarding new staff members in the trial's second year.

RESULTS

A total of 287 strategies were deployed. Strategies in the develop stakeholder interrelationships cluster predominated in both the Preparation (35%) and Implementation (31%) phases, followed by strategies in the use iterative and evaluative approaches cluster, though these were more prevalent during trial Preparation (24%) as compared to trial Implementation (18%). When surveyed on strategy usefulness, strategies in the provide interactive assistance, use financial approaches, and support staff clusters were most useful, per staff responses.

CONCLUSIONS

While strategies to develop stakeholder interrelationships were used most frequently during trial Preparation and Implementation, program staff perceived strategies that provided technical assistance, supported clinicians, and used financial approaches to be most useful and should be deployed when onboarding new staff members. Research teams are encouraged to adapt and apply implementation strategy tracking methods when partnering with social service staff and deploy practical strategies that support pragmatic trial success given staff needs and preferences.

TRIAL REGISTRATION

NCT05357261. May 2, 2022.

The case study of a city-level business-led household food waste sorting incentive scheme in Nanjing, China

Economic incentive is thought a good intervention type that can encourage residents to do food waste sorting by many cities' government in China. However, there is a lack of long-term, large-scale study. So the business-led incentive scheme was studied by a case study in Nanjing, China, which focuses on food waste sorting. The results showed that the incentive can encourage at most an average 37% of residents to start and then continue to do food waste sorting regularly. Later, the incentive cannot encourage more even with many non-economic interventions. And most of these participating residents (31%) were encouraged at the first 12 months. The results also showed that house price had a negative relationship with the community sorting performance. The comparative study results showed that the community committee must be involved in the non-economic interventions to encourage more residents to take part; otherwise, the company will fail even after many attempts. So the government should apply the incentive policy by dialectical view in food waste sorting. And the incentive scheme should involve all the stakeholders to apply non-economic interventions to encourage more residents to do food waste sorting.

Applying and Assessing Participatory Approaches in an Environmental Flows Case Study

Environmental flows (e-flows) management takes place within a complex social-ecological system, necessitating the involvement of diverse stakeholders and an appreciation of a range of perspectives and knowledge types. It is widely accepted that incorporating participatory methods into environmental flows decision-making will allow stakeholders to become meaningfully involved, improving potential solutions, and fostering social legitimacy. However, due to substantial structural barriers, implementing participatory approaches can be difficult for water managers. This paper assesses the effectiveness of an e-flows methodology that combines elements of structured decision-making and participatory modeling, whilst constrained by project resources. Three process-based objectives were identified by the group at the start of the process: improving transparency, knowledge exchange, and community ownership. We evaluated the success of the approach according to those objectives using semi-structured interviews and thematic analysis. In evaluating how well the participatory approach achieved the process objectives, we found that at least 80% of respondents expressed positive sentiment in every category (n = 15). We demonstrate that the values-based process objectives defined by the participant group are an effective tool for evaluating participatory success. This paper highlights that participatory approaches can be effective even in resource-constrained environments when the process is adapted to fit the decision-making context.

Development and Feasibility of the Self-Report Quantified Tuberous Sclerosis Complex-Associated Neuropsychiatric Disorders Checklist (TAND-SQ)

BACKGROUND

Tuberous sclerosis complex-associated neuropsychiatric disorders (TAND) are often present but underidentified and undertreated in individuals with tuberous sclerosis complex (TSC). The clinician-completed TAND-Lifetime Checklist (TAND-L) was developed to address this identification and treatment gap. Stakeholder engagement identified the need for a TAND Checklist that can (1) be completed by caregivers or individuals with TSC and (2) quantify TAND difficulties. The aim of this study was to develop a self-report quantified TAND Checklist (TAND-SQ) and conduct feasibility and acceptability testing.

METHODS

This aim was addressed in three phases: (1) development of the TAND-SQ Checklist, (2) feasibility and acceptability testing of the "near-final" TAND-SQ Checklist, and (3) preparation of the final TAND-SQ Checklist. Participants included 23 technical experts from the TAND consortium in all phases and 58 lived experts (caregivers and individuals with TSC) in phase 2. All participants completed a TAND-SQ Checklist and a checklist feedback form.

RESULTS

Phase 1 additions to the TAND-SQ, when compared with the TAND-L, included four new items and a quantification rating. Phase 2 showed high ratings for the "near-final" TAND-SQ Checklist on comprehensiveness, clarity, ease of use, and overall acceptability. In phase 3, questions on strengths, strategies, and a TAND Cluster Profile were added.

CONCLUSION

The TAND-SQ Checklist is presented here for use by individuals with TSC and their caregivers. The next steps as part of the TANDem project include internal and external validation of the checklist and linking of TAND Cluster Profiles generated from the checklist to evidence-informed consensus recommendations within a smartphone application.

Lab Meets World: the Case for Use-Inspired Basic Research in Affective Science

We join others in envisioning a future for affective science that addresses society's most pressing needs. To move toward this vision, we consider a research paradigm that emerged in other disciplines: use-inspired basic research. This paradigm transcends the traditional basic-applied dichotomy, which pits the basic goal of fundamental scientific understanding against the applied goal of use in solving social problems. In reality, these goals are complementary, and use-inspired basic research advances them simultaneously. Here, we build a case for use-inspired basic research-how it differs from traditional basic science and why affective scientists should engage in it. We first examine how use-inspired basic research challenges problematic assumptions of a strict basic-applied dichotomy. We then discuss how it is consistent with advances in affective science that recognize context specificity as the norm and consider ethical issues of use being a complementary goal. Following this theoretical discussion, we differentiate the implementation of use-inspired basic research from that of traditional basic science. We draw on examples from recent research to illustrate differences: social problems as a starting point, stakeholder and community engagement, and integration of research and service. In conclusion, we invite affective scientists to embrace the "lab meets world" perspective of use-inspired basic research as a promising pathway to real-world impact.

The importance of discourse when discussing microplastic pollution with oyster stakeholders in Massachusetts, USA

Oysters have socioeconomic and environmental importance globally and are currently threatened by microplastic pollution. Whether solutions (e.g., laws, policies, or best management practices) are needed to protect oysters from microplastic pollution is still in question given the complexity of the issue and the multitude of stakeholders involved. Minimal research has been done to examine the public's view of the microplastic problem and, separately, few economic studies have examined non-monetary values for oysters. Here, we employed a discourse-based method (deliberative multicriteria evaluation methodology) to engage with oyster-relevant stakeholders in Massachusetts, USA, to evaluate how the stakeholders discussed and interacted with each other on the topic of 'microplastics polluting oyster habitats' using hypothetical scenarios. Our qualitative analysis indicated that participants discussed human welfare and non-human welfare aspects of oysters when considering what is threatened by microplastic pollution in oyster habitats. In all the workshops, an important theme emerged which is the role of oysters in supporting services (e.g., the concept that microplastic filtration or ingestion by oysters might impact the oysters' role as eco-engineers). Decision-making is not a linear process, especially when complex pollutants (e.g., microplastics) are involved. Here, we learned that both environmental and social data are needed for the oyster stakeholders to make decisions, and discussion among stakeholders can highlight gaps in scientific knowledge. The results were then used to inform the development of a decision-making process for evaluating complex environmental issues, like microplastic pollution.

Primary care engagement in health system change: a scoping review of common barriers and effective strategies

BACKGROUND

The complexity of health systems necessitates coordination between a multitude of stakeholders to enact meaningful change. Primary care physicians are a crucial partner to engage, as their investment and participation are critical to the success of any system-level initiative. The aim of this scoping review is to identify common barriers and effective strategies when engaging primary care physicians in designing and implementing health system change.

METHODS

A scoping review was performed. A literature search was performed in March 2020 using five databases. 668 unique articles were identified and underwent a title and abstract review. 23 articles met criteria for full text review and 10 met final inclusion criteria. A backward citation analysis identified two articles. 12 articles underwent data extraction and thematic analysis.

RESULTS

Several barriers to engagement were identified including a lack of trust between primary care physicians and decision-makers, strong professional physician identity, clinically irrelevant and complex proposals, and a lack of capacity and supports. Described strategies to overcome these barriers included building trust and relationships, contextual engagement strategies, working with physician leadership, enabling open and intentional communication channels, designing clinically relevant and straightforward initiatives, and considering financial incentives.

CONCLUSIONS

Barriers to primary care engagement should be addressed with contextually designed strategies and a focus on relationship building, collaborative efforts, and implementing relevant and feasible initiatives. Further research should explore how to best develop relationships with primary care, working with collective voices of primary care physicians, and to better understanding the impact of financial incentives on engagement.

Stakeholder engagement in the development of an upper extremity outcome measure for children with rare musculoskeletal conditions

BACKGROUND

Upper extremity (UE) involvement is prevalent in 73% of individuals with arthrogryposis multiplex congenita (AMC), yet no AMC-specific outcome measure exists. When developing a measure specific to a population with a rare musculoskeletal condition, clinicians' and patients' perspectives and involvement is a crucial and necessary step. This study sought to determine the most clinically useful items for an outcome measure of UE function for children with AMC as defined by caregivers and clinicians.

METHODS

To ensure the perspectives and needs of caregivers of children with AMC and clinicians were considered in the development of the UE measure for AMC, a Nominal Group technique (NGT) with caregivers of children with AMC (phase 1) followed by a three-round survey with clinicians (phase 2) were carried out.

RESULTS

Phase 1: Eleven individuals participated in the nominal group technique and identified 32 items. The most important items were Picking up an object (n = 11), Eating (n = 10), Reaching mouth (n = 10), Getting out of bed (n = 10). Phase 2: Invitations to participate to an online survey was sent to 47 experts in the field of AMC, 20 participants completed round 1, 15 completed round 2 and 13 completed round 3. Throughout the survey, participants were asked about movement required to screen the UE, essential domains to be included in the measure, establishing a scoring guide and identifying tasks associated with joint motion and position.

CONCLUSION

A preliminary version of an UE AMC-specific outcome measure was developed with the help of caregivers' perspectives and expert opinions.

Positioning patients to partner: exploring ways to better integrate patient involvement in the learning health systems

Globally, health systems are increasingly striving to deliver evidence based care that improves patients', caregivers' and communities' health outcomes. To deliver this care, more systems are engaging these groups to help inform healthcare service design and delivery. Their lived experiences-experiences accessing and/or supporting someone who accesses healthcare services-are now viewed by many systems as expertise and an important part of understanding and improving care quality. Patients', caregivers' and communities' participation in health systems can range from healthcare organizational design to being members of research teams. Unfortunately, this involvement greatly varies and these groups are often sidelined to the start of research projects, with little to no role in later project stages. Additionally, some systems may forgo direct engagement, focusing solely on patient data collection and analysis. Given the benefits of active patient, caregiver and community participation in health systems on patient health outcomes, systems have begun identifying different approaches to studying and applying findings of patient, caregiver and community informed care initiatives in a rapid and consistent fashion. The learning health system (LHS) is one approach that can foster deeper and continuous engagement of these groups in health systems change. This approach embeds research into health systems, continuously learning from data and translating findings into healthcare practices in real time. Here, ongoing patient, caregiver and community involvement is considered vital for a well functioning LHS. Despite their importance, great variability exists as to what their involvement means in practice. This commentary examines the current state of patient, caregiver and community participation in the LHS. In particular, gaps in and need for resources to support their knowledge of the LHS are discussed. We conclude by recommending several factors health systems must consider in order to increase participation in their LHS. Systems must: (1) assess patients', caregivers and community understanding of how their feedback are used in the LHS and how collected data are used to inform patient care; (2) review the level and extent of these groups' participation in health system improvement activities; and (3) examine whether health systems have the workforce, capacity and infrastructure to nurture continuous and impactful engagement.

Participatory prioritisation of interventions to improve primary school food environments in Gauteng, South Africa

BACKGROUND

In South Africa, overweight and obesity affect 17% of children aged 15-18. School food environments play a vital role in children's health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model.

METHODS

A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or 'very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5).

RESULTS

We identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) "regulate what kinds of foods can be sold at schools", 2) "train school staff through workshops and discussions to improve school food environment", and affix 3) "compulsory, child-friendly warning labels on unhealthy foods".

CONCLUSION

Prioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa's childhood obesity epidemic effectively.

A framework for stakeholder engagement in the adoption of new anti-malarial treatments in Africa: a case study of Nigeria

BACKGROUND

Recent reports of artemisinin partial resistance from Rwanda and Uganda are worrisome and suggest a future policy change to adopt new anti-malarials. This is a case study on the evolution, adoption, and implementation of new anti-malarial treatment policies in Nigeria. The main objective is to provide perspectives to enhance the future uptake of new anti-malarials, with an emphasis on stakeholder engagement strategies.

METHODS

This case study is based on an analysis of policy documents and stakeholders' perspectives drawn from an empirical study conducted in Nigeria, 2019-2020. A mixed methods approach was adopted, including historical accounts, review of programme and policy documents, and 33 qualitative in-depth interviews and 6 focus group discussions.

RESULTS

Based on policy documents reviewed, the adoption of artemisinin-based combination therapy (ACT) in Nigeria was swift due to political will, funding and support from global developmental partners. However, the implementation of ACT was met with resistance from suppliers, distributors, prescribers, and end-users, attributed to market dynamics, costs and inadequate stakeholder engagement. Deployment of ACT in Nigeria witnessed increased developmental partner support, robust data generation, ACT case-management strengthening and evidence on anti-malarial use in severe malaria and antenatal care management. A framework for effective stakeholder engagement for the future adoption of new anti-malarial treatment strategies was proposed. The framework covers the pathway from generating evidence on drug efficacy, safety and uptake; to making treatment accessible and affordable to end-users. It addresses which stakeholders to engage with and the content of engagement strategies with key stakeholders at different levels of the transition process.

CONCLUSION

Early and staged engagement of stakeholders from global bodies to community level end-users is critical to the successful adoption and uptake of new anti-malarial treatment policies. A framework for these engagements was proposed as a contribution to enhancing the uptake of future anti-malarial strategies.

Priority topics for child and family health research in community-based paediatric health care according to caregivers and health care professionals

Background

Patient-oriented research (POR) aligns research with stakeholders' priorities to improve health services and outcomes. Community-based health care settings offer an opportunity to engage stakeholders to determine the most important research topics to them. Our objectives were to identify unanswered questions that stakeholders had regarding any aspect of child and family health and prioritize their 'top 10' questions.

Methods

We followed the James Lind Alliance (JLA) priority setting methodology in partnership with stakeholders from the Northeast Community Health Centre (NECHC; Edmonton, Canada). We partnered with stakeholders (five caregivers, five health care professionals [HCPs]) to create a steering committee. Stakeholders were surveyed in two rounds (n = 125 per survey) to gather and rank-order unanswered questions regarding child and family health. A final priority setting workshop was held to finalize the 'top 10' list.

Results

Our initial survey generated 1,265 submissions from 100 caregivers and 25 HCPs. Out of scope submissions were removed and similar questions were combined to create a master list of questions (n = 389). Only unanswered questions advanced (n = 108) and were rank-ordered through a second survey by 100 caregivers and 25 HCPs. Stakeholders (n = 12) gathered for the final workshop to discuss and finalize the 'top 10' list. Priority questions included a range of topics, including mental health, screen time, COVID-19, and behaviour.

Conclusion

Our stakeholders prioritized diverse questions within our 'top 10' list; questions regarding mental health were the most common. Future patient-oriented research at this site will be guided by priorities that were most important to caregivers and HCPs.

Adapting to sea level rise: participatory, solution-oriented policy tools in vulnerable Mediterranean areas

The coasts of the Mediterranean basin are exposed to the ongoing effects of climate change and anthropogenic pressure. Low elevated coastal plains, river deltas, lagoons and reclamation areas are experiencing beach retreat, coastal erosion and marine flooding. This makes them particularly vulnerable to sea level rise (SLR), which is expected to increase up to 1 m by 2100 AD, according to the projections of the Intergovernmental Panel on Climate Change. In this study, selected stakeholders from four Mediterranean coastal areas that are highly vulnerable to the impacts of SLR have been engaged through a structured participatory process for the development of solution-oriented, case-specific and site-specific Policy Tools to address SLR. The developed Policy Tools for the Venice Lagoon, the Metaponto reclamation area and the Basento river mouth, in Italy, the Ebro River Delta in Spain, and the coastal plain of Chalastra, near the Axios River Delta, in Greece, contain relevant, effective and implementable actions stemming from stakeholder interaction and consensus building. The interconnected stakeholder engagement steps employed in this study identified relevant issues that should be considered when defining SLR adaptation policies to bridge knowledge and perception gaps, facilitate knowledge exchange and foster social learning through structured science communication on SLR. This participatory stakeholder process can lay the foundations for more extensive participation in public processes through which the resulting Policy Tools can materialise into collectively accepted, concrete actions to help vulnerable areas adapt to the expected SLR and consequent coastal hazards by the end of this century.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10669-023-09910-5.

Key issues for stakeholder engagement in the development of health and healthcare guidelines

Established in 2015, the Multi-Stakeholder Engagement (MuSE) Consortium is an international network of over 120 individuals interested in stakeholder engagement in research and guidelines. The MuSE group is developing guidance for stakeholder engagement in the development of health and healthcare guideline development. The development of this guidance has included multiple meetings with stakeholders, including patients, payers/purchasers of health services, peer review editors, policymakers, program managers, providers, principal investigators, product makers, the public, and purchasers of health services and has identified a number of key issues. These include: (1) Definitions, roles, and settings (2) Stakeholder identification and selection (3) Levels of engagement, (4) Evaluation of engagement, (5) Documentation and transparency, and (6) Conflict of interest management. In this paper, we discuss these issues and our plan to develop guidance to facilitate stakeholder engagement in all stages of the development of health and healthcare guideline development.

The participatory value-sensitive design (VSD) of a mHealth app targeting citizens with dementia in a Danish municipality

The Sammen Om Demens (together for dementia), a citizen science project developing and implementing an AI-based smartphone app targeting citizens with dementia, is presented as an illustrative case of ethical, applied AI entailing interdisciplinary collaborations and inclusive and participative scientific practices engaging citizens, end users, and potential recipients of technological-digital innovation. Accordingly, the participatory Value-Sensitive Design of the smartphone app (a tracking device) is explored and explained across all of its phases (conceptual, empirical, and technical). Namely, from value construction and value elicitation to the delivery, after various iterations engaging both expert and non-expert stakeholders, of an embodied prototype built on and tailored to their values. The emphasis is on how moral dilemmas and value conflicts, often resulting from diverse people's needs or vested interests, have been resolved in practice to deliver a unique digital artifact with moral imagination that fulfills vital ethical-social desiderata without undermining technical efficiency. The result is an AI-based tool for the management and care of dementia that can be considered more ethical and democratic, since it meaningfully reflects diverse citizens' values and expectations on the app. In the conclusion, we suggest that the co-design methodology outlined in this study is suitable to generate more explainable and trustworthy AI, and also, it helps to advance towards technical-digital innovation holding a human face.

Organizational transformation for greater sustainability impact: recent changes in a scientific research infrastructure in Europe

Context

Scholars across holistic, transdisciplinary, place-based fields of research, such as landscape ecology and social ecology, have increasingly called for an 'all-hands-on-deck' approach for transformations toward greater sustainability of social-ecological systems. This Perspective showcases organizational transformation toward sustainability in the context of a research network dedicated to place-based, social-ecological research in Europe.

Objectives

Using the European LTER research infrastructure (eLTER RI) as a case, we analyze recent organizational-level shifts motivated by desires to increase sustainability impact. These shifts include knowledge integration between the natural and social sciences, stakeholder engagement, and a reformulation of administrative guidelines and practices.

Methods

Following a program evaluation, new conversations led to new initiatives in the eLTER RI. As researchers who were involved in the program evaluation and the development of new initiatives, we rely on our professional experience and participant observation to provide insights about this process and its developments.

Results

Recommendations from a recent assessment that critiqued and provided recommendations for the research infrastructure have recently been implemented in the eLTER RI. eLTER has leveraged a unique and timely opportunity-formal recognition and project funding by the EU-to upscale and standardize its infrastructure by creating novel protocols and enacting steps towards implementation.

Conclusions

This Perspective demonstrates how eLTER's research agenda and related protocols have evolved to better integrate multiple knowledge types, promote stakeholder integration into research, and foster greater equity and reflexivity in doing science, all of which are considered necessary to increase sustainability impact. We conclude by considering current and potential future challenges.

Assessing the design of road traffic death information systems in Iran: A participatory systems approach

AIM

To describe and analyze the information architecture and information pathways of the road traffic death recording, registration and reporting system in Guilan Province, northernIran.

METHODS

We used Business Process Mapping, a qualitative approach. This participatory and iterative approach consists of a document review, key informant interviews, development of a process map and a participatory workshop with key stakeholders to illuminate and validate the findings. We classified the tasks performed in the system into three phases: (1) Identification and recording; (2) Notification and registration, and (3) Production of statistics.

RESULTS

We identified 13 stakeholders, with operating and influencing roles in the process of identification, registration and production of statistics about road traffic deaths in Guilan province. The three main sources of road traffic death statistics are the Ministry of Health and Medical Education, the National Organization for Civil Registration and the Forensic Medicine Organization. Our results reveal a highly fragmented system with minimal cross-sectoral data exchange. Each stakeholder operates in a silo resulting in delays and redundancies in the operating system. In the absence of an effective communication among stakeholders, the information exchange was dependent on the family of the deceased. These fragmented information silos alter the compilation of cause of death statistics and result in under-reporting and discrepancies in road traffic deaths figures.

CONCLUSIONS

Designing a comprehensive road traffic information system that provides accurate and timely information requires an understanding of the information flow and the entangled web of different stakeholders operating in the system. Participatory systems approaches such as process mapping can assist in capturing the complexity of the system and the integration process by facilitating stakeholders' engagement and ownership in improving the design of the system.

Acceptability of neural stem cell therapy for cerebral palsy: survey of the Australian cerebral palsy community

BACKGROUND

Neural stem cells (NSCs) have the potential to engraft and replace damaged brain tissue, repairing the damaged neonatal brain that causes cerebral palsy (CP). There are procedures that could increase engraftment of NSCs and may be critical for efficacy, but hold notable risks. Before clinical trials progress, it is important to engage with the CP community to understand their opinions. The aim of this study was to determine the acceptability of NSC therapy for CP in the CP community.

METHODS

Australian residents with CP and parents/carers of those with CP completed a questionnaire to determine their willingness to use NSCs from three sources (fetal, embryonic and induced pluripotent stem cells) and their willingness to undergo accompanying procedures (neurosurgery, immunosuppression) that carry potential risks. To further explore their views, participants also answered free text questions about their ethical concerns regarding the source of NSCs and their perceptions of meaningful outcomes following NSC treatment.

RESULTS

In total, 232 responses were analyzed. Participants were willing to use NSCs from all three cell sources and were willing to undergo NSC therapy despite the need for neurosurgery and immunosuppression. Participants identified a range of outcome domains considered important following NSC treatment including gross motor function, quality of life, independence and cognitive function.

CONCLUSIONS

Hypothetical NSC therapy was acceptable to the Australian CP community. This study has identified important findings from the CP community which can be used to inform future NSC research, including the design of clinical trials which may help to increase recruitment, compliance and participant satisfaction.

Protocol for a hybrid II study exploring the feasibility of delivering, evaluating, and implementing a self-management programme for people with neuromuscular diseases at a specialist neuromuscular centre

BACKGROUND

Self-management support (SMS) forms a central pillar in the management of long-term conditions. It is firmly aligned with UK health policy but there is a paucity of evidence exploring how it is enacted in the context of neuromuscular diseases (NMDs). Bridges is a SMS programme originally developed in stroke. A new version of the programme (Neuromuscular Bridges) has recently been co-designed with people with lived experience of NMD and requires evaluation. The implementation of SMS is inherently complex with potential barriers at the level of the patient, provider, and wider organisation. The success of implementing programmes can be highly dependent on context, indicating a rationale for considering implementation determinants at an early stage. This study aims to explore the feasibility of (1) delivering, (2) evaluating, and (3) implementing Neuromuscular Bridges at a specialist neuromuscular centre.

METHODS

This study employs a hybrid II design underpinned by Normalisation Process Theory (NPT), which has been used prospectively to inform the implementation plan and will also inform the analysis. The feasibility of delivering, evaluating, and implementing Neuromuscular Bridges will be assessed using a single-arm pre-post design. In terms of delivery and evaluation, we will explore acceptability, demand within the service, performance of outcome measures, recruitment, and retention. Implementation strategies have been selected from a refined taxonomy of strategies, mapped to NPT, and targeted at known barriers and facilitators at the specialist centre that were identified from preliminary stakeholder engagement activities. The impact of the strategy bundle on fidelity, acceptability, appropriateness, and adoption will be evaluated using qualitative interviews, administrative data, surveys, and a notes audit.

CONCLUSIONS

This this study will provide valuable feasibility data on a co-designed SMS programme for people with NMDs that will be used to inform a larger implementation study, requirements for embedding it in a specialist centre, and rollout to other specialist centres. Using hybrid methodology at the feasibility stage is unusual and this study will provide important insights into the usefulness of taking this approach at this point in the research pipeline.

TRIAL REGISTRATION

ISRCTN Trial ID: ISRCTN14208138 . Date registered: 18/08/2021.

Digital tools for brownfield redevelopment: Stakeholder perspectives and opportunities

Brownfield redevelopment is a complex process often involving a wide range of stakeholders holding differing priorities and opinions. The use of digital systems and products for decision making, modelling, and supporting discussion has been recognised throughout literature and industry. The inclusion of stakeholder preferences is an important consideration in the design and development of impactful digital tools and decision support systems. In this study, we present findings from stakeholder consultation with professionals from the UK brownfield sector with the aim of informing the design of future digital tools and systems. Our research investigates two broad themes; digitalisation and the use of digital tools across the sector; and perceptions of key brownfield challenge areas where digital tools could help better inform decision-makers. The methodology employed for this study comprises the collection of data and information using a combination of interviews and an online questionnaire. The results from these methods were evaluated both qualitatively and quantitatively. Findings reveal a disparity in levels of digital capability between stakeholder groups including between technical stakeholder types, and that cross-discipline communication of important issues may be aided by the development of carefully designed digital tools. To this end, we present seven core principles to guide the design and implementation of future digital tools for the brownfield sector. These principles are that future digital tools should be: (1) Stakeholder driven, (2) Problem centred, (3) Visual, (4) Intuitive, (5) Interactive, (6) Interoperable, and (7) Geospatial data driven.

A proposal for engagement in MPAs in areas beyond national jurisdiction: The case of Macaronesia

The Ocean is the largest ecosystem on the planet, supporting millions of people's livelihood. Marine protected areas (MPAs) are key to guarantee Ocean resilience. About 62 % of the Ocean surface coincide with areas 200 miles from coastlines, called areas beyond national jurisdiction (ABNJ). However, MPAs in ABNJ are only 1,18 % of the high seas. Stakeholder involvement is a keystone in the governance process. This is of particular importance in Macaronesia, and the need for compatibility between human activities and conservation, through the synergetic engagement of the local-maritime community. The present paper aims to develop a MPA proposal in the ABNJ context through expert consultation. The proposal was built upon the analysis of the Macaronesia region study case. Results show that there is no integrated international body to fully address the range of problems to be tackled, therefore the option to use the Conference of Parties model seems to be adequate. Considering Macaronesia region specific features, the conclusion is that select local focal points in each archipelago to enhance the local maritime community is essential. Furthermore, it would be necessary to implement Working Groups, rotative between archipelagos, to address different solutions for local conservation practices. Moreover, clear communication is fundamental since the very beginning to guarantee visibility and transparency.

Boundary spanning in the context of stakeholder engagement in collaborative water management

Boundary spanners are individuals able to reach across organizational borders to build relationships and interconnections to help better manage complex problems. What is not clear, however, are the skills that allow boundary spanners to cross diverse scales, sectors, and organizations. To address this gap, we use a qualitative case study approach to examine evidence for how boundary spanning skills are implemented in the context of stakeholder engagement for addressing water challenges in agricultural settings. We employ a hybrid deductive-inductive thematic analysis approach to examine interview data collected with 25 stakeholder participants as well as direct observation of engagement behavior. Interview instruments were designed to elicit responses related to six deductively derived skills of boundary spanning: relationship builder, authentic leadership, trustworthiness, autonomy, perspective-taking, and effective science communication. Our inductive analysis identified evidence for three additional boundary spanning skills. Our study finds that some boundary spanning skills were exhibited more than others, and their frequency of use varied throughout the engagement process, and certain skills were used interchangeably. This research provides guidance on what boundary spanning looks like in action, and thus provides guidance on identifying and enhancing these skills in stakeholder engagement for water resource management.

Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers

BACKGROUND

Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers.

METHODS

A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes-no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans).

RESULTS

Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good fit for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process.

CONCLUSIONS

A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations.

The (un)shared responsibility in the reverse logistics of portable batteries: A Brazilian case

The Brazilian National Solid Waste Policy (BNSWP) determines that reverse logistics (RL) of waste batteries is mandatory and adopts the principle of shared responsibility among stakeholders. In this work, we sought to diagnose the current state of the RL chain for batteries in Vale do Aço, Brazil, and identify challenges and potentialities related to its improvement. Data were obtained by means of questionnaires sent to the main stakeholders involved in the batteries RL chain and by consultation of official Brazilian databases. The results showed that the main obstacles to the implementation of the RL of portable batteries in the region are: the lack of information by consumers and retailers regarding the BNSWP and management of waste batteries; the existence of few collection and consolidation points in the region; lack of municipal waste management plans; and lack of sustainability of waste picker organizations. The identified potentialities were: the good receptivity of environmental education actions by the population; the possibility of taking advantage of direct logistics of local retail chains to collect waste; the existence of a special waste management and transportation company in the region; and the existence of waste picker organizations interested in integrating the RL system. Finally, by a SWOT analysis, strategies for the implementation of a more effective RL system were drawn up. This work can serve as a basis for the structuring and implementation of the batteries RL system at the Metropolitan Region of Vale do Aço (MRVA) and can be a reference for other settings.

Factors to Consider During Identification and Invitation of Individuals in a Multi-stakeholder Research Partnership

BACKGROUND

Health research teams increasingly partner with stakeholders to produce research that is relevant, accessible, and widely used. Previous work has covered stakeholder group identification.

OBJECTIVE

We aimed to develop factors for health research teams to consider during identification and invitation of individual representatives in a multi-stakeholder research partnership, with the aim of forming equitable and informed teams.

DESIGN

Consensus development.

PARTICIPANTS

We involved 16 stakeholders from the international Multi-Stakeholder Engagement (MuSE) Consortium, including patients and the public, providers, payers of health services/purchasers, policy makers, programme managers, peer review editors, and principal investigators.

APPROACH

We engaged stakeholders in factor development and as co-authors of this manuscript. Using a modified Delphi approach, we gathered stakeholder views concerning a preliminary list of 18 factors. Over two feedback rounds, using qualitative and quantitative analysis, we concentrated these into ten factors.

KEY RESULTS

We present seven highly desirable factors: 'expertise or experience', 'ability and willingness to represent the stakeholder group', 'inclusivity (equity, diversity and intersectionality)', 'communication skills', 'commitment and time capacity', 'financial and non-financial relationships and activities, and conflict of interest', 'training support and funding needs'. Additionally, three factors are desirable: 'influence', 'research relevant values', 'previous stakeholder engagement'.

CONCLUSIONS

We present factors for research teams to consider during identification and invitation of individual representatives in a multi-stakeholder research partnership. Policy makers and guideline developers may benefit from considering the factors in stakeholder identification and invitation. Research funders may consider stipulating consideration of the factors in funding applications. We outline how these factors can be implemented and exemplify how their use has the potential to improve the quality and relevancy of health research.