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Deviation from protocolized assessment times is commonplace in pragmatic randomized clinical trials. Working with a stakeholder advisory board for a Patient-Centered Outcomes Research Institute®-funded project on statistical methods for handling potential biases introduced by irregular assessment times, we identified reasons for off-schedule or missed assessments. We used the Consolidated Framework for Implementation Research 2.0 to organize our findings. We conjectured that timely completion of outcome assessments is a function of multiple determinants, only some related to participants’ health status. We identified potential determinants that can be modified during the protocol design stage and can be reassessed and mitigated during trial implementation stage. Research to more formally evaluate our findings is warranted as well as studies to evaluate multi-level strategies that reduce off-schedule or missed assessments. [ABSTRACT FROM AUTHOR]

Background: Suicide prevention policy in Australia is in a period of reform. The National Suicide Prevention Office is leading the development of a new National Suicide Prevention Strategy (Strategy). Stakeholder input is a critical element in the development of the new Strategy. This article describes key informant views about government-led suicide prevention efforts in Australia obtained as part of an environmental scan conducted as one input to inform the Strategy development process. Methods: We interviewed 24 key informants in November and December 2022. Key informants were purposively recruited to ensure representation from cross-jurisdiction government departments/agencies, peak bodies and leaders in the suicide prevention sector, people with lived experience of suicide, and suicide prevention researchers. We enquired about successes, challenges, and opportunities. NVivo was used to conduct thematic analysis. Results: Key themes identified as successes in Australia's suicide prevention efforts included: leadership and funding for programs, services, and research; valuing the collective lived experience voice; moving towards a whole-of-government/system approach; and high community and political suicide (prevention) awareness. Key themes emerging as challenges in the sector were: defining the suicide prevention sector, limitations in the service system, workforce issues, and building the evidence base. Key themes mentioned as opportunities for improving suicide prevention efforts were: leveraging the current unprecedented awareness and desire for collaboration among multiple stakeholder groups; adopting wellness rather than crisis-driven models of care; including lived experience and co-design in all stages and aspects of policy planning, service development, and evaluation; and investing in data, research, and evaluation. Conclusions: Key informants from across the suicide prevention sector in Australia identified a range of issues for consideration in the development of Australia's new National Suicide Prevention Strategy which are also relevant for suicide prevention policy and program development in other high-income countries. Key issues include the need for concerted efforts to define and build the capacity of the suicide prevention sector, implement and monitor a whole-of-government approach that includes wellness models of care and lived experience, and bolster the evidence base. These efforts require effective leadership and resourcing. [ABSTRACT FROM AUTHOR]

To achieve triple bottom line sustainability, a system requires a balance of its social, economic, and environmental axioms. This multi-dimensional system has multiple stakeholders with different objectives acting within the system, leading to an increased level of complexity. Product design is an area with significant potential to achieve sustainable development, which is also influenced by policies. Product designers/managers and policymakers have been identified as critical stakeholders within this complex system, and their decisions directly affect the transition toward sustainable product design. However, these stakeholders have different perspectives on sustainability, and there is a lack of understanding of the main characteristics of a sustainable design system and its requirements. This research aims to find a detailed and unified understanding of these stakeholder's perspectives, practices, and requirements. An online survey investigated the views of engineers/managers and policymakers in the United States to find their definitions of sustainability, their assessment methods, drivers, and barriers of sustainability. Finally, the participants were asked to identify their requirements for a sustainable design tool that can assist them effectively in designing a sustainable product. Considering the exploratory nature of this study, a targeted sample of 50 participants was selected to capture in-depth, qualitative insights, enabling a nuanced understanding of this complex system. The open-ended questions were designed to obtain detailed responses, which were analyzed qualitatively to develop a comprehensive view of the current state and future requirements for sustainable design tools. This targeted approach allowed the study to probe deeply into each stakeholder's frame of reference, facilitating the identification of critical factors for a successful transition to sustainable design in both industry and policy. The results identified the critical factors that contribute to a successful transition toward sustainable product design in industry and policies while the requirements found in this study provided a road map to meet the diverse needs of these stakeholders. [ABSTRACT FROM AUTHOR]

This study examines the dynamics of collaborative rural planning through an in-depth single case study of participatory land consolidation. It argues that while complete consensus might be considered a utopia, effective collaboration among stakeholders requires a certain degree of alignment in perspectives. By analyzing how stakeholders’ perspectives evolve, this study investigates how this convergence occurs. Furthermore, it explores how planning professionals try to promote convergence, focusing on a project manager’s approach and insights from a focus group. The findings emphasize the complexity of achieving joint understanding for fostering cooperative decision-making. The paper proposes clear process parameters to stimulate this convergence. [ABSTRACT FROM AUTHOR]

Background: Low-quality care for low back pain (LBP) is pervasive in Australia. Drivers of low-quality care have been identified elsewhere and include misconceptions about LBP, vested interests and limited funding for evidence-based interventions. Yet, the literature that identified such drivers is not specific to the Australian context, and therefore, it is likely to represent only part of the local problem. This study aimed to determine where the most influential drivers of LBP care are in the Australian healthcare system and what could be done to address them. Methods: Clinical leaders from various disciplines, academics, hospital managers, policy-makers, consumers involved in LBP advocacy, board members of relevant health profession boards and private insurers were invited to participate in one-on-one interviews. Interviews were transcribed verbatim. Interview data were analysed using content analysis. Results: We interviewed 37 stakeholders. Challenges that hinder LBP care in Australia included variability in care and inconsistent messages, funding models that are not supportive of appropriate care for LBP, the community's understanding of LBP, vested interests and commercial forces, difficulties in accessing timely and affordable conservative care, neglect of social determinants and health inequities, short consultations, siloed practices, uncertainties that stem from gaps in evidence and the experience of having LBP, individual and contextual variability, the mismatch between evidence and practice, the Australian healthcare system itself, the lack of political will and acknowledgement of LBP as a public health issue, stigma, the need to improve human aspects and the compensation system. When discussing factors that could improve LBP care, participants raised collaboration, changes in funding, improvement of access to – and affordability of – models of care and care pathways, public health campaigns targeting LBP, enhancement of policy and governance, increasing and better training the workforce, consideration of inequities, making improvements in information sharing and reforming the worker's compensation sector. Conclusions: LBP is a wicked problem, influenced by several systemic factors. An agenda for system change in the LBP landscape should be guided by a collaborative, coherent and integrated approach across sectors to enhance quality of care and system efficiency for those who seek and provide care. [ABSTRACT FROM AUTHOR]

Currently, the need for a clean transition has made the upscaling of sustainable energy investment projects imperative. This paper addresses the increasing importance of sustainable energy investment projects in the context of climate change and the urgent need for a global energy transition. Given the complexity of decision-making in this field, a multi-criteria decision-making (MCDM) approach is employed to assess the main criteria considered by project developers and financial institutions. Using the Analytic Hierarchy Process (AHP) method, eight criteria are identified and evaluated. Results highlight differing priorities between project developers and investors, emphasizing the need for adaptable approaches to accelerate sustainable energy investments. The study underscores the importance of understanding diverse stakeholder preferences and priorities in formulating effective strategies and managing associated risks to effectively promote sustainable energy projects. Future research should focus on real-life case studies and policy assessments to further enhance the understanding of sustainable energy investment dynamics. [ABSTRACT FROM AUTHOR]

This paper reports on the first phase of a longitudinal project investigating the perceived purposes that different stakeholders have for primary physical education (PE). In the study, the views of 19 teacher educators from seven countries across Europe were sought. While teacher educators may have some influence across the layers of an education system, little is known about this stakeholder group and their views about primary PE. Analysis of focus group conversations depicts that, while the teacher educators come from a wide range of contexts, their views on the purposes of primary PE were more similar than different. With primary PE in danger of disconnecting into different schools of thought, this finding is important because it suggests that more coherent and connected approaches have the potential to be developed. In line with most government policies from the seven countries, similarities focused on both an educational and outward-looking view of primary PE. Significantly, while the teacher educators recognised the key role of physical learning in primary PE, they also highlighted how children's social, emotional, and cognitive learning form part of an integrated view of primary PE. Teacher educators recognised the importance of primary PE expanding beyond the hall/gymnasium and into classroom, school, and community settings. However, some concerns were voiced about the influence of outsourcing and sport agendas that currently dominate. The views of these teacher educators offer a useful starting point for further investigation, particularly as they present the purposes of primary PE from both an integrated and educational perspective. [ABSTRACT FROM AUTHOR]

Chiang Mai Old City, a cultural heritage site and major tourist destination in Thailand, has significant cultural capital but lacks a well-designed urban lighting system, limiting its nighttime development potential. This issue arises from the absence of an urban lighting master plan, a crucial tool for guiding the city's growth. The challenge lies in reconciling the diverse perspectives of stakeholders to create a comprehensive lighting master plan that meets shared goals. This research proposes a system dynamics approach to analyze stakeholder complexity. A qualitative, multi-stage method was employed, through in-depth interviews and focus groups with 60 stakeholders from three groups: government, professionals, and end users, to prioritize critical factors. Causal Loop Diagrams (CLDs) were used to illustrate the interrelations among those factors, leading to alternative scenarios for the lighting master plan's development. The findings demonstrate that safety and security is the top priority, followed by cultural and economic factors. Eleven reinforcing loops and two balancing loops are proposed through CLD visualization. This framework highlights the importance of a participatory process, advocating for a systematic and holistic approach where all stakeholders with diverse perspective collaborate side-by-side in the development of the urban lighting master plan for Chiang Mai Old City. [ABSTRACT FROM AUTHOR]

Abstract Background Low-quality care for low back pain (LBP) is pervasive in Australia. Drivers of low-quality care have been identified elsewhere and include misconceptions about LBP, vested interests and limited funding for evidence-based interventions. Yet, the literature that identified such drivers is not specific to the Australian context, and therefore, it is likely to represent only part of the local problem. This study aimed to determine where the most influential drivers of LBP care are in the Australian healthcare system and what could be done to address them. Methods Clinical leaders from various disciplines, academics, hospital managers, policy-makers, consumers involved in LBP advocacy, board members of relevant health profession boards and private insurers were invited to participate in one-on-one interviews. Interviews were transcribed verbatim. Interview data were analysed using content analysis. Results We interviewed 37 stakeholders. Challenges that hinder LBP care in Australia included variability in care and inconsistent messages, funding models that are not supportive of appropriate care for LBP, the community’s understanding of LBP, vested interests and commercial forces, difficulties in accessing timely and affordable conservative care, neglect of social determinants and health inequities, short consultations, siloed practices, uncertainties that stem from gaps in evidence and the experience of having LBP, individual and contextual variability, the mismatch between evidence and practice, the Australian healthcare system itself, the lack of political will and acknowledgement of LBP as a public health issue, stigma, the need to improve human aspects and the compensation system. When discussing factors that could improve LBP care, participants raised collaboration, changes in funding, improvement of access to – and affordability of – models of care and care pathways, public health campaigns targeting LBP, enhancement of policy and governance, increasing and better training the workforce, consideration of inequities, making improvements in information sharing and reforming the worker’s compensation sector. Conclusions LBP is a wicked problem, influenced by several systemic factors. An agenda for system change in the LBP landscape should be guided by a collaborative, coherent and integrated approach across sectors to enhance quality of care and system efficiency for those who seek and provide care.

Purpose: Existing life cycle sustainability assessments (LCSAs) suffer from a lack of comprehensiveness, consistency and practical tools for implementation. A robust and operational methodology for LCSA of products was developed in which life cycle costing (LCC) covers the economic dimension. We aim to define a comprehensive LCC methodology not tailored to a specific type of product for the purpose of LCSA and test its applicability. Methods: Based on a literature screening, best practice and research needs are identified. Subsequently, a comprehensive LCC methodology is developed that (a) suits LCSA purposes, (b) explicitly addresses double counting, (c) is applicable to different stakeholder needs, (d) addresses externalities and (e) facilitates LCC. It can be used as part of the LCSA, but also stand-alone. The LCC methodology is applied in two case studies, one on the business-to-business (B2B) "beverage carton package" and one on the consumer product "outdoor wool jacket". Results and discussion: To align specifically with the LCSA's environmental part, guidance for an environmental LCC for a generic product was established. While providing minimum requirements, it also allows flexibility in terms of considering discounting or positive cash flows and thus the choice of the economic indicator, depending also on the defined goal and scope, and the chosen stakeholder perspective. Practical guidance on data collection and management is provided in the form of an extended cost breakdown structure and regarding the allocation of product-unspecific costs. Double counting within LCC and within LCSA is addressed. The methodology was applied in two case studies, quantifying the "total undiscounted value" (package) and "total undiscounted cost" indicators (jacket). A solution to communicating results containing confidential data and from different stakeholder perspectives was found for the jacket case. Confidentiality and the lack of publicly available data of sufficient quality prevented the sharing of the "package" results. Conclusions: An LCC methodology for use in LCSA is developed, and its applicability is tested in two case studies. Novelties concern the methodological consideration of different stakeholder perspectives, suggesting alternative aggregated economic indicators, the proposed cost breakdown structure as an economic inventory, guidance on allocation of product-unspecific costs and addressing double counting. Data availability, including confidentiality, and quality remain barriers to publishing LCC results. [ABSTRACT FROM AUTHOR]

Background: The hearing health sector is an example of a health sector that is experiencing a period of rapid innovation driven by digital technologies. These innovations will impact the types of interventions and services available to support the communication of deaf and hard-of-hearing individuals. This study explored the perceptions of informed participants on the topic of innovation and regulation within hearing healthcare in Australia and the United Kingdom (UK). Methods: Participants (N = 29, Australia [n = 16], UK [n = 13]) were purposively sampled and joined one of two online workshops. Participants included adults with hearing loss and family members, hearing health professionals, academics/researchers, representatives of hearing device manufacturers, regulators and policymakers. Workshop data were analysed using reflexive thematic analysis. Results: Participants conceptualised the hearing health sector as a network of organisations and individuals with different roles, knowledge and interests, in a state of flux driven by innovation and regulation. Innovation and regulation were perceived as mechanisms to ensure quality and mitigate risk within a holistic approach to care. Innovations encompassed technological as well as non-technological innovations of potential benefit to consumers. Participants agreed it was essential for innovation and regulation to be congruent with societal values. Critical to ethical congruence was the involvement of consumers throughout both innovation and regulation stages, and the use of innovation and regulation to tackle stigma and reduce health disparities. Participants expressed the desire for accessible and inclusive innovation in the context of fair, transparent and trustworthy commercial practices. Conclusions: This study explored how stakeholders within the hearing health sector understand and make sense of innovation and the role of regulation. Overall, and despite reservations relating to health care professionals' changing roles and responsibilities, innovation and regulation were conceptualised as beneficial when situated in the context of holistic, whole-person, models of care. The results of this study will inform considerations to support the development and implementation of innovations and regulation within the hearing sector and across other health sectors influenced by technological advances. [ABSTRACT FROM AUTHOR]

Despite growing scholarly consensus on the need for nature-based solutions (NBS) as holistic and sustainable alternatives to traditional engineering solutions, stakeholder acceptance and implementation of NBS remain low. This study investigates stakeholder narratives on implementing nature-based solutions (NBS) for mitigating hydro-meteorological risks across five European river basin sites in Eastern and Central Europe. Utilising the Q-methodology and narrative analysis, we identified three ideal–typical narratives: idealist, reformist, and sceptic—each providing distinct perspectives on evidence-based policy formation and NBS integration. Our results demonstrate that: (1) idealists' optimistic outlook risks overlooking critical engagement with implementation challenges; (2) neglecting sceptic concerns may impede NBS adoption and invite accusations of green-washing, and (3) reformists promote evidence-based approaches and transparent stakeholder engagement to bridge narrative divides. The study underscores the importance of identifying shared values, stakeholder collaboration, and a nuanced understanding of contextual factors in fostering NBS implementation. The study contributes to a practical framework aligning NBS projects with prevailing narratives, offering guidance for navigating the complex landscape of NBS implementation. Future research should prioritize in-depth analysis of agent perspectives, place-specific influences on narratives, and the application of narrative analysis to other emerging technologies and environmental topics (e.g. circular economy), deepening our understanding of the socio-political dynamics shaping the acceptance and implementation of sustainable solutions. [ABSTRACT FROM AUTHOR]

Multistakeholder platforms (MSPs) are increasingly applied in environmental governance as institutions to collectively negotiate challenges, opportunities, and policy options in contested landscapes. However, their contributions and effectiveness depend on how stakeholders perceive and frame the role of MSPs in addressing social and environmental challenges. Despite this dependence, stakeholder perceptions of MSPs are currently under-researched. Hence this empirical study carried out in Zambia's Kalomo District asks: how do stakeholder groups perceive the role of MSPs in addressing landscape challenges, given the context of the dual land tenure system, and what does this imply for the implementation of integrated landscape approaches? This study uses Q-methodology to analyze the perceptions of purposefully selected stakeholders from state institutions, civil society organizations, land users, and others familiar with existing MSPs at the district and village levels. The findings reveal three narratives. The first one presents MSPs as institutions that foster dialogue. The second narrative foregrounds the role of the government and private sector, despite acknowledging the diversity of stakeholders in MSPs. In this narrative, MSPs should focus on supporting market-driven solutions to resolve landscape challenges. The third narrative recognizes power imbalances and considers MSPs as institutions to identify policy gaps and needs. The first two narratives are positioned in Dryzek's discourse classification as environmental problem-solving, while the third inclines toward green radicalism. Despite this divergence, there was consensus that MSPs have the potential to harmonize policies in a dual governance system and encourage dialogue between stakeholders to reconcile landscape challenges. [ABSTRACT FROM AUTHOR]

Augmentative alternative communication (AAC) devices or systems are often prescribed to minimally verbal or nonspeaking autistic individuals and other individuals with complex communication needs to facilitate communication or as an alternative to spoken language. AAC use can result in communication gains and improved quality of life for minimally verbal or nonspeaking individuals. Despite this, AAC abandonment is high, limiting societal participation of the individual on the autism spectrum with complex communication needs. Our study is a novel exploration of the barriers of AAC use from a multi-stakeholder perspective, and a qualitative analysis of similarities and differences between stakeholders. We conducted semi-structured interviews and focus groups with 30 parent-carers, educators and clinicians currently supporting AAC users in Western Australia and analysed the data using reflexive thematic analysis. Barriers from each stakeholder group were coded, resulting in 17 subthemes forming five main themes common to all stakeholders: Stakeholder Knowledge, Stakeholder Attitudes and Stigma, Resources, AAC User Engagement, and Device Fit. Contrasting perspectives included actual and perceived stigma associated with AAC use (parent-carers vs clinicians); different struggles with resources and knowledge (parent-carers vs clinicians and educators); and a lack of clinician communication in the processes that determined AAC-fit for school environments (educators only). Findings are discussed in the context of improving inter-stakeholder collaboration and capacity building in Australian health service and practice to better support minimally verbal or nonspeaking autistic individuals and individuals with complex communication needs. Suggestions are also offered for communication partner training. [ABSTRACT FROM AUTHOR]

This research scrutinizes the Sustainable Development Goals (SDGs) as a pivotal global framework to tackle socio-economic and environmental challenges. Through a meticulous examination of progress, challenges, and strategic avenues, it dissects the complexities of SDG implementation. Leveraging statistics, surveys, and case studies, the study unveils the interwoven nature of the 17 goals, highlighting their mutual dependencies. It underscores the urgency of accelerating progress towards sustainable development by elucidating key barriers and opportunities. The research advocates for enhanced international cooperation, innovative financing mechanisms, and strengthened governance structures to drive SDG advancement. By analyzing stakeholder perspectives and exemplary initiatives, it offers actionable recommendations for transformative change. Ultimately, this study underscores the imperative of collective action and targeted interventions to realize the vision of a sustainable and equitable future. [ABSTRACT FROM AUTHOR]

The Chinese education system has been a subject of global interest, known for its emphasis on rigorous assessment practices and the ongoing pursuit of educational reform. The study delves into the landscape of educational reform and student evaluation practices within the Chinese education system, using the Singaporean Excellent School Model as a prism for evaluation. With a focus on nine quality criteria from the Singaporean model, the research aims to understand and enhance student evaluation processes in China. Assessing the impact of these practices on the overall education standard, the study gathers perspectives from educational leaders, teachers, students, and administrators regarding the role of leadership in fostering educational reform. Through a qualitative research approach, involving semi-structured interviews with 16 individuals in China's educational sphere, the study reveals a nuanced picture of evaluation processes. Traditional assessment methods, particularly standardized testing, persist, but formative assessment is gaining ground. Policymakers primarily drive education reform, emphasizing creativity and critical thinking, aligning with aspects of the Singaporean model. Leadership in the reform process manifests as distributed and visionary. This research significantly contributes to the discourse on education in China, offering a comprehensive understanding of assessment techniques, reform dynamics, leadership roles, and stakeholder perspectives. Building on prior research, it provides fresh insights into the diverse landscape of education reform in China, with implications for policymakers, educators, and stakeholders shaping the direction of Chinese education. [ABSTRACT FROM AUTHOR]

BackgroundEncouraging positive parenting practices through evidence-based interventions is vital for the achievement of SDG target 16.2, which aims to eradicate all forms of violence against children while promoting their safety and mental wellbeing. As low- and middle- income countries increasingly adopt parenting programs, policymakers and implementers face the challenge of efficiently transporting, adapting, and implementing them across multiple settings.PurposeThis study seeks to evaluate the real-world experiences, challenges, and best practices in implementing parent support programs in Botswana.MethodA series of interviews with program implementers and stakeholders from governmental and non-governmental organizations were conducted. Key informants from governmental and non-governmental institutions were recruited through purposive and snowball sampling and 17 practitioners participated in the study. Data collection was carried out through online Zoom video conferencing at a convenient time and location for participants.FindingsThe findings indicate several factors that contribute to the successful implementation of parenting programs in Botswana, including (a) enabling factors such as supportive policies, regulations and guidelines, (b) innovative factors such as capacity building, program adaptation and mixed method program delivery, (c) bridging factors through collaborations with skilled organizations, and (d) intra-organizational factors such as organizational resources, program sustainability, and support for program staff.ConclusionNo single organization or strategy can sustainably foster positive parenting support in Botswana. Instead, a collective and collaborative learning approach is necessary to develop lasting and scalable solutions.

Issue Addressed: Supporting healthy behaviours (quality diet, physical activity, sleep) through home‐based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale‐up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research‐practice translation. Methods: Stakeholders (n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi‐structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale‐up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale‐up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. Results: Individual‐level: Targeting multiple systems (primary, tertiary, community‐based care) and entry points (early, mid‐postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at‐risk women, was suggested. Provider‐level: Stakeholders identified strategies to enhance future roll‐out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding; online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems‐level: Political support and community champions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. Conclusions: For sustainable implementation and potential scalability of a home‐based multi‐behaviour postnatal intervention, multi‐level implementation and scale‐up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. So What?: This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future. [ABSTRACT FROM AUTHOR]

Improving social communication is a frequent goal of early autism services. However, it is unclear whether existing models of social communication align with the perspectives and priorities of key stakeholders, including parents, teachers, and expert clinicians. Stakeholder perspectives on social communication characteristics and priorities for young autistic children were gathered during seven focus groups. Participants included parents (three groups; n = 21), teachers (two groups; n = 8), and experts in early social communication and autism (two groups; n = 14). Content analysis procedures were used to develop and refine a codebook for themes and sub-themes that emerged from the focus group data and to code this data. Qualitative data analysis revealed several themes consistent with existing models of social communication in autism (expressive and receptive communication; social interaction), as well as novel themes related to unconventional communication, the impact of context on social communication, and the role of emotion regulation in social communication. Overall, participants expressed that adequately capturing autistic children's social communication skills was challenging because autistic social communication is influenced greatly by a number of contextual, relational, motivational, and regulatory factors. These findings provide valuable insight for aligning social communication measurement and support with stakeholder priorities. Improving social communication is often one goal during early autism services. However, researchers do not yet know whether their ideas about which social communication skills should be targeted during services for young autistic children are the same as the goals of autism community members, such as parents, teachers, and expert clinicians. This study used focus groups (meetings of small groups of community members) to ask people from these groups about what aspects of social communication are most important to support in young autistic children. A total of 43 people participated in these focus groups. These groups included parents (three groups; 21 people), teachers (two groups; 8 people), and experts in early social communication and autism (two groups; 14 people). Focus group participants talked about several aspects of social communication that were already familiar to the research team, such as problems with expressive communication, language understanding, and social interaction. However, participants also talked about several parts of social communication that were less familiar to the research team and had usually not been mentioned in previous research. These included (1) considering the value of unusual forms of communication, (2) taking context and setting into account when considering social communication, and (3) how communication and emotion regulation impact one another. The information from these focus groups will be helpful to making sure that researchers and clinicians focus their social communication supports on areas that are most important to parents and teachers. [ABSTRACT FROM AUTHOR]

Introduction: Hospital‐acquired pressure injuries (HAPIs) are a global high‐stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability. Design: A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices. Methods: Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co‐investigators for congruence and applicability to the research questions. Results: Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub‐theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs. Conclusion: The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally. Clinical Relevance: The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in‐depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level. [ABSTRACT FROM AUTHOR]

This research compares perspectives regarding strategic environmental assessment (SEA) and evaluates SEA implementation bottlenecks in Botswana through the purview of two stakeholder groups, namely environmental assessment practitioners (EAPs) and engineers. It also evaluates SEA regulation and practices in the country. The results highlight that stakeholders in Botswana concur on many SEA-related aspects such as the definition of the concept of SEA and criteria for evaluating SEA effectiveness. Compared to engineers, EAPs have a much more accurate understanding of the type of effects to be assessed during SEA. Challenges to the success of SEA include passive and ineffectual public participation; lack of data sharing; limited technical capacity regarding SEA and dated guidance; deeply entrenched preferences for distinct SEA approaches; low proponent's willingness to pay for environmental costs including SEA; oppressive practitioner pay structures; and, commercialised environmental assessment consultancy. These manifest as conflict over purpose and approach to SEA, limited awareness regarding SEA, de-skilled planners and diverging practices. These factors are also symptomatic of higher institutional problems such as intense corruption and would suggest that SEA in Botswana is not yet fully institutionalised. [ABSTRACT FROM AUTHOR]

This article discusses stakeholder perspectives on the implementation of campus autonomy at Tribhuvan University in Nepal. The study uses qualitative research methods to gather data on challenges and opportunities related to autonomy implementation. The findings emphasize the importance of strategic planning, capacity development, addressing disparities, upholding academic freedom, maintaining coordination, and balancing autonomy and accountability. The research provides valuable insights for decision-making, academic quality, governance, innovation, stakeholder engagement, and policy recommendations in developing a high-quality higher education system. Additionally, the article includes a list of references and citations for further research on higher education, autonomy, governance, and sustainability. Another article explores stakeholder perceptions of the performance of Sidi Mohammed Ben Abdellah University, highlighting the importance of stakeholder engagement in improving university systems. [Extracted from the article]

Governments and international organizations are increasingly determined to create more sustainable food value chains (SFVCs). However, only little empirical evidence is available on how SFVCs are understood. Enquiring African food value chain actors allows gathering valuable insights into their perception of sustainability, which characteristics of sustainable food value chains they prioritize, and which obstacles to a sustainable transformation they identify. By means of a Q-methodology involving interviews with 33 Kenyan respondents, four perspectives were distinguished. The first perspective, "economic productivity and growth," prioritizes economic growth and has only limited attention to the social dimension of sustainability. The second perspective, "food security and food availability," believes that ensuring food security should be the key goal of SFVCs. The third perspective, "environment first," is dedicated to the environmental dimension of sustainability; the perspective implies that protecting natural resources is the primary way to sustain this level of production. The fourth perspective, "transformative knowledge," entails that by innovating and sharing knowledge, food value chains can become more sustainable in different areas. Overall, this study provides reliable insights into how Kenyan food value chain actors perceive sustainability in their sector and which elements they believe should be prioritized when rethinking food systems. The study results are valuable for policy-making to further define an SFVC in Kenya and to pave the way for a sustainable transformation of the food sector in developing countries. [ABSTRACT FROM AUTHOR]

Abstract Background Gene drive modified mosquitoes (GDMMs) have the potential to address Africa’s persistent malaria problem, but are still in early stages of development and testing. Continuous engagement of African stakeholders is crucial for successful evaluation and implementation of these technologies. The aim of this multi-country study was, therefore, to explore the insights and recommendations of key stakeholders across Africa on the potential of GDMMs for malaria control and elimination in the continent. Methods A concurrent mixed-methods study design was used, involving a structured survey administered to 180 stakeholders in 25 countries in sub-Saharan Africa, followed by 18 in-depth discussions with selected groups and individuals. Stakeholders were drawn from academia, research and regulatory institutions, government ministries of health and environment, media and advocacy groups. Thematic content analysis was used to identify key topics from the in-depth discussions, and descriptive analysis was done to summarize information from the survey data. Results Despite high levels of awareness of GDMMs among the stakeholders (76.7%), there was a relatively low-level of understanding of their key attributes and potential for malaria control (28.3%). When more information about GDMMs was provided to the stakeholders, they readily discussed their insights and concerns, and offered several recommendations to ensure successful research and implementation of the technology. These included: (i) increasing relevant technical expertise within Africa, (ii) generating local evidence on safety, applicability, and effectiveness of GDMMs, and (iii) developing country-specific regulations for safe and effective governance of GDMMs. A majority of the respondents (92.9%) stated that they would support field trials or implementation of GDMMs in their respective countries. This study also identified significant misconceptions regarding the phase of GDMM testing in Africa, as several participants incorrectly asserted that GDMMs were already present in Africa, either within laboratories or released into the field. Conclusion Incorporating views and recommendations of African stakeholders in the ongoing research and development of GDMMs is crucial for instilling stakeholder confidence on their potential application. These findings will enable improved planning for GDMMs in Africa as well as improved target product profiles for the technologies to maximize their potential for solving Africa’s enduring malaria challenge.

The study is premised on the notion that a systematic comprehension of stakeholders’ perspectives on domestic tourism is crucial in developing a sustainable and resilient tourism sector in sub-Saharan Africa. The focus of this paper is on stakeholders in the tourism industry in the Khomas region of Namibia located in the central highlands of the country. The study aimed to gather stakeholders’ views on how the domestic tourism industry can be revived in the wake of the Covid-19 pandemic. Semi-structured interviews were done with 35 purposively sampled tourism stakeholders in the Khomas region. The results of the study showed that Namibia focuses attention mostly on international tourism neglecting the domestic market. The locals feel excluded from tourism and prices of tourism products are generally viewed as exorbitant by domestic tourists. As a result, this leads to resentment towards tourism operators by the locals. The study also concludes that several structural issues are hindering effective collaboration among key stakeholders in the Namibian tourism industry.

Public perception of Agri-PV cannot be reliably assessed at this time, in part because the agricultural context and appearance of each Agri-PV system varies widely. Therefore, within the research project "Agri-PV Fruit Growing", a social impact analysis of Agri-PV in a fruit growing region (predominantly apple growing) was carried out in May 2021 and interviews with local social representatives with public functions (multi-stakeholder approach) were conducted. The goal of the survey, which took place in parallel to the implementation of a pilot Agri-PV plant, was to get detailed insights to acceptance factors among the relevant stakeholder groups. As well, the implications regarding communication and informal participation in future Agri-PV plants will be elaborated.

Mental illness affects individuals, families, and communities globally. It disrupts family dynamics, with family members often acting as caregivers and facing financial strain and emotional stress. This policy brief explores the impact of mental illness on families and the importance of family-centered mental health policies. It examines Senate Bill 26 in Texas and stakeholder perspectives on family dynamics. Insights from mental health professionals highlight concerns about a youth mental health crisis and limited access to services. Recommendations include workforce solutions, enhanced interdisciplinary collaboration, educational initiatives, and inclusive policy review to address family mental health challenges. [ABSTRACT FROM AUTHOR]

As part of the large-scale 'COVID-19, Building Back Better'-project, primary school (grade 0-6) stakeholders (students (N = 2.427), parents (N = 153), school staff (N = 176) and school leaders (N = 14)) answered the open-ended survey-question: 'What have you learned during the COVID-19 pandemic that could be used to make school and teaching better in the future?'. The responses are inductively organised. The analysis points at several learning potentials from COVID-19 and suggests different politically and ethically feasible focus points for quality teaching and education after COVID-19 (e.g. more efficient teaching/worktime, a focus on students' and school staff's well-being in school, outdoor teaching/outdoor time, movement in teaching, online teaching, new and creative teaching methods, clear and simple structure, shorter school days, no parents at school, improved school-home collaboration and information/communication from school). We discuss the feasibility of implementing the suggestions and argue for cooperative procedures paying attention to contradicting perceptions when reimagining education in the future. [ABSTRACT FROM AUTHOR]

Background: Gene drive modified mosquitoes (GDMMs) have the potential to address Africa's persistent malaria problem, but are still in early stages of development and testing. Continuous engagement of African stakeholders is crucial for successful evaluation and implementation of these technologies. The aim of this multi-country study was, therefore, to explore the insights and recommendations of key stakeholders across Africa on the potential of GDMMs for malaria control and elimination in the continent. Methods: A concurrent mixed-methods study design was used, involving a structured survey administered to 180 stakeholders in 25 countries in sub-Saharan Africa, followed by 18 in-depth discussions with selected groups and individuals. Stakeholders were drawn from academia, research and regulatory institutions, government ministries of health and environment, media and advocacy groups. Thematic content analysis was used to identify key topics from the in-depth discussions, and descriptive analysis was done to summarize information from the survey data. Results: Despite high levels of awareness of GDMMs among the stakeholders (76.7%), there was a relatively low-level of understanding of their key attributes and potential for malaria control (28.3%). When more information about GDMMs was provided to the stakeholders, they readily discussed their insights and concerns, and offered several recommendations to ensure successful research and implementation of the technology. These included: (i) increasing relevant technical expertise within Africa, (ii) generating local evidence on safety, applicability, and effectiveness of GDMMs, and (iii) developing country-specific regulations for safe and effective governance of GDMMs. A majority of the respondents (92.9%) stated that they would support field trials or implementation of GDMMs in their respective countries. This study also identified significant misconceptions regarding the phase of GDMM testing in Africa, as several participants incorrectly asserted that GDMMs were already present in Africa, either within laboratories or released into the field. Conclusion: Incorporating views and recommendations of African stakeholders in the ongoing research and development of GDMMs is crucial for instilling stakeholder confidence on their potential application. These findings will enable improved planning for GDMMs in Africa as well as improved target product profiles for the technologies to maximize their potential for solving Africa's enduring malaria challenge. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze qualitative data to understand a sport organization's external stakeholders' (i.e. sport fans', non-sport fans'/community members') environmental attitudes, ascription of responsibility, and preferences for environmental initiatives that should be prioritized. A purposive sampling technique was used to distribute an online survey through Qualtrics. As part of the broader survey, 100 respondents provided open-ended comments to three prompts related to environmental sustainability and/or sport, and these comments serve as the basis for this study. Eight themes were established and resulted in the subdivision of sport-centric and political themes. Participants felt that both cities and sport organizations have responsibilities and platforms for supporting pro-environmental issues. Political attitudes influenced differences between respondents. There were preferences towards initiatives directly related to benefitting a sport organization and others to benefitting the community. Our results can help fill the gap in the strategic approach sport practitioners take when deciding what environmental initiative(s) to prioritize based on data from stakeholder input and preferences. These initiatives could apply to both internal efforts and community engagement activities. This is the first study to examine sport and non-sport fan responses to environmental sustainability issues in a sport context. Our findings inform future researchers who explore the response of stakeholders (e.g. fan, community members) to environmental initiatives in sport. Our findings can also lend to the creation of a sport-focused materiality assessment. [ABSTRACT FROM AUTHOR]

Abstract Background A new Health and Wellbeing pathway was introduced into the Improving Access to Psychological Therapies (IAPT) service in one geographical area of the UK in 2021 to address the wider determinants of mental health problems. It comprised assisted signposting to wider services and physical health promotion. This qualitative study aimed to understand stakeholders’ experiences of implementing and receiving this new support and the barriers and facilitators to its delivery. Methods Forty-seven interviews were conducted, with service developers (n = 6), service deliverers (n = 12), service users (n = 22) and community and clinical partners (n = 7), as part of a larger mixed-methods evaluation. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis. Results Three themes spanned all participant groups and represented key aspects of the service: (1) identifying suitability, (2) a holistic service, and (3) moving forward. The sub-themes represent the barriers and facilitators to processes working in practice, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment, tailoring the support and delivery mode, and increasing transparency around continued care to drive sustained benefits. Limitations Service users may have been selected due to their positive experiences of IAPT and were not demographically representative of the population, although participants’ experiences of the service did suggest variation in our sample. Conclusions The Health and Wellbeing pathway was perceived as having a positive impact on mental health and could reduce the burden on therapeutic services. However, service- and individual-level barriers need to be addressed to enhance statutory and community support links, manage service users’ expectations, and improve accessibility for certain groups.

This exploratory study presents Greenland as a case of a peripheral destination that complicates and contradicts global definitions of sustainable tourism. Using empirical data that consists of 39 semi-structured interviews, the author employs an inductive approach to discuss the conceptualisation of sustainable tourism according to local stakeholders in Greenland. The key points of conflict surrounding sustainable tourism in Greenland are identified and discussed, with a focus on how local stakeholders contradict each other, and on how the debates prevalent at the local scale can inform tourism development in other peripheral places. The paper contributes to academic literature by offering a deeper understanding of how core-periphery dynamics can influence perceptions of and priorities for sustainable tourism in peripheral places. It benefits the industry by exposing the main debates around the issue of sustainable tourism in Greenland, which can be used to inform the nation's tourism development. [ABSTRACT FROM AUTHOR]

The study is premised on the notion that a systematic comprehension of stakeholders' perspectives on domestic tourism is crucial in developing a sustainable and resilient tourism sector in sub-Saharan Africa. The focus of this paper is on stakeholders in the tourism industry in the Khomas region of Namibia located in the central highlands of the country. The study aimed to gather stakeholders' views on how the domestic tourism industry can be revived in the wake of the Covid-19 pandemic. Semi-structured interviews were done with 35 purposively sampled tourism stakeholders in the Khomas region. The results of the study showed that Namibia focuses attention mostly on international tourism neglecting the domestic market. The locals feel excluded from tourism and prices of tourism products are generally viewed as exorbitant by domestic tourists. As a result, this leads to resentment towards tourism operators by the locals. The study also concludes that several structural issues are hindering effective collaboration among key stakeholders in the Namibian tourism industry. [ABSTRACT FROM AUTHOR]

Territorial User Rights for Fisheries (TURF) are established to grant privileged rights exclusively to local fishing communities to manage their stock within a bounded fishing ground. Theoretically, they will improve their sense of ownership which will eventually lead to stewardship and responsibility. In Indonesia, contemporary TURF has been introduced to meet such social outcomes and address the overfishing problems caused by open-access systems. The primary objective of this study was to determine how different project initiators perceive the system’s performance of TURF in Kepulauan Seribu Marine National Park. This study used an online Q methodology to determine what key actors thought of similarities and differences in TURF implementation by developing a concourse based on the original TURF project success elements. The results show that there are two different perspectives on what the essential aspects of TURF succeed in Kepulauan Seribu. The first opinion group appreciated the technical design of TURF, particularly the exclusion mechanism and boundary, which are crucial. A second opinion group argues that the clarity of rights, roles, and responsibilities is fundamental. Both opinion groups agreed that consistent law enforcement is the key to a successful TURF implementation. This study evaluated key stakeholders’ perspectives on co-management programs to identify points of consensus and disagreement that could ultimately help ensure the long-term success of TURF and similar co-management programs.

Decentralized court finance and personnel management practices have been criticized for breeding extra-judicial interventions and corruption in China. Determined to advance law-based governance and to constrain recalcitrant local leaders, the Chinese leadership under Xi Jinping in 2014 rolled out reforms to centralize local court finance to the provincial level with the aim to sever local courts from local influence. Despite high expectations, implementation is at best partial. Close to half of all provinces have not accomplished the required changes, and more than half of all court expenditure continues, to date, to remain reliant upon local governments. The direct reason is that provincial governments lack sufficient and sustainable fiscal capacity to finance the operation of local courts without central assistance. Different interests between major stakeholders, namely the courts and the fiscal bureaus, also add to coordination problems and difficulties in reform implementation, in particular the tension between fiscal adequacy pursued by the judiciary and fiscal management efficiency stressed by finance bureaus. [ABSTRACT FROM AUTHOR]

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Stakeholder perspectives on supply chain risks (SCRs) play a crucial role in managing risks, achieving goals, and determining performance of an organization. Herein, the role of stakeholders and the complex interrelationships between stakeholders are important factors influencing the supply chain, and, besides, failure to manage SCRs can result in significant losses for the organization. In West Papua, study related to stakeholder perspectives on the risks in palm oil SCs is still limited. Accordingly, to fill this gap, this paper aims to identify SCRs from the perspectives of key stakeholder of the Indonesian palm oil industry in West Papua. This study employs qualitative research methods. Key risks in the palm oil supply chain (SC) were identified from semi-structured interviews with 64 key stakeholders across 25 different stakeholder groups, using NVIVO software for thematic analysis. The results show that the palm oil SC in West Papua has five tiers and five distribution channels of material, information, and financial flows. Public and private stakeholders identified in palm oil SCs play crucial roles in determining palm oil operations in West Papua. Herein, there are seven identified groups as key stakeholders with thirty-two major risks in the SC. Smallholder farmers are exposed to most of the risks, followed by plantation companies, local cooperatives, and government agencies. Interestingly, risks in palm oil SCs in West Papua are predominantly caused by conflicts of interest among multiple stakeholders. [ABSTRACT FROM AUTHOR]

Background: Neuropsychological assessment enables clinicians to use standardised tools and systemic formulation approaches to assess cognition and provide targeted psycho-education and rehabilitative input. The research literature is currently limited regarding the perspectives of different stakeholders on the neuropsychological assessment experience, and resulting reports. Aims: This paper explores what professional stakeholders consider to be a 'good' neuropsychological assessment/what is important to them, and examines service user experiences of neuropsychological assessment within a neuropsychology outpatient service. Method: A small-scale service evaluation project comprised an online survey completed by 17 professionals who receive neuropsychological report from this service. A semi-structured schedule was used to guide telephone interviews with nine service users who had recently experienced a neuropsychological assessment. Results: Both professional stakeholder surveys and service user telephone interviews provided feedback regarding what they found helpful and unhelpful in neuropsychological assessments, and suggested areas for improvement including: provision of an information booklet, offering a choice of remote or in-person appointments, and offering follow-up appointments after the assessment. Discussion: Recommendations are made for service improvements, and for future larger-scale research projects within this subject area. [ABSTRACT FROM AUTHOR]

Background: A new Health and Wellbeing pathway was introduced into the Improving Access to Psychological Therapies (IAPT) service in one geographical area of the UK in 2021 to address the wider determinants of mental health problems. It comprised assisted signposting to wider services and physical health promotion. This qualitative study aimed to understand stakeholders' experiences of implementing and receiving this new support and the barriers and facilitators to its delivery. Methods: Forty-seven interviews were conducted, with service developers (n = 6), service deliverers (n = 12), service users (n = 22) and community and clinical partners (n = 7), as part of a larger mixed-methods evaluation. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis. Results: Three themes spanned all participant groups and represented key aspects of the service: (1) identifying suitability, (2) a holistic service, and (3) moving forward. The sub-themes represent the barriers and facilitators to processes working in practice, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment, tailoring the support and delivery mode, and increasing transparency around continued care to drive sustained benefits. Limitations: Service users may have been selected due to their positive experiences of IAPT and were not demographically representative of the population, although participants' experiences of the service did suggest variation in our sample. Conclusions: The Health and Wellbeing pathway was perceived as having a positive impact on mental health and could reduce the burden on therapeutic services. However, service- and individual-level barriers need to be addressed to enhance statutory and community support links, manage service users' expectations, and improve accessibility for certain groups. [ABSTRACT FROM AUTHOR]

Abstract Background Novel public health interventions are needed to address the toxic drug supply and meet the needs of people who use drugs amidst the overdose crisis. Safer supply – low-barrier distribution of pharmaceutical grade substances – has been implemented in some jurisdictions to provide safer alternatives to the unregulated drug supply, yet no studies to date have explored professional stakeholder perspectives on this approach. Methods We used purposive sampling to recruit professional stakeholders (n = 17) from four locations in British Columbia, Ontario, and Nova Scotia, including program managers, executive directors, political and health authority representatives, and healthcare providers involved in the design, implementation, and/or operation of safer supply programs in their communities. Semi-structured, one-to-one interviews were conducted, and interview data were coded and analyzed using thematic analyses. Results Participants defined safer supply as low-barrier access to substances of known quality and quantity, offered on a continuum from prescribed to a legal, regulated supply, and focused on upholding autonomy and liberation of people who use drugs. Stakeholders expressed support for safer supply but explained that current iterations do not meet the needs of all people who use drugs and that implementation is limited by a lack of willing prescribers, stigma towards people who use drugs, and precarity of harm reduction programs to political ideology. Stakeholders expressed strong support for wider-reaching approaches such as decriminalization, legalization, and regulation of substances as a way to fully realize a continuum of safer supply, directly address the overdose crisis and toxic drug supply, and ensure equity of access nationally. Conclusion The results of this study highlight the need for innovative strategies to address the overdose crisis and that safer supply has the potential to benefit certain people who use drugs. A one-size-fits-all approach is not sufficient and the perspectives of professional stakeholders should be considered alongside those of people who use drugs when designing and implementing future safer supply.