Additional In-depth Interviews Research Articles

РЕГИОНАЛЬНЫЕ ПОДХОДЫ К РАЗРАБОТКЕ МУНИЦИПАЛЬНЫХ СТРАТЕГИЙ

Introduction: since 2015, many municipalities have started to work out development strategies, although the current legislation is not biding the latter to be mandatory strategic planning documents at this level of governance. At the same time, regional authorities themselves often initiate processes of strategy development in municipalities, thus making actual the research into the regional authorities approach in this process. Aims: to identify regional approaches to working out socio-economic development strategies in municipalities. Methods: combination of sociological, comparative and documentary analysis methods. Results: three groups of criteria are proposed for inter-regional comparisons: the institutional, reflecting the degree of the municipal strategy meeting the presentday requirements; the organizational, determining the strategy structure and duration, as well as the specific guidelines; the content ones, reflecting the content and specific requirements to building individual blocks within the strategy. The comparative analysis has been carried out based on the guidelines produced in 11 regions of the Russian Federation, in which the regional authorities initiated development strategies at the municipal level. Using the survey results for Sverdlovsk region local governments representatives and additional in-depth interviews on the regional government guidelines for strategy development, the main arguments for and against the existing methods of regional authorities participation in municipal strategic planning have been identified. Conclusion: the study confirmed the hypothesis outlining a variety of regional approaches to municipal strategies development, namely: those covering the entire cycle of strategic planning; focused only on the strategy; not providing for independent strategies but regulating the participation of municipalities in a regional strategy development. A differentiated approach is recommended to be used when extending strategies to the municipal level.

The policy discourses of patient autonomy in home care and the re-shaping of nurses’ professional work and identities

Introduction: Over the last decade, new health care policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. The aim was to explore how nurses in home care deal with the transformation to fostering patient autonomy. The research questions included: How do community nurses perceive the required changes in professional knowledge, skills and attitudes in promoting self-management of patients and their families? What challenges or dilemmas do they encounter and how do they cope with these? Answering these questions provides insight into the changes in professional work practices and professional identities and the ways practitioners cope with these changes, learn from and develop their own practices. Methods: A qualitative case study was conducted in community care Yin, 2013. The ‘case’ was a professional development project for community nurses, funded by ZonMW, aiming to increase nurses’ professional knowledge, skills and attitude to support autonomy of clients and their social system. Data were collected by the researcher as participant observer of the four meetings of one professional development group. Reflective notes of the observations were taken before, during and after learning circle meetings. A narrative analysis Riessman, 2008 was conducted on these data and three main themes constructed. Theory: The theoretical notion of ‘relational agency’ Edwards, 2010 and the moral concept of ‘practices of responsibility’ Walker, 2007 were used to conduct a narrative analysis on the nurses’ stories about patient autonomy. Findings: Three main themes expressed the moral demands experienced and negotiated by the nurses: adapting to the person; activating patients’ strengths; and collaboration with patients and informal caregivers. The overarching challenge the nurses face, is creating an equal partnership with clients and family members. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on health care budget savings. This is mirrored in the nurses’ ‘stories of ambiguity’: the turn towards autonomy in healthcare raises moral questions about responsibilities for care. Conclusion: Each of these tasks has troublesome elements and presents challenges and ethical dilemmas for the nurses, resulting in shifts in professional identity and practice. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. Lessons learned: The ‘relational turn in expertise’ Edwards, 2010 requires long-term coaching of individual practitioners as well as teams, and a culture change in healthcare practice. Co-education of nurses, patients and informal caregivers is needed to achieve this goal of promoting patient autonomy. Limitations and suggestions for future research: additional in-depth interviews could have added to the insight into dilemmas and tensions in practice and in nurses’ coping strategies. More research is needed into the conversations and co-actions within patient-family-practitioner partnerships: the relational dynamics of making decisions, establishing connections and breaking them, negotiating responsibility and creating trust or mistrust.

Cost of Quality Analysis on Tailors’ Industry in Aceh

Objective – This research aims to explore and find out the application of Cost of Quality in Managerial Accounting perspective on the Tailor’s businesses in Banda Aceh during the period of 2015 – 2017. In addition, the research purposes are to analyze the firms plan and control of the Cost of Quality and how the firms arrange the cost in order to improve the quality with minimum budget cost.Design/methodology – The study uses qualitative descriptive research approach and being conducted using data from the firms annual reports and additional in-depth interview with the owners. The technique of purposive sampling is used in this study with the data availability criteria. The population of the research are the Micro, Small and Medium Enterprises (MSMEs) in Banda Aceh, and the sample criteria among others are tailor industry factories in Banda Aceh that have already prepared financial report during the observed period. CV Kuta Alam Tailor and CV Aceh Moda Tailor have been selected as the samples and as the study case location. The researcher analyzed the data by analyzing and examining the costs incurred by the firms, at how much and what kind of it, related to the cost of quality and cost of goods sold before and after the cost of quality is being added. Results – The result shows that CV. Kuta Alam Tailor and CV. Aceh Moda Tailor in term of cost of quality is still above 2.5% of the sales, thus indicates that the cost extravagancy and there are big differences in the cost of the goods sold if the cost of quality is included into the cost of goods sold. In addition, it is also found that both firms do not make a quality cost report specifically.Research limitations/implications – The research is based on the qualitative approach and does not using empirical research tools, so then it can not be generalized for overall tailor industry in Aceh nor Indonesia, outside of the observed firms and location. Therefore, it is necessary for the future research to explore more this phenomenon by using quantitative approach in order to analyze the influence of quality cost and firm performance or budget efficiencies.Novelty/Originality – The research focuses on analyzing and examining the cost of Quality in manufactur industry, particularly in the Job-Process Industry, such as Tailor industry is still very novice and need to be nurtured. Thus, this study contributes to this area by examining the implementation and aplication of the cost of quality whether the cost information can produce managerial information through financial and managerial reporting that will improve the product quality toward cost effeciency.Keywords Cost of Quality, Prevention Cost, Appraisal Cost.

Accelerating Transformation Program in Indonesian Regional Development Banks: The Importance of High-Quality Information

Objective – The role of Indonesia Regional Development Bank (RDB) as an agent of development in each specific operational area is expected to give a significant contribution to regional economics. The Transformation Program in Indonesian RDB started since 2015 is created to optimize the RDB’s role. This study is aimed to gain some description about the level of information quality in Indonesian RDB, to obtain real situation on the implementation of Transformation Program in Indonesian RDB, and to test whether the high-quality information will accelerate the implementation of Transformation Program in Indonesian RDB.Design/methodology – The study was conducted using data from the annual report of Indonesian RDBs and additional in-depth interview with RDB practitioners. The technique of purposive sampling is used in this study with the data availability criteria. The statistic analysis uses multiple regression with t-test and F-test to test the influence of information quality and some control variables on the implementation of Transformation Program in Indonesian RDB. Results – The Indonesian RDBs’ quality of information still cannot be perceived at a high level. The implementation of Transformation Program in Indonesian RDBs has already run in the first phase of foundation building with various obstacles. The high-quality information produced by financial reporting of RDB is proven can accelerate the implementation of Transformation Program in Indonesian RDBs. Research limitations/implications – The theoretical contribution of this study is giving empirical evidence that the information quality accelerates the implementation of Transformation Program in Indonesian RDB. The managerial implication is that Indonesian RDBs must improve their financial reporting system and create some innovations for the successful Transformation Program. The main limitation of this research is the limited scope of study. It is recommended to make further relevant research on the same issue in a wider context to get more enriched findings.Novelty/Originality – The area of implementation of Transformation Program in Indonesian RDBs has been insufficiently examined currently. Thus, this study contributes to this area by examining whether high-quality information produced by financial reporting will accelerate the implementation of Transformation Program in Indonesian RDB.Keywords Information Quality, Financial Reporting, Banking Transformation.

A virtual health coach application to provide psychosocial support post-stroke: Feasible or not?

The development of services that provide home-based rehabilitation for stroke patients has attracted increasing interest. Research has demonstrated this new rehabilitation approach should include a psychosocial component. The purpose of this study was to evaluate the use, feasibility and acceptability of virtual assistant technology to provide post-discharge psychosocial support for people with stroke receiving telerehabilitation, and their caregivers. This was a pragmatic usability study using a convenience sample from a hospital based home rehabilitation service. For four weeks Anna acted as a virtual assistant via a tablet application, and provided participants with 11 different health coaching sessions (HCS) delivering stroke-specific educational content. Other app features included daily facts, scheduling and messaging. Outcome measures were app usage, ease of use and usefulness (7-point Likert scale). Additional in-depth interviews explored participants’ perspectives on the assistive mobile technology. Fifteen patients (71% male, mean age 67 ± 11 years) and their caregivers followed the program. Adherence was high, with on average 8.4 ± 2.9/11 HCS completed. The use of calendar and messenger functions ranged from never to frequent. Ease of use (mean 6.1 ± 0.9) and usefulness (mean 6.2 ± 1.3) scores were high. In the interviews, participants considered the HCS informative, relevant and comprehensive. The majority of patients evaluated Anna as supportive and encouraging. All expressed preference for an avatar based app over other ways of information provision and all believed Anna supported them in their rehabilitation program. The participants related to, and felt supported by the virtual health coach Anna. Virtual assistant technology seems a feasible and acceptable means of providing educational information, HCS, and support among community-dwelling people with stroke and their caregivers. Future studies are required to determine the potential benefit of this support system on health outcomes as well as costs.

Attendance of male partners to different reproductive health services in Shinyanga District, North western Tanzania

Background: Male involvement in reproductive health (RH) services in Africa has been associated with improved maternal and child health outcomes. The objective of this study was to determine the prevalence and factors affecting male partner attendance to available reproductive health services in Shinyanga district, north-western Tanzania.Methods: A house to house survey using a structured questionnaire was conducted among randomly selected married men. Additional in-depth interviews were conducted among married men found attending RH services. Factors that motivates the uptake of locally available RH services together with their partners were explored.Results: A total of 204 men participated in the study, 94.4 % (193/204) of them reported to have ever attended the RH service with their female partners at least once whereas 50.6% (103/204) of them attended at least thrice. Three quarters (154/204) attended HIV counselling and testing (VCT) and 63% (129/204) attended antenatal services (ANC). Reported attendance to sexually transmitted infections (STIs/STDs), prevention of HIV transmission from mother to child (PMTCT), and reproductive health cancer services were all less than 13%. The male partners age group (25-34 years; χ2=9.347, df =3 p-value < 0.001), female partner invitation to HR services (χ2= 29.901, df=1, p-value <0.001) and having less than 2 children (χ2= 6.201, df= 2, p-value < 0.05) were associated with higher RH service attendance. Only 20% (4/20) of married men attended RH because they expected better health outcomes in their presence whilst majority attended because they were summoned or just happen to be at the clinic for other purposes.Conclusion: The male attendance to RH services together with their female partners’ in rural Shinyanga was mainly focused ANC and VCT. Most of men attended because were verbally invited by their partners. Education on couple communication empowerment among women attending RH clinics could sustainably improve attendance to all RH services.

Evaluation of Environmental Impact Assessment Framework Effectiveness

In 2011, Greece reformed its Environmental Impact Assessment (EIA) system publishing law 4014/2011 on the assessment of effects of certain public and private projects on the environment. However, six years since its issuing, no systematic evaluation has taken place to establish whether this legislative reform achieved its aims. In this paper, the results of an extensive EIA system effectiveness evaluation study which makes use of data from the first ever Greek EIA National Survey, additional in-depth interviews and a quality review of over 100 EIA statements are presented. The methodology involved an exhaustive legislative review juxtaposing the EU and Greek legislative provisions. Furthermore, in order to more holistically evaluate the effectiveness of the EIA system, a National survey was conducted, involving key EIA stakeholders (EIA Specialists and regional Environmental Authorities, as well as in the ministry officials). The results of the study highlight serious issues with the Greek EIA System depicting a chasm between new legal provisions and implementation in practice. The most significant weaknesses are located in the Alternatives, Non-technical Summary and Mitigation measure categories. It should be highlighted that the most significant reason for the insufficiency of the EIA system according to stakeholders is the fact that the supporting tools prescribed in the legislation (e.g. Electronic Environmental Registry) have not yet been activated.

Value Tools in Managed Care Decision Making: Current Hurdles and Future Opportunities.

Organizations such as the National Comprehensive Cancer Network, American Society of Clinical Oncology, Institute for Clinical and Economic Review, and Memorial Sloan Kettering have created distinct tools to help different stakeholders assess the value of oncology treatments. However, the oncology value tools were not necessarily created for payers, and it is unclear whether payers are using these tools as part of their drug management process. To understand what value tools payers are using in oncology management and what benefits and shortcomings the tools may have from the payer perspective. A survey targeting drug coverage decision makers at health plans was conducted in August 2016. Respondents attesting to using 2 or more value tools in drug management were eligible for an additional in-depth interview to understand the respondents' perceived benefits and shortcomings of current value tools. Respondents also were asked to describe desired attributes of a hypothetical payer-centric value tool. A total of 28 respondents representing approximately 160 million commercially insured medical lives completed the survey. Twenty respondents (71%) reported using at least 1 value tool in their drug management process. Twelve respondents (43%) used at least 2 tools, and 4 respondents (14%) used at least 3 tools. A total of 6 respondents were selected for in-depth interviews. Interviewees praised value tools for advancing the discussion on drug value and incorporating clinical evidence. However, interviewees felt available value tools varied on providing firm recommendations and relevant price benchmarks. Respondents most commonly recommended the following attributes of a proposed payer-centric value framework: taking a firm position on product value; product comparisons in lieu of comparative clinical trials; web-based tool access; and tool updates at least quarterly. Interview respondents also expressed some support for allowing manipulation of inputs and inclusion of quality-of-life and patient-reported outcome data. Although nearly half of payers surveyed use 2 or more value tools in the drug management process, payers identified a number of areas where the tools could be revised to increase their utility to payers. No outside funding or assistance of any kind was used for this research or in manuscript preparation. Schafer and Galante are employed by Precision for Value, a payer ad marketing agency that works exclusively with life science companies. Shafrin is employed by Precision Health Economics, a consulting company to insurance and life science industries. Shafer, along with Galante and Shafrin, contributed to study design, data collection, and manuscript preparation. The authors contributed equally to data analysis and interpretation and manuscript revision.

The Effect of Organic Food Labels on Consumer Attention

ABSTRACTThis paper aims to reveal consumer perceptions of organic food with a special emphasis on the labelling of organic products. The objectives were to find out, whether or not a significant difference between men´s and women´s perception existed. Two groups (88 subjects in the experimental group, 59 subjects in the control group) were shown various food labels; with organic product labelling (experimental) and without (control). Results suggest the importance of organic labelling using eye-tracking data and additional in-depth interviews to discover the importance of the labelling for participants. Based on eye-tracking data, the greatest visual attention was paid to product brand, graphic elements and organic labelling claims with additional information, such as a quantity or flavour, also being important. Additional in-depth interviews discovered that labelling, particularly of the origin, is important for most consumers. Contrary to what was expected, eye-tracking showed very little difference in the perception of organic product labelling based on gender. Although organic food is being purchased by more people, 50% of participants mentioned, during interviews, that they buy organic food only occasionally. The combination of eye-tracking and in-depth interviews shows that organic product labelling can play a role in decision-making, but regardless 27% of participants do not care about the organic quality labels or don’t pay attention to them.

Doctoring the ball

PurposeTax incentives can be a useful tool to stimulate investment in developing countries. However, interest groups often are able to exert considerable influence in its management, if not its design. The purpose of this paper is to use a power-based approach to the political economy of tax reform to analyse the case of tax incentives for investment in the Dominican Republic. Based on original interviews and a detailed analysis of regulations, the authors study how interest groups work within the institutional framework to seek outcomes that best fit their objectives. However, when unsuccessful, they become powerful advocates of change. These power dynamics have important implications for the design and management of tax incentives in the Dominican Republic and in other developing economies.Design/methodology/approachCase study based on informed interviews with policy makers, lobbyists and researchers combined with statistical and administrative information to test the main hypotheses.FindingsWhile the role of influence groups in creating tax schemes has been widely studied, the authors show that these groups can also have an important role in the administration of the regime and making it more or less open to modifications. The paper shows that the capture of investment incentives has rendered the tax system rigid and unstable in the Dominican Republic, subjecting the public interest hostage to the gain of few.Research limitations/implicationsTherefore, there is a need to review and reform tax policy, not just from a technical viewpoint, but more importantly altering the political arrangements. More transparency in assessing the impact of these schemes, disclosing information of who has access to tax exemptions and budgeting the tax expenditures can also be tools to increase public control over these instruments. Also, making it more difficult to grant tax incentives, for example by asking for an ex-ante justification and quantification of the externalities supposedly being created would reduce the abuse by power groups of these instruments. Without more balanced and independent leadership, it would be extremely difficult to advance in these fields.Originality/valueThe literature on the political economy of tax incentives normally focuses on how key actors work around the institutional framework to solve conflict of interests. This paper addresses a complementary – and in the viewpoint equally relevant – aspect of the political economy of tax incentives: once enacted, vested interests have a particular motivation to keep the incentives in place, and therefore the authors should understand how key actors work from within the institutional framework to seek the outcomes that better suit their interests. The analysis focuses on Dominican Republic, based on official data and additional in-depth interviews with policy makers, entrepreneurs and consultants that assist firms with tax and regulation issues.

A Survey of Doctors’ Awareness of the Role of Communication Skills in Developing a Caring Doctor-Patient Relationship

Using a questionnaire and an interview schedule, a survey about the doctors’ awareness of the role of communication skills in developing a caring relationship was conducted with a sample of 75 Senior and Very Senior doctors. Questionnaires were circulated to all the 75 while additional in-depth interviews were conducted with 10 Very Senior doctors. A main question, followed by eight sub-questions, was posited and answers sought to validate the hypotheses formed. It was revealed that there existed general awareness about the positive role played by good communication in developing a caring relationship. However, there was scant understanding of the skills required to communication efficiently. Communication was largely associated with demagogy. Doctors were also not aware of the nature of communication studies as a serious discipline and its potential to provide a range of skills to communicate efficiently. Since there was little understanding of the skills involved, it was recommended that programmes of varying durations aimed both at medical students and practising doctors be developed. A list of sample topics that could form a curriculum for such programmes is suggested.

CATCH Court: Changing Actions to Change Habits—A Preliminary Evaluation Study

ABSTRACTThis preliminary evaluation study reports on the Changing Actions to Change Habits (CATCH) specialized docket in Franklin County, Columbus, Ohio. Founded in 2009 for human-trafficking victims, including victims of sexual exploitation, CATCH blends punitive sentences with a 2-year treatment-oriented nonadversarial program for participants with multiple services for physical and psychological problems. From 2009 to 2013, CATCH served 130 participants (12% graduation rate). In this mixed-method study, data were collected from court records, a participant survey, and participant focus group. The five quantitative goals and objectives were partially met. Program completers had fewer jail days, arrests, and recidivism and had improved employment/volunteer/educational status than noncompleters with statistically significant lower recidivism for completers. Qualitative analysis revealed one major theme regarding the program, “It Works!” and eight subthemes: Caring, Support, No Judgments, Growing Self-Esteem, Physical and Emotional Help, Improved Family Relationships, Hope: From Victim to Victor, and Life Saving. Correspondences were evident in the quantitative survey and qualitative findings. Recommendations for further research include more frequent and discrete court data collection, larger sample sizes, and additional individual in-depth interviews. The success of the CATCH program to date supports its use as a model for similar courts in Ohio and nationally.

The battle over employers’ demand for “more flexibility”

PurposeThe purpose of this paper is to place empirical research on New Zealand employers’ attitudes to collective bargaining and legislative change within the context of the long running debate of flexibility.Design/methodology/approachA cross-sectional survey design using a self-administered postal questionnaire, covering private sector employers with ten or more staff and including employers within all 17 standard industry classification. To explore particular issues, an additional in-depth interviews were conducted of 25 employers participating in the survey.FindingsIt is found that employers support overwhelmingly recent legislative changes though there are variations across industries and firm sizes. There is also considerable variation in terms of which legislative changes are applied in the workplace. Despite fewer constraints on employer-determined flexibility, there was a rather puzzling finding that most employers still think that employment legislation is even balanced or favouring employees.Originality/valueCross-sectional survey findings of New Zealand employer attitudes to legislative changes are few and provide valuable data for policy makers, unions, employers and employment relations researchers. The paper also contributes to a more comprehensive understanding of pressures to increase employer-determined flexibility in many western countries.

Geographies of Social Capital: Catastrophe Experience, Risk Perception, and the Transformation of Social Space in Postearthquake Resettlements in Sichuan, China

This article explores the relationships between catastrophe experience and risk perception, social interaction, and household response to future catastrophes. Our main argument recognizes the geographical context in which social capital is formed and reproduced. Social relationships and norms adjust to the social landscape, which can be transformed by the spatial consequences of natural catastrophes. We therefore argue that sources of household resilience could be derived from the spatial transformation of social practices and not necessarily from catastrophe experience and risk perception directly. A case study was conducted in two postearthquake rural communities in China. The inquiry is primarily based on a household survey of 371 local residents and is further supported by an analysis of additional in-depth interviews and a review of key changes in the neighborhoods under study. The findings challenge the assumption that catastrophe experience and risk perception are related to residents' intentions to prepare for future catastrophes. Nonetheless, the relationship might be mediated by social relationships and social norms. Catastrophe experience and risk perception can be construed as a geographical contextual factor. Further analysis provides one example of such a factor: The spatial features of postearthquake resettlements have increased the proximity between residents. This shift facilitates neighborly interaction and risk communication across a neighborhood. We discuss the nonlinear, dynamic relationships between the variables examined and the grounding of social capital in space.

Psychological aptitude evaluation of the special forces candidate

IntroductionChanges in recruitment procedures reduced early dismissal rates from Swiss military basic recruitment schools; however, such improvements were not reflected in premature discharge rates from the special forces (SF) (Grenadier)...

The effect of information about overdetection of breast cancer on women's decision-making about mammography screening: study protocol for a randomised controlled trial

IntroductionWomen are largely unaware that mammography screening can cause overdetection of inconsequential disease, leading to overdiagnosis and overtreatment of breast cancer. Evidence is lacking about how information on overdetection affects...

Accessibility to Information and Communications Technology for the Social Participation of Youths with Disabilities: A Two‐way Street

The current study examined by mixed method the effectiveness of an accessibility to Information and Communications Technology (ICT) program that provided computers, assistive technology, tutors, and internet connection to 65 youths with severe disabilities (aged 13.22 ± 3.4 years) in their homes. The quantitative evaluation included assessment of computer task performance, computer skills, and participation in social ICT leisure activities before and after the program. Findings revealed low baseline and significant progress on most outcome measures 6 months after the program, mostly among those youths who had tutors. Additional in-depth interviews were conducted 1 year later with 10 participants to explore their ICT use and its impact on their social participation. The analysis revealed a significant contribution of the ICT use, while critical thinking about its risks and some disappointment with the social needs that ICT does not address. Our findings raise awareness of 'two-way streets' policies and programs to ensure e-inclusion.

Buzzing health: health education by buzz compared to print media

Marketeers and service providers increasingly turn to word of mouth (WOM) as a means to persuade and inform individuals regarding an organization, brand or product. Positive results have been reported within the commercial sector, but does WOM also work within the context of a health education campaign? To explore the potential of WOM in health education, effects of medium channel (WOM vs. print vs. control condition) and consumer involvement (low vs. high) on participant responses were investigated. Furthermore, additional in-depth interviews were conducted in which participants disclosed their experiences. The findings suggest that WOM communications, instigated by a relatively small number of highly involved participants, can inspire attitude change among those who are lowly involved with the subject at hand. Interview results, however, indicate that health professionals should be aware of the increased efforts required from participants that WOM entails.

The Role of HIV-Related Stigma in Utilization of Skilled Childbirth Services in Rural Kenya: A Prospective Mixed-Methods Study

Childbirth with a skilled attendant is crucial for preventing maternal mortality and is an important opportunity for prevention of mother-to-child transmission of HIV. The Maternity in Migori and AIDS Stigma Study (MAMAS Study) is a prospective mixed-methods investigation conducted in a high HIV prevalence area in rural Kenya, in which we examined the role of women's perceptions of HIV-related stigma during pregnancy in their subsequent utilization of maternity services. From 2007-2009, 1,777 pregnant women with unknown HIV status completed an interviewer-administered questionnaire assessing their perceptions of HIV-related stigma before being offered HIV testing during their first antenatal care visit. After the visit, a sub-sample of women was selected for follow-up (all women who tested HIV-positive or were not tested for HIV, and a random sample of HIV-negative women, n = 598); 411 (69%) were located and completed another questionnaire postpartum. Additional qualitative in-depth interviews with community health workers, childbearing women, and family members (n = 48) aided our interpretation of the quantitative findings and highlighted ways in which HIV-related stigma may influence birth decisions. Qualitative data revealed that health facility birth is commonly viewed as most appropriate for women with pregnancy complications, such as HIV. Thus, women delivering at health facilities face the risk of being labeled as HIV-positive in the community. Our quantitative data revealed that women with higher perceptions of HIV-related stigma (specifically those who held negative attitudes about persons living with HIV) at baseline were subsequently less likely to deliver in a health facility with a skilled attendant, even after adjusting for other known predictors of health facility delivery (adjusted odds ratio = 0.44, 95% CI 0.22-0.88). Our findings point to the urgent need for interventions to reduce HIV-related stigma, not only for improving quality of life among persons living with HIV, but also for better health outcomes among all childbearing women and their families.

Customer-facing supply chain practices—The impact of demand and distribution management on supply chain success

Traditionally, distribution has been viewed as the key (physical) link between a company's internal supply chain activities and its customers. More recently, demand management has emerged as a new dimension at the customer interface. Although it has become increasing popular in industry, it has not yet been analyzed in depth with respect to its impact on supply chain performance. Both distribution management and demand management entail customer-facing processes and practices and that are interrelated and (may) jointly determine supply chain performance. In this paper we seek to extend the stream of research in supply chain management by systematically investigating the impact of customer-facing supply chain practices on supply chain performance. Specifically, the paper examines the relative impact of relevant practices associated with demand and distribution management. To this end, we collected data from 116 multi-national companies based in Europe and analyzed it using structural equation modeling techniques. Our results suggest that (i) high demand management performance has a substantial positive impact on the overall supply chain performance, (ii) this effect is stronger than that of distribution management performance, and (iii) there is no evidence that demand management might be an enabler for effective distribution management. Among the individual practices that constitute demand and distribution management, adherence to the demand and distribution management processes and demand segmentation emerged as the strongest performance levers. Based upon additional in-depth interviews conducted with selected companies from our sample, we shed light on some of the most important findings that emerged from our survey analysis.