Factors Influencing Adolescents' Use of Anonymous Reporting Systems to Seek Help for Peers in Severe Mental Distress.

The shortage of clinical training sites and preceptors has become a major barrier in the development of health workforce across North America. Innovation will be essential to ensure equitable access to preceptors and quality supervised clinical practice experiences. Success will require a collaborative framework between various stakeholders. In this paper, we discuss approaches and lessons learned in optimizing clinical education through a regional coordinating center for physician assistant/associate (PA) programs in the state of Maryland. The specific aims of our regional collaborative center were to (1) build a clinical coordinator consortium, (2) host a web-based clinical education hub, (3) offer a preceptor development academy fellowship, (4) build a state-wide clinical site and preceptor database, (5) enhance telehealth education within the PA programs and (6) provide simulation training and leverage emerging technologies such as virtual reality and artificial intelligence for clinical teaching. Despite challenges in stakeholder engagement, the collaborative has produced significant positive outcomes, including expanded clinical training capacity, reduced workload for clinical coordinators, shared resources, improved communication, and standardized approaches to preceptor incentives. This model has the potential to be replicated on a national scale. Key ingredients for success include building trust, effective leadership, financial resources, identifying champions, and ease to pool and invest resources. Preliminary observations have been used in securing additional state and federal funding to scale up the initiative and further optimize clinical education in Maryland.

To explore administrators' and clinicians' views on the factors that influence their use and adoption of a machine learning clinical decision support system (ML-CDSS) to predict patients' risk of hepatic and renal deterioration during chemotherapy. This was a qualitative study that used purposive sampling. 18 participants with administration and clinical backgrounds working in cancer care in England were recruited. Qualitative data were collected by conducting semi-structured interviews and a focus group. Data were analysed thematically using the framework method to identify key themes. Participants acknowledged that monitoring blood chemistry is a core component of chemotherapy as it helps clinicians assess patient fitness and treatment response. The ML-CDSS was perceived as a potentially valuable tool for identifying patients at increased risk of hepatic and renal deterioration, supporting clinical decision-making and enhancing care efficiency. However, several concerns were raised regarding its potential implementation in practice. Participants questioned clinicians' willingness and capacity to integrate the tool into their existing workflows. Participants also believed it was important to demonstrate the ML-CDSS's sensitivity, specificity and validity in accurately predicting patients' risk to build clinicians' trust in the tool, demonstrating evidence of its efficacy and effectiveness in practice. Administrators and clinicians recognised the potential benefits of the ML-CDSS to enhance the delivery of chemotherapy by identifying patients at risk for hepatic and renal deterioration. Successful adoption in practice depends on building trust with the tool by being transparent in its development, its effectiveness and impact. Future work should demonstrate the ML-CDSS being used in practice to generate real-world evidence.

Despite progress in antimicrobial resistance (AMR) surveillance, migrants and ethnic minorities, who bear disproportionate AMR burdens, remain underrepresented in programmes. Digital health is common, but we found no interventions using large language models (LLMs) to reduce AMR in these communities. In three workshops, we identified priorities: culturally and linguistically inclusive design; context specific knowledge from community settings; and trust building via community health workers, with data protection and bias mitigation.

Nurses' experiences regarding role boundaries in collaborative AI-Assisted nursing: A meta-synthesis.

ABSTRACT Purpose: Farming challenges continue to affect labor availability, environmental sustainability and economic viability. Smart Farming Technologies (SFTs) offer a data-driven approach to enhance efficiency and sustainability in agricultural practices. This study examines the key factors influencing farmers’ adoption of SFTs, while addressing the current gap in empirical research. Design/methodology/approach: The study analyzed adoption factors using the TOE (Technology-Organization-Environment) framework based on data collected from 150 farmers. Stratified random sampling was used to ensure representation across different categories of farmers (small, medium and large landholders). The research model was evaluated using Partial Least Squares Structural Equation Modeling (PLS-SEM). Findings: The results indicate that technological and organizational factors are critical in determining adoption behavior, whereas environmental factors exert a comparatively moderate influence. Practical implications: The study informs policymakers and Agri-Tech stakeholders on key drivers of smart farming technology adoption. Emphasis should be placed on enhancing organizational readiness and building trust in technology providers. Targeted extension and advisory interventions can support adoption across diverse farming categories. Theoretical implications: This research extends the TOE framework within the agricultural context, confirming the importance of technological and organizational factors. It provides empirical evidence on the comparatively moderate role of environmental factors. The use of PLS-SEM enhances methodological rigor for future empirical research. Originality/value: Using a stratified farmer sample, the study provides empirical evidence on smart farming adoption. It offers insights into the role of trust and organizational dynamics in adoption behavior. The research adds value by grounding theoretical models in real-world agricultural settings.

To quantitatively assess veterinarian perceptions of barriers and solutions to pet nutrition communication during small animal appointments in the US and Canada. An anonymous online survey was circulated by the Veterinary Information Network to its members between March 28 and April 13, 2022. Respondents included veterinarians in active practice. The survey included fixed-choice and free-text response items. Fixed-choice items were tabulated with R software. Free-text items were coded thematically with Atlas.ti software. From 561 survey respondents, the top 3 barriers identified were pet owner preconceived notions about nutrition (86% [483 of 561]), insufficient time (63% [352 of 561]), and pet owner resistance to discussing nutrition (41% [230 of 561]). The top 3 solutions identified were showing/talking to owners about what veterinary professionals feed their pets (59% [332 of 561]), having direct yet compassionate conversations with owners (58% [327 of 561]), and specific nutrition recommendations (49% [274 of 561]). Free-text responses clarified nuances within each potential solution, such as the importance of establishing veterinary-owner trust first and not being too technical with specific recommendations. Small animal veterinarians reported that pet owner preconceived notions about nutrition were the most common reported barrier to nutrition communication. What veterinary professionals feed their pets, direct yet compassionate conversations, and specific nutrition recommendations were reported as potential solutions, with the caveat that veterinary-owner trust was important to establish first. Building trust with pet owners, being proactive with direct yet compassionate nutrition conversations, and including specific nutrition recommendations may be helpful in breaking down barriers to nutrition communication.

International graduate students contribute significantly to Canadian universities through their roles in research, teaching, and the enrichment of academic and cultural life. Despite these contributions, they face distinct mental health challenges related to cultural adjustment, financial pressures, and social isolation. Campus-based mental health services are often their primary source of support, yet little is known about the experiences of those providing this care. This study employed interpretative phenomenological analysis to explore the lived experiences of 13 campus-based mental health service providers across two Ontario universities. Semi-structured interviews revealed the complex, emotionally layered realities of supporting international graduate students in resource-constrained and culturally diverse contexts. Four interrelated themes emerged: witnessing intersecting pressures and cultural transitions; building trust and connection; embracing linguistic and cultural diversity; and navigating structural and cultural dimensions of care. Providers described the intensity of working with students balancing academic demands, familial expectations, and immigration uncertainties, often compounded by stigma and systemic limitations such as session caps and wait times. They emphasized the relational work of trust-building, the challenge of bridging linguistic and cultural gaps, and the tension of operating within predominantly Western models of therapy. Many also extended their responsibilities beyond traditional counseling, acting as advocates, navigators, and informal case managers, while reflecting critically on their own positionality and the limits of cultural understanding. By centering service providers' perspectives, this study underscores the need for institutional investment in culturally responsive, flexible, and accessible campus-based mental health care, alongside policy reforms addressing systemic barriers.

Background: Financial innovation in Indonesian banking has evolved alongside changes in the banking system. While the adoption of Internet Banking (IB) services has been fast, bank value indicators, like Price-to-Book Value (PBV), have shown significant fluctuations, raising questions about whether financial innovation truly adds value. Objective: This study examines the impact of financial innovation on firm value and financial performance in Indonesian banks, and whether financial performance mediates this relationship. It views financial innovation not only through its financial outcomes but also as part of the broader technology-driven digital transformation in banking towards sustainability and resilience. Methods: The research was conducted by analyzing Secondary data from 13 banks listed on the Indonesia Stock Exchange (BEI) annual financial report data with the period of 2019–2024 which were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) technique. Results: Financial innovation directly affects firm value, but does not directly affect financial performance that can be used to significantly mediate the relationship between financial innovation and firm value. What this means is that, rather than an immediate profitability boost, the additional value to the firm from financial innovation is likely due to a long-term perspective of growth potential and viability. Conclusion: Market participants value innovation not just for short-term financial gains, but for its role in building resilience and long-term business models. While some innovations may offer short-term benefits, they remain a key strategy for enhancing firm value and building trust in the market over time.

Amid accelerating socio-ecological crises—climate breakdown, mass extinctions and widening inequalities—there is an urgent need for transformative approaches that address root causes rather than symptoms. Disruptive sustainability seeks such transformations; however, it remains theoretically underdeveloped regarding how radically different knowledge systems can work together across the life-cycle of technologies. Drawing on science and technology studies and decolonial scholarship, we build a decolonial typology of knowledge integration in ‘pluriversal technologies’—technologies co-designed, co-produced and co-owned across epistemic communities. We identify four modes: extractive appropriation, parallel operation, adaptive integration and transformative integration. We demonstrate how each appears along the design, production and ownership dimensions of a technology's life-cycle. This study makes three contributions. First, by demonstrating that a single technology can occupy different integration modes across its life-cycle, it exposes the dimensional unevenness that often derails ostensibly collaborative initiatives. Second, it moves beyond binary treatments of integration to a graded, four-mode framework. Third, it identifies catalytic mechanisms—such as trust building, co-learning, shared governance, recognition and reparation—that enable initiatives to shift between modes. This typology enriches research on disruptive sustainability by clarifying how diverse knowledge systems can collaborate or clash and by mapping routes toward more just, sustainable and effective innovation. • Decolonial typology of knowledge integration in pluriversal technologies • Four modes: extractive, parallel, adaptive and transformative • Integration varies across design, production and ownership phases • Identifies mechanisms enabling shifts between integration modes • Moves sustainability transitions beyond participatory/not-participatory framings

Violence against children remains a serious social issue in Pekanbaru City, as indicated by the fluctuating number of reported cases despite the implementation of child protection policies and the involvement of various institutions. This condition highlights the need for collaborative efforts among multiple actors, including government institutions and the community. This study aims to analyse the collaboration between the government and the community in handling violence against children in Pekanbaru City. This study employs a qualitative method with a phenomenological approach to understand the experiences and interactions of actors involved in child protection. Data were collected through semi-structured interviews and documentation involving DP3APM, the Social Service Office, the Police, and community actors through PATBM. Data analysis was conducted using NVivo 12 Plus to identify patterns and themes in the collaborative process. The results show that collaboration has been implemented through five components of collaborative governance: face to face dialogue, trust building, commitment to process, shared understanding, and intermediate outcomes. This collaboration has contributed to improved responsiveness in case handling, better coordination in victim recovery services, and increased community participation in reporting cases. However, the collaboration still faces challenges, particularly the absence of integrated SOP or MoU across institutions and differences in operational coordination. Strengthening cross-sector coordination and developing integrated collaboration mechanisms are necessary to support a more effective and sustainable child protection system.

• Trust is key in coordination of Thai smallholder-based retailer-driven value chains. • Actors invest in trust building and maintenance not assets for business development. • Trust-based ties stabilize trade but reinforce power asymmetries. • The combination of trust and power asymmetry leads to lock-in, limiting upgrading. • Relational governance calls for new strategies in informal agri-food markets. This article builds on perspectives from relational economic geography to delve deeply into the micro-social processes that underpin market coordination. We examine how trust functions as a central coordinating mechanism in smallholder-based agri-food value chains in Thailand. Drawing on qualitative interviews with actors from the different segments of the value chains for onions and Chinese cabbage, two major crops in Thailand, the study explores how interpersonal relations, inherited networks and socio-cultural norms underpin economic transactions. Instead of viewing trust as a relational supplement to governance structures, the article argues that trust constitutes a primary mode of coordination in hybrid and informal market systems. While trust-based relations enable continuity and stability in volatile agricultural markets, they also reinforce dependency and power asymmetries, particularly for upstream actors. Trust can facilitate upgrading by reducing uncertainty and enabling access to resources, yet the results show that reinforced dependencies and power asymmetries inhibit innovation and investment into business development through lock-in effects. This results in limited opportunities for upgrading and economic development, particularly among smallholders and the smaller traders. The findings challenge conventional typologies of global value chains by highlighting the micro-social foundations of coordination and the double-edged nature of trust in shaping upgrading opportunities. We argue that there is a need to understand these micro-social processes of market coordination and value chain governance in order to address uneven patterns of economic development, particularly among smallholders and traders in agri-food value chains.

Vaccine hesitancy is a multifactorial phenomenon that challenges health systems, impacting vaccination coverage and favoring the resurgence of vaccine-preventable diseases. In this context, Primary Health Care (PHC) assumes a strategic role as a mediator between immunization policies and communities. This study analyzed the role of PHC in addressing vaccine hesitancy, focusing on communication practices, trust building, and community engagement. This is an integrative literature review, with a qualitative approach, conducted in the Scopus, PubMed, Web of Science, and SciELO databases, including publications from 2020 to 2025. The selection followed the PRISMA 2020 protocol, and the analysis was performed through thematic synthesis. The results indicate that PHC is central to the coordination of care, promoting bonding and trust between professionals and users. Vaccine hesitancy is associated with institutional distrust, social inequalities, and sociocultural factors. Strategies such as empathetic communication, active listening, and cultural adaptation proved effective in increasing vaccine adherence. Community engagement, with the participation of community agents and local leaders, strengthens the legitimacy of immunization actions. Challenges persist, such as time constraints, insufficient training, and organizational weaknesses. It is concluded that strengthening primary health care, coupled with improved communication and social participation, is fundamental to expanding vaccination coverage and sustaining public health policies.

This study aimed to evaluate influenza vaccine hesitancy among healthcare workers (HCWs) at Istanbul Okan University Hospital and also explore the factors influencing their decision to get the influenza vaccine. A cross-sectional questionnaire was conducted with 428 HCWs, and a 94% response rate was achieved. The questionnaire included demographic data, knowledge assessments about influenza, and vaccination history. Only 22% of participants reported receiving the influenza vaccine in 2024, while 78% did not. The main reasons for hesitancy were distrust in vaccine efficacy (32%), fear of side effects (32%), and distrust of vaccine manufacturers (31%). Among those who were vaccinated, the key motivations included self-protection (19%) and being part of a risk group (15%). Interestingly, 91% of respondents had received the coronavirus disease 2019 (COVID-19) vaccine, citing similar reasons for acceptance or refusal. Despite well-documented evidence of the influenza vaccine's role in reducing morbidity and mortality, hesitancy remains prevalent, reflecting certain trends also observed in the literature. Educational and health promotion campaigns, on-site vaccination programs, and awareness initiatives emerged as potential strategies that would improve the vaccine uptake. This study highlights the critical need for targeted interventions to address vaccine hesitancy among HCWs. Building trust, providing accurate information, and ensuring easy access to vaccines are essential steps to boost influenza vaccination rates and enhance public health outcomes.

Purpose This paper examines a puzzling pattern in cross-cultural entrepreneurship: Why do some risk-averse societies produce thriving entrepreneurial ecosystems while others do not? We propose that societal trust is the critical contingency explaining this variation. The study challenges the field assumption that cultural risk avoidance uniformly suppresses entrepreneurship, arguing instead that trust can neutralize risk aversion's negative effects through its influence on entrepreneurial beliefs about self-efficacy, fear of failure, perceived opportunities and status of entrepreneurship. Design/methodology/approach We analyze pooled cross-sectional data from 57 countries spanning 2010–2015, integrating measures from the Global Entrepreneurship Monitor (GEM), Global Preferences Survey (GPS), Heritage Foundation and World Bank (224 country-year observations). Using structural equation modeling with maximum likelihood estimation, we test direct effects of risk avoidance on entrepreneurial activity and indirect effects through four belief pathways: entrepreneurial self-efficacy, fear of failure, perceived opportunities and status of entrepreneurship. Moderated mediation analysis examines whether societal trust weakens these indirect effects. Robustness checks include alternative measures, lagged variables, different entrepreneurship types and reverse causality tests. Findings Risk avoidance significantly reduces entrepreneurial activity, with this relationship mediated by all four belief pathways. Perceived opportunities emerge as the strongest mediator, accounting for over three-quarters of the total effect. Crucially, societal trust moderates all four pathways, weakening risk aversion's negative indirect effects. The fear-of-failure pathway is particularly trust-sensitive, becoming statistically non-significant at high trust levels. These findings support the risk-trust paradox: equally risk-averse societies produce dramatically different entrepreneurial outcomes depending on trust levels, explaining why some risk-averse societies maintain thriving entrepreneurship while others struggle despite similar cultural orientations toward risk. Research limitations/implications The study relies on repeated cross-sectional panel data, limiting causal inference despite robustness checks with lagged variables. Our trust measure captures generalized interpersonal trust rather than institutional trust, and certain regions (Africa and the Middle East) remain underrepresented. Future research should examine how different forms of trust buffer against risk aversion and employ longitudinal designs to establish causality. For theory, our findings challenge the assumption that risk avoidance uniformly suppresses entrepreneurship, suggesting scholars should model cultural values as configurations rather than independent dimensions. The complete neutralization of the fear-of-failure pathway at high trust levels warrants further investigation into trust's relational mechanisms. Practical implications For policymakers in risk-averse, low-trust societies, trust-building initiatives may prove more effective than attempting to change deeply embedded risk orientations. Specific interventions include entrepreneur networks, mentorship programs, transparent regulations, supportive bankruptcy laws and second-chance programs that reduce failure stigma. For risk-averse, high-trust societies, efforts should focus on enhancing opportunity visibility through entrepreneurship education and publicizing entrepreneurial role models, given that perceived opportunities are the strongest mediator. Entrepreneurship educators in risk-averse contexts should emphasize failure-positive narratives, skill development that builds self-efficacy and exposure to diverse entrepreneurial paths that enhance opportunity recognition. Social implications The risk-trust paradox reveals that societies need not overcome cultural risk aversion to foster entrepreneurship; building trust offers an alternative path. This finding has equity implications: risk-averse societies are not inherently disadvantaged in developing entrepreneurial ecosystems if they invest in relational infrastructure. The complete neutralization of fear of failure at high levels of trust suggests that supportive communities can protect aspiring entrepreneurs from the social isolation and stigma that otherwise accompany entrepreneurial setbacks. Cultivating societal trust may thus democratize entrepreneurial opportunity by creating environments where individuals from risk-averse backgrounds can pursue ventures without facing compounded cultural and relational barriers. Originality/value This study introduces the risk-trust paradox, a previously unrecognized phenomenon whereby societal trust neutralizes risk aversion's negative effects on entrepreneurship. Unlike prior research treating cultural dimensions as independent predictors, we demonstrate that risk avoidance's effects are contingent on trust levels, challenging the field assumption that risk-averse cultures are inherently entrepreneurship-hostile. We specify the mechanisms through which trust buffers against risk aversion, revealing that fear of failure is uniquely trust-sensitive due to its relational nature. These findings reframe cross-cultural entrepreneurship research from classifying cultures as favorable or unfavorable toward examining how cultural configurations interact to shape entrepreneurial outcomes.

The success of the Madiun Street lighting PPP as the first small-scale regional PPP project to reach the operational stage is interesting to study. The role of champions in leading and initiating projects is crucial in realizing good governance in infrastructure provision. This study introduces a new perspective on the leadership of the Regent of Madiun as a champion in small-scale PPP projects, which has not been widely researched through empirical studies. This study adopts a qualitative research design, with primary data were obtained through an interview and focus group discussion with multi-stakeholders, and secondary data trough analyzing webinar video related. This research found that in his leadership, the Regent of Madiun built collaboration by empowering all levels and stakeholders involved in the project. Building trust in business entities and stakeholders through open dialogue and discussions in informal forums. Facilitative leadership successfully fastered trust, collaboration, and a sense of ownership among stakeholders.

Purpose: This study examines the factors influencing employees’ intention to pay professional zakat in the Jakarta area. Although the potential of professional zakat in Indonesia is substantial, its collection remains low due to limited public understanding and participation. Methodology: This research uses a quantitative approach with data collected from 120 employees through a structured questionnaire. Multiple linear regression analysis was conducted using SPSS version 26 to test the influence of zakat knowledge, altruism, transparency, and trust on payment intention. Results: The findings reveal that zakat knowledge, altruism, and trust significantly influence the intention to pay professional zakat, while transparency has no significant effect. These results highlight the importance of cognitive and trust-related factors in shaping payment intention. Conclusion: Strengthening zakat literacy and building trust in zakat institutions are essential strategies to enhance professional zakat participation. The study underscores that internal understanding and trust are stronger predictors than perceived transparency. Implications: The limited sample size and focus on the Jakarta area may restrict the generalizability of the findings. Future research should expand the scope and consider broader populations to validate the results. Originality: This study offers originality by simultaneously analyzing zakat knowledge, altruism, transparency, and trust within a single empirical model. It provides a more comprehensive perspective compared to prior studies that examined these variables separately.

This article presents an analysis of the impact of a doctor’s personal brand on the corporate image of a healthcare organisation. The study takes the form of a systematic review and analytical synthesis of academic publications focusing on doctors’ reputations, patient trust, digital interaction and behavioural responses in healthcare. The main focus is on the interrelationship between the characteristics of a doctor’s personal brand, the development of patient trust and their subsequent behavioural intentions, and the influence of these factors on the perception of the healthcare organisation. Key components of a doctor’s personal brand are examined, including professional expertise, communication style and digital presence. It has been established that the influence of a personal brand is indirect in nature and is realised through the building of trust, which acts as a link between individual interaction and institutional perception. It is shown that a patient’s assessment of a healthcare organisation is determined by the doctor’s professional characteristics, as well as the consistency and transparency of communication signals in both offline and online environments. The authors propose a model that reflects the sequential transformation of a doctor’s personal brand into trust, perceived value and safety, patients’ behavioural intentions, and the corporate image of the healthcare organisation, taking into account the spillover effect of trust. The results obtained allow the doctor’s personal brand to be viewed as a manageable strategic factor influencing patient behaviour and the sustainability of a healthcare organisation’s reputation. The article may be of use to healthcare organisation managers, healthcare marketing specialists and practising doctors interested in improving the effectiveness of their interactions with patients.

This study examined how school heads build and sustain relationships with teachers in secondary schools, guided by Relational Leadership Theory and Leader Member Exchange (LMX) Theory. It sought to explore the lived experiences of teachers, the strategies used by school heads, and the insights gained from these interactions in shaping professional relationships within the school setting. Anchored in a constructivist and qualitative research paradigm, the study employed a phenomenological design to capture and understand the meanings teachers assign to their interactions with school leaders. Eight purposively selected Junior High School teachers participated in in-depth interviews and a focus group discussion using a validated semi-structured interview guide to ensure consistency and depth in data collection. Data was collected through audio-recorded interviews and analyzed using thematic analysis, with the researcher maintaining reflexivity throughout the process to ensure accurate and unbiased interpretation. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability. Findings revealed that trust building, empathy, open communication, and supportive leadership practices strengthen teacher relationships and enhance motivation, commitment, and collaboration. The study underscored the importance of relational competence in school leadership and recommended leadership development initiatives and future research across varied educational contexts to further strengthen leadership practices.

Inclusion as a clinical tool: Building trust in the dermatology examination room