Change Program Research Articles

Causal pathways in the political economy of climate adaptation: Winners and losers in Turkana, Kenya solar mini-grid projects

International development aid is widely considered essential to support climate adaptation efforts in low-income countries. There has been a rapid increase in the number and geographic range of case studies reporting outcomes of low-carbon development projects, while a limited number of complementary analytical frameworks have also been produced to enable insights to be translated into tangible guidelines and recommendations for policy makers. A particularly important outcome from this body of research has been to demonstrate how poor design and implementation of these projects can create significant negative socio-economic and ecological outcomes at a local level. However, unpicking the causal mechanisms through which these unintended outcomes are created within complex systems remains a challenge. Making use of Sovacool et al.’s (2015) influential 4Es framework and combining it with the ‘Mechanisms of Social Change’ (MOSC) language for analysing systems, our study aims to provide an approach for setting out causal pathways that explain how the implementation of adaptation projects creates negative as well as positive impacts. To illustrate this approach, we map the system of solar mini-grid projects in northern Kenya and use this to analyse impact on local communities. We suggest that this approach can strengthen analysis of existing climate change programmes and support better design of future adaptation interventions.

Embedding a Behavior Change Program Designed to Reduce Sedentary Time Within a Pulmonary Rehabilitation Program Is Feasible in People With COPD.

This study examined the feasibility of embedding a 4-wk intervention, which sought to reduce sedentary time (SED), into a pulmonary rehabilitation program (PRP) in people with chronic obstructive pulmonary disease. This was an intervention study that comprised one face-to-face session and three follow-up visits. Primary outcomes related to feasibility and included adherence to data completion undertaken before and during the intervention period, participant satisfaction with the intervention (out of 100%), and participant achievement of intervention goals. Secondary outcomes, collected before and after the intervention period, included SED and daily step count. Of 28 eligible individuals approached to participate, 21 (75%) were enrolled and 19 (90%) completed the program (13 females; age 69.1 ± 8.7 yr). Sixteen participants (84%) were adherent to wearing a physical activity monitor before and during the intervention period. The satisfaction score was 90 ± 12%. Over the intervention period, a total of 73 intervention goals were set, of which 41 (56%) were achieved. The effect of the intervention on SED was unclear. Embedding this intervention in a PRP appears to be feasible; however, its impact on SED should be further evaluated.

Developing a future pipeline of applied social researchers through experiential learning: The case of a data fellows programme

This paper presents an innovative model for developing data and statistical literacy in the undergraduate population through an experiential learning model developed in the UK. The national Q-Step (Quantitative Step change) programme (2013–2021) aimed to (i) create a step change in teaching undergraduate social science students quantitative research skills, and (ii) develop a talent pipeline for future careers in applied social research. We focus on a model developed at the University of Manchester, which has created paid work placement projects in industry, for students to practise their data and statistical skills in the workplace. We call these students data fellows. Our findings have informed the development of the undergraduate curriculum and enabled reflection on the skills and software that we teach. Data fellows are graduating into careers in fields that would previously have been difficult to enter without a STEM (Science, Technology, Engineering and Mathematics) degree. 70% of data fellows to date are female, with 25% from disadvantaged backgrounds or under-represented groups. Hence the programme also addresses equality and diversity. The paper documents some of the successes and challenges of the programme and shares insight into non-STEM pipelines into social research careers that require data and statistical literacy, A major advantage of our approach is the development of hybrid data analysts, who are able to bring social science subject expertise to their research as well as data and statistical skills. Focusing on the value of experiential learning to develop quantitative research skills in professional environments, we provoke a discussion about how this activity could not only be sustained but also scaled up.

A Momentum for Change? Systemic effects and catalytic impacts of transnational climate action

Non-state and subnational climate actors increasingly commit to act across borders to reduce greenhouse gas emissions, to help communities adapt to climate change, and to push governments into more ambitious climate policies. The effectiveness of such transnational climate initiatives, however, is still largely unknown. Current studies often only seek to estimate the mitigation potential of such initiatives or to study the design elements that may be more or less conducive to their effectiveness. Little is known about the impacts of such initiatives on broader social and environmental goals and about their “catalytic” impacts, that is, whether such transnational initiatives can grow and possibly replicate. Here we develop an approach inspired by political systems theory to reach a fuller understanding of the effectiveness of transnational initiatives. We operationalize a generalized framework through a combination of methodologies, using a new dataset of climate actions under the Momentum for Change program of the United Nations Framework Convention on Climate Change, which we combine with surveys, database analysis, and contextualizing interviews. We conclude with a reflection on the applicability of the framework and a discussion on opportunities for the Momentum for Change program to strengthen its efforts.

Description and Pilot Evaluation of a Dreamer Ally Training for Higher Education Staff and Faculty

We describe a Dreamer Ally training provided to staff and faculty on a university campus and present results of a pilot evaluation of this training. The Dreamer Ally training was designed to (a) increase university faculty and staff awareness, understanding, and self-efficacy for working with Dreamer students and (b) stimulate action to make the campus more responsive to the challenges and contributions of Dreamer students. For the purpose of this study we define Dreamer students as inclusive of undocumented students, students with the temporary protection of DACA (Deferred Action for Childhood Arrivals), students who qualify for the state’s tuition equity program, and students from mixed legal status families. Study goals were to describe the training, gather pilot data on participant learning goals, post-training satisfaction and self-efficacy for supporting Dreamer students, and generate participant feedback about utility of training components and their plans for subsequent action. Participants completed questionnaires before and after the training. Responses to open-ended questions indicated that most participants attended in order to learn how to better support Dreamer students. Paired samples (pre and post) t-tests indicated significantly higher self-efficacy for supporting Dreamer students at posttest. Participant satisfaction with the training was high and found the information session content and working through different Dreamer student scenarios most useful. Action plans included changing program or unit websites to be more inclusive of Dreamers. Limitations include the absence of a control group. Findings can inform institutional efforts to raise faculty and staff awareness of and responsiveness to the challenges facing Dreamer students.

HIV Prevalence and Associated Factors Among Men in South Africa 30 Years into the Epidemic: The Fifth Nationwide Cross-Sectional Survey.

We investigated HIV prevalence and associated factors among men ≥ 15years in South Africa using data from a 2017 nationwide cross-sectional survey. HIV prevalence was 10.5% among 6 646 participants. Prevalence increased from 4.1% in the younger men (15-24years), 12.5% in young men (25-34years) to 12.7% in older men (≥ 35years). Odds of being infected with HIV were lower among younger men who had secondary level education and those who reported poor/fair self-rated health. Young and older men of other race groups had lower odds of HIV infection. Odds of infection were lower among young men who had moderate/high exposure to HIV communication programmes. Men not aware of their HIV status had higher odds of HIV infection, including older men who never married. Improved access to education, behavioral change programmes, and awareness of HIV status are necessary to reduce the risk of HIV infection among Black African men.

Governing changes in government: the water story of Mahabubnagar

Theoretical basis Kotter’s framework of change management adapted to the situation of public policy implementation under the leadership of a civil service officer in the rural areas of a developing economy in South Asia. Research methodology This case has been written using the primary data collected from the protagonist through personal and computer-based interviews. Some of the documents associated with the event shared by the protagonist are also reproduced as case exhibits. Secondary data from government official websites were also used to enrich the case. Case overview/synopsis Mahbubnagar, an arid agricultural district in central India faced the threat of a water crisis owing to the unscientific water extraction by the resident farmers. The government appointed a task force to investigate the problem. The team executed the idea to harvest excess water from the fields through a cheap and efficient method. Though it showed spectacular results in the initial months, the farmers gave up the innovation soon. When the team met two years later, they were shocked by the unenthusiastic response of the farmers. This case pertains to the failure of policy innovations and change management in government. Complexity academic level This case is useful for undergraduate-level courses in public management, public policy and governance with modules in change management, innovation management, rural development and programme implementation. Training modules for novice public service professionals and programme management personnel in government organisations. Elective courses on public policy, government relations and public sector management for undergraduate students of business administration.

Football and Ice Hockey Fans' Experience of a 12-Week Training and Weight-Loss Pilot Intervention (ViSiT) in Sweden—A Focus Group Study

Background: Excess weight is associated with an increased risk of poor health and premature mortality. This is more problematic for men than for women because men have a lower life expectancy and a higher prevalence of several lifestyle-related diseases. A concept whereby overweight male supporters of professional football clubs are recruited and offered a weight-loss intervention has been developed in Scotland. In the present study, we explore participants' experiences of a similar pilot intervention, called ViSiT, conducted with supporters in one ice hockey club and one football club in Sweden to assess the feasibility of using the intervention in a Swedish context.Methods: In this user centered evaluation, focus groups were conducted with 12 men who had completed the 12-week ViSiT intervention. Participants discussed reasons for participating in and completing the intervention, effects of the intervention, advantages, and areas of improvement of the intervention, and thoughts on the club's involvement. The material was analyzed using thematic analysis according to Braun and Clarke.Results: The analyses revealed four themes: reasons to participate, motivation and reinforcement, change of habit, and areas for improvement. The intervention was seen as an opportunity to change daily lifestyle behaviors. The group format, as well as the involvement of a prestigious sports club, was important for signing up to the intervention and for motivating continued involvement. The intervention had also resulted in increased knowledge on health and changed mindsets about being more attentive to regulating day-to-day behavior. Although the overall feedback on the intervention was positive, the participants suggested that possibilities to have more individual coaching should be added.Conclusions: The ViSiT weight loss and lifestyle intervention may be feasible in a Swedish context to reach overweight men at risk of poor health. The ice hockey and football club supporters expressed similar experiences from participating in the intervention. ViSiT seem to have a potential to be adopted by many sports clubs for a widespread reach to a group normally considered reluctant to participate in lifestyle change programs.

Relevance of it in libraries: Desire a tread a front to advanced library in current trends

Smart is a network which allows free access to all digital libraries in the electronic society. Smart libraries is a cyber-security and well-being behavior change program designed to equip libraries and link users of libraries with the skills they need to use technology in a smart, healthy and responsible manner. Being smart means knowing how to protect against online security and privacy threats, downloading content in a legal and ethical way, researching and referencing information, and managing cyberspace reputations and relationships. Smart helps to incorporate a culture of constructive use of technology, establish policies, processes, and gain access to evidence-informed resources and track progress in being intelligent. The term internet is a major component of daily life, and libraries are the information centers that are at the forefront of delivering the resources required to access and support the community. Smart enables libraries to provide a good atmosphere in which people can experience feelings of security, become part of real and virtual communities, and learn the skills they need. We believe that community-based acts such as smart libraries can really push e-safety worldwide as a cultural standard in communities. Keywords: Advanced Library, Solid Communities, economic wellbeing, Cloud computing, Web 2.0, E-Granthalaya 4.0, Freeware Applications, etc.

From artmaking to changemaking: Conceptualizing the PATCH (Palliative care patient-led change) programme

This article charts the learning from an online, artmaking programme supporting individuals with a life-limiting illness. The programme sought to fill a gap caused by the temporary closure of face-to-face UK hospice-based day therapy programmes during the COVID-19 pandemic. Participants’ comments on this arts-based programme illustrated the sense of disrupted and diminished identity, linked to a deceased sense of agency, which terminal illness can bring. Responding to this need for increased agency led to the development of the PATCH (Palliative care patient-led change) programme. Individuals with a terminal illness will be invited to join an online collaborative group, to identify a specific issue they wish to address and to lead the change they wish to see. The PATCH group will be supported by a facilitator and a team of volunteers, whose roles will include supporting participants in planning and executing their change strategy. This article presents the conceptual underpinning for the PATCH programme, offering a tentative theory of the relationship between identity, moral purpose, agency, illness and the leadership of change for those living with a life-limiting illness. Challenging stereotypical views of palliative care patients, it explores a new community and asset-based approach to end-of-life care which supports individuals at the end of life in developing a positive self-view.

Perspective of volunteer staff on the effectiveness of peer-support programs: a case study

Purpose This study aims to explore perceived effectiveness in the Warriors' Ascent program through interviews of volunteer staff, to leverage improvements in the design and delivery of programs through peer-volunteers. Design/methodology/approach Focused interviews were conducted to explore peer-volunteer perspectives on program effectiveness. The alignment of themes and statements emerging from interviews was explored in detail relative to the program curriculum. Findings Five main themes emerged, with alignment for 86% of the peer-volunteers’ commentary and program curriculum. Areas of non-alignment may present opportunities for program growth. Practical implications Analysis of peer-volunteer perspectives on practical activities and overall program effectiveness identified options to enhance program delivery. Warriors’ Ascent and both existing and emerging organizations (such as those who will serve distressed frontline pandemic workers) are essential social resources poised to evolve by encompassing appreciation and more effective use of non-professional volunteer support staff. Originality/value Peer-volunteers supporting behavior change programs are an emerging focus for research. Peer-volunteers contribute unique perspectives, common experiences and building of relations with a program’s participants serving as an effective agent of change contributing toward healthier lifestyles. Considering the influences of peer-volunteers during program evaluation allows triangulation among sources of information and offers additional opportunities for influencing program growth.

Interaction Effect of Gender on Academic Procrastination and Achievement Orientation among In-School Adolescents

The study investigated the interaction effect gender on academic procrastination and achievement orientation among in-school adolescents. The study adopted a pretest posttest non-equivalent control group quasi-experimental design with a population of 804 SS II students (518 female and 286 males). The sample size of 129 SS II students from Udenu Local Government Area of Enugu State was drawn through purposive sampling technique. Procrastination Assessment Scale for Students (PASS) and Achievement Orientation Questionnaire (AOQ) were used for data collection. Confirmatory factor analysis was used to validate the measures. Internal consistency reliability coefficients of 0.69 and 0.87 for PASS and AOQ were estimated through Cronbach alpha. Mean and standard deviation were used to answer the research questions while ANCOVA and t-test were used to test the hypotheses at 0.05 level of significance. It was found that gender does not significantly have effect on in-school adolescents’ academic procrastination and achievement orientation. The researchers recommended that among others that the government at all levels should employ competent educational psychologists/psychotherapists and provide enabling environment and facilities for regular cognitive behavioural change programme for in-school adolescents who may be facing problems with academic procrastination. More so, government agencies and professional bodies whose responsibility is to design and revise curriculum for secondary schools should incorporate and emphasize the use of rational emotive behavioural therapy in secondary schools.

Embodiment and Women in STEM: A Proposal

We advocate that change programs aimed at faculty women’s advancement in STEM fields engage with embodied knowledge both because lived bodies are at the heart of such projects and because embodiment is not. We discuss two challenges for centering the material body in such intervention programs. The first challenge is overturning a paradigmatic research bias that marginalizes embodied knowing. The second challenge is the integration of embodied knowledge into programs that seek to transform advancement practices and policies. To this end, we make several suggestions for pragmatic approaches that draw on our own experiences working on gender equity in academe.

Systematic review on the current Public Health Challenges for Dengue Transmission Control and Prevention in the Philippines

The dengue virus is a flavivirus endemic in over 100 countries, in which Southeast Asian countries are greatly affected due to the evident lack in public health intervention and laboratory resources. In 2019, the Philippines was able to observe a sudden increase in dengue cases, declaring a state of epidemic. The government then proposed several measures to address the sudden rise of dengue, which showed a significant decrease in dengue deaths during the first half of 2020, but dengue still remains a cause of concern given the uncertainty of possible future epidemics. Therefore, a systematic review was conducted according to the PRISMA 2020 guidelines using journals and articles published between Jan 1, 2015 and Dec 31, 2020 from Science direct, PubMed, HERDIN, Western Pacific Surveillance and Response (WPSAR), and Taylor and Francis Journal under the search strings “Dengue in the Philippines'' and “Dengue prevention and control in the Philippines”. The risk of bias was assessed using phase 2 and 3 of the ROBIS tool. A total of 19 articles identifying factors that influence public health interventions were included. Vector elimination and control (e.g., 4s strategy) through community participation has been the main focus of the current dengue prevention programs in the country, but these programs are presented with limitations. Various challenges and recommendations from different literatures were identified, but all consistently show the need for accurate identification and representation of dengue prevalence and burden to avoid higher overall healthcare costs, better involvement of the government and healthcare providers in information dissemination, advocacies with emphasis on behavioral change programs, and further research and development of a cost-effective, efficient, and less complex diagnostic method. It was therefore concluded that understanding the prevention and control of dengue in the Philippines would involve an elaborate public health investigation and review of several different factors aside from its viral mechanisms and pathogenesis, and that several aspects originating from individual behavior and practices of people up until coordination of LGUs, communities, and National-level agencies including coordinated budget allocations must all be aligned to efficiently lessen the prevalence of dengue. Research limitations encountered included the exclusive use of electronic databases and free/accessible published articles that inhibited the review’s capability to include “grey literature”, as well as the inability to have a registered protocol due to time constraints. An expansion in the criteria, databases used, and type of literature, along with the further exploring of each individual factor identified is recommended for future research.

Increasing participation by National Health Service knowledge and library services staff in patient and public information: The role of Knowledge for Healthcare, 2014-2019.

BackgroundThe strategy lead for the National Health Service (NHS) knowledge and library services withn the NHS in England is held by Health Education England, working with 184 local NHS libraries based predominantly in hospitalsObjectivesAs part of the strategic framework Knowkedge for Healthcare, the objective was to increase the role NHS knowledge and library services staff play in both indirect an direct support for evidence‐based information for patients and the public.MethodsThe study took an integrated multi‐level approach: encouraging local staff to share their expertise through Task and Finish groups, developing tools, offering training and reviewing levers available through Health Education England's quality assurance role.ResultsBetween 2014 and 2019, the percentage of services supporting patient and public information increased from 27% to 78%. Qualitative evidence demonstrates a wide range of roles played by local services, working either indirectly or directly to ensure access to evidence‐based health information for patients and the public.DiscussionThe study shows the benefits of engaging people with local expertise in developing the skills and resources for system‐wide change.ConclusionSimilar system‐wide change programmes should also consider an integrated approach, involving people, developing tools, offering training and drawing on incentive structures such as quality assurance measures.

Low sex hormone binding globulin: a potential predictor of future glucose dysregulation in women.

Learning Points • Sex hormone binding globulin (SHBG) concentration associates with insulin-resistance. • We looked at the relation between baseline SHBG concentration and future glycaemic status over an up to 10-year period, for women who were normoglycaemic at baseline. • In multiple linear regression analysis, a lower SHBG was associated with a higher fasting glucose independent of age and index of multiple deprivation. • These findings suggest that a low SHBG level, at a relatively young age is a risk marker for future impaired glucose handling in women. Precis: In a laboratory study, we found that low sex hormone-binding globulin level is a risk marker for future relative dysglycaemia in women, with index of multiple deprivation also an independent predictor of future prediabetes/type 2 diabetes mellitus.Editor, Previous work has suggested that a low sex hormone-binding globulin (SHBG) concentration associates with insulin resistance [1]. We previously showed that a low circulating SHBG level (<30 nmol/L) is associated with the presence of the metabolic syndrome in a multiethnic population [2] with lower levels found in both men and women of Pakistan ethnic origin compared with Caucasian and African-Caribbean origin people. In that study SHBG correlated positively with insulin sensitivity as estimated by HOMA-S [3] and negatively with waist-hip ratio, BMI and DBP across all ethnic groups, whereas in multivariate logistic regression analysis a low SHBG increased the likelihood of the metabolic syndrome being present. Furthermore, SHBG levels are often lower in women with polycystic ovarian syndrome (PCOS) [4–6]. There is therefore the potential for SHBG, given its relative ease of measurement (commonly by automated immunoassay), not requiring fasting status or special processing to have utility in identifying people at increased risk or developing impaired glucose handling in the future. In the light of this, we looked at the predictive value of SHBG in relation to the future development of impaired glucose handling in women in a preliminary study in 115 women, over an up to 10-year period. The women were normoglycaemic at baseline. Outcome was either fasting glucose or glycosylated haemoglobin (HbA1c) [7], as measures of glycaemia. ‘As anonymised data were used for the analysis from a laboratory database and no patient was contacted in this study, approval was sought and obtained from the Research and Innovation team’. The mean age of the women at the start of follow-up was 26.8 years (SD, 9.0; range, 16–65). Over the up to 10-year follow-up period, 6% developed non-diabetic hyperglycaemia (defined as HbA1c 42–47 mmol/mol) to and 1% type 2 diabetes (T2DM, defined as HbA1c ≥48 mmol/mol). In multiple linear regression analysis, a lower SHBG was associated with higher fasting glucose [normalised beta (β) −0.22; P = 0.02] independent of age (β 0.28; P = 0.01) and index of multiple deprivation (IMD) (β −0.11; P = 0.06) and South Asian ethnicity (β −0.13; P = 0.04). In logistic regression, we found that age was predictive of subsequent development of prediabetes/T2DM [odds ratio 1.08 (95% CI, 1.02–1.15); P = 0.01] independent of IMD/SHBG/ethnicity. In the light of these results, we suggest that a low SHBG level may have value as a risk marker for the development of future glucose dysregulation in women, with age also an independent predictor of nondiabetic hyperglycaemia/T2DM. Where someone has been found to have a low SHBG, there is the potential for targeted lifestyle measures to be implemented to prevent or delay the onset of glucose dysregulation. In our study, a younger age profile of the group likely influenced the low cumulative incidence of T2DM over the 10-year follow-up period. Nevertheless, SHBG may prove to be a useful future marker for the impact of lifestyle change programmes to reduce metabolic risk those people found to have a low SHBG, including women with PCOS. We plan further work to improve our understanding of this and to continue to follow-up this cohort of women in the coming years. Acknowledgements Conflicts of interest There are no conflicts of interest.

Data-driven approach for tailoring facilitation strategies to overcome implementation barriers in community pharmacy

BackgroundImplementation research has delved into barriers to implementing change and interventions for the implementation of innovation in practice. There remains a gap, however, that fails to connect implementation barriers to the most effective implementation strategies and provide a more tailored approach during implementation. This study aimed to explore barriers for the implementation of professional services in community pharmacies and to predict the effectiveness of facilitation strategies to overcome implementation barriers using machine learning techniques.MethodsSix change facilitators facilitated a 2-year change programme aimed at implementing professional services across community pharmacies in Australia. A mixed methods approach was used where barriers were identified by change facilitators during the implementation study. Change facilitators trialled and recorded tailored facilitation strategies delivered to overcome identified barriers. Barriers were coded according to implementation factors derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Tailored facilitation strategies were coded into 16 facilitation categories. To predict the effectiveness of these strategies, data mining with random forest was used to provide the highest level of accuracy. A predictive resolution percentage was established for each implementation strategy in relation to the barriers that were resolved by that particular strategy.ResultsDuring the 2-year programme, 1131 barriers and facilitation strategies were recorded by change facilitators. The most frequently identified barriers were a ‘lack of ability to plan for change’, ‘lack of internal supporters for the change’, ‘lack of knowledge and experience’, ‘lack of monitoring and feedback’, ‘lack of individual alignment with the change’, ‘undefined change objectives’, ‘lack of objective feedback’ and ‘lack of time’. The random forest algorithm used was able to provide 96.9% prediction accuracy. The strategy category with the highest predicted resolution rate across the most number of implementation barriers was ‘to empower stakeholders to develop objectives and solve problems’.ConclusionsResults from this study have provided a better understanding of implementation barriers in community pharmacy and how data-driven approaches can be used to predict the effectiveness of facilitation strategies to overcome implementation barriers. Tailored facilitation strategies such as these can increase the rate of real-time implementation of innovations in healthcare, leading to an industry that can confidently and efficiently adapt to continuous change.

Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers.

Tobacco use is disproportionately elevated among patients with substance use disorders relative to the general U.S. population. Tobacco interventions are lacking within substance use treatment centers (SUTCs) due to lack of knowledge and training. This study examined knowledge gain and the organizational factors that might moderate knowledge gains following tobacco education training provided to employees (N = 580) within 15 SUTCs that were participating in a tobacco-free workplace program. The number of total annual patient visits, unique annual patient visits, number of full-time employees, and organizational readiness for implementing change (ORIC) as assessed prior to implementation were examined as potential moderators. Results demonstrated significant knowledge gain (p < 0.001) after training overall; individually, 13 SUTCs had significant knowledge gain (p’s < 0.014). SUTCs with fewer total annual patient visits and fewer full-time employees showed greater knowledge gains. The ORIC total score and all but one of its subscales (Resource Availability) moderated knowledge gain. SUTCs with greater initial Change Efficacy (p = 0.029), Valence (p = 0.027), and Commitment (p < 0.001) had greater knowledge gain than SUTCs with lower scores on these constructs; SUTCs with greater Task Knowledge (p < 0.001) regarding requirements for change exhibited less knowledge gain. Understanding the organizational-level factors impacting training effectiveness can inform efforts in organizational change and tobacco control program implementation.

Investigating the relevance of the traditional marketing mix across different stages of change: empirical evidence from household recycling

PurposeThis study aims to provide empirical evidence and a different perspective on the relevance of the traditional marketing mix in social marketing programmes. This is a response to the ongoing debate about the (in)compatibility of the traditional marketing mix (the 4Ps) in the field of social marketing. In doing so, this study examines the important role that the stages of behaviour change play in influencing the effectiveness of traditional marketing mix elements in the context of recycling in South African households.Design/methodology/approachThis study follows a quantitative method, relying on a survey of 699 heads of households in South Africa. Multigroup analysis and structural equation modelling were applied to test the impact of stages of changes on the potential effect of marketing mix elements on the intention to recycle household waste.FindingsThe results established that although the traditional marketing mix elements have a marginal effect on the intention to recycle household waste, further analyses revealed that this impact of the marketing mix is contingent on the stage of change in which the target audience is found. Thus, the findings indicated that the marketing mix elements significantly influence the intention to recycle when the target audience is at the contemplation and preparation phases.Originality/valueWhilst both critics and proponents of the adoption of the traditional marketing mix in social marketing initiatives have provided relevant arguments, the debate had remained largely theoretical. This study discusses the limitations of the traditional marketing mix in behaviour change programmes and the need for a segmented approach based on the stages of behaviour change when using the 4Ps. However, given the hegemony of the 4Ps in the social marketing literature, this study sheds light on the appropriate “Ps” to activate to influence recycling behavioural intention at different stages of change.

Effects of supervised exercise program and home exercise program in patients with systemic sclerosis: A randomized controlled trial.

To compare the effects of supervised exercise and home exercise program in patients with systemic sclerosis (SSc). Thirty-seven SSc patients were included. Patients with SSc were allocated into 2 groups as supervised and home exercise. Breathing, aerobic and resistance exercises were performed with a physiotherapist for 12weeks in the supervised exercise group. Breathing, posture and aerobic exercises were given to the home exercise group as a home program for 12weeks. All patients were assessed at baseline and 12weeks later in terms of functional capacity, pulmonary functions, respiratory-peripheral muscle strength, dyspnea severity, health-related quality of life (HRQoL) and fatigue level. Significant improvements were observed in the functional capacity, measured by 6minute walking test in the supervised exercise group (before=376.21±65.50, after=518.78±75.84m) and home exercise group (before=384.44±68.14, after=432.7±70.8m; (P<.05). Respiratory-peripheral muscle strength (with the exception of inspiratory muscle strength and upper limb strength in the home exercise group) and HRQoL were significantly increased and fatigue level was significantly decreased in the supervised exercise and home exercise groups (P<.05). However, pulmonary functions and dyspnea severity were significantly improved only in the supervised exercise group (P<.05). The supervised exercise program was found superior to the home exercise program for change in all parameters (P<.05). This study suggests that exercise interventions should be applied in addition to the medical treatments of patients with SSc as supervised and home exercise programs play an important role in the functionality and health status of these patients.