Service Delivery Research Articles

Ethical Dilemmas and Their Impact on Accountability in Local Governments: A Study of the Greater Kigezi Sub-Region in Uganda

This study examines the impact of ethical dilemmas on accountability in local governments within the Greater Kigezi sub-region of Uganda comprising of Kabale, Kanungu, Kisoro, Rubanda and Rukiga local governments and therefore, sufficient enough to represent and enable generalization of findings to other local governments in the country. Over the past few decades, public sector reforms have sought to enhance transparency, efficiency, and service delivery. Despite these efforts, Uganda continues to face challenges in maintaining strong accountability systems, particularly at the local government level. Ethical dilemmas—stemming from conflicts of interest, political pressure, resource constraints, and cultural norms—undermine accountability and transparency, leading to corruption and diminished public trust. The study investigates these dynamics by exploring how ethical challenges affect governance in local governments through the aid of questionnaires and interviews with stakeholders drawn from the local governments and opinion leaders who represent the voices of the grassroots. Focusing on the Greater Kigezi sub-region, the research highlights widespread governance issues such as nepotism, political interference, and weak institutional oversight. Findings reveal that ethical dilemmas hinder public sector performance by compromising decision-making and oversight processes. To address these challenges, the study suggests enhancing ethical training, strengthening oversight institutions, fostering civic engagement, and developing clearer policies on ethics and accountability. By implementing these policy reforms, stakeholders can create more transparent and accountable local governance systems that better serve community needs

Challenges and Opportunities

In this article, the authors consider the future possibility of public administration in South Africa being transformed by artificial intelligence (AI). It discusses the difficulties and advantages of AI/ML in this set up. They can use artificial intelligence (AI) to enhance the productivity of the public sector, quality in decision, and contribute to people's participation. The results show that AI can reduce paperwork, anticipate public health trends, make recommendations for people to get the best chance of recovery, and even optimise resource allocation – all with a view towards improving service delivery and governance. Problems with infrastructure, gaps in digital access, as well as scarcity of AI expertise within the public service work against any real integration of artificial intelligence. The study underscores the significance of strategic planning, large-scale infrastructural investments, and robust policy reforms in order to harness the full range of benefits from artificial intelligence (AI) with a fair share accruing to all.

Testing the effects of merit appointments and bureaucratic autonomy on governmental performance: Evidence from African bureaucracies

AbstractAppointing bureaucrats based on merit and protecting them from excessive political interference have become bedrocks of modern bureaucracy. Populist leaders throughout the world, however, are looking to undermine merit systems and politicize bureaucracies. This study analyzes the impact of merit‐based appointments and bureaucratic autonomy on service delivery effectiveness, using longitudinal data from a panel of African countries. Throughout Africa, social, economic, and political conditions have made it difficult for meritocratic and autonomous bureaucracies to take root and flourish as they have elsewhere. Despite these challenges, the study's main finding is that the practice of appointing bureaucrats based on merit has a positive effect on the provision of public services like transportation infrastructure, standardized education, drinking water, sanitation, and waste disposal. Political leaders undercutting meritocratic civil services and expanding patronage appointments do so at their own peril due to the adverse consequences of their actions on governmental performance. Little evidence is found of a relationship between bureaucratic autonomy and service delivery effectiveness.

What Supports Do Incarcerated Mothers and Their Families Need? The Views of Incarcerated Mothers and Service Providers

Maternal incarceration causes complex and diverse outcomes, affecting the mother, her family, and her community. Despite this, there are few evidence-based models of support. This paper aims to identify participant’s perspectives in developing a model of support by identifying needs, preferred services, and current barriers. Incarcerated mothers (n = 75) and service providers (n = 24) in Queensland, Australia contributed through workshops. Participants identified three support areas: (i) children’s wellbeing and mother-child relationships; (ii) while mothers are incarcerated; and (iii) when mothers return to the community. Mothers prioritized relational and self-development goals whereas service providers prioritized material needs and service delivery methods. Barriers reflected mothers’ multifaceted needs and the complex service delivery area. Preferred programs incorporated individualized, multi-modal, long-term, culturally-informed, and trauma-informed care, while system-level barriers included administrative burdens and navigating complex systems. Overall, models of support must incorporate optimal program-level and system-level characteristics to improve the outcomes of mothers and their children.

Targeting online sales through last‐mile delivery platform integration

AbstractWe analyze channel integration between a last‐mile delivery platform and a general merchandise retailer in two distinct stages: (1) platform delivery access (PDA), where the retailer continues to offer standard delivery through its own website but directs customers to the platform's website for new same‐day delivery; and (2) integrated delivery access (IDA), where customers can continue to use same‐day delivery service at the delivery platform website but can purchase products in a single order with both same‐day and standard delivery options at the retailer's website. We perform a quasi‐experiment using consumer spending data from retailer, target, and delivery platform, Shipt. We find that PDA provides positive impacts to the delivery platform through increased sales. IDA, on the other hand, increases the retailer's online channel sales but does not impact the delivery platform's sales. Moreover, we find that the positive effects of PDA on the delivery platform's sales are stronger in markets where online grocery penetration is lower, indicating that the effects were likely driven by increased purchases for groceries. Finally, the positive effect of IDA on the retailer's online channel sales is stronger in markets where the retailer has a greater loyal customer base and online grocery penetration is lower.

Knowledge, Attitude, and Practice of General Dentists Towards Tele-dentistry

Background: Considering the growing importance of tele-dentistry and its potential to enhance the delivery of dental services, this study aimed to assess the knowledge, attitude, and practice (KAP) of private dental offices towards this technology. Methods: This analytical cross-sectional study included 50 general dentists practicing in Semnan city, selected based on entry criteria through the enumeration method. Participants completed a demographic questionnaire (including gender and years since graduation) and a 15-item researcher-made questionnaire designed to assess their KAP towards tele-dentistry. Results: Among the participants, 54% (27 participants) were female, and 46% (23 participants) were male, with an average age of 30.2 ± 6.48 years. The mean number of years since graduation was 7.74 ± 5.13 years. The mean and standard deviation of KAP scores were 5.96 ± 1.07 (knowledge), 34.32 ± 3.41 (attitude), and 1.44 ± 0.50 (practice), respectively. Men scored significantly higher in knowledge compared to women (7.26 ± 0.91 vs. 6.70 ± 1.14; P = 0.037). There was a significant inverse correlation between knowledge scores and years since graduation (r = -0.292; P = 0.032). Additionally, 52% (26 participants) reported having used tele-dentistry, while 96% (48 participants) expressed an intention to use it in the future. Conclusions: The findings suggest that knowledge regarding tele-dentistry was notably higher among men and those with fewer years since graduation. Health policies should prioritize training programs to enhance general dentists' knowledge and practice of tele-dentistry, supporting its effective implementation in dental care.

Evaluating Supply Chain Management Models for Third Party Logistics Operated Supply Processing Distribution in Thai Hospitals: An Analytical Hierarchy Fuzzy TOPSIS Approach

Background: This study introduces a novel supply chain management (SCM) model tailored for the hospital industry in Thailand. The model emphasises the integration of third-party logistics (3PL) providers to streamline supply-processing-distribution (SPD) functions. By outsourcing non-core activities like SPD to 3PL providers, hospitals can enhance their operational efficiency, allowing healthcare professionals to focus on core tasks and ultimately improving service delivery. Methods: This research employed a dual methodology, combining an analytic hierarchy process (AHP) with a Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (Fuzzy TOPSIS). These approaches evaluated various SCM models based on multiple hospital logistics performance attributes. Results: The AHP results highlighted on-time delivery, patient safety, utilisation rate, and emergency procurement as critical criteria for selecting the optimal model. Fuzzy TOPSIS analysis identified the SCIII: W-G-H model as the most suitable for implementation in Thai hospitals. This model incorporates a centralised warehouse for negotiation leverage, a Group Purchasing Organisation (GPO) for cost efficiency, and regional SPD hubs for effective inventory management and rapid responses to demand fluctuations or emergencies. Conclusions: Adopting this SCM model is expected to significantly enhance supply chain performance, reduce operational costs, and improve the quality and safety of patient care in Thai hospitals.

Tracing the Success of QRIS Policy Implementation in Surabaya City’s Parking Levy System

This research explores the effectiveness of the Surabaya City Government’s policy on parking levy payments via the Quick Response Code Indonesian Standard (QRIS). The study aims to analyze the policy’s success in increasing Regional Original Income (Pendapatan Asli Daerah or PAD) and enhancing community welfare by improving the payment experience for parking users and supporting efficient management by parking attendants. Using Van Meter and Van Horn’s policy implementation framework, which includes six critical factors—policy standards and objectives, resource allocation, characteristics of implementing organizations, inter-organizational communication, implementer disposition, and socio-political and economic environment—the study evaluates both the facilitating and hindering elements of the policy. A qualitative descriptive methodology was employed, with data gathered through literature reviews, field observations, and structured interviews with key stakeholders, including government officials, parking service providers, and users. Analysis revealed that QRIS implementation has been beneficial in promoting transparency and efficiency in revenue collection, supporting PAD growth. However, challenges such as varying levels of digital literacy among users, limited internet access in certain areas, and reluctance among some parking attendants to adopt digital systems were identified as barriers to optimal implementation. Key findings suggest that the policy’s long-term success hinges on consistent inter-agency coordination, community engagement initiatives to raise digital payment awareness, and ongoing training for parking attendants to improve digital proficiency. The study concludes that achieving sustainable success in implementing non-cash transactions for parking levies requires a holistic approach, integrating community awareness, inter-organizational support, and policy adaptability. This research offers valuable insights for policymakers seeking to improve public service delivery through digital transactions. It highlights the importance of adaptive management in fostering community welfare alongside regional revenue growth.

Preferences and valuation of small-scale wastewater treatment system maintenance using discrete choice method: Case of community-managed system in Jakarta, Indonesia

The focus of public service delivery on sustainability and universal access has enabled the enactment of many community-based programs in Indonesia. However, relevant studies that examine the willingness to pay among households that utilize community-managed facilities are lacking, despite it being one of the most important factors for maintenance and a strong indicator of commitment. In the present study, we aimed to estimate household users' preferences and willingness to pay (WTP) to understand their demand for related services. It estimates household user preferences and willingness to pay to understand the demand for related services through a choice experiment. By comparing all service attributes, the results highlight that users derive the highest utility if they updated reactors and pipelines, and, conversely, if the responsible authority is changed. The desire for quality improvement and service expansion were confirmed using this model. The mixed model estimated a willingness to pay of 0.03–3.13 USD for average users, depending on the attributes. Our findings confirm that families who belong to a community that operates a decentralized system derive greater benefits from improved maintenance; thus, they are willing to pay more to enjoy the service. Notably, at its core, a community-managed system, such as the Sanimas Program, is a co-production initiative between multiple levels of government institutions and local residents. Therefore, maintenance actions should involve resource- and payment-intensive efforts, such as half-year sanitary desludging and system replacement owing to deterioration and hazards. Policy regulations that correct the distribution of roles among partners for maintaining the system should be initiated. These findings provide evidence for the government's commitment to the community and could help convince other stakeholders to redirect their attention to supporting sustainable system performance.

The role of emotional marketing in enhancing strategic customer behavior through financial knowledge: An analytical study of a sample of shopping malls in Iraq

The research aims to diagnose the logical relationships between emotional marketing and its role in enhancing strategic customer behavior through financial knowledge to reach results in the dynamic environment of shopping malls. The paper was designed in light of adopting the descriptive analytical approach to variables and collecting data and information through the questionnaire tool distributed to the shopping malls of the research sample. Using statistical analysis programs to reach the results, the study sample reached (25) shopping malls in the local environment of the country. The results showed that there is a threat in the local environment in which these malls operate through the entry of foreign investment projects in this field, which led to an increase in supply and competition in terms of quality, prices and delivery services to gain customers. The studied malls had to develop a strategy on how to attract and retain customers by using emotional marketing practices and relying on financial knowledge to influence strategic customer behavior, as the current and future customer has become rapidly changing in tastes, needs, desires and transformation through technological development and the world has become a small village that can be viewed at any time and in short periods of time. The research also concluded that the threat of new investment through the establishment of new malls as new investment projects affects supply and demand in the environment in which these studied malls operate. The research also concluded that there is a correlation and influence relationship between the research variables of the studied malls, which includes a package of results that benefit the research community. The paper aims to bridge the knowledge gap between the variables of the paper in the dynamic environment by using emotional marketing as a competitive tool in influencing strategic customer behavior through financial knowledge to gain and maintain the current customer and gain the potential customer.

Variation Exists in Service Delivery: Similarities and Differences in the Provision of a Whole Genome Sequencing Service for Paediatric Rare Disease Patients in the English National Health Service

Introduction: The English National Health Service (NHS) is the first to offer whole genome sequencing (WGS) as part of standard care. As a high-income country with a universal healthcare system, England contributes a valuable perspective to global developments in WGS. Methods: We used an implementation science approach with mixed methods to characterise delivery of WGS for paediatric rare diseases. Observations and field notes of consent appointments in clinical genetics and mainstream settings and follow-up qualitative semi-structured interviews with the clinical team. Process maps were developed for each department to identify similarities and variations between sites, and thematic analysis of interview data to understand barriers and facilitators. Results: Data collection occurred in 12 departments (7 genetic, 3 neurology, 1 cardiology and 1 general paediatric) across 7 NHS Trusts. 26 observations of 21 healthcare professionals were conducted, alongside 19 follow-up interviews. Two master maps were developed – one for clinical genetics and one for the mainstream. We identified 11 steps involved in delivering WGS, including 9 variations and 9 similarities. We identified most variation in the processes related to the ‘who’, ‘when’, ‘how’ and ‘where’ as these were aspects that could be adapted to fit into the specific set-up of the department. Barriers included reluctance to uptake in the mainstream and difficulties tracking samples. Conclusion: Recommendations include developing SOPs and hiring healthcare professionals responsible for facilitating consent alongside administrative aspects. These would reduce the burden on clinical geneticists and improve turnaround times as well as contribute to streamlining and standardisation of the service.

Evolving HIV service delivery: scalability of pharmacist-led care

Abstract Introduction With declining healthcare budgets and numbers of HIV medical trainees1, workforce innovation is crucial to sustain delivery of HIV care. Since local introduction of an advanced pharmacist practitioner (APP) role, we have demonstrated the ability of pharmacists to provide holistic care to people living with HIV, including those with complex medical needs. Scaling up pharmacist-led care may be a potential solution to sustain service delivery2 whilst addressing the needs of an ageing cohort3. Further APP clinics were introduced with consultant support and supervision. Aim We aim to evaluate the impact and outcomes of these APP clinics. Method Prospective data collection of consultations conducted by four pharmacist practitioners (PP) across four HIV clinics between January to December 2023. Surveys were distributed after the appointment to capture service users’ opinions on the pharmacists’ role and care provided. Ethical approval was not required as this does not constitute as research. This was registered as a service evaluation with the research and innovation team at Chelsea and Westminster NHS Foundation Trust. All patient information is anonymised. Results A total of 634 consultations (513 individuals) within 170 clinical sessions were conducted during the 12 month period: 585 (92%) in person; 176 (34%) female; median age 52 (IQR 43-58); 233 (45%) non-white ethnicity; mean number of co-morbidities 2 (0-8); 87 (17%) had more than 5 co-medications (0-21); 87% virologically suppressed [viral load (VL) <50cp/mL]. Of 55 individuals seen with detectable VL, 32 (58%) resuppressed within 6 months. PPs have made 522 interventions and investigations in total, for example 147 referrals to other specialities such as dietitians and mental health services, 112 imaging requested (e.g DEXA and liver ultrasounds) and 99 initiation or switching of antiretroviral therapy (ART). Following investigations, 44 new medical conditions were identified and managed by the PPs which included namely 18 cases of micronutrient deficiencies, 8 cases of skin conditions and 6 cases of metabolic disorders. From the survey, 55% (30/55) of service users were aware that pharmacists could review their overall health. All (100%) respondents felt that the quality of care received met or exceeded expectations and 54 (98%) would attend a pharmacist-led appointment in future. Discussion/Conclusion We have previously successfully demonstrated implementation of pharmacist practitioner clinics as a novel way of utilising and developing the pharmacist workforce. We demonstrate scalability of this service delivery model in our large, urban multi-site centre by successfully increasing the number of pharmacist practitioner clinics from three clinics to six clinics week. The positive feedback from service users indicates high acceptability of this model. HIV services may consider investment into mobilising senior pharmacists to facilitate expansion of this advanced practitioner role in order to address increasing levels of co-morbidities, polypharmacy and complex medical needs observed in our ageing population. The knowledge base of HIV pharmacists means they are ideally placed to facilitate communication across sectors, specialties and disciplines. Future development plans include expanding to other specialist areas such as HIV pre-exposure prophylaxis, contraception, gender health and research delivery and enhanced skills such as phlebotomy, injectable ART administration.

Qualitative study exploring perceptions and experiences of Pharmacy technicians’ professional identity in NHS Scotland

Abstract Introduction Pharmacy technicians worldwide share workplace challenges including: job role; scope of practice; level of pharmacist’ supervision; and education1. In the USA, Canada and many European countries, pharmacy technicians require national or state registration2. In the UK, Pharmacy technicians became registered professionals in 2011, as a means of improving patient safety through compliance with General Pharmaceutical Council (GPhC) standards. There are approximately 2,500 pharmacy technicians and 5,500 pharmacists registered with the GPhC in Scotland3. Given the importance of professional identity, and the lack of research exploring pharmacy technicians’ professional affiliation, we explored the perspectives and experiences of pharmacy technicians’ professionalism across Scotland. Aim To explore pharmacy technicians’ perceptions and experiences of their professional status and professional identity. Methods Following West of Scotland Research and Ethics Service Scientific Officer’s approval, Pharmacy technicians from all fourteen Scottish territorial health boards were invited by email using snowball sampling technique to provide a national representation. A draft semi-structured interview was piloted on four pharmacy technicians. Between May and August 2023, 36 pharmacy technicians were recruited: 23 from acute services; mental health (n=1); rehabilitation hospitals (n=1); primary care (n=8); and community pharmacy (n=3). Twenty two participants were interviewed in person and 14 on line. Interviews lasted between 17-91 minutes, were audio recorded, transcribed verbatim and accuracy checked, then analysed thematically using a framework approach and NVivo software. Three researchers analysed data including initial coding, categorisation, and theme generation. Any disagreements were discussed and addressed within the research team. Results Seven themes emerged from the data describing pharmacy technicians: feeling stuck in the shadow of pharmacists; underrepresented in policy and practice; and marginalised, undervalued and underpaid. There was frustration at the lack of awareness of pharmacy technician roles amongst the wider healthcare team. Primary care pharmacy technicians were thought to have more opportunities than secondary care colleagues. There was a pervasive feeling that pharmacy technicians were increasingly squeezed between pharmacists and support workers and a lack of confidence and feeling unsupported in the delivery of clinical roles. Pharmacy technicians acknowledged that they may not have used their initiative to take new opportunities, but did not feel they had sufficient clinical and educational opportunities. Catalysts to professional development were recognised including pharmacy technician led management and leadership, readiness to undertake traditional pharmacist roles and the potential positive impact of strengthened professional identity. Interviewees described the absence of a structured, funded career framework, and lack of post-registration higher-level professional qualification as inhibiting increased responsibility and scope of practice. Discussion/Conclusion Professional registration does not appear to have strengthened pharmacy technicians’ professional identity. There is a pervasive lack of development opportunities impacting negatively on pharmacy technicians and therefore, service delivery across Scotland. A review of defined roles is required. A lack of previous qualitative evaluation limits comparisons with the perceptions and experiences of pharmacy technicians worldwide. Findings offer a starting point to inform practice and policy. Further research could explore pharmacy technicians’ perceptions of the potential impact of the emerging career framework on developing roles and responsibilities. Keywords: Pharmacy technician, Professional identity

Exploring Consumer Satisfaction and Service Quality at Bhatbhateni Supermarket

Background: Customer satisfaction and service quality are pivotal to the success of businesses, particularly in the competitive retail landscape of Kathmandu. Bhatbhateni, as one of the leading retail chains in Nepal, plays a crucial role in offering a wide array of products and services. Understanding customer perceptions regarding service quality and satisfaction is essential for enhancing operational strategies and maintaining a competitive edge in this dynamic market. Objectives: This study aims to analyze the demographic profile of Bhatbhateni's customers, evaluate their perceptions of service quality and satisfaction, identify key service needs and expectations, and assess the likelihood of repurchase and recommendations among customers. Methods: A quantitative research approach was employed, utilizing structured questionnaires distributed to a sample of 120 customers of Bhatbhateni, selected through convenience sampling to ensure a diverse representation of gender and age. The questionnaire encompassed demographic inquiries and Likert scale items measuring customer satisfaction, service quality, and overall service experience. Data analysis involved descriptive statistics to summarize findings and identify trends in customer perceptions. Findings: The results indicated that the sample comprised 53.3% male and 46.7% female customers, with 61.7% of respondents aged between 15-25 years. A substantial 70.0% of respondents felt that Bhatbhateni understood their service needs effectively. In terms of satisfaction levels, 43.3% of customers reported being somewhat satisfied, while 12.5% expressed being very satisfied with the products. Moreover, 45.8% of respondents rated Bhatbhateni's quality management as good, and 41.7% positively rated staff responsiveness. Additionally, 48.3% indicated a high likelihood of repurchasing products, and 61.7% stated they would likely recommend Bhatbhateni to others. Conclusion: The study reveals a generally positive perception of service quality among Bhatbhateni's customers, highlighting key areas of strength and potential for improvement. Customer satisfaction is significantly influenced by the understanding of service needs and the quality of management. These findings suggest that Bhatbhateni is well-positioned for sustained growth through enhanced customer engagement and service delivery. Novelty: This research contributes valuable insights into the relationship between service quality and customer satisfaction within the specific context of Bhatbhateni, a prominent retail chain in Nepal. By employing a structured questionnaire and statistical analysis, the study adds to the limited existing literature on customer service perceptions in Nepal's retail sector. The findings can guide Bhatbhateni and similar businesses in developing targeted strategies to improve customer satisfaction and loyalty, ultimately enhancing business service management practices in the region.

Establishing a biologics and biosimilars committee/network: assessing educational requirements of pharmacy and other healthcare professionals

Abstract Introduction Successful professional networking involves shared, mutually beneficial interactions between individuals and/or individuals and groups1. Biologics and biosimilar medicines prescribing is rapidly evolving with an increasing number of clinical indications in healthcare2,3. Despite their importance, the absence of a structured national network dedicated to these complex therapies has left a gap in professional education and resource sharing among pharmacists. Recognising the necessity for a cohesive support system, this work explores the learning and professional needs of pharmacists regarding biologics and biosimilars and the potential development of a national pharmacy network to address these gaps. Aim The survey aimed to explore the educational needs and preference for a network and/or committee for pharmacy and other healthcare professionals focused on biologics and biosimilars medicines. Methods An electronic survey was developed and deployed for pharmacy and other healthcare professionals involved in the management of biologics and biosimilars via email cascade and social media, 12th February - 6th March 2023. The survey explored the preferred structure of the proposed group; formal committee and/or informal network, what the group would deliver, and any educational needs for members. The survey included questions about the respondent’s roles, sectors of work, regions and their clinical area(s). The open text responses were themed. The NHS health Research Authority tool was used to identify this project as service improvement and development, therefore did not require ethical approval. Results The responses received were from 46 pharmacists, 1 pharmacy technician, 15 doctors and nurses and 4 participants whose roles were unknown, working across multiple sectors; hospital, community, industry, and academia with representation from the devolved nations (n=3) and internationally (n=1). Most respondents expressed a need for a dedicated network and committee n=52 (79%), n=10 (15%) formal network, and n=4 (6%) informal committee. Common themes in response to what the group should deliver and educational needs included; harmonisation of approaches to guidelines and policies, pathway design, reduction in unwarranted variation (68%); platform to share new ideas, knowledge and peer advice (44%); strategy and leadership in service delivery and promotion of best practice and cost training, horizon scanning (29%); working collaboratively to produce multi-centre research projects (24%); to create a structured training programme for health care professionals (9%). Discussion/Conclusion The survey results highlight a gap in the current educational and professional support systems for PP’s concerning biologics and biosimilar medicines. The identified learning needs point to a strong demand for a structured network that can provide targeted education, share best practices and facilitate professional networking. The expertise within the group can also create formal eLearning programmes for healthcare professionals. This work serves as a foundational step towards the development this network, highlighting the critical areas of focus and the collective interest of the pharmacy community in bridging these gaps. The network should also facilitate communication and collaboration across different sectors, fostering a more cohesive and informed pharmacy community. Such an innovative network would not only enhance individual competency but also contribute to the overall advancement of pharmaceutical care in this specialised area.

Experience of Service Questionnaire (ESQ) in children and adolescents: factor structure, reliability, validity, item parameters and interpretability of the parent version for practical use in Greece

BackgroundHealth systems need tools to assess patient’s experience of service, but existing tools lack reliability and validity assessment. Our aim is to investigate the factor structure, reliability, validity, item parameters and interpretability of the parent version of the Experience of Service Questionnaire (ESQ) for practical use in Greece.MethodsA total of 265 caregivers that were using mental health services in Greece participated in this study as part of the Nationwide cross-sectional survey from the Child and Adolescent Mental Health Initiative (CAMHI). Confirmatory Factor Analysis was used to test factor structure. Reliability of all models were measured with omega coefficients. Tobit regression analysis was used to test for convergent and discriminant validity with specifically designed questions. Item parameters were assessed via Item Response Theory. Interpretability was assessed by means of IRT-based scores.ResultsWe found that ESQ is best represented and scored as a unidimensional construct, given potential subscales would not have enough reliability apart from a general factor. Convergent and discriminant validity was demonstrated, as caregivers who perceived that their child benefited from the received mental health care had 6.50 higher summed scores (SMD = 1.14, p < 0.001); while those who believed that their child needed additional help had 5.08 lower summed scores on the ESQ (SMD = −0.89, p < 0.001). Average z-scores provided five meaningful categories of services, in terms of user satisfaction, compared to the national average.ConclusionsOur study presents evidence for the reliability and validity of the ESQ and provides recommendations for its practical use in Greece. ESQ can be used to measure experience of service and might help drive improvements in service delivery in the Greek mental health sector.

A Review on the Approach to Herbal Medicine in Cuban Healthcare System.

Background:Cuban healthcare system, emphasizing a holistic approach with herbal medicine as a key component, has achieved significant advancements in a multitude of health indicators. The aim of this study was to investigate the approach of Cuban healthcare system to Herbal medicine. Methods: The study conducted a review in the year 2024 in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Multiple databases, namely PubMed, Scopus, ProQuest, and the Cochrane database of systematic reviews were searched and the quality of the studies was assessed using the AACODS checklist. Finally, a thematic analysis was conducted on the data. Results: 7 studies included within the study. The quality assessment scores presented high level of quality of the final studies with low level of bias. The thematic analysis resulted in six themes including: International collaboration, Universal coverage, Education and encouragement, Utilization, integration, and innovation, Efficiency and sustainability, and Prevention-focused and strategic approach. The Cuban healthcare system incorporates global herbal medicine knowledge, particularly from China, and provides free, regionalized services. It emphasizes the "Green Pharmacy" concept in each neighborhood and integrates herbal medicine into service delivery through a sustainable, prevention-focused policy. Conclusion: The Cuban healthcare system has implemented a multifaceted program on herbal medicine.

Impact of Financial Intermediation and Regulatory Frameworks on Financial Deepening and Economic Growth: Insights from Lesotho

Purpose: The purpose of this study is to analyse the impact of financial intermediation and regulatory frameworks on financial deepening and economic growth in Lesotho, utilizing data from 2003 to 2022. The objective is to explore the relationships between selected financial and economic indicators and assessing their influence on financial deepening. Methodology: This study utilized secondary time series data, which poses challenges regarding authenticity and reliability since it was collected by external parties. However, these concerns were addressed by using data from reputable global agencies like the IMF, World Bank, and the Central Bank of Lesotho’s annual report from 2003 to 2022. The analysis was conducted using the Ordinary Least Squares (OLS) regression method. Findings: The findings highlight the complex role of financial intermediation and regulatory frameworks in shaping financial deepening and economic growth. Higher cash reserve ratios and treasury bill rates negatively affect financial deepening by reducing liquidity and increasing credit costs. However, increased commercial bank deposits with the central bank positively contribute to financial stability and deepening. Moderate inflation also fosters financial deepening by raising the nominal value of financial assets. While ATMs per capita enhance financial access and growth, an increase in bank branches per capita shows inefficiencies, underscoring the need for effective infrastructure and service delivery. Unique Contribution to Theory, Policy and Practice: The study suggests that policymakers should adjust cash reserve requirements, monitor credit expansion to avoid over-lending, and improve banking infrastructure. It highlights the need for careful interest rate management and promoting financial innovation to enhance market depth.

Tipping Dilemma in Restaurants’ Age of Automation: Exploring the Role of Social Obligations, Explicit Requests, and Their Timing

ABSTRACT Despite the wide implementation of automated services (e.g. self-service kiosks and mobile checkouts) to optimize service efficiency, restaurant customers’ perceptions related to tipping in this context have received less attention. Two between-subject experiments were conducted among US consumers. The findings reveal that explicit tip requests increase unfairness perceptions when people feel more obliged to tip (Study 1), and for those who feel a higher obligation to tip, the unfairness perceptions are enhanced when the tip is requested before the service delivery (Study 2). This study enhances the existing literature on tipping behavior and service automation, additionally providing valuable insights for restaurant managers by offering guidelines for tip requests aimed at mitigating negative customer reactions such as perceptions of unfairness and decreased trust in the restaurant.

Property Comparison of Different Standard Wood Pallets for Possible Local Sourcing

The global expansion of freight transport across business types has impacted supply chain logistics in terms of coordinating the storage and delivery of goods and services across the supply chain. Wooden pallets are in high demand due to their price and environmental impact; however, the wood raw materials needed for making pallets are in short supply. This research was aimed at analyzing the possibility of using local wood instead of imported wood in the production of standard industrial pallets. Industrial pallets were designed using local acacia wood to replace some or all of the imported Radiata pine. This local acacia wood was utilized to prepare and construct pallets of the standard dimensions that were in accordance with the designs. Pallets made from the same type of wood and mixed woods were heat treated to meet the criteria of the ISPM 15 protocol for export. Flat pallet testing was conducted in accordance with industrial standards for the evaluation of the finished products. All types of pallets, including pallets containing local wood components, showed no visible damage during drop tests and compression strength assessments. However, the variability in diagonal span rates was influenced by the wood used in the fabrication process. Pallets frabricated from both partial and full acacia wood exhibited increased bending rates of 2081 and 2650 MPa, respectively, due to the higher levels of cellulose and lignin found in acacia wood. Our research suggests that there is an opportunity to manufacture standard pallets using locally sustainable wood resources, with some modifications to current industrial processes required.