Expectation Gap Research Articles

Expectation, perception, and satisfaction of antenatal care services among pregnant women attending health facilities of Lumbini province, Nepal: a cross-sectional study

Background: Antenatal care (ANC) plays a crucial role in ensuring the health and well-being of pregnant women by providing regular checkups to identify potential complications and deliver important guidance on pregnancy and childbirth. While the expectations surrounding ANC services are shaped by user's individual needs and preferences, the quality of care experienced is largely determined by the service providers. The level of service quality significantly influences the utilization of ANC service, as women are more likely to use services that satisfied their expectations. This study aimed to assess the expectations, perceptions, and satisfaction levels of pregnant women concerning the ANC services offered by health institutions in Lumbini Province. Methods: An institution-based cross-sectional analytical study was carried out involving 2,986 pregnant women, selected through multistage cluster sampling. Quantitative analysis was carried out to calculate the perception, expectation, and satisfaction score. The SERVQUAL tool was utilized to measure expectation, perception and service quality gap. Results: The study involved 2,986 pregnant women, the majority of whom (76.7%) were aged 20-30 years, 38.5% were Janajati, most of them (32.5%) had a secondary level of education, and 78.8% were housewives. The expectation score was higher than the perception. Overall, only 67% of pregnant women were satisfied with the services. Conclusions: Significant disparities exist between the expectations and actual perceptions of ANC users, indicating a lower level of satisfaction among mothers with the ANC services. The study concluded that decreased satisfaction with the service is likely to reduce the trend of service utilization.

Energy Transition in Northern Netherlands: seeking a balance between top-down and bottom-up initiatives

This brief report focuses on top-down and bottom-up processes within the field of energy transition. It aims at gaining a better understanding of the needs of the local energy initiatives. On this basis, policy recommendations are formulated to help the municipality of Groningen to facilitate local energy initiatives, ultimately leading to a more balanced approach of the local energy transition. Thus, this study explored the (mutual) interests, barriers and expectations of the municipality and local citizen initiatives. The theoretical framework is the implementation analysis framework, distinguishing top-down and bottom-up approaches. Specifically, this qualitative (thematic analysis) research study investigates the mismatch in expectations between a number of local energy initiatives and the municipality of Groningen regarding their roles within the local energy transition context. To this end, semi-structured interviews have been conducted with members of the municipality of Groningen, Grunneger Power (a local energy intermediary), and four local energy initiatives. Need and expectation gaps have been identified and potential solutions have been explored. The main findings of the study illustrate the need of professional support for citizen initiatives, at both technical and organizational level, especially in the first phases of their development. Additionally, clear mutual communication on short and long-term planning and ambitions of the involved parties is of key importance for the alignment of the interests and the course of actions. Consequently, a clear context is needed, within which an exchange of feedback on the envisioned strategies, and the subsequent energy saving or generation interventions, can take place in an efficient and effective way. Additionally, such a context increases confidence and provides a clear understanding to the citizen initiatives regarding their role and the level and nature of support they can expect in their intended projects and activities. Based on these findings, policy implications have been drawn.

What works to reduce regional health inequalities? A case of East vs West Germany post reunification

Abstract Regional inequalities in mortality are rising across the globe. The case of German reunification offers a unique opportunity to explore how such inequalities can be reduced, or even eliminated: following reunification, a long-standing life expectancy gap between East and West Germany was closed for women and markedly reduced for men in a period of less than 15 years. Drawing from theory on health inequalities, we investigate the contribution of material, behavioural and psychosocial factors likely related to the narrowing of the life expectancy gap between East and West Germany following reunification. We used regional data from official national statistics covering the period 1994-2020 for 15 regions in East and West Germany. Using fixed-effects models with an interaction term for regions in the East, we investigated whether within-region changes in key hypothesised factors (social security expenditure, healthcare improvements, changes in alcohol consumption, and life satisfaction), have had differential impacts on life expectancy at birth and at 65 years. We find that increases in social security benefits in the East following reunification has been the most important factor for lowering inequalities between the two parts of Germany: for every standard deviation increase in social security benefits, life expectancy at birth increased by an additional 0.20 [0.07,0.33] years for males and by 0.15 [-0.01,0.31] years for females in East relative to West Germany. We find the protective effect of social security benefits also for women at 65 years (additional 0.14 years [0.006,0.268]) but not for men. Overall, our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing health disparities across regions with different levels of economic development. This provides additional support for the relevance of the materialist hypothesis and the political economy of root causes of health inequalities. Key messages • Our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing regional health disparities. • We find support for the materialist and political economy approaches to explaining health inequalities.

The Implementation of the KAM Reforms in Saudi Arabia: Stakeholder Perspectives on the Audit Expectations Gap

ABSTRACTThis exploratory study investigates the implementation of key audit matters (KAM) in audit reports under ISA701 to better understand how KAM disclosures may help narrow the audit expectations gap. The study draws on findings from semi‐structured interviews with 28 professional stakeholders from the Kingdom of Saudi Arabia (KSA). The study's aim was to explore the relationship between KAM disclosures and the audit expectations gap considering audit quality concerns. Our findings reveal that (i) financial statement users report that they better understand what the auditor does, which enhanced their confidence in the audit process; and (ii) at least some financial statement users report that KAM disclosures provide new information about companies' risks that management was not already providing. We further report that many interviewees (particularly Big Four external auditors) indicated that the KAM reforms did not enhance audit quality in KSA. Interestingly, a small number of non‐Big Four auditors believed that KAM disclosures have enhanced audit quality. The key message is that the KAM reforms did not necessarily improve audit quality but that they are perceived to have played a role in further narrowing the audit expectations gap and reducing the need for communication, thus creating market efficiencies.

An effective approach to tackling complex health policy challenges. Using a clinical microsystems approach and rethinking codesign

That people with serious mental illness have poor physical health and face a significant life expectancy gap compared with the general population is well known. Despite considerable policy focus in some countries, the gap in life expectancy remains. Tackling complex and persistent health problems such as this requires a systems-based approach, recognising the complexity of interacting components and their effects on the problem and on each other and applying collaborative analysis, design and implementation by those with knowledge of and expertise in the problem and the context. This paper describes the methods used to develop the Australian Being Equally Well National Policy Roadmap for better physical health care and longer lives for people with severe mental illness. Whilst recognising that high rates of physical health comorbidities are caused by many factors including lifestyle, access to high-quality healthcare and medication side effects, the work was focused on what could be done within Australian primary care to improve the physical health of this cohort. A Clinical Microsystem Approach was applied to synthesise clinical evidence with professional and lived experience, and an innovative policy development process was established, creating trust across all system levels. Participants with different kinds of knowledge and experience worked in discrete groups according to their professional or expert role whilst also being supported to participate in an intensive cross-collaboration. The potential value of this methodology for tackling other complex problems in health policy is discussed.

Expectation Gap: the Story of the Auditor`s Necessary and Impossible Mission

Expectation Gap: the Story of the Auditor`s Necessary and Impossible Mission

A framework for skills development for employability in Botswana’s competitive accounting environment

Orientation: The accounting labour market has undergone a metamorphosis in recent years, leading to new demands for generic skills. Universities have responded to the new demands by implementing several reforms in the accounting curriculum to address skills gap. Despite these major reforms, educational expectation gap is persistent in Botswana.Research purpose: The purpose of this study was to develop a framework for skills development for employability in the competitive and dynamic accounting environment in Botswana.Motivation for the study: A skills gap was identified, implying the need for a framework for skills development for employability in the competitive and dynamic environment, thereby improving the graduate’s pervasive skills.Research design, approach and method: This study employs a qualitative research approach to extract and analyse key themes, quotes and insights from recent reports submitted to Institutions of Higher Learning (IHLs) by students and industrial supervisors. Utilising thematic data analysis, this research systematically examines the qualitative data gathered to elucidate the effectiveness of competency frameworks as perceived by both parties.Main findings: Institutions of Higher Learning in Botswana are mandated to equip students with job market-relevant skills. However, graduates often fall short in critical areas such as advanced cognitive abilities, socio-behavioural competencies and information technology (IT) proficiency, hindering their effective transition from academia to the workforce.Practical and/or managerial implications: The contribution and societal impact of this study are summed up in a proposed framework for skills development for employability in the competitive and dynamic accounting environment in Botswana.Contribution and/or value-add: The proposed framework is designed so that universities can equip students with soft skills needed in ever changing accounting environment.

A Comparative Analysis of the Factors Influencing Job Expectations among Unemployed Men and Women in Sri Lanka

In Sri Lanka, persistent gender differences in unemployment rates exist, with women enduring greater rates of unemployment de-spite having a higher average educational attainment than men. Gender differences in job search intensity vary with attitudes to-ward employment or unemployment as attitudes play a significant role in employment decision-making. These differences are intimately linked to people's expectations and mindsets regarding their work, which are strongly influenced by societal and cultural gender roles. This study looks at how job expectations differ between unemployed men and women in Sri Lanka. This study relies on data from the Department of Census and Statistics Sri Lanka Labour Force Survey (2021) and a multinomial logistic model to analyse the total unemployed, male unemployed, and female unemployed separately while taking two dependent variables; job sector expectations and occupational expectations. The study's findings emphasise the pivotal role of gender in sharpening job expectations among the unemployed. Regarding job sector expectations, unemployed women are more inclined towards jobs in the public sector than those in the private sector because of the government's reputation for offering standardized working hours and a work-life balance conducive environment. Furthermore, there are noteworthy differences in occupational expectations as unemployed women are more likely to expect professional and managerial level jobs with the increase in higher education enrolment. This study offers a groundbreaking contribution to the literature by unveiling unique, gender-specific determinants of job expectations among Sri Lanka's unemployed, highlighting the influence of unemployment duration, and employing distinct analytical models to bridge significant theoretical, empirical and methodological gaps. Finally, this study puts forth the broader discourse on gender, unemployment, and labour market dynamics in Sri Lanka, offering gender-specific policy recommendations aimed at bridging the expectation gap between unemployed men and women in Sri Lanka.

IXBRL Adoption and the Pricing of Audit Services

ABSTRACT This study examines how inline XBRL (iXBRL) mandatory adoption impacts audit fees. Although iXBRL can make financial reporting information accessible to a wide range of external stakeholders, the presentation format change should have no impact on audit pricing. However, audit firms note that presenting nonaudited XBRL metadata on top of audited financial statements could lead to an expectation gap where external stakeholders believe that the inline tags have been audited despite no procedures being required. We find that iXBRL adoption is associated with higher audit fees. Upon further examination, we find that the increase in audit fees reflects more of a risk premium being placed on iXBRL clients rather than increased audit effort, as audit quality does not necessarily improve following adoption. We provide timely information on how auditors respond to iXBRL adoption. JEL Classifications: M41; M42; O33.

From Fandom to Fadeaway: Unpacking Factors Contributing to Anime Dropout

ABSTRACTThis study explores a case of anime dropout/disengagement to understand media information users. Particularly, this study identifies elements in anime (e.g., Tropes) that prevent audience from continue watching what they had started (i.e., dropout/disengagement). A content analysis of 226 posts from MyAnimeList.net, an online anime database and fan community, suggests that the major elements that motivate audience dropout are Plot/Narrative, Tropes, Artwork/Visual Style, Characters, and Mood. The expectation gap and sunk cost also contribute to disengagement. This study presents a way to enrich anime metadata through analyzing the identified elements. Additionally, this study suggests that understanding anime disengagement may contribute to the search and recommendation of anime.

Individual-Level Exposure to Residential Redlining in 1940 and Mortality Risk.

Historic redlining, the practice by the Home Owners' Loan Corporation (HOLC) of systematically denying credit to borrowers in neighborhoods that were inhabited by primarily African American individuals, has been associated with poor community outcomes, but the association with individual risk of death is not clear. To examine if exposure to residential redlining practices by HOLC in 1940 is associated with increased risk of death later in life. The study linked individuals who resided within HOLC-graded neighborhoods (defined as Census Enumeration Districts) in 1940 with administrative death records data. The study estimated hazard ratios as well as age-specific life expectancy gaps (at age 55, 65, and 75 years) for HOLC grading exposure. This was done using methods that adapted standard parametric survival analysis to data with limited mortality coverage windows and incomplete observations of survivors. The analysis sample consisted of 961 719 individual-level observations across 13 912 enumeration districts within 30 of the largest US cities (based on 1940 population counts) across 23 states. Data were analyzed between December 1, 2023, and September 4, 2024. The exposure was HOLC grade based on historic HOLC maps, with A representing "best" or creditworthy areas; B, "still desirable"; C, "definitely declining"; and D, "hazardous" areas not worthy of credit (ie, redlined), and the main outcome was age at death from the Social Security Numident file. The 961 719-person individual sample had a mean (SD) age of 19.26 (9.26) years in 1940 and a mean (SD) age at death of 76.83 (9.22) years. In a model adjusted for sex (52.48% female; 47.52% male), race and ethnicity (7.36% African American; 92.64% White), and latent place effects, a 1-unit lower HOLC grade was associated with an 8% (hazard ratio, 1.08 [95% CI, 1.07-1.09]) increased risk of death. At age 65 years, these hazard differentials translated into an estimated life expectancy gap of -0.49 (95% CI, -0.56 to -0.43) years for each 1-unit decrease of the HOLC grade. This study found that individuals who resided within redlined neighborhoods in 1940 had lower life expectancy later in life than individuals who resided within other HOLC-graded areas.

2024 practice analysis: a comparison of expectations vs actual performance of essential competencies in public relations

PurposeWe conducted the Universal Accreditation Board (UAB) practice analysis to examine perceptions of US public relations practitioners and educators regarding the essential competencies for entry-level and mid-career professionals. This is a trend analysis survey that is conducted every five years to assess changes in required competencies.Design/methodology/approachThe survey was distributed via email to organizations affiliated with the UAB. Two variations of the survey were available to differentiate between practitioners and educators. The study was conducted from February through March of 2024.FindingsWe found practitioners’ expectations for others exceeded their own actual performance levels. This may be attributed to social comparison bias. We have provided recommendations for updating the Accreditation in Public Relations (APR) and certificate exams based on our findings. For example, we recommend senior professionals adopt a nurturing leadership style when mentoring young professionals. The study also revealed that educators overestimated generative artificial intelligence (AI) use in the workplace, as practitioners exhibited a slower rate of adoption of AI. The literature and theories that guided the paper were AI use, the history of accreditation in public relations and the diffusion of innovation theory.Originality/valueThis research paper provides insights related to the diffusion of AI competencies in the workplace. Additionally, this research adds to public relations literature by revealing the gap in expectations of senior professionals for beginning and mid-career professionals and their own job performance.

How Early Career Family Medicine Women Physicians Negotiate Their First Job After Residency.

Nested within a growing body of evidence of a gender pay gap in medicine are more alarming recent findings from family medicine: a gender pay gap of 16% can be detected at a very early career stage. This article explores qualitative evidence of women's experiences negotiating for their first job out of residency to ascertain women's engagement with and approach to the negotiation process. We recruited family physicians who graduated residency in 2019 and responded to the American Board of Family Medicine 2022 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women's experiences through the transitory stages from residency to workforce. A qualitative researcher used Zoom to interview 19 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed using NVivo software following an Inductive Content Analysis approach. Three main themes emerged from the data. First, salary was found to be nonnegotiable, exemplified by participants' inability to change initial salary offers. Second, the role of peer support throughout residency and early career was crucial to uncovering and rectifying salary inequity. Third, a pay expectation gap was identified among women from minority and low-income households. To rectify the gender pay gap in medicine, a systems-level approach is required. This can be achieved through various levels of interventions: societally expanding the use of and removing the stigma around parental leave, recognizing the importance of contributions not currently valued by productivity-based payment models, examining assumptions about leadership; and institutionally moving away from fee-for-service systems, encouraging flexible schedules, increasing salary transparency, and improving advancement transparency.

Gender gap in consumer expectations

ABSTRACT This paper provides empirical evidence of the persistence of gender gaps in consumer expectations regarding personal finances and the national economy’s performance. Using individual-level data from two independent but comparable consumer attitude surveys – one nationally representative of the US and the other statewide representative of Florida – it demonstrates that women are significantly less likely than men to hold optimistic expectations about their personal financial situation and US business conditions over the next year and the next 5 years. These gender expectation gaps, ranging from 5% to 8.5% points, remain highly significant even after controlling for respondents’ socio-demographic characteristics, as well as survey-month and geographic location (including zip code) fixed effects. Furthermore, these gaps are prevalent in both surveys and have been present for more than four decades. Although persistent over time, these gender differences tend to narrow during periods of economic hardship and widen during economic expansions.

“I CAN'T TAKE IT ANYMORE”: THE EXPERIENCE OF BEING MANAGED FOR SUSPECTED CAUDA EQUINA SYNDROME IN THE EMERGENCY DEPARTMENT

Purpose and backgroundCauda equina syndrome (CES) leads to nerve compression in the lumbar spine, and requires immediate treatment to prevent permanent neurological dysfunction, including urinary/anorectal incontinence. The consequences for the patient are significant as, in the decade to 2018, CES has cost the NHS £186,134,049. No study has reported patients’ experiences of being managed with suspected CES in an emergency department (ED), and this study explores patients’ experiences and how the NHS can optimise care for patients experiencing this condition.Methods and ResultsIn this qualitative secondary analysis, 14 participants (aged 23–63 years) with suspected CES were purposively sampled from 4 EDs in England. Online, semi-structed interviews were undertaken (in 2021, during the pandemic), and were audio-recorded and transcribed verbatim. Data were managed using a Framework approach and analysed thematically.Three themes were identified: quality of care; environmental factors; and expectations. The quality of care included managing uncertainty, the importance of communication, appropriate assessment and follow-up care. Environmental factors, including the chairs, waiting times and the busy nature of the ED, negatively impacted patients’ experiences. Furthermore, an expectation gap was identified, as most individuals came to the ED expecting to receive a scan, an accurate diagnosis and a cure. Despite frustrations, patients expressed gratitude towards the ED staff.ConclusionThis study highlights the importance of empathically acknowledging the patient's pain and providing comprehensive assessments and management plans for people attending ED with suspected CES. Optimising the ED environment to minimise patients’ pain and distress while waiting to access care is paramount and overdue.No conflicts of interest Sources of fundingFunding for primary data: Health Education England & National Institute of Health and Care Research (ICA-CDRF-2018-04-ST2-040)

Escaping ‘Groundhog Day’: the transformative possibilities of reconceptualising audit

The statutory company audit can be a puzzling phenomenon. While heralded as a public interested function, its resulting audit reports are only addressed to the members of the audited company. Audit may be widely acknowledged as a social construction, but it has remained conceptually static, with a recycling of reform proposals and a resulting, persistent audit expectations gap. Recent responses to this state of affairs, however, have included calls for a ‘dynamic repair’ of audit and an official proposal by the Brydon review for the UK government to give legislative backing to a significantly expanded purpose for audit. This paper further advances such proposals by illuminating the transformative possibilities of conceptualising audit as an innovation ecosystem in its own right and classifying auditors as ecosystem engineers. Collectively, such a conceptual reconfiguration can serve to enhance both the social purposefulness of audit and its public interested sense of professionalism by freeing audit from the constraints of excessive standardisation and promoting its inherent, functional diversity.

Effectiveness of Auditor’s Report as a Medium of Communication to Reduce the Level of the Audit Expectation Gap of Amon Chartered Accountants

Effectiveness of Auditor’s Report as a Medium of Communication to Reduce the Level of the Audit Expectation Gap of Amon Chartered Accountants

Reducing the Gap in Knowledge and Expectations between Clinicians and People with Polycystic Ovary Syndrome or Adrenal Conditions: Simulation via Instant Messaging—Birmingham Advance: Patient and Public Involvement (SIMBA-PPI) Study

BackgroundTo evaluate the efficacy of SIMBA as an educational intervention for both HCPs and people with either PCOS or adrenal conditions and to study the change in knowledge of people with PCOS or adrenal conditions about the conditions and expectations from the HCPs involved in their care following SIMBA-PPI sessions.MethodsTwo SIMBA-PPI sessions (SIMBA-PPI Polycystic ovary syndrome (SIMBA-PCOS) and SIMBA-PPI Adrenal conditions (SIMBA-Adrenal conditions)) were conducted in September 2021 and March 2022. In both sessions, HCPs interacted with moderators on patient management through WhatsApp. Patients with respective conditions underwent workshop-style learning in the same cases. SIMBA-PCOS transcripts were also translated into Brazilian Portuguese and workshops were held in both Brazilian Portuguese and English. The two groups (HCPs and patients) were then brought together to discuss exploring gaps in knowledge and expectations. The Wilcoxon Signed-Rank test compared differences in pre- and post-SIMBA self-reported confidence levels in HCPs and patients. Qualitative data from the online recordings were transcribed and analysed with inductive thematic analysis to identify gaps in knowledge and expectations from managing the cases.Results48 HCPs and 25 patients participated in our study. When compared to pre-SIMBA confidence levels, SIMBA-PPI sessions effectively improved clinicians’ confidence in managing PCOS (40.5%, p < .001) and adrenal conditions (23.0%, p < .001) post-SIMBA. Patient participants’ confidence in HCPs significantly increased in the PCOS session (SIMBA-PCOS: 6.25%, p = 0.01).ConclusionsIntegration of PPI into SIMBA improved HCPs' confidence in managing PCOS and adrenal conditions. SIMBA-PPI also improved patients’ confidence in HCPs. Our findings suggest that participating in SIMBA-PPI sessions can reduce the gap in knowledge and expectations between patients and HCPs involved in their care.

Impact of Digital Transformation on Carbon Performance of Industrial Firms Considering Performance–Expectation Gap as a Moderator

The swift advancement of the industrial economy has depleted resources and degraded the environment, hindering global economic growth. Digitalization provides a novel approach to decrease carbon emissions and enhance the environment. This study utilized panel data from 2012 to 2021 of listed A-share industrial enterprises as the research sample. It employed suitable measures to assess digitalization and corporate carbon performance. Furthermore, a double fixed-effects regression model was constructed to examine the correlation between digitalization and corporate carbon performance. The findings indicate that digital transformation and corporate carbon performance varied widely across different firms, but there was notable overall progress. Adopting digital transformation in the industrial sector had a substantial and favorable effect on enterprises’ carbon performance. This effect remained substantial despite multiple robustness tests. An examination of the mechanisms involved indicated that digital transformation enhances the carbon performance of industrial sector enterprises by improving the clarity and accessibility of company information. Corporations may intentionally seek difficulties and take strategic risks due to performance–expectation discrepancies. Due to the digital transformation, this behavior may improve the carbon performance of listed industrial businesses. The carbon performance of industrial businesses after digital transformation depends on elements like property rights, market rivalry, industry pollution, and capital investment.

Educational inequalities in deaths of despair in 14 OECD countries: a cross-sectional observational study

BackgroundDeaths of despair are a key contributor to stagnating life expectancy in the USA, especially among those without a university-level education, but these findings have not been compared internationally.MethodsMortality and...