Experiences Of Stakeholders Research Articles

Policy and the politics of COVID-19 communication responses: a comparative case study of two border provinces in Thailand

This article aims to explore the policy interpretations of Thailand’s risk communication policy formulation and implementation process, and its potential challenges during the COVID-19 pandemic by comparing the situations in two Thai border provinces: Tak (Thailand-Myanmar) and Nong Khai (Thailand-Lao PDR). This research adopted a comparative case study design, analyzing policy documents and interviewing key policy stakeholders. It combined an interpretive policy framework with a ‘multiple streams/critical juncture’ to understand the perceptions and experiences of policy stakeholders and the interpretation of policy texts during a public health crisis. The findings demonstrate that these two similar cases have had different local health communication policy implementations. Indeed, the results showed the different policy operations and communication challenges in both areas, which included outdated bureaucratic routines and complex government communication mechanisms resulting in health communication response delays, cultural and language barriers, and problems with access to services caused by digital health disruptions. The health communication outcomes in the two provinces also reflected the impact of both Thai border health politics and the international politics between Thailand and its neighboring countries on health communication operations and the interpretations of all policy agents.

Exploring indirect impacts of COVID-19 on local health systems from the perspectives of health workers and higher education stakeholders in the Philippines using a phenomenological approach

BackgroundOur study aimed to explore the experiences of stakeholders from local government units, health facilities and higher education institutions on the delivery of non-COVID-19 health services after the initial wave of the pandemic.MethodsTwenty-nine public health workers, thirteen university staff, and four hospital administrators in the Philippines participated. Using a descriptive phenomenological approach, we analysed transcripts from six focus group discussions conducted online between March and June 2021.FindingsThe COVID-19 pandemic made the routine health programs inaccessible due to hesitancy among patients to visit health facilities, a shift in public health priorities, and lack of students to augment the existing workforce.Public health workers reported stress and mental health exhaustion. Apart from fear of infection during service provision, public health workers and university staff experienced work overload, pressure to learn new technology, and webinar fatigue. Mental health problems have surfaced as health workers and young people have become more affected while support services remain insufficient.Public health workers have reported actions to maintain service delivery in the new normal such as use of telehealth and social media. However, issues on workforce wellbeing and digital equity posed adaptation challenges. Participants suggested partnership with higher education institutions as pivotal to position local health systems towards recovery.InterpretationThe rapid change in the service landscape highlights the importance of sustainable partnerships, effective workforce management, equitable digital innovations, and promoting mental wellbeing to preserve community, school, and occupational health and rebuild resilient local health systems in low-resourced areas.FundingThis research is proudly supported by the Australia-ASEAN Council, Australian Government Department of Foreign Affairs and Trade.

Innovation, Commerce and Assisted Reproductive Technology: Opportunities and Challenges

Background: The increasing demand for ART services in Australia has supported the development of a significant number of private sector commercial providers. This sector is innovative and research active, but the effects of commercial influences on research and clinical innovation have not been fully explored. Here we report on the results of a National Health and Medical Research-funded project exploring the views and experiences of professionals working in the ART field. Aims: To elucidate the views and experiences of expert stakeholders regarding research and innovation in the ART sector. Method: We interviewed 31 ART industry stakeholders including medical, nursing, counselling, management and scientific staff, owners/directors, regulators, advocates, and referring clinicians using a standardised semi-structured interview guide. Participants were asked about strengths and weaknesses of the current system and what, if any, reform is necessary. Three team members coded the data for themes relevant to research and innovation and analysed it in accordance with the principles of thematic analysis. Results: There are several positive impacts of commercial forces on research and innovation, including competition, scale, and clinicians’ financial stake in research. Commercialised services can more easily commit to large national, transnational and technology-intensive research projects, and they can translate results rapidly into practice. It is, however, difficult to perform clinical trials in the ART setting and there are incentives to implement interventions in advance of comprehensive evaluation. Clinical innovation is a crucial component of ART practice, but it is hampered by lack of a clear, agreed distinction between innovation, experimentation, and ‘add-on’ treatments; deficiencies in the formal processes used to appraise the outcomes of innovation and challenges of communication and consent. Conclusions: Professionals who have a deep understanding of research and innovation in the ART sector recognise both benefits and harms of its current commercial organisation. To harness the benefits of commercialisation, the ART industry requires a fair, sustainable, coordinated and needs based approach to research funding and a consistent and principled-based approach to clinical innovation.

Equity, diversity and inclusion of pediatric clinician-scientists in Canada: a thematic analysis.

Underrepresented voices and perspectives are missing from academic and clinical health sciences. We aimed to define the unique opportunities and challenges of pediatric clinician-scientists related to equity, diversity and inclusion; and to identify key components of training needed to support people from equity-seeking groups as emerging and early-career pediatric clinician-scientists to generate diverse health research leaders in knowledge generation, implementation and translation. Using a qualitative descriptive approach, we examined the experiences of clinician stakeholders. Semistructured interviews were conducted with pediatric clinician-scientist stakeholders. Thematic analysis was performed. We interviewed a total of 39 individuals. Our analysis resulted in 4 interrelated themes: the pervasiveness and invisibility of sexism; the invisibility and visibility of racism; proposed individual-level solutions to the sexism and racism; and proposed institutional and system-level changes to address the porous and leaky pipeline. These themes acknowledged that, ultimately, system change is required for addressing equity, diversity and inclusion in clinical and academic training environments. These findings highlight the importance of addressing systemic biases that limit the inclusion of women and racialized individuals in pediatric clinician-scientist careers. Further research is needed to explore the problem of exclusion, which will, in turn, inform education of pediatric clinician-scientists and inform better ways to promote equity, diversity and inclusivity; these steps are needed to foster systemic change in the cultures that perpetuate exclusivity in both academic and clinical communities.

Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned

BackgroundA well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource–constrained settings.MethodsWe designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey (n = 25) and qualitative data through in-depth interviews (n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes.ResultsAll mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention.ConclusionWe offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention’s success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.

A Qualitative Investigation of Individual, Interpersonal, and Institutional Contributions to Postpartum Work-Family Balance

Managing personal and professional responsibilities may be challenging during the postpartum period, as employees navigate new roles, responsibilities, and family dynamics. The purpose of this paper was to understand the work/life balance experiences of diverse stakeholders and identify opportunities to improve the work environment. We conducted a series of in-depth focus groups with faculty, staff, and graduate students (n = 22), and in-depth interviews with administrators (n = 10) at a research-intensive university in the United States. A six-phase thematic analysis approach was used to examine the experiences and perspectives of individuals with different roles. Three themes with subsequent subthemes emerged: 1) employee role shapes perspectives on campus policies and practices; 2) confusion about policies exacerbates return-to-work issues; and 3) coworkers and supervisors are the primary sources of postpartum support in this workplace. Employees in our study expressed strong desires for clear, consistent institutional policies to ensure employees’ postpartum return-to-work experiences were not dependent on informal arrangements with coworkers and supervisors. Faculty, staff, and graduate student postpartum needs are shaped by individual, interpersonal, and community factors. Clear communication between individuals who make policy decisions and those who are subject to the policies may reduce employee issues during the postpartum period.

The Love to Read Programme

The Love to Read Programme
 Oxley, E; Ricketts, J; Shapiro, L & McGeown, S.
 
 Collaborative research practices, which involve children, young people, teachers and/or stakeholders partnering in research, draws upon the distinct, yet complementary knowledge, expertise and experience of each. Collaborative research approaches have potential to narrow the gap between educational research and practice (NFER, 2017) and position the needs and experiences of stakeholders at the centre of the research (Calderón López & Theriault, 2017).
 
 This poster describes the Love to Read project, which aims to increase children’s reading motivation and engagement by synthesising relevant theory and research, with children’s ideas and experiences, and teachers' pedagogical expertise. In Phase 1, (Phase 1 preregistration: https://osf.io/5ztjk), 59 demographically diverse children from across the UK, with different reading attitudes and experiences, participated in online or in-person interviews. An inductive data-driven approach to thematic analysis was used (Braun & Clarke, 2006) to understand the diversity of children’s book reading experiences and children’s ideas for practices to promote reading motivation and engagement. In Phase 2, children’s insights were shared with teachers, as the research team and teachers collaborated to co-design a professional development programme aimed at increasing reading motivation and engagement in children (Phase 2 preregistration:https://osf.io/xsjhc). The final part of Phase 2 aims to evaluate the co-design process, from participating teachers’ and researchers’ perspectives.
 While pre-registration has recently gained momentum in qualitative research, especially experimental studies, open science practices are used considerably less in qualitative research. The Love to Read project has pre-registered all qualitative methods for Phases 1 and 2, including interview schedules and data analysis protocols. Traditionally, preregistration is a tool used to distinguish exploratory and confirmatory research. Qualitative research, however, is exploratory by nature. For example, using data-driven thematic analysis meant hypotheses could not be drawn in advance, as this could have created bias in our analysis. Furthermore, interview schedules can change or adapt depending on the responses from the interviewee. Therefore, strict compliance to methods such as those which would take place for quantitative data collection are not wholly possible. Nonetheless, using pre-registration should still be encouraged for qualitative researchers to add credibility and transparency of their research.
 This project uses co-design, with children, teachers and other professionals, creating a unique opportunity to develop a professional learning programme which is likely to be engaging and relevant to children, and acceptable and feasible to teachers, maximising the likelihood of uptake, and successful and sustained implementation. The project completion will result in free and openly available continued professional development materials for teachers.

Higher Education Stakeholders’ Early Responses to the COVID-19 Crisis

In early 2020, the COVID-19 pandemic necessitated a swift and dramatic shift in how higher education teaching, learning, and other operations occurred. In the months that followed, higher education stakeholders endured major transitions and unexpected challenges. Higher education leaders, policymakers, students, faculty, and staff were influenced by the pandemic in a variety of ways. There is much to be learned from the experiences of higher education stakeholders during the early months of the pandemic. This article introduces the two-part special issue on Higher Education Stakeholders’ Early Responses to the COVID-19 Crisis, situating the research presented in the special issue within the broader context of high-stakes decision-making during a period of global uncertainty, stress, and conflict. The first part of the special issue presents research on the responses of institutional leaders and policymakers to the COVID-19 crisis. The second part of the special issue examines student and “classroom” experiences during the early months of the pandemic. Studies such as these on the responses of higher education stakeholders to the COVID-19 crisis enhance important understanding about how institutional leaders, policymakers, and other stakeholders made sense of and took steps to address the challenges presented by the pandemic.

The school stakeholder community as a source of capital for the talent development of black students in a high school engineering career academy

PurposeThis paper aims to examine the role of school stakeholders (e.g. advisory board members, school administrators, parents, teachers and school board members) at a 99% black academy in promoting the achievement and broadening participation of high school black students in engineering career pathways.Design/methodology/approachThe authors followed a qualitative case study design to explore the experiences of school stakeholders (e.g. students, district and school personnel and community partners) associated with the implementation of the career academy (Stake, 2006; Yin, 1994).FindingsThe authors found that the school relied heavily on the support of the community in the form of an advisory board – including university faculty and industry leaders – to actively develop culturally responsive strategies (e.g. American College Test preparation, work-based learning opportunities) to ensure the success of black students interested in pursuing career pathways in engineering. Thus, school stakeholders in the academy of engineering served as authentic leaders who inspired academy students by serving as role models and setting examples through what they do as engineering professionals. It was quite evident that the joy and fulfillment that these authentic leaders gained from using their talents directly or indirectly inspired students in the academy to seek out and cultivate the talents they are good at and passionate about as well (Debebe, 2017). Moreover, the career academy provided environmental or sociocultural conditions that promoted the development of learners’ gifts and talents (Plucker and Barab, 2005). Within that context, the goals of career academy school stakeholders were to support students in the discovery of what they are good at doing and to structure their educational experiences to cultivate their gifts into talents.Research limitations/implicationsIt is also important to acknowledge that this study is not generalizable to the one million career academy students across the nation. Yet, the authors believe researchers should continue to examine the career academy advisory board as a source of capital for engaging and preparing diverse learners for success post-high school. Further research is needed to investigate how advisory boards support students’ in school and postsecondary outcomes, particularly for diverse students.Practical implicationsThe authors highlight promising practices for schools to implement in establishing a diverse talent pipeline.Social implicationsOn a theoretical level, the authors found important insights into the possibility of black students benefiting from a culturally responsive advisory board that provided social and cultural capital (e.g. aspirational, navigational and social) resources for their success.Originality/valueWhile prior researchers have studied the positive impact of teachers in career academies as a contributor to social capital for students (Lanford and Maruco, 2019) and what diverse students bring to the classroom as a form of capital Debebe(Yosso, 2005), research has not identified the role of the advisory board (in its efforts to connect the broader community) as a vehicle for equipping ethnically and racially diverse students who come from economically disadvantaged backgrounds with social capital. Within that sense, the authors believe the advisory board at Stanton Academy relied on what the authors term local community capital to provide resources and supports for black students’ successful transition from high school into science, technology, engineering, and mathematics (STEM)-related college and career pathways.

Using systems-mapping to address Adverse Childhood Experiences (ACEs) and trauma: A qualitative study of stakeholder experiences.

Adverse childhood experiences (ACEs) and trauma have been linked to decreased psychosocial and physiological health functioning. While various individual and community-level interventions to address ACEs have been reported, one novel approach that has not been explored in detail is a community-engaged causal loop diagramming project, or systems mapping project (SMP), in which diverse stakeholders work together to document the forces that are creating the outcomes and patterns within the community. To better document and understand the impact of participation in an SMP, we conducted in-depth, qualitative interviews with 16 stakeholders who were involved in a systems-mapping process facilitated by a local nonprofit in Eastern North Carolina. We used an iterative, content analysis coding process to generate and analyze themes from these interviews. Three major themes emerged: 1) Recognition and understanding of own trauma, 2) Trauma as both a community issue and an individual issue, and 3) Systems-mapping as a conceptual tool with practical benefits. All participants strongly recommended the systems-mapping approach to other communities and believed that it is a valuable tool for empowerment and provided several considerations for future organizers of similar systems-mapping projects. Our findings suggest that systems mapping is a feasible, transferable, and promising modality for understanding and addressing ACEs at the individual, interpersonal, and community-levels, as well as for putting community voices at the forefront of efforts to address ACEs.

Digital Twins for Managing Health Care Systems: Rapid Literature Review.

BackgroundAlthough most digital twin (DT) applications for health care have emerged in precision medicine, DTs can potentially support the overall health care process. DTs (twinned systems, processes, and products) can be used to optimize flows, improve performance, improve health outcomes, and improve the experiences of patients, doctors, and other stakeholders with minimal risk.ObjectiveThis paper aims to review applications of DT systems, products, and processes as well as analyze the potential of these applications for improving health care management and the challenges associated with this emerging technology.MethodsWe performed a rapid review of the literature and reported available studies on DTs and their applications in health care management. We searched 5 databases for studies published between January 2002 and January 2022 and included peer-reviewed studies written in English. We excluded studies reporting DT usage to support health care practice (organ transplant, precision medicine, etc). Studies were analyzed based on their contribution toward DT technology to improve user experience in health care from human factors and systems engineering perspectives, accounting for the type of impact (product, process, or performance/system level). Challenges related to the adoption of DTs were also summarized.ResultsThe DT-related studies aimed at managing health care systems have been growing over time from 0 studies in 2002 to 17 in 2022, with 7 published in 2021 (N=17 studies). The findings reported on applications categorized by DT type (system: n=8; process: n=5; product: n=4) and their contributions or functions. We identified 4 main functions of DTs in health care management including safety management (n=3), information management (n=2), health management and well-being promotion (n=3), and operational control (n=9). DTs used in health care systems management have the potential to avoid unintended or unexpected harm to people during the provision of health care processes. They also can help identify crisis-related threats to a system and control the impacts. In addition, DTs ensure privacy, security, and real-time information access to all stakeholders. Furthermore, they are beneficial in empowering self-care abilities by enabling health management practices and providing high system efficiency levels by ensuring that health care facilities run smoothly and offer high-quality care to every patient.ConclusionsThe use of DTs for health care systems management is an emerging topic. This can be seen in the limited literature supporting this technology. However, DTs are increasingly being used to ensure patient safety and well-being in an organized system. Thus, further studies aiming to address the challenges of health care systems challenges and improve their performance should investigate the potential of DT technology. In addition, such technologies should embed human factors and ergonomics principles to ensure better design and more successful impact on patient and doctor experiences.

The Evaluation of an Interprofessional QI Program: A Qualitative Study.

Background: Quality Improvement (QI) is the key for every healthcare organization. QI programs may help healthcare professionals to develop the needed skills for interprofessional collaboration through interprofessional education. Furthermore, the role of diversity in QI teams is not yet fully understood. This evaluation study aimed to obtain in-depth insights into the expectations and experiences of different stakeholders of a hospital-wide interprofessional QI program. Methods: This qualitative study builds upon 20 semi-structured interviews with participants and two focus groups with the coaches and program advisory board members of this QI program. Data were coded and analyzed using thematic analysis. Results: Three themes emerged from the analysis: “interprofessional education”, “networking” and “motivation: presence with pitfalls”. Working within interprofessional project groups was valuable, because participants with different experiences and skills helped to move the QI project forward. It was simultaneously challenging because IPE was new and revealed problems with hierarchy, communication and planning. Networking was also deemed valuable, but a shared space to keep in contact after finalizing the program was missing. The participants were highly motivated to finish their QI project, but they underestimated the challenges. Conclusions: A hospital-wide QI program must explicitly pay attention to interprofessional collaboration and networking. Leaders of the QI program must cherish the motivation of the participants and make sure that the QI projects are realistic.

Benefits and drawbacks of EIA decentralisation in Pakistan

Environmental impact assessment (EIA) was decentralised in Pakistan in 2010. The literature mentions compromised EIA effectiveness in the country, but no previous study tried to investigate how decentralisation of environmental governance has influenced EIA effectiveness. This study is the first of its kind which explores the opinions of key EIA stakeholders regarding the benefits and drawbacks of EIA decentralisation. Thirty-seven semi-structured interviews were conducted with officials from environmental protection agencies (EPAs), Ministry of Climate Change (MoCC) and former Ministry of Environment officials and EIA consultants. Interview data was categorised into themes related to pros and cons of decentralisation. The biggest benefit offered by decentralisation to the EPAs was to make their own customised EIA laws and regulations. However, to date, four EPAs have somewhat modified the 1997 Pakistan Environmental Protection Act and two have updated the 2000 Initial Environmental Examination/EIA regulations. Limited coordination between EPAs and MoCC, political influence and lack of accountability of EPAs were highlighted as the drawbacks of decentralisation. Some EPA officials, however, mentioned that the environmental condition of their areas has improved due to the autonomy of EPAs. Decentralisation is a good idea if provinces use their right to legislate effectively and some sort of accountability mechanisms for EPAs are introduced. The study holds significance because it fills an important knowledge gap. The experience of key EIA stakeholders from the entire country regarding a decentralised EIA system provides insight not just for Pakistan but to policymakers worldwide who may want to decentralise or recentralise EIA in their countries. Future studies may be conducted to evaluate the effectiveness of EIA legislation updated by some EPAs.

Paper 1: Demand-driven rapid reviews for health policy and systems decision-making: lessons from Lebanon, Ethiopia, and South Africa on researchers and policymakers’ experiences

BackgroundRapid reviews have emerged as an approach to provide contextualized evidence in a timely and efficient manner. Three rapid review centers were established in Ethiopia, Lebanon, and South Africa through the Alliance for Health Policy and Systems Research, World Health Organization, to stimulate demand, engage policymakers, and produce rapid reviews to support health policy and systems decision-making. This study aimed to assess the experiences of researchers and policymakers engaged in producing and using rapid reviews for health systems strengthening and decisions towards universal health coverage (UHC).MethodsUsing a case study approach with qualitative research methods, experienced researchers conducted semi-structured interviews with respondents from each center (n = 16). The topics covered included the process and experience of establishing the centers, stimulating demand for rapid reviews, collaborating between researchers and policymakers, and disseminating and using rapid reviews for health policies and interventions and the potential for sustaining and institutionalizing the services. Data were analyzed using thematic analysis.ResultsMajor themes interacted and contributed to shape the experiences of stakeholders of the rapid review centers, including the following: organizational structural arrangements of the centers, management of their processes as input factors, and the rapid reviews as the immediate policy-relevant outputs. The engagement process and the rapid review products contributed to a final theme of impact of the rapid review centers in relation to the uptake of evidence for policy and systems decision-making.ConclusionsThe experiences of policymakers and researchers of the rapid review centers determined the uptake of evidence. The findings of this study can inform policymakers, health system managers, and researchers on best practices for demanding, developing and using rapid reviews to support decision- and policymaking, and implementing the universal healthcare coverage agenda.

A protocol to evaluate the impact of embedding Public and Patient Involvement in a structured PhD program for stroke care.

BackgroundEmbedding Public and Patient Involvement (PPI) in postgraduate research has been recognized as an important component of post-graduate training, providing research scholars with an awareness and a skillset in an area which prepares them for future roles as healthcare researchers. Improving Pathways for Acute STroke And Rehabilitation (iPASTAR) is a structured PhD training program [Collaborative Doctoral Award (CDA)] which aims to design a person-centered stroke pathway throughout the trajectory of stroke care, to optimize post-stroke health and wellbeing. PPI is embedded at all stages.PurposeThe iPASTAR research programme was strongly informed by a round-table PPI consultation process with individuals who experienced stroke and who provided broad representation across ages, gender, geographical locations (urban and rural) and the PhD themed areas of acute care, early supported discharge and lifestyle-based interventions after stroke. Four PhD scholars taking part in the CDA-iPASTAR now work collaboratively with four stroke champions, supported by a wider PPI advisory panel.MethodsThis study will evaluate the process and impact of embedding PPI during a PhD program. We will conduct a longitudinal mixed-methods evaluation, conducting focus groups at 24, 36, and 48 months to explore the experiences of the key stakeholders involved. The participants will include PhD scholars, PPI partners (PPI Advisory Group and PPI Champions), PhD supervisors and a PPI manager. An independent researcher will conduct the evaluation. We will include focus groups, individual interviews and participant reflections. Qualitative data will be analyzed using thematic and content analysis, quantitative data will be analyzed using descriptive statistics.DiscussionPPI and patient voice initiatives bring together researchers, family, and people with health care issues into meaningful dialogue and allow the development of a patient-voice learning network. Embedding PPI training within a PhD program can build meaningful capacity in PPI partnerships in stroke research.

Resident-to-Resident Aggression in Private Seniors’ Residences

Abstract: Resident-to-resident aggression (RRA) is a globally-recognized problem in long-term care centers which is presently understudied among private seniors’ residences (PSRs) for independent and semi-independent older adults. This research documents the manifestations of RRA in PSRs in Québec and identifies the need to develop a program promoting wellness care and countering RRA from the viewpoint of residents who experienced it as well as employees and external intervenors who intervene in such situations. We conducted 25 individual interviews in four PSRs showing that RRA can manifest in diverse forms. The explicit and implicit needs identified refer to prevention and intervention. This research is the first to conceptualize the needs of experienced stakeholders in PSRs to develop a program promoting wellness care and countering RRA.

Community-based house improvement for malaria control in southern Malawi: Stakeholder perceptions, experiences, and acceptability.

House improvement (HI) refers to the full screening or closing of openings such as windows, doors, and eaves, as well as the installation of ceilings, to reduce mosquito-human contact indoors. HI is a viable supplementary intervention that reduces malaria transmission further than the existing strategies alone. In Malawi, HI has not been widely implemented and evaluated for malaria control. Concerns about lack of local evidence, durability in different epidemiological and cultural settings, and the cost of large-scale implementation are among the reasons the strategy is not utilised in many low-income countries. This study assessed community perceptions, experiences, and acceptability of community-led HI in Chikwawa district, southern Malawi. This was a qualitative study where separate focus group discussions were conducted with members from the general community (n = 3); health animators (n = 3); and HI committee members (n = 3). In-depth interviews were conducted with community members (n = 20), and key-informant interviews were conducted with health surveillance assistants and chiefs (n = 23). All interviews were transcribed and coded before performing a thematic content analysis to identify the main themes. Coded data were analysed using Nvivo 12 Plus software. Study participants had a thorough understanding of HI. Participants expressed satisfaction with HI, and they reported enabling factors to HI acceptability, such as the reduction in malaria cases in their villages and the safety and effectiveness of HI use. Participants also reported barriers to effective HI implementation, such as the unavailability and inaccessibility of some HI materials, as well as excessive heat and darkness in HI houses compared to non-HI houses. Participants indicated that they were willing to sustain the intervention but expressed the need for strategies to address barriers to ensure the effectiveness of HI. Our results showed the high knowledge and acceptability of HI by participants in the study area. Intensive and continued health education and community engagement on the significance of HI could help overcome the barriers and improve the acceptability and sustainability of the intervention.

Design and Implementation of a Blended Learning System for Higher Education in the Democratic Republic of Congo as a Response to Covid-19 Pandemic

Until now, the higher education system in the Democratic Republic of Congo has relied on the traditional face-to-face teaching method, which consists in the real physical presence of students and teachers during classes and lectures. Thus, the United Nations Educational, Scientific and Cultural Organization (UNESCO) is currently advocating e-learning as the only alternative for education in the COVID-19 era. It goes without saying that this requires specific frameworks and appropriate resources, including access to a good quality internet connection. Several countries around the world have implemented this recommendation since the first quarter of 2020 to protect their populations from the significant risks of Covid-19 contamination. In educational environment however, given the disadvantageous realities of the Democratic Republic of Congo, including the cost and quality of internet, the low rate of electrification, and the lack of experience of the educational stakeholders involved, the migration to e- learning remains a challenge. Thus, we propose in this paper a blended learning model that can smoothly introduce e-learning through a platform specially designed to integrate with the traditional way of delivering courses in Congolese higher education by combining the old method and e-learning based on ICT.

A qualitative exploration of the motor skills required for elite triathlon performance

PurposeThe purpose of this research was to investigate the beliefs, attitudes, and experiences of stakeholders in youth triathlon regarding the important motor subskills that are required to be successful at the elite level of triathlon competition. MethodTwenty-five participants were recruited from five stakeholder groups in triathlon and interviewed via video conference. A constructionist and relativist approach to thematic analysis was used to identify three first order themes and several second order themes. ResultsThe first, first order theme was ‘Continuous Motor Skills' which consisted of the invariant features of triathlon's continuous motor skills and the parameterization of continuous motor skills. The second, first order theme was ‘Discrete Motor Skills' and consisted of discrete motor skills involved with cornering and change of direction in each discipline and transition phases in triathlon. The final first order theme was ‘Adaptability in Continuous and Discrete Motor Skills'. ConclusionThis research provides a novel and more broad understanding of the beliefs, attitudes, and experiences of stakeholders in triathlon regarding important motor skills that are required to succeed at the elite level of the sport. This novel and broad understanding of important triathlon motor skills has theoretical implications for evaluating triathlon performance with skill acquisition as a primary focus. Additionally, this research is practically important for coaches, administrators, and athletic performance staff who design training programs and pathways for young, developing triathletes.

Can Personalization or Creativity Reduce Banner Blindness?

<h3>Introduction</h3> Loneliness and social isolation have been identified as significant public health concerns, but improving relationships and increasing social participation may improve health outcomes and quality of life. The aim of the Project About Loneliness and Social networks (PALS) study is to assess the effectiveness and cost-effectiveness of a guided social network intervention within a community setting among individuals experiencing loneliness and isolation and to understand implementation of Generating Engagement in Network Involvement (Genie) in the context of different organisations. <h3>Methods and analysis</h3> The PALS trial will be a pragmatic, randomised controlled trial comparing participants receiving the Genie intervention to a wait-list control group. Eligible participants will be recruited from organisations working within a community setting: any adult identified as socially isolated or at-risk of loneliness and living in the community will be eligible. Genie will be delivered by trained facilitators recruited from community organisations. The primary outcome will be the difference in the SF-12 Mental Health composite scale score at 6-month follow-up between the intervention and control group using a mixed effects model (accounting for clustering within facilitators and organisation). Secondary outcomes will be loneliness, social isolation, well-being, physical health and engagement with new activities. The economic evaluation will use a cost-utility approach, and adopt a public sector perspective to include health-related resource use and costs incurred by other public services. Exploratory analysis will use a societal perspective, and explore broader measures of benefit (capability well-being). A qualitative process evaluation will explore organisational and environmental arrangements, as well as stakeholder and participant experiences of the study to understand the factors likely to influence future sustainability, implementation and scalability of using a social network intervention within this context. <h3>Ethics and dissemination</h3> This study has received NHS ethical approval (REC reference: 18/SC/0245). The findings from PALS will be disseminated widely through peer-reviewed publications, conferences and workshops in collaboration with our community partners. <h3>Trial registration number</h3> ISRCTN19193075