Individual-level Outcomes Research Articles

Sender outcomes of online word-of-mouth transmission

PurposeDespite the importance of online word-of-mouth (WOM) communication to senders, receivers and concerned companies alike, a surprisingly limited amount of research exists on the impacts of online WOM participation on the senders themselves. Motivated by an attempt to fill this significant gap in the literature, this paper aims to investigate the sender outcomes of online WOM participation.Design/methodology/approachThe authors draw on insights from focus group studies and psychological theories of emotions, catharsis and regret and the signaling theory to develop a conceptual model linking the drivers and content characteristics of online WOM participation and sender outcomes.FindingsThe findings show that sender outcomes from online WOM transmission differ by the types of drivers stimulating the online sharing activity and the level of exaggeration in the senders’ self-generated contents. Specifically, online WOM triggered by emotions leads to catharsis and emotional homeostasis among the senders, while that stimulated by motivational drivers such as altruism, reciprocity, self-enhancement and belongingness leads to sender happiness. Exaggeration in self-generated WOM contents by the senders, in turn, leads to delayed outcomes of sender regret and reduced sender trust in general online WOM contents.Research limitations/implicationsThe most important contribution to online WOM research lies in the study of the outcomes of WOM transmission from a sender’s point of view. By drawing on our exploratory findings and psychological theories of emotions, catharsis and regret and the signaling theory, the authors develop a conceptual model linking the drivers and the exaggeration nature of online WOM participation and sender outcomes.Practical implicationsManagers should realize that the most fundamental way of ensuring positive consumption experiences is to listen to customer voices, including even the most negative of feedback shared privately or publicly, and use that information to improve essential customer experience aspects. The finding on the effects of online WOM exaggerations on sender regret suggests that companies and consumers alike should work on ensuring producing more accurate and complete online customer reviews. The finding on the negative effect of online WOM exaggerations on sender trust raises an important question on the meaning of high quality reviews from the company’s perspective. To pursue high quality reviews, merchants should not only aim at receiving the highest possible numeric ratings but also encourage most truthful accounts of purchase and usage experiences. In turn, online platforms such as Amazon should also factor the quality of online ratings more effectively into their product recommendation algorithms.Social implicationsIn further consideration of consumer welfare implications, online WOM transmissions should be more recognized as a tool for allowing consumers to cleanse their emotions associated with marketing stimuli.Originality/valueOverall, the qualitative study and proposed conceptual model contribute to a more thorough and deeper understanding of individual-level sender outcomes of online WOM participation.

When Is Proactivity Wise? A Review of Factors That Influence the Individual Outcomes of Proactive Behavior

There is solid evidence that proactivity, defined as self-initiated and future-focused action to change oneself or the situation, can positively benefit individuals and organizations. However, this way of behaving can sometimes be ineffective or have negative consequences. We seek to understand what factors shape the effect of proactivity on individual-level outcomes. On the basis of a review of 95 articles, we identify three categories of factors that mitigate or exacerbate the effectiveness of proactive behavior: task and strategic considerations (e.g., situational judgment), social and relational considerations (e.g., having an open leader), and self-regulatory considerations (e.g., learning orientation). We then extrapolate from this review, and draw on psychological theories of wisdom, to suggest that individuals can be more or less “wise” in the proactive goals they set, and in how they pursue those goals. In closing, we identify further research directions that flow from the notion of wise proactivity.

Does Social Context Affect Poverty? The Role of Religious Congregations

This paper contributes to the literature that aims at identifying and measuring the impact of social context on individual-level outcomes. We focus on religious congregations (social groups with which Christian worshipers feel associated) and investigate congregation effects on individual poverty using U.S. data and a multilevel approach. In order to correct for selection effects, we model congregation choice using a multinomial logit model and subsequently incorporate correction components into the multilevel model of congregation effects. Our empirical results support the existence of congregation effects and, therefore, the importance of social context on individual poverty. We find that congregation size, recreational services, initiatives to integrate new members and behavior standards play important roles in shaping the probability that churchgoers experience poverty. Individual behavior (in terms of participation in the religious life of congregations) also matters. These findings are in line with the idea that congregations’ activities can foster social interactions and cooperation reducing the individual probability of experiencing poverty.

The Multilevel Relationships of HIV-Related Stigma to Child and Caregiver Mental Health among HIV-Affected Households in South Africa.

HIV/AIDS-related (HAR) stigma is still a prevalent problem in Sub-Saharan Africa, and has been found to be related to mental health of HIV-positive individuals. However, no studies in the Sub-Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV-negative, HIV-affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra-individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community-representative sample of 508 HIV-affected households nested within 24 communities in KwaZulu-Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual-level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV-affected adults; and that community-level HAR stigma significantly predicts both individual-level mental health outcomes (anxiety) among HIV-affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV-affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.

Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial

BackgroundAlthough reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported.MethodsFollowing completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures.ResultsOf 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = − 69, 125) or IVR control condition (− 70 SSB kcals/day, 95% CI = − 209, 64). Call completion rates were similar across maintenance conditions (4.2–4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ.ConclusionOverall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption.Trial registryClinicaltrials.gov; NCT02193009; Registered 11 July 2014. Retrospectively registered.

Antecedents and Effects of Green IS Adoptions

This article develops an empirically grounded model of antecedents and effects of green information systems (IS) initiatives. The model is empirically based on an in-depth case of the Nordic financial institution. The authors' study examines the effect of several organizational factors, and characteristics of Green IS initiatives themselves on organizations' intention to adopt Green IS initiatives. Their study finds that employees' attitudes toward these initiatives affect their participation in the initiatives, as well as the success of Green IS initiatives. The adoption of the initiatives was seen to affect individual and organizational level outcomes, with positive experiences enabling employees to continue to use/support the initiatives, and organizations also often realizing improvements in practice.

Effects of Fine Particulate Matter and Its Constituents on Asthmatic and Allergic Symptoms in Preschool Children: A Cross-Sectional Study in Six Cities of China

Background/Aim: Few studies examined the effects of specific PM2.5 constituents on childhood asthma and allergy in China. We aimed to investigate the effects of various PM2.5 constituents on asthmatic and allergic symptoms in preschool children in China.Methods: A cross-sectional study was conducted among 48219 preschool children in six cities (Shanghai, Nanjing, Chongqing, Changsha, Urumqi and Taiyuan) based on China , Children ,Home and Health (CCHH) project in China. Information on allergic symptoms as well as demography were collected by questionnaires. Data for ambient PM2.5 concentration and its 5 constituents: BC, NH4&amp;#43;, SO42-, NO3- and OC were obtained from the global burden disease project to 205 kindergartens at a spatial resolution of 0.01&amp;#215;0.01(1km&amp;#215;1km) in six cities. A hierarchical logistic regression model was performed to explore the associations between kindergarten-level PM2.5 components and individual-level outcomes of asthmatic and allergic symptoms controlling for demography and other covariates.Results: A total of 30759 participants (51.7% male) were finally completed the study due on the missing data. Both the single-pollutant and two-pollutants model showed that ambient PM2.5 per 10ug/m3 increase positively associated with the prevalence of diagnosed asthma by an adjusted odds ratio (AOR) and 95% confidence interval(CI) of 1.18(1.01-1.35) and 1.13(1.02-1.24), respectively. Furthermore, the concentration of SO42- and NO3- were significantly associated with the prevalence of asthma and current rhinitis by the AOR for each 1ug/m3 increase in SO42-, and NO3- concentrations of 1.09(1.03-1.15) for asthma and 1.04(1.00-1.07) for current rhinitis, respectively.Conclusion: Components of PM2.5, especially NO3- and SO42- exposure were associated with asthmatic and allergic diseases in preschool children in China. Considering the related sources and combustion, it may represents an preventable risk factor for childhood asthma and allergic diseases.

The housing first technical assistance and training (HFTAT) implementation strategy: outcomes from a mixed methods study of three programs

BackgroundThis paper discusses the initial testing of the Housing First Training and Technical Assistance (HFTAT) Program, a multifaceted, distance-based strategy for the implementation of the Housing First (HF) supportive housing model. HF is a complex housing intervention for serving people living with serious mental illness and a substance use disorder that requires significant individual- and structural-level changes to implement. As such, the HFTAT employs a combined training and consultation approach to target different levels of the organization. Training delivered to all organizational staff focuses on building individual knowledge and uses narrative storytelling to overcome attitudinal implementation barriers. Consultation seeks to build skills through technical assistance and fidelity audit and feedback.MethodWe employed a mixed method design to understand both individual-level (e.g., satisfaction with the HFTAT, HF knowledge acquisition and retention, and HF acceptability and appropriateness) and structural-level (e.g., fidelity) outcomes. Quantitative data were collected at various time points, and qualitative data were collected at the end of HFTAT activities. Staff and administrators (n = 113) from three programs across three states participated in the study.ResultsSatisfaction with both training and consultation was high, and discussions demonstrated both activities were necessary. Flexibility of training modality and narrative storytelling were particular strengths, while digital badging and the community of practice were perceived as less valuable because of incompatibilities with the work context. HF knowledge was high post training and retained after 3-month follow-up. Participants reported training helped them better understand the model. Attitudes toward evidence-based interventions improved over 6 months, with qualitative data supporting this but demonstrating some minor concerns related to acceptability and appropriateness. Fidelity scores for all programs improved over 9 months.ConclusionThe HFTAT was a well-liked and generally useful implementation strategy. Results support prior research pointing to the value of both (a) multifaceted strategies and (b) combined training and consultation approaches. The study also provides evidence for narrative storytelling as an approach for changing attitudinal implementation barriers. The need for compatibility between specific elements of an implementation strategy and the work environment was also observed.

Closing the Loop: Measuring Entrepreneurial Self-Efficacy to Assess Student Learning Outcomes

Accredited degree programs primarily use graded assignments in the embedded-course method to measure individual-level assurances of learning (AoL). This method is expensive, subjective, retrospective, and difficult to implement for continuous program improvement. The purpose of our research is to explore the use of entrepreneurial self-efficacy (ESE) as an individual-level AoL outcome to augment the quality management of accredited entrepreneurship degree programs. Previous research on ESE, arising from intention models and theory of planned behavior, has used the construct primarily for predicting start-up intent or differentiating nonentrepreneurs from entrepreneurs. In contrast, we begin from an educational assessment and social cognitive theory perspective in constructing our ESE scale. The new ESE scale is operationalized by theoretically justifying 8 learning outcomes, testing 70 items based on scales in the extant literature, and extracting 11 factors or subdomains of ESE using principal components analysis to create a parsimonious new 44-item ESE scale. Expanding the ESE construct to 11 subdomains also expands the use of ESE into the fields of educational assessment, AoL, and program accreditation. This enables understanding the links between pedagogy, curriculum, assignments, grades, enactive mastery experiences, and peer feedback to achieve meaningful student transformation through self-efficacy beliefs.

Strategies to improve the implementation of policies, practices or programmes in sporting organisations targeting poor diet, physical inactivity, obesity, risky alcohol use or tobacco use: a systematic review

ObjectivesThe primary aim for this review is to determine the effectiveness of strategies to improve the implementation of policies, practices or programmes in sporting organisations. The secondary aims are to...

Comparison of Health Behaviour Mortality Hazards in Canada and the United States

IntroductionNational health surveys, available in over 100 countries, are the most common data used for health behaviour surveillance and are increasingly being linked to individual-level health outcomes. We propose that improved health behaviour hazard estimates can be obtained from pooled international population health surveys linked to outcome data.&#x0D; Objectives and ApproachThe objective of this study was to compare smoking, alcohol, diet and physical activity all-cause mortality hazards in Canada and the United States using individual-level, linked population health survey data and common model specifications. The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Variable definitions consistent across the CCHS and NHIS were developed and used to estimate country-specific mortality hazards with sex-specific Cox proportional hazard models, including health behaviours, sociodemographic indicators and proximal factors including disease history.&#x0D; ResultsA total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 62,226 respondents and 497,909 person-years from the NHIS were included. Hazards of smoking, alcohol consumption, diet and physical activity in Canada and the United States are of similar magnitude and direction, with similar dose response relationships. The largest health behaviour mortality hazards were associated with female heavy smokers in both Canada (HR: 3.36, 95% CI: 2.86, 3.95) and the United States (Female HR: 2.63, 95% CI: 2.11, 3.27), compared to non-smokers.&#x0D; Conclusion/ImplicationsHealth behaviour mortality hazards are comparable in Canada and the United States, supporting the use of hazards obtained from pooled analyses for population heath. These hazards can replace those obtained from independent epidemiology studies that are often incompletely adjusted, rarely population-based and often not generalizable to the population of interest.

Impact of Corporate Social Responsibility Attributions on Employees’ Creative Performance: The Mediating Role of Psychological Safety

This study contributes to the growing literature on individual-level outcomes of corporate social responsibility (CSR). Employing a sample of 339 subordinate–supervisor dyads, we explored the differential impact of CSR attributions on employees’ creative performance in the telecom industry. We also introduced and tested the role of psychological safety as a mediator underlying this relationship. The results indicate that although intrinsic CSR attributions are not directly related to creative performance, extrinsic CSR attributions have a significant negative effect on creative performance. We also found that psychological safety mediates the positive relationship between intrinsic CSR and creative performance and the negative relationship between extrinsic CSR and creative performance. Directions for future research and implications for practice are discussed.

Change at the Micro, Meso, and Macro Levels: Connecting Across Research in US Public Education

The last several decades of research and practice in US public education have become increasingly focused on the design and implementation of reform efforts that seek to address inequities in academic performance observed in school organizations across the country. Central to these efforts is an interest in organizational change as new programs and interventions alter the ways and means schools go about their work. While a plethora of approaches to change in education exist, less attention has been paid to drawing connections across varying efforts in the field. One way to address this challenge is to cast a lens on change-oriented programs in education from the vantage point of multiple levels of analysis. Given that the theoretical and methodological traditions of micro, meso, and macro level empirical work varies, our understanding of whether organizational change in education is most effective when focusing on individual, group, or system level outcomes is limited. In this symposium, three works of empirical research in public education will be presented, each situated at a different level of analysis. The presentations highlight a range of change relevant outcomes such as individual work-related non-cognitive perceptions, group stereotypes, and organizational ambidexterity. By putting work at multiple levels in conversation with each other, a clearer understanding of the advantages and challenges of doing work at each respective level of analysis can be made clearer, thereby enhancing our understanding of how and when to use certain organizational change approaches. Career-related Non-cognitive Outcomes: A Network Analysis of a Higher Education Intervention Presenter: Cortney Evans; Harvard U. Presenter: Monica Higgins; Harvard U. Presenter: David Sherer; Harvard U. The Paradox of Stereotypes in Education Reform Presenter: Renee M. Rinehart; Harvard Graduate School of Education The Ambidextrous School System: Case Studies of Process Management Programs in Education Presenter: Maxwell Yurkosfsky; Harvard U. Presenter: Amelia Peterson; Harvard U. Presenter: Kim Furmin; Harvard U. Presenter: Andrew Volkert; Harvard U. Presenter: Jal Mehta; Harvard U.

Assessing the causal association between 25-hydroxyvitamin D and the risk of oral and oropharyngeal cancer using Mendelian randomization.

Circulating 25‐hydroxyvitamin D (25OHD) is an appealing potential intervention for cancer risk and has been associated with oral and oropharyngeal cancer risk but evidence is inconsistent. The availability of genetic variants, uncorrelated with known confounders, but predictive of 25OHD and genetic data in a large oral and oropharyngeal cancer collaboration aids causal inference when assessing this association. A total of 5,133 oral and oropharyngeal cancer cases and 5,984 controls with genetic data were included in the study. Participants were based in Europe, North America and South America and were part of the Genetic Associations and Mechanisms in Oncology (GAME‐ON) Network. Five genetic variants reliably associated with circulating 25OHD were used to create a relative genetic measure of 25OHD. In the absence of measured 25OHD, two‐sample Mendelian randomization using individual level outcome data were used to estimate causal odds ratios (OR) for cancer case status per standard deviation increase in log25OHD. Analyses were replicated in an independent population‐based cohort (UK Biobank). In the GAME‐ON study, there was little evidence of a causal association between circulating 25OHD and oral cancer (OR = 0.86 [0.68;1.09], p = 0.22), oropharyngeal cancer (OR = 1.28 [0.72;2.26], p = 0.40) or when sites were combined (OR = 1.01 [0.74;1.40], p = 0.93). Replication in UK Biobank and pooled estimates produced similar results. Our study suggests that a clinically relevant protective effect of 25OHD on oral and oropharyngeal cancer risk is unlikely and supplementation of the general population with 25OHD is unlikely to be beneficial in preventing these cancers.

Improving rational use of ACTs through diagnosis-dependent subsidies: Evidence from a cluster-randomized controlled trial in western Kenya.

BackgroundMore than half of artemisinin combination therapies (ACTs) consumed globally are dispensed in the retail sector, where diagnostic testing is uncommon, leading to overconsumption and poor targeting. In many malaria-endemic countries, ACTs sold over the counter are available at heavily subsidized prices, further contributing to their misuse. Inappropriate use of ACTs can have serious implications for the spread of drug resistance and leads to poor outcomes for nonmalaria patients treated with incorrect drugs. We evaluated the public health impact of an innovative strategy that targets ACT subsidies to confirmed malaria cases by coupling free diagnostic testing with a diagnosis-dependent ACT subsidy.Methods and findingsWe conducted a cluster-randomized controlled trial in 32 community clusters in western Kenya (population approximately 160,000). Eligible clusters had retail outlets selling ACTs and existing community health worker (CHW) programs and were randomly assigned 1:1 to control and intervention arms. In intervention areas, CHWs were available in their villages to perform malaria rapid diagnostic tests (RDTs) on demand for any individual >1 year of age experiencing a malaria-like illness. Malaria RDT-positive individuals received a voucher for a discount on a quality-assured ACT, redeemable at a participating retail medicine outlet. In control areas, CHWs offered a standard package of health education, prevention, and referral services. We conducted 4 population-based surveys—at baseline, 6 months, 12 months, and 18 months—of a random sample of households with fever in the last 4 weeks to evaluate predefined, individual-level outcomes. The primary outcome was uptake of malaria diagnostic testing at 12 months. The main secondary outcome was rational ACT use, defined as the proportion of ACTs used by test-positive individuals. Analyses followed the intention-to-treat principle using generalized estimating equations (GEEs) to account for clustering with prespecified adjustment for gender, age, education, and wealth. All descriptive statistics and regressions were weighted to account for sampling design. Between July 2015 and May 2017, 32,404 participants were tested for malaria, and 10,870 vouchers were issued. A total of 7,416 randomly selected participants with recent fever from all 32 clusters were surveyed. The majority of recent fevers were in children under 18 years (62.9%, n = 4,653). The gender of enrolled participants was balanced in children (49.8%, n = 2,318 boys versus 50.2%, n = 2,335 girls), but more adult women were enrolled than men (78.0%, n = 2,139 versus 22.0%, n = 604). At baseline, 67.6% (n = 1,362) of participants took an ACT for their illness, and 40.3% (n = 810) of all participants took an ACT purchased from a retail outlet. At 12 months, 50.5% (n = 454) in the intervention arm and 43.4% (n = 389) in the control arm had a malaria diagnostic test for their recent fever (adjusted risk difference [RD] = 9 percentage points [pp]; 95% CI 2–15 pp; p = 0.015; adjusted risk ratio [RR] = 1.20; 95% CI 1.05–1.38; p = 0.015). By 18 months, the ARR had increased to 1.25 (95% CI 1.09–1.44; p = 0.005). Rational use of ACTs in the intervention area increased from 41.7% (n = 279) at baseline to 59.6% (n = 403) and was 40% higher in the intervention arm at 18 months (ARR 1.40; 95% CI 1.19–1.64; p < 0.001). While intervention effects increased between 12 and 18 months, we were not able to estimate longer-term impact of the intervention and could not independently evaluate the effects of the free testing and the voucher on uptake of testing.ConclusionsDiagnosis-dependent ACT subsidies and community-based interventions that include the private sector can have an important impact on diagnostic testing and population-wide rational use of ACTs. Targeting of the ACT subsidy itself to those with a positive malaria diagnostic test may also improve sustainability and reduce the cost of retail-sector ACT subsidies.Trial registrationClinicalTrials.gov NCT02461628

The Association Between PM2.5 and Ozone and the Prevalence of Diabetes Mellitus in the United States, 2002 to 2008.

To examine the association between air pollution and diabetes prevalence in the United States, 2002 to 2008. Annual average particulate matter (PM2.5) and ozone concentrations were calculated using daily county-level data from the CDC's Tracking Network. Individual-level outcome and covariate data were obtained from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System for 862,519 individuals. We used Poisson regression analyses to examine associations between each air pollutant (per 10-unit increase) with diabetes, including regional sub-analyses. Analyses were adjusted for year, age, sex, race, ethnicity, education, income, smoking status, body mass index, exercise, and asthma. Positive associations between each pollutant and diabetes were found (PM2.5: prevalence ratio [PR] = 1.10; 95% confidence interval [CI] = 1.03, 1.17; ozone: PR = 1.06; 95% CI = 1.03, 1.09). There was limited evidence of effect modification by region. Interventions to reduce ambient air pollution may help alleviate the diabetes burden in the US.

A new approach to hierarchical data analysis: Targeted maximum likelihood estimation for the causal effect of a cluster-level exposure.

We often seek to estimate the impact of an exposure naturally occurring or randomly assigned at the cluster-level. For example, the literature on neighborhood determinants of health continues to grow. Likewise, community randomized trials are applied to learn about real-world implementation, sustainability, and population effects of interventions with proven individual-level efficacy. In these settings, individual-level outcomes are correlated due to shared cluster-level factors, including the exposure, as well as social or biological interactions between individuals. To flexibly and efficiently estimate the effect of a cluster-level exposure, we present two targeted maximum likelihood estimators (TMLEs). The first TMLE is developed under a non-parametric causal model, which allows for arbitrary interactions between individuals within a cluster. These interactions include direct transmission of the outcome (i.e. contagion) and influence of one individual's covariates on another's outcome (i.e. covariate interference). The second TMLE is developed under a causal sub-model assuming the cluster-level and individual-specific covariates are sufficient to control for confounding. Simulations compare the alternative estimators and illustrate the potential gains from pairing individual-level risk factors and outcomes during estimation, while avoiding unwarranted assumptions. Our results suggest that estimation under the sub-model can result in bias and misleading inference in an observational setting. Incorporating working assumptions during estimation is more robust than assuming they hold in the underlying causal model. We illustrate our approach with an application to HIV prevention and treatment.

Talent management in the context of mindful organizing and organizational mindfulness

Purpose: The purpose of this paper is to show the unexplored relationship between mindful organizing, organizational mindfulness and talent management with regard to its outcomes. Methodology: The paper presents an integrative review of the literature available in relation to talent management and organizational mindfulness and provides the development of a theoretical framework based on integration and synthesis of this literature. Findings: The literature review revealed that organizational mindfulness and mindful organizing belong to the factors which may enhance individual level outcomes of talent management, such us: organizational commitment, motivation to work, extra-role behaviour and this, in turn, results in better organization’s performance. Practical implications: In order to enhance the individual level outcomes of talent management, the mindfulness needs to operate across all organizational levels. It should be create by top administrators and translate across organizations’ levels by middle managers for the front-line employees. Research limitations: This study is based on theoretical analysis and its assumptions should be tested empirically. Originality/value of the paper: Although the authors indicate many factors that may shape talent management process and its outcomes, the potential infl uence of mindful organizing and organizational mindfulness on talent management outcomes has not been analysed so far, meanwhile these phenomena’s have a lot in common with managing talented employees. Therefore, it is expected that mindful organizing (directly) and organizational mindfulness (indirectly) may enhance individual level outcomes of talent management.

Effectiveness of capacity building interventions relevant to public health practice: a systematic review

BackgroundThis systematic review assessed the effectiveness of capacity building interventions relevant to public health practice. The aim is to inform and improve capacity building interventions.MethodsFour strategies were used: 1) electronic database searching; 2) reference lists of included papers; 3) key informant consultation; and 4) grey literature searching. Inclusion (e.g., published in English) and exclusion criteria (e.g., non-English language papers published earlier than 2005) are outlined with included papers focusing on capacity building, learning plans, or professional development plans within public health and related settings, such as non-governmental organizations, government, or community-based organizations relating to public health or healthcare. Outcomes of interest included changes in knowledge, skill or confidence (self-efficacy), changes in practice (application or intent), and perceived support or supportive environments, with outcomes reported at the individual, organizational or systems level(s). Quality assessment of all included papers was completed.ResultsFourteen papers were included in this review. These papers reported on six intervention types: 1) internet-based instruction, 2) training and workshops, 3) technical assistance, 4) education using self-directed learning, 5) communities of practice, and 6) multi-strategy interventions. The available literature showed improvements in one or more capacity-building outcomes of interest, mainly in terms of individual-level outcomes. The available literature was moderate in quality and showed a range of methodological issues.ConclusionsThere is evidence to inform capacity building programming and how interventions can be selected to optimize impact. Organizations should carefully consider methods for analysis of capacity building interventions offered; specifically, through which mechanisms, to whom, and for which purpose. Capacity-building interventions can enhance knowledge, skill, self-efficacy (including confidence), changes in practice or policies, behaviour change, application, and system-level capacity. However in applying available evidence, organizations should consider the outcomes of highest priority, selecting intervention(s) effective for the outcome(s) of interest. Examples are given for selecting intervention(s) to match priorities and context, knowing effectiveness evidence is only one consideration in decision making. Future evaluations should: extend beyond the individual level, assess outcomes at organizational and systems levels, include objective measures of effect, assess baseline conditions, and evaluate features most critical to the success of interventions.

Associations between local descriptive norms for overweight/obesity and insufficient fruit intake, individual-level diet, and 10-year change in body mass index and glycosylated haemoglobin in an Australian cohort

BackgroundDescriptive norms (what other people do) relate to individual-level dietary behaviour and health outcome including overweight and obesity. Descriptive norms vary across residential areas but the impact of spatial variation in norms on individual-level diet and health is poorly understood. This study assessed spatial associations between local descriptive norms for overweight/obesity and insufficient fruit intake (spatially-specific local prevalence), and individual-level dietary intakes (fruit, vegetable and sugary drinks) and 10-year change in body mass index (BMI) and glycosylated haemoglobin (HbA1c).MethodsHbA1c and BMI were clinically measured three times over 10 years for a population-based adult cohort (n = 4056) in Adelaide, South Australia. Local descriptive norms for both overweight/obesity and insufficient fruit intake specific to each cohort participant were calculated as the prevalence of these factors, constructed from geocoded population surveillance data aggregated for 1600 m road-network buffers centred on cohort participants’ residential addresses. Latent growth models estimated the effect of local descriptive norms on dietary behaviours and change in HbA1c and BMI, accounting for spatial clustering and covariates (individual-level age, sex, smoking status, employment and education, and area-level median household income).ResultsLocal descriptive overweight/obesity norms were associated with individual-level fruit intake (inversely) and sugary drink consumption (positively), and worsening HbA1c and BMI. Spatially-specific local norms for insufficient fruit intake were associated with individual-level fruit intake (inversely) and sugary drink consumption (positively) and worsening HbA1c but not change in BMI. Individual-level fruit and vegetable intakes were not associated with change in HbA1c or BMI. Sugary drink consumption was also not associated with change in HbA1c but rather with increasing BMI.ConclusionAdverse local descriptive norms for overweight/obesity and insufficient fruit intake are associated with unhealthful dietary intakes and worsening HbA1c and BMI. As such, spatial variation in lifestyle-related norms is an important consideration relevant to the design of population health interventions. Adverse local norms influence health behaviours and outcomes and stand to inhibit the effectiveness of traditional intervention efforts not spatially tailored to local population characteristics. Spatially targeted social de-normalisation strategies for regions with high levels of unhealthful norms may hold promise in concert with individual, environmental and policy intervention approaches.