Multi-stakeholder Involvement Research Articles

Looking for a preventive approach to sexual harassment in academia. A systematic review

AbstractThe systematic review (PRISMA) on sexual harassment (SH) in academia looks at studies conducted since 2018 with the aim to direct updated research findings toward an effective prevention perspective. The findings confirm that academia is a breeding ground for SH due to power imbalances and that vulnerabilities related to the macro-dynamics of power, social and cultural inequalities are risk factors for SH. It is recommended that SH prevention interventions in academia 1. adopt a socio-ecological perspective; 2. include evidence-based programs such as those dedicated to bystanders; 3. are integrated with each other through valuable networking and multistakeholder involvement and 4. pay attention to support complaints, victim listening and intake activities. Future SH studies should promote: SH standardized definitions, intersectional perspectives, “all targets” surveys, research on protective factors, research on perpetrator perspective. Future interventions should act at the cultural level fighting structural inequality and a greater enhancement of evidence-based programs is required.

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria.

School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Sinergi Pembangunan Wisata Bahari Berkelanjutan dalam Rangka Mewujudkan Visi Maritim 2024 di Pulau Nusa Penida, Klungkung, Bali

This research explores the synergy of sustainable marine tourism development in realizing the 2024 maritime vision on Nusa Penida Island, Klungkung, Bali, as well as the factors that affect it. The method used is a literature study with qualitative descriptive analysis. The results show that the synergy is achieved through communication and coordination of Indonesia's maritime vision with the implementation of optimization of marine tourism development under the Indonesian Marine Policy Action Plan 2021-2025 and Presidential Regulation Number 34 of 2022. Tourism in Bali has an economic impact on local communities, but its distribution needs to be more evenly distributed. Social, economic, and cultural tourism provides opportunities to utilize local potential with the participation of policy stakeholders. The tourism sector encourages the development of infrastructure and educational institutions, increasing human resources in the field of tourism. Factors influencing the synergy of marine tourism development include Indonesia's maritime history and politics, maritime biological and non-biological resources, socio-cultural factors, and maritime industry and economy. Recommendations include improving the marine ecotourism product program, multi-stakeholder involvement in planning, and the establishment of a special department in the Ministry of Tourism to focus on developing sustainable marine tourism to realize the 2024 maritime vision.

Haemophilia care in Asia: Learning from clinical practice in some Asian countries.

The healthcare systems in Asia vary greatly due to the socio-economic and cultural diversities which impact haemophilia management. An advisory board meeting was conducted with experts in haemophilia care from Asia to understand the heterogeneity in clinical practices and care provision in the region. The overall prevalence of haemophilia in Asia ranges between 3 and 8.58/100,000 patients. Haemophilia A was more prevalent as compared to haemophilia B with a ratio of around 5:1. There is under-diagnosis in the region due to lack of diagnosis, registries and/or lack of appropriate facilities in suburban areas. Most patients are referred to the haematologists by their families or primary care physicians, while some are identified during bleeding episodes. Genetic testing faces obstacles like resource constraints, services available at limited centres and unwillingness of patients to participate. Prophylaxis is offered for people with haemophilia (PWH) with a severe bleeding phenotype. Recombinant factors are approved in most countries across the region and are the preferred therapy. The challenges highlighted for not receiving a high standard of care include patients' reluctance to use an intravenous treatment, poor patient compliance due to frequency of infusions, budget constraints and lack of funding, insurance, availability and accessibility of factor concentrates. Prevalence of neutralizing antibodies ranged from 5% to 20% in the region. Use of immune tolerance induction and bypassing agents to treat inhibitors depends on their cost and availability. Haemophilia care in Asia has evolved to a great extent. However, some challenges remain for which a strategic approach along with multi-stakeholder involvement are needed.

Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis.

Non-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation. This study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors' network. This descriptive qualitative study design is guided by the "Three I's" framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries. The following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs. The shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process.

Governing in the digital age: The emergence of dynamic smart urban governance modes

There is growing concern that implementing effective governance constitutes a significant element in cities becoming ‘smart’ due to its multidisciplinarity, complexity of urban challenges and multi-stakeholder involvement. It is assumed that in smart city initiatives, new governance modes arise through the interplay of technological artefacts and political and social factors, viewed through a sociotechnical perspective. We also argue that traditional urban governance modes help explain emerging modes and the nature of citizen-government interactions. Thus, a combination of the sociotechnical view with the modes of urban governance as a theoretical approach was used to understand the dynamics of emerging governance modes in smart city initiatives. Two cases were studied using a longitudinal qualitative case study and temporal bracketing analysis for an in-depth understanding. Our findings evidenced that the configuration of the elements, governance mode, information and communication technology (ICT) and types of citizen-government interaction varies from one initiative to another and changes over time, across multiple sociotechnical networks in practice, which leads to emerging new governance modes. We highlight that a new understanding of smart urban governance for sustainable development in the digital age needs to be developed as a dynamic process. Moreover, we identified two emerging governance modes and proposed a dynamic approach to investigate smart urban governance in other contexts.

Public perception and community-level impact of national action plans on antimicrobial resistance in Vietnam.

Vietnam was the first country from the WHO Western Pacific Region to adopt a national action plan (NAP) on antimicrobial resistance (AMR) in 2013. The multilayered nature of AMR requires coordination across 'One Health' sectors, dedicated financing, multistakeholder involvement, and widespread community engagement to implement the action plans. This study explores the perceived impact of NAP implementation at the community level. Key informant interviews (KIIs) were used for data collection during 2021. An interview tool was used for the KIIs and purposive sampling was used to identify study participants from Vietnam. The study participants were those engaged with a substantial scale of antimicrobial usage, diagnosis of infections or concerned with antimicrobial content in effluents in their professional life. Twelve KIIs were conducted with participants from human health, animal health and the environmental sector. The data were entered into Microsoft Excel, and manifest and latent content analysis was done. The analysis highlighted themes such as limited public awareness of AMR, ongoing capacity building and quality assurance initiatives, implementation of guidelines and regulations for AMR containment, sustained investment in improving infrastructure, and challenges relating to accountability whilst prescribing and selling antibiotics. There were many positive critical developments during the NAP implementation period in Vietnam towards AMR mitigation. For better impact, there is a need to revitalize the implementation machinery of NAPs by improving the enforcement capacity of regulations, cross-sectoral collaboration and promoting community ownership.

Stakeholder Analysis as a strategic tool in framing collaborative governance arenas for marine litter monitoring

Monitoring and assessment of marine litter requires multi-stakeholder involvement at national and subnational levels. Collaborative governance approaches are important, but often fail without adequate effort towards identifying and engaging stakeholders with appropriate profiles for the issue at stake. Stakeholder Analysis (SA) is increasingly used to ensure efficient governance arrangements. Our hypothesis is that SA contributes to collaborative governance processes for marine litter policies. We explored a pioneer participatory process in Brazil, where SA was applied to identify, categorize, and prioritize stakeholders, and analyze their power and interest, for the Strategic Plan for Monitoring and Assessing Marine Litter in the state of São Paulo. A top-down/bottom-up approach revealed that snowball sampling complemented the stakeholder assemblage identified by the consultation of experts. Prioritization of data-related stakeholders streamlined the participatory process. The interest-power matrix evaluated stakeholders' influences, guiding specific engagement strategies. We highlight the significance of SA in collaborative governance and mobilizing key stakeholders for effective marine litter monitoring initiatives, contributing to the global agenda to combat marine pollution.

Fiscal policies and regulations for healthy diets in Sri Lanka: an analysis of the political economy of taxation and traffic light labelling for sugar-sweetened beverages

ABSTRACT Background Unhealthy dietary patterns significantly contribute to rising non-communicable diseases (NCDs) in Sri Lanka. The government has implemented policy measures to promote healthy dietary patterns, including the traffic light labelling (TLL) system for sugar-sweetened beverages (SSBs) in 2016 and taxation on SSBs in 2017. Objectives To analyse how ideas, institutions, and power dynamics influence the formulation and implementation of these two interventions, and to identify strategies for public health actors to advocate for more effective food environment policies in Sri Lanka. Methods This study drew on Kingdon’s theory of agenda-setting and Campbell’s institutionalist approach to develop the theoretical framework. We examined the political economy at the policy development and implementation stages, adopting a deductive framework approach for data collection and analysis. Data were collected from documents and key informants. Results NCDs and nutrition are recognised and framed as important policy issues in health-sector policy documents, and the SSB tax and TLL system are seen as means of improving diets and health. Sri Lanka’s commitment to addressing NCDs and nutrition-related issues is evident through these policies. The Ministry of Health led policy development, and key stakeholders were involved. However, there are opportunities to learn and strengthen policy in Sri Lanka and elsewhere. Limited involvement and commitment of some stakeholders in developing national policies, industry interferences, and other gaps resulted in weaker policy design. Gender considerations were also given minimal attention in policy formulation and implementation. Conclusions To enhance the effectiveness of the policies and regulations to promote healthy diets in Sri Lanka, comprehensive policy coverage, multistakeholder involvement and commitment to national policies, balanced power dynamics, technical feasibility, government commitment backed with high-level political support, awareness, and knowledge creation, managing industry interferences, integrating gender considerations are crucial factors.

An Inclusive Social Health Insurance for People with Disabilities in Three Southeast Asia Countries: A Systematic Review

This article examines how inclusiveness is implemented for People with Disabilities (PWDs) in social health insurance programs in Southeast Asia by focusing on the National Health Insurance (NHI) in Indonesia, the National Health Insurance Program (NHIP) in the Philippines, and Social Health Insurance (SHI) in Vietnam. The concept of inclusive social insurance for PWDs is used as an analytical tool to explore inclusivity criteria, such as target specifications, service benefits, multi-stakeholder involvement, service functions, and the program's impact. Drawing on the qualitative systematic review method, which refers to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), PRISMA Protocols 2015, and evidence-based guidelines, this article analyzes 25 selected pieces of literature. The results of the study show that: First, there are no special schemes and mechanisms in those programs that target PWDs directly and specifically. Second, those programs have not been able to meet the specific health needs of PWDs. Third, the implementation of those programs has involved three stakeholder actors: the state, the private sector, and NGOs. Fourth, those programs have not shown a significant impact on improving the health quality of PWDs. Finally, it can be concluded that the three programs are not yet truly inclusive in covering PWDs in social health insurance programs.

Stakeholder Synergy in Social Innovation: Efforts to Reduce the Impact of Poverty in Indonesia

Objective: The problem of poverty requires a social innovation-based assistance strategy that involves various parties or collaboration in solving a social problem. Poverty alleviation policies are not only centered on bureaucratic aspects but are also always human-centered (human-centered design) in defining and formulating innovative policies. This research aims to identify stakeholders in social innovation in order to overcome the impacts of poverty. Theoretical framework: This research uses 6 dimensions of social innovation in analyzing the impact of poverty in Indonesia. Apart from that, this research also explains the role of stakeholders through the Quintuple Helix concept where there is a continuous balance between government and society. Method: This research is a type of qualitative research with 50 research informants who refer to five requirements for selecting informants. Researchers conducted in-depth interviews with social practitioners so that researchers could get more concrete information about the problems that occurred. Results and conclusions: In the Social Exclusion Dynamics dimension, it was found that the Indonesian Government's policies were able to provide accelerated handling that was not trapped in bureaucratic, techno-technical aspects. By making the community work partners or volunteers who are socially active. The Mobilization of Resources dimension is related to the synergy aspect of multi-stakeholder involvement which is able to provide community capacity development, mastery and understanding of technological information so that it can improve the quality of life. In the Satisfaction of Human Needs dimension, pragmatism in the government system often causes a loss of innovation and creativity in exploring local resources in society. In the context of health service policy, it is often not possible to explore the source of the main problems in society. The dimension of empowerment is the creation of knowledge. Knowledge is data and information combined with ability, intuition, experience, ideas, and motivation from competent sources. In the dimension of Change in Social Relations, social innovation is ultimately able to determine permanent changes in the social environment, power, relations between social groups, government, and society, the state and the private sector. These dynamics are related to those displayed in the triangle of vision, intention, development culture, identity, organizational and institutional dynamics. Meanwhile, in the Territorial Specificity dimension, the research results show that funding for poverty alleviation activities is assisted by CSR programs from industry as well as social assistance from various elements of society, such as institutions, individuals, companies, zakat institutions, foundations, volunteers and others. Research implications: This research has implications for the involvement of stakeholders in social innovation in overcoming the impacts of poverty Originality/value: The value of this research lies in the application of the social innovation dimension through the role of multi-stakeholders in overcoming the impacts of poverty. The research results also provide new value to the role of organic intellectuals which refers to actors who play an important role in society.

Nutritional Knowledge, Practices and Challenges of Food and Nutrition Security in the Tharparkar, Sindh, Pakistan

Background: Nutrition is a fundamental need of human beings worldwide. Hunger has increased rapidly all over the world and reached a high level with more than one billion people living with chronic hunger. Objective: The main objective of the proposed study was to identify the challenges of food and nutrition insecurity. Methods: The research team conducted interviews in the respective union councils (UCs) with support of the field team, and subsequently collected and analyzed the data. Results and Discussion: The findings of the present study indicated that 32% of households gave their children food/fluids within one month, followed by breastfeeding. About 81% breastfeeding practice is strictly followed at the household level. Only 23%, 22%, 27% and 28% of children with the ages between 6 and 23 months were given one, two, three and four meals, respectively. The data indicates that about 11% of children faced issues during their feeding practices, while 89% of children did not face any feeding issues. The majority of pregnant and lactating women (PLWs) reported that they did not receive any additional food. The consumption of fresh vegetables and fruits was around 30% twice in a week. The vegetables and fruits, including watermelon, jujube, peroon, singari, pipoon, musk melon, keria and gangheti, were cultivated, which are solely dependent on the seasonal rain. The diseases, such as respiratory diseases, skin diseases, cardiac disease, malaria, dengue and mental illness, were reported; whereas, measles and night blindness were not reported in the selected area. Conclusion: There is a need of spreading the message through media at the district and province levels with the involvement of multi-stakeholders, so that the efforts are synergized to have a sustainable and long-term impact.

Age-friendly practices during the COVID-19 pandemic: Findings from a scoping review

Abstract Background The COVID-19 pandemic called for innovation and leverage of existing age-friendly practices to promote older people's functional ability and enable them to contribute to their communities and enjoy life. Our aim was to explore the evidence available concerning the development, adaptation, and evaluation of age-friendly practices during the COVID-19 pandemic. Methods A review was conducted in line with the Joanna Briggs Institute scoping review methodology. We considered publications of practices across the 8 domains of the World Health Organization (WHO) age-friendly framework. Our search strategy comprised databases (PubMed, Web of Science, Scopus) and grey literature sources. Results Preliminary findings identified 37 practices by member organizations of the WHO network. The most targeted domains were community support and healthcare services; communication and information; and social participation; while the least targeted were transportation; housing; and outdoor spaces and buildings. Adaptive strategies often relied on remote delivery of information and services through digital or phone contact. Most practices were led by local authorities in collaboration with community organizations, universities, and healthcare practitioners. Opportunities for older people to contribute to the design and implementation of practices varied widely across settings. Enablers for adaptation or development included pre-existing collaborations between stakeholders, availability of contact details of older people in the community, and availability of human and material resources to implement changes. Challenges included limited literacy and access to digital technologies, and participants’ distrust of remote activities. Conclusions Findings emerging from the scoping review provide insights regarding age-friendly practices during COVID-19 and may inform the development of appropriate multi-stakeholder and participatory interventions during future public health crises. Key messages • Age-friendly practices may significantly contribute to meet older people’s material, social and affective needs during public health crises. • Opportunities to leverage age-friendly practices increase with the inclusion of older people’s voices, intergenerational solidarity, multi-stakeholder involvement and strong political will.

Assessing and Comparing Participatory Governance in Energy Transition: Evidence from the 27 European Union Member States

The Energy Union governance regulation (CE 2018/1999) set new participatory procedures and governance standards for energy planning of Member States. This paper aims at identifying the contribution of this new mode of regulation in developing multi-sector, multi-level, and multi-stakeholder involvement and dialogue in the formulation of Energy Union plans. The article refines the concept of participatory governance in the energy sector and provides an operational and multidimensional definition. It innovatively compares the formulation process of the 27 Member States’ energy plans (draft and final) to highlight national evolution in participatory governance dimensions, cross-country convergence, and variations in alignment with EU regulation. Despite the significant differences in the governance of national energy planning, the empirical evidence highlights the contribution of EU governance regulation in promoting, along different dimensions, the participatory processes of all Member States.

Recommendations for initiating and engaging local energy communities in alignment with justice principles – evidence from seven European citizen engagement processes

Background The promotion of local energy communities is highlighted as a solution to accelerate the transition towards a more decentralised, decarbonised and just energy system. EU policies are actively trying to strengthen the role of local energy communities as vital actors in the energy system. These developments open up a space for energy communities across Europe that are initiated, supported and/or strengthened from actors outside of the community. Such approaches have received limited attention by academic literature. The perspective of energy justice can serve as a normative framework to assess how the engagement of local residents and stakeholders in energy communities should take place. This paper points out injustices in seven different community engagement trajectories that took place as part of the Horizon project Lightness. Methods Relevant data was collected over the course of more than two years of field work, including interviews with residents and engagement leaders, workshops and site visits. A framework based on justice principles called The Voicer model was applied to analyse the data and pinpoint injustices. Results Based on these findings it provides ten recommendations for engaging residents and other local stakeholders in a just manner in local energy communities (LECs). These recommendations address among others the competences required for engaging residents in community-building, the importance of accessible communication and how to deal with the complexity of multi-stakeholder involvement. Conclusions The pathways for just engagement shown in this paper are limited in scope and would benefit from application in contexts with different legal, economic and governance configurations. Doing so can provide engagement practitioners with tangible tools to let diverse groups of residents enjoy the benefits that a just energy transition has in offer.

Policy analysis on municipal solid waste management in Dhaka South City Corporation, Bangladesh: A qualitative study

Background: Inadequate and improper municipal solid waste (MSW) management is one of the significant reasons behind the environmental deterioration in Bangladesh. The projected daily waste generation for 2025 in Dhaka City is 47,665 tons, half of which remains uncollected despite door-to-door community-based waste collection. There are few studies on MSW management in Bangladesh, most focusing on household-level waste management, measurement of the amount of MSW, etc., but none applied a political economy lens to examine the policy issues related to MSW management. This study aimed to explore the context, actors, and processes regarding MSW management of policies in Dhaka City, Bangladesh, applying the policy-triangle-framework. Methods: This study adopted an exploratory qualitative approach, and document reviews and key informant interviews were conducted from September 2016 to January 2017. Results: We found that the issue of MSW slowly entered the policy documents starting with the Sixth-Five Year Plan (2011-2015), with some earlier sporadic policy initiatives. Due to its being a relatively new concept, stakeholders still lack the expertise to tackle the issue leading to donor dependence. MSW management demands multi-stakeholder involvement, which, in turn, depends on multi-ministerial and -departmental coordination, which is chronically deficient. MSW policies, like most other social policies, demand citizen involvement, without which both policy formulation processes and their proper implementation are compromised. Conclusion: In order to overcome these policy challenges, the technical and financial capacity of the stakeholders for MSW management should be enhanced, high-level multi-ministerial coordination needs to be strengthened, and citizen empowerment and engagement must be ensured at every step of the MSW policy cycle.

Strategic environmental assessment in Palu Central Sulawesi reflecting water provision profile based on ecosystem services

Reconciling development activities with Natural resources conservation has become one of the essential elements in the search for sustainable development. The degradation of Natural resources attributed to human activities through development increase rapidly. This trend is exacerbated by policies encouraging land conversion and natural resource overexploitation, as well as a need for more information about the value of natural resource conservation. Consequently, it can alter the ecosystem and change the natural resources and their functions. Protecting natural resources begins with policymaking, followed by development plans and programs. In this study, describe how the Strategic Environmental Assessment (SEA) is a safeguarding tool for controlling natural resource loss in Palu City, Central Sulawesi. Natural resources are one of the vital aspects to be considered in SEA. Development in the central city, opening the land for agriculture on a large scale (plantation), and mining were the main issues that contributed to high risk to the natural resources. Regional development plans and programs assess by predicting, evaluating, and mitigating the environmental impact produced by the development. Our study found that the involvement of multi-stakeholders, Government, legislative, universities, social communities, and nongovernmental organizations successfully collected strategic development goal issues related to natural resources conditions in Palu, Central Sulawesi. Assessment of the plans and programs of development that will contribute to the mitigation of natural resource degradation and decide alternative recommendations for regional development plans and programs. This study demonstrates the integration of SEA in controlling natural resource degradation due to development.

Organising Stakeholder Participation in Global Climate Governance: The Effects of Resource Dependency and Institutional Logics in the Green Climate Fund

Public or stakeholder participation in environmental governance has been strongly advocated within the United Nations (UN) since the early 1990s. A relatively new mechanism for global climate finance that emphasises stakeholder engagement is the Green Climate Fund (GCF), a UN strategy for channelling funds from the Global North to the Global South. Drawing on previous critical approaches to multi-stakeholder involvement in global governance, this article explores stakeholder involvement within the GCF. The study combines ideas from institutional logics and resource dependency to provide a better understanding of how stakeholder arrangements are shaped in climate organisations. Results show that the GCF stakeholder arrangement favours private sector stakeholders – stakeholders that take a technical and apolitical approach to climate finance – and disfavours smaller, less resourceful stakeholders as well as those who perform a politicised watchdog function.

Stakeholders’ involvement in an evidence-based sustainable tourism plan

Sustainable tourism planning is recommended for destination governance to ensure long-term development that balances the impacts of tourism on a community, especially in overtourism contexts. This study examines a sustainable tourism planning process focusing specifically on stakeholder involvement and the use of co-created evidence. A multi-stakeholder involvement management framework (MSIM) for sustainable tourism was applied to examine its fit to a rigorous case study. The study enhances the MSIM framework, featuring three stages from scene-setting, management of stakeholder involvement, to assessment. The new framework details objectives and tools for each step, and influential factors in managing stakeholders’ involvement. A significant enhancement is the extensive incorporation of evidence into the framework for different purposes (eg developing management policies, plan objectives and implementation tactics, evaluating stakeholders’ involvement). Multiple stakeholders participated in producing and using a variety of evidence throughout the planning process to provide a foundation for planning. This study is one of the first in sustainable tourism to examine evidence as a component of a broad framework to manage stakeholder involvement. It shows the usefulness, position, and dynamic of evidence in destination management.

Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study.

Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers' contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle.