Meso Level Research Articles

Population stratification based on healthcare trajectories: A method for encouraging adaptive learning at meso level

This paper proposes a method to support population management by evaluating population needs using population stratification based on healthcare trajectories.Reimbursed healthcare consumption data for the first semester of 2017 contained within the inter-mutualist database were analysed to create healthcare trajectories for a subset of the population aged between 60 and 79 (N = 22,832) to identify (1) the nature of health events, (2) key transitions between lines of care, (3) the relative duration of different events, and (4) the hierarchy of events. These factors were classified using a K-mers approach followed by multinomial mixture modelling.Five population groups were identified using this healthcare trajectory approach: “low users”, “high intensity of nursing care”, “transitional care & nursing care”, “transitional care”, and “long time in hospital”.This method could be used by loco-regional governing bodies to learn reflectively from the place where care is provided, taking a systems perspective rather than a disease perspective, and avoiding the one-size-fits-all definition. It invites decision makers to make better use of routinely collected data to guide continuous learning and adaptive management of population health needs.

Healthcare practices among refugee older adults: A protocol for a scoping review

Background: Healthcare systems worldwide face the significant challenge of meeting the complex healthcare needs of refugee older adults. These individuals encounter numerous barriers at micro, meso, and macro levels in accessing and using healthcare in their host or resettled countries. Beyond these barriers, understanding their specific healthcare needs, healthcare-seeking behaviors, health practices, and the facilitators that enhance their access to and utilization of both formal and informal healthcare is crucial for improving their health outcomes. Objective: Our scoping review aims to capture the scope and range of evidence on refugee older adults’ healthcare needs, healthcare-seeking behaviors, health practices, and facilitators and barriers to access to and utilization of formal and informal healthcare. Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews along with the PRISMA-ScR framework will guide this scoping review. Literature written in English and published between 2011 and 2024 will be selected if they focused on refugee older adults who are 55 years of age and older. Scholarly literature will be searched using CINAHL, SocINDEX, Academic Search Complete, PsycINFO and MEDLINE, and gray literature will be captured by searching ProQuest’s Dissertations and Theses Global, Google, and Google Scholar. The extracted data will be synthesized, and narratively presented and supported by tables designed to align with the scoping review’s objective. Implications: The results of this scoping review will be used to offer actionable insights for healthcare providers, policymakers, and researchers. By mapping the existing landscape and identifying gaps, we also hope to inform the development of more inclusive and responsive healthcare models that address the specific needs of refugee older adults.

Researchers’ perspectives of self-agency within a context of violence and harm in maternity care

ProblemThere is an increasing awareness of the prevalence of obstetric violence within maternity care and that some women and birthing people are at greater risk of experiencing violence and harm. BackgroundSupporting self-agency for women and birthing people in maternity care may be a way of addressing the disparities in vulnerability to violence and harm. AimTo explore researchers’ perspectives of self-agency for women from different backgrounds, what inhibits and prevents self-agency, and how self-agency can be enabled. MethodsA qualitative research design was undertaken underpinned by a reproductive justice framework. Group interviews were held with researchers working with perinatal women/birthing people with histories and experiences of violence and abuse. Reflexive thematic analysis using Bronfenbrenner's ecological systems theory was undertaken. Findings12 participants took part in two group interviews. Two themes were developed: ‘defining self-agency’ and ‘ecological influences on self-agency’. DiscussionThe findings identify how self-agency should not be perceived as an intrinsic attribute, but rather is underpinned by exogenous and endogenous influences. Whether and how self-agency is enacted is determined by interacting factors that operate on a micro, meso and macro level perspective. Self-agency is undermined by factors including immigration policies and sociocultural perspectives that can lead to under-resourced and judgemental care, other intersectional factors can also lead to some individuals being more vulnerable to violence and harm. ConclusionImplications from this work include strategies that emphasise woman-centred care, staff training and meaningful organisational change to optimise positive health and wellbeing.

The multifaceted nature of trust in the uptake of advice: policy advice utilization in ministerial cabinets

ABSTRACT What makes policy advice circulate more easily towards the apex of governments and shape the opinions of its users along the way? This article investigates the utilization of policy advice in ministerial cabinets, by focusing on the individuals appointed to work as closest aides of ministers: ministerial advisers. While we know quite a lot about the operation of policy advisory systems at the macro and meso levels, the micro-dispositions affecting the circulation and utilization of policy advice are under-researched topics. Building on recent research waves on policy advice and policy advisory systems, we expect that trust between ministerial advisers and their advice-suppliers is a pivotal driver of policy advice utilization. Based on an original survey conducted in the ministerial cabinets of French-speaking Belgium, this article provides evidence that ministerial advisers’ overall propensity to trust advice-suppliers tends to boost policy advice utilization. Yet, we show that the characteristics of advice suppliers also come into play in advisory relationships and that ministerial advisers have various needs in that regard, depending on them being high or low trust individuals. Our findings speak to the importance of paying attention to relational dynamics and informality in policy advising.

Making Social Work More Socially Sustainable Through Participation: Rhetoric or Innovation?

This paper aims to explore the connection between social sustainability and participatory processes in the realm of social work, through a theoretical reflection. The guiding research questions for the work are: a) How can user participation enhance the social sustainability of social work? b)What should be the dynamic of participation between institutions and users to ensure the social sustainability of social work? In an effort to address these inquiries, we will initially conduct a comprehensive analysis of the current state of social sustainability literature to underscore the significance of user participation in social work. Subsequently, our focus will shift towards examining various forms and dynamics associated with user participation at the meso level of social work practice within the domain of welfare services in Italy. Our aim is to advocate for the adoption of co-creation processes, characterised by a bottom-linked dynamic, as an innovative approach with the potential to enhance the social sustainability of social work.

A qualitative study to understand the barriers and facilitators in smoking cessation practices among oncology health care practitioners in one health system.

Despite the benefits of quitting smoking for those who have cancer, including improved health outcomes and reduced therapeutic toxicities, it is unclear how many people are supported in quit attempts during this time. Variations in the availability and provision of smoking cessation (SC) services are reported, with little understanding of the challenges and solutions. This co-designed study aimed to understand the perspectives of health care professionals (HCPs) working in oncology settings to engage in SC practices and identify recommendations for developing an SC pathway. This was a qualitative study. Eighteen HCPs participated in semi-structured interviews from July 2021 to May 2022. We used thematic analysis approaches to code data and present four emergent themes and SC strategies at micro, meso and organizational levels. Four themes emerged specifically: 1) timing and knowledge, 2) building a relationship, 3) frequent asking with infrequent action, and 4) removing the barriers and tailoring the system. While HCPs discuss SC, there are variations in documentation and when conversations occur. Primarily, HCPs value the time to build therapeutic relationships with patients and thus may limit SC discussions in preference to treatment in clinical interactions. The role of structural barriers, including prescriptive authority for nurses, hinders active SC processes, as it is the lack of continuity and embedding of services supported by a clinical champion for SC. The study suggests re-evaluating the status quo in SC service, highlighting service gaps and suggesting opportunities at organizational levels to reduce structural barriers. Variations in smoking cessation services exist in designated cancer centres. The data from this study can be used to inform a real time health systems approach for SC services in oncology settings. Developing tailored smoking cessation services and interventions that are patient-centred and informed by their experiences are required. The data in this study suggests developing specialist education and training to upskill HCPs for equitable engagement if we are to meet EU and Moonshot goals for cancer reduction.

Theoretical basis and path choice of current industrial structure transformation--Analysis in the perspective of Marxist political economy

The transformation of industrial structure is a key task for realizing high-quality economic development. Different from western economics, which locates the industrial structure and its transformation in the ratio of the three industries of the national economy and their changes, this paper logically analyzes the theoretical content of Marxist political economy, takes into account the "qualities" of the organic composition of capital of the industry, and summarizes the transformation of the industrial structure as the process of optimizing the ratio between the two categories of social reproduction and their intersectoral relations to realize the upgrading of the industry in the contradictory movement of the productive forces and the relations of production. The transformation of industrial structure is summarized as the process of industrial upgrading, in which scientific and technological innovation promotes the adjustment of the organic composition of capital, optimizes the proportion between the two major categories of social reproduction and their respective sectors. This process has different manifestations at micro, meso and macro levels, and is constrained by the objectives of total social reproduction balance, structural balance and productive labor-based. Accordingly, the article proposes that we should base ourselves on the level of development of productive forces, strengthen the real economy, adjust the relations of production, improve the form of ownership, strengthen macroeconomic regulation and control, and promote scientific and technological innovation in order to realize the transformation of China's industrial structure.

Casual, customized and contemptuous relationships with education: Social solvation and young people's strategies during multi‐crisis

AbstractThis paper focuses on individual responses to education in crisis, with the strategies of students contextualised and examined within a wider multi‐crisis reality. Offering a conceptual framework of social solvation, the proposed model explains how failures in the education system at the macro (state) and meso (institutional) levels translate into young people's behaviours at the individual (micro) level. Based on the analysis of 26 in‐depth interviews with young students, we identify and discuss three main micro‐rational strategies that the interviewees relied upon to navigate their learning during the pandemic: (1) casualisation (2) customisation and (3) contempt towards the broader system. We argue that the already weak Polish education system was further impaired by the COVID‐19 crisis. In response to growing social and educational risks, young people forge and employ highly individualised strategies. As micro‐rational social actions essentially bypass the unwieldy education system in a variety of ways, they have vital implications for educational futures.

HOSPITAL ADMINISTRATION IN A PERIPHERAL REMOTE LOCATION HOSPITAL: A EVIDENCE BASED STUDY

Objective: The organisation of the human society has undergone a unique transition throughout the last decades. With the rise of ever growing technologization and disruptive innovations, populations also demand more social and environmental initiatives from firms and governments. In 2015, the United Nations (UN) member states agreed upon a 2030 Agenda for Sustainable Development. Developing a sustainable UHC is decisive to ensure better economic prospects and social equality across socioeconomic classes. This can be achieved by lowering the barriers to access health services to the most vulnerable groups and improve mortality and disability rates in the potential workforce. Methods: The present study was conducted in a remote location defence hospital catering to the health care needs of serving personnel of Indian armed forces and civilians residing in this peripheral area. The basic specialties including Obstetrics, paediatrics, medicine and general surgery are provided at this centre 24*7 by the dedicated medical officers of Indian Armed forces. Results: Sustainability of care continuously evolves towards becoming a major factor for public healthcare organisations, and more accountability will likely be demanded of managers to deliver on each aspect of its triple bottom line. This study shows that prevention and patient empowerment both carry great potential to attain this objective. Conclusion: It is necessary to set priorities and act according to available resources and organisational vision. The central threats to sustainability of public health care welfare systems in peripheral hospitals identified, namely the ageing population and rise in chronic diseases. UHC at a meso and micro level, could provide a much better rationale for scholars to evaluate the need for change, and contribute to draft more inclusive sustainable strategies.

Disaster Capitalism and Social Policy: Social Work in the Aftermath of Natural Disasters

ABSTRACT Unpredictable timing, disruption of community and health services, severe economic impacts, and the deterioration of psychosocial well-being necessitate the evaluation of natural disasters from a social work perspective. Social workers play critical roles in these situations, such as connecting disadvantaged groups with necessary resources, protecting individuals’ well-being, assessing needs, and providing relief and support. The core roles and functions of the social work profession, which emphasize a people-centered, rights-based approach, become particularly significant after a disaster. Neoliberal policies and disaster capitalism exploit the fear and anxiety generated by natural disasters to gain public consent for practices that may not be in their best interests. In this context, fear appeals can be manipulated as a persuasive tool to make disaster-affected citizens accept policies and practices they would typically reject. This study outlines the issues that social workers should address at micro, meso, and macro levels to counteract the influence of neoliberal policies and disaster capitalism, which leverage the fear and anxiety induced by natural disasters to secure public consent for unfavorable practices.

Unveiling the Constructed Identity of Santris: A Stylistic Exploration

This article aims at finding how santris living at modern pesantren construct their identities. The study is conducted at MBI AU a pesantren in Mojokerto, East Java with 156 respondents, 79 males and 77 females. The data are taken from their chats in WhatsApp groups for private contexts and from book communication and their public performance for public context. Interview is also conducted to support the data. The study reveals that at the macro level, santris, both males and females are not different from teenagers in general. At the meso level, santris are differentiated into the speakers of the east Javanese dialect (EJ), Non-east Javanese dialect (NEJ), and Non-Javanese (NJ). In this level, male santris of EJ tend to show a stronger Javanese identity compared to the females who show more accommodating natures. The NEJ and NJ santris are showing a higher tendency of doing relation of adequation toward the East Javanese dialect suggesting the drives for social allegiances and instrumental attachment toward the East Javanese dialect. Unlike the NJ santris who tend to show their home language as their self-constructed identity, the NEJ santris are using more bahasa gaul to distinguish themselves from the EJ santris.

The future of pharmacy work: How pharmacists are adapting to and preparing for technology infusion

BackgroundThe pharmacy sector is rapidly evolving due to technological advancements, presenting challenges and opportunities for pharmacists. However, limited literature exists on the future of pharmacy work, especially concerning technology adoption. ObjectiveThis exploratory study investigates pharmacists' perspectives on the impact of technologies on the profession - including career security, role evolution, adjustments to changes - and the impact of the COVID-19 pandemic on technology implementation and the broader future of work in pharmacy. MethodA cross-sectional survey design was used, targeting all registered pharmacists in New Zealand. A questionnaire, adapted from Future of Work literature, was piloted and distributed to 3037 pharmacists. Data were analyzed using descriptive statistics, two-step hierarchical analysis, and content and thematic analysis. Ethics approval was obtained. Results177 responses met the inclusion criteria, yielding a 5.82% response rate. Respondent demographics included a lower proportion of community pharmacists and individuals of Asian ethnicity, but a higher proportion of males and hospital pharmacists compared to the national workforce. Most respondents were aged between 30 and 59 years, representing all District Health Board locations.Qualitative analysis identified two themes: 1) Factors affecting technology adoption across macro, meso and micro levels, including COVID-19's impact on work efficiency, regulatory gaps, fragmented IT and organizational infrastructures, patient safety, and attitudes at workforce and individual levels; 2) Career impacts, highlighting role expansion, job replacement fears, and the need for adaptation and upskilling. Quantitative findings indicate that early technology adopters are more prepared to learn new skills and plan their careers. Technology impact positively correlates with career planning, while job loss concerns negatively affect skill development readiness. ConclusionThe study underscores the importance of early technological adoption for readiness to acquire new skills and career planning in pharmacy. Embracing technological change, supported by regulatory and policy frameworks, is crucial for advancing the profession.

A fRAmework of the DetermInants of Arts aNd Cultural Engagement (RADIANCE): integrated insights from ecological, behavioural and complex adaptive systems theories.

Arts and cultural engagement (ACEng) is ubiquitous across every human culture since palaeolithic times, but in contemporary society, ACEng is unevenly distributed, demographically, socio-economically, geographically and politically. But what are the "determinants" of ACEng (i.e., the facilitators or barriers to people's engagement) and how can they be optimised? Despite a large body of theory and evidence on individual determinants, this work has largely occurred in disciplinary silos, which has led variously to contrasting discourses and approaches, criticism, and inconsistent findings. What we lack is a rigorous comprehensive understanding of these determinants (both those already theorised and those that have been little recognised as determinants to date) that goes beyond descriptively showing inequalities, instead explaining why these inequalities exist and how they can be overcome. This paper explores the currently recognised determinants of ACEng, and existing theoretical approaches to these determinants. Drawing on the theoretical bases of ecological systems theory, ecosocial theory and complex adaptive systems science, we conducted a review and iterative theorising process. We propose a new theoretical framework of the determinants of arts and cultural engagement (RADIANCE) developed through cross-disciplinary literature reviewing, domain mapping, and consensus building. Overall, we identified 35 different factors that can act as determinants of ACEng across micro, meso, exo, macro and chrono levels. We broadly categorised these as social (i.e. a primary feature being the interaction of people), tangible (i.e. a primary feature involving physical assets or resources or the production of physical assets), and intangible (i.e. constructs that do not have a primary physical basis but instead have a virtual or imaginary basis). The relevance and implications of this framework for broader research, policy, and practice and case studies of it in use are presented.

Ageing and wellbeing co-creation: systematic literature review and future avenues for Transformative Service Researchers

ABSTRACT Ageing is a natural process that is accompanied by several physical, psychological, cognitive, and social changes, which can have significant impact on health and wellbeing. This bibliometric analysis combined with a systematic thematic examination of the literature delves into the interplay of ageing, wellbeing, and service provision with a focus on reviewing publications in the eight top-tier service journals. This review seeks to answer how transformative service providers address the changing needs and unique requirements of the ageing populations, co-create services with them, and assess the challenges and potential advantages they encounter in co-creating wellbeing with the ageing population. This research examines the service ecosystem ‘wellbeing of the ageing population’ across all levels, including the ageing individuals (micro level), service providers (meso level), and government (macro level). Thematic analysis revealed eight salient key themes, illuminating how transformative services impact wellbeing co-creation when ageing. A comprehensive future research agenda for Transformative Service Research (TSR) is proposed to guide the development of services for wellbeing co-creation with the ageing population. This review calls attention to the pivotal role of transformative services in maintaining and enhancing wellbeing among ageing individuals and offers valuable insights to inform policy and practice.

Seeing knowledge hiding through a multi-level lens

This study investigates knowledge hiding (KH), a growing research area of increasing importance across multiple organisational levels. The rapid expansion of KH research runs the risk that existing knowledge is not accumulated but constantly re-invented. Therefore, this study aims to enhance our understanding by systematically reviewing the antecedents, boundary conditions and outcomes of KH. We develop a thematic mapping of 173 papers, identifying key antecedents, boundary conditions and outcomes of KH alongside emerging knowledge gaps and pertinent research questions. Leveraging these insights, we construct a multi-level framework that categorises KH at the micro, meso and macro levels, integrating findings from our thematic analysis. This study provides a consolidated view of KH literature and is a valuable guide for scholars seeking to advance this domain.

Programme evaluation in action: theory to practice from an Asian educational context

ABSTRACT Programme evaluation has developed tremendously over the past 50 years, with a proliferation of evaluation research, an increase in the institutionalization of evaluation, and growth in the professionalization of evaluation. However, existing research and developments are still largely in North America, Europe, Australia, and New Zealand, with less from Asia. As theory building of policy and programme evaluation practices necessarily occur within specific political, economic, and cultural contexts, the applicability of Western-centric evaluation literature in Asian contexts warrants further examination. In this article, we explore the interconnections between evaluation theory, evaluation policy, and evaluation practice in the Ministry of Education Headquarters (MOE-HQ) in Singapore. We describe our theory of change of how evaluation theory influenced evaluation practice from the ground-up at the micro (individual) level, and from the top-down at the meso (organization) level. In the process, we also discuss how common challenges and tensions in evaluation (e.g., evaluation as an accountability vis-à-vis learning tool; appropriateness of randomized controlled trials vis-à-vis other approaches) acted out and were mitigated. We conclude with our learning points and implications for future research.

Трудовая миграция в российских регионах в контексте обеспечения экономической безопасности

In the accepted understanding of the role of labor migration as a leading factor in ensuring the economic security of Russia and its regions, it is necessary to proceed from the content of migration as a complex, multidimensional phenomenon, characterized by multidirectional and contradictory dynamics of the processes occurring in it. In conditions of geopolitical and macroeconomic instability, the diagnosis of these processes is updated in connection with sharp structural shifts in labor migration and changes in their influence on the economic security of Russian regions and the country. Based on a structural-dynamic analysis made with the use of official statistical information, the dynamics and effectiveness of the processes accompanying labor migration and their impact on the economic security of Russia, its regions, and macro-regions were identified. The main trends in labor migration at the macro level are the predominance of internal migration flows over external ones against the negative increase in labor migrants from countries outside the CIS countries and the reorientation of labor flows to other countries; changes in the sectoral structure of migration; and the high share and growth of illegal migration. At the meso level, there is a high level of differentiation in labor migration flows and, as a result, their ambiguous impact on the economic security of Russian macro-regions and their constituent entities. The main factors hindering the positive impact of labor migration on the economic security of the regions of the Southern Federal District are differences in their sectoral specialization; the state of social infrastructure, education, and healthcare; level of employment; environmental and climatic living conditions; composition and structure of the population; and quality of life. The solution to the problems of labor migration in the Southern Federal District, which can ensure an increase in the migration attractiveness of the territories of the macro-region, lies, first of all, in the growth and balance of the quality of life of the population in the regions of the Southern Federal District, increasing the effectiveness of the state regional industrial and social policy, and strengthening the place and role of migration policy in long-term programs of regional development.

Institute for Convergent Systems Engineering: A Strategic Plan for Ethical Sustainability

AbstractThe last few years have made it clear that the world is entering a new phase in which sustainability is of paramount importance to the survival and well‐being of our global societies. This paper describes the strategic plan for the Institute for Convergent Systems Engineering which is addressing the challenge of ethical sustainability in which social, environmental, and economic implications are carefully considered and balanced. Included is a discussion of the criticality of convergent systems engineering and its values and principles. The paper also presents a three part strategy for sustainability at the macro, meso, and micro levels entailing the consideration of end‐to‐end global value supply chains. The foundational pillars of research, education, and collaboration are also described.

A facilitator's reflection on the democratizing potential of emancipatory practice development.

Emancipatory practice development (ePD) is a practitioner-led research methodology which enables workplace transformation. Underpinned by the critical paradigm, ePD works through facilitation and workplace learning, with people in their local context on practice issues that are significant to them. Its purpose is to embed safe, person-centred learning cultures which transform individuals and workplaces. In this article, we critically reflect on a year-long ePD study in an acute care hospital ward. We explore the challenges of practice change within systems, building collective strength with frontline collaborations and leadership to sustain new learning cultures. Our work advances practice development dialogue through working closely with the underpinning theories. Our critique analyses how ePD can enact and sustain change within a complex system. We argue that ePD works to strengthen safety cultures by challenging antidemocratic practices through communicative action. By opening communicative spaces, ePD enables staff to collectively deliberate and reach consensus. Their raised awareness supports staff to resist ways of working which conspire against safe patient care. Sustainability of practice change is fostered by the co-operative democracies created within the frontline team and meso level enablement. We conclude that the democratising potential of ePDt generates staff agency at the frontline.

Playful by Design: Embedding Children's Rights into the Digital World

To explore ‘what good looks like’ for children’s play in a digital world,the Digital Futures Commission consulted children, companies, policy makers, regulators and academics. Responding to public scepticism that play online could match the benefits of traditional free play, our research compared insights from play in non-digital and digital contexts and integrated them within a holistic account of how play possibilities emerge from the intersection of people, products and places, conceived at micro, meso and macro levels. This very complexity helps to transcend reductive judgments about digital play and suggests multiple levers for design innovation, synthesised as ‘Playful by Design’ principles. We operationalised these by co-designing an interactive tool for developers and designers of children’s digital play. Finally, by mapping the principles to the UN Convention on the Rights of the Child, we position play as a use case for the broader agenda of Child Rights by Design.