Local Contextual Factors Research Articles

Feasibility of a Lifestyle Intervention Program for Prevention of Diabetes Among Women With Prior Gestational Diabetes Mellitus (LIVING Study) in South Asia: A Formative Research Study.

Aim: To refine and contextually adapt a postpartum lifestyle intervention for prevention of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM) in Bangladesh, India, and Sri Lanka.Materials and Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with women with current diagnosis of GDM, and health care professionals involved in their management, to understand relevant local contextual factors for intervention optimization and implementation. This paper describes facilitators and barriers as well as feedback from participants on how to improve the proposed intervention. These factors were grouped and interpreted along the axes of the three main determinants of behavior–capability, opportunity, and motivation. IDIs and FGDs were digitally recorded, transcribed, and translated. Data-driven inductive thematic analysis was undertaken to identify and analyze patterns and themes.Results: Two interrelated themes emerged from the IDIs and FGDs: (i) The lifestyle intervention was acceptable and considered to have the potential to improve the existing model of care for women with GDM; and (ii) Certain barriers such as reduced priority of self-care, and adverse societal influences postpartum need to be addressed for the improvement of GDM care. Based on the feedback, the intervention was optimized by including messages for family members in the content of the intervention, providing options for both text and voice messages as reminders, and finalizing the format of the intervention session delivery.Conclusion: This study highlights the importance of contextual factors in influencing postpartum care and support for women diagnosed with GDM in three South Asian countries. It indicates that although provision of postpartum care is complex, a group lifestyle intervention program is highly acceptable to women with GDM, as well as to health care professionals, at urban hospitals.

Contextualizing certification and auditing: Soy certification and access of local communities to land and water in Brazil

• We investigated certification and auditing of soy in western Bahía, in the most dynamic agricultural frontier in Brazil. • We draw on 72 semi-structured interviews and a systematic analysis of public audit reports from RTRS-certified farms. • Certification and auditing have not successfully protected the access of local communities to land and water. • Shortcomings are explained by the business-dominated nature of RTRS, auditing practices and domestic contextual factors. The massive expansion of soy production in Brazil has contributed to a loss of access for local communities to land and water, particularly in highly dynamic frontier regions in the Cerrado. Soy certification standards like the Roundtable on Responsible Soy (RTRS) contain principles that are supposed to prevent such problems. In this paper, we examine the extent to which certification and auditing have served to protect local communities’ access to land and water in western Bahía state in the Cerrado’s Matopiba region. We draw on findings from field research in Brazil and western Bahía, 72 semi-structured interviews with corporate, state and civil society actors, and a systematic analysis of audit reports from RTRS-certified farms in Bahía. We find that auditing practices are not effective in protecting the rights and access of local communities to land and water due to three inter-related sets of factors: 1) the business-dominated nature of the drafting and content of the RTRS standard, 2) the structural limitations and everyday practices of auditing, and 3) domestic and local contextual factors in Brazil and western Bahía. This study aims to contribute to a re-thinking and re-assessment of certification and auditing practices and suggests that new approaches are required to govern global commodity chains in a more environmentally just way. We advocate for a locally embedded and community-sensitive perspective in research on certification and auditing, to complement previous research in the fields of critical political economy and sustainability governance.

Re-analysing Ebola spread in Sierra Leone: The importance of local social dynamics.

The 2013-15 Ebola epidemic in West Africa was the largest so far recorded, and mainly affected three adjacent countries, Guinea, Liberia and Sierra Leone. The worst affected country (in terms of confirmed cases) was Sierra Leone. The present paper looks at the epidemic in Sierra Leone. The epidemic in this country was a concatenation of local outbreaks. These local outbreaks are not well characterized through analysis using standard numerical techniques. In part, this reflects difficulties in record collection at the height of the epidemic. This paper offers a different approach, based on application of field-based techniques of social investigation that provide a richer understanding of the epidemic. In a post-epidemic study (2016-18) of two districts (Bo and Moyamba) we use ethnographic data to reconstruct local infection pathways from evidence provided by affected communities, cross-referenced to records of the epidemic retained by the National Ebola Response Commission, now lodged in the Ebola Museum and Archive at Njala University. Our study documents and discusses local social and contextual factors largely missing from previously published studies. Our major finding is that the epidemic in Sierra Leone was a series of local outbreaks, some of which were better contained than others. In those that were not well contained, a number of contingent factors helps explain loss of control. Several numerical studies have drawn attention to the importance of local heterogeneities in the Sierra Leone Ebola epidemic. Our qualitative study throws specific light on a number of elements that explain these heterogeneities: the role of externalities, health system deficiencies, cultural considerations and local coping capacities. Social issues and local contingencies explain the spread of Ebola in Sierra Leone and are key to understanding heterogeneities in epidemiological data. Integrating ethnographic research into epidemic-response is critical to properly understand the patterns of spread and the opportunities to intervene. This conclusion has significant implications for future interdisciplinary research and interpretation of standard numerical data, and consequently for control of epidemic outbreaks.

Determinants of household air pollution exposure mitigating factors in urban Uganda

Background/Aim: Urban slum populations in sub-Saharan Africa (SSA) can be subject to high levels of exposure to household air pollution (HAP) from domestic use of polluting fuels. We know very little, however, about the local determining factors that can mitigate or exacerbate exposure to HAP among SAS’s urban poor. Methods: Among urban households in Kampala, Uganda (N=1294), we administered cross-sectional surveys and used multivariable logistic regression to identify household, demographic and local contextual determinants that can mitigate or exacerbate exposure to HAP from cooking with polluting fuels. Results: Most households used solid fuels for cooking (93%). Multivariable logistic regression revealed that households whose children were indoors during cooking (OR=3.93), or who used a polluting fuel (kerosene lantern) for lighting the home (OR=2.56), had significantly (p<0.05) higher odds of never opening windows during cooking with solid fuels indoors. Significantly higher odds of cooking indoors with polluting fuels was observed for households that light their home with a polluting fuel (OR=2.00), report being very concerned about neighborhood traffic-related air pollution (OR=1.57), have higher educational attainment (OR=1.51), or who cook more meals per day (OR=1.47). Lower household income (OR=3.65), younger child age (OR=8.16), cooking in a structure separate from the main living area (OR=3.56), or younger age for those who perform cooking duties in the home, were all significantly associated with higher odds of keeping the child indoors during cooking with polluting fuels indoors. Conclusions: Multiple household and demographic characteristics, as well as local contextual factors, were strongly associated with factors that can either mitigate (e.g., children outdoors during cooking) or exacerbate (kerosene for lighting) exposures to HAP from polluting cooking fuels. Tailored and targeted HAP interventions in urban SSA slum populations are needed that are sensitive to local contextual (traffic-related air pollution), demographic (age and income), and exposure-mitigating factors.

Tourism opportunities drive woodland and wildlife conservation outcomes of community-based conservation in Namibia's Zambezi region

Initiatives to promote community-based natural resource management (CBNRM) have been evaluated with mixed results in socio-economic and ecological outcome dimensions. In Namibia, community conservancies are being established since the 1990s mainly to reconcile wildlife conservation and rural development. As Namibia gears up for participation in Reducing Emissions from Deforestation and Forest Degradation (REDD+), land use and land cover change and related biomass carbon dynamics may become increasingly important additional outcome indicators for the country's approach to CBNRM. Based on a social-ecological conceptual framework, we identify spatially heterogeneous local context factors that may drive positive and negative effects of CBNRM on vegetation cover in Namibia's Zambezi region. We test our theoretical predictions using panel data in a spatially explicit, quasi-experimental evaluation design and find that, on average, CBNRM somewhat increased elephant presence, but had a negative effect on woodland cover. Heterogeneous treatment effect analysis indicates that CBNRM does work for woodland conservation when communities are located in and around wildlife corridors, which provide tourism income opportunities. Despite success in stabilizing wildlife populations in the region, our results suggest that complementary conservation incentives may be required to make Namibia's CBNRM model fit for REDD+.

How do MNCs translate corporate talent management strategies into their subsidiaries? Evidence from MNCs in Thailand

How do MNCs translate corporate talent management strategies into their subsidiaries? Evidence from MNCs in Thailand

A comparative study of bike-sharing systems from a user’s perspective: An analysis of online reviews in three U.S. regions between 2010 and 2018

Seeking to reduce carbon emissions and increase active travel, U.S. cities have increasingly adopted bike-sharing systems in recent years. However, despite the growing popularity of and markets for bike-sharing systems, little is known of how users perceive and evaluate their quality. By conducting (1) descriptive analysis of numeric ratings and (2) content analysis of the narrative sections of Yelp reviews, this study investigates the perceived quality of bike-sharing systems and factors affecting such perceptions in three U.S. regions: New York, Washington, D.C., and Chicago. It particularly focuses on regional and temporal variations in users’ evaluations of bike-sharing services, which remains understudied. The results show that the average rating of a bike-sharing system, as well as the factors included in users’ major evaluation criteria and complaint factors, are similar among regions. However, temporal shifts in users’ assessments of bike-sharing systems differ greatly by region, which reflect the different local contextual factors and the resultant regional variations in the bike-sharing service features. In addition to providing valuable guidance for increasing the use of bike-sharing systems, this study suggests that social media content can inform the development of planning solutions that are responsive to users’ needs.

Structural Barriers to Health-provider Training Programmes for Ethnic Minorities: The Case of the Katu and Diabetes Management in Vietnam

Background: Training of primary care practitioners is one of the most implemented interventions in medical international development programmes targeting non-communicable diseases (NCD). Yet in many cases their effectiveness is below expectations. One potential cause of this is that they struggle to account for local context, especially when working with ethnic minorities. Here we begin to address this gap through a qualitative case-study of how local contextual factors have impacted the success of a World Health Organization (WHO) healthcare training programme on Type 2 diabetes with an ethnic minority group in rural central Vietnam.
 Design: A qualitative case-study collected data during 2018. We conducted 25 semi-structured interviews, two focus groups, and participant observation with patients, healthcare professionals, and members of a local non-governmental organisation involved in the programme. We used thematic coding to identify important contextual factors and how they helped or hindered programme delivery. Next, we synthesised each of these themes in a narrative style, drawing on the rich detail provided by respondents.
 Results: We found that, despite using a notionally decentralised approach, the effectiveness of the training was hindered by social, political, and economic determinants of health which influenced the inhabitants’ relations to healthcare and diabetes. Particular barriers were the political perceptions of minorities, their economic access to services, the healthcare prejudices toward ethnic rural populations and the rigidity of medical training.
 Conclusions: Given the similarity of our case with other WHO NCD programmes, we view that our findings are of wider relevance to global public health policy and practice. We suggest that better recognising and addressing local contextual factors would make such programmes more polyvocal, grounded, and resilient, as well as enabling them to better support long-term transformative change in public health systems. We conclude by discussing methods for implementing this in practice.

The cost of improving care: a multisite economic analysis of hospital resource use for implementing recommended postpartum contraception programmes

BackgroundThe costs of quality improvement efforts in real-world settings are often unquantified. Better understanding could guide appropriate resource utilisation and drive efficiency. Immediate postpartum contraceptive care (ie, placement of an...

Using Health Systems Engineering Approaches to Prepare for Tailoring of Implementation Interventions.

Implementation of evidence-based practices often requires tailoring implementation strategies to local contextual factors, including available resources, expertise, and cultural norms. Using an exemplar case, we describe how health systems engineering methods can be used to understand system-level variation that must be accounted for prior to broad implementation. Within the context of a single-center quality improvement activity, a multi-disciplinary stakeholder team used health systems engineering methods to describe how pre-endoscopy antithrombotic management was executed, and implemented a redesigned process to improve clinical care. The research team then conducted multiple stakeholder focus groups at four different health-care systems to describe and compare current processes for pre-endoscopy antithrombotic medication management. Detailed work flow maps for each health-care system were developed, analyzed, and integrated to develop an overarching current work flow map, identify key process steps, and describe areas of process variation. Five key process steps were identified across the four health systems: (1) place an endoscopy order, (2) screen for antithrombotic use, (3) coordinate medication management, (4) instruct the patient, and (5) confirm appropriate medication management before procedure. Across health systems, we found a high degree of variation in each step (e.g., who performed, use of technology, systematic vs. ad hoc process). This variation was influenced by two key system-level contextual factors: (1) degree of health system integration and (2) role and training level of available staff. These key steps, areas of variation, and contextual factors were integrated into an assessment tool designed to facilitate tailoring of a future implementation and dissemination strategy. Tools from health systems engineering can be used to identify key work flow process steps, variations in how those steps are executed, and influential contextual factors. This process and the associated assessment tool may facilitate broader implementation tailoring.

Emergency department clinical leads\u2019 experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study

BackgroundTo manage increasing demand for emergency and unscheduled care NHS England policy has promoted services in which patients presenting to Emergency Departments (EDs) with non-urgent problems are directed to general practitioners (GPs) and other primary care clinicians working within or alongside emergency departments. However, the ways that hospitals have implemented primary care services in EDs are varied. The aim of this study was to describe ED clinical leads’ experiences of implementing and delivering ‘primary care services’ and ‘emergency medicine services’ where GPs were integrated into the ED team.MethodsWe conducted interviews with ED clinical leads in England (n = 19) and Wales (n = 2). We used framework analysis to analyse interview transcripts and explore differences across ‘primary care services’, ‘emergency medicine services’ and emergency departments without primary care services.ResultsIn EDs with separate primary care services, success was reported when having a distinct workforce of primary care clinicians, who improved waiting times and flow by seeing primary care-type patients in a timely way, using fewer investigations, and enabling ED doctors to focus on more acutely unwell patients. Some challenges were: trying to align their service with the policy guidance, inconsistent demand for primary care, accessible community primary care services, difficulties in recruiting GPs, lack of funding, difficulties in agreeing governance protocols and establishing effective streaming pathways. Where GPs were integrated into an ED workforce success was reported as managing the demand for both emergency and primary care and reducing admissions.ConclusionsIntroducing a policy advocating a preferred model of service to address primary care demand was not useful for all emergency departments. To support successful and sustainable primary care services in or alongside EDs, policy makers and commissioners should consider varied ways that GPs can be employed to manage variation in local demand and also local contextual factors such as the ability to recruit and retain GPs, sustainable funding, clear governance frameworks, training, support and guidance for all staff. Whether or not streaming to a separate primary care service is useful also depended on the level of primary care demand.

Grade inflation versus grade improvement: Are our students getting more intelligent?

The move from elite to mass systems of higher education has been accompanied by concerns relating to the quality of provision and standards, particularly in relation to the increasing proportion of higher grades awarded to students. Bayesian multilevel models were used to investigate the temporal trend of grade attainment in 101 higher education providers across the UK, between the 2009/10 and 2018/19 academic years, to understand if rising grades are due to inflation or a consequence of improvements across the higher education system. The results suggest a much more positive and proactive picture of a higher education system that is engaged in a process of continuous enhancement. The unexplained variables, rather than automatically being labelled as grade inflation, should instead point to a need to investigate further the local institutional contextual factors that inform grade distribution. The deficit lens through which ‘grade inflation’ is often perceived is a damaging and unhelpful distraction. Measures, such as improved assessment literacy, are suggested as approaches that the sector could adopt to further develop its understanding of grade improvement as opposed to grade inflation.

Localizing Strategies for Situating a New OT Master’s Program in the Local Culture & Context of the Caribbean

Abstract Date Presented 03/26/20 Effective education is situated in the local culture and context; however, it is not known how OT educators create a curriculum that is responsive to the local culture and context. This ethnographic case study demonstrated that educators responded to local cultural and contextual factors and student-learning needs specific to the Caribbean by using localizing strategies. Localizing strategies were processes and approaches that made the curriculum relevant to the local community. Primary Author and Speaker: Bill Roberts Contributing Authors: Barb Hooper

The Role of Hybrid Companies in Local Entrepreneurial Ecosystems: Complements or Competitors?

Using the organizational ecosystem perspective, we investigate relationships between hybrid companies, mainstream for-profit firms, and nonprofit organizations within a geographically-bounded ecosystem, and how these relationships are influenced by local contextual factors. We analyze panel data from 264 US Metropolitan Statistical Areas across 16 years. We find that hybrid companies tend to be positively related to the presence of nonprofit organizations in an ecosystem, whereas the interaction between entrepreneurial activity and nonprofit organizations elicits fewer hybrids. We conclude that the role of hybrid companies in local entrepreneurial ecosystems is nuanced and differentiated from that of mainstream for-profit firms or nonprofit organizations.

Healthy Habits, Happy Homes Scotland (4HS) feasibility study: Translation of a home-based early childhood obesity prevention intervention evaluated using RE-AIM framework

ObjectiveHealthy Habits, Happy Homes (4H) is a home-based, pre-school childhood obesity prevention intervention which demonstrated efficacy in North America which we translated to Scotland (4HS) by considering contextual factors and adapting study design. RE-AIM Framework was used to assess 1) extent to which development of 4HS intervention (including recruitment) was participatory and inclusive; 2) feasibility of translating a complex public health intervention from one setting to another; 3) extent to which translation was pragmatic and 4) fidelity of intervention to the principles of Motivational Interviewing (MI). Study designFeasibility testing, process evaluation and measurements of intervention fidelity were undertaken to evaluate the translation of 4H to an economically deprived area of Scotland (4HS). Methods4HS study processes; participatory approach, recruitment methods, level of pragmatism were evaluated using the RE-AIM framework. Qualitative and quantitative measures identified key implementation features and functioning of 4HS intervention. Fidelity MI principles was determined through coding of audiotapes using Motivation Interviewing Treatment Integrity (MITI) code. ResultsKey facilitators for positive impact with families, included: inclusive recruitment methods, appropriate channels of communication and correspondence (Reach) with n ​= ​126 enquiries and n ​= ​26 (21%) families recruited. Positive links with local parents and community workers integral to the research process at n ​= ​9 meetings (Effectiveness). 61.5% of families lived in the most deprived data zone in Scotland, 23% were one parent families, thus awareness and consideration of local contextual factors (Adoption) and locally relevant materials were important. 4HS was feasible to deliver, pragmatic in nature and intervention demonstrated good fidelity to MI (Implementation). ConclusionTranslation of 4H from North America to Scotland was successful. Future studies should consider implementation of 4HS approach within routine practice within the UK (practice based evidence) or through thoughtful evaluation in a future trial (evidence based practice).

Perceptions of barriers and levers of health-enhancing physical activity policies in mid-size French municipalities

BackgroundPolicy is one of the levers for initiating structural change to foster the promotion of health-enhancing physical activity (HEPA). To this end, policy-makers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been conducted on this topic at the local level. The purpose of this study was to identify the perceived barriers and levers of HEPA policies according to department heads and elected officials across various sectors in mid-size French municipalities.MethodsThis study used a mixed method primarily based on an adaptation of the concept mapping approach. A list of statements completing the sentence: ‘In a mid-size municipal context, to develop HEPA policies, it is necessary to …’ was submitted to key informants of 17 mid-sized French cities. Key informants in each municipality first rated the importance of each statement without considering their local context; they then rated the feasibility of each statement given their local context. In both cases, they used a Likert scale ranging from 1 to 6.ResultsA total of 23 municipal department heads and 10 elected officials from the sport (n = 14), health (n = 10) and social (n = 9) sectors in 11 mid-size French cities participated in this study. A list of 84 statements, sorted into 16 categories, was rated by participants according to their importance (M = 4.52, SD = 0.86) and their feasibility (M = 3.77, SD = 0.74). Potential barriers to (n = 10) and levers of (n = 38) HEPA policy development were identified. These results varied according to the position and sector of the participants.ConclusionsThe results suggest that local contextual factors can affect the development of HEPA policies in mid-size French municipalities. The different perceptions of the potential levers and barriers according to sector might affect intersectoral collaboration. This study contributes by enhancing understanding of how local HEPA policies are developed in the French context.

Glocalisation dynamics: The appropriation of the ‘creative turn’ discourse in Buenos Aires, Argentina (2007–2015)

The global wave that elevates the creative economy and CI as instruments to gain urban competitiveness has been criticised in academia, for it presents extensive debates around definitions, methods and the overall impact of the CI. Scholars have been questioning the role of CI in economy and society: while some authors argue that CI are a generalised prescription that serve as vehicle to export neoliberal policy recommendations; others defend the ideal of a CI discourse with policy variance and attention to local contextual factors. However, those questioning or supporting the role of CI are mainly mapping examples from the Global North with only a few exceptions of study cases of from South-East Asia, Australia, Easter-Europe and Africa. As such, we introduce the case of Latin America, with the example of the city of Buenos Aires, as representative of a region that acquired similar strategies in their policies with respect to the CI. Accordingly, we remind how the creative turn adopted by cities is necessarily embedded in the territorialisation of global dynamics regarding creative theories and policies. By providing a deep analysis of the adoption of the creative turn in Buenos Aires at the beginning of the XXI century, this paper suggests that global theories may have different socio-economic impacts in different local contexts. CI are neither critical, nor can be disregarded, for social and economic change; rather they call for a more nuanced perspective that is much needed both in policy and academia to understand the specific contexts of the creative sectors. • Link global-local in the adoption of the concept of Creative Industries (CI). • The creative turn reached Buenos Aires and found fertile terrain. • Questioning the understanding of development that focus exclusively on economic aspects. • Local circumstances, global conceptions. • Need of a more nuanced perspective of the relationship between CI and development.

Geographic variation in tobacco use in India: a population-based multilevel cross-sectional study.

ObjectiveThis study aims to quantify the extent to which people’s use of tobacco products varies by local areas (city ward and village) across India and the variation in this clustering by tobacco products.DesignCross-sectional study.Setting and participantsData on 73 954 adults across 2547 city wards and villages were available for analysis from 30 states and 2 union territories in India.Primary and secondary outcome measuresWe included as primary outcomes self-reported any tobacco use, current cigarette smoking, current bidi smoking, current smokeless tobacco use and a derived variable for dual use describing respondents who engaged in both smoking and smokeless tobacco use.ResultsThe median risk of an individual using tobacco was 1.64 times greater if a person hypothetically moved from an area of low to high risk of tobacco use (95% CI: 1.60 to 1.69). Area-level partitioning of variation differed by tobacco product used. Median ORs ranged from 1.77 for smokeless tobacco use to 2.53 for dual use.ConclusionsTobacco use is highly clustered geographically in India. To be effective in India, policy interventions should be directed to influence specific local contextual factors on adult tobacco use. Where people live in India influences their use of tobacco, and this association may be greater than has been observed in other settings. Tailoring tobacco control policies for local areas in India may, therefore, provide substantial public health benefits.

Gentrification and functional change in Budapest – ‘ruin bars’ and the commodification of housing in a post-socialist context

AbstractThe growth of the tourism and hospitality industry played an important role in the gentrification of the post-socialist city of Budapest. Although disinvestment was present, reinvestment was moderate for decades after 1989. Privatisation of individual tenancies and the consequent fragmented ownership structure of heritage buildings made refurbishment and reinvestment less profitable. Because of local contextual factors and global changes in consumption habits, the function of the dilapidated 19th century housing stock transformed in the 2000s, and the residential neighbourhood which was the subject of the research turned into the so called ‘party district’. The process was followed in our ongoing field research. The functional change made possible speculative investment in inner city housing and played a major role in the commodification of the disinvested housing stock.

Who defines “good” climate change adaptation and why it matters: a case study from Abaiang Island, Kiribati

Pacific Island Countries, despite significant variation in levels of exposure and internal adaptive capacities, are often portrayed homogenously as the world’s most vulnerable region to climate change. As such over the past few decades, a plethora of projects intended to assist communities across the region adapt to future climate change have been developed, channelled through multilateral and bilateral funding mechanisms and implemented in communities across a range of countries. Whether such adaptation projects have been effective in reducing the vulnerability of targeted groups remains unclear. This paper evaluates a climate change adaptation project focused on food security implemented across two communities on Abaiang Island, Kiribati (central Pacific). The project was independently evaluated using the following criteria: appropriateness, equity, efficacy, impact, and sustainability. Data was gathered from focus groups with recipient community members (n = 84) supplemented by interviews (n = 26) with relevant local stakeholders involved in implementation. Results show that while the project inputs (such as tangible and intangible goods and services) were provided, the outcomes of the project were largely ineffective and unsustained amongst the target communities. The main lesson is that local contextual factors—be they social norms, environmental, or local governance and decision-making structures—must be clearly identified, meaningfully acknowledged, and accounted for when designing and implementing local-level adaptation initiatives. This then raises broader questions about who is currently, and who should be defining “good” adaptation. The answer to this question has ramifications for social justice as well as broader issues for developing effective sustainable responses to the challenges of climate change in such places.