Multi-stakeholder Perspective Research Articles

HTA104 A Multicriteria Decision Analysis - Proposal of Evaluation Criteria for Treatments of Rare Diseases in Brazil

From a multi-stakeholder perspective, propose relevant criteria for the evaluation of rare disease treatments in Brazil.

Multi-stakeholder perspectives regarding preferred modalities for mental health intervention delivered in the orthopedic clinic: a qualitative analysis

BackgroundAlthough depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders’ perceptions regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care.MethodsThis single-center, qualitative study was conducted within a tertiary care orthopedic department. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders’ interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention.ResultsPatients included 30 adults out of 85 approached (mean (SD) age 59 [14] years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person support from a mental health specialist into orthopedic care.ConclusionsAlthough digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients.Trial registrationNot applicable.

Modeling key enablers influencing FinTechs offering SME credit services: A multi-stakeholder perspective.

The study models inter-relationship among key enablers that influence the growth of FinTechs that offer credit services to small and medium enterprises (SMEs). It focuses on emerging market of India, which is the world's third-largest FinTech centre. It employs Grey DEMATEL method to measure the cause-effect relationship based on the assessment given by FinTech practitioners, experts, policymakers, and investors. The results show that credit demand by SME borrowers, availability of alternate data sources, and Covid-19 are the critical enablers that exercise strong impact on FinTech system. Collaboration between FinTechs and traditional financial institutions, end-to-end financial solutions, and scalability of business operations are recognized as critical dependents that are hugely affected by others. The study recommends policymakers to foster collaborative environment, strengthen digital data landscape, and improve financial literacy to develop FinTech sector. It recommends practitioners to focus on data security and to offer end-to-end financial solutions to its SME borrowers.

Integrating driver behavior into last-mile delivery routing: Combining machine learning and optimization in a hybrid decision support framework

The overall quality of last-mile delivery in terms of operational costs and customer satisfaction is primarily affected by traditional logistics planning and the consideration and integration of driver knowledge and behavior. However, this integration has yet to be exploited. This phenomenon is mirrored in two largely separated research bodies on logistics planning and driver behavior. Bridging this gap by using and integrating historical data from actually driven tours into last-mile delivery planning is promising for research and practice. Still, it also leads to complex and large-scale routing problems, which require the development of an overall methodology that goes beyond classical optimization approaches as the needed approach requires a multi-stakeholder perspective, calls for a hybrid-analytical approach by incorporating tour prediction and prescription, and requires both data science and optimization methods. Accounting for these challenges, we suggest a hybrid decision support framework for the traveling salesman problem with time windows that combines machine learning techniques and conventional optimization methods and considers the deviation between suggested and predicted tours. We demonstrate the applicability of our framework in a case study that draws on real-world logistics data. Relying on a sensitivity analysis, we investigate and illustrate the trade-off between the level of deviation between predicted and suggested tours and tour costs. Our case study draws general managerial implications and recommendations that guide decision makers in building their decision support systems for last-mile delivery routing by instantiating our generic framework.

Tracking activity-based therapy for people living with spinal cord injury or disease: insights gained through focus group interviews with key stakeholders

Purpose The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. Materials and methods Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. Results Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. Conclusions Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada.

Multi-stakeholder perspectives on sustainability transitions in the cosmetic industry

A compelling sustainability vision has shaped today's industries worldwide, including the fast-growing cosmetics sector. Sustainability issues have become even more challenging in a developing country because of greater economic inequalities and regulatory weaknesses. However, with the lack of empirical and holistic evidence in this specific context, this research aims to understand business and policy perspectives on sustainability transitions in Thailand's cosmetic industry where little has been investigated. This qualitative study conducted 12 semi-structured interviews with industry and policy stakeholders. A deductive content-analysis approach was utilized to extend the application of product life cycle thinking and circular economy to sustainability-related practices and policies. We found that multinational cosmetic companies pursue initiatives to improve sustainability dimensions more prominently and holistically as part of their corporate strategies. Meanwhile, local cosmetic companies still lack resources, a holistic understanding of life cycle impacts, and a full integration of sustainability into the core business. From a regulatory perspective, the lack of regulations for green cosmetics highlights the need for a total market approach in policy-making to encourage transparency in business practices and improve the role of trust in the relationship between producers and consumers. Policy recommendations include mandatory sustainability reporting, extended producer responsibility regulations for packaging, a directive on the communication of green claims, and financial incentives for green markets to facilitate sustainability transitions for the cosmetic industry.

The impact of policy changes on the mustard ecosystem: a multi-stakeholder perspective

PurposeDespite various consequences for different stakeholders in the mustard ecosystem, India prohibited blending in mustard oil to achieve self-reliance in edible oils and promote consumer health. This paper uncovers the implications of this policy on mustard production, consumption and prices.Design/methodology/approachThis paper deploys system dynamics (SD) to model the mustard ecosystem. SD uses simulation modeling to comprehend the nonlinear behavior of complex systems over time utilizing causal-loop and stock-flow diagrams.FindingsWhile the mustard price does not vary in the short run, it diverges toward a higher side in the long run due to the changed policy mandate. Surprisingly, due to the predominance of market prices, the policy administered minimum support price (MSP) was found to have a limited influence on mustard prices. Hence, the focus should be on supply augmentation through non-price-based measures like disseminating information to enhance the yield rate of seed production and promoting the adoption of efficient technologies with higher oil conversion efficiency.Research limitations/implicationsThe paper allows policymakers to quantitatively evaluate the effectiveness of policy interventions to mitigate the adverse impacts of policy mandate. It presents a reliable roadmap for policymakers to roll out effective policies.Originality/valueThe paper uncovers the system-level impact of policy on stakeholders and examines the effectiveness of MSP.

Tipping, Disrupted: The Multi-Stakeholder Digital Tipped Service Journey

The shift from analog to digital point-of-sale systems (e.g. Square) and app-based service platforms (e.g. Uber) disrupted frontline services by creating new tipping processes that occur in an ever-expanding range of service contexts and involve new stakeholders. The increasing importance of tipping in the global economy and the uncertainty regarding tipping practices suggest the need for a comprehensive framework that accounts for evolving tipped service networks. We introduce the multi-stakeholder service journey lens to build a conceptual framework that accounts for the competing interests of customers, employees, frontline service managers, technology providers, and other stakeholders in emergent tipped services. This framework examines interactions between stakeholders at different points along the tipped service journey, while accounting for the technologies and contexts that shape stakeholder interactions and the sometimes divergent outcomes that result. Stakeholder interactions at each stage of the tipped service journey suggest theoretically rich research questions, such as “How do digital tipping technologies diffuse into and realign cultural practices?”, and important practical questions, such as “Which tip request framing and formatting choices result in the highest tips, most customer satisfaction, and optimum employee outcomes?” Our conclusion emphasizes the importance of multi-stakeholder service journey perspectives for examining digitally disrupted services.

A Political Economy and Multi-Stakeholder Perspective of Net-Zero Emission Urban Bus Transportation in the United Kingdom

The transition to net-zero emission urban bus (ZEB) systems is receiving increased attention in research and policymaking. Most studies in this area focus on techno-economic aspects and the views of a narrow group of stakeholders. This offers limited insight into the range of barriers that constrain transitions in real-world contexts. This article offers a political-economic and multi-stakeholder perspective on the technical and non-technical barriers to ZEB transitions within the UK context. It develops a theory-guided empirical case study, informed by stakeholder theory perspectives and semi-structured interviews with stakeholders in the local bus transportation system. It finds that a transition to net zero will require addressing technical, policy, market, and cooperative barriers across sectors and policy levels. On the one hand, this relates to high costs and performance uncertainties over ZEB technology and infrastructure. On the other hand, it concerns unsustainable bus networks from passenger patronage and coordination perspectives, stakeholder cooperative gaps, and high car use and dependency in urban areas. Policy portfolios and stakeholder collaborations, beyond a ‘net-zero’ and sectoral focus, could tackle barriers to system-level change. Further application of the theoretical framework can contribute to a broader body of knowledge about transition barriers operating in different political and economic contexts.

Magico-religious beliefs, stigma and help-seeking for adolescent mental health at the community level – A multi-stakeholder qualitative exploration in southern India

Background: Almost half of all mental health disorders begin before the age of 14. However, several barriers exist to seeking help for mental health conditions among adolescents in the Indian context. The present study aimed at exploring multi-stakeholder perspectives on adolescent mental health and help-seeking behavior as well as referral. Methods: Our study adopted a qualitative design with focus group discussions (FGDs) and in-depth interviews (IDIs) conducted over a span of one year among 70 participants using purposive sampling. Participants included parents of adolescents, adolescents aged 14–16 years, high school teachers, and mental health professionals (MHP) and a pediatrician. The study was conducted in selected educational blocks of Udupi taluk. Parental written informed consent and assent from adolescents were obtained. Data was transcribed and thematic analysis was performed using Atlas.ti (version 8) to identify codes and code families following which themes were identified. Results: Our findings elicited community-held beliefs and attitudes indicating pathways and barriers to seeking care. Participants perceived that increased device use, accessing pornographic material, experiencing bullying, academic stress and negative perceptions surrounding mental health with the addition of magico-religious beliefs contributed to delayed help-seeking. Barriers to help-seeking included stigmatizing cultural perceptions. A considerable proportion of families found traditional healing more acceptable in the community. Conclusions: Stigma related to mental health continues to be one of the major barriers to early intervention. School counselors, teachers and even religious leaders in the community were found as effective liaisons in providing referrals to MHP. Recommendations for future studies and the way forward are discussed.

Food system actor perspectives on future-proofing European food systems through plant breeding

Crop improvement is a key innovation area in the pursuit of sustainable food systems. However, realising its potential requires integration of the needs and priorities of all agri-food chain stakeholders. In this study, we provide a multi-stakeholder perspective on the role of crop improvement in future-proofing the European food system. We engaged agri-business, farm- and consumer-level stakeholders, and plant scientists through an online survey and focus groups. Four of each group’s top five priorities were shared and related to environmental sustainability goals (water, nitrogen and phosphorus efficiency, and heat stress). Consensus was identified on issues including considering existing alternatives to plant breeding (e.g. management strategies), minimising trade-offs, and addressing geographical variation in needs. We conducted a rapid evidence synthesis on the impacts of priority crop improvement options, highlighting the urgent need for further research examining downstream sustainability impacts to identify concrete targets for plant breeding innovation as a food systems solution.

Ethical and legal considerations influencing human involvement in the implementation of artificial intelligence in a clinical pathway: A multi-stakeholder perspective.

Ethical and legal factors will have an important bearing on when and whether automation is appropriate in healthcare. There is a developing literature on the ethics of artificial intelligence (AI) in health, including specific legal or regulatory questions such as whether there is a right to an explanation of AI decision-making. However, there has been limited consideration of the specific ethical and legal factors that influence when, and in what form, human involvement may be required in the implementation of AI in a clinical pathway, and the views of the wide range of stakeholders involved. To address this question, we chose the exemplar of the pathway for the early detection of Barrett's Oesophagus (BE) and oesophageal adenocarcinoma, where Gehrung and colleagues have developed a "semi-automated", deep-learning system to analyse samples from the CytospongeTM TFF3 test (a minimally invasive alternative to endoscopy), where AI promises to mitigate increasing demands for pathologists' time and input. We gathered a multidisciplinary group of stakeholders, including developers, patients, healthcare professionals and regulators, to obtain their perspectives on the ethical and legal issues that may arise using this exemplar. The findings are grouped under six general themes: risk and potential harms; impacts on human experts; equity and bias; transparency and oversight; patient information and choice; accountability, moral responsibility and liability for error. Within these themes, a range of subtle and context-specific elements emerged, highlighting the importance of pre-implementation, interdisciplinary discussions and appreciation of pathway specific considerations. To evaluate these findings, we draw on the well-established principles of biomedical ethics identified by Beauchamp and Childress as a lens through which to view these results and their implications for personalised medicine. Our findings are not only relevant to this context but have implications for AI in digital pathology and healthcare more broadly.

Prioritizing risk factors and identifying target areas to address with interventions to improve sustainable employment of persons with a brain injury or a spinal cord injury - A multi-stakeholder consensus process.

Achieving sustainable long-term employment is the goal of work integration for persons with acquired brain injury (ABI) or spinal cord injury (SCI). However, decreasing employment rates over time for persons with ABI and SCI indicate that remaining employed in the long-term is a challenge. To identify the most important risk factors that pose a barrier to sustainable employment of persons with ABI or SCI from a multi-stakeholder perspective, and to propose corresponding interventions that address them. Multi-stakeholder consensus conference and follow-up survey. From 31 risk factors to sustainable employment of persons with ABI or SCI identified in previous studies, nine were defined as most important to address with interventions. These risk factors either impacted the person, the work environment or service provision. Potential interventions to address these factors were proposed in mixed condition groups, of which ten were voted on as priority interventions. The follow-up survey revealed strong agreement on the intervention proposals, strong to moderate agreement on impact, but moderate to low feasibility, as most of the interventions were measures at the meso- (service) and macro- (legislation and state regulation) level. Holding micro-level stakeholder conferences is a valuable method for identifying the most important risk factors to sustainable employment and for developing measures to address them. To implement measures that involve decisions at the meso- or macro-level, representatives from these levels of the healthcare and social system have to be involved.

The role of integrated thinking in corporate governance during the COVID-19 crisis: perspectives from South Africa

PurposeThis study aims to examine how integrated thinking principles can be used to assist those charged with governance during and after a crisis.Design/methodology/approachAn autoethnographic approach was used to collect and reflect on information related to the economic, social and environmental impact of COVID-19. This was complemented with a bibliometric analysis of academic articles including “corporate governance”, “integrated thinking” and “crisis” as a keyword. This information was used to produce a data mind map of core themes. This was supplemented with a qualitative exploratory approach based on semi-structured interviews with 16 participants comprising preparers of financial statements, board members and corporate governance specialists to obtain insights into using integrated thinking in corporate governance during a crisis.FindingsThe results of the study indicate that those charged with governance can use integrated thinking to repurpose their business model by considering a multi-capital and multi-stakeholder perspective to value creation. The study highlights the importance of implementing a holistic capital integration process to gauge risks, capitalise on opportunities and improve business processes in response to a crisis. This can be leveraged by both the private and public sectors to manage a crisis and deal with the long-term indirect impacts of a crisis.Social implicationsAn integrated thinking approach can be used by both the private and public sectors to bolster confidence, tackle pressing social and environmental challenges and contribute to improved performance relative to the sector.Originality/valueThe expert interviews contribute empirical evidence to the profile of mainstream social and environmental accounting literature and offer a practical contribution by offering insights that can directly be used by organisations’ investors, non-governmental organisations and other stakeholders to manage a crisis. This paper also advances the sustainability agenda by assessing how a crisis can be managed in the context of a developing economy and advancing normative recommendations which will be broadly applicable to an international audience.

Multistakeholder Perspectives on Interventions to Support Youth During Mental Health Boarding.

To identify and prioritize opportunities to improve the psychiatric boarding experience for youth awaiting admission or transfer to inpatient psychiatric care. This study utilized an exploratory mixed methods design. The study team convened multidisciplinary stakeholder focus groups to discuss proposed hospital-based solutions to mental health boarding, potential psychosocial interventions deliverable during boarding, and outcomes measurement. Focus group responses were transcribed and analyzed to extract themes pertaining to these improvement opportunities. These results informed a follow-up survey which was then sent to the stakeholders to rate the feasibility and importance of modifications using a modified RAND-UCLA Appropriateness Method. Qualitative analyses revealed 9 themes across 2 domains related to psychiatric boarding care: in-hospital improvements and transitions of care. The follow-up survey identified 6 improvement opportunities rated as both feasible and important. Additionally, 6 psychosocial interventions, 2 delivery modalities, and 5 outcomes were rated as both feasible and important. Stakeholders concerned with the psychiatric boarding of youth identified numerous opportunities for improving the boarding process within 2 domains of in-hospital improvements and transitions of care. Most of the improvements were considered feasible and important with several serving as particularly viable strategies. These have the potential for implementation to improve the care of this vulnerable population and inform local and national quality improvement efforts.

Deploying predictive analytics to enhance patient agility and patient value in hospitals: A position paper and research proposal

Patient value in hospital care has become increasingly important over the last decade. This paper argues that patient value could be ameliorated by investing in patient agility. Patient agility constitutes the capabilities that enable hospitals to sense the health service needs of their patients and respond to the changing health service demands of these patients. This paper further posits that hospitals’ current sensing and responding capabilities are inherently reactive as they detect, act upon and pursue occurrences and patterns in the needs and demands of patients after these have already manifested themselves. Hence, we assert that this reactive nature thwarts hospitals in preventing negative trends or capitalizing on positive trends necessitating a shift to sensing and responding capabilities that are more predictive. We postulate that this necessary organizational shift can be facilitated by implementing and utilizing the power of predictive analytics and that this particular issue has not yet been adequately addressed by existing scientific literature. Based on this argument, an initial research proposal is established centering around the role of predictive analytics in fostering patient agility and patient value in hospitals. The initial research proposal sets out to examine this topic in an inclusive, integrated and comprehensive manner as it outlines a coherent conceptual model, incorporates a multi-stakeholder perspective and integrates biomedical as well as health service needs and demands. The initial proposal is meant to serve as a conceptual framework for future research as well as an initial point of departure for further refinement, improvement, elaboration, and discussion.

The effects and conflicts of co-opetition in a rail-water multimodal transport system.

This study investigates a rail-water multimodal transport system composed of a railway company, a liner company, and an emerging multi-modal operator. Based on the co-opetition game, we discuss decision strategy preference and conflict from a multi-stakeholder perspective to optimize individual profit and system efficiency. It is found that although the invasion of multi-modal operators into the market poses a threat to competition, their service effort directly affects the market demand and promotes the profits of each carrier. The free-riding and market expansion effects triggered by service effort interact with each other. However, multi-modal operators can cope with the negative impact of the free-riding effect through the service strategy and promote system efficiency optimization. Specifically, discussing each carrier's decision-making preferences for maximizing profits, we find that the multi-modal operators' strategy can achieve the Pareto optimal of triple-win, and the system efficiency is also optimal simultaneously.

Knowledge, skills and abilities (KSAs) as a metric to re-conceptualise aptitude: a multi-stakeholder perspective

ABSTRACT Aptitude is a hypernym used in training and practice-based contexts to refer to a person’s natural or acquired ability to do something. It tends to be an attribute that is ‘forward-looking’, i.e. referring to a person’s probability of achieving success in the future. This paper adopts a retrospective perspective in looking at the ‘success achievement’ of (would-be) interpreters and employs the term knowledge, skills and abilities (KSAs). The research questions that this paper addresses relate to frequency of KSAs referred to across four ‘stakeholder areas’ relevant to interpreter performance: studies from pedagogues on training and (pre-qualification) testing; testing/credentialing authorities; industry-based organisations; and trainee and practising interpreters themselves. Comparison across the four stakeholder areas shows that the training and testing, and credentialing stakeholder areas most frequently identify linguistic and transfer-based KSAs, with moderate attention afforded to intercultural skills, discourse analysis skills, social interactional skills and knowledge bases across different thematic areas, and demonstration of knowledge of ethics. The industry-based stakeholder area records high levels of frequency for KSAs to do with research, terminology, business, self-assessment and ICT skills, alongside linguistic, and interactional KSAs. Overall, however, the broadest spread of frequently identified KSAs is recorded amongst the trainee and practitioner stakeholder group.

Qualitative Analysis of the Content Validity of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) in Schizophrenia: A Multi-Stakeholder Perspective.

The US Food and Drug Agency (FDA) requires clinical trials targeting cognitive impairment associated with schizophrenia (CIAS) to demonstrate the functional relevance of cognitive improvements by employing a functional co-primary measure. Although quantitative evidence supports the suitability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) for this purpose, FDA guidelines for qualification of clinical outcome assessments require evidence of content validity, defined as qualitative evidence that key stakeholders view the measure as relevant and important. To collect this important qualitative data, semi-structured interviews were conducted with outpatients with schizophrenia (n = 24), caregivers (n = 12), and professional peer support specialists (n = 12) to elicit their views about the definition and importance of functional independence, the importance of the functional domains assessed by the VRFCAT (meal planning, using transportation, handling money, shopping), and the relevance of the VRFCAT tasks to these domains. Qualitative thematic analyses revealed consistent themes across groups in defining functional independence, including performing instrumental self-care, financial, and social tasks; making decisions autonomously; and not depending on others to carry out daily activities. There were, however, notable differences in their views regarding the importance of and barriers to functional independence. All groups viewed the VRFCAT as assessing skill domains that are central to independent functioning and, with some minor differences, the VRFCAT tasks were viewed as relevant and meaningful examples of the domains. These qualitative results provide converging evidence that key stakeholders view the VRFCAT as a content-valid measure.

Design of integrated passenger-freight transport: A multi-stakeholder perspective

Integrated passenger freight transport (IPFT) is a tactical solution that can potentially reduce travel demand and the costs of first- and last-mile services. Although the scientific interest in this topic increased in the last decade, IPFT contributions are still mostly related to the definition of a general framework. Conversely, the design of the service attributes and the evaluation of the operational performances have been object of less attention. To address such a research gap, this paper presents the results of a Delphi survey with international stakeholders. The aim is to verify the minimum requirements upon the introduction of the IPFT in both urban and rural contexts, including fare reductions for users, which are necessary to compensate for the differences as compared with passenger-only and freight-only services. The survey results indicate the necessity of an efficient service in terms of information, environmental performances, space division, and security (the last aspect refers more to passenger than to freight transport). Other attributes, such as cleanliness on board, are more debated. Policymakers and practitioners can use these findings as a benchmark for the definition of performance requirements and boundaries for designing the service. The suitability of the IPFT scheme in real-case contexts is then verified. New suburban and urban IPFT services are designed by modifying the characteristics of two existing urban and suburban bus lines that operate in the Italian provinces of Forlì-Cesena and Rimini according to both the results of the Delphi survey and the territorial specificities. The scheme’s suitability to the existing schedules is finally determined. As next steps, the new design has to be assessed through a) a stated preference survey submitted to potential users of the service; b) a supply model that verifies the matching of supply and demand under the new configuration, and c) an economic evaluation of the service, which considers the perspective of single actors.