Non-family Members Research Articles

Breaking with the Past to Face the Future? Organizational path dependence in family businesses

This study adopts a qualitative approach in order to determine why and how the idiosyncrasies of family business influence path formation and path-breaking (and their outcomes) in strategically persistent family businesses. Findings are based on an analysis of six in-depth case studies of family businesses from Switzerland’s textile industry, including interviews with family and nonfamily firm members, archival data and expert interviews. The study finds that idiosyncrasies rooted in power hierarchy, chronicle orientation, and network embeddedness spur self-reinforcing mechanisms – in particular expectation effects and learning and investment effects – in path formation. However, at a later stage, they may become drivers of path-breaking. The study contributes to research on organizational path dependence by illuminating the role of power hierarchies in path formation and breaking. Path-breaking requires certain shifts in formal and informal power hierarchies; such shifts of power happen not only with respect to individual family members but also between family subgroups and nonfamily members. The study further identifies different strategic outcomes of path-dependent processes: protecting by renewing, pivoting and perfecting. While protecting by renewing and pivoting encompass path-breaking, perfecting occurs within the framework of a strategic path by leveraging incremental changes. In the case of protecting by renewing, businesses develop new revenue streams detached from the previous core business; these are partly used to subsidize the remains of the previous core business, thereby accepting inefficiencies for parts of the business. Pivoting refers to changing the business model without accepting inefficiencies. Implications for family and nonfamily businesses are discussed.

Bystander-witnessed cardiopulmonary resuscitation by nonfamily is associated with neurologically favorable survival after out-of-hospital cardiac arrest in Miyazaki City District.

BackgroundBystander intervention in cases of out-of-hospital cardiac arrest (OHCA) is a key factor in bridging the gap between the event and the arrival of emergency health services at the site. This study investigated the implementation rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) and 1-month survival after OHCA in Miyazaki prefecture and Miyazaki city district as well as compared them with those of eight prefectures in the Kyushu-Okinawa region in Japan. In addition, we analyzed prehospital factors associated with survival outcomes in Miyazaki city district.MethodsWe used data from an annual report released by the Fire and Disaster Management Agency of Japan (n = 627,982) and the Utstein reporting database in Miyazaki city district (n = 1,686) from 2015 to 2019.ResultDespite having the highest rate of bystander CPR (20.8%), the 1-month survival rate (15.7%) of witnessed OHCA cases of cardiac causes in Miyazaki city district was comparable with that in the eight prefectures between 2015 and 2019. However, rates of survival (10.7%) in Miyazaki prefecture were lower than those in other prefectures. In 1,686 patients with OHCA (74 ± 18 years old, 59% male) from the Utstein reporting database identical to the 5-year study period in Miyazaki city district, binary logistic regression analysis demonstrated that age of the recipient [odds ratio (OR) 0.979, 95% confidential interval (CI) 0.964–0.993, p = 0.004)], witness of the arrest event (OR 7.501, 95% CI 3.229–17.428, p < 0.001), AED implementation (OR 14.852, 95% CI 4.226–52.201, p < 0.001), and return of spontaneous circulation (ROSC) before transport (OR 31.070, 95% CI 16.585–58.208, p < 0.001) predicted the 1-month survival with favorable neurological outcomes. In addition, chest compression at a public place (p < 0.001) and by nonfamily members (p < 0.001) were associated with favorable outcomes (p = 0.015).ConclusionsWe found differences in 1-month survival rates after OHCA in the Kyushu-Okinawa region of Japan. Our results suggest that on-field ROSC with defibrillation performed by nonfamily bystanders who witnessed the event determines 1-month neurological outcomes after OHCA in Miyazaki city district. Continued education of citizens on CPR techniques and better access to AED devices may improve outcomes.

Occupational mental health of non-family members in family firms: Evidence from Pakistan.

Family-owned firms display distinct dynamics as compared to other firms. Consequently, the outcomes and consequences of these dynamics are also expected to be different. The aim of this study was to explore the impact of perceived employee-organization psychological distance (EOPD) on the occupational mental health (OMH) of the employees. Considering the complexities associated with employee–employer relationship, the study also investigated how this relationship between PD and OMH might be mediated by psychological safety (PS) perceived by the employees. Furthermore, the study also included proactive personality (PP) as a potential moderator of the relationship between PD and OMH. Results using SEM and fsQCA show a partial mediation effect on psychological safety. The study contributes by examining the distinct nature of family firms and their impact on the mental health of non-family member employees. This study contributes to the family firm literature by adopting a novel methodological approach to unveil the complexity behind the relationship between employees and owner-employers of family firms.

Investigating the Critical Factors of Employees’ Retention: A Medium Family Business in Egypt

A model of 9 Employee Retention factors (6 dependent variables and 3 demographics as moderators) is developed in the context of Family business Medium Egyptian Company. A qualitative method is used via structured interviews with 4 managers working in the company and reveals that only 5 dependent and one moderator are impacting Employee Retention which are: Salary, Benefits, Supervisor Support, Working Environment and Career Opportunities plus experience. monetary and non-monetary factors are important for employees retention, however, considering medium company inside a developing country like Egypt, how is this applied? In most of studies; salary and benefits were mentioned combined in one factor such as “compensation” or “remuneration”, which known as strong retention factor, in this study it must be separated according to the problem, as provided benefits having different effect on employees’ retention than basic salary. Another question was; are the employees demographics having effect on employees deciding wither benefits are more important than salary that impacting their retention? Results approved the necessity of separation between salary and benefits, plus they showed only experience as a moderator matters, in addition, the effect of family business which mainly concerns with work environment factor was not critical as other factors.The goal of this research is to investigate the critical factors between provided ones. The research also examines (gender, marital status, experience) if they have influence on the employees’ decision-choosing between benefits and salary. The importance of current study is to make a guide for similar contexts to find a way to consider important factors that will help to retain valuable employees. The value of this research is conducting the investigation on non-family members, with disregard of personal reasons or out of control reasons like force majeure.

Exploring the meaning of happiness of middle childhood children

Recognizing the importance of childhood happiness as a quality-of-life indicator, as well as the scarcity of studies that have been carried out concerning the happiness of children in Indonesian context, this study aims to explore the meaning, situations, and people who generate a feeling of happiness for children in Indonesian context. This research took an inductive, exploratory approach involving 46 middle childhood children as respondents (50% boys, 50% girls, Mage = 7,76). Data were collected through interviews and analyzed using a thematic analysis framework. Findings of this research revealed several themes emerge as meaning as well as sources of happiness: 1) Positive affect; 2) doing enjoyable activities; 3) receiving something; 4) achieving something; 5) relating with others; 6) having a positive physical condition; 7) performing religious activities; and 8) special days or events. Furthermore, both family and non-family members contribute a share in children’s happiness. The results confirm the findings of previous studies conducted in the context of younger children and studies in Western and Asian countries. Additional findings and suggestions for further research are discussed further in a more comprehensive manner.

Stewardship theory of corporate governance and succession planning in family businesses of UAE: views of the owners

PurposeThis paper aims to explore corporate governance (CG) and succession planning in family-owned businesses in the United Arab Emirates (UAE).Design/methodology/approachSemi-structured interviews are conducted with 16 owners and heirs of UAE family businesses. The interviews – face-to-face and asynchronous electronic – are conducted instead of a questionnaire to get an in-depth analysis of the topic in the context of both medium- and large-sized family businesses.FindingsThe responses are mixed with regard to governance challenges (duality, gender, internal control, transparency, etc.). The majority of the interviewees indicate that succession planning remains one of the biggest challenges for family businesses in the UAE. Fifteen of the sixteen interviewees document that a sound succession strategy must be in place to ensure the continuity of the business and prevent future disputes among potential successors. Similarly, the respondents also emphasise the importance of transparency and accountability for the sustainability of family businesses. The sustainability of family businesses relies on many aspects, such as national regulations, corporate systems and the succession process. Finally, most of the respondents from medium-sized companies opined that incorporating CG is a time-consuming and expensive process.Practical implicationsThe interviewees supported stewardship theory in case family members are occupying positions on the board as they have more long-term commitment and a greater sense of belonging to the business (socio-emotional wealth) compared to non-family members. The interviewees acknowledge that the lack of professionalism and conflicts of interest among family members can be offset by recruiting non-family members.Originality/valueFamily businesses are particularly significant in the Arab world as they account for over 60% of gross domestic product (GDP) and use above 80% of the workforce which make them interesting research subject. In addition, this paper explores the CG challenges faced by both large- and medium-sized family businesses in the UAE within the theoretical framework of stewardship theory.

The Boss Behind the Scenes: Nonfamily Leadership and Earnings Management

ABSTRACT We examine the effect of nonfamily leadership in family firms, whereby family members do not act as either a board chair or a CEO, on corporate earnings management. We find that firms with nonfamily leadership conduct significantly more earnings management than firms with family leadership, although this effect can be alleviated by more effective internal control and a stronger reputation concern. Additional analyses show that the increased related-party transactions can be one mechanism through which the nonfamily leadership increases earnings management. We further find that nonfamily leaders in family firms are on average weaker but receive higher (excess) payment than their peers in nonfamily firms, all consistent with the role of the nonfamily member as a marionette for the family’s misbehaviors. Moreover, earnings management increases with the degree of family noninvolvement and is mainly driven by nonfamily chairs rather than the CEOs. Overall, our paper suggests that not having a family leader aggravates incentives for the controlling family to manage earnings to realize private benefits.

The mediating effect of family business self-efficacy on parental support and succession intention relationship

PurposeDrawing on the social cognitive theory, this research examines the relationship of perceived parental support factors and the next-generation succession intention in the family business regarding the mediating effect of family business self-efficacy factors.Design/methodology/approachThis study uses the structural equation modelling method to analyse 16,521 cases from the global university entrepreneurial students' spirit survey (GUESSS) 2018 project.FindingsThis study provides evidence that parental support can influence the family business self-efficacy of the next-generation members, leading to succession intention of the family business. However, having high self-efficacy towards non-family members does not necessarily increase next-generation members' intention to engage in family business succession.Research limitations/implicationsThis research lacks information about the next-generation's perception of parental psychological control, which is needed to examine the model of next-generation engagement more comprehensively in the family business.Originality/valueAttempting to complement the family business literature, this study provides evidence about the determinants of next-generation members' succession intention and extends prior discussions on family business self-efficacy.

How do women entrepreneurs influence the strategic orientation of family businesses? A typology of Swedish decision-making in Småland community

PurposeThis paper aims to add to the theorization of family dynamics and women’s entrepreneurship by examining women’s influence on decision-making in family businesses. Business decisions in family firms, in particular, are not free from family influence in terms of goals and strategies, and the role of women in decision-making processes is of particular interest. Consequently, the role of women entrepreneurs in family firms and their influence on business development requires a more fine-grained analysis of the family dynamic within the family and the business.Design/methodology/approachThis study draws on a qualitative study and focuses on the life story narratives of nine women in rural family businesses in rural communities of Småland province in Sweden to empirically examine the decision-making processes. This region is known both for its entrepreneurial culture and traditional gender order. Based on the narrative accounts of women entrepreneurs in family businesses, the data analysis method is thematic, using a Gioia-inspired method.FindingsThe complexity of decision-making in rural family firms is further complicated in part due to a closeness with the rural community. Thus, a typology of three decision-making modes in family firms emerges an informal family-oriented mode, a semistructured family/employee consensus mode and a formal board mode with at least one nonfamily member. Moreover, the advantages, disadvantages and strategies that women use to influence decisions within the respective mode are outlined.Originality/valueThis work contributes to the study of women’s agency and its implications in family business and entrepreneurship in the rural context. The study implies that women’s agency shapes the (rural) entrepreneurship context and, likewise, the (rural) entrepreneurship context influences women’s agency. Hence, the author challenges the view of women as only caregivers and sheds light on the practices and processes behind the scenes of entrepreneurial family businesses.

Family involvement and proactive tax management behaviour in private family SMEs

PurposeThis paper investigates whether board composition, a family chief executive officer (CEO) and the firm's managerial capabilities affect proactive tax management in family small and medium-sized enterprises (SMEs). The main statement is that the professionalisation of corporate government and management practices explains the difference in tax avoidance behaviour in closely held family SMEs.Design/methodology/approachUsing the 2012 Spanish thin-capitalisation rule as a quasi-experiment, the authors estimate panel regressions with firm fixed effects and robust standard errors. This model represents a triple difference-in-differences combined with propensity score matching (PSM-DID).FindingsAnalysis shows that having a high proportion of non-family board members and a high endowment of managerial capabilities lead to tax liability optimisation in family SMEs. Conversely, familial boards and family SMEs with low managerial capabilities lack enough expertise to weigh the costs of tax avoidance over the benefits, resulting in a reluctance to engage in tax optimisation behaviours. Alike, results show no significant relation between CEO's family affiliation and tax management behaviour.Practical implicationsWhen implementing fiscal policies, the specific needs of family SMEs should be considered, and how these needs interact with corporate governance and managerial mechanisms. Moreover, policymakers need a deeper understanding of family SMEs in order to develop policies appropriate to their characteristics. A more comprehensive knowledge of how family firm heterogeneity affects corporate decisions, such as indebtedness and fiscal decisions, may improve public policies.Originality/valueThis study addresses the issue of tax behaviour in family SMEs in a particular event that implies a specific logic to weigh the pros and cons of each alternative: reducing debt or paying more taxes. This study’s conclusions are based on a model that deals with potential endogeneity problems, which avoids bias in the findings.

Exploring Knowledge-Hiding Methods and Reasons in a Small Chinese Family Business

In the highly competitive business environment, family businesses represent the backbone of the economy in various countries; meanwhile, they face tremendous survival challenges. Knowledge, particularly tacit knowledge, is the key to organisational survival because the hard-to-imitate characteristics could create value and technology innovation. However, it is challenging for family businesses to obtain tacit knowledge because it resides in people’s minds; and compared with sharing, people prefer hiding it for self-protection. In recent years, knowledge hiding has increasingly attracted scholars' and practitioners' attention but few in the family business context. Hence, this research aims to investigate how and why the employees hide tacit knowledge in the small family business. The present study used the Self-determination theory (SDT) as the theoretical foundation to explain knowledge hiding behaviours from the motivational perspective. The single case study was conducted in China, as Chinese family business has distinctive cultural characteristics influencing knowledge hiding. Data were collected and analysed from 22 participants in a small Research and Development company through semi-structured interviews and thematic analysis. The findings revealed that skilled employees used various methods to hide knowledge, such as pretending not to know, using no time as an excuse, and hiding the core knowledge. The reasons for knowledge hiding primarily reflected the unfair issues between the family and non-family employees in terms of the favouritism of the owner-manager toward the family employees, no bonus and ‘996’ timetable (people need to work from 9:00 am to 9:00 pm and 6 days per week) for the non-family members. Theoretically, this study contributes to understanding knowledge hiding behaviours by analysing motivations within SDT and corporate contextual influences in the small family business. These findings facilitate enhancing the owner-manager's awareness of the effects of unfairness on knowledge hiding and providing practical solutions to the unfairness and knowledge hiding among employees, as this has immense implications in any business.

Women in Latin American family businesses: an institutional logics perspective

PurposeThe authors conceptually theorize the obstacles and opportunities that women encounter in family businesses embedded in Latin America, by differentiating between two clusters of countries embedded in this continent.Design/methodology/approachUsing secondary data obtained from various sources, the authors adopted a flexible pattern matching methodology, which involves linking theoretical propositions with actual observed patterns. For each proposition, the authors categorize the comparison with the observed data as either confirming or rivaling the expected patterns in the clusters.FindingsThis study’s findings reveal that women have more leadership and employment opportunities in the first cluster (Brazil, Chile, and Mexico) than in the second (Argentina, Colombia, and Peru). The authors propose that these differences are the result of higher tolerance for women in political leadership positions and of the presence of larger and more internationally expanding corporations in the first cluster. We also find differences between two groups of women: female family members and female nonfamily members, with the former being granted much more opportunities than the latter.Practical implicationsThis research increases the understanding of potential avenues for managers and policymakers in Latin America to foster gender diversity as a means to remain competitive in a global market. While actions at the state level may be more long-term oriented, others, such as those taken by small and medium-sized family businesses may have more immediate effects in minimizing gender biases and encouraging a greater participation of females in business.Originality/valueBy differentiating between two clusters of countries in Latin America, and by making careful consideration of whether females have family ties, the authors provide a more realistic and contextualized theoretical map that depicts the situation of women in Latin American family businesses. This contextualization is one of the first that attempts to examine how multiple institutional logics impact women in family businesses in an underexplored region of the world while differentiating between female family members and female nonfamily members. These findings inform policymakers and family business owners in Latin America on the peculiar challenges that women encounter in their context, while calling for more measures promote the active presence of females in Latin American family businesses.

Scapegoating a Nonfamily Member after Organizational Misconduct in Family Firms

Who is blamed for organizational misconduct in family firms? While extant studies assume that dismissing executives/directors is a corrective action to avoid future misconduct, doing so may operate as a defensive action to placate stakeholders without organizational change by scapegoating less responsible executives/directors. Nonetheless, several theories suggest a mixed role of family members in scapegoating (the likelihood that nonfamily members will exit a firm, as opposed to family members). For example, agency theory argues that less agency conflict will lead to less scapegoating, but behavioral theory posits that high socioemotional wealth will result in scapegoating. By combining agency and behavioral theories, this paper theorizes that scapegoating occurs in family firms. These family firms may scapegoat nonfamily members after organizational misconduct as the number of family member executives/directors increases. This scapegoating is based on several reasons; in this case, the board emphasizes the preservation of socioemotional wealth, less attribution to family member executives given their family-based emotional ties, family members’ low motivation to abandon their family-firm specific resources, and their strong power from the top hierarchy and family identity. Additionally, family member executives’ power from sitting on board can strengthen the scapegoating of nonfamily members. This study further explores the consequence of nonfamily member departure in family firms: not significant evidence for reducing future violations. Overall, this study contributes to the literature on organizational misconduct by suggesting that scapegoating serves as a firm’s defensive response.

Bifurcation Bias in Executive Compensation System and Family Firm Performance

Family firms tend provide preferential treatment toward family members vis-à-vis nonfamily members. Prior studies defined such practices as bifurcation bias, and suggested that bifurcation bias can trigger nonfamily members’ perceptions of unfairness, and thus is detrimental to family firm performance. Drawing upon a social categorization approach to distributive justice, we extend this line of research by suggesting not all bifurcation bias practices have the same impact on firm performance, given that nonfamily member may perceive some bifurcation bias practices as unfair, whereas view other bifurcation bias practices as just. With data on family firms publicly traded in China, we found that bifurcation bias in salary compensation and bifurcation bias in equity compensation have divergent impacts on family firm performance.

Impact of respite care on health-related quality of life in children with medical complexity: A parent proxy evaluation

PurposeThis study examined the impact of respite care received by children with medical complexity (CMC) on their health-related quality of life (HRQOL). We hypothesized that out-of-home respite care would increase both opportunities to engage in activities and participation with non-family members and help with acquiring autonomy and social skills. Design and methodsThis cross-sectional study of CMC aged between 8 and 18 years living at home used a web-based questionnaire survey that parents living with the target CMC answered for proxy evaluation of CMC's HRQOL (KIDSCREEN-27). We asked 3142 parents to participate in the study through 237 special-needs schools throughout Japan. Path analysis was used to estimate the variation in each aspect of HRQOL with respite care time of in-home care services, day care services, short-stay services, and school time. ResultsWe analyzed the responses from 618 parents of CMC. The results showed that respite care by day care services and special-needs schools increased “physical well-being,” “psychological well-being,” and “peers and social support,” which are components of the HRQOL. Furthermore, respite care at schools had an impact on “school environment.” ConclusionsRespite care provided by special-needs schools and day care services has implications not only in terms of relief for caregivers but also in improving the HRQOL of CMC. Practice implicationsNurses can provide respite care that does not require parental accompaniment at school or day care facilities, which can lead to CMC's involvement in fostering autonomy and social skills. (249/250 words).

Board gender diversity and performance in family firms: exploring the faultline of family ties

Using a sample of 1134 firm-year observations of non-financial family firms listed on the Spanish stock market in the period 2003–2020, we explore how women directors affect company performance, distinguishing between family and non-family female members on the board. We believe there might be faultlines between family and non-family women on boards that may well impair performance due to differences in agency conflicts and socioemotional links with the family firm. As the number of female family directors grows, we reveal that conflicts with non-family sub-groups become more prevalent, impairing firm performance. Opening boards to non-family women does, however, seem to be an effective way of enhancing firm performance when there is a critical mass of female directors. The results are robust to alternative measures of board gender diversity and different econometric specifications.

THE EFFECT OF CORPORATE GOVERNANCE, CASH FLOW, AND DIVIDEND POLICY ON COMPANY PERFORMANCE WITH FAMILY OWNERSHIP AS MODERATING VARIABLES ON MANUFACTURING COMPANIES LISTED ON INDONESIA STOCK EXCHANGE

The purpose of this research is to examine the effect of corporate governance, cash flow, and dividend policy on firm performance in manufacturing companies listed on Indonesia Stock Exchange period of 2016 – 2020. This research uses firm age as a control variable and family ownership as a moderating variable. The technique for the quantitative data uses a statistical tool, i.e. Moderated Regression Analysis (MRA). The results shows that cash flow has a positive effect on firm performance. Meanwhile, corporate governance, and dividend policy have no effect on firm performance the implication is the members of corporate governance may come from non-family members or majority are non-family member so the family can not force regulation as well as dividend policy. Then family ownership is able to strengthen the relationship between corporate governance on firm performance since family members can enforce regulations and procedures. However, family ownership is not able to strengthen or weaken the relationship between cash flow, and dividend policy on firm performance because cash flow and dividend policy are based on company’s daily operation.

Gambling-related harms to concerned significant others: A national Australian prevalence study.

Background and aimsGambling-related harm to concerned significant others (CSOs) is an important public health issue since it reduces CSOs' health and wellbeing in numerous life domains. This study aimed to 1) estimate the first national prevalence of CSOs harmed by gambling in Australia; 2) identify the characteristics of CSOs most at risk of harm from another person's gambling; 3) compare the types and number of harms experienced by CSOs based on their relationship to the person who gambles; and 4) compare the number of harms experienced by CSOs by self-identified gender.MethodsBased on a national CATI survey weighted to population norms, 11,560 respondents reported whether they had been personally and negatively affected by another person's gambling in the past 12 months; and if so, answered detailed questions about the harms experienced from the person's gambling who had harmed them the most.ResultsPast-year prevalence of gambling-related harm to adult Australian CSOs was (6.0%; 95% CI 5.6%–6.5%). CSOs most commonly reported emotional harms, followed by relationship, financial, health and vocational harms, respectively. Former partners reported the most harm, followed by current partners, other family members and non-family members, respectively. Female CSOs were more likely to report more harm and being harmed by a partner or other family member, and male CSOs from a non-family member.Discussion and conclusionsThe findings provide new insights into the wider societal burden of gambling and inform measures aimed at reducing harm to CSOs from gambling and supporting them to seek help.

Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries.

AimsTo explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics.DesignA qualitative focused mixed methods design was used.MethodsIn total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven‐phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed.ResultsThree clusters of caregivers were identified: spouses, adult children and non‐family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health.ConclusionsInformal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure.ImpactA comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real‐world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi‐dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words.Three clusters were identified in the samples, including spouses, adult children and non‐family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission.Patient or Public ContributionCarers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure.

Barriers to accessing follow up care in post-hospitalized trauma patients in Moshi, Tanzania: A mixed methods study.

Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20-33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43-41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03-0.90]), 0.11 [95% CI 0.01-0.61], 0.14 [95% 0.02-0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors' orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers.