Overarching Strategies Research Articles

How to address the barriers to meaningful adolescent involvement in health research: A qualitative study.

The under-involvement of adolescents in health research has been attributed to multiple barriers faced by both researchers and adolescents. Despite identifying these barriers, the literature offers few solutions, mostly from the perspective of researchers. To address this, we conducted a qualitative study to explore effective strategies to address these barriers from the perspective of both researchers and adolescents. We conducted semi-structured interviews with adolescents (n = 25) and researchers (n = 25) from 14 countries. We included adolescents aged 10-24 years with experience of contributing to health research studies and health researchers with experience of engaging adolescents in health research. The interviews explored the mitigation strategies to commonly reported barriers to meaningful adolescent involvement for researchers and adolescents. Data were analyzed using reflexive thematic analysis. We identified three overarching strategies to address the commonly experienced barriers to adolescent involvement. First, participants suggested the need to plan for adequate resources, organizational support, capacity building, accessibility, compensation, and adolescents' safety. Second, they recommended building relationships by engaging the community, fostering trust and respect with adolescents, promoting teamwork, and maintaining transparent communication. Third, they proposed making involvement engaging for adolescents by creating a conducive environment, increasing their representation, using interesting methods, and addressing power dynamics. These findings build on the current best practices for adolescent involvement in health research by highlighting which strategies should be incorporated early on to plan for and prevent potential challenges to adolescent involvement.

Urban sustainability commitment in Germany – attempts to nail a pudding to the wall

ABSTRACT Knowledge about urban sustainability policies seems highly relevant regarding the ability to govern sustainable development actively. Based on this assumption, this paper reports on a new dataset in which the sustainability policies of 189 German cities are collected and aggregated into an index measuring the city’s overall sustainability commitment in 2021. This is the first attempt to collect the sustainability policies of a high number of German cities based on a multidimensional understanding of sustainability and from a policy-analytical perspective using the concept of policy density. The analysis shows that 80% of the cities are engaged with sustainability but to a significantly varying degree: ‘Beginner’ cities with a low index value do not only use less binding or symbolic policies and not all ‘leading’ cities have formulated overarching strategies. These findings fit the assumption that dichotomous operationalization of sustainability commitment, which is mainly found in the literature, might fall short of capturing the actual extent of cities’ sustainability efforts, while the developed index allows for a more differentiated operationalization. The index can be used for future analyses aimed at examining the impact of policies on sustainable development or investigating why some cities actively commit to sustainability, and others do not.

Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study

Purpose A lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers. Methods We conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC). Results Barriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow. Conclusions In this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies.

The management of international boycotts in historical perspective: Volkswagen and the Arab League boycott, 1960–1977

Research has shown that multinational enterprises (MNEs) manage international boycotts by demonstrating commitment to shared social values. However, international boycotts often revolve around contentious issues and values that are not universally embraced, requiring firms to implement different strategies to maintain legitimacy across markets. This paper analyses Volkswagen’s management of the Arab League boycott of Israel to develop a typology of MNEs’ management strategies for international boycotts. The Arab League boycott posed a business dilemma: non-compliance endangered revenues in Arab League member states, but compliance risked counterboycotting in the US and Israel. Analysis of corporate and federal archives reveals that Volkswagen used three overarching strategies: prevention, delay, and negotiation. Volkswagen first camouflaged its engagement in Israel to prevent the boycott. When facing the boycott threat, Volkswagen pursued delaying strategies to create room for negotiations with actors from home, host, and third countries that eventually preserved the firm’s legitimacy across markets.

Planetary Welcare principles for just and sustainable futures: a compass for system change, trade reforms, and transformations

International trade, a cornerstone of the global economy, has witnessed substantial growth since the start of the 21st century. This expansion, largely driven by liberalizing policies and supported by initiatives like the United Nations Sustainable Development Goals, has deeply integrated economies worldwide, making trade a substantial part of global gross domestic product (GDP). However, this growth also spotlights cultural, social, and environmental consequences. Studies indicate that trade is responsible for up to 70% of global environmental impacts, often transferring burdens from “developed” to “developing” nations. While trade bolsters economies, it also poses risks to people, nature, and the planet. In this article, I introduce the Planetary Welcare compass, an innovative framework designed to navigate these multifaceted challenges and drive transformative change. This framework integrates diverse perspectives on development, equity, sustainability, and planetary health into five interconnected principles: enhancing well-being, promoting balanced consumption, fostering accountability with integrity, embracing rooted globalism, and championing environmental stewardship. The article delves into the foundation of this framework and applies it to the overarching strategies of both the World Trade Organization (WTO) and the International Fair Trade Charter (IFTC), highlighting their divergent approaches and associated challenges. In conclusion, the Planetary Welcare compass offers a comprehensive set of principles to guide and assess production and consumption systems, including trade policies and agreements. It suggests a significant shift from the traditional welfare-state model toward a broader focus on planetary health, equity, and sustainability, ushering in the emergence of a “Welcare state” paradigm for a just and sustainable future.

Базова структура верстки телевізійних новин: стандартизований підхід до виробництва новин

This research introduces an original definition of the «news layout model,» emphasizing its significance as a conventional approach in crafting news broadcasts. The study reveals that the architecture of this model encompasses the principles of selection and ranking of topics, methodologies for information presentation, and on-air techniques. These components are inherently linked to strategic approaches in topic selection and ranking, which are grounded in the foundational principles of news creation. The presentation methods relate to the overarching strategies for assembling a news broadcast, employing a system of techniques that enable the creation of a comprehensive information segment. Meanwhile, the layout techniques are aligned with strategic approaches that ensure the news program is structured and visually organized. In the rapidly evolving landscape of television production, the meticulously developed news layout model stands as a cornerstone for swift and coordinated preparation of news segments, thereby facilitating channel discourse management.

Cardio-oncology in advanced prostate cancer.

Treatment intensification with androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPi) have led to improved survival in advanced prostate cancer. However, ADT is linked to significant cardiovascular toxicity, and ARPi also negatively impacts cardiovascular health. Together with a higher prevalence of baseline cardiovascular risk factors reported among prostate cancer survivors at diagnosis, there is a pressing need to prioritise and optimise cardiovascular health in this population. Firstly, While no dedicated cardiovascular toxicity risk calculators are available, other tools such as SCORE2 can be used for baseline cardiovascular risk assessment. Next, selected patients on combination therapy may benefit from de-escalation of ADT to minimise its toxicities while maintaining cancer control. These patients can be characterised by an exceptional PSA response to hormonal treatment, favourable disease characteristics and competing comorbidities that warrant a less aggressive treatment regime. In addition, emerging molecular and genomic biomarkers hold the potential to identify patients who are suited for a de-escalated treatment approach either with ADT or with ARPi. One such biomarker is AR-V7 splice variant that predicts resistance to ARPi. Lastly, optimization of modifiable cardiovascular risk factors for patients through a coherent framework (ABCDE) and exercise therapy is equally important. This article aims to comprehensively review the cardiovascular impact of hormonal manipulation in metastatic hormone-sensitive prostate cancer, propose overarching strategies to mitigate cardiovascular toxicity associated with hormonal treatment, and, most importantly, raise awareness about the detrimental cardiovascular effects inherent in our current management strategies involving hormonal agents.

If at first, you don’t succeed: Strategies used by environmental activist volunteer leaders to overcome failure

ABSTRACT Environmental activist leaders play a critical role in organizing grassroots activism. They often do so in a voluntary capacity while enduring long periods of failure in their quest to achieve environmental goals. Through 21 interviews we investigate how environmental activist volunteer leaders experience failure and the strategies they use to overcome it. Using a two-stage reflexive thematic analysis approach, four dimensions of failure were identified: movement, campaign, organization, and individual. Participants used three overarching strategies to manage these experiences of failure: Re-evaluating outcomes, emphasizing individual benefits, and changing tactics. Our findings suggest that environmental activist volunteer leaders regularly experienced failure across all four dimensions. The strategies they used to manage failure enabled them to maintain belief that success is achievable. We conclude with a discussion of how these findings can be used to develop tools and resources to enhance activist leaders’ capacity to prevail in the face of failure.

Factors in Learning Dynamics Influencing Relative Strengths of Strategies in Poker Simulation

Poker is a game of skill, much like chess or go, but distinct as an incomplete information game. Substantial work has been done to understand human play in poker, as well as the optimal strategies in poker. Evolutionary game theory provides another avenue to study poker by considering overarching strategies, namely rational and random play. In this work, a population of poker playing agents is instantiated to play the preflop portion of Texas Hold’em poker, with learning and strategy revision occurring over the course of the simulation. This paper aims to investigate the influence of learning dynamics on dominant strategies in poker, an area that has yet to be investigated. Our findings show that rational play emerges as the dominant strategy when loss aversion is included in the learning model, not when winning and magnitude of win are of the only considerations. The implications of our findings extend to the modeling of sub-optimal human poker play and the development of optimal poker agents.

Challenges and Adaptation Strategies of Service Providers in Vocational Rehabilitation - A Mixed-Methods Analysis

The aim of this study was to identify current challenges faced by service providers (SPs) as well as those likely to arise in the future and the coping strategies to deal with them. Challenges are requirements externally imposed on the SPs and perceived by them as central to their work. We focus on SPs that offered disability-specific programs financed by the Federal Employment Agency in December 2016. The study is based on a mixed-methods design. In summer 2017, a quantitative online survey of SPs (n=266) was conducted, as well as in-depth qualitative guided interviews (44 representatives at 32 SPs) until mid 2019. Factor analysis (STATA) and analyses in the sense of Grounded Theory (MaxQDA) were carried out. The experts at the SPs addressed three main challenge contexts or types: 1. competitive framework conditions (such as decreasing numbers of participants, increasing price competition or rising cost pressure), 2. changes in the structure of participants (such as decreasing educational competencies, more participants with behavioral problems, mental illnesses or multiple disabilities) and 3. changing demands of the labor market (such as increasing importance of computer-based activities, higher demands on qualifications or decrease in simple tasks). For the first two types, SPs had clear and overarching strategies. For example, SPs responded to the first type by changing their facility portfolio or opening up to target groups. Concerning the second type, SPs responded - according to their specific contexts of action - with further training of the staff, arrangement of permanent positions or hiring of new staff (especially psychologically trained staff) as well as negotiations with the financers of vocational rehabilitation. The third type, however, presented a very broad picture with few clear, tangible, overarching strategies. In general, SPs also looked upon financers as having an obligation to further optimize the rehabilitation process, in particular, to adequate allocation of programs and the provision of more flexible and individualized program concepts. There is no one-size-fits-all response to current and future challenges. However, the COVID-19 pandemic has shown that strategies for expected developments - such as the need to further develop digitization - must not be put on the back burner.

Operationalizing antiracism in health systems: Strategies state government administrative organizations use towards racial and ethnic mental health equity

Although a growing body of literature recommends strategies for improving racial equity in organizations and populations, little is known about how racial equity goals are operationalized in actuality, particularly in the context of state health and mental health authorities (SH/MHAs) attempting to promote population wellness while navigating bureaucratic and political constraints. This article seeks to examine the number of states engaging in racial equity work in mental health care, what strategies SH/MHAs use to improve their state's racial equity in mental health care, and how the workforce understands these strategies. A brief survey of 47 states found that all but one state (98%) is enacting racial equity interventions in mental health care. Through qualitative interviews with 58 SH/MHA employees in 31 states, I created a taxonomy of activities within six overarching strategies: 1) running a racial equity group; 2) gathering information and data about racial equity; 3) facilitating training and learning for staff and providers; 4) collaborating with partners and engaging with communities; 5) offering information or services to communities and organizations of color; and 6) promoting workforce diversity. I describe specific tactics within each of the strategies as well as the perceived benefits and challenges of the strategies. I argue that strategies bifurcate into development activities, which are activities creating higher-quality racial equity plans, and equity-advancing activities, which are actions directly impacting racial equity. The results have implications for how government reform efforts can impact mental health equity.

Gender mainstreaming research funding: a study of effects on STEM research proposals

AbstractPolicymakers increasingly try to steer researchers to choose topics of societal concern and to conduct research in ways that reflect such concerns. One increasingly common approach is prompting researchers to integrate certain perspectives into the content of their research, but little is known about the effects of this governance modality. We analyze 1,189 science, technology, engineering, and mathematics research proposals submitted to the Swedish Research Council which, starting in 2020, required all applicants to consider including the sex and/or gender perspectives in their research. We identify three overarching strategies upon which researchers rely (content-, performer-, and impact-centered) and analyze the ways in which researchers across disciplines motivate, through text, the inclusion or exclusion of these perspectives. Based on our findings, we discuss the scope of the desired effect(s) of a requirement of this kind.

How do tobacco control policies work in low-income and middle-income countries? A realist synthesis

BackgroundThe burden of tobacco use is disproportionately high in low- and middle-income countries (LMICs). There is scarce theorisation on what works with respect to implementation of tobacco control policies in...

More than recycling – The potential of the circular economy shown by a case study of the metal working industry

The steel industry is responsible for a quarter of all industrial greenhouse gas emissions. So far, the environmental savings are mainly due to steel recycling. Besides recycling, the circular economy offers strategies to increase material efficiency and thus decrease the primary raw material demand. However, the potentials remain unexploited because circular economy concepts with a higher degree of circularity are not considered. The presented case study of an industrial machining knife illustrates how the production process can be improved by implementing various circular strategies. The environmental performance is analyzed by calculating and comparing the carbon footprint, the cumulative energy demand and the material footprint, and the material efficiency indicator. The results show that the implementation of the three overarching strategies of the circular economy - narrowing, closing, and slowing – contributes to a significant increase in material efficiency. The implementation also has a positive effect on the overall environmental performance. The circular production processes require less energy and resources and cause fewer emissions. Auxiliary processes such as additional transport routes are relevant, as they can reduce or even overcompensate for savings. These processes must be adequately considered and designed.

How doctors manage conflicts with families of critically ill patients during conversations about end-of-life decisions in neonatal, pediatric, and adult intensive care

PurposeIntensive care is a stressful environment in which team-family conflicts commonly occur. If managed poorly, conflicts can have negative effects on all parties involved. Previous studies mainly investigated these conflicts and their management in a retrospective way. This study aimed to prospectively explore team-family conflicts, including its main topics, complicating factors, doctors’ conflict management strategies and the effect of these strategies.MethodsConversations between doctors in the neonatal, pediatric, and adult intensive care unit of a large university-based hospital and families of critically ill patients were audio-recorded from the moment doubts arose whether treatment was still in patients’ best interest. Transcripts were coded and analyzed using a qualitative deductive approach.ResultsTeam-family conflicts occurred in 29 out of 101 conversations (29%) concerning 20 out of 36 patients (56%). Conflicts mostly concerned more than one topic. We identified four complicating context- and/or family-related factors: diagnostic and prognostic uncertainty, families’ strong negative emotions, limited health literacy, and burden of responsibility. Doctors used four overarching strategies to manage conflicts, namely content-oriented, process-oriented, moral and empathic strategies. Doctors mostly used content-oriented strategies, independent of the intensive care setting. They were able to effectively address conflicts in most conversations. Yet, if they did not acknowledge families’ cues indicating the existence of one or more complicating factors, conflicts were likely to linger on during the conversation.ConclusionThis study underlines the importance of doctors tailoring their communication strategies to the concrete conflict topic(s) and to the context- and family-related factors which complicate a specific conflict.

Tuberculosis control in Pakistan: A decade (2011-2020) in review

This paper reviews the overarching strategies, implementation rigour, achievements, strengths and weaknesses, and challenges and opportunities faced by Pakistan’s National Tuberculosis Control Program (NTP) during the period 2011-2020. NTP’s annual reports, Global Tuberculosis (TB) Report (2019 & 2020), peer-reviewed journal articles, NTP and NSP plans, along with voluminous programmatic data reviewed. Pakistan’s national and provincial tuberculosis control program has treated around four million people and gained more than 90% treatment success. Iterative planning, partnership with the private sector, strategic advocacy, communication, social mobilization, operational research, and increasing domestic funding are essential to improving case notification and treatment success. Lack of adequate political commitment, over-and under-reporting, lack of a systematic mechanism for sputum transport, and inefficient coverage from the private sector are the main areas for improvement. Local and national strategic planning in funding, program development, and implementation is imperative from a multisectoral perspective for ending TB. Ensuring universal health coverage, treating drug-resistant cases, maintaining and strengthening the national health information system, and upgrading the vital registration system is the cornerstone for ending TB.

Going beyond supplier diversity to economic Inclusion:Where are we now and where do we go from here?

Supplier diversity is not a new concept but has increased in urgency due to racial unrest and social polarization across the globe. As culture shifts globally, demanding more diversity and inclusion in businesses, companies are having to rethink their overarching values and strategies. Supplier diversity programs foster more inclusive relationships with diverse and underrepresented populations of suppliers to produce both economic and social impact. Researchers have shown if managed effectively, a diverse and inclusive supply base can help organizations reduce risk, enhance brand image, and increase innovation and flexibility. The intent of this Notes and Debates article is to introduce and define supplier diversity, showing how an economically inclusive supplier diversity program enhances organizational benefits and provides greater economic and social benefits. A secondary intent is to begin the dialogue on the benefits of transitioning from traditional supplier diversity programs to fully embedded economic inclusion models. What is the purpose behind the transition? Is more supplier diversity necessarily better? What enablers or capabilities may be needed to evolve from a traditional supplier diversity program to a strategically positioned economic inclusion mindset? Suggestions are made about embedding key enablers within an organizational structure so that companies can mature in supplier diversity efforts and drive stronger social and economic value. This Notes and Debates piece uses support from ongoing research efforts that include interviews with companies engaged in supplier diversity programs and several supplier diversity councils. Some initial observations and remarks are incorporated in the text to help illustrate how to move from supplier diversity to economic inclusion. The enablers that help move from traditional diversity programs to economic inclusivity appear to mature and develop over time. Some organizations remain in the early, more traditional phases while others have dynamic ecosystems that have developed to support this transition.

Strategies commercially-insured families use to manage the cost of asthma care: a qualitative interview study

Objective Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, we conducted a qualitative study to explore how families manage asthma care costs. Methods We conducted phone interviews with commercially-insured, US adults (n = 59) who had asthma and/or a child with asthma. Our purposive sample included participants with high- and low/no-deductible health plans. We analyzed data using thematic content analysis to identify strategies for managing asthma care costs and to assess strategies’ implications for adherence. Results Our analysis identified four overarching strategies for managing asthma care costs. First, participants used prevention strategies to avoid costly acute care by minimizing exposure to asthma triggers and adhering strictly to preventive medication regimens. Second, participants used shopping strategies to reduce costs, including by comparing medication prices across pharmacies, using medication coupons or free samples, and switching to lower-cost medications. Third, budgeting strategies involved putting aside funds, including in tax-exempt health savings accounts, or taking on debt to pay for care. Finally, some participants sought to reduce costs by forgoing recommended care, including by skipping medication doses or replacing prescribed medications with alternative therapies. Conclusion Commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. Our typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care.

Behavioral and Psychological Aspects of the Physician Experience with Deimplementation.

Deimplementation, or the structured elimination of non-evidence-based practices, faces challenges distinct from those associated with implementation efforts. These barriers may be related to intrinsic psychological factors, as perceptions and emotions surrounding the discontinuation of established practices appear to differ from those associated with practice adoption. This study aims to explore barriers and facilitators experienced by pediatric clinicians engaging in deimplementation projects. We used behavioral economics concepts to inform our qualitative study design following a theory-informed inductive approach. We conducted semistructured interviews with participants from two national quality improvement collaboratives where the primary outcomes were deimplementation measures. Using purposeful sampling, we recruited project leaders at institutions in the top and bottom quartiles from within each collaborative. Finally, we conducted a thematic analysis using a combination of inductive and deductive coding. In total, we interviewed participants from 12 high-performing sites and 7 low-performing sites. Participants identified nine concepts associated with successful deimplementation practice and three psychological barriers that impacted behavior change: (1) loss, (2) fear, and (3) action bias. Participants further identified four overarching strategies for mitigating the identified psychological barriers, including (1) making allowance for nonconformism; (2) permission to change; (3) normalizing; and (4) reframing. There is potential for more effective deimplementation through the proactive incorporation of an awareness of specific psychological barriers of loss, fear, and action bias, as well as specific mitigation strategies to address the psychocognitive experience.

“You’re too thick to change the station” – Impoliteness, insults and responses to insults on Twitter

AbstractThis paper aims to propose a typology of replies to insults based on data retrieved from Twitter, which is ripe with offensive comments. The proposed typology is embedded in the theory of impoliteness, and it hinges on the notion of the perlocutionary effect. It assumes that what counts as an insult depends primarily on whether or not an utterance is evaluated as offensive by the insultee. The evaluation can be signalled behaviourally or verbally and includes expressed replies as well as so-called silent replies. The insults, regardless of the presence or absence of an insulting intention of the insulter (potential insult), that are not rendered as offensive by the target are only attempted insults, while those that are experienced as offensive amount to genuine insults. The analysis has illustrated select types of reactions and has shown that potential, attempted and genuine insults may be further divided into: in/direct insults, explicit/implicit, non-/pure, and non-/vocatives, whilst reactions can be subsumed by three overarching strategies: agreeing, attacking and rejection.