Participatory Approach Research Articles

Engaging co-creators network in a public mental health intervention: MENTBEST

Abstract Background MENTBEST, a 5-year EU-funded project, addresses mental health challenges among vulnerable groups using community-based interventions and innovative technologies. It aims to mitigate adverse impacts, focusing on migrants, older individuals, younger individuals, long-term unemployed individuals, and those with mental disorders in Albania, Germany, Spain, Denmark, Greece, Ireland and Estonia. MENTBEST seeks to provide tailored support to vulnerable populations, promoting mental well-being and resilience through two interventions (a) Mentina a mobile app and (b) a complex community intervention based upon the European Against Depression 4-level intervention. Methods A Participatory Action Approach has been employed through each research stage of MENTBEST where stakeholders across Europe have become part of the research team and provide input towards designing and evaluating the two interventions mentioned above. The PRODUCES framework was used to establish the Co-creators Network, ensuring inclusivity and relevance through: stakeholder mapping, prioritization, and engagement strategies. An online platform has been established for the network to collaborate as a community of practice, but also as means of upskilling co-creators through MOOCs and brief courses. Results The Co-creators Network comprises 24 diverse members strategically distributed among vulnerable groups through all participating Mentbest countries. Engagement activities include workshop participation on taking decisions on a range of research topics such as designing content, evaluation of the interventions, implementation of the interventions etc. Conclusions The Co-creators Network represents a milestone for MENTBEST, ensuring a collaborative approach to public mental health intervention. Innovative strategies highlight the project’s commitment to addressing the mental health needs of vulnerable populations. Key messages • Collaborative approach in MENTBEST fosters inclusive public mental health interventions. • Co-creators Network drives innovative strategies to address mental health needs of vulnerable groups.

5.K. Scientific session: Health literacy in Ireland: A participatory action approach with Sláintecare Healthy Communities

Abstract This workshop offers a comprehensive exploration of the dynamics, challenges, and opportunities surrounding health literacy in Ireland. In 2023, Dublin City University and Sláintecare Healthy Communities, driven by a commitment to foster equitable healthcare access and outcomes, embarked on a research project aimed at deciphering the intricacies of health literacy and its implications for public health in Ireland. The series of interactive presentations will transparently share learnings from the process and outcomes of this project, which can be applied across different sectors, contexts, and countries. The workshop will begin with an overview of the rationale underpinning Sláintecare Healthy Communities’ engagement in this research project. This is one of the first pilot programmes of its kind. By transparently exploring the driving forces and strategic approaches of this organisation, participants will gain insight into the imperative of addressing health literacy from the perspective of a cross-government and multi-discipline initiative. Following from this, a series of presentations will detail the rigorous scientific approaches undertaken. This includes an umbrella review of international conceptualisations of health literacy and a systematic review of health literacy research conducted on the island of Ireland in the last decade. Findings from these reviews highlight the evolving challenges and emerging trends shaping health literacy practices nationally and internationally. It is also recognised that responsive health literacy development requires thoughtful involvement of diverse local communities. Programmes and actions that ‘leave people behind’ can exacerbate health inequalities. As a result, meaningful community based participatory research, including innovative design thinking approaches, were utilised throughout this project. The Sláintecare Healthy Communities Programme identified two contrasting areas to participate in this work, presenting both an urban and rural context. The health literacy strengths, needs and issues encountered in these communities will be presented in the community members own words. This workshop will close with the presentation of a series of co-designed, and crucially actionable, recommendations for evidence-based best practices in health literacy promotion in Ireland. Leveraging the synthesis of research findings and stakeholder insights, a number of actions aimed at enhancing health literacy proficiency and fostering health equity will be detailed. This presentation in particular will be interactive, and will challenge participants to identify health literacy promoting actions that may be suitable for their own contexts. This workshop offers a timely and pragmatic exploration of health literacy promotion in Ireland. By fostering dialogue, knowledge exchange, and collaboration, the workshop serves as a catalyst for transformative change, paving the way towards more inclusive, equitable, and health-literate societies, both in Ireland and beyond. Key messages • This workshop offers a timely and pragmatic exploration of health literacy promotion in Ireland. • Presenters from both practice and research will detail how the needs analysis was conducted, and how we suggest these co-designed recommendations can be actioned.

Exploring the perceived dynamic system driving inequities in the community obesogenic environment

Abstract Introduction Persons in socioeconomically disadvantaged situations (PSEDS) are more susceptible and disproportionally exposed to obesogenic environments, resulting in poorer dietary outcomes and lower levels of physical activity. This study aimed to map the complex dynamic system within the community obesogenic environment driving unhealthy eating and insufficient physical activity among PSEDS in Flanders, and to identify potential local actions. Methods Participatory group model building (GMB), a qualitative system dynamics method, was used to engage PSEDS (n = 7), local decision makers (n = 7) and local stakeholders (n = 5) in two Flemish municipalities. A two-day GMB session was held in each municipality during which a causal loop diagram (CLD) was created and potential local actions were identified by considering causal pathways and reinforcing loops in the system. Results The CLD was designed around two main variables (i) healthy eating and (ii) physical activity among PSEDS. Seven sub-systems could be identified: 1) social environment, 2) facilities and activities, 3) mobility options, 4) information, 5) affordability, 6) safety (specifically for physical activity), and 7) industry and advertisement (specifically for eating behaviour). Several actions to improve the local environment to promote eating behaviour and physical activity among PSEDS were identified. Conclusions The CLD illustrates the complex interactions between individual and environmental determinants contributing to inequalities in eating behaviour and physical activity by including multiple perspectives of community members in socioeconomically disadvantaged situations, local decision makers and local stakeholders. Both the participatory GMB approach and the final CLD visualization can provide the basis for planning local actions for promoting healthy eating behaviour and physical activity among PSEDS. Key messages • Group model building is an effective approach to explore and understand a dynamic complex system through a shared understanding among diverse stakeholders. • A systems approach is valuable to provide a more comprehensive and context-specific understanding of the perceived factors contributing to inequities in the obesogenic environment.

Exploring the policy context of Whole School in eight EU countries: the Schools4Health project

Abstract Background Moving from the recognition of WHO principles of health promoting school (HPS) to concrete practices is challenging. The Schools4Health project is an EU initiative with the aim to introduce, strengthen, and sustain the adoption of a participatory whole-school approach to health and wellbeing. The aim of this work is to present an update about the policy environment around HPS approaches in eight EU countries. Methods Between September-November 2023, Schools4Health partners from Spain, Belgium, Hungary, Greece, Latvia, the Netherlands, Romania and Slovenia carried out a preliminary scoping exercise to investigate the policy conditions which can influence the national uptake of HPS approaches. A three-step methodology was developed: a. identification of core stakeholders b. Rapid Situation Analysis survey and c. national roundtable meetings, to assess stakeholders’ awareness of and engagement in health promotion programs in schools. Results In total, n = 192 responses from stakeholders from health, education, social and agricultural sectors were selected. Most experts were aware or partly aware of the HPS concept. While there is consensus that health promotion at school is essential, there is a lack of, or weak implementation of legislation and voluntary initiatives due to barriers such as limited time and financial resources, teachers burnout and insufficient interaction between education and health governmental bodies. Conclusions Effective advocacy can highlight the potential of HPS in addressing the urgent challenges related to wellbeing in youth, and the associated decline in educational performance across Europe. Policymakers, public authorities and the broader community should also be engaged. Key messages • Creating HPSs should not solely fall on schools and teaching staff. • Policymakers, public authorities and the broader community around schools have responsibility to ensure that policy measures and instruments embed the key considerations for HPS approach.

Co-designing health literacy actions: Connecting the dots to create meaningful impact

Abstract In closing the workshop, this presentation will bring together the participatory research recommendations for promoting and developing healthy literacy in Ireland, which will be led by Slaintécare Healthy Communities in practice, dissemination and scale up. In particular, a worked example from a third Slaintécare Healthy Community (Westmeath) will be presented; a healthy literacy “Train the Trainer” professional development course for local health literacy champions. In this presentation, we will also challenge attendees to offer suggestions of how to support and facilitate other recommendations suggested by our participants, and invite them to consider how this participatory action approach to a health literacy needs analysis could be utilised in their own contexts.

Climate change adaptation measures in the context of health promotion using participatory foresight

Abstract Issue/problem Climate change is regarded as a big threat to human health (WHO 2023), requiring action to prepare our health systems. Using participatory foresight approach has the potential to increase capacities of communities and to sustain future health. The process is easily transferable to other regions or countries across Europe. The work is part of the Austrian “Climate-Resilience-Check Health for regions and municipalities”. Description of the problem We present an innovative qualitative method to contribute to a climate change and health vulnerability and adaptation assessment following WHO’s guidelines. Questions answered by the project were: • What measures can be taken to shape the regions’ potential for a health-promoting lifestyle and to increase climate resilience? • Does participatory foresight represent a well-suited method to develop climate adaptation measures which address local needs? Taking place between 10/23 to 12/23, the participatory foresight process consisted of (1) a foresight-workshop facilitating development of adaptation measures through the creation of personas and (2) intervention boards, which gave the broader population the opportunity to vote for measures developed in the workshop. The aim of the approach was to identify measures that receive approval within the population. Results The participatory foresight process highlighted the local populations’ wish of revitalizing village centers to strengthen social cohesion. Particular emphasis was placed on the establishment of a community center and the expansion of daycare services. Lessons The process will be conducted in further regions as part of the Climate-Resilience-Check Health for Austrian regions and provides lessons of good practice for roll-out across European countries aiming to bridge efforts for climate adaptation and health promotion at regional levels.

Innovative approaches to measuring and promoting employee vitality and sustainable employability

Abstract Background Employers find it difficult to develop interventions for vitality and sustainable employability (SE), particularly for employees in low-skilled jobs. Measures based on the employee perspective on SE that would give direction to interventions fall short, and effective programs to improve vitality and SE in this group are lacking. This study aims (1) to get insight into the effect and implementation of an innovative organizational, dialogue-based approach ‘Healthy HR’ (HHR)* to promote job control and SE, and (2) to refine and further validate the Maastricht Instrument for SE (MAISE)-Easy (an HHR tool for needs assessment). Methods (1) An effect evaluation with a pretest-posttest design with a 1 year follow up (N = 71), and a mixed-methods process evaluation were conducted. Data were collected using questionnaires, interviews with employees and employers (N = 26), focus groups (N = 4) and logbooks. (2) A questionnaire containing the MAISE-Easy-items, proxy variables (health and vitality) and demographics was answered by 1223 employees from 7 organizations. Construct validity, reliability and criterion validity were tested through PCA, CFA, Cronbach’s alpha and correlations. Results (1) A higher dose of HHR resulted in better job control and SE (n.s.). HHR had a positive impact on the awareness level of vitality and healthy workplaces of all stakeholders. (2) Reliability, construct and criterion validity of the MAISE-Easy were good, and MAISE-Easy 2.0 was constructed. This tool consists of 8 scales and 20 items divided over 4 areas: (1) Level of SE; (2) Factors affecting my SE; (3) Overall responsibility for SE; and (4) Responsibility for factors affecting my SE. Conclusions MAISE-Easy 2.0 is a valuable, valid and reliable tool in HHR which serves as a needs assessment for SE interventions. The innovative participatory approach HHR can improve job control and SE of employees in low-skilled jobs by giving them an active voice. *doi.org/10.1186/s12889-021-11278-7 Key messages • Healthy HR (HHR) is an effective, organisational dialogue-based approach (online toolkit) to promote job control, vitality and sustainable employability (SE) of employees in low-skilled jobs. • MAISE-Easy-2.0 (Maastricht Instrument for SE) is a new and thoroughly validated HHR tool for needs assessment, which measures SE and the responsibility for SE from the employee perspective.

Slaintécare Healthy Communities: Engaging with evidenced based best practice to promote health literacy in Ireland

Abstract This workshop will include a blend of presenters from both practice and research, with tangible examples of how the needs analysis was conducted, how meaningful partnerships were developed, and how we suggest these suggestions can be brought to life. This opening presentation will set the scene, detailing the role of Sláintecare Healthy Communities, the rationale for a focus on health literacy, the incredible value of adopting a meaningful participatory approach, and learnings from collaborating with a research team/project.

8.N. Scientific session: Transferability and adaptation of vaccination interventions: Learning from underserved communities

Abstract Removing barriers in the health system that make it difficult for cultural, religious or ethnic minorities to access vaccinations is an urgent concern in order to prevent infectious diseases in the future. Childhood vaccine uptake for MMR and HPV in most underserved communities is lower than in the general population. The project RIVER-EU (Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities) engages the migrant community in Greece, females with a Turkish or Moroccan migration background in the Netherlands, the Ukrainian minority in Poland and marginalized Roma communities in Slovakia to remove health system barriers to vaccination. Barriers include, e.g., lack of culturally and linguistically appropriate information, financial barriers, insufficient capacities, coordination and delivery of health care. Based on a Participatory Action Research (PAR) approach we selected and adapted potentially transferable evidence-based interventions in partnership with the communities. First, we pre-selected 6 useful interventions from a realist review on 36 effective vaccine uptake interventions. Second, we assessed them in depth for their transferability. Building a bridge between evidence on interventions and community needs is not an easy task: We involved various stakeholders in a longitudinal process under consideration of contextual conditions in the primary intervention context and the context of the respective underserved community. We co-created knowledge through 25 workshops and 39 interviews or focus groups for decision-making and determining need for adaptation of selected interventions. The aim of this workshop is to present the results of this co-creative process in each country. Special attention is payed to facilitators and barriers for transferability of evidence-based interventions from the perspective of underserved communities, and contextual commonalities and differences that lead to a specific intervention tailoring. This workshop will contribute to an improved understanding of how to consider contextual needs underserved communities have to remove health system barriers to vaccination on the one hand and suitable evidence on interventions to improve their situation on the other hand. The workshop will include five presentations of eight minutes and a questions and answers session to involve the audience. First, an introductory presentation on transferability of interventions for HPV and MMR vaccine uptake to underserved communities in specific contexts will be given. Then each country will present the intervention(s) to address health system barriers adapted to their context. Thereby, we will underline common key elements that have potential for transferability in all countries. After all presentations, we will discuss the need for context-based decision-making on evidence-based interventions and intervention tailoring to improve vaccine uptake for cultural, religious or ethnic minorities. Key messages • Improving vaccine uptake in underserved communities requires local solutions with tailored interventions. Trusted partnerships with various stakeholders are key to reducing health system barriers. • Participatory approaches to evidence-informed decision-making build bridges between evidence on interventions and needs of underserved communities to understand the transferability of interventions.

Developing a community engagement toolkit for health impact assessment in Ireland

Abstract Background Community involvement is a core principle of Health Impact Assessment (HIA). However, current guidance for HIA published by Ireland’s Institute for Public Health does not include guidelines on community engagement in HIA. As part of the project HIA-IM - ‘Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities,’ a Community Engagement Toolkit was created, with the aim of providing guidance for those carrying out HIAs and engaging with community in the process. The project will implement two HIAs, on the Cork City Development Plan (2022-2028) and the national Climate Action Plan (2024). Incorporating the learnings from the first HIA, the Toolkit will be employed in the second HIA of the project. Methods To develop the toolkit, a literature review of community engagement in HIA was conducted, with benefits and challenges, key approaches, and case studies of HIA’s gathered from grey literature and peer reviewed articles. In line with the participatory nature of HIA, a public consultation event was held, which was presented as a case study within the Toolkit. Results Findings from the literature review contend that engaging with community in HIA captures the lived experiences and local circumstances of the community, fostering empowerment and greater health awareness. However, many practitioners find community engagement to be practically challenging, citing factors such as time and resource constraints; with risks of consultation fatigue and raising expectations. Conclusions The review identified tools that have been used to mitigate these challenges and risks to facilitate meaningful community participation. These findings, along with learnings from conducting the first HIA, has informed the content of the Toolkit. Therefore, this Toolkit aims to complement national HIA guidance to centre the community voice in future HIA practice. Key messages • Developing a toolkit to strengthen participatory approaches and community engagement in health impact assessment in Ireland. • Centering the community voice in health impact assessment: the inclusion of lived experiences and local circumstances in health impact assessment practice in Ireland.

Improving physical healthcare for people experiencing mental illness: The COMITMENT project

Abstract Background People experiencing mental illness (PMI) face significant challenges in accessing and using somatic healthcare services, reducing their overall life expectancy by up to 20 years. The COMITMENT project aimed to identify barriers and facilitators in accessing and using somatic healthcare services for PMI and co-design strategies that could address existing challenges. Methods This study employed a qualitative participatory approach, involving a “trialogic” steering group composed of a person with lived experience of mental illness, a family member and caregiver of PMI, as well as a health professional. Two co-design workshops were conducted with members of each trialogic group, based on “World Café” methodology, facilitating open discussion between and among the three perspectives. Data was gathered through participant observations and systematically collecting participants’ workshop contributions, and analyzed thematically. Results Overall, 52 people participated in the two workshops. Findings identified six overarching themes regarding challenges in somatic healthcare access/use for PMI: (1) accessibility and facility design, (2) support and bureaucracy, (3) awareness among healthcare professionals, (4) societal awareness, (5) structural diversity of services, and (6) lack of networking abilities. Notable insights include inclusivity design requirements for healthcare facilities and the importance of integrating lived experiences of PMI into the training of healthcare professionals to reduce stigma. Conclusions This study underscores the critical need for systemic changes to improve somatic care for PMI. It suggests that greater awareness among healthcare professionals, coupled with more inclusive service design and enhanced networking abilities, could substantially improve the quality of healthcare for PMI. The COMITMENT project provides robust and co-designed results for social, systemic, and political reforms aimed at reducing healthcare inequity. Key messages • This study shows how direct involvement of relevant stakeholders improves the design of interventions that truly meet the needs of people with mental illness regarding somatic healthcare services. • To improve healthcare access and treatment for people experiencing mental illness, systemic social, design, educational, and political changes and adaptations are required.

Cancer Prevention in People Experiencing Mental Ill-Health: A co-designed Patient Navigation Concept

Abstract Introduction People experiencing mental ill-health have greater disparities in cancer specific morbidity and mortality. Factors influencing cancer prevention include increased risk behaviours and frequent encounters with barriers to health care utilization. The Patient Navigation Model (PNM) has been proven to reduce barriers in accessing cancer preventive care in vulnerable populations. To facilitate successful implementation, the conceptual features of the PNM were co-designed with patients and other relevant stakeholders. Methods Twelve focus groups were conducted in January 2024 at four pilot sites in Austria, Greece, Poland, and Spain. Iterative focus group discussions were carried out following key considerations for the PNM as outlined by DeGroff et al., audio recorded and transcribed verbatim. Transcripts were analysed deductively using a directed content analysis while allowing for potential inductive emergence of codes and topics. A total of 50 participants attended, representing five groups (individuals with mental ill-health, care givers, care team members, representatives of mental health organizations, and representatives of service managers). Results The co-design focus groups allowed for the PNM to be contextually adapted to each pilot site, but similarities in the approach emerged within the following four themes: 1) the requirement for a person-centred approach, 2) consideration of both person-specific and context-specific needs, 3) flexibility and competencies of navigators and 4) variation of navigation services (e.g., improving health literacy, promoting a healthy lifestyle, and providing practical support). Conclusions Participatory approaches in co-designing interventions allow for context specific development of interventions to meet the requirements of people with complex needs. Co-designing the PNM is part of activities of the CO-CAPTAIN project funded by the European Union’s Horizon Europe Programme (GA 101104784). Key messages • The Patient Navigation Model for Primary Cancer Prevention is a tailored intervention aiming to meet the needs of individuals experiencing mental ill-health. • The conceptual features of the Patient Navigation Model for Primary Cancer Prevention were co-designed with patients and other relevant stakeholders.

Paving the way for equitable and guaranteed access to vaccination for Newly Arrived Migrants

Abstract Background There is a gap in knowledge on the country-specific access to vaccination for Newly Arrived Migrants (NAM) in Europe, the obstacles encountered, and the resources available to surmount these barriers. The AcToVax4NAM project addresses gaps in the vaccination process of NAM in 8 European countries by developing country-specific, action-oriented flowcharts of the vaccination pathway that identify barriers and provide barrier-specific solutions. The flowcharts are linked to a comprehensive Repository of Tools aimed at providing tools to overcome system barriers and ensuring equitable immunization access for NAM in all consortium countries. Methods Country-specific action-oriented flowcharts group the vaccination pathway for NAM in the five hubs (entitlement, reachability, adherence, achievement, and evaluation) and offer solutions for identified barriers. Participatory research validated these flowcharts via focus group discussions with 84 total professionals FOR health (PFH) involved in NAM immunization. The tools were sourced from all consortium countries, encompass diverse formats and languages, and provide a holistic approach to vaccination promotion. Results The validated instrument was deemed useful, relevant, and easily understandable. Validated barriers included the lack of multi-stakeholder collaboration, culturally competent PFH, tailored educational materials, and language barriers. Meanwhile, the linked Repository includes 359 tools categorized according to the five hubs of the vaccination pathway. These can be filtered by language, country, type of tool, year of issuance, and/or intended target population. Conclusions The flowcharts and the Repository serve as the basis for a pilot intervention aiming to strengthen healthcare system responsiveness to promote NAM immunization. This participatory approach aims to equip PFH with a clear understanding of system-level vaccination barriers and solutions to enhance vaccination uptake among NAMs.

10.O. Scientific session: Breaking Barriers: Advancing Vaccine Access for Newly Arrived Migrants in Europe

Abstract Health disparities are particularly evident in Europe among Newly Arrived Migrants (NAM), in accessing healthcare systems and navigating vaccination services. The AcToVax4NAM project emerged as a pioneering initiative aimed at identifying solutions to overcome system barriers, following a life-course approach. These solutions consist of a broader strategy to promote organisational vaccination literacy and enhance vaccine uptake among NAM. Employing a participatory approach, the project engaged with professionals FOR health (PFH) and ΝΑΜ to ensure the relevancy of the practices developed, along with the widespread acceptance of proposed solutions and tools tackling access to vaccination services. This workshop is not just about showcasing the outcomes and impact of the AcToVax4NAM project; it’s about equipping PFH with practical tools and strategies that are immediately applicable and will ultimately increase vaccine literacy and uptake. By delving into the challenges encountered, strategies employed, and recommendations formulated, the workshop offers invaluable insights for professionals seeking to address similar issues in their respective contexts. We believe that by sharing our experiences and best practices, we can empower others to make a real difference in their communities. The workshop will contain 5 presentations that follow the functional structure of the project, starting with a presentation on the General Conceptual Framework, the foundational element guiding project activities. Following this, we will discuss the development of a migrant-centered and migrant-sensitive tool aimed at improving the communication skills of PFH by providing definitions of vaccine-related terms in an easily digestible way. The third presentation will detail the development of action-oriented flowcharts across consortium countries validated through focus group discussions with PFH; the flowcharts are linked to a comprehensive repository of 359 tools. The workshop will then explore the consortium’s efforts in providing vaccine literacy and cultural competency training to more than 200 healthcare professionals. Finally, the outcomes of the pilots implemented in consortium countries will be presented, and recommendations will be made that summarize the evidence-based accumulation of improved access to vaccinations for NAM and, consequently, increase vaccine uptake. This workshop fosters dialogue among stakeholders and showcases collaborative efforts to promote vaccination literacy and uptake among NAMs in Europe. Sharing experiences and best practices empowers PFH to address similar challenges in their communities, offering insights into effective strategies for improving healthcare access and promoting health equity. Finally, insights from the presentations and discussions can inform evidence-based policymaking and shape the development of immunization public health strategies at the local, national, and European levels, inspiring real change in communities. Key messages • Equipping Professionals for Health with strategies to Enhance Vaccine Access for Newly Arrived Migrants. • Equity through Collaborative Efforts in Promoting Vaccination among Newly Arrived Migrants.

Recovering Hope and a Sense of Agency Through Transformative Education for Internationally Educated Healthcare Professionals in Canada

This study examines the outcomes of transformative education in the program Fostering Canadian Integration for IEHPs: From Learning to Action, created to accompany internationally educated health professionals (IEHPs) in the difficult journey to find fair professional employment in Canada. It shows the importance of self-reflection, a learning community and a welcoming, participatory approach to learning that led to cognitive, emotional and conative transformation for participants. Increased self-awareness of their life journey and emotional patterns, together with critical understanding of their worldviews and new reality supported the participants in the recovery of hope and a sense of agency.

Participation in Energy Transitions: A Comparison of Policy Styles

Stakeholder and public participation in policymaking for energy transitions is one of the most promising approaches to fulfilling the promises of a democratic sustainability transition. Over the years, many studies have been published about concepts, methodologies, and empirical results of participatory approaches and implementations. In this paper, we focus on the compatibility of participatory processes with different policy styles of democratic governance. We conducted a systematic literature search comparing different concepts of democratic governance and applying them to public participation, in particular that associated with energy transitions. Our main objective in this paper is to link the requirements for a sustainable energy transition to governance processes and structures; we further aim to delineate suitable formats for stakeholder and public participation. Our analysis provides a basis for a wide-ranging and multi-perspective research agenda that promises to provide a deeper understanding and explanation of complex governance arrangements for energy transitions. The five democratic policy styles that we selected for this review are: autocratic, adversarial, collaborative, reflexive, and inclusive governance. We conclude that none are adequate on their own, and so we put forth a novel hybrid we call the “mediative approach.” From this approach, we derive a new research framework for addressing the current challenges of democratic decision-making in energy transitions. Three pressing questions emerge, one relating to the interplay of top-down and bottom-up modes of governance; a second to the conditions for actor collaboration; and a third to the perception of democratic legitimacy by affected parties.

Fostering Multicultural Community Harmony to Enhance Peace and Sustainable Development Goals (SDG’s)

Purpose: This service aims to foster harmony in a multicultural community in the city of Solo as a concrete step to increase peace and support the achievement of the Sustainable Development Goals (SDGs). Theoretical Framework: This study uses a cultural integration thinking framework and a participatory approach to building social harmony. The focus is on developing an understanding and appreciation of cultural diversity, as well as increasing positive interactions between ethnicities and religions to create an inclusive environment. Methods: This service uses a participatory approach involving a variety of local stakeholders, including ethnic and religious communities, local governments, and community institutions. Activities include organizing intercultural dialogue workshops, cultural diversity training, and public campaigns to promote tolerance and peace. Results and Conclusion: The results of this service show an increased awareness of cultural diversity and appreciation for differences among the people of Solo. Inter-ethnic and religious interactions are increasing, creating a stronger foundation for social harmony. In conclusion, participatory and integrative approaches are effective in building harmony in multicultural societies to support peace and sustainable development. Implications: This service has a positive impact by increasing tolerance, reducing social conflicts, and strengthening social cohesion in the city of Solo. The impact is also seen in increasing community participation in local development activities and achieving related SDGs targets. Originality/value: Its uniqueness lies in its participatory approach that actively involves all relevant parties, as well as focusing on cultural integration as the main foundation for the development of sustainable social harmony in a multicultural environment such as the city of Solo.

Strengthening uptake of breast cancer screening services in Tanzania; re-visiting the breast cancer screening messages

BackgroundBreast Cancer remains among the top five cancers responsible for morbidity and mortality globally. For many years, infectious (communicable) diseases were a primary concern in low- and middle-income countries (LMICs) compared to higher-income countries, where non-communicable diseases (NCDs) were already a major concern. However, starting from the early 2000s, the LMICs including Tanzania has witnessed an epidemiological transition being equally affected by NCDs, and breast cancer, is among the prevalent NCDs. While the evidence is vast on the role of breast cancer screening messages in promoting screening, debunking myths, and addressing barriers to the uptake of breast cancer services, context-specific messages are limited. Amidst the changing technology, growth of social media and cultural dynamics, context-specific breast cancer screening messages are needed. We aimed to analyze the breast cancer screening messages from the experiences of women seeking care at Ocean Road Cancer Institute in Tanzania.MethodsAn exploratory qualitative case study adopting in-depth interviews (IDI) and focused group discussion (FGD) was carried out among purposefully selected women aged from 18 years to 65 years seeking care from Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Eighteen women participated in the IDIs, and 16 women participated in FGD. Data analysis followed inductive qualitative content analysis.FindingsThree main categories emerged: the existence of multiple sources of breast cancer screening messages, the strengths and weaknesses of breast cancer screening messages, and clients’ mixed perceptions of breast cancer screening messages.ConclusionThe findings of this study depict that although breast cancer screening promotion messages are regarded as a source of information about cancers, they fall short of completeness and relevance to the otherwise at-risk population and trigger negative perceptions toward screening. Therefore, this study advocates revisiting the breast cancer screening messages, employing participatory approaches to tailor the screening messages and communication media to fit specific audiences. This calls for re-designing both the content of the messages and means of delivery; thus, collaborative efforts are needed.

Breaking Down the Barriers: Rethinking Government's Role in Indonesian Tourism Destination Development

Stakeholder involvement is essential to destination development. They may serve as catalysts or impediments to the growth of tourist sites. This study explores the barriers to tourism destination development associated with the role of local tourism authorities. A qualitative approach, employing semi-structured interviews, was utilized to examine the root causes of these challenges. Sixteen stakeholders, including ten government officials responsible for regional tourism development and six community leaders, were selected as informants in this study. Thematic analysis was used to analyze the interview data. The investigation revealed four main barriers to destination development from government agencies. There are bureaucratic hurdles, contrived program activities, overlapping roles of local governments, and the community’s misconceptions about the government’s role in destination development. These factors collectively hinder the successful implementation of government-led tourism programs. The study suggests that understanding and addressing these barriers are vital to fostering a progressive, sustainable, competitive tourist destination. On a practical level, the findings can help policymakers redesign their strategies to create more community-centric programs, clearly define roles, and manage community expectations. Conceptually, this study expands the existing literature on the role of government and bureaucracy in developing tourist destinations. The study highlights the importance of a participatory approach that engages all stakeholders in the planning and implementation tourism policies and programs.

Strengthening Community Resilience in the Face of Environmental and Economic Challenges in Southeast Mexico

Objective: The problems in the sustainable management of natural resources in their fishing practices in the community of Aztlán Quinta Seccion Palomillal in Tabasco, Mexico, are analyzed to develop community solutions and improve sustainability and socioeconomic results. Theoretical Framework: It is based on the theory of sustainability (World Commission on Environment and Development, 1987, p. 43), the natural resources management model (Natural Resources Commission, 2012, p. 3) and the theory of participatory research (Reason & Bradbury, 2008, p. These frameworks are the context in which fishing practices are developed in the community, serving as a relevant case study for southeastern Mexico, facilitating the analysis of the problems and proposed solutions. Method: A qualitative case study design focused on community-based participatory research was applied, involving key community actors, including fishermen and leaders of the fishing cooperative. Data collection was through semi-structured interviews, focus groups and participant observation. The interviews were designed to learn about challenges in resource management, while focus groups facilitated discussions about possible solutions. Participant observations were carried out during community meetings and the sociocultural and environmental context. Results and Discussion: The problems of sediment accumulation, the presence of invasive species, the lack of adequate infrastructure and low educational levels were identified. There is an urgency to implement strategies that combine traditional knowledge with modern practices to improve the sustainability of fishing activities. The importance of community participation is highlighted. Research Implications: It has significant practical and theoretical implications for sustainable resource management in rural fishing communities and can be applied in other similar rural contexts and contributes to the theoretical development of community-based participatory research. Originality/Value: An innovative community-based participatory research approach is applied for sustainable natural resource management in a rural fishing community, replicable for sustainable resource management in vulnerable contexts.