Primary Stakeholders Research Articles

Super citizens: the power of social innovation in İzmir/Turkey

This study aims to define the characteristics of social innovators, measure the impact of social innovation, and investigate its effects on urban transformation in İzmir. The study is based on semi-structured interviews with 14 social innovators and conducted by adopting a conceptual framework. We identify the characteristics of ‘super citizens’ in the literature that can contribute to SI’s empowerment in cities. The first finding shows that these individuals are expected to have 8 characteristics: being an activist, a social entrepreneur, a mediator, having a wide network, organizing goal-oriented works, involving all actors in the process, producing new solutions focused on the subject and finally being able to keep up with the change. The second finding shows that they are the most important actors in sustaining urban development, and their projects have impacts on urban transformation from a city level to an international level. If the interaction mechanism between relevant actors is provided by the local government through the Penta-helix model, super citizens may become one of the primary stakeholders to promote SI and create a more sustainable urban development.

Local community's engagement and enactment of social value from hydropower infrastructure

PurposeSocial needs of local community are highly essential in the context of public infrastructure and have an impact on their performance. This paper explores the local community subjectivity in interaction with primary stakeholders to deepen our understanding of social value and this category of misunderstood stakeholders.Design/methodology/approachThe paper presents a partnership framework that aims to help stakeholders be reflexive and construct knowledge about social value of the infrastructure. The empirical material includes an extensive review of the public infrastructure documents published between 1981 and 2021 and 13 interviews with key members of local community.FindingsThe main contribution of this study is an integrated model to study the social value of an infrastructure and a dynamic approach to study how a local community engages and enacts social value. The dynamic approach highlights three plans of stakeholder’s subjectivity, which are relational, representational and operational plans to promote inclusive stakeholder’s management (“of” and “for”).Originality/valueThe study combines an analytical and a theoretical framework to investigate the enactment of social value.

Exploring tourism competitiveness in developing economies: residents’ perspective

Understanding the factors that contribute to tourism competitiveness in developing economies is essential for policymakers, industry stakeholders, and researchers, as these countries still struggle to fully capitalize on their tourism potential. The residents’ perspective, often overlooked in Tourism Destination Competitiveness (TDC) models, is crucial because they are the primary stakeholders who directly experience the consequences of tourism activities in their daily lives. Their positive attitudes can contribute to a welcoming and friendly environment, enhancing the competitiveness of the destination in the global tourism market. Up to now, there have been a few studies that relate residents’ attitudes to tourism destination competitiveness. However, none have focused on developing a tailor-made model for measuring residents’ perspectives on TDC. To develop such a specific model and contribute to the existing theory in this area, our research applied a multi-step approach, including a literature review of existing models, pilot testing for indicator selection, and model validation through CFA. The data were collected through a survey of residents in Serbia, chosen as an example of a developing country. The final model of the study consists of five factors: Natural and Cultural Resources, Quality of Tourist Offer and Infrastructure, Situational Framework of Tourism Development and Management, Destination Perception and Experience, and Pollution, containing 32 indicators. Practical applicability of the model and theoretical contributions are discussed in the paper, as well as the TDC evaluation for Serbia.

Does ESG decoupling reduce customer stability? Evidence from China

ABSTRACT This paper examines the influence of corporate environmental, social, and governance (ESG) decoupling on customer stability. Using a sample of Chinese listed firms, we discover a significantly negative nexus between corporate ESG decoupling and customer stability. Mechanism tests reveal that ESG decoupling reduces customer stability by damaging corporate reputation and increasing information asymmetry. Cross-sectional analyses demonstrate that ESG decoupling’s adverse influence on customer stability is more prominent in state-owned companies, non-high-tech firms, and firms with fiercer industry competition. Our results show that customers, as corporate primary stakeholders, punish suppliers’ ESG decoupling behaviour. This paper enriches the emerging literature on the consequences of ESG decoupling. Meanwhile, our findings offer implications for firms to maintain supply chain security and stability.

Assessing Corpsmen Training Needs: Enhanced Medical Readiness in the Indo-Pacific for Near Peer.

Naval operations rely on Corpsmen to provide combat casualty and primary care services to the fleet, including the Fleet Marine Force. The United States faces new conflict challenges with near-peer adversaries in the modern geo-political climate. Corpsmen will likely require new skills to care for patients in anti-access/area-denial regions and transport patients across expansive maritime environments. To help them adapt to these new challenges, we evaluated the need for Corpsmen curriculum reform at the III Marine Expeditionary Force (MEF). This model begins with a general needs assessment to target gaps between the current and ideal approaches identified by the stakeholders. We identified 4 primary stakeholders within the Fleet Marine Force community: Marine Commanders (Society), Marines receiving treatment (Patients), Corpsmen providing care (Health Care Workers), and medical providers supervising Corpsmen (Medical Educators). We invited all ranks from III MEF to participate. The participants were interviewed in a mixture of focus groups and individual interviews in conversational and open-ended discussions. Transcripts of these discussions were analyzed and inductively coded using principles of grounded theory to identify prevailing themes that connected across interviews. The study was exempted by the Institutional Review Board at Naval Medical Center San Diego and Headquarters Marine Corps. The study involved 47 participants, including all stakeholders in III MEF and ranks from E1 through general officers. Through interviews and focus groups, 4 key themes emerged regarding Corpsmen's education: "Training," "Tasking," "Performance," and "Impact". "Training" discussions covered formal education, including gaps in basic training and the applicability of skills in civilian settings. "Tasking" examined daily responsibilities and equipment needs, such as teaching roles and first-responder care. "Performance" highlighted the quality of care and challenges in maintaining skills amid non-clinical tasks. Lastly, "Impact" assessed Corpsmen's influence on mission success and job satisfaction, revealing positive and negative perceptions among participants regarding their role and career prospects. The discussion emphasizes the importance of contextual factors in developing a Corpsmen-based curriculum, focusing on themes such as Training, Performance, and Impact. Tasking highlights critical areas for curriculum development, especially in educating Corpsmen as Educators, Leaders, and First-responder Caregivers. Gaps in training were identified, particularly in Non-trauma and First-responder Care, impacting Corpsmen's ability to handle diseases and injuries independently. Drawing parallels with Community Health Worker and Physician Extender (PE) education paradigms, we suggest adapting existing models to meet Corpsmen's needs. The discussion also delves into the history of employing PEs and developing training programs within the Naval Service. We propose a combination of Community Health Worker and PE-based education to enhance Corpsmen's competency and job satisfaction while facilitating their transition to civilian health care. Standardized curricula and training programs could improve skill transferability and readiness for Corpsmen in both military and civilian settings.

Street art and place-making of villages: examples of Italian painted villages

PurposeThis study aims to discuss the contribution of street art projects to the place-making of villages and the effects it generates for local stakeholders.Design/methodology/approachA conceptual framework is developed based on the main characteristics of the place-making process, street art, creative place-making, as well as place identity, revitalisation and regeneration. This framework defines a set of thematic categories for the qualitative content analysis of online information, e.g. websites, media and blog posts, as well as in-depth interviews with local stakeholders.FindingsThis research presents the contribution of street art in place-making involving citizens, local businesses and international artists in a collective act to preserve local identity and revitalise and regenerate villages.Research limitations/implicationsThe research is focused only on villages. Cities are not considered in the research.Practical implicationsStreet art projects provide villages with several opportunities, such as stimulating place regeneration and revitalisation, giving new shape and decoration to neighbourhoods and streets and attracting visitors and business. Moreover, street art is commonly used to communicate local history, culture, traditions and social and political facts, helping places to vehiculate their identity and their messages to the next generations. Street art is also used as a part of a place branding strategy.Social implicationsThe village gets the opportunity to exploit the street art value proposition to stimulate the restocking of the place, if the primary stakeholders of the place are ready to invest in the new place identity giving trust to the street art project.Originality/valueStreet art projects contribute to the place-making of villages. They are used to communicate place identity, fostering cooperation between local stakeholders and economic and social development.

Bandung as a Creative City in Indonesia: The Role of Community in Developing a Creative Tourism Urban Village Initiative

Bandung City Government, in collaboration with the Bandung City Culture and Tourism Office, has implemented the activation of creative tourism urban villages as a strategic measure to promote regional autonomy through the development of the creative economy. Prior studies have not extensively addressed the concept of creative tourism in urban villages as an alternative form of tourism. Therefore, this research aims to explore the involvement of communities in the management of creative tourism urban villages in Bandung, seeing them as the primary stakeholders. The objective of this study is to chart the potential and obstacles facing creative tourism urban villages in Bandung City from the perspective of tourism awareness groups as managers of creative tourism urban villages. The study employed qualitative methodologies with a phenomenological approach, specifically in-depth interviews with managers of creative tourism urban villages, as well as field observations of 8 activated creative tourism urban villages in Bandung city. The activation of creative tourism urban villages in the city of Bandung to promote the sustainable development goal is characterized by three primary themes: community dynamics, infrastructure readiness and external support. Community dynamics refers to the interactions that take place among community members as they collaborate to establish creative tourism urban villages in different regions through stories, conflicts and the active involvement of community members. The availability of infrastructure is contingent upon the presence of tangible assets that facilitate the execution of creative tourism urban village business operations, encompassing aspects such as road accessibility, parking availability, and building structures. Assistance from external entities refers to the support provided by external parties to foster the growth of creative tourism in urban villages, including mentoring, training, sponsorship, and collaboration networks. The activation of creative tourism urban villages needs to be accompanied by community independence and involvement in a bottom-up development process, not just a top-down one, so as to maintain the sustainability of creative tourism urban villages after the government no longer supports activities carried out by tourism awareness groups.

COMMUNITY EMPOWERMENT AND IT’S INFLUENCE ON IMPLEMENTATION OF WATER PROJECTS IN MACHAKOS COUNTY OF KENYA

Objective: This study focused on the extent to which Community empowerment influence Implementation of water projects in Machakos County of Kenya. Accessibility to safe water has been a great challenge not only in Machakos County but to the developing world. The purpose of this study was to establish Community empowerment influence on Implementation of water projects in Machakos County of Kenya. Theoretical Framework: The study was anchored on Pragmatic paradigm and used descriptive survey research design. The target population for this study was Machakos County water representatives both staff and Community. Research sample comprised of, Water Resources Users Association officials, Water Resource Management Authority employees, County Ministry of Water and Irrigation staff, Water Services Trust Fund staff and Tana Athi Water Services Agency Staff, giving a total target population of 572 individuals. Method: The sample size of the study was derived from the various strata’s by using Krejcie and Morgan Table for sample size determination which gave a sample size of 226 participants. The research instruments used included: questionnaires; Key informant Interviews, Focus Group discussions, observation, documents review and Interview guides. Data was analysed using descriptive statistics and inferential statistics. Quantitative data was analysed using frequencies, percentages, mean, standard deviation, composite mean and standard deviation. Qualitative data was analysed by content analysis. Research Implications: This Study is significant to policy makers, students, water agency managers and primary stakeholders in the research region. It was concluded that Community empowerment significantly influence implementation of water projects in Machakos County in Kenya.

Barriers and facilitators to the implementation of personalised medicine at the micro-, meso- and macro-regional levels

Abstract Background/Introduction Personalised Medicine (PM) involves tailoring treatment to a patient's characteristics, needs and preferences. It classifies patients based on their disease risk or response to treatment using diagnostic markers and aims to improve treatment control, precision and disease prediction. An organised approach is crucial for the integration of PM into European healthcare systems in order to shape the future of health and social care. PM's dynamic evolution, which takes into account individual factors in disease progression and drug efficacy, allows for more accurate and tailored care. Despite its emergence, the economic focus on specific interventions has neglected a comprehensive theoretical framework, potentially hindering the progress of PM in clinical practise. [1] Purpose The purpose of the study was to identify barriers and facilitators to the implementation of innovative interventions and to identify best practises that are applicable across European countries and support the implementation of e-health, m-health and PM interventions at micro-, meso- and macro-regional levels. The research was funded and carried out as part of the international Regions4PerMed (H2020) project. Methods The methodology of the study consisted of a combination of desk research and qualitative research methods. Desk research involved analysing existing articles, with a focus on the literature related to barriers and facilitators in e-health and m-health. Following the desk research, a semi-structured questionnaire entitled "Barriers and facilitators of Personalised Medicine implementation - qualitative study under Regions4PerMed (H2020) project" was developed. In addition, three focus groups were organised to explore the topic of the study in greater depth. Results The findings on potential support for adapting e-health, m-health and PM to citizens' needs were categorised into different areas of need, including education, funding, dissemination, data protection/data sharing, data analysis, system changes, integrated care policies, cooperation, healthcare providers, physicians, public and patient engagement. The barriers and facilitators were categorised according to the primary stakeholders involved in the implementation challenges. Conclusion(s) The implementation of technological solutions improves diagnostic procedures and decision making in health and social care, leading to more precisely tailored treatments, lower costs and shorter treatment durations. PM plays a crucial role in rationalising the diagnosis, prevention and treatment of diseases. The overall aim is to break down barriers between healthcare providers such as public authorities and hospitals in order to promote closer collaboration. However, PM faces challenges, including incongruent legislation, bureaucratic procedures and lengthy legislative processes. Obstacles also include the approach to physician education and the lack of social awareness of PM.

Long-term monitoring of a flagship bird species in agroecosystems enhances stakeholder engagement in biodiversity conservation

Conservation efforts are needed in the face of the rapid decline in farmland birds over the past decades. While existing conservation strategies have shown limited success, there is a growing recognition of the role of farmers as primary stakeholders in agroecosystems conservation. We applied the "Human Dimension" approach, which emphasizes the importance of human perspectives on wildlife conservation, to assess whether a long-term monitoring project of barn swallows Hirundo rustica, ongoing since 1999, has heightened farmers’ awareness regarding biodiversity protection. Indeed, while monitoring serves to track population trends and understand the factors influencing species dynamics, it also provides opportunities for interaction between researchers and farmers. Through in-person administration of the questionnaire, we investigated the impact of the barn swallow monitoring project on farmers’ environmental consciousness in terms of their perceptions of the environment, knowledge about priority habitats for biodiversity, and preferences for environmental awareness strategies. Subsequently, we investigated whether environmental consciousness and the participation in the barn swallow monitoring project translated into their inclination to implement costless actions for barn swallow conservation. Our findings suggest that the barn swallow monitoring project may not have enhanced farmers’ environmental consciousness. However, a higher environmental consciousness and the engagement in the barn swallow monitoring project were associated to a greater willingness to undertake actions in support of barn swallows. This study highlights the potential of long-term projects in fostering the conservation of charismatic species through establishing a mutual trust between farmers and researchers over years of monitoring, with cascading benefits for the barn swallows.

Why Effective Communication is Important in Management of Public Health Emergencies – A Viewpoint

Purpose: This article aims to present a reflective viewpoint of what entails effective communication and why it is important in a public health setting when dealing with emergencies. Methodology: The article uses the COVID 19 pandemic as a template to illustrate how effective communication is needed to address a public health emergency effectively. Findings: Centralized and non-conflicting communication is integral in ensuring effective management of a public health emergency. Effective management requires consistent, centralized, and simple to understand and implement communication. Unique Contribution to Theory Practice and Policy: Public Health Emergencies are national emergencies and require collaboration of multiple agencies and stakeholders to effectively address and control the situation. This process must ensure that the public who are the primary stakeholder receive the maximal benefits from any intervention to safeguard their health and safety while guaranteeing economic and social stability.

Stakeholders’ participation in decreasing wildfire risk in the context of natural resource management in the Podpoľanie region of Slovakia

Key MessageAs the number and extent of wildfires are increasing due to climate change and human impacts, the demand for effective risk reduction strategies is growing. Due to limited resources or management capabilities in Slovakia, appropriate multistakeholder participation could help decrease the risk of wildfires while continuing to implement the principles of sustainable forest management. Thus, we recommend improving relationships with responsible stakeholders and increasing their knowledge.ContextAlthough the frequency of wildfires has declined in Slovakia, the total burned area per year and the average burned area per fire have increased rapidly, mainly due to traditional land management and increasing numbers of natural disasters resulting from climate change.AimThe objective of this study is to assess the participation and management of stakeholders in the region of Podpoľanie, which is the region of Slovakia that is most prone to wildfires. In particular, this study investigates the questions of who is accountable, in what networks, and with regard to what issues with the goal of enhancing efforts to combat wildfires.MethodsThis single-country case study features an exploratory sequential mixed-methods design. While stakeholders’ participation was explored via face-to-face interviews and interest-influence matrices, stakeholders’ prioritization was assessed via an online survey and the quantitative mapping of stakeholders’ involvement, power, interest, and knowledge.ResultsWe separately identified primary stakeholders (e.g., fire departments and state-owned forest enterprises) and secondary stakeholders (e.g., municipalities and community members). Tasks related to efforts to combat wildfires were largely in compliance with legal regulations and other mandates. Nonetheless, some stakeholders (e.g., governmental organizations involved in nature protection or nonstate forest owners and the associated enterprises) lacked the knowledge, experience, or responsibility necessary to perform these tasks.ConclusionThese stakeholders should be informed and monitored closely to achieve outcomes that can benefit a variety of stakeholders. We recommend a plan that involves improving the relationships among primary and secondary stakeholders, increasing their knowledge, and promoting effective participation to decrease the risk of wildfires in the region.

A Multi-dimensional Framework of Valued Output for Primary Care in England.

Improving efficiency and productivity are key aspects to ensure that general practices in England can meet the needs of a growing population with increasingly demanding and costly healthcare needs. However, current evidence on the efficiency and productivity of general practices is weak, partly due to suboptimal approaches to measure their 'valued' output. To overcome this limitation, this paper presents a multi-dimensional framework and indicators of valued output from the healthcare decision-maker's perspective. We identified existing primary care performance frameworks through a targeted literature review. We reviewed the frameworks and selected the dimensions relating to the impact on patients' health outcomes, corresponding with the definition of 'valued' output from the healthcare decision-maker perspective. For each dimension, we reviewed the National Institute for Health and Care Excellence (NICE) evidence base and guidance on best practice to develop indicators of valued output. Clinical experts and representatives of the main primary care stakeholders reviewed and validated the framework's comprehensiveness and development process. Based on a review of three existing frameworks, we synthesised a multi-dimensional output framework comprising 13 dimensions for significant primary care-related conditions and services and 51 indicators of valued output. Each indicator of valued output measures a healthcare episode and the resulting impact on patient's health. The multi-dimensional framework and indicators provide a theoretical tool to improve the measurement of primary care output in economic efficiency and productivity studies. Future research should explore the measurability of the indicators through available datasets and the implementation of the framework through analytical approaches for efficiency measurement.

Hexahelix Analysis: Accelerating Food Loss and Waste Management in Support of Circular Economy Implementation in the Local Region

The substantial amount of food waste generated in Sragen Regency due to inadequate food loss and waste (FLW) management has a detrimental impact on the environment. This study aims to analyze the efforts to optimize FLW management, examine the relationships between variables, and assess stakeholder synergy in accelerating FLW management to support the implementation of a circular economy in the Sragen Regency. This research employs a mixed-methods approach, with data analysis conducted using MICMAC and MACTOR methodologies. The MICMAC analysis results indicate that stakeholder relationships, waste prevention, location factors, cultural factors, and community scale are the core variables for accelerating improvements in FLW management. In contrast, the MACTOR analysis identifies the Environmental Agency (DLH), Kecik Waste Bank, and Si Repi Waste Bank as the primary stakeholders in these efforts. Additionally, the MACTOR analysis highlights changes in community behavior and the utilization of FLW in the circular economy as primary objectives agreed upon by all stakeholders. The findings from the MICMAC and MACTOR analyses provide a basis and reference for determining the model and grand design of an FLW management acceleration strategy to support the implementation of a circular economy in the Sragen Regency.

CRITICAL REVIEW ON INSTITUTIONAL REAL ESTATE INVESTMENT DECISION-MAKING MODELS

This critical review delves into the underexplored realm of institutional real estate investment decision-making, a domain that holds paramount significance in the financial landscape. Despite the extensive scrutiny of individual real estate investors' decision-making processes, there exists a noticeable lack of research on the pivotal role played by institutional investors. As the primary stakeholders armed with substantial financial resources, institutional investors, encompassing entities such as investment funds, insurance companies, and pension funds, wield unparalleled influence in the market. This paper aims to unravel the complex decision-making models employed by institutional investors, focusing on the period from 2000 to 2024. Employing the PRISMA model, the review meticulously incorporates 21 pertinent articles, and a comprehensive thematic analysis, facilitated by ATLAS.ti version 23.2.1, reveals three prominent decision-making models – the Normative Model, the Descriptive Model, and the Prescriptive Model. In dissecting the factors that shape institutional real estate investment, the study identifies four key influencers: political, economic, legal, and real estate market fundamentals. The intricate interplay of these factors forms the crux of decision-making strategies adopted by institutional investors, as they diligently safeguard the interests of their trustees. Moreover, a noteworthy revelation surfaces regarding the geographical bias in existing research, with a scarcity of studies in developing countries, notably in Malaysia. This observation not only underscores the need for more comprehensive exploration in these regions but also presents a compelling avenue for future research endeavors. This critical review not only contributes to the ongoing discourse but also paves the way for a more nuanced understanding of the dynamic landscape of institutional real estate investment decision-making.

Exploring Undergraduates’ Underachievement in Science Technology Engineering and Mathematics: Opportunity and Access for Sustainability

Growing human capacities in STEM remain the most practicable way to solving present and future challenges. Improved test score, opportunities to learn, resources and facilities have been recommended in the literature to build capacity and improve achievement for effective and qualitative delivery in STEM classrooms. We focus on the two primary stakeholders in teaching and learning in the university who are students and lecturers. This manuscript explores the causes of underachievement among undergraduates in STEM fields by employing a mixed methods for data collection and analysis among 150 undergraduates and 45 lecturers from six public universities using purposive and quota sampling. Three main research questions were raised on student, lecturer and institution base factors along with perceived hindrances to STEM learning and teaching. Three instruments; Students Factors for Underachievement (SFUA), Lecturers Factor for Underachievement (LFUA) and Lecturers Perceived Factors for Underachievement (LPFU) were employed for data collection through survey and interview. Among other findings, poor prior knowledge among learners, non-utilisation of instructional resources, inaccessibility to library and laboratory and it resources were principal hindrances of undergraduates, lecturers and institution-base factors. The study concluded that efforts and better commitment is required from stakeholders to alleviate the present inadequacies and recommend interventions to remediate areas of need.

How safety value is exchanged in Chinese modern megaprojects: A stakeholder value network perspective

To visualize and quantify these exchanges among primary stakeholders in megaprojects, this study introduces network stakeholder value network as the core methodology. Starting with a qualitative organizational safety behavior model encompassing 8 stakeholders and 61 value flows, it's built based on 3 organizational safety behavior categories. Moreover, questionnaire data from 356 experts quantifies the model, and the design structure matrix identifies 13845 safety value paths, including 4827 cycles. Analysis delves into critical cycles, stakeholders, flows, and organizational safety behavior types to refine safety strategies. The findings, based on Chinese megaprojects, suggest that contractors and governments must lead safety awareness efforts, with safety compliance paramount for all parties. The study's contributions are threefold: firstly, it broadens the scope to encompass organizational safety behavior; secondly, it introduces a novel approach to visualize and quantify safety value flows; and thirdly, it considers multiple types of value exchanges, underscores their significance in promoting safety value, and offers practical recommendations to strengthen construction safety performance.

Affective Dimensions of Compound Crises in Tourism Economies: The Intermountain Western Gateway Community of Nederland, Colorado

Affective economies align people and places according to identities and emotional capital, particularly during compound crises such as COVID-19. Through an embodied research approach, affect becomes an integral part of furthering knowledge production within crisis management to understand individual and community resilience. This research explores how affective dimensions express individual and community resilience as part of crisis and disaster management of tourism-based economies. We contribute knowledge of sustainable destination management in the context of intermountain western gateway communities (IWGCs) to center residents as primary stakeholders within conservation and resilience planning. The IWGC of Nederland, Colorado, is presented as a microcosm of change through which the lived experiences of residents during COVID-19 are analyzed. This approach embraces the potential of affective scholarship for conservation and destination planning through creative qualitative methods of inquiry. Within a crystallization methodology guided by a feminist new materialist epistemology, we incorporate residents’ creative expressions to understand how affective dynamics influenced resilience throughout compound crises. Findings are presented via three themes including affective dimensions of resilience, identity, belonging and responsibility, and affective tourism economies. Affective knowledge centering resident experiences may inform future planning for crisis and disaster management across IWGCs and other gateway communities balancing tourism, conservation, and community planning.

Does financial distress suppress CSR gap? The moderating effect of state ownership and market competition

AbstractCompanies will prioritize external corporate social responsibility (CSR) practices over internal ones, a phenomenon known as the corporate social responsibility gap (CSR gap). Previous studies have mostly focused on its consequences, little is known about its antecedents. We argue that such practice is illegitimate because it goes against stakeholder expectation that primary stakeholders' interests should be prioritized, but it also has potential to gain differentiation benefit for intense investment on external CSR. Drawing on compensatory orchestration logic and the three types of firm legitimacy, we argue that firms that have gained high pragmatic legitimacy are more likely to engage in morally illegitimate but differentiation gaining activities such as CSR gap. Using financial distress to indicate low pragmatic legitimacy, we predict that distressed firms are inclined to practice low CSR gap. Considering the competing logics in China, we further argue that this negative relationship will be less pronounced if firms are state‐owned or operating in a competitive industry. Using Chinese listed firms from 2010 to 2019 as an empirical sample, the results provide support for our arguments.

Access to primary health care: perspectives of primary care physicians and community stakeholders

BackgroundAction on the social determinants of health is important to strengthen primary health care and promote access among underserved populations. We report on findings from stakeholder consultations undertaken at one of the Canadian sites of the Innovative Models Promoting Access-to-Care Transformation (IMPACT) program, as part of the development of a best practice intervention to improve access to primary health care. The overarching objective of this qualitative study was to understand the processes, barriers, and facilitators to connect patients to health enabling community resources (HERs) to inform a patient navigation model situated in primary care.MethodsFocus groups and interviews were conducted with primary care physicians, and community health and social service providers to understand their experiences in supporting patients in reaching HERs. Current gaps in access to primary health care and the potential of patient navigation were also explored. We applied Levesque et al., (2013) access framework to code the data and four themes emerged: (1) Approachability and Ability to Perceive, (2) Acceptability and Ability to Seek, (3) Availability and Accommodation, and Ability to Reach, and (4) Appropriateness.ResultsDeterminants of access included patient and provider awareness of HERs, the nature of the patient-provider relationship, funding of HERs, integration of primary and community care services, and continuity of information. Participants’ perspectives about the potential scope and role of a patient navigator provided valuable insight for the development of the Access to Resources in the Community (ARC) navigation model and how it could be embedded in a primary care setting.ConclusionAdditional consultation with key stakeholders in the health region is needed to gain a broader understanding of the challenges in caring for primary care patients with social barriers and how to support them in accessing community-based primary health care to inform the design of the ARC intervention.