Decision-making Priorities Research Articles

Eating and Drinking with Acknowledged Risks (EDAR) in Older Adults: A Qualitative Study of the Experiences of Clinicians in Japan and the UK.

Eating and drinking are fundamental to life. However, older patients are often restricted with oral intake due to feared risk of aspiration. Eating and Drinking with Acknowledged Risks (EDAR) is an alternative process which enables comfort, dignity, and autonomy for these patients. While national guidance has been developed for EDAR in the UK, other ageing societies such as Japan do not have such guidance. To understand the perspectives and experiences of healthcare professionals regarding the complex decision-making process around EDAR we planned a mixed methods study comparing the two countries. This was the qualitative phase of the study. Twelve healthcare professionals (two doctors, nurses and speech and language therapists each in Japan and the UK) participated in semi-structured interviews on their roles and experiences related to EDAR in older adults. We analysed the data thematically, and three themes emerged: (1) healthcare professionals and healthcare systems, (2) priorities in decision-making and (3) relationship with family and patient. There were many similarities but also differences across the countries, in the setting, training and individual experience. Decision-making was shaped by a complex combination of individual, structural and cultural factors, which indicated in the Japanese culture a greater likeliness to defer clinical decision-making and to side with families' wishes. Healthcare professionals' experiences and attitudes towards EDAR differed depending on various factors related with the individual and environment. The next quantitative phase of our research aims to establish the mechanism to increase confidence around EDAR in professionals and training options.

Epilepsy in CHAD: Realities, constraints, and prospects.

Epilepsy is a significant public health problem. More than 50 million people worldwide live with epilepsy, and over three-quarters of them are in low- and middle-income countries. The situation in Chad regarding people with epilepsy is challenging to assess, starting from the shortage of scientific data, the inadequacy of technical facilities, the lack of human resources, and the inadequacy of government action. The Ministry of Health and Chadian Society of Neurology are looking forward to prioritizing epilepsy as well as improving the living conditions of persons with this disease. The epilepsy treatment issue is also problematic. Most of the patients are either off treatment or under-medicated. Few antiseizure medications (ASMs) are available, notably carbamazepine, phenobarbital, and valproic acid. Epilepsy remains little-known and does not seem to be a priority for decision-makers. We describe the current situation in Chad, to improve the conditions under which epilepsy is treated. PLAIN LANGUAGE SUMMARY: Epilepsies is a chronic brain problem that is common in poorer settings. The daily lives of people with epilepsy are chaotic in Chad. The challenges are numerous, particularly those related to health infrastructures, due to the lack of adequate diagnostic means and the lack of neurologists. The cultural and language challenges, especially since epilepsy is still considered the devil's disease and the name differs according to the dialects. Stigmatization is also frequent and is often responsible for school dropout, refusal, or dismissal from work. Care and prevention are daily challenges that require government action. Social coverage is insufficient and almost absent in rural areas. It is urgent to prioritize epilepsy in future action plans and also to increase awareness of the conditions to overcome these challenges.

Fostering Gender Transformative Cities around the World

In the context of rapid urbanisation and the effects of climate change and conflicts, social inclusion and stakeholder engagements remain a low priority for most decision-makers in shaping the future of cities. The urban development initiative Her City intends to mainstream gender and age perspectives in urban planning and design decision-making processes. Her City offers a toolbox for municipal professionals, urban actors, and local decision-makers to involve girls and young women in urban planning and design processes and challenge exclusionary practices and social inequalities. This viewpoint asserts that integrating girls' perspectives leads to more responsive urban planning and the creation of inclusive and economically viable public spaces across the world. Applying an intersectional approach to urban planning, in a multitude of urban settings with different social, cultural, political and economic prerequisites, have proven to be an efficient shortcut to sustainable cities, Additionally, the initiative's success is underscored by its alignment with the Sustainable Development Goals (SDGs), delivering resilient cities for all. This viewpoint presents lessons learned from the application of Her City in Peru, Jamaica, Mozambique, Uganda, Palestine, Thailand, and Italy. These localised projects in various regions demonstrate how Her City can deliver tangible outcomes, such as the revitalisation of public spaces, community empowerment, and the promotion of gender equality, while fostering social cohesion, economic empowerment, and environmental sustainability. By championing gender-responsive urban development, Her City offers a blueprint for creating inclusive, resilient, and sustainable cities globally.

What we owe (to) the present: Normative and practical challenges for strong longtermism

This paper critically examines the conceptual, normative, and practical challenges to strong longtermism—the view that the far future is the key priority in moral decision-making. The main challenge is that if we take strong longtermism seriously, it follows that harming present and near-future people is permissible, if not obligatory. Given that this conclusion is repugnant to most, we argue that strong longtermism must be substantially weakened. Furthermore, even if strong longtermists bite the bullet on the challenge of what we owe to the present, we raise a set of related concerns that demand attention. Specifically, we argue that it is questionable whether the far future can be a difference-maker in moral decision-making. Even if it could, our inability to predict or understand how the far future will unfold, or what values future generations will hold, severely limits our capacity to account for it. Finally, the implementation of strong longtermism requires a level of progressive moral reasoning that far exceeds our current cognitive and ethical capabilities. While these objections do not necessarily debunk strong longtermism, they seriously challenge its plausibility—as it currently stands.

Artificial intelligence-based expert weighted quantum picture fuzzy rough sets and recommendation system for metaverse investment decision-making priorities

There should be some improvements to increase the performance of Metaverse investments. However, businesses need to focus on the most important actions to provide cost effectiveness in this process. In summary, a new study is needed in which a priority analysis is made for the performance indicators of Metaverse investments. Accordingly, this study aims to evaluate the main determinants of the performance of the metaverse investments. Within this context, a novel model is created that has four different stages. The first stage is related to the prioritizing the experts with artificial intelligence-based decision-making method. Secondly, missing evaluations are estimated by expert recommendation system. Thirdly, the criteria are weighted with Quantum picture fuzzy rough sets-based (QPFR) M-Step-wise Weight Assessment Ratio Analysis (SWARA). Finally, investment decision-making priorities are ranked by QPFR VIKOR (Vlse Kriterijumska Optimizacija Kompromisno Resenje). The main contribution of this study is the integration of the artificial intelligence methodology to the fuzzy decision-making approach for the purpose of computing the weights of the decision makers. Owing to this condition, the evaluations of these people are examined according to their qualifications. This situation has a positive contribution to make more effective evaluations. Organizational effectiveness is found to be the most important factor in improving the performance of metaverse investments. Similarly, it is also identified that it is important for businesses to ensure technological improvements in the development of Metaverse investments. On the other side, the ranking results indicate that regulatory framework is the most critical alternative in this regard.

Endocrine, gender dysphoria, and sexual function benefits of gender-affirming bilateral orchiectomy: patient outcomes and surgical technique.

Gender-affirming bilateral orchiectomy (GABO) may be completed as either a standalone procedure (sGABO) or at the same time as gender-affirming vaginoplasty (vGABO). GABO is postulated to decrease gender-affirming hormone therapy (GAHT) dosages and reduce gender dysphoria, but these phenomena are not empirically described in the medical literature. The primary aim of this study was to describe changes in GAHT dosages after sGABO and vGABO. A secondary aim was to assess sGABO patients' preoperative decision-making priorities and postoperative satisfaction. A retrospective chart review identified 204 patients who completed GABO as either a standalone procedure (64% of patients) or at the same time as vaginoplasty (36%). Patient demographic data, surgical outcomes, and pre- and postoperative GAHT dosage data were recorded. Patients completed an opinion questionnaire to assessed decision-making priorities, as well as postoperative satisfaction and changes in quality-of-life measures. Primary outcomes included pre- and postoperative dosages of estradiol, progesterone, and spironolactone. Secondary outcomes included sGABO patient priorities, satisfaction with sGABO, changes in quality-of-life measures between sGABO and vGABO patients, and sGABO recommendations to future patients. The sGABO and vGABO patients experienced a statistically significant dosage reduction in all three GAHT assessed: estradiol, progesterone, and spironolactone (P < .05). All patients discontinued spironolactone postoperatively. Zero complications related to GABO were recorded for patients in either group. The patient questionnaire revealed that sGABO patients prioritize decreasing endogenous testosterone and reducing their GAHT as most important in their decision to undergo sGABO prior to vaginoplasty. A majority of sGABO patients reported improvement in all nine quality-of-life indices. None of the sGABO patients would recommend against sGABO to a friend who is waiting for vaginoplasty. For patients who are interested in vaginoplasty, sGABO may serve as a more immediate, low-risk, intermediary step that comes with the benefits of GABO, including significant GAHT medication reduction and gender dysphoria relief. This study offers a comprehensive evaluation of the impact of GABO on patients, combining empirical data with subjective patient feedback. Limitations include the retrospective design and the use of unvalidated survey questions. Prevaginoplasty GABO is a viable option to more immediately alleviate gender dysphoria and reduce GAHT medications for patients who are interested in gender-affirming vaginoplasty.

DOES THE LEGAL FRAMEWORK GOVERNING EMERGING INSTITUTIONS IN ALGERIA DIFFER FROM THAT OF TRADITIONAL PROJECTS?

Emerging institutions have garnered significant worldwide attention due to their unique characteristics and pivotal roles in fostering economic development. These institutions represent innovative economic models that have gained prominence in numerous countries, aiming to nurture emerging ventures and empower innovators. Like many nations, Algeria has adopted an alternative economic approach to achieve sustainable development and elevate the national economy. This approach prioritizes fostering creativity and innovation, enabling economic diversification, and encouraging the establishing of emerging institutions. Algeria aims to drive the desired development and investment momentum by expanding business opportunities within a sound economic environment. This strategy is a viable alternative to wealth creation and economic expansion beyond the hydrocarbon sector and traditional economic rents. Hence, Algeria issued an arsenal of legal texts to encourage these institutions and open the door for those with innovative ideas to implement their ideas on the ground. Therefore, supporting emerging enterprises has become a priority for Algerian economic decision-makers to contribute to advancing development and enhancing local production.

What does your partner want? Using a gender equality lens to assess partner support and involvement in family planning in Uganda.

It is unclear if there are any differences in the ways men and women perceive partner support in the context of family planning. The USAID-funded Social and Behavior Change Activity (SBCA) in Uganda explored male versus female priorities in the decision-making considerations and preferred measures of partner support related to family planning. Data were from a cross -sectional nationally representative telephone survey of 1177 men and women aged 18-49 years old in sexual partnerships. Key measures included current family planning use (Are you or your partner currently doing anything to prevent or delay becoming pregnant?); family planning decision-making considerations (In your experience, which of the following are the three most important considerations as you make family planning decisions?); and preferred partner support (What level of involvement would you like to see from your partner in your family planning decisions?). Multivariable logistic regressions explored factors associated with decision-making priorities and preferred partner support, adjusting for sociodemographic confounders. Two-thirds (66%) of men and women wanted a high level of involvement from their partner, which was associated with higher odds of using family planning (aOR: 2.46, 95% CI: 1.87-3.24). Specific ways partners could be involved included accompanying them to health services (39%), permitting them to get family planning services (26%), and jointly discussing family planning options (23%). Of note, more women wanted their partner to accompany them (45%) than men (33%) while more men (29%) wanted to jointly discuss options than women (15%). Social and behavior change interventions should operationalize partner support differently for men and women. Study findings were used to implement a health campaign that explicitly encouraged partner dialogue and support across the various life stages; empowering women with knowledge and skills to have honest conversations with their partners about birth spacing and timing.

Mediation of psychological ownership between green human resources management and nursing faculty's green behavior.

Greening organizations have become a top priority for decision-makers in the 21st century. Psychological ownership can be improved through responsible administration, which, in turn, improves green behavior. Investigating the mediating role of psychological ownership in the relationship between green human resources management (HRM) and green behavior among nursing faculty. A correlational analytical research design was utilized to conduct the study following the STROBE guidelines. A convenience sample of 204 academic staff was used. Four data collection tools were used: sociodemographic characteristics, the green HRM questionnaire, the Psychological Ownership Scale, and the Green Behaviour Scale. Faculty members who perceive strong green HRM practices are more likely to have heightened psychological ownership, positively influencing their engagement in green behavior. Conversely, weaker perceptions of green HRM are associated with lower levels of green behavior. Psychological ownership was found to act as a partial mediator between green HRM and green behavior. Even when considering the influence of psychological ownership, green HRM has a significant and direct impact on green behavior. Faculty members who perceive a high level of green HRM practices are more likely to have a high level of psychological ownership that, in turn, influences their green behavior. Workshops on psychological ownership and green behavior can foster environmental sustainability. Policies should integrate green HRM practices into nursing education and healthcare facilities, recognizing psychological ownership's role. Incentivizing green initiatives can motivate staff, aligning with broader conservation goals. Encouraging an ethos of environmental stewardship benefits both the healthcare and sustainable development agendas.

Predicting Academic Success of College Students Using Machine Learning Techniques

College context and academic performance are important determinants of academic success; using students’ prior experience with machine learning techniques to predict academic success before the end of the first year reinforces college self-efficacy. Dropout prediction is related to student retention and has been studied extensively in recent work; however, there is little literature on predicting academic success using educational machine learning. For this reason, CRISP-DM methodology was applied to extract relevant knowledge and features from the data. The dataset examined consists of 6690 records and 21 variables with academic and socioeconomic information. Preprocessing techniques and classification algorithms were analyzed. The area under the curve was used to measure the effectiveness of the algorithm; XGBoost had an AUC = 87.75% and correctly classified eight out of ten cases, while the decision tree improved interpretation with ten rules in seven out of ten cases. Recognizing the gaps in the study and that on-time completion of college consolidates college self-efficacy, creating intervention and support strategies to retain students is a priority for decision makers. Assessing the fairness and discrimination of the algorithms was the main limitation of this work. In the future, we intend to apply the extracted knowledge and learn about its influence of on university management.

Being a "Good Parent" to a NICU Infant With a Major Congenital Anomaly.

In the United States, up to one-third of infants with a congenital anomaly require neonatal intensive care unit (NICU) hospitalization. Parents of these infants may have different decision-making priorities, which may be influenced by the timing of the infant's diagnosis. (1) To compare the ranked importance of decision-making beliefs for parents of infants who received a prenatal versus postnatal congenital diagnosis and (2) explore how parents describe their decision-making beliefs. A cross-sectional, sequential mixed-methods pilot design was applied to collect quantitative data using the Good Parent Ranking Exercise and further explore parents' decision-making beliefs through qualitative interviews. Maximum difference scaling/hierarchical Bayes estimation and content analysis were used to analyze the quantitative and qualitative data, respectively. Forty mothers completed the Good Parent Ranking Exercise and 20 mothers completed qualitative interviews. Four of the top 5 ranked parenting beliefs were shared by mothers in the prenatal and postnatal groups. Mothers in the postnatal group ranked "focusing on my child's quality of life" higher. Qualitative interviews revealed that previously identified decision-making beliefs were consistent in this NICU parent population, with 1 additional belief identified. Mixed-methods analysis revealed high concordance between the prenatal and postnatal groups. NICU nurses need to know that decision-making beliefs for parents who receive a prenatal versus postnatal congenital diagnosis, while largely similar, may have differences. Future research should explore decision-making beliefs in demographically diverse parent groups (ie, fathers, partnered vs nonpartnered couples) and effective strategies for promoting NICU parents' decision-making beliefs.

Personalized Learning in English Flipped Classrooms: Exploring ESL Learners’ Decision-Making Styles in Academic Reading

This concept paper attempts to explore how Personalized Learning opportunities within a Flipped Classroom model can be enhanced by understanding the decision-making styles of English as a Second Language students during academic reading activities. Flipped classrooms – where initial content exposure occurs outside of class via recorded lectures and readings have potential to facilitate more tailored, self-paced instruction. However, limited research has examined students’ use of decision-making skills in reading academic materials during asynchronous learning, especially in developing English literacy skills essential for academic success. Utilizing a qualitative case study approach, this study attempts to investigate how ESL undergraduate students who are advanced English readers, make decisions while engaging with reading materials during asynchronous learning for flipped classrooms, including factors influencing choices of texts and materials, and their decision-making styles as proposed by Janis &amp; Mann (1977). Triangulated data from semi-structured interviews and class observation in this study could provide rich insights into ESL students’ in-class engagement and decision-making priorities. Exploring connections between ESL learners’ approaches to self-regulated learning through decision-making skills in academic reading and how they experience flipped classroom instructions have practical implications for designing pre-work class that cultivates autonomy and stronger personalized outcomes. The study provides opportunities to derive key design principles and guidelines for flipped English classroom materials in a way that responds sensitively and systematically to the unique decision-making needs of ESL learners in higher education contexts.

(Invited) Evaluating Urban Water-Energy Systems Based on UN Sustainable Development Goals (SDGs)

Evaluating Urban Water-Energy Systems Based on UN Sustainable Development Goals (SDGs) Water, food, and energy are three of the major resource issues facing the world today. To help address these issues, urban wastewater is now being considered as a renewable resource than as a waste- a resource for water, for energy, and fertilizers. It is now well recognized that the traditional urban wastewater infrastructure needs to be re-engineered for improved environmental, social, and economic sustainability by minimizing the energy input for treating the wastewaters and by recovering water, energy, and fertilizers from the wastewater for beneficial reuse. In recent years, several alternate technologies have been proposed to take advantage of the water-energy nexus in urban wastewater infrastructure systems. This paper presents a case study evaluating sustainability of four urban water-energy nexus based on the 17 United Nations Sustainable Development Goals (SDGs) that have been unanimously endorsed by all 193 member countries. A multi-criteria decision making (MCDM) approach is used in this study to evaluate the four alternate urban water-energy systems in terms of 30 criteria spanning environmental, social, and economic sustainability. The 30 criteria selected here were derived from the 17 SDGs. The MCDM approach was selected in this study because of its ability to handle quantitative and qualitative criteria and rank the options on a numerical scale. The four wastewater treatment alternatives were evaluated under 12 different scenarios considering high/low priorities of decision-makers towards six different water-energy nexus attributes (pathogen removal, energy consumption, gaseous emission, resource recovery, footprint, and past records).

Admission Functional Status is Associated With Intensivists Perception of Extracorporeal Membrane Oxygenation Candidacy for Pediatric Acute Respiratory Failure.

To determine the association between admission Functional Status Scale (FSS) category and perceived extracorporeal membrane oxygenation (ECMO) candidacy for pediatric acute respiratory failure. Prospective, cross-sectional study. Single-center, quaternary, and ECMO referral academic children's hospital between March 2021 and January 2022. Pediatric intensivists directly caring for patients admitted with acute respiratory failure secondary to shock or respiratory disease. None. Pediatric intensivists were surveyed about current patients within 72 hours of initiation or escalation of invasive mechanical ventilation on whether they would offer ECMO should their patient deteriorate. Baseline functional status was assessed using trichotomized admission FSS: 1) normal/mild dysfunction (6-9), 2) moderate dysfunction (10-15), and 3) severe dysfunction (> 16). Multivariable logistic regression clustered by physician was used to assess the association between admission FSS category with perceived ECMO candidacy. Thirty-seven intensivists participated with 76% (137/180) of survey responses by those with less than 10 years of experience. 81% of patients (146/180) were perceived as ECMO candidates and 19% of patients (34/180) were noncandidates. Noncandidates had worse admission FSS scores than candidates (15.5 vs. 9, p < 0.001). After adjustment for age, admission FSS category of severe dysfunction had lower odds of perceived ECMO candidacy compared with normal to mild dysfunction (odds ratio [OR] 0.18 [95% CI, 0.06-0.56], p < 0.003). Patients with an abnormal communication subscore domain had the lowest odds of being considered a candidate (unadjusted OR 0.44 [95% CI, 0.29-0.68], p < 0.0001). In this prospective, single-center, cross-sectional study, admission FSS category indicating worse baseline functional status impacted pediatric intensivists' perceptions of ECMO candidacy for patients with acute respiratory failure. Abnormal FSS subscores in the neurocognitive domains were the most important considerations. Future studies should better seek to define the decision-making priorities of both parents and medical specialists for the utilization of ECMO in children with acute respiratory failure.

Patient Priorities, Decisional Comfort, and Satisfaction with Metformin versus Insulin for the Treatment of Gestational Diabetes Mellitus.

We compared patient priorities, decisional comfort, and satisfaction with treating gestational diabetes mellitus (GDM) with metformin versus insulin among pregnant individuals with GDM requiring pharmacotherapy. We conducted a cross-sectional study of patients' perspectives about GDM pharmacotherapy in an integrated prenatal and diabetes care program from October 19, 2022, to August 24, 2023. The exposure was metformin versus insulin as the initial medication decision. Outcomes included standardized measures of patient priorities, decisional comfort, and satisfaction about their medication decision. Among 144 assessed individuals, 60.4% were prescribed metformin and 39.6% were prescribed insulin. Minoritized individuals were more likely to receive metformin compared with non-Hispanic White individuals (34.9 vs. 17.5%; p = 0.03). Individuals who were willing to participate in a GDM pharmacotherapy clinical trial were more likely to receive insulin than those who were unwilling (30.4 vs. 19.5%; p = 0.02). Individuals receiving metformin were more likely to report prioritizing avoiding injections (62.4 vs. 19.3%; adjusted odds ratio [aOR]: 2.83; 95% confidence interval [CI]: 1.10-7.31), wanting to take a medication no more than twice daily (56.0 vs. 30.4%; aOR: 3.67; 95% CI: 1.56-8.67), and believing that both medications can equally prevent adverse pregnancy outcomes (70.9 vs. 52.6%; aOR: 2.67; 95% CI: 1.19-6.03). Conversely, they were less likely to report prioritizing a medication that crosses the placenta (39.1 vs. 82.5%; aOR: 0.09; 95% CI: 0.03-0.25) and needing supplemental insulin to achieve glycemic control (21.2 vs. 47.4%; aOR: 0.36; 95% CI: 0.15-0.90). Individuals reported similarly high (mean score > 80%) levels of decisional comfort, personal satisfaction with medication decision-making, and satisfaction about their conversation with their provider about their medication decision with metformin and insulin (p ≥ 0.05 for all). Individuals with GDM requiring pharmacotherapy reported high levels of decision comfort and satisfaction with both metformin and insulin, although they expressed different priorities in medication decision-making. These results can inform future patient-centered GDM treatment strategies. · Pregnant individuals with GDM requiring pharmacotherapy expressed a high level of decisional comfort and satisfaction with medication decision making.. · Individuals placed different priorities on deciding to take metformin versus insulin.. · These results can inform interventions aimed at delivering person-centered diabetes care in pregnancy that integrates patient autonomy and knowledge about treatment options..

Prevalence and Impact of Frailty in Pancreatic Cancer: A Systematic Review and Meta-Analysis Based on 35,191 Patients.

Frailty has been associated with increased mortality among patients with pancreatic cancer. Nevertheless, several lines of evidence regarding the prevalence of frailty in patients with pancreatic cancer and mortality in patients with pancreatic cancer and frailty have not been thoroughly investigated and require clarification. A systematic review and meta-analysis of studies indexed in PubMed, Scopus, Web of Science, and Embase through March 2023 were conducted, and the pooled prevalence and relative risk (RR) estimate were calculated. A total of 18 studies containing 35,191 patients with pancreatic cancer were included. The prevalence of frailty in pancreatic cancer was 45% (95% CI = 29-62; I2 = 99.9%; p = 0.000). In patients with pancreatic cancer, frailty was associated with increased relative risk for mortality (RR = 1.70; 95% CI = 1.30-2.22; I2 = 84.8%, p = 0.000). Frailty prevalence in pancreatic cancer is common and exerts a significant negative impact on the survival of patients with pancreatic cancer. Our findings are characterized by significant heterogeneity, and caution is warranted in their interpretation. However, these findings highlight the importance of evaluating frailty, which may provide prognostic data and inform decision-making priorities.

Urban green spaces and their relationship with groundwater quality: the case of a shallow aquifer in the south of Mexico City

Water supply security is a top priority for decision-makers in cities. Urban population growth increases water demand from aquifers, while urban expansion reduces water infiltration and boosts water pollution sources. Urban green spaces are a few of the remaining infiltration areas. Therefore, they are essential for water supply and urban hydric resilience. The urban dynamic directly influences shallow aquifers, but they usually are unappreciated. This work illustrates the relationship between urban green spaces and city water quality by evaluating the influence of urban green space, Reserva Ecológica del Pedregal de San Angel (REPSA), on a shallow aquifer in Mexico City. Five springs were sampled: two upstream of REPSA, a spring within REPSA, and two downstream. Because the study area is mainly residential but with an industrial history, water quality was tested based on microbiological pathogens, nutrients, pharmaceutical drugs, and heavy metals. Results showed an enhancement of water quality of the shallow aquifer in the sampling points downstream of REPSA for some of the pollutants. These results illustrate how urban green spaces can help to dilute pollutants present in the water of shallow aquifers, increasing water quality in cities.

Preferences of patients with diabetes mellitus for primary healthcare institutions: a discrete choice experiment in China

ObjectivesTo quantify the preference of patients with diabetes mellitus (DM) for primary healthcare (PHC) institutions in China to redirect the patient flow and improve health outcomes.DesignCross-sectional study. Discrete choice experiment...

“So let me give you money, you give me what I want”: decision-making priorities around contraceptive method and source choice among young women in Kenya

BackgroundMany factors influence young women’s choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and the relationship between these choices. This study qualitatively explored decision-making around contraceptive method and source choice among young women in Kenya.MethodsIn August–September 2019, 30 in-depth interviews were conducted with women ages 18–24 who had used two or more contraceptive methods and resided in three counties: Nairobi, Mombasa or Migori. Participants were recruited from public and private health facilities and pharmacies. Interview guides captured information about decision-making processes for each contraceptive method the respondent had ever used. Responses were audio-recorded, transcribed, translated into English, coded, and analyzed thematically.ResultsThe majority of respondents knew which method they wanted to use prior to seeking it from a source. This was true for all types of methods that women ever used. Of the small number of respondents who selected their source first, most were in the post-partum period or experiencing side effects and sought counseling at a source before choosing a method.ConclusionsThis study highlights the importance of providing young women with high quality counseling that provides full information about contraceptive options and addresses that young women’s needs vary along the reproductive health continuum of care. This will ensure that young women have information to inform future contraceptive decision-making prior to seeking care.

A Knowledge Mobilization Framework: Toward Evidence-Based Statistical Communication Practices in Education Research

The evidence-based decision-making movement often assumes that once evidence is available (e.g., via the What Works Clearinghouse), decision-makers will integrate it into their practice. Research-practice partnership studies have shown this is not always true. In this paper, we argue that instead of assuming research will be useful and used, we should directly study strategies for disseminating evidence and mobilizing knowledge. We present a framework for organizing knowledge mobilization research into three facets: (1) examining norms embedded in evidence we communicate, (2) descriptively understanding how decision-makers reason about this evidence as well as their varied decision-making needs, and (3) prescriptively developing and evaluating communication strategies that facilitate better use of evidence by decision-makers. We delineate this three-faceted framework—normative, descriptive, prescriptive—and demonstrate how it considers the perspectives and priorities of both researchers and decision-makers. Focusing on a case study—of how statistical evidence is conveyed by clearinghouses—we point to existing evidence in education and other fields such as data visualization and cognitive psychology that should inform our communication practices and identify areas where further knowledge mobilization research is needed.