Salient Contextual Factors Research Articles

En-Gendering Choice: Preferences for Exercising in Gender-Segregated and Gender-Integrated Groups and Consideration of Overweight Status

Understanding the contextual preferences that people have for engaging in a health-enhancing physical activity has been identified as particularly important, as these preferences have been implicated in the maintenance of active lifestyle behaviors. The primary purpose of this study was to examine adults' preferences for exercising in both gender-segregated and gender-integrated physical activity groups. The secondary purpose was to examine whether overweight status moderates adults' preferences for gender-segregated groups relative to gender-integrated groups. Survey data were obtained from a representative sample of 772 adults (N (males) = 407; N (females) = 365) in a large city in the United Kingdom. Males and females reported a stronger preference for exercising with members of their own gender relative to exercising in gender-integrated groups. In addition, overweight participants were found to report an accentuated relative preference for gender-segregated groups when compared to normal weight respondents. These findings suggest that both within-group gender composition and overweight status should be considered as salient contextual factors when attempting to implement successful group-based exercise programs.

Discharge from Outpatient Orthopaedic Physiotherapy: A Qualitative Descriptive Study of Physiotherapists' Practices

To describe the clinical and contextual factors that influence physiotherapists' discharge decision-making processes in outpatient orthopaedic settings. The study used a descriptive qualitative design that included three key-informant interviews and two focus groups (n=7) of orthopaedic physiotherapists (total n=10) working in the Greater Toronto Area. Interviews and focus groups followed a semi-structured interview guide that included questions pertaining to participants' discharge decision-making processes, salient contextual factors, and challenges. Data were coded and analyzed for emerging categories and themes using constant comparison techniques and group analyses. Participants indicated that a combination of factors and strategies were brought to bear on discharge decision making but that the process changed with clinical experience. Over time, further emphasis was attributed to the patient's role in his or her rehabilitation, and self-management goals were increasingly promoted. Experience affected how therapists conceptualized their roles in discharge decisions and how they negotiated goals with patients. Discharge decision making is a complex process that requires integrating numerous factors and negotiating with patients. Physiotherapists' decision-making practices evolve with experience and reveal the complexity of implementing models of "client-centred care" in practice. Further research is needed to explore these findings in other settings.

Transfer and Adoption of Advanced Information Technology Solutions in Resource-Poor Environments: The Case of Telemedicine Systems Adoption in Ethiopia

The study of the adoption of information technology (IT) by individuals has taken two approaches, one emphasizing rationalistic goal-oriented behavior and the other focusing on poignant forces that influence an individual's reaction to a new IT. These approaches are not necessarily mutually exclusive. Individuals' acceptance and subsequent usage of a new IT is predicated on both. Additionally, the tendency in past studies has been to examine either the rational or the poignant factors in the context of a "resource-rich" environment-one in which there is an abundance of IT, adequate infrastructure, and a high level of acculturation to technology solutions. Consequently, there is a clear need for the examination of these factors in resource-poor environments, where assumptions on technology abundance and technology culturation do not hold. We empirically test a model that explains the intention of physicians in a resource-poor environment (epitomized by rural Ethiopia) to adopt telemedicine systems. This model integrates the rational factors driving goal-oriented behavior with the poignant/emotive factors that are an innate part of each adopter's reaction to the new technology. We use the model to expose salient contextual factors that explain the acceptance behavior of individuals toward complex information and communications technology (ICT) solutions and implications of these on the management of technology transfer initiatives in a resource-poor environment. The model is parsimonious, yet explains 28% of the variance in the intention to adopt telemedicine systems and 58% in perceived ease of use. The theoretical and practical implications of this model are discussed. Namely, Sub-Saharan African, in general, and Ethiopian culture, in particular, plays an integral role in the adoption of ICT solutions. Organizational positions and roles among physicians, clinical professionals, and superiors stand to impact the adoption of telemedicine and other healthcare applications. Last, the degree to which users perceive that ICT is easy to use (i.e., ease of use) can be a function of technology experience and can influence perceived usefulness on behalf of users and healthcare organizations.

Knowledge ties among subsidiaries in MNCs: A multi-level conceptual model

Abstract While ties among subsidiaries—the key players of a MNC network—are a prerequisite for the formation of the network and the flow of knowledge within the organization, we know little about factors influencing the formation of such ties. By building on the literature on inter-firm networks and knowledge-based view of the firm, we develop a multi-level model consisting of subsidiary characteristics, dyadic dynamics, and salient contextual factors to explain the inter-subsidiary collaboration for knowledge development and exchange. We bring to the fore the importance of examining multiple dimensions in understanding what predicts tie formation and the efficacy of these ties in creating a knowledge advantage. This paper advances the notion of subsidiary knowledge networking capability—the ability to form, manage, and leverage a network for gaining and sharing knowledge—and suggests that such capability is critical for subsidiaries and by extension the MNC, to achieve a competitive advantage.

Creating Community Responsibility for Child Protection: Possibilities and Challenges

Deborah Daro and Kenneth Dodge observe that efforts to prevent child abuse have historically focused on directly improving the skills of parents who are at risk for or engaged in maltreatment. But, as experts increasingly recognize that negative forces within a community can overwhelm even well-intentioned parents, attention is shifting toward creating environments that facilitate a parent's ability to do the right thing. The most sophisticated and widely used community prevention programs, say Daro and Dodge, emphasize the reciprocal interplay between individual-family behavior and broader neighborhood, community, and cultural contexts. The authors examine five different community prevention efforts, summarizing for each both the theory of change and the empirical evidence concerning its efficacy. Each program aims to enhance community capacity by expanding formal and informal resources and establishing a normative cultural context capable of fostering collective responsibility for positive child development. Over the past ten years, researchers have explored how neighborhoods influence child development and support parenting. Scholars are still searching for agreement on the most salient contextual factors and on how to manipulate these factors to increase the likelihood parents will seek out, find, and effectively use necessary and appropriate support. The current evidence base for community child abuse prevention, observe Daro and Dodge, offers both encouragement and reason for caution. Although theory and empirical research suggest that intervention at the neighborhood level is likely to prevent child maltreatment, designing and implementing a high-quality, multifaceted community prevention initiative is expensive. Policy makers must consider the trade-offs in investing in strategies to alter community context and those that expand services for known high-risk individuals. The authors conclude that if the concept of community prevention is to move beyond the isolated examples examined in their article, additional conceptual and empirical work is needed to garner support from public institutions, community-based stakeholders, and local residents.

A critical realist approach to understanding and evaluating heart health programmes

Secondary prevention programmes for Coronary Heart Disease (CHD) aim to reduce cardiovascular risks and promote health in people with heart disease. Though programmes have been associated with health improvements in study populations, access to programmes remains low, and quality and effectiveness is highly variable. Current guidelines propose significant modifications to programmes, but existing research provides little insight into why programme effectiveness varies so much. Drawing on a critical realist approach, this article argues that current research has been based on an impoverished ontology, which has elements of positivism, does not explore the social determinants of health or the effects on outcomes of salient contextual factors, and thereby fails to account for programme variations. Alternative constructivist approaches are also weak and lacking in clinical credibility. An alternative critical realist approach is proposed that draws on the merits of subjectivist and objectivist approaches but also reflects the complex interplay between individual, programme-related, socio-cultural and organizational factors that influence health outcomes in open systems. This approach embraces measurement of objective effectiveness but also examines the mechanisms, organizational and contextual-related factors causing these outcomes. Finally, a practical example of how a critical realist approach can guide research into secondary prevention programmes is provided.

Disclosing Situational Constraints to Ecological Behavior: A Confirmatory Application of the Mixed Rasch Model* * The original data upon which this paper is based are available at www.hhpub.com/journals/ejpa

Summary: The present paper explores whether differential endorsement probabilities are related to the behavioral consequences of certain environments, rather than being solely indicative of method bias. One's living environment is among the more salient contextual factors affecting ecological performance. By applying the mixed Rasch model confirmatorily, we aimed at disclosing valid situational influences that can be held responsible for facilitating and constraining people's ecological behaviors in three particular residential environments. A cross-sectional survey of 895 Swiss residents living in various residential contexts revealed that living in urban and rural environments resulted in three distinguishable arrays of behavioral consequences, each the result of situational factors, such as an environment's particular performance opportunities, the predominant features of its public transportation systems and its respective social climate. Remarkably, an environment's being suburban has no apparent uniform significance for people's ecological behavior.

Negotiating risks in context: a perspective on unprotected anal intercourse and barebacking among men who have sex with men--where do we go from here?

Recently, an alarming trend toward unprotected anal intercourse has emerged in men who have sex with men. A highly dangerous form of unprotected anal intercourse, barebacking--the deliberate and conscious choice to engage in anal sex without condoms knowing that there are risks involved--has received much attention in the gay press. This trend poses new challenges for HIV prevention. As the target population changes, prevention interventions must also evolve to remain effective. A review of the scientific literature on risk behaviors and the popular literature and websites devoted to barebacking suggests that many contextual factors influence the decision to engage in unprotected anal intercourse. This review examines the most salient contextual factors affecting risk behavior in gay/bisexual men. It also identifies four main cohorts and predominant contextual factors that appear to motivate unprotected anal intercourse in each. In answering the question "where do we go from here," we conclude that contextual issues must be addressed in hybrid prevention interventions that include harm reduction, motivational interviewing, and traditional approaches.