Self-selected Research Articles

Does the European Union Start-Up Aid Help Young Farmers to Innovate and to Join Networks?

The endurance and vitality of European agriculture are threatened by the aging of farmers, together with the lack of generational change. The small share of young farmers also impacts on the innovative capacity and competitiveness of the sector. The Common Agricultural Policy of the European Union started addressing the issue long ago by providing financial aid to help young farmers to start up. Over time, the aid increased and packages of measures were set to reinforce the aid and to promote investments, innovations, and networks at the farm level. While the literature focuses on analyzing the effectiveness of the start-up aid in fostering new entries, this paper assumes an original perspective as it seeks to assess whether this aid has actually promoted innovations and networks in the beneficiary farms. The analysis relies on sample data collected in 2021 in Italy and Poland via interviews of 500 farmers under 40 who had entered the sector both with and without the aid. A probit model estimates whether the beneficiaries have a higher probability to innovate and network. Then, the contribution of the aid to the intensity of the adoption of innovations and networks is estimated via an Average Treatment Effect on the Treated model (ATT). Results suggest that the start-up aid increased the adoption of innovations and networks. The ATT indicates that this positive effect holds even after correcting for self-selection bias. By adopting an original perspective, our analysis suggests that the start-up aid for young farmers goes beyond rejuvenating agriculture by fostering innovation at the farm level and by promoting networking, thus enhancing agricultural change. However, farmer behaviors in the two countries are different, suggesting quite complex patterns for the impact of this measure.

Factors influencing noise annoyance across various transportation modes: lessons from the citizen science project "De Oorzaak"

The citizen science initiative "De Oorzaak" invited adult residents of Flanders (Belgium) to fill out the "Large Sound Survey", gathering over 8,000 answers in a month. This comprehensive 51-question survey evaluated annoyance levels across various transportation modes, drawing on established questionnaires like the Epworth Sleepiness Scale, Weinstein Noise Sensitivity Scale and Written Environmental Survey (SLO), organized by the Flemish government. It also aided in selecting participants for subsequent project phases. Comparing LSS results to the latest SLO report revealed a significant self-selection bias, with 33.3% highly annoyed by noise compared to 11.6% from the SLO. A profile could be drawn for the most annoyed participants: noise-sensitive individuals living in apartments or studios, adults (26-61 years old), and residing in densely populated areas. Regarding transportation noise, passenger cars and trucks lead as the most annoying sources, with %HA of 24.5% and 23.5%, respectively, followed by motorcycles and alike (%HA =21.5%). Conversely, rail and air traffic annoyance are considerably lower. Correlations were drawn between the several noise annoyance sources and individuals' characteristics. Overall, population density, age, fatigue level and quality of life are the personal aspects that correlate more consistently with road, rail, and air traffic noise annoyance.

Does integrated reporting offer firms more legitimacy?

PurposeThe study delves into the impact of integrating reporting (IR) on three earnings management tools, namely classification shifting (CS), real-based earnings management (REM) and accrual-based earnings management (AEM) under the Indian institutional settings.Design/methodology/approachThe data analysis involved the application of panel data regression models. Our dataset comprises 2,244 firm-years listed on the Bombay Stock Exchange spanning over financial years from March 2015 to 2021. To address endogeneity and self-selection bias concerns, a propensity score matching technique has been employed.FindingsOur empirical results exhibit that IR-adopting firms are engaged in earnings management. Further, we find that IR-adopting firms have reduced their engagement in AEM and REM, however, their CS practices have been increased, indicating the substitution relationship between earnings management tools after the adoption of IR. It implies that firms shift their preference from more to less observable earnings management tools after the adoption of the IR, which aligns with the idea that firms adopt IR to gain legitimacy, however, their intention to deceive stakeholders through earnings management remains unchanged. The inclination of firms toward CS can be ascribed to its cost-effectiveness, as it leaves net profit unchanged, hence less likelihood of being detected by auditors. Overall, our results align with the principle of legitimacy theory.Research limitations/implicationsThe study focuses exclusively on three primary forms of accounting manipulation and assesses IR holistically, rather than investigating the influence of each capital individually within IR.Practical implicationsWith a shift towards less detectable methods like CS, auditors must adapt their scrutiny and be mindful of their clients' IR adoption. Investors should scrutinize IR-adopting firms' financial disclosures, especially line items, as CS does not impact the net profits.Originality/valueIt is the pioneering research to thoroughly explore the impact of IR on different earnings management tools and strengthen the conceptual frameworks of legitimacy theory by documenting that firms adopt IR to gain legitimacy, however their intention to engage in earnings management remains intact.

Implementation and impact of integrated information systems in Albanian SME’s

Abstract This research work analyses how information technology improves business efficiency, creates employment, and fosters economic development. This paper investigates the level of integrated information systems used by small and medium enterprises in Albania. The research philosophy employed in this research work based on the case study method, and researcher interaction has been applied as a technique for data collection. Through careful observation and investigation of practical and real cases, a complete picture of the actual interaction of factors and events are obtained. A self-selection sampling technique was used. Through this technique, cooperation with managers was enabled to recommend possible concrete improvements in the systems or subsystems of information they apply. Results indicate that while information technology adoption is growing, significant barriers such as financial constraints and lack of technical skills persist. The empirical work showed that the firms involved in the study used information systems for different aspects such as sales, accounting, or quality control, but they were not integrated. The lack of the “smart” use of the information systems hampered their efficiency and make them less competitive. By leveraging such systems, SMEs can overcome challenges posed by limited resources and achieve sustainable growth.

Exploring the income impact of rural e-commerce comprehensive demonstration project and determinants of county selection

The development of rural e-commerce in China is viewed as an opportunity to increase rural income. Using panel data from 592 national-level key poverty-stricken (NLKPS) counties from 2014 to 2020, we confirm that the National Rural E-commerce Comprehensive Demonstration Project (NRECDP), launched by the Chinese government, delivers significant rural income growth for selected counties by providing financial support. Digital inclusive finance has facilitated rural e-commerce development, thereby promoting rural income. Our study uses the endogeneity switching regression (ESR) model to address self-selection bias and finds that NRECDP participation increases rural income by ~12.97%. The determinants of participation in the NRECDP include levels of economic development, e-commerce development, infrastructure development, industry structure, and digital inclusive finance. Additionally, the determinants of rural income include education levels and population density. Moreover, our heterogeneity analysis reveals that the rural income growth effect of NRECDP involvement is more significant for NLKPS counties in non-ethnic regions, central regions, higher industry structures, and the three regions and three prefectures. Additionally, entrepreneurship serves as a potential channel linking NRECDP implementation and rural income growth.

Perceptions and Effectiveness of a Fully-Automated Brief Behavioral Insomnia Therapy, Delivered by a Virtual Companion, in Older and Young Adults

Abstract Background and Objectives One of the most common sleep disturbances in older people is insomnia. Cognitive-behavioral therapy is the first-line treatment for this condition in older adults, but in-person treatment is costly and often unavailable. In this study, in a group of older and young subjects, we aimed to compare: (1) their initial perceptions of a fully-automated mobile health intervention to manage insomnia, (2) how these perceptions related to treatment completion, and (3) the effects of the intervention on insomnia severity and related outcomes. Research Design and Methods A case series study was conducted with a self-selected sample of older (> 65 years) and young (18-35 years) adults (n=5,660) who downloaded a free app, available in France, that delivers a brief behavioral intervention for insomnia aided by a virtual companion. The 17-day intervention included sleep hygiene and stimulus control recommendations. Primary outcome was treatment completion (yes/no). At the beginning of the intervention, treatment acceptability and trust in the virtual companion were assessed with two short questionnaires (completion rate: 1,597 users). Insomnia was evaluated with the Insomnia Severity Index. Results Logistic regression analyses showed that higher credibility and trust in the app’s virtual companion were associated with higher odds of treatment completion, but only in older adults (Trust scores x Age group: OR=1.12, [95%CI=1.01-1.25], p < .05, and Credibility scores x Age group: OR=1.25, [95%CI=1.06-1.47], p < .01). Within the subset of users who completed the intervention (n=289), insomnia remission (χ2=2.72, NS) and insomnia response rates (χ2=2.34, NS) were comparable across both groups. Discussion and Implications This brief behavioral intervention appears to be efficacious for the self-management of insomnia symptoms in older adults. The integration of persuasive interaction elements, such as avatars and virtual coaches, in fully-automated interventions could be particularly useful to stimulate older adults’ engagement.

The Effect of Student Loan Debt on Emergency Savings and the Moderating Role of Financial Knowledge: Evidence from the U.S. Survey of Household Economics and Decisionmaking

This study examines data from the U.S. 2018 and 2019 Survey of Household Economics and Decision making (SHED) to understand the association between student loan debt and emergency-saving decisions, including the moderating role of financial knowledge. Controlling self-selection bias through a propensity score and coarsened exact matching approach, the findings reveal that individuals with student loan debt are less likely to save for financial emergencies. The findings also show that financial knowledge is positively associated with a higher likelihood of having emergency savings. Furthermore, the results from the moderating analysis indicate a statistically significant interaction effect. Based on the empirical results and the corresponding interaction plots, the findings suggest that targeted financial education may lead to improved financial outcomes for student loan borrowers, rather than assuming that such education occurred prior to a loan application.

Greenhouse gas assurance and carbon emission performance in light of the auditor’s reputation and the country’s development level

PurposeThe objective of this study is to determine the impact of GHG assurance on firms’ carbon emissions performance (CEP) regarding curbing carbon emissions and the effect on such by the GHG assurance provider’s affiliation and reputation. It also explores whether the affiliation and reputation of GHG assurance providers imply the relationship between GHG assurance and the firm’s CEP. Further, this study examines the moderating effect of the country’s development level on the relationship.Design/methodology/approachBased on a sample of international firms from 56 countries spanning the period from 2012 to 2020, this study utilizes the ordinary least squares (OLS) regression. We also run the OLS regression at times t+1 and t+2 to verify the baseline results. To address the endogeneity concerns arising from self-selection bias and the causality effect, this study applies the generalized method of moment (GMM) and the Heckman test.FindingsThis study finds that GHG assurance leads to better CEP by firms. We also find that engaging with accounting assurance providers leads firms to a better CEP than non-accounting assurance providers. Our results show that Big Four auditors can help firms decrease carbon emissions. We also find that the positive effect of GHG assurance is prevalent in firms operating in developed countries.Research limitations/implicationsOur study only considers the influence of the assuror’s reputation and affiliation on CEP without examining other factors that may influence the quality of assurance services provided.Practical implicationsOur study provides a practical implication related to the influence of a GHG assurance provider’s affiliation and reputation globally by providing evidence that accounting and Big Four assurance providers do play a significant role in a firm’s carbon emission performance. This study offers great insights into the GHG assurance impact on CEP with the interplay between the assuror’s affiliation and reputation and the country’s development.Originality/valueThis paper enriches the limit evidence on GHG assurance and CEP by providing novel evidence on the relationship between GHG assurance and a firm’s CEP. Moreover, this study provides insights into the implication of a country’s development level on the role of GHG assurance in CEP.

Estimating Test-Retest Reliability in the Presence of Self-Selection Bias and Learning/Practice Effects

Test-retest reliability is often estimated using naturally occurring data from test repeaters. In settings such as admissions testing, test takers choose if and when to retake an assessment. This self-selection can bias estimates of test-retest reliability because individuals who choose to retest are typically unrepresentative of the broader testing population and because differences among test takers in learning or practice effects may increase with time between test administrations. We develop a set of methods for estimating test-retest reliability from observational data that can mitigate these sources of bias, which include sample weighting, polynomial regression, and Bayesian model averaging. We demonstrate the value of using these methods for reducing bias and improving precision of estimated reliability using empirical and simulated data, both of which are based on more than 40,000 repeaters of a high-stakes English language proficiency test. Finally, these methods generalize to settings in which only a single, error-prone measurement is taken repeatedly over time and where self-selection and/or changes to the underlying construct may be at play.

Stakeholder Perspectives on Research, Policy and Practice Priorities to Increase Human Milk Feeding Rates in the United Kingdom.

Human milk feeding rates in the United Kingdom are a public health concern. Changes to United Kingdom policy and practice are needed to improve lactation support. These should be informed by those with lived experience of human milk feeding and those who provide support. The aim of this study was to identify research, policy, and practice priorities for increasing human milk feeding rates using insights from a wide range of stakeholders. A secondary aim was to evaluate the influence of a World Café on individual attendees and their interactions within the organizations and communities of which they are a part. The research employed a participatory qualitative design, incorporating a cross-sectional survey and World Café discussions. World Café is a novel approach to engaging stakeholders in discussion, resulting in consensus-building and participatory-driven recommendations. A pre-event survey was completed by a self-selected sample of 67 participants; 37 of these (55%) took part in World Café discussions or an online focus group. World Café discussions and the online focus groups were recorded and transcribed verbatim. Following the World Café, 12 participants (32%) completed a post-event survey, and eight (22%) completed an additional follow-up survey at 2 months. Priority policy and practice changes were identified, including enhancing education, the need for dedicated funding for human milk feeding support, the need to include family within support provision, and the need to change policy regarding media representations of infant feeding. In addition, World Café methodology proved valuable for facilitating networking and instigating changes in relation to support. World Café generated stakeholder agreed-on priorities for research and policy. Many of the recommendations from historical policy and guidance continue to be areas for further development.

It's not all that bad: associations among pain characteristics and sexual well-being in people living with chronic pain.

Individuals experiencing chronic pain often report adverse effects on their sexual functioning. However, other important aspects of sexual well-being (SWB), such as sexual distress and sexual self-esteem, have received little attention. This is an important omission because a SWB involves more than just good sexual function. Similarly, past research has not examined how chronic pain characteristics affect the different aspects of SWB. The goal of this cross-sectional study was to examine the SWB of individuals living with chronic pain and to examine the extent to which SWB is associated with different chronic pain characteristics. A total of 310 individuals (28.1% men, 70.6% women, 1.3% transgender men) with ages between 21 and 50 (M = 31.96, SD = 6.13) who were in a romantic relationship and with self-reported chronic pain for three months or longer completed an online survey. The following indicators of SWB were included in the study: frequency of genital sexual activity, sexual satisfaction, sexual self-esteem, sexual desire, sexual function, genital pain, and sexual distress. The results show that most individuals with chronic pain maintain an active and satisfying sexual life and feel positive about themselves as a sexual partner. Slightly more than a fourth reported experiencing at least one sexual functioning difficulty and almost three-fourths of them found those difficulties sexually distressing. A first canonical correlation showed that more negative pain characteristics were associated with poorer SWB. The second canonical correlation showed that greater perceived partner support can offset the negative relationship between pain and some aspects of SWB. These findings show that individuals living with chronic pain can experience positive SWB. Furthermore, the buffering effect of partner support suggests it is important to involve romantic partners in interventions aimed at improving the SWB of people living with chronic pain. The study examined a large number of indicators of SWB using a sample of individuals with different types of chronic pain. Limitations include potential self-selection bias and a sample that was predominantly white and highly educated. The results paint a more positive picture of the SWB of individuals living with pain and show that individuals living with chronic pain can experience positive SWB. These findings can help for researchers, educators, and clinicians about how to conceptualize, understand, and improve the SWB of individuals living with chronic pain.

Integrating evidence synthesis services in Zimbabwean state university libraries

This article explores how Zimbabwean state university libraries incorporate evidence synthesis services in their traditional research support services as the evidence synthesis methodology begins to gain popularity among researchers beyond the health sciences. The literature indicates that academic libraries around the world are responding to the need for evidence synthesis services. However, there is a lack of evidence concerning how libraries in Zimbabwean state university libraries have adapted to this trend. Exploratory research that involved sub-librarians and faculty librarians as participants was conducted. Purposive and self-selection sampling techniques were utilised in addition to the use of questionnaires and interviews for data gathering. The results reveal that some libraries have started offering evidence synthesis services, particularly in the disciplines of agriculture and applied sciences. The results also show that systematic and scoping reviews are evidence synthesis types commonly conducted by researchers. While the study shows that some librarians demonstrated a good understanding of evidence synthesis, most lacked practical experience and relied on self-teaching and peer-to-peer learning for skill acquisition.

Engagement With Sports After Solid Organ Transplant.

Introduction Transplant Games lend a unique opportunity not only by providing a platform for donors and recipients to engage in sports but also to counter the negativity surrounding organ donation and showcase to the world that transplant recipients can lead active lives. When the Transplant Games were held in Kochi, Kerala, India, for the first time, it provided a venue to engage with transplant recipients, donors, and the families of deceased donors. We aimed to understand the impact that engagement in sports brings on the lives of donors and recipients. Methods After obtaining permission from the organizers, we explained the objectives of the survey to the participants and encouraged them to participate. A survey, covering basic demographic information, transplantation details, and questions related to sports engagement was formulated. Participants could complete the survey electronically via a quick response code or in hard copy. They were fully informed about the objectives of the survey and had the right to withdraw at any stage without consequences. The survey was available for five hours during the games. The study received institutional ethics committee approval (ECASM-AIMS-2024-059). Results Among the approximate 150 participants, we received 78 respondents (52%). After the nine who withdrew consent were removed, we had a full response from 69 participants. Of these, 59 were males (85.5%), and 10 (14.5%) were females. The average age of the participants was 45 ± 13 years. Self-motivation was the most common factor in taking up sports for 30.4% of the responders, followed by family and friends in 23.2% and transplant doctors in 5.8%. Liver Foundation of Kerala (LIFOK), a self-help group of transplant recipients, played a major role in 4.3% of the responders. Bowling was the most popular sport with 23 mentions, followed by carroms and badminton with 27 and 20 mentions, respectively. Donors started to take an active role in sports earlier than recipients, 3.1 ± 1.89 vs. 5.7 ± 5.5 months. The most common reason cited for taking up sports was to become part of the transplant community, followed by a desire to embrace a healthier lifestyle and improve fitness levels. Although none had a personalized coach, most intensified their training and improved nutrition as part of their preparation for the games. Conclusion Our survey is limited by its small and self-selected sample size. Our study highlights the significant role of self-motivation, family support, and self-help groups in encouraging solid organ transplant recipients and donors to engage in sports after surgery. It also highlights the need for more proactive encouragement from doctors and better availability of sports facilities and support staff to help transplant recipients and donors engage in physical activities, which are crucial for their physical and emotional well-being.

Examining the importance of neighborhood natural, and built environment factors in predicting older adults' mental well-being: An XGBoost-SHAP approach

BackgroundPrevious studies have shown that urban neighborhood environmental factors significantly influence the health outcomes of urban older adults. However, most cross-sectional studies exploring the health effects of these factors have failed to quantify the relative importance of each factor. MethodsWe use XGBoost machine learning techniques and SHAPley Additive Interpretation (SHAP) to rank the importance of urban neighborhood environmental factors in shaping the mental health of urban older adults. To address self-selection bias in housing choice, we distinguish older adults living in private housing from those living in public as residents in private housing have more freedom to choose where to live. ResultsThe results show that both natural and built environmental factors in urban neighborhoods are important predictors of mental well-being scores. Five natural environmental factors (blue space, perceived greenery quantity, NDVI, street view greenness, aesthetic quality) and three built environmental factors (physical activity facilities quality, physical activity facilities quantity, neighborhood disorder) had considerable predictive power for mental well-being scores in two groups. Among them, blue space, perceived greenery quantity and street view greenness quantity became less important after controlling for self-selection bias, possibly because of the unequal distribution of quantity and quality, and the performance of neighborhood disorder, aesthetic quality and physical activity facilities quality was more sensitive in public housing. ConclusionsThese results highlight the nuanced and differential effects of neighborhood environmental exposures on mental well-being outcomes, depending on housing preferences. The results of this study can provide support for decision makers in urban planning, landscape design and environmental management in order to improve the mental well-being status of urban older adults.

Does online privacy self-efficacy help promote e-participation for rights protection?

This paper focuses on the relationship between internet users’ online privacy self-efficacy and e-participation behaviour, which merits in-depth study but remains underexplored in the literature. Drawing upon a representative sample of Chinese citizens, this paper finds that online privacy self-efficacy is positively associated with e-participation for rights protection. Instrumental variable (IV) estimation and the propensity score matching (PSM) method are used to address concerns about endogeneity problems and self-selection bias. We also find that individuals’ perceptions of internet empowerment positively influence the relationship between online privacy self-efficacy and e-participation frequency. This paper proposes that the government further optimizes the online environment and improves internet users’ knowledge and skills related to online privacy protection to strengthen citizens’ orderly online participation.

The power of preferences: productivity and stress in new teleworkers during COVID-19

Abstract This study of teleworking during the COVID-19 pandemic avoids a common self-selection bias by controlling for preferences and whether the introduction of teleworking was voluntary or mandatory. In a survey (n = 1,500) conducted in December 2020, we inquired about working arrangements and agent preferences in January, April, and December 2020. Productivity levels initially did not significantly differ for newly teleworking individuals after correcting for age, gender, marital status, breadwinner and management roles, childcare gap, area, job type, and general awareness, but were negatively affected by a preference mismatch (PM; around −3pp) and cognitive dissonance (not going with one’s preference in spite of having a chance to do so, adding another −5pp). By December 2020, individuals with a PM lost as much as 9pp of their productivity levels, but the net effect for those in partially remote work was only about −2pp. Similarly, stress levels initially did not differ for newly teleworking individuals using largely the same controls as before. By December 2020, stress levels for individuals newly undertaking fully remote telework were significantly lower than for the control group of individuals with unchanged working arrangements, but the PM contributed significantly to higher stress levels.

Revisiting the stock market reactions to the private securities litigation against informational misconducts in China

The recently revised Securities Law in December 2019 and subsequent judicial interpretations issued by the Supreme People's Court (SPC) improved the efficiency of private securities litigation in China. Such a milestone legal reform is also reflected by Chinese courts awarding historically high amount of damages to aggrieved investors. These events are used as the sources of exogenous shocks to both de jure and de facto private enforcement intensity, and the stock market reactions to these events are examined. To control for potential self-selection bias, a sample of “culpable” listed companies is employed. Our sample companies react most significantly to the first game-changing court decision in “Wuyang Judgment”, in which the defendants were ordered to pay more than 1 billion damages. Such effects are observed in addition to the previous changes of “on-the-book” laws of private securities litigation. Finally, the magnitude of the estimated abnormal return is positively correlated with the local judiciary quality proxied by the percentage of cases disclosed, which suggests that the market expects that listed companies in regions with high-quality adjudication should be liable to pay higher damages.

Solar empowerment in agriculture: investigating photovoltaic energy’s impact on efficiency among wheat farmers

Persistent electricity shortages in Pakistan, causing prolonged grid power load shedding, have adversely impacted various sectors, notably agriculture and the livelihoods of rural farmers. Literature suggests that adopting photovoltaic solar energy can mitigate these issues. This research aims to measure the impact of photovoltaic solar energy on the technical efficiency of food productivity in Khyber Pakhtunkhwa, Pakistan, applying data from 580 respondents. Addressing self-selective bias through ESR and stochastic frontier production function model is utilized to assess technical efficiency. The findings of this study reveal that farmers using solar energy experience a significant improvement in technical efficiency, with 15.8 percent of them achieving a 7.643 percent increase, after accounting for self-selection bias. Furthermore, the positive effects are more pronounced among larger farms and those with greater farming experience. This study underscores the importance of evidence-based approaches in implementing solar energy solutions, highlighting their potential to foster sustainability and equitable development at the grassroots level. The research culminates with policy recommendations that underscore the importance of promoting the photovoltaic solar energy use among farmers to improve food security and increase agricultural productivity.

The role of shared decision-making in enhancing patient experience: Insights from a cohort of curative head and neck cancer patients

IntroductionShared decision-making (SDM) is on the NHS policy agenda, and the preferred model for preference-sensitive decisions. This study establishes baseline patient-perceived SDM in a radical head and neck cohort, and explores patients’ views on SDM in a large, specialist trust. MethodsAn SDM questionnaire was distributed to all radical head and neck radiotherapy patients (N = 165), June–December 2023. This combined a well-validated instrument for measuring SDM from the patient perspective, SDM-Q-9, with additional questions exploring patient views. Thematic analysis was used to construct and interpret themes. Results65/165 (39%) questionnaires were returned. SDM-Q-9 mean standardised score was 78.6 (SD 26.3). There was a moderate ceiling effect (26%). Scores were not sensitive to sex (p = 0.64) or age (ρ = 0.1). Higher levels of SDM were perceived by participants who stated SDM was very important (51/65, 79%) than somewhat or not at all important (82.4 vs. 62.7; p = 0.02; Cohen d = 0.75). Individuals who discussed their personal priorities with the clinician (46/65, 70.8%), were more likely to be very satisfied with their involvement in SDM (89.1% vs. 52.9%). Thematic analysis generated three themes: Control, Desire for Transparency and Understanding, and Doctor as the Expert. ConclusionPatient-perceived SDM levels are high for head and neck patients. Participants who value SDM also perceive higher levels of SDM. Patient satisfaction increases when individuals discuss their personal priorities. The modest response rate and self-selection bias affect the generalisability of the results. Only radiotherapy patients were included; those who chose alternative treatment may perceive different levels of SDM. The moderate ceiling effect may limit the use of SDM-Q-9 to measure impact of future interventions to improve SDM. Implications for practiceSDM-Q-9 should be combined with an objective, observer measure of SDM.

Perceived built environment as a mediator linking objective built environment and leisure-time physical activity in Chinese cities

Numerous studies have suggested that the perceived built environment is shaped by the objective built environment and influences human physical activity. However, the empirical examination of this pathway remains scant. Addressing this gap, our study investigates whether the built environment affects leisure-time physical activity through its impact on the perceived built environment, utilizing data collected from 760 residents in Fuzhou, China. Structural Equation Modeling results reveal a modest correlation between objective and perceived built environment elements, with the objective built environment being a stronger predictor of leisure-time physical activity. Notably, perceived recreational facilities significantly mediate the relationship between objective recreational facilities and leisure-time physical activity, accounting for 15% of the variance in physical activity due to objective recreational facilities. This mediation effect is consistent across subpopulations, irrespective of residential self-selection biases. These results highlight the imperative for urban planning and policy to extend beyond mere spatial allocation of amenities to enhancing both the actual and perceived accessibility of these facilities, thus underlining the study's profound implications for public health and urban development strategies.