Stakeholder Focus Groups Research Articles

Stakeholder Focus Groups: Co‐creation of a toolkit for public consultations

Abstract Three online focus groups were convened as part of the European Food Safety Authority (EFSA)'s initiative to enhance communication and engagement with EFSA's registered stakeholders participating in public consultations. The primary objective was to gather insights and feedback from EFSA's registered stakeholders regarding their experiences, expectations and challenges related to EFSA's consultation process. Additionally, the aim was to identify key areas for improvement and inform the development of a comprehensive communication toolkit. The chosen format, which included three focus groups following the same style and agenda, proved effective. The length of the focus groups and the number of participants in each group were well‐suited for this purpose, bringing the desired results and meeting the assignment objectives. The focus groups provided valuable insights into the stakeholders' perspectives on EFSA's public consultations. The findings underscore the importance of effective communication, transparency, and stakeholder engagement in facilitating meaningful participation and enhancing the quality of EFSA's decision‐making processes. Moving forward, the development and implementation of a comprehensive communication toolkit based on these insights will be instrumental in fostering greater collaboration and trust between EFSA and its stakeholders.

A proposal to measure the resilience of the Andalusian Commnunity Social Services

Introduction. The COVID-19 pandemic shed light on the weaknesses of social services directed towards the most vulnerable populations. A robust social services framework is, thus, necessary to mitigate the impact of the crisis. In this work, a resilience index is advanced based on the capacities of social services to buffer and alleviate the adverse effects of crises, including the recent pandemic. Thus, the study’s objective was to create a resilience index based on accessible data to assess the extent to which Andalusia’s social services were capable of mitigating the effects of the pandemic. Methodology. A novel methodology, the HVCRA (Hazard, Vulnerability, Risk, and Capacity Analysis), is introduced in this paper. Though traditionally used to assess natural disasters, HVCRA was applied here to gauge the pandemic's impact on social services. To develop the index, expert validation was conducted through the Delphi method, stakeholder evaluation, and the calculation of pre- and post-pandemic resilience indices for municipalities in Andalusia (an autonomous region in southern Spain). Results. The study unfolded in three phases: identification of resilience indicators, data selection, and index calculation. High modal values were obtained with the Delphi method, and significant variables were identified in stakeholder focus groups. The applicability of the final index, reduced to 17 indicators, could be improved through ongoing contextualisation efforts. Discussion. Critical indicators to assess social service resilience were put forward, in line with the research conducted by Kruk et al. who propose a resilience index for healthcare. Structural indicators, such as budget allocation and personnel, play pivotal roles, though data availability challenges persist, particularly in municipalities with over 20,000 inhabitants. Despite the study’s limitations, the proposed indicators are promising in terms of offering a comprehensive resilience assessment method directed towards community social service systems. Conclusions. The study establishes a robust framework for evaluating community social service resilience, although data accessibility remains a challenge. While acknowledging the study’s limitations, the proposed indicators lay the groundwork for attaining a comprehensive evaluation in the future, underscoring the imperative of addressing data availability in order to achieve a more nuanced assessment of social service resilience.

Mindful self-compassion for lung cancer (MSC-LC): Incorporating perspectives of lung cancer patients, clinicians, and researchers to create an adapted intervention to reduce lung cancer stigma.

Stigma is a pervasive and distressing problem experienced frequently by lung cancer patients, and there is a lack of psychosocial interventions that target the reduction of lung cancer stigma. Mindful self-compassion (MSC) is an empirically supported intervention demonstrated to increase self-compassion and reduce feelings of shame and distress in non-cancer populations. However, there are several anticipated challenges for delivering MSC to lung cancer patients, and modifications may be needed to improve acceptability, appropriateness, and feasibility. To gather feedback from lung cancer patients, psycho-oncology researchers, expert MSC teachers, and oncology clinicians to identify themes supporting the adaptation of MSC to reduce lung cancer stigma. We conducted a two-phase process of stakeholder focus groups with researchers and clinicians (n=12) and semi-structured interviews with lung cancer patients (n=14) with elevated stigma. Transcripts were analyzed using thematic content analysis. Five themes were identified: (i) Patients expressed a desire for an intervention that bolstered self-compassion and addressed stigma; (ii) Intervention instructions were acceptable and understood clearly; (iii) Patients preferred intervention content to directly address lung cancer and stigma yet mentioned that doing so should be done with sensitivity; (iv) Ambivalence about delivering the intervention in person or remotely; (v) Acceptance for an intervention of 8-weeks (or longer) with 90-minute sessions and a group size of ≤ 15. Findings informed the development of an adapted clinical protocol for MSC for lung cancer (MSC-LC), which can be pilot tested to determine implementation outcomes (e.g. acceptability, feasibility, efficacy).

Standardized Outcomes for Randomized Controlled Trials Targeting Early Interventions in Patients With Moderate-to-Severe Traumatic Brain Injury: Protocol for the Development of a Core Outcome Set.

: With more than 60 million new cases around the world each year, traumatic brain injury (TBI) causes substantial mortality and morbidity. Managing TBI is a major human, social, and economic concern. In the last 20 years, there has been an increase in clinical trials in neurocritical care, leading mostly to negative results. The evaluation of neurological outcomes, predominantly as primary outcomes, using clinical scales (Glasgow Outcome Scale) has limitations that could explain these results. Moreover, patient-centered outcomes are seldom reported despite their recognized clinical relevance. : The aim of this project is to establish a core outcome set (COS) for patients with moderate-to-severe TBI in randomized control trials in neurocritical care research. This study will follow five distinct steps: (1) systematic review to identify outcomes that have been reported in trials; (2) semistructured interviews with patients and their families to identify their priorities after TBI and explore potential patient-centered outcomes; (3) health care stakeholder focus groups with clinicians, researchers, and policy makers to describe potential outcomes; (4) an eDelphi survey with stakeholder groups to make a list of previously identified core outcomes; and (5) a consensus workshop to establish a COS for moderate-to-severe TBI clinical trials. : The systematic review was published in August 2024. Regarding Step 2, 30 semistructured interviews of patients and relatives were performed from July 2021 to December 2023, and analyses were completed in October 2024. Step 3 is currently under development, and Step 4 is planned for the end of 2025. Step 5 is expected to occur during fall/winter 2026. Conclusions: Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations. Establishing a COS, to be consistently measured and reported in TBI trials in neurocritical care will ensure rigorous reporting, avoid bias, and improve the integrity, transparency, and usability of clinical research. The French context of the study is the main limitation, but we are seeking international collaboration on the project. The results of each step of the project will be disseminated through abstracts, publications, and patient associations. DERR1-10.2196/54525.

Practical Application of Value-Based Medicine in Chronic Pelvic Pain: A Qualitative Study.

Chronic pelvic pain syndrome (CPPS) is prevalent and a complex multifactorial condition. The incidence is rising. CPPS patients may benefit from multidisciplinary care in a structured care pathway. The aim of this explorative study is to give an overview of patient and healthcare provider perspectives on the current patient journey to implement these perspectives in a CPPS care pathway. A Qualitative study was performed using nominal group technique. The participants were nine female patients CPPS and fourteen healthcare providers involved in CPPS care. The perspectives of the stakeholder groups on the individual components of the CPPS patient journey were collected. Five overarching key topics were identified: structured start of the patient journey, execution of the patient journey, follow-up after the patient journey, administration during the patient journey, and communication and education. The following recommendations were formulated based on the prioritised points: implementation of a multidisciplinary approach from the start of the journey, adding a case manager and expanding the multidisciplinary team, providing a collaborative triage, updating the questionnaires, improving communication, developing a rehabilitation programme, and reducing waiting times. Stakeholder focus groups using the nominal group technique was a pivotal step in the development of our CPPS care pathway. This step led to fundamental recommendations, of which a personalised treatment plan at an earlier stage in the patient journey might be the most impactful. This is now implemented, and we monitor the effects on outcomes, quality of life and patient's satisfaction.

Occupational therapy embedded in early childhood education (OTEEC): Developing a population-focused, place-based approach to early intervention through occupational therapy and early childhood education center partnerships

ABSTRACT Occupational therapy practices supporting population health are emphasized in the American Occupational Therapy Association’s Vision 2025 statement, yet limited examples of how practitioner’s design, construct, and evaluate health promotion practices exist in the literature. This manuscript describes how occupational therapy providers collaborated with early childhood education administrators, teachers, and parents to create a novel approach to supporting young children’s development and learning called the Occupational Therapy Embedded in Early Childhood Education (OTEEC) Partnership Model. Educational design research informed how the OTEEC Partnership Model was developed and refined via the integration of scientific inquiry within the context of program development. We completed literature reviews, conducted in-depth interviews with key decision-makers, hosted stakeholder focus groups, and engaged in critical reflection as an occupational therapy provider team to arrive at the foundational principles and unique practices of the OTEEC Partnership Model. Early childhood education center administrators, teachers, and parents believed the strengths of the OTEEC Partnership Model included universal access to an occupational therapy provider, collaborative partnerships with teachers and parents, and integrating occupational therapy practices within an early childhood classroom context. Occupational therapy providers can use the procedures described in this manuscript to develop innovative practices focused on population health and may consider if elevating their own classroom involvement, interprofessional collaboration, and partnerships with parents can enhance their current practices. Occupational therapists may also consider how to create new access pathways for children who might benefit from occupational therapy yet do not qualify for services within current practice guidelines.

Evaluation of a complex intervention: the Latch On randomized controlled trial of multicomponent breastfeeding support for women with a raised body mass index.

Latch On's objective was to achieve improved breastfeeding rates in women with raised body mass indices using a multicomponent breastfeeding support intervention. A hybrid type 1 implementation-effectiveness trial with mixed-methods process and health economics analyses were conducted. Data collection included stakeholder questionnaires, interviews, focus groups, fidelity data, participant and health system costs. The intervention was delivered with fidelity but the high breastfeeding rates at 3months were not different between intervention and usual care. Participants receiving the minimum intervention dose were more likely to initiate breastfeeding (P=0.045) and be breastfeeding at hospital discharge (P=0.01) compared with participants below the threshold. Participant exit interview themes highlighted the importance of improving breastfeeding support to women, the effect of COVID-19 on the breastfeeding experience, and found that the intervention improved the experience of establishing breastfeeding. The intervention cost €157 per participant, with no other cost difference between groups. Process analysis found that follow-up breastfeeding services continued in half of sites after study completion. This low-cost intervention resulted in a more enjoyable breastfeeding experience for participants and changed practice in some study sites. The intervention dose received may impact effectiveness, but further research is needed to provide definitive evidence of clinical and cost effectiveness.

Master Narratives surrounding Rural Emerging Adult Migration: Resources for Postsecondary Decision-making in Rural Communities

This study examined the cultural messages informing postsecondary decision-making processes surrounding emerging adult migration from/to a predominately rural state in the northeastern U.S. Utilizing an ecological approach to sampling, this study used 27 interviews and 5 focus groups of stakeholders working in educational, employment, and quality of life sectors. Narrative analysis yielded evidence of a predominant master narrative of migration as a developmental requirement during emerging adulthood. Stakeholders spoke of normative and prescriptive expectations that emerging adults particularly in rural areas orient their plans and decision-making around, including leaving their home communities for developmental reasons. Implications for emerging adult development and migration and future research on identity formation vis-a-vis master narratives are discussed.

Understanding the challenges of robotic-assisted surgery adoption: Perspectives from stakeholders and the general population on human-interaction, built environment, and training

This study aims to explore adoption barriers from three aspects critical to facilitating robotic-assisted-surgery (RAS) adoption: the human-robot-interaction, built-environment, and training. Guidelines for research and design are identified from these perspectives. This study consisted of three phases: 1) surveys to RAS stakeholders and a crowd-sourcing survey; 2) stakeholder focus groups; and 3) a workshop with subject-matter experts to prioritize future research for RAS. Barriers from the human-robot-interaction perspective include hesitancy among clinicians to trust automation and physical discomfort during prolonged RAS. Barriers impeding communication and workflow disruptions were identified considering the built-environment. Training barriers were exemplified by varying curriculums from formal (courses) to informal (peer training) for surgeons. Crowd-sourced survey results suggest socio-economic status plays a role in RAS perception. Design guidelines include: 1) improved ergonomics; 2) deliberate introduction of automation; 3) sufficient in-room storage for prospective operating rooms; and 4) the development of compact RAS devices for older/smaller rooms.

Development and early Evaluation of a novel tool for assessment of individualised risk tolerance during surgical consent

Purpose The legal interpretation of consent has transitioned over the last decade. Surgeons must identify what patients value to individualise surgical consent. This presents a considerable challenge during busy ward rounds or outpatient clinics. We aimed to develop and evaluate a novel risk tolerance tool to aid surgical consent. Methods This prospective, longitudinal cohort study evaluated the views of adult, elective surgical patients from a single centre. Attitudes to the existing surgical consent process were assessed (n = 48) and responses underwent thematic analysis. From these responses and a stakeholder focus group, a novel risk tolerance tool was developed. The risk tool was evaluated using questionnaires in 25 pre-operative patients. Post-operatively, the same cohort were followed-up with a telephone clinic 6–8 weeks after discharge. Results Overall patients were satisfied with the current consent process, but negative themes emerged including that it is generalised, impersonal, and time pressured. The developed risk tool contained six domains: death, pain, loss of physical function, loss of cognitive function, need for repeat medical interventions, and social disability. Loss of physical function (mean = 34.0, SD = 12.8) and loss of cognitive function (mean = 34.0, SD = 6.1) had lowest risk tolerance, and need for repeat medical interventions (mean = 18.8, SD = 10.9) had the highest risk tolerance. Thirteen (93%) patients had a positive experience of the consent process vs 85% of patients in pre-consent tool cohort. Conclusions The tool demonstrated good patient acceptability and patient reported experience. The tool gathered data that may enhance understanding of patient risk tolerance and personalise the surgical consent process.

Testing best practices in small scale fisheries management: Evidence from a collaborative intervention in two marine protected areas of the central Mediterranean Sea

Adopting best practices (BPs) in small scale fisheries (SSF) is generally acknowledged to enhance ecological and social conditions, improving SSF management overall. Yet studies that empirically assess the effects of BPs on social-ecological outcomes (e.g., fishers' catches, revenues, and level of support towards management measures) remain limited. This study aimed to assess the effects of adopting BPs on catch per unit of effort (CPUE), revenue per unit of effort (RPUE) and small-scale fishers' perceptions in two Marine Protected Areas (MPAs) in Campania, Italy (Santa Maria di Castellabate (CAS-MPA) and Regno di Nettuno (NET-MPA)). Two BPs were implemented and tested in the two MPAs: i) five selective gears with three different mesh/hook sizes and ii) a participatory approach to increase dialogue between fishers and managers. The results from 36 surveys with small scale fishers and 158 SSF operations monitored using photo-sampling and image analysis techniques (between 2020 and 2022) are presented. Analyses of landings showed that significant differences in CPUE and RPUE between mesh/hook sizes were found in a limited number of cases (i.e., combination of fishing gears used in the 2 MPAs). Significant but divergent effects were found on CPUE in the two MPAs for gillnet used to target amberjack (GNA) only. RPUE was significantly higher in the NET-MPA when adopting the largest mesh size for GNA and the largest hook size for bottom longlines (BLL). When analyzing perceptions, fishers generally reported that the BPs adopted had a positive impact on their revenues, improved their relationship with MPA managers and increased their support for the MPA. In addition, eight stakeholder focus groups were held which helped investigators better understand the context, feedback the data gathered from the research and open up dialogue between the relevant stakeholders. The study concluded that increasing mesh/hook sizes, within the range tested here, does not negatively impact fishers’ revenues, while likely improving the status of target populations. Moreover, increasing dialogue between fishers and decision-makers can generate more positive perceptions towards the MPA and improve mutual understanding, helping to reconcile biodiversity conservation with human wellbeing for SSF.

Optimizing Pediatric Rapid Response Teams: Stakeholder Focus Groups.

Rapid response teams (RRTs) can improve outcomes in both adult and pediatric hospitals. Most pediatric hospitals have RRT-type systems; however, little is known about stakeholders' perspectives regarding how to optimize RRT quality and efficiency. We aimed to better understand multidisciplinary stakeholder perspectives on how to improve the RRT process. We held 4 stakeholder focus groups including floor nurses, pediatric trainees (interns and residents), pediatric hospitalists, and the responding PICU team (PICU fellows and nurses). We used deductive coding to identify potential solutions and subsequent themes. Focus groups identified 10 potential solutions within 3 major themes. Themes included (1) the value of a standardized RRT workflow based on stages, (2) the benefit of promoting a safety culture, and (3) the need to implement ongoing RRT education. Stakeholders described a shared mental model of RRT workflow with important events or tasks occurring within each stage. These stages were coded as 1: trigger, 2: team arrival and information sharing, 3: intervention, and 4: disposition and follow-up. Additional proposed solutions included waiting for the entire team to arrive, a systematic information sharing process, and closed loop communication for follow-up plans for patients remaining on the general care floor. RRT stakeholder focus groups provide valuable insight into efforts to optimize RRT events. Standardizing RRT workflow into a staged process may facilitate communication and information sharing. Promoting a culture of safety and implementing ongoing education may help reinforce RRT standardization.

Benefits and challenges of geographic information systems (GIS) for data-driven outreach in black communities experiencing overdose disparities: results of a stakeholder focus group

BackgroundBlack individuals in the U.S. face increasing racial disparities in drug overdose related to social determinants of health, including place-based features. Mobile outreach efforts work to mitigate social determinants by servicing geographic areas with low drug treatment and overdose prevention access but are often limited by convenience-based targets. Geographic information systems (GIS) are often used to characterize and visualize the overdose crisis and could be translated to community to guide mobile outreach services. The current study examines the initial acceptability and appropriateness of GIS to facilitate data-driven outreach for reducing overdose inequities facing Black individuals.MethodsWe convened a focus group of stakeholders (N = 8) in leadership roles at organizations conducting mobile outreach in predominantly Black neighborhoods of St. Louis, MO. Organizations represented provided adult mental health and substance use treatment or harm reduction services. Participants were prompted to discuss current outreach strategies and provided feedback on preliminary GIS-derived maps displaying regional overdose epidemiology. A reflexive approach to thematic analysis was used to extract themes.ResultsFour themes were identified that contextualize the acceptability and utility of an overdose visualization tool to mobile service providers in Black communities. They were: 1) importance of considering broader community context; 2) potential for awareness, engagement, and community collaboration; 3) ensuring data relevance to the affected community; and 4) data manipulation and validity concerns.ConclusionsThere are several perceived benefits of using GIS to map overdose among mobile providers serving Black communities that are overburdened by the overdose crisis but under resourced. Perceived potential benefits included informing location-based targets for services as well as improving awareness of the overdose crisis and facilitating collaboration, advocacy, and resource allocation. However, as GIS-enabled visualization of drug overdose grows in science, public health, and community settings, stakeholders must consider concerns undermining community trust and benefits, particularly for Black communities facing historical inequities and ongoing disparities.

Gender-Affirming Psychotherapy (GAP): Core Principles and Skills to Reduce the Mental Health Care "GAP" for Transgender Youths.

Transgender youths are more likely than cisgender youths to need mental health care because of their high exposure to discrimination and victimization, including within health care systems. Accordingly, transgender youths have low care satisfaction and high rates of treatment dropout, further exacerbating existing mental health inequities. To reduce these inequities, mental health providers need knowledge and skills to enhance transgender youths' treatment engagement and benefits. However, a comprehensive set of practices addressing the needs of transgender youth patients and their providers does not exist. The authors developed gender-affirming psychotherapy (GAP), an evidence-informed set of skills and principles to augment mental health treatments for transgender youths. GAP was developed by using a human-centered design, a methodological approach for creating interventions that prioritize the needs of key stakeholders, which in this study included mental health providers and transgender youths and their parents (N=36). A scoping review of the literature and stakeholder focus groups were conducted to create GAP, which encompasses core principles and skills to enhance mental health services for transgender youths. GAP encompasses 27 principles and 38 skills, organized within 10 domains. All principles and skills were designed to be relevant for various provider types (e.g., psychiatrists and social workers) and to be flexibly adapted to meet diverse patient needs. GAP offers a scalable and flexible approach to addressing the growing mental health care needs of transgender youths. The findings of this study suggest that a human-centered design is a feasible and efficient method for developing interventions to address health inequities.

Issues and Needs for the Sustainable Development of Shellfish Farming in Italy

The Italian shellfish industry mainly comprises clams, mussels, and oysters. While clam production thrives and Italy leads Europe, mussel farming faces economic challenges. Oyster production is relatively new and holds potential. Sustainable development is crucial for meeting growing seafood demand while ensuring resource conservation and food safety. This paper, part of the VALUE-SHELL project funded by the Italian Ministry of Agriculture, Food Sovereignty and Forests (MASAF) as part of support activities for the National Strategic Plan of Aquaculture, combines desk research on industry structure and public interventions using a collaborative approach involving stakeholder interviews and focus groups with producers and local entities to assess the sector’s most compelling needs. The collaborative process highlighted key challenges across the following four sustainability pillars: environmental (global warming, predator control, and pollution mitigation are critical concerns for ecosystem balance); economic (increased production costs and limited diversification opportunities affect profitability); social (fear of generational decline due to limited training and education opportunities poses a threat to the industry’s future); and institutional (lack of a dedicated aquaculture law and fragmented governance hinder long-term planning). The project identifies policy bottlenecks hindering the sector’s potential, caused by not fully addressing producer needs. Sustainable development strategies are essential for addressing these challenges and ensuring the Italian shellfish industry’s future.

Perceptions of Remediation Policies and Procedures in Pharmacy Education

ObjectiveThis study aimed to (1) explore the perceptions of current remediation processes among pharmacy program administrators and faculty, and (2) identify factors surrounding successful or unsuccessful remediation in a pharmacy program. MethodsThis qualitative study used the following 3 stakeholder focus groups with distinct perspectives: didactic faculty, experiential faculty, and administrators. A screening survey was used to identify eligible participants, and quota sampling was used to represent various institution types and stakeholder experience. Focus groups were conducted using structured interview questions by an expert interviewer who was not part of the research team. Data were coded using the constant comparison method until consensus was achieved on the identified themes. ResultsThree themes associated with remediation were identified with 12 coded categories. The codes discussed by all 3 stakeholder groups included methods to identify students who need remediation, types of remediation, remediation challenges, consequences of remediation, remediation effectiveness, and necessary improvements to the remediation process. The didactic and experiential faculty groups discussed the management of remediation plans, methods of remediation prevention, and lessons learned from remediation. The timing of remediation was discussed by didactic faculty. The experiential faculty noted the need for preceptor development to provide timely feedback and ensure successful remediation. All 3 groups mentioned having clear policies and procedures for successful remediation. ConclusionOverall, faculty and administrators had similar perceptions regarding remediation practices. The differences in concerns about remediation were most notable between the experiential and didactic faculty. While all 3 groups believed that remediation may be useful and necessary, challenges remain and monitoring is needed to determine the most effective practices, particularly in experiential education.

Assessment and management of constipation in post-operative patients in the spinal surgery ward: a best practice implementation project.

Constipation is a common complication following spinal surgery that can result in distension, abdominal pain, infection, and even intestinal perforation. This study reports on an evidence-based implementation project to reduce the incidence of constipation in spinal surgery wards. The project was conducted in the spinal surgery ward of a general tertiary hospital in Changsha City, China, from March to August 2022. We used the JBI Implementation Framework and the JBI Model of Evidence-Based Healthcare for audits and feedback. Data were collected and analyzed using JBI's Practical Application of Clinical Evidence System (PACES) software. Seven audit criteria were developed based on the best practice recommendations summarized by JBI. A baseline audit was conducted with 20 nurses and 50 patients in the spinal surgery ward, and a follow-up audit was conducted using the same sample size and setting. The baseline audit revealed compliance below 46% for five of the seven criteria. Strategies developed to address poor compliance included educating nurses and patients, developing a post-operative constipation risk assessment sheet, organizing stakeholder focus group meetings, establishing a constipation management routine, and effective empowerment of nurses. The follow-up audit showed positive compliance results, with the highest rate for Criterion 7 (100%) and the greatest increase for Criterion 2 (from 0% to 78%). Furthermore, the incidence of post-operative constipation decreased from 48% to 16%. The project improved compliance with audit criteria, reduced the incidence of constipation, and enhanced the efficiency of quality management in the spinal surgery ward. http://links.lww.com/IJEBH/A186.

Empirical analysis of social impacts of a rural social enterprise: insights for local and regional development

ABSTRACT In developing countries the most marginalised and disadvantaged people are in rural, remote and regional areas and social enterprises in these areas – rural social enterprises (RSEs) – have been identified as key development actors in this context. However, their impacts are rarely rigorously measured. Our study fills this gap by measuring an RSE’s social impact in a developing country. A smallholder farmers’ survey (n = 1021) is utilised in a propensity score-based method which allowed us to generate counterfactual and estimate outcomes between members and non-members of an RSE. This method was complemented by a stakeholder focus group discussion. Predictors of participation and social impacts of the RSE are identified besides an evaluation of its interventions. Results generate implications for social enterprise practitioners, supporters and policymakers interested in applying RSEs as local and regional development actors as well as researchers involved in social impact measurement.

Required elements for an educational programme for lay exercise instructors in charge of community-based exercise targeting young adults with schizophrenia spectrum disorders – A stakeholder focus group study

BackgroundExercise plays a crucial role in addressing the increased cardiometabolic morbidity and premature mortality in people with schizophrenia spectrum disorders. When delivered in community-based settings, exercise may also reduce loneliness, while promoting overall physical activity behaviours. Skilled instructors are essential to deliver effective community-based exercise; however, knowledge about their roles and required training is lacking. We aim to explore various stakeholders’ perspectives regarding lay exercise instructors’ roles, and the required elements in an educational programme supporting the delivery of community-based exercise for young adults with SSD.MethodsWe used semi-structured homogeneous focus groups with representatives from different stakeholder groups (i.e., including representatives of clinical staff within mental health, physiotherapists, exercise instructors, young adults with schizophrenia spectrum disorders, and relatives of individuals with schizophrenia spectrum disorders) targeted or affected by a community-based exercise intervention. Data were analysed using qualitative content analysis.ResultsWe conducted six focus groups comprising a total of 30 individuals representing five different stakeholder groups The analysis identified three categories: (i) awareness and understanding of mental illness, i.e., providing basic knowledge to dispel common myths and stigma regarding mental illness (ii) protecting youth identity, i.e., supporting the feeling of being more than just a patient, and (iii) promoting exercise as a shared activity, i.e., a communal pursuit, fostering personal growth among participants, their peers and the instructors.ConclusionsAn educational programme for lay exercise instructors delivering community-based exercise targeting young adults with SSD should empower the instructors to assume the role of guardians of an inclusive exercise culture. Educational elements identified were adapted and integrated into an educational programme implemented and evaluated as a part of the Vega trial. Our results may be transferable to the education of lay workers in mental health care where the aim is to facilitate sustainable, recreational, community-based activities.

Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine.

Entrustable professional activities (EPAs) are a widely used framework for curriculum and assessment, yet the variability in emergency medicine (EM) training programs mandates the development of EPAs that meet the needs of the specialty as a whole. This requires eliciting and incorporating the perspectives of multiple stakeholders (i.e., faculty, residents, and patients) in the development of EPAs. Without a shared understanding of what a resident must be able to do upon graduation, we run the risk of advancing ill-prepared residents that may provide inconsistent care. In an effort to address these challenges, beginning in February 2020, the authors assembled an advisory board of 25 EM faculty to draft and reach consensus on a final list of EPAs that can be used across all training programs within the specialty of EM. Using modified Delphi methodology, the authors came to consensus on an initial list of 22 EPAs. The authors presented these EPAs to faculty supervisors, residents, and patients for refinement. The authors collated and analyzed feedback from focus groups of residents and patients using thematic analysis. The EPAs were subsequently refined based on this feedback. Stakeholders in EM residency training endorsed a final revised list of 22 EPAs. Stakeholder focus groups highlighted two main thematic considerations that helped shape the finalized list of EM EPAs: attention to the meaningful nuances of EPA language and contextualizing the EPAs and viewing them developmentally. To foreground all key stakeholders within the EPA process for EM, the authors chose within the development process to draft; come to consensus; and refine EPAs for EM in collaboration with relevant faculty, patient, and resident stakeholders. Each stakeholder group contributed meaningfully to the content and intended implementation of the EPAs. This process may serve as a model for others in developing stakeholder-responsive EPAs.