Stakeholder Interviews Research Articles

Exploring the benefits of outdoor activity participation in national parks: a case study of the Peak District National Park, England

ABSTRACT This study aims to explore the role that regular outdoor activity participation in national parks plays in subjective wellbeing (SWB). It also considers the influences on SWB, including the national park environment, resilience-building, coping skills, mental health and stress alleviation. There is a wealth of research on the benefits of outdoor recreation in natural settings, yet studies which specifically examine the impacts of regular activity engagement in national parks are scarcer. Using the Peak District National Park (England) as a case study, fifteen online stakeholder interviews were conducted, probing participants about their outdoor recreation experiences both during and before the onset of the pandemic. Findings suggest that frequent outdoor activity participation in the Park positively influences coping, resilience and subjective wellbeing, and, relatedly, helps to improve mental health, and alleviate stress. These outcomes are valuable for dealing with the vicissitudes of everyday life and in facilitating long term SWB.

A multi-faceted construct to guide geriatric dental education: Findings from a scoping review with consultation.

Older adults report unmet oral health care needs and barriers in access to care, due in part to provider attitudes and discomfort towards treating older patients. Our study asked: What is known from the literature about the use of undergraduate dentistry programmes to influence dental students' attitudes, perceptions and comfort towards treating geriatric patients? And how can interdisciplinary care facilitate the ability of dentists to work with geriatric patients? A scoping review and stakeholder consultation followed established methodological guidelines. Four databases and two grey literature sources were searched. Two researchers independently selected articles using predefined inclusion criteria. Pertinent information was inputted into an iteratively developed extraction table. NVivo 12 was used to organise the extracted data into themes. Key findings were confirmed through stakeholder consultation. Sixty-eight articles were included in the scoping review. Five key themes emerged: (1) Curricular targets; (2) Intervention components; (3) Dentist and patient factors; (4) The role of interdisciplinary care; and (5) Post-graduation insights on knowledge-seeking patterns. Stakeholder consultations involved 19 participants from Southwestern Ontario and generally confirmed our findings. Inconsistent reporting of multiple intervention dimensions constrains our ability to strengthen this knowledge. Future interventions and their reporting could be improved by adopting "willingness to treat" as an overarching, multi-faceted concept which encompasses knowledge on ageing, attitudes towards older patients, perceived competence and empathy. Stakeholder interviews complemented these findings.

Assessing stakeholder participation in coastal zone management: Methodological proposal and its application in a case study from Cádiz Bay, Andalusia (Spain)

Stakeholder participation (SP) is widely acknowledged in the literature as a vital tool for improving coastal zone management (CZM) and facilitating conflict mediation, resource allocation, and program implementation. However, in Spain, as in other countries, participation in CZM faces significant challenges, including underrepresentation, limited stakeholder influence in decision-making, and various resource-related issues. Despite the robust theoretical framework established in the literature, practical methods for evaluating SP and overcoming these challenges are lacking, with most efforts focused on assessing processes rather than outcomes. This study addresses this gap by proposing a systematic assessment approach built on criteria and operational indicators capable of assessing stakeholder participation in CZM from the process to its outcomes. It also examines stakeholder participation in PAs and CZs of Cádiz Bay (Spain) through the application of this approach to identify which of these challenges are present in the region, highlighting areas for improvement. The approach was developed through a multistep process, including identifying participation components via a literature review, categorizing these components into each participation dimension (who, when, how, why), formulating criteria and indicators based on these components, consulting and validating with experts, and operationalizing the approach through an analysis matrix. Data collection involved reviewing official documents, minutes of participatory arenas, and stakeholder interviews. The approach comprises six criteria - representativeness, timing, promotion, accountability and clearness, influence, and effectiveness - providing a valuable tool for understanding the progression and outcomes of participatory processes. However, the findings also highlight the need for refinement to better capture the quality and significance of participation and to make it more applicable beyond scientific research contexts. The application of the approach in Cádiz Bay revealed challenges such as underrepresentation, limited influence, resource constraints, transparency issues, and effectiveness in fostering cooperation and trust. Participation also appears to be sectorized, reflecting the fragmented institutional framework in the CZM of Cádiz Bay.

Implementation of a Multidisciplinary Team to Improve the Quality of Care for Older Surgical Patients at a Rural Academic Medical Center.

For the first time in history, people age older than 65 years make up >20% of the non-metro population, compared with 16% of the metro population. From 2010 to 2020 the nonmetro population age older than 65 years grew by 22%, while the working-age population declined by 4.9%, and the population aged under 18 years declined by 5.7%.1,2 Multidisciplinary geriatric surgical programs are an increasingly recognized approach to the care of older surgical patients and preliminary data suggest they can reduce length of stay. Although rural areas have the greatest proportion of patients age older than 65 years, implementation of such programs faces special challenges in rural settings with limited resources. Dartmouth-Hitchcock Medical Center is one of the most rural academic centers in the United States. Challenges include a shortage of geriatric-trained providers, long distances to access primary care and subspecialists, and extremely limited postacute care options and skilled nursing facility beds. To address the unique needs of our provider and patient population we began with a development period where we conducted stakeholder interviews. Using these data, we mapped out a workflow and developed pilot projects to address different portions of the workflow, such as preoperative screening for frailty and cognitive impairment, interdisciplinary weekly case conferences, proactive case management, delirium and geriatric surgery postoperative pathway order sets, and a variety of tools for reorientation and delirium management. Herein we describe the process of development and pragmatic clinical implementation of geriatric-focused care for older surgical patients in our rural tertiary center, including some of the main challenges we faced and the strategies we undertook to overcome them, and some of our early patient centered and clinical outcomes. This information may assist other institutions as they design geriatric-focused surgical programs to address the growing population of older adults and the need for compliance with state legislation. The clinical program described is not a research study, and the outcome data we report is for the purpose of description, and should not be interpreted as a rigorous research investigation of the effect of our intervention.

Role of the built environment stakeholders in climate change adaptation

PurposeThere is an urgent need to translate climate change awareness into tangible climate adaptation strategies. The built environment is identified as one of the kick-off points in making climate change adaptation as the built environment shares a dual-way relationship. While the built environment largely contributes to the climate change-triggering factors, it also becomes highly vulnerable in the face of climate change impacts. Tied up with the interconnectedness of the built environment processes and associated systems, the involvement of numerous stakeholders from different spectrums creates the need for a holistic and multi-stakeholder approach in developing climate response strategies for the built environment. Accordingly, this study aims to identify the roles and responsibilities of the different built environment stakeholders in climate change adaptation.Design/methodology/approachThe study consisted of a scoping review at the initial stage, contextualising studies based on secondary data, and semi-structured expert interviews in five different countries: the UK, Sweden, Malta, Spain and Sri Lanka. The paper summarises the findings of the individual country-level desk studies and 65 built environment stakeholder interviews representing national and local governments, communities, academia and research organisations, civil organisations, professional bodies and the private sector. The findings were validated through focus group discussions in two stakeholder seminars.FindingsThe findings summarised a set of key roles and sub-roles for each stakeholder category, considering the current status and needs. The national governments need to set a long-term vision, enabling multi-sector interventions while promoting investment and innovation in climate change adaptation. The local governments overlook local adaptation plans, while the community is responsible for decarbonising operations and practising adaptation at the local level. Civil organisations and professional bodies are the voice of the community, linking policy and practice. Academia and research are responsible for nurturing skills and new knowledge, and the private sector must contribute by adopting climate resilience into their business portfolio and corporate social responsibility.Research limitations/implicationsThis research is part of an Europe-Union-funded research project, Built Environment leArning for Climate Adaptation (BEACON), which aims to develop skills and competencies of the built environment professionals so that they will be adequately equipped to handle the adaptation process of the built environment needs to adapt in facing the climate change impacts.Originality/valueThe paper provides an in-depth analysis of the roles and responsibilities pertaining to each category of the different stakeholders in effectively adapting the built environment to withstand the climate change consequences. Demarcation of each stakeholder’s roles and responsibilities separately facilitates collaboration and coordination between the different parties and provides a more holistic approach to climate change adaptation in the built environment.

Assistance in Fattening Goat Farming Business: Diversification Strategy and Productivity Improvement "Gus Shor Farm" Kanugrahan Maduran Lamongan Village

The development of Goat Farm Fattening Business "Gus Shor Farm" in Kanugrahan Village, Maduran, Lamongan is a strategic effort in increasing the productivity and sustainability of goat farming business. In this context, diversification strategies and productivity improvement are the main focus. The study aims to analyze local market potential, identify business diversification strategies, and design measures to increase goat farm productivity. Research methods used include field surveys, stakeholder interviews, and data analysis. The results showed that the demand for goat meat in the local market continues to increase, providing a great opportunity for "Gus Shor Farm" to develop a goat fattening business. Business diversification strategies include the development of processed goat products such as sausages, jerky, and goat cheese, which can increase the added value and attractiveness of products. In addition, productivity improvement is carried out through the application of technology and efficient management practices, including the use of high-quality feed, good livestock health management, and selection of superior goat breeds. By implementing this strategy, "Gus Shor Farm" can increase income, reduce financial risk, and contribute to economic and social development in Kanugrahan Village, Maduran, Lamongan.

Involvement of children and young people in the conduct of health research: A rapid umbrella review.

Patient and public involvement and engagement (PPIE) have long been considered important to good research practice. There is growing, yet diverse, evidence in support of PPIE with children and young people (CYP). We must now understand the various approaches to involvement of CYP in research. This rapid umbrella review aimed to provide an overview of when, how and to what extent CYP are involved in the conduct of health research, as well as the reported benefits, challenges, and facilitators of involvement. We searched OVID Medline, Embase and PubMed. Published reviews were included if they reported meaningful involvement of CYP in the conduct of health research. Extracted data were synthesised using thematic analysis. The 26 reviews included were predominately systematic and scoping reviews, published within the last decade, and originating from North America and the United Kingdom. CYPs were involved in all stages of research across the literature, most commonly during research design and data collection, and rarely during research funding or data sharing and access. Researchers mostly engaged CYP using focus groups, interviews, advisory panels, questionnaires, and to a lesser extent arts-based approaches such as photovoice and drawing. Visual and active creative methods were more commonly used with children ≤12 years. The evidence showed a shared understanding of the benefits, challenges, and facilitators for involvement of CYP, such as time and resource commitment and building partnership. Overall, the review identified consistency in the range of methods and approaches used, and stages of research with which CYP are commonly involved. There is a need for more consistent reporting of PPIE in the literature, both in terminology and detail used. Furthermore, the impact of approaches to CYP involvement on research and community outcomes must be better evaluated. This review forms part of broader research initiatives being led by the authors. Together, these projects aim to support embedding of child voices in research practice and to explore the desirability and suitability of Young Persons Advisory Groups within birth cohort studies. The findings from this review, alongside public and stakeholder consultation, will inform development of resources such as practice recommendations to guide future involvement of CYP in health research undertaken at the author's respective institutions.

Mitigating Toxic Metal Exposure Through Leafy Greens: A Comprehensive Review Contrasting Cadmium and Lead in Spinach.

Metals and metalloids (hereafter, metal(loid)s) in plant-based foods are a source of exposure to humans, but not all metal(loid)-food interactions are the same. Differences exist between metal(loid)s in terms of their behavior in soils and in how they are taken up by plants and stored in the edible plant tissue/food. Thus, there cannot be one consistent solution to reducing toxic metal(loid)s exposure to humans from foods. In addition, how metal(loid)s are absorbed, distributed, metabolized, and excreted by the human body differs based on both the metal(loid), other elements and nutrients in the food, and the nutritional status of the human. Initiatives like the United States Food and Drug Administration's Closer to Zero initiative to reduce the exposure of young children to the toxic elements cadmium, lead, arsenic, and mercury from foods warrant careful consideration of each metal(loid) and plant interaction. This review explores such plant-metal(loid) interactions using the example of spinach and the metals cadmium and lead. This review highlights differences in the magnitude of exposure, bioavailability, and the practicality of mitigation strategies while outlining research gaps and future needs. A focus on feasibility and producer needs, informed via stakeholder interviews, emphasizes the need for better analytical testing facilities and grower and consumer education. More research should focus on minimization of chloride inputs for leafy greens to lessen plant-availability of Cd and the role of oxalate in reducing Cd bioavailability from spinach. These findings are applicable to other leafy greens (e.g., kale, lettuce), but not for other plants or metal(loid)s.

Benefits and harms of antenatal and newborn screening programmes in health economic assessments: the VALENTIA systematic review and qualitative investigation.

Health economic assessments are used to determine whether the resources needed to generate net benefit from an antenatal or newborn screening programme, driven by multiple benefits and harms, are justifiable. It is not known what benefits and harms have been adopted by economic evaluations assessing these programmes and whether they omit benefits and harms considered important to relevant stakeholders. (1) To identify the benefits and harms adopted by health economic assessments in this area, and to assess how they have been measured and valued; (2) to identify attributes or relevance to stakeholders that ought to be considered in future economic assessments; and (3) to make recommendations about the benefits and harms that should be considered by these studies. Mixed methods combining systematic review and qualitative work. We searched the published and grey literature from January 2000 to January 2021 using all major electronic databases. Economic evaluations of an antenatal or newborn screening programme in one or more Organisation for Economic Co-operation and Development countries were considered eligible. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. We identified benefits and harms using an integrative descriptive analysis and constructed a thematic framework. We conducted a meta-ethnography of the existing literature on newborn screening experiences, a secondary analysis of existing individual interviews related to antenatal or newborn screening or living with screened-for conditions, and a thematic analysis of primary data collected with stakeholders about their experiences with screening. The literature searches identified 52,244 articles and reports, and 336 unique studies were included. Thematic framework resulted in seven themes: (1) diagnosis of screened for condition, (2) life-years and health status adjustments, (3) treatment, (4) long-term costs, (5) overdiagnosis, (6) pregnancy loss and (7) spillover effects on family members. Diagnosis of screened-for condition (115, 47.5%), life-years and health status adjustments (90, 37.2%) and treatment (88, 36.4%) accounted for most of the benefits and harms evaluating antenatal screening. The same themes accounted for most of the benefits and harms included in studies assessing newborn screening. Long-term costs, overdiagnosis and spillover effects tended to be ignored. The wide-reaching family implications of screening were considered important to stakeholders. We observed good overlap between the thematic framework and the qualitative evidence. Dual data extraction within the systematic literature review was not feasible due to the large number of studies included. It was difficult to recruit healthcare professionals in the stakeholder's interviews. There is no consistency in the selection of benefits and harms used in health economic assessments in this area, suggesting that additional methods guidance is needed. Our proposed thematic framework can be used to guide the development of future health economic assessments evaluating antenatal and newborn screening programmes. This study is registered as PROSPERO CRD42020165236. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127489) and is published in full in Health Technology Assessment; Vol. 28, No. 25. See the NIHR Funding and Awards website for further award information.

Lessons Learned in Forming an Academic-Community Partnership with Families Affected by the Juvenile Justice System

Abstract: Background: Families of youth involved in the juvenile justice system (YJJ) are integral to YJJ well-being, so it is important to consider the direct input of YJJ families as well as YJJ themselves in justice system reform efforts aiming to improve YJJ health outcomes. Objective: Our university research team partnered with one Midwest county’s juvenile court, as well as YJJ family members, to form an advisory council to the juvenile court. We report lessons learned through a case study of this council. Methods: Researchers reviewed and analyzed council records, meeting minutes, and interviews of varied stakeholders, including system representatives, leaders of similar advisory councils, and individuals with lived experience of the juvenile justice system. Lessons Learned: Council sustainability required addressing participation barriers, valuing authentic experiences, seeking out system-based champions, and identifying concrete opportunities for members to be heard. Conclusions: Investments in community health partnerships with YJJ families could improve system efforts to meet YJJ needs.

Qualitative evaluation of digital vending machines to improve access to STI and HIV testing in South West England: using a Person-Based Approach

ObjectivesTo report the development, implementation, acceptability and feasibility of vending machines offering HIV and sexually transmitted infection (STI) testing kits.DesignA qualitative study using the Person-Based Approach with patient and public...

Understanding the extent of economic evidence usage for informing policy decisions in the context of India’s national health insurance scheme: Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY)

IntroductionAyushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world’s largest tax-funded insurance schemes. The present study was conducted to understand the decision-making process around the evolution...

Revolutionizing Healthcare: Lessons Learned from an Integrative Approach to Transforming the Hospital Accreditation System in Lebanon

Background: Lebanon was the first country in the Eastern Mediterranean region to develop and implement a national hospital accreditation system, but the system has not been updated since 2011. This study aims to describe the process of developing and piloting context-specific hospital accreditation standards in Lebanon, and share lessons from extensive stakeholder consultations. Methods: Mixed-methods approach was used for development and piloting of standards. This included extensive documentation review, stakeholder and expert consultations, standard review, and capacity building for piloting. Experts were required to review standards using pre-identified criteria and expert sub-group meetings were conducted to discuss changes. Piloting of standards included assessment of feasibility and compliance with standards/guiding measures in addition to implementation considerations. Results: More than 60 experts were consulted. Pilot testing showed a positive outcome for clarity, feasibility, and compliance of hospitals to standards. Managing stakeholders’ expectation was challenging at the policy-political encounter. The rigorous expert review led to the development of context-specific and robust standards that provided guidance for hospitals to improve quality care. Results showed that health system changes at the governance, finance and delivery levels are needed to achieve and sustain the gains of accreditation. Conclusions: The study methodology showed the promising influence of using science in development of accreditation standards. Stakeholder involvement remains critical to push the agenda of accreditation. Continuous follow-up to the survey process is recommended to ensure optimal impact of the accreditation system. The process can be scaled up and replicated in the Eastern Mediterranean Region (EMR) and beyond. Patient or Public Contribution: Patients and public where not involved in this study. While patients and the public bring are key for sharing lived experiences, the development of the standards required deep understanding and expertise especially with regards to healthcare and health systems. Highlights Implications for policy makers • Study can be replicated in contexts without a national accreditation system • Ensuring political commitment is critical for implementation of accreditation • Rigorous approaches are key in managing resistance to change • Stakeholder engagement is pivotal for developing contextualized standards

Cashing in: cost-benefit analysis framework for digital hospitals

BackgroundFor many countries, especially those outside the USA without incentive payments, implementing and maintaining electronic medical records (EMR) is expensive and can be controversial given the large amounts of investment. Evaluating the value of EMR implementation is necessary to understand whether or not, such investment, especially when it comes from the public source, is an efficient allocation of healthcare resources. Nonetheless, most countries have struggled to measure the return on EMR investment due to the lack of appropriate evaluation frameworks.MethodsThis paper outlines the development of an evidence-based digital health cost-benefit analysis (eHealth-CBA) framework to calculate the total economic value of the EMR implementation over time. A net positive benefit indicates such investment represents improved efficiency, and a net negative is considered a wasteful use of public resources.ResultsWe developed a three-stage process that takes into account the complexity of the healthcare system and its stakeholders, the investment appraisal and evaluation practice, and the existing knowledge of EMR implementation. The three stages include (1) literature review, (2) stakeholder consultation, and (3) CBA framework development. The framework maps the impacts of the EMR to the quadruple aim of healthcare and clearly creates a method for value assessment.ConclusionsThe proposed framework is the first step toward developing a comprehensive evaluation framework for EMRs to inform health decision-makers about the economic value of digital investments rather than just the financial value.

Improving person-centred care for older persons with serious multimorbidity in LMICs.

Few interventions are documented to meet person-centred needs of older people with serious multimorbidity in low- and middle-income countries where access to palliative care is limited. Most of the care in these settings is delivered by primary care health workers. This study reports the development and acceptability testing of a communication skills training and mentorship intervention for primary health care workers in Malawi. This study was conducted at Mangochi District Hospital in the south-eastern region of Malawi. Twelve primary health care workers (four clinical officers and eight nurses) working in the primary care clinics received the intervention. The intervention was designed using modified nominal group technique, informed by stakeholder interviews and a theory of change workshop. Acceptability is reported from thematic analysis of a focus group discussion with primary health care workers who received the intervention using NVivo version 14. Older persons with serious multi-morbidity and their caregivers identified a need for enhanced communication with their healthcare providers. This helped to inform the development of a communication training skills and mentorship intervention package based on the local best practice six-step Ask-Ask-Tell-Ask-Ask-Plan framework. Primary health care workers reported that the intervention supported person-centred communication and improved the quality of holistic assessments, although space, workload and availability of medication limited the implementation of person-centred communication. The Ask-Ask-Tell-Ask-Ask-Plan framework, supported person-centered communication and improved the quality of holistic assessment.Contribution:This intervention offers an affordable, local model for integrating person-centered palliative care in resource-limited primary healthcare settings.

Identification and prioritization of risks for new entrants in automobile sector using Monte Carlo based approach

The automotive industry serves as a crucial support system for the economies of industrialized nations in their pursuit of international market competitiveness. Despite this industry's importance, most developing countries face the challenge of acquiring a reasonable economic position at the global level in the automotive sector for various reasons. The most salient reasons include inconsistent government policies, multiple taxes, investor insecurity, political instability, and currency devaluation. Identifying risks is crucial for a new entrant in the already-established automotive industry. The researchers have used multiple (qualitative and quantitative) techniques to identify and prioritize risks in setting up manufacturing plants. The efforts to tackle these identified risks are undertaken at the domestic and government levels to smoothen the establishment of industry. The risks are first identified, in the current study, by reviewing the previous literature and conducting interviews of the various stakeholders (automotive dealers, managers, and customers). Then this study uses Monte Carlo simulation (MCS) approach and develops a risk exposure (high, medium, or low) matrix for the automotive industry of Pakistan. The findings reveal that the depreciation of local currency against the foreign exchange, oligopoly nature of competition, and low market acceptability of new entrants due to their products' image are the most critical risks the automobile industry faces. These findings will help automotive research institutes in developing national policies that specifically aim to support new players in the automotive industry, particularly in addressing high-priority hazards. The results may also provide valuable insights for new participants seeking to identify and address the key challenges in the Pakistani automotive industry before entering it.

Social Cohesion, Economic Security, and Forced displacement in the Long-run: Evidence From Rural Colombia

Millions of people around the world are internally displaced. And yet – compared to other forms of wartime victimization – scholars know relatively little about the long-run consequences of displacement for victims. This gap in the literature is problematic since displacement is distinct from other forms of victimization, and because IDPs face unique challenges in post-conflict transitions. This study contributes to the literature on the effects of displacement in three ways. First, the study brings to bear a unique sample of households in Colombia that is largely homogeneous along key confounders – mostly poor, rural, and conflict-afflicted – yet varies in their exposure to displacement. Next, the study draws on a rich set of covariates and outcomes to provide plausible estimates on the long-run effects of internal displacement. The study finds that a decade or more after displacement, victims experience substantial negative welfare deficits yet exhibit higher levels of social cohesion than their counterparts. Finally, combining a prediction framework with key stakeholder interviews, the study explores variation in outcomes among victims, particularly why some can return home and seek reparations while others are not. The results reveal a wide assortment of consequences resulting from displacement and should help inform policy-making bearing on support for internally displaced people.

Engagement of private healthcare sector in addressing noncommunicable diseases at primary care level in the Eastern Mediterranean Region.

The private healthcare sector is a critical stakeholder in the provision of health care services, including noncommunicable diseases (NCDs), and engagement with the sector is increasingly being advocated in efforts to achieve Universal Health Coverage. This study was conducted to explore the role of the private health sector in delivering NCD-related primary care services in selected countries of the WHO Eastern Mediterranean Region (EMR): Jordan, Oman, Pakistan, Sudan, and the Syrian Arab Republic. We adapted the analytical framework for this study from the "Framework for action to implement the United Nations political declaration on noncommunicable diseases". We conducted a desk review to gather evidence, identify gaps and provide direction for the subsequent stakeholder interviews. Key informant interview respondents were selected using the snowball sampling method. Data from the interviews were analysed using MAXQDA, version 2020. We reviewed 26 documents and interviewed 19 stakeholders in Jordan, Oman, Pakistan, Sudan and the Syrian Arab Republic. Our results indicated increasing advocacy at the regional and national levels to align the private and public health sectors, just as there were efforts to reduce the risk factors for NCDs by implementing tobacco laws, introducing food labelling guidelines, increasing taxes on soft drinks, and promoting the healthy cities approach. NCDs health information systems varied widely among the countries, from being organized and developed to having poor recordkeeping. The private health sector is the predominant provider of care at primary level in most of the EMR countries. Increased collaboration between the public and private sectors is essential for better management of NCDs in the EMR. Governments need to strengthen regulation and defragment the private health sector and harness the sector's strengths as part of efforts to achieve national health targets, NCD goals and Universal Health Coverage.

Corporate Social Responsibility in E-commerce: Insights from Pinduoduo Stakeholder Interview

This study explores the Corporate Social Responsibility (CSR) practices within Pinduoduo, a leading and controversial e-commerce platform. Through qualitative interviews with Pinduoduo’s market promotion employees and resident merchants, the research reveals a nuanced relationship between rapid growth and ethical business conduct. While Pinduoduo’s innovative business model and aggressive marketing strategies have driven significant growth, they have also led to concerns about counterfeit goods and consumer-first policies. The study recommends stricter merchant entry regulations and continuous monitoring to enhance ethical standards. Pinduoduo’s commitment to ESG principles is highlighted through supply chain optimization and technological advancements in logistics, which have reduced environmental impacts. Strengthening collaborations with government agencies and consumer protection associations is also suggested to further improve regulatory compliance and consumer trust. This research underscores the importance of integrating CSR into core business strategies to achieve sustainable growth in the e-commerce sector.

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey

ObjectiveDevelop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves.DesignA mixed methods design, combining semistructured stakeholder interviews, quantitative validation using...