Stakeholder Representatives Research Articles

Exploring perspectives on implementing the World Health Assembly’s Resolution for Strengthening Rehabilitation in Health Systems in Switzerland: a representative rehabilitation stakeholder survey

Purpose In 2023, the World Health Assembly endorsed a Resolution on Strengthening Rehabilitation in Health Systems. This study aims to explore the perspectives of Swiss rehabilitation stakeholders regarding the relevance, challenges, and opportunities of the Resolution for Switzerland. Methods A cross-sectional online survey was conducted among Swiss rehabilitation stakeholders. Purposive snowball sampling with a quota system ensured a representative sample. Survey development and reporting adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Descriptive analysis was applied to quantitative data, while thematic analysis was used for free-text responses. Results A representative sample of 282 Swiss rehabilitation stakeholders completed the survey. Developing multidisciplinary rehabilitation skills emerged as the most relevant action in the Resolution. Primary challenges centred on financing and workforce issues and integrated care, while main opportunities included policy development and advocacy efforts. Conclusion This study enhances the understanding of current challenges and opportunities for rehabilitation in Switzerland. Leveraging this approach and related findings into national and international policy considerations can support policymakers responding in a contextualised manner to the urges of the Resolution.

Identifying priorities for future research on reducing and stopping psychiatric medication: results of a James Lind Alliance priority-setting partnership.

The objective of this study is to identify the top 10 research priorities on reducing and stopping psychiatric medication that reflect the perspectives and unmet needs of three key stakeholder groups (people with lived experience, family members/carers/supporters and healthcare professionals). A priority-setting partnership was conducted using the James Lind Alliance's seven-step process. This involved (1) creating an international Steering Group of key stakeholder representatives and (2) identifying potential partners; (3) gathering stakeholders' uncertainties about reducing and stopping psychiatric medication using an online survey and summarising the survey responses; (4) checking the summary questions against existing evidence and verifying uncertainties; (5) shortlisting the questions using a second online survey; (6) determining the top 10 research questions through a prioritisation workshop; and (7) disseminating the results. A total of 3635 questions were collected in the initial survey from 884 respondents of which 32 questions were verified as uncertainties. These questions were then ranked in a second online survey by 526 respondents and the findings discussed in a final prioritisation workshop by 30 participants to produce the final top 10 list of research questions. These questions cover a range of areas including the most effective ways of safely reducing/stopping psychiatric medication and providing support to individuals undergoing the discontinuation process, as well as the best ways to educate healthcare professionals on this topic. The top 10 list of research priorities was produced through extensive engagement with key stakeholders and highlights important uncertainties and gaps in the existing evidence base that need to be addressed by future research.

Developing mental wellbeing promotion practices in Finnish primary schools: The CONSENSUS project

Abstract Issue/problem Schools constitute a key arena for promoting mental wellbeing among children and adolescents, and the Finnish welfare state has many beneficial structures in place for promoting mental wellbeing in schools. However, as mental health problems are prevalent, the need to advance this work is vital, ideally applying a holistic approach focusing on school-family interaction. Description of the problem The Finnish CONSENSUS project (2021-2025) focuses on the development of new practices and collaboration models in mental wellbeing promotion, targeting pupils in 13 primary schools in the Ostrobothnia region. The project answers question such as: What focal areas are prioritized by stakeholders in the development of mental wellbeing promotion in schools? How do participatory principles contribute to the development process and related outcomes? Results In 2024, a synthesis of previous project results (interviews, focus groups and longitudinal survey data collected among pupils, school personnel, school health care services and parents) was generated. The synthesis encompasses 20 possible priority areas to focus on in the development of mental well-being promotion actions, which are ranked by stakeholder representatives utilizing Delphi methods. Some pinpointed priority areas are implemented and evaluated in collaboration with self-selected schools during the academic year 2024-2025. Lessons Results highlight priorities in the development of mental wellbeing promotion in Finnish primary schools and describe focal areas being piloted, also illustrating opportunities and challenges when implementing participatory principles in action research projects. Key messages • Project results highlight prioritized areas in the development of mental wellbeing promotion in Finnish schools, as well as new initiatives currently being piloted. • The project approach emphasising participatory principles provides lessons for other initiatives focusing on mental wellbeing promotion development in schools.

The experience of women in construction craftspeople apprenticeship programmes in Nigeria

The construction industry needs skilled personnel for its sustainability due to the shortage of skilled workers. Women are reputed to bridge the gap created by skills shortages in construction, which can be achieved by increasing their participation in the industry through the instrumentality of construction craftspeople apprenticeship training. This qualitative study explored the experiences of women in construction craftspeople apprenticeship programmes in Nigeria. Twelve female apprentices and two representatives of stakeholders (senior managers at the apprenticeship programmes) from two construction craftspeople apprenticeship programmes were interviewed on the factors that motivated women to join construction crafts apprenticeship training and the challenges confronting female apprentices. The data retrieved were transcribed and qualitatively analysed using code-based content analysis. Findings indicated that the main factors motivating women to participate in construction craftspeople apprenticeship programmes are: the desire to acquire skills and intrinsic factors such as employment opportunities and better remuneration. Payment issues such as non-payment of allowance, and issues related to apprenticeship training, such as inadequate tools for training, were the prominent challenges faced by female apprentices in construction craftspeople apprenticeship programmes. The study identified factors that can be enhanced by stakeholders in construction craftspeople apprenticeship training to attract women to the construction industry.

Perspectives of stakeholders on onboard training: A thematic analysis of qualitative interviews

ABSTRACT The training and education of seafarers have evolved significantly with the establishment of the International Maritime Organization (IMO) and the adoption of International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW). This paper explores maritime industry key stakeholders’ perspectives on onboard training (OBT) focusing on its benefits, curriculum, and challenges. The thematic analysis of the opinions of representatives of key stakeholders highlighted the critical role of OBT in providing real-world experience, applying theoretical knowledge in practice, and gaining cultural insights essential for maritime cadets’ professional growth. Some obstacles related to financial constraints of shipping companies, common ship activities, living conditions on board, unexpected weather conditions, regulatory inconsistencies, and characteristics of curriculum, such as trainers’ competencies, number of trainers on board, different implementation of OBT by different companies were revealed. The respondents agreed that the traditional 12-month OBT period is necessary, however proper integration of technological advancements in achieving competences with harmonized international regulations, updated curriculum, and enhanced stakeholder collaboration can be helpful to reduce the duration of OBT. Further research should identify competences to be developed through integration of technologies including simulator training.

National stakeholder consultation on how to measure care home residents' quality of life.

The Developing research resources And minimum data set for Care Homes' Adoption and use or DACHA study aims to create a prototype minimum data set combining residents' information recorded by care homes with their data held in health and social care data sets. The DACHA minimum data set will contain information on quality of life. Internationally and in the UK, there is no consensus on collecting information on quality of life in a standardised format equivalent to the consensus for health measures. This paper describes an online consultation with stakeholder representatives about how to measure the quality of life of residents in UK older-adult care homes, for inclusion in the DACHA minimum data set. We drew on principles of the Delphi technique, identifying participants knowledgeable about living, working in and visiting care homes, and preference scoring. We used a bespoke online research engagement platform (Thiscovery, www.thiscovery.org, Cambridge, UK) to engage the participants. Participants included care home staff and managers, old age specialists (clinical/research), commissioners/providers/regulators, primary care professionals, relatives/family carers of care home residents. The consultation is complementary to DACHA's research and patient and public involvement and engagement activities, which have involved people living in care homes; thus, care home residents were not included in this consultation. The first round asked 30 participants to rank the most important principles and domains to consider when measuring quality of life in care homes. Responses to round 1 informed the selection of quality of life measures that round 2 (September 2022) participants were asked to report their familiarity with and confidence in a range of outcome measures all of which met the criteria identified as important in round 1. Recruitment was extended in round 2, and 72 individuals participated. Based on the rankings and the qualitative feedback in round 2, we included four of the shortlisted quality of life outcome measures in DACHA's prototype minimum data set for care homes. The qualitative feedback suggested a shared understanding across the different representative groups about the strengths and limitations of the selected measures. This work makes an important contribution, understanding the opportunities that quality of life measures pose for different stakeholder groups as regular users of care home resident data. In future DACHA work, interviews and focus groups will collect further data about the perceptions of care home staff who completed measures during the pilot study and about the usefulness of the data collected via these measures. The quality-of-life section of the DACHA minimum data set can contribute to informing similar care home data sets internationally. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR127234.

Using intervention mapping to facilitate and sustain return-to work after breast cancer: protocol for the FASTRACS multicentre randomized controlled trial

BackgroundWomen with breast cancer face many barriers to return to work (RTW) after their cancer. The main objective of the FASTRACS-RCT is to evaluate the impact of the FASTRACS (Facilitate and Sustain Return to Work after Breast Cancer) intervention on the sustainable RTW of breast cancer patients, 12 months after the end of active treatment.MethodsFASTRACS-RCT is a prospective, national, multicentre, randomized, controlled and open-label study. A total of 420 patients with early breast cancer scheduled for surgery and (neo)adjuvant chemotherapy, will be randomly assigned (1:1 ratio) to: (i) the intervention arm comprising four steps over 6 months : Handing over the intervention tools; transitional medical consultation with the general practitioner (GP); pre-RTW visit with the company’s occupational physician (OP); catch-up visit with a hospital-based RTW expert (if sick leave > 10 months) (ii) the control arm to receive usual care. The design of the FASTRACS intervention was informed by intervention mapping for complex interventions in health promotion planning, and involved patients and representatives of relevant stakeholders. Specific tools were developed to bridge the gap between the hospital, the GP, the OP and the workplace: a toolkit for breast cancer patients comprising a theory-based guide; specific checklists for the GP and the OP, respectively; and a theory-based guide for workplace actors (employer, manager, colleagues). The primary endpoint will associate sustainable RTW (full-time or part-time work at 50% or more of working time, for at least 28 consecutive days) and days off work. It will be assessed at 4, 8 and 12 months after the end of active oncological treatment. Secondary endpoints will include quality of life, anxiety, depression, RTW self-efficacy, physical activity, social support, job accommodations, work productivity, job status, and the usefulness and acceptability of the intervention’s tools.DiscussionFASTRACS-RCT will be supplemented by a realist evaluation approach aimed at understanding the influence of context in activating the intervention’s mechanisms and effects. If the expected impact of the intervention is confirmed, the intervention will be adapted and scaled-up for other cancers and chronic diseases to better integrate healthcare and work disability prevention.Trial registrationNCT04846972 ; April 15, 2021.

A Multi-dimensional Framework of Valued Output for Primary Care in England.

Improving efficiency and productivity are key aspects to ensure that general practices in England can meet the needs of a growing population with increasingly demanding and costly healthcare needs. However, current evidence on the efficiency and productivity of general practices is weak, partly due to suboptimal approaches to measure their 'valued' output. To overcome this limitation, this paper presents a multi-dimensional framework and indicators of valued output from the healthcare decision-maker's perspective. We identified existing primary care performance frameworks through a targeted literature review. We reviewed the frameworks and selected the dimensions relating to the impact on patients' health outcomes, corresponding with the definition of 'valued' output from the healthcare decision-maker perspective. For each dimension, we reviewed the National Institute for Health and Care Excellence (NICE) evidence base and guidance on best practice to develop indicators of valued output. Clinical experts and representatives of the main primary care stakeholders reviewed and validated the framework's comprehensiveness and development process. Based on a review of three existing frameworks, we synthesised a multi-dimensional output framework comprising 13 dimensions for significant primary care-related conditions and services and 51 indicators of valued output. Each indicator of valued output measures a healthcare episode and the resulting impact on patient's health. The multi-dimensional framework and indicators provide a theoretical tool to improve the measurement of primary care output in economic efficiency and productivity studies. Future research should explore the measurability of the indicators through available datasets and the implementation of the framework through analytical approaches for efficiency measurement.

Health visiting in the UK in light of the COVID-19 pandemic experience: (RReHOPE) findings from a realist review.

Child health programmes in the United Kingdom offer every child and their family an evidence-based programme to support child health and development. During the COVID-19 pandemic, health visiting services in many areas were reduced to a partial service, with significant variability between and within the four United Kingdom countries. This study investigated the impact of the pandemic on health visiting services and developed recommendations for policy and practice. Conduct a realist review of relevant literature. Engage with key stakeholders in policy, practice and research across the United Kingdom. Identify recommendations for improving the organisation and delivery of health visiting services, with a focus on services being equitable, effective and efficient. The realist review followed Pawson's five iterative steps and involved key stakeholder representatives at every step. We searched five electronic databases and references of included articles, as well as relevant organisational websites, to find quantitative, qualitative, mixed-methods and grey literature related to health visiting services in the United Kingdom during the COVID-19 pandemic. An assessment of their relevance to our initial programme theory determined inclusion in the review. Data were extracted, organised and presented as draft context, mechanism and outcome configurations. These were iteratively refined through meetings with 6 people with lived experience of caring for babies during the pandemic and 23 professional stakeholders. Context, mechanism and outcome configurations were then translated into findings and recommendations. One hundred and eighteen documents contributed to the review and collectively revealed the far-reaching, uneven and enduring impact of the COVID-19 pandemic on babies and families. Data uncovered significant concerns of families and practitioners amidst the pandemic, along with the service's corresponding actions. These concerns and responses underscored the critical importance of fostering and sustaining trusting relationships between health visitors and families, as well as conducting holistic assessments for early intervention. Although we found minimal evidence of decision-making within organisational/managerial levels, the data illustrated the diverse and complex nature of health visiting work and the need for flexibility and resourcefulness. The primary limitation of this review was a lack of specific evidence from the United Kingdom nations other than England. There was also a lack of data focusing on changes during the COVID-19 pandemic at a local management level. The needs of babies, children and families, and the delivery of services to support them, were not prioritised in the early phase of the pandemic response. Our data show that the health visiting service was concerned with maintaining visibility of all children, and especially supporting families with a new baby. Health visiting services adapted in numerous ways to respond to these concerns. Implications for policy and practice are presented, identified from our analysis and discussions with stakeholders. The RReHOPE study is part of a jigsaw of evidence, which will provide a much stronger evidence base for future policy and practice. This realist review presents several areas for future research, including how health visiting is organised at local management level; how to optimise limited resources; factors affecting differing uptake in different regions; and analysis of the effectiveness of health visiting using large cohort studies. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme under award number NIHR134986.

Роль держави та громадських організацій у підтримці соціально відповідального бізнесу

The article examines the importance of social responsibility and clarifies the role of the state and public organizations in supporting socially responsible businesses. Today, many Ukrainian enterprises and organizations realize the importance of socially responsible business and increasingly create and implement socially responsible business projects. Such social projects may be related to charity, creating new jobs for IDPs or people with certain special needs, introducing new ecological technologies in energy or food, and other social initiatives. Modernity has faced a whole chain of quite complex problems, for example, the rapid growth of social inequality, global environmental crises, and protracted armed conflicts. The article focuses on the fact that overcoming the mentioned problems requires significant general efforts not only of power structures but also of business and scientific circles and the public. The author analyzes publications devoted to the formation and improvement of socially oriented behavior of business entities and analyzes the experience of using public-private practices and approaches to creating and implementing projects regarding the social responsibility of representatives of state authorities, business structures, public organizations, and other stakeholders. The social responsibility of the state is one of the main levers of ensuring the quality and effectiveness of state administration. The author emphasizes that the state has an essential task in shaping the socially responsible behavior of citizens. Legislative influence, educational policy, support for socially responsible businesses, and public campaigns are all tools the state can use to support and develop socially responsible behavior that contributes to creating an ethical and sustainable society. Public organizations also play an essential role in implementing these principles and forming an ethical business environment. The most crucial function of NGOs is to change people. In our fragmented society, non-governmental organizations promote social inclusion and integration. Public organizations are active initiators of social projects and social initiatives aimed at creating comfortable living conditions for communities, improving the quality of education, etc. The author emphasizes that the state is vital in regulating and stimulating socially responsible business behavior. Legislation, financial incentives, and other instruments of government intervention can contribute to the formation of an effective system of social responsibility. It was also found that public organizations monitor and promote the principles of social responsibility. They can influence business by demanding compliance with high standards of ethics and integrity. Keywords: social responsibility of business, state, public organizations, social state, social projects.

Hurtful Digital Communications In Hong Kong: Stakeholder Accounts

Hurtful digital communications (HDC) is an umbrella term referring to a wide variety of text and image-based practices online, such as cyberbullying or the non-consensual distribution of intimate images (NCDII). They can cause significant harm to victims and, as elsewhere, these practices are on the rise in Hong Kong. This paper represents the first stage of a project aimed at developing a coherent, broad-spectrum response to that rise. It discusses nine interviews with stakeholder groups or representatives in Hong Kong, revealing commonalities and themes in their experiences with clients who have been victims of HDC. While Hong Kong has recently adopted piecemeal reform of criminal laws targeting certain HDC practices such as ‘up-skirting’, NCDII, and doxing, these interviews suggest that these reforms alone are unlikely prove effective. Amongst other things, the interviews reveal a desire by victims not simply for punishment but resolution and restitution. Other jurisdictions have responded to these desires through the adoption both of expanded civil actions and broader regulatory regimes. This paper sets the groundwork for justifying similar reforms in Hong Kong. Keywords: Law, Technology, Cyberbullying, NCDII, Communications, Hong Kong, Privacy, Tort, Regulation

Shared Micro-mobility Market Disturbances: the Polish Bike Sharing Market in Light of Z-score Analysis

Urban transportation has changed dramatically in the recent years through the large scale implementation of shared micro-mobility services, especially bike sharing systems (BSS) and electric scooter sharing (ESS). The COVID-19 pandemic brought further changes and uncertainty to this turbulent business environment. In 2020, the major BSS operator in Poland filed for bankruptcy claiming that its problems arise from the COVID-19 pandemic. Market reports and media speculated that BSS business, despite being publicly financed, and considered to be a of part of public transportation system, could be unsustainable in face of the competition from ESS. We used Z‑score analysis to investigate if bike sharing systems operators’ problems began before or during the COVID-19 pandemic and large scale development of ESS. Our study focuses on the Nextbike company, which held a dominant stake in the Polish BSS market. It also covers two other major Polish operators and includes a German operator for comparative analysis. To complement the quantitative findings from z‑score analysis, we have also interviewed representatives of major stakeholders, which deepened our understanding of BSS problems. The results of our research indicate that although the market was affected by the COVID-19 pandemic and growing scooter-sharing competition, the problems of the largest BSS operator were specific to this company, and the entire market was not under the risk of failure.

Social media and inclusive humanitarian intervention: the case of Cyclone Idai in Chimanimani district, Zimbabwe

Purpose The world-over, it is evident that, numbers and frequency of natural disasters have increased tremendously. The effects have given birth to a worldwide, all-inclusive humanitarian response and preparedness. In Zimbabwe, Cyclone Idai has ushered in the exploitation of various social media platforms by humanitarian organisations as a way of reaching out to the wider population on critical issues pertaining to the devastating effects of the cyclone. This study herein, aims to interrogate the efficacy of various social media platforms that were exploited by various humanitarian organisation involved in the Cyclone Idai humanitarian response. The various social media platforms are interrogated to establish their contribution to inclusivity or lack of it in relaying humanitarian interventions. Design/methodology/approach A mixed-method approach was used to conduct the research. Quantitative and qualitative methods were applied to gather the data. Quantitative data was collected using questionnaires with Likert scales and other closed questions provided. These were administered to representatives from the government, United Nations, donors, non-governmental organisations (NGOs), and members of the community. On the contrary, qualitative data was gathered from members of the community and humanitarian organisations through open-ended responses provided from interviews. Quantitative data was collected from a total of 384 stakeholder representatives who were randomly selected from Chimanimani district of Manicaland province. In addition, 12 interview participants were purposively selected to complement the research tools listed above. Findings The study findings show that social media platforms to a greater extent are effective tools for creating inclusive humanitarian response. The study findings reveal that social media has a significant positive influence on inclusive humanitarian response, with a 5% level of significance. These quantitative results agree with results obtained from interviewed participants. Managers of NGOs, community-based groups, government agencies and churches engaged in managing rescue, relief and humanitarian aid are supposed to access the study's findings in the future, and may find the results resourceful. Research limitations/implications This study's generalisability to other districts and countries is constrained because it was conducted in the setting of the Chimanimani district. Future research can therefore be expanded to other Zimbabwean areas as well as to other countries in the Southern African region and beyond. Practical implications Humanitarian supply chain managers engaged in managing rescue, relief and humanitarian aid are proposed as having access to the study's findings in the future as they may find them useful. Originality/value This study contributes to the literature by providing insights that can improve information flow. This can be achieved by including different stakeholders in decision-making through the use of social media during disaster preparedness and response processes and helping them to better prepare for and respond to future disasters.

Adoption of artificial intelligence and big data analytics: an organizational readiness perspective of the textile and garment industry in Bangladesh

PurposeThe purpose of this paper is to investigate the organizational readiness perspective of adopting artificial intelligence and big data analytics in the textile and garment industry in Bangladesh along with identifying the associated factors.Design/methodology/approachThe research uses a qualitative method using semi-structured interviews with representatives of business organizations and stakeholders of Bangladesh’s textile and garment industry.FindingsThe research reveals that the textile and garment industry in Bangladesh currently has low organizational readiness to adopt artificial intelligence and big data analytics. This is due to moderate knowledge- and leadership-readiness along with low human-, finance- and engagement-readiness of most of the business organizations. The readiness aspects interplay with each other and need to be improved holistically.Practical implicationsConsidering the significant global and national importance of Bangladesh’s textile and garment industry, gaining insights into the industry’s current state of readiness for adopting artificial intelligence and big data analytics would offer valuable assistance to both national and global economies and may enhance economic outcomes.Originality/valueSince no exploratory study was conducted to understand the organizational readiness aspects of adopting artificial intelligence and big data analytics of the globally significant textile and garment industry in Bangladesh, the paper analyzes five key aspects of such readiness and offers a basis for conducting similar studies in other emerging economies.

Steps to construct educational interventions on sexual dysfunction for healthcare professionals and patients. Experiences from the SECRET research study-group

ObjectivesTo design an educational intervention on sexual dysfunction for patients suffering from schizophrenia and diabetes based on patients' and other relevant stakeholders' preferences, and to offer transparency into the basic decision-making process behind a final design. MethodsWe conducted a three-part investigation to explore theory, preferences, and feasibility based on literature searches and interviews with patients, healthcare professionals, heads of Assertive Community Treatment Centres and experts. Based on a content analysis of this material, a draft of the intervention was developed. The draft was quality-checked by involvement of stakeholder representatives and refined to its final design. ResultsThe intervention evolved into having two components: One intervention for patients and one for healthcare professionals. In patient education, meeting peers and predictability were important factors. For healthcare professionals, daily clinical activities were prioritised. ConclusionsWe present a framework for an educational intervention about sexual dysfunction, schizophrenia and diabetes targeting both patients and healthcare professionals. InnovationThe transparency of the design process underlying the interventions allows for reproduction and eases further refinement, extension, and adjustment if implemented in other contexts.

Halal tourism ecosystem: networks, institutions and implementations in Indonesia

PurposeThis study aims to investigate the components of a halal tourism ecosystem and how to establish a model for an effective halal tourism ecosystem. Therefore, each component can play a role in encouraging the productivity of halal tourism.Design/methodology/approachA qualitative approach was applied through in-depth interviews and focus group discussion (FDGs) with representatives of stakeholders who are associated with the development of halal tourism in Indonesia.FindingsThe results show that the effectiveness of the halal tourism ecosystem is primarily determined by the role of the government as an initiator and a policymaker. The halal tourism ecosystem must be run with universal Islamic norms, and it must be avoid exclusive rules.Originality/valueThis research concludes that the symbols in the halal ecosystem are not components that can glue the differences between various organizations and institutions in the context of tourism. However, the role of adhesive is substituted by its practice or implementation that can accommodate shared understandings of Sharia norms.

Towards inclusive learning environments in post-graduate medical education: stakeholder-driven strategies in Dutch GP-specialty training.

A recent study found that ethnic minority General Practice (GP)-trainees receive more negative assessments than their majority peers. Previous qualitative research suggested that learning climate-related factors play a pivotal role in unequal opportunities for trainees in post-graduate medical settings, indicating that insufficient inclusivity had put minority students at risk of failure and dropout. We aimed to develop broadly supported strategies for an inclusive learning climate in Dutch GP-specialty training. We employed Participatory Action Research (PAR)-methods, incorporating Participatory Learning and Action (PLA)-techniques to ensure equal voices for all stakeholders in shaping Diversity, Equity, and Inclusion (DEI)-strategies for GP-specialty training. Our approach engaged stakeholders within two pilot GP-specialty training institutes across diverse roles, including management, support staff, in-faculty teachers, in-clinic supervisors, and trainees, representing ethnic minorities and the majority population. Purposeful convenience sampling formed stakeholder- and co-reader groups in two Dutch GP-specialty training institutes. Stakeholder discussion sessions were based on experiences and literature, including two relevant frameworks, and explored perspectives on the dynamics of potential ethnic minority trainees' disadvantages and opportunities for inclusive strategies. A co-reader group commented on discussion outcomes. Consequently, a management group prioritized suggested strategies based on expected feasibility and compatibility. Input from twelve stakeholder group sessions and thirteen co-readers led to implementation guidance for seven inclusive learning environment strategies, of which the management group prioritized three: • Provide DEI-relevant training programs to all GP-specialty training stakeholders; • Appoint DEI ambassadors in all layers of GP-specialty training; • Give a significant voice to minority GP-trainees in their education. The study's participatory approach engaged representatives of all GP-specialty training stakeholders and identified seven inclusive learning climate strategies, of which three were prioritized for implementation in two training institutions.

Implementation of the electronic health record in the German healthcare system: an assessment of the current status and future development perspectives considering the potentials of health data utilisation by representatives of different stakeholder groups.

The digitalisation of the German healthcare system enables a wide range of opportunities to utilize healthcare data. The implementation of the EHR in January 2021 was a significant step, but compared to other European countries, the implementation of the EHR in the German healthcare system is still at an early stage. The aim of this paper is to characterise the structural factors relating to the adoption of the EHR in more detail from the perspective of representatives of stakeholders working in the German healthcare system and to identify existing barriers to implementation and the need for change. Qualitative expert interviews were conducted with one representative from each of the stakeholder groups health insurance, pharmacies, healthcare research, EHR development and panel doctors. The interviews with the various stakeholders revealed that the implementation process of the EHR is being delayed by a lack of a viable basis for decision-making, existing conflicts of interest and insufficient consideration of the needs of patients and service providers, among other things. The current status of EHR implementation is due to deficiency in legal regulations as well as structural problems and the timing of the introduction. For instance, the access rights of various stakeholders to the EHR data and the procedure in the event of a technical failure of the telematics infrastructure are remain unclear. In addition, insufficient information and communication measures have not led to the desired acceptance of EHR use among patients and service providers.

Beef Cattle Production and Market of Beef Cattle Farmer in Lamphun Province

The objectives of this research were to study: 1) beef cattle production of farmers, 2) beef cattle markets in Lamphun province, and 3) problems and recommendations on beef cattle production in Lamphun province. The research samples consisted of two groups. Group 1, for quantitative research, were 210 beef cattle farmers in Lamphun province who had more than 21 head of beef cattle each. The data were collected using questionnaires and analyzed by descriptive statistics as percentage, mean, maximum, minimum and standard deviation. Group 2, for qualitative research, were 13 key informants who were representatives of beef cattle farmers and stakeholders in beef cattle production and market in Lamphun province. The data were collected by in-depth interview and analyzed by content analysis. The results showed that: 1) Most of farmer were male (about 93.33 %) with average ages of 42±34.58 years. Approximately 43.81 % were educated at primary level and had 35±26.15 years of experience in beef cattle production. Lamphun province had two types of beef cattle production which were 95.24% independent beef cattle farmers and 4.76% beef cattle community enterprise members. Farmers raised 4 types of beef cattle which were purebred beef cattle (50.71%), fattening beef cattle (31.44%), culled beef cattle (13.31%) and fattening quality beef cattle (4.54%). 2) Beef cattle markets in Lamphun province included beef cattle markets and beef markets. Beef cattle were sold at the farms, at beef cattle and buffalo markets and beef cattle fattening market, while butchered beef was sold through local markets in Lamphun province. And 3) the problems in beef cattle production were in beef cattle breeds, feed and farm management. The recommendations for beef cattle production were that beef cattle farmers should establish collaborative groups to develop beef cattle fattening quality production, and relevant agencies should advise and help farmers in farm management, implementing standard slaughterhouse and sources for selling beef cattle.

A smart KPI system for reinforcing sustainable urban mobility plans under pandemic crises

The latest worldwide application of social distancing measures highlighted dramatic effects on the daily life, mobility, well-being, mental health, and economic activity of citizens during the pandemic. Unfortunately, societies were unprepared to confront a pandemic and applied movement restriction measures, often harsh and unbalanced, creating confusion, uncertainty, and annoyance to communities. In this paper, we reviewed a wide array of databases to categorise the mobility management measures implemented internationally in response to the social distancing restrictions that had to be taken during the first wave of the COVID-19 pandemic. Furthermore, to comprehensively assess the measures implemented to contain the COVID-19 pandemic from the perspective of the local community, we conducted focus group interviews with specific population groups that may have been affected to a greater extent. These groups consisted of vulnerable road users, such as mobility-impaired people and people who are facing severe health problems, representatives of the local economy and businesses and representatives of institutional stakeholders and policymakers. Our research showed that in the post-pandemic era, accessibility and not mobility should be at the heart of economic and social welfare. At the same time, the assurance of physical activity, which is strongly associated with the mental health of citizens, and the protection of the local economy are issues of outermost importance. However, local authorities were unprepared to manage these issues and often made fragmented and punitive decisions. By recognising the need for a regional or metropolitan emergency mechanism, this study aims to introduce a new system of indicators specifically adapted to the particularities and challenges encountered during the pandemic, accounts for local communities' unique needs and requirements, and complies with the general principles of Sustainable Urban Mobility Plans (SUMPs). In the future, the SUMP methodology should be revised to be able to handle and manage mobility systems under pandemic conditions.