Views Of Stakeholders Research Articles

Professional stakeholders’ expectations for the future of community pharmacy practice in England: a qualitative study

ObjectivesTo explore the views of professional stakeholders on the future of community pharmacy services in England. Specific objectives related to expectations of how community pharmacy services will be provided by...

Acceptance Toward Coursera MOOCs Blended Learning: A Mixed Methods View of Vietnamese Higher Education Stakeholders

This triangulation mixed methods study employed the Technology Acceptance Model (TAM) to investigate the factors affecting continuance intention toward Coursera MOOCs blended learning (CMBL) with undergraduate students at a Vietnamese private higher education institution (HEI). IBM AMOS version 24 was employed, with which Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) were used to examine the reliability and validity of the data collected from 637 students. Manual coding and thematic analysis of qualitative data collected from 30 interviewees, namely administrators, lecturers, curriculum developers, and students, were also conducted to identify the emerged themes and sub-themes. Content feature, social influence, and perceived usefulness were critical factors influencing the HEI students’ continuance intention to use CMBL. This study makes two significant contributions. First, we contribute to the literature from a theoretical standpoint by comparing factors influencing students’ acceptance of CMBL from critical stakeholders in a higher education institution. Second, our findings have practical implications on increasing undergraduate students’ acceptance of blended learning using MOOCs for the long term, which could provide beneficial pointers for HEIs planning to integrate MOOCs for teaching and learning within the higher education context.

Navigating Pakistan’s Educational Policy Landscape in Pursuit of Sustainable Development Goal 4: A view of Stakeholders

Navigating Pakistan’s Educational Policy Landscape in Pursuit of Sustainable Development Goal 4: A view of Stakeholders

Feasibility of introducing effective alcohol harms reduction strategies in a low regulation region: A qualitative study from Hong Kong

To counter the harms of excessive alcohol use, the World Health Organization (WHO) outlined a series of alcohol policy recommendations, including the most cost-effective “Best Buys”. This study aims to obtain key stakeholder views on feasibility of implementing various publicly endorsed alcohol policies in Hong Kong, a relatively low alcohol consumption region with few extant alcohol regulations. Between 2019 and 2021, we conducted semi-structured interviews with stakeholders involved in alcohol policy adoption and implementation. Interviewees included hospitality/alcohol sales workers (n = 13) and government officers (n = 4). The stakeholders noted that although WHO advocacy facilitated local policy considerations, the adoption of stringent measures was challenged by low political priority due to the low visibility of harms. For implementing strategies, the stakeholders cited alignment with social norms as a major facilitator, whereas law enforcement difficulties and resistance from industry/business sectors were viewed as major obstacles. There was a general belief that population-level alcohol policies would be effective for certain groups of drinkers but would also harm the local economy and detract from Hong Kong's image as a “world city”. Hong Kong may not be ready to adopt a wide range of highly restrictive population-level alcohol policies. Local governments should carefully consider contextual factors when following international recommendations.

VALIDATE approach on medication adequacy clinical decision support systems: Holistic assessment for optimal technology adoption

IntroductionLately, Health Technology Assessment (HTA) has narrowed its scope to analyses of mainly clinical and economic benefits. Recent challenges emphasize the need for holistic assessments to obtain accurate recommendations for decision-making considering empirical facts and stakeholder's values. VALIDATE approach considers stakeholder's views and empirical facts allowing for more comprehensive HTAs. This study frames the assessment for clinical decision support systems (CDSS) using VALIDATE. MethodsA systematic review of the literature was conducted to gather evidence on the CDSS's effectiveness and published stakeholder perspectives. Considering the retrieved information, semi-structured interviews with stakeholders were conducted to uncover issues around CDSSs such as problem definition regarding the occurrence of medication errors, judgement of existing preventive methods and previous experiences with CDSSs, background theories regarding thoughts on future impact and personal beliefs, and barriers/facilitators for implementation. ResultsWhen including multi-stakeholder views, reasons different from the literature are shown to interfere with CDSS acceptance/implementation, such as: i) Occurrence of ME (no traceability of medication taken/poor patient empowerment), ii) Technology as a tool to prevent ME (insufficient if only implemented at one point-of-care), iii) Previous experiences with CDSSs (low CDSSs development due to drug prescription being lastly digitalized in hospitals) and iv) CDSSs metrics (data inputted should be measured to control CDSSs performance). ConclusionIncluding multi-stakeholders views in scoping technology evaluation brings added value and new information for the assessment, resulting in more comprehensive assessment; otherwise, it can lead to inaccurate information resulting in inaccurate decisions on if, when and how to adopt CDSS. Public Interest SummaryIncluding varied stakeholders into health technology assessment provides a deeper understanding of what value can a technology bring in. The present study develops a framework to assess clinical decision support systems (CDSS) considering different stakeholders. They were interviewed to understand their perspective on different parts of the problem CDSSs try to solve (medication errors) and the solution itself (CDSSs). Some reasons on the interviews were different from the literature published so far, that are shown to hinder CDSS acceptance/implementation, such as: no traceability of medication taken/poor patient empowerment, CDSSs being insufficient if only implemented at one point-of-care, low CDSSs development due to drug prescription being lastly digitalized in hospitals and CDSS metrics (data inputted should be measured to control CDSSs performance). This approach can improve both implementation chances and posterior assessment of CDSSs.

TB programme stakeholder views on lessons from the COVID-19 response in South Africa.

The global COVID-19 pandemic has reversed many of the hard-won gains made in TB programmes and the associated reduction in the number of TB deaths, case notifications and incidence over the last three decades. Modelling estimates show that the impact will be lasting. There are global calls to recover the shortfalls along the TB care cascade that have resulted from COVID-19, with the recognition that the COVID-19 response holds lessons to inform more robust and comprehensive TB programmes and services. To explore lessons from response measures to the COVID-19 pandemic in two high TB burden South African provinces. This was an exploratory qualitative study. We conducted interviews with TB programme stakeholders (managers and facility-level staff: n = 35) between February and June 2022. We identified eight facilitators of the COVID-19 response, including political will, rapid policy development, multi-sectoral collaboration, patient-centred models of care delivery, community engagement, mHealth and telehealth technologies, rigorous contact tracing and widespread mask wearing. Political will was singled out as a critical driver of the response. Leveraging COVID-19 inspired collaborations, technologies and avenues for health service delivery is an opportunity to maximise benefits for the TB programme. Reinvestment in national TB programmes and political prioritisation of TB are critical.

Perspectives on informed assent and bodily integrity in prospective deep brain stimulation for youth with refractory obsessive-compulsive disorder

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances.

Stakeholder views of prevalent unethical practices in the Ghanaian construction industry

PurposeThis study aims to investigate stakeholders' perception of the most prevalent unethical practices in the Ghanaian construction industry.Design/methodology/approachData used for this study came from a cross-sectional survey (questionnaire), which was administered to 273 stakeholders in the construction industry using convenience sampling technique. The data were analyzed using statistical software package SPSSv17 to determine the most prevalent unethical practices. The ranking factor was calculated based on relative importance index (RII) value.FindingsThe results of this study reveal that corruption was perceived by major stakeholders as the most prevalent unethical behavior (RII = 0.82) followed by bribery (RII = 0.79). Political interference and kickback came third (RII = 0.77) and fourth (RII = 0.74), respectively. However, the least prevalent unethical behaviors were extortion (RII = 0.56), workplace violence (RII = 0.57), alcohol abuse (RII = 0.59) and harassment (RII = 0.59). The findings suggest that when the various groupings were taken into consideration separately, the differences in their perceptions were obvious.Research limitations/implicationsData for this study were collected from construction stakeholders in Ghana who were conveniently sampled. As a result, in reference to the sampling framework which focused on major stakeholders in only two regions of Ghana does not sufficiently ensure full generalization of the results.Practical implicationsThe findings of the study provide significant information for construction organizations and practitioners regarding unethical practices, which are most prevalent in the Ghanaian construction industry. Construction organizations and practitioners seeking to mitigate the negative effect of unethical practices on their performance should focus on educating construction workers on how to avoid corrupt practices and report same to the authorities. Also, ethics training programs must be instituted for staff coupled with constant and random inspection and checking of ethical compliance, verbal promotion and praise for ethical conduct and in some cases increase in employees pay.Originality/valueThis paper is one of the first to have accessed the views of broader stakeholders, i.e. consultants, contractors, professionals, suppliers, regulators, clients and construction workers in the construction industry regarding the most prevalent unethical practices in the Ghanaian construction industry in one study. This study, therefore, enriches the current literature by providing additional dimension to the understanding of unethical practices in the Ghanaian construction industry.

Addressing the fetal alcohol spectrum disorder (FASD) ‘data gap’: Multi-method and multi-disciplinary public engagement to ascertain the acceptability and feasibility of establishing the first UK National linked database for FASD

ObjectivesTo conduct public engagement work to establish the views of key stakeholders on the feasibility, acceptability, key purposes, and data structure of the first national linked longitudinal research database for fetal alcohol spectrum disorder (FASD) in the UK.
 MethodsWe conducted stakeholder mapping and identified contacts through collaborator networks and online searches. We consulted with stakeholders using a range of formats, including: online focus groups (one for adults with FASD [and their supporters] N=5; one for guardians of people with FASD N=7), 1:1/small-team video calls and email communication with clinicians, data providers, policy-makers, data-governance experts, third-sector representatives and researchers [N=~85]), and one hybrid workshop (N=16 [N=10 in-person, 6 online attendees; 15 clinical and one third-sector]). Consultations included discussions on data sharing, harmonisation, perceived benefits, and challenges of a national linked database for FASD. We analysed consultation transcripts and notes using thematic analysis.
 ResultsOur tailored, multi-method approach resulted in high levels of engagement with diverse stakeholders. Overall, stakeholders expressed strong support for a national linked database for FASD. For people living with FASD and third-sector representatives, the main perceived benefit was the potential for increased understanding, awareness, and support for FASD. Clinicians reported that a national database could provide new insights into FASD profiles, supporting more efficient diagnosis. Researchers highlighted potential for increased knowledge of FASD epidemiology and impacts. Policy-makers noted its clear alignment with contemporary FASD and data transformation policies. Common concerns were around privacy and data-sharing, particularly the tension between public good and disclosure risks if sample numbers were low. Clinicians expressed the importance of retaining space for clinical judgement and flexibility alongside the potential insights gained from quantitative analysis of data.
 ConclusionMulti-method and multidisciplinary stakeholder engagement demonstrated the feasibility and acceptability of establishing the first UK national linked database for FASD. Perceived benefits and concerns varied by stakeholder group, demonstrating that flexible, diverse, embedded stakeholder collaboration will be essential as we seek to establish this database.

18 Early supported discharge for older adults admitted to hospital with medical complaints: a qualitative study exploring the views of stakeholders

Abstract Background Early Supported Discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD reduces length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. Methods We conducted a qualitative interview and focus group study at University Hospital Limerick (UHL) from November 2021 to January 2022. Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used for focus groups. Braun and Clarke’s approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021). Results Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: (1) Pre-ESD experiences of providing and receiving older adult inpatient care, (2) Navigating discharge procedures from acute hospital services and (3) A vision for more integrated model of care and a medical ESD team. Conclusion This qualitative study was the first to explore the views and perceptions of older adults and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. The current experiences and barriers to efficient and safe discharge home from hospital were highlighted by stakeholders. The potential role for ESD in this population group was discussed, as well as the key factors to be considered in running an ESD service for medical older adults.

Socially Responsible Artificial Intelligence Empowered People Analytics: A Novel Framework Towards Sustainability

Series of reports on AI misconduct from multiple renowned organizations have triggered a surge of public awareness, calling for more responsible and sustainable use of AI. Noting socially responsible AI (SRAI) as a new concept in the field of PA and HRD, we delved into the subject through an integrative literature review of 75 articles and incorporated three sustainability concepts into AI-enabled PA: corporate social responsibility (CSR), environment, social, and governance (ESG), and UN sustainable development goals (SDGs). Through a stakeholder view, we identified major SRAI stakeholders (subjects) and analyzed their essential considerations (objectives), the impediments of AI technology (causes), and the solutions (means). The analysis illuminated key requirements and considerations for enhancing AI-enabled PA to SRAI-empowered PA towards sustainability. Moreover, we proposed a holistic framework to thoroughly understand SRAI in theory and provided practical implications, recommendations, and future research directions for HRD scholars and professionals.

O.1.3-1 Senior stakeholder views and experience of cross-sector engagement and collaboration to improve long-term health and wellbeing in Wales

Abstract Purpose We aimed to explore the challenges and opportunities to developing and implementing a strategic long-term national physical activity, health and wellbeing strategy. Wales has created innovative legislation through the Wellbeing of Future Generations (Wales) Act 2015 (WBFGA) and continues to drive progress on long-term strategies for health and wellbeing, with physical activity as a key outcome. Methods Senior stakeholders (n = 11) that held leadership roles within the sport, environment, central/ local government, healthcare and public health participated in semi-structured, in-depth interviews (July - September 2022). The interviews were transcribed and analysed through Braun & Clarke’s (2014) thematic analysis using NVivo software. Results The major themes related to: influencing within and outside the leaders’ own organisation; advocating long-term health strategies; protecting the allocated resources to long-term health outcomes from short-term pressures; and disruptive changes such as Covid-19 and government election cycles. The participants felt that physical activity is relevant to multiple strategies and departments within government, so resources should be “pooled together” across central government budgets to meet the needs of the populations and deliver on long-term strategies. Spanning sector and organisation boundaries was viewed as essential by all senior leaders and some noted that partnerships should be led with purpose and authenticity. The innovative WBFGA was mentioned as the key facilitator for creating shared accountability and a shared vision for Wales. The relatively small size of Wales was noted as an additional facilitator to forging positive and long-standing relationships with individuals and organisations. The participants recognised a key element of their leadership role which was engaging and collaborating with strong intent and authenticity. Conclusions The value and role of spanning boundaries to promote and establish long-term strategies for physical activity, health and wellbeing remains largely uncaptured and not well understood. This study contributed to understanding the perspectives of senior leaders, from diverse sectors, on developing and implementing long-term health strategies. The contemporary shift towards whole systems approaches and long-term partnerships to deliver healthier future generations, will require better understanding of what works for engaging wider stakeholders and maintaining momentum to a shared agenda.

Enhancing Tour Guide Training for Delivering Nature-Based Tourism Experiences in a Developing Country

ABSTRACT Tour guides provide frontline services to the nature-based tourism industry, but research is limited on how to enhance their training, especially in developing countries. The present study investigates tour guide training requirements, preferred modes and content for training delivery, and the challenges of offering nature-based tourism experiences in Sri Lanka. Informed by stakeholder theory, we used a mixed-method approach to gain the views of key stakeholders, using a questionnaire-based survey and interviews to sample both national tour guides and key informants in Sri Lanka. Two-thirds of the survey respondents expressed interest in tour guide training, particularly online or workshop-based training on subject-specific knowledge such as wildlife and plant life, local cultural history, marine life, and tropical ecology. Also, quarter of the tour guides did not perceive training needs and note the practicalities of participating in training opportunities. Both tour guides and key informants recognize the challenges of the nature-based tourism industry in Sri Lanka, lack of adequate visitor facilities provided at the entrance and inside of parks, along with overcrowding and visitor safety issues. We recommend increasing awareness of the varied functions of tour guides and the importance of training to ensure a high quality of service delivery.

‘We’re supposed to be at the forefront’: a multiple case study exploring how institutional context shapes engineering diversity and inclusion initiatives

Research suggests the normative culture of engineering perpetuates the marginalization of individuals with excluded identities, contributing to a lack of diversity in academia and the workforce. As evidenced by recent funding opportunities, stakeholders view diversity and inclusion (D&I) as critical to broadening participation, and many engineering units have espoused their commitment to D&I efforts. However, additional research is needed to better understand how institutional contexts shape D&I efforts occurring in academic engineering units. This multiple case study examined engineering units at three U.S. universities that received the same National Science Foundation grant to cultivate an inclusive engineering culture. Drawing from the field of organizational theory, I analyzed data from 11 interviews and 209 pages of documents to understand how university context shaped engineering D&I efforts. The theory of neoinstitutionalism was used as a lens to understand similarities and differences among the cases. Findings suggest D&I efforts were heavily shaped by institutional contexts including the desire for prestige, availability of resources, and pressure from internal and external stakeholders. Implications for policymakers, funding agencies, and engineering leaders point to the need to re-imagine markers of engineering education legitimacy.

How does place matter in circular/waste management transition? Comparison of five European peri-urban regions from the view of stakeholders' perspective

How does place matter in circular/waste management transition? Comparison of five European peri-urban regions from the view of stakeholders' perspective

Towards cervical cancer elimination in Zambia: Stakeholder views on lessons learned, progress to date, and future needs and priorities.

Zambia has strived to reduce cervical cancer-related burden through screen-and-treat services for detection and treatment of precancerous lesions. Understanding health system barriers and opportunities could strengthen further scale-up. We conducted semi-structured interviews with 23 stakeholders working in different levels and roles. Interviews covered program organization; screen-and-treat, referrals, and linkages; and unmet needs. Interviews were audio-recorded, transcribed, and coded on key themes. National leadership, establishment of provincial focal points, and effective partnerships were seen as accomplishments, while reliance on donor resources was a major concern. Somewhat competing priorities emerged: scaling-up existing screen-and-treat v. ensuring screen-positive women receive treatment. Supply chain issues, screening with HPV DNA testing, task-shifting for treatment, and linkages to invasive cancer care were important themes. Despite challenges, stakeholders recognized notable progress scaling up screen-and-treat services. Given realities of budget constraints and donor dependency, relative prioritization of screen-and-treat scale-up vs. linkages to care should be deliberated and task-shifting considered.

Produce or Not Produce Certified Foods? An Exploratory Analysis from Portugal

The certification of origin and quality of rural provenance foods paves routes of protection and promotion of the products and the territories. While the importance of certification at socioeconomic, policy, and consumption levels has been addressed in previous research, the views of other key stakeholders—the producers—remain somehow underexplored. The present study contributes to this topic by analyzing data from a survey of producers (n=104) working with urban specialty shops located in three Portuguese cities. The sample was examined considering the differences between those who produce certified food products (n=74) and those who do not (n=30). Chi-square tests were used to compare the socio-demographic features, type of products produced and selling venues. Independent samples T-tests were applied to compare the differences between producers’ motivations, perceived challenges, and impacts of the production. Findings indicate that producers of certified products have distinct motivations, and value different aspects of their productions, namely to contribute to sustainable and healthier production and consumption and to the preservation of local and traditional ways of producing. They also perceive more positive economic impacts on rural places of provenance and tend to value more the Portuguese food products’ image.

Barriers and Enablers for Implementation of an Artificial Intelligence-Based Decision Support Tool to Reduce the Risk of Readmission of Patients With Heart Failure: Stakeholder Interviews.

Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context. This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system. Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework. Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized. Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process.

Institutional Resistance to Medical Assistance in Dying in Canada: Arguments and Realities Emerging in the Public Domain.

Since the legalization of medical assistance in dying (MAiD) in Canada in 2016, volitional non-participation in MAiD on the part of some healthcare institutions has revealed ethical uncertainties, potential access problems, and policy gaps. The problem has remained much neglected in the literature base, with no comprehensive studies on the subject so far. We analyzed print media articles and grey literature on institutional objections to and non-participation in MAiD. Thematic analyses were performed on all data to better understand the diverse stakeholder arguments and positions that characterize this important public health debate. Our search yielded 89 relevant media articles and 22 legislative, policy, and other relevant documents published since 2016 in the English language. We identified four main themes about institutional refusals to participate in MAiD, articulated as the following questions: (1) Who has the right to conscience? (2) Can MAiD be considered a palliative practice? (3) Are there imbalances across diverse stakeholder rights and burdens? and (4) Where are the gaps being felt in MAiD service implementation? Stakeholder views about institutional conscience with respect to MAiD are varied, complex, and evolving. In the absence of substantial systematic evidence, public domain materials constitute a key resource for understanding the implications for service access and determining the relevance of this contentious issue for future MAiD research and policy.

Stakeholder views on the barriers and facilitators of psychosocial interventions to address reduction in aggressive challenging behaviour in adults with intellectual disabilities.

Success of psychosocial interventions in reducing aggressive challenging behaviour is likely to be related not only to mechanistic aspects but also to therapeutic and system factors. The study aims to examine the facilitators and barriers that influence whether psychosocial interventions for aggressive challenging behaviour in adults with intellectual disabilities lead to positive change. We conducted 42 semi-structured interviews with adults with intellectual disabilities who display aggressive challenging behaviour, family/paid carers, and professionals engaged in or delivering a psychosocial intervention across the UK. Data were analysed thematically using a framework approach. Stakeholders considered therapeutic and supportive relationships and personalised care as facilitating factors in addressing aggressive challenging behaviour. The operational structure of community intellectual disability services and conflicting expectations of professionals and carers were the main contextual barriers that impeded the implementation of psychosocial interventions in adults with intellectual disabilities. Findings highlight the valued components that maximise positive change in adults with intellectual disabilities who display aggressive challenging behaviour. Several operational adjustments including referral criteria, roles of professionals and workforce issues need to be addressed in services to maximise the implementation of psychosocial interventions leading to reduction in aggressive challenging behaviour in this population.