scholarly journals Key factors of the willingness of rural populations settling in cities (RPSC) from a Lacanian psychoanalysis theory perspective

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243775
Author(s):  
Zhiheng Yang ◽  
Nengneng Shen ◽  
Chenxi Li
Keyword(s):  
Decision Making ◽  
Urban Areas ◽  
Social Background ◽  
Healthcare Services ◽  
Rural Populations ◽  
Key Factors ◽  
Lacanian Psychoanalysis ◽  
Policy Makers ◽  
Employment Insurance ◽  
Realistic Choice

The migration of populations from rural to urban areas is a typical phenomenon of urbanization in developing countries. Based on Lacanian psychoanalysis theory, this study analyzes the decision-making mechanism of the willingness of rural populations settling in cities (RPSC), and analyzes the key factors that affect the willingness of RPSC by using the binary Logit regression method based on survey data in Changyi, China. The results show that the willingness of RPSC is a realistic choice under the joint action of the ‘mirrored’ incarnation and the ‘non-mirrored’ order. Among the factors, ‘age’, ‘ethnic groups’, ‘educational attainment’, and ‘social intercourse’, representing the ‘mirrored’ incarnation, and ‘communities’ safety gap’, ‘healthcare services policy’, ‘public housing policy’ and ‘employment insurance gap’, representing the ‘non-mirrored’ order, are significant in affecting the willingness of RPSC. These findings validate the adaptability of psychoanalysis to analyze the willingness of RPSC, and increases the understanding of individual willingness and behavioral choice in the context of a specific social background, which can provide decision-making reference for urban and rural planning and public policy makers.

Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions

2011 ◽  
Vol 27 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Irina Cleemput ◽  
Mattias Neyt ◽  
Nancy Thiry ◽  
Chris De Laet ◽  
Mark Leys
Keyword(s):  
Decision Making ◽  
Policy Making ◽  
Threshold Value ◽  
Healthcare Services ◽  
Healthcare Systems ◽  
Quality Adjusted Life Year ◽  
Decision Making Process ◽  
Threshold Values ◽  
Social Security Systems ◽  
Policy Makers

Background: In many countries, the incremental cost-effectiveness ratio (ICER) is used to assess whether an intervention is worth its costs. At the same time, policy makers often feel uncomfortable with refusing reimbursement of any intervention purely on the basis of the fact that the ICER exceeds a specific threshold value. Reluctance to define a single threshold value for the ICER seems to have been stronger in social security systems than in national healthcare services systems. This study explores how basic differences between healthcare systems impact upon the potential usefulness of an ICER threshold value.Methods: This study is a narrative review of literature about the theoretical foundations of the ICER threshold value approach and its practical relevance in different types of healthcare systems.Results: A single ICER threshold value cannot be maintained, defined, or measured and should not be used as a policy-making tool. None of the solutions presented up until now to make the ICER threshold approach a valuable policy-making tool overcome the important weaknesses of the approach.Conclusions: ICERs and ICER threshold values are insufficient for assessing interventions' value for money. Rather, they should be considered as one element in the decision-making process. Complete rationalization of the decision-making process by means of quantitative decision criteria is undesirable and not feasible. Increasing transparency in the criteria used for a decision and explicitness about the relative importance of each criterion should, therefore, be the major goal.

scholarly journals Millennials - The Missing Piece in the NHS Workforce Puzzle?

2020 ◽  
Vol 13 (1) ◽  
pp. 21-25
Author(s):  
Farica Patel ◽  
Indranil Chakravorty
Keyword(s):  
Decision Making ◽  
Working Conditions ◽  
Learned Helplessness ◽  
Trade Unions ◽  
Healthcare Services ◽  
Junior Doctors ◽  
Policy Makers ◽  
Governmental Agencies ◽  
Multiple Factors ◽  
Healthcare Workforce

UK healthcare is in the throes of a workforce crisis. There are 10,000 fewer doctors and over 50,000 fewer nurses than are required to run a safe and sustainable service. Multiple factors from removal of nursing bursaries, introduction of university fees, poor working conditions, under-resourcing of healthcare services, unmanageable workloads, learned helplessness of clinical risk and a culture of incivility or blame is driving the workforce of the future away from NHS. Several governmental agencies, arm’s length bodies and trade unions have been grappling with this challenge. A few solutions have been recommended under the new contract for junior doctors, reintroduction of support for nurses and expansion of medical school places, but some are yet to be implemented. NHS leaders continue to support blue-sky thinking in terms of workforce innovations but tend to drag their feet when it comes to adoption. This reluctance by senior clinicians, managers and policy makers may be related to a lack of understanding of the values that drive the millennial generation that most younger healthcare workforce belong to. This article will explore the challenges and solutions from a generational perspective and offer an insight to guide future decision-making.

"Catastrophic Risk Assessment, Using Integrated Multi-Criteria Flood Vulnerability Index for Various Spatial and Temporal Mining Scales : A Case Study of Kosi Flood Affected Five Districts"

2015 ◽  
Vol 6 (2) ◽  
Author(s):  
Prince Divakar Saxena ◽  
Sanjay Pande
Keyword(s):  
Decision Making ◽  
River Basin ◽  
Urban Areas ◽  
Vulnerability Index ◽  
Flood Vulnerability ◽  
Policy Makers ◽  
Spatial And Temporal Scales ◽  
Decision Making Processes ◽  
Main Components ◽  
Flood Vulnerability Index

Human population worldwide is vulnerable to natural disasters, which are increasing due to the consequences of socio-economical and land-use developments and due to climate change. In recent years the impacts of floods have gained importance because of the increasing amount of people who are affected by its adverse effects. In this study a methodology to compute a flood vulnerability index, based on indicators, is developed, aiming at assessing the conditions which favour flood damages at various levels: river basin, sub-catchment and urban area. This methodology can be used as a tool for decision making to direct investments at the most needed sectors. Its implementation could guide policy makers to analyse actions towards better dealing with floods. The methodology involves two concepts. First, vulnerability, which covers three related concepts called factors of vulnerability: exposure, susceptibility and resilience. The other concept concerns the actual flooding; understanding which elements of a system is suffering from this natural disaster. Three main components of a system are recognized which are affected by flooding: social, economical and environmental The interaction between the vulnerability factors and the components serves as the base of the proposed methodology. The methodology has been applied in various case studies spatial and temporal scales, which resulted in interesting observations on how vulnerability can be reflected by quantifiable indicators. The testing results indicate that the FVI of a river basin as a whole can be better reflected by the average FVI of its sub-catchments, thereby improving decision-making processes at regional levels. However, the average FVI of urban areas does not reflect the FVI of the sub-catchment or river basin in which they are located.

scholarly journals Women’s decision-making autonomy and utilisation of maternal healthcare services: results from the Bangladesh Demographic and Health Survey

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017142 ◽  
Author(s):  
Bishwajit Ghose ◽  
Da Feng ◽  
Shangfeng Tang ◽  
Sanni Yaya ◽  
Zhifei He ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Survey ◽  
Rural Areas ◽  
Urban Areas ◽  
Healthcare Services ◽  
Demographic And Health Survey ◽  
Maternal Healthcare ◽  
Cross Sectional ◽  
Nationally Representative ◽  
Antenatal Visits

ObjectivesThe aim of this study was to determine the association between women’s decision-making power and utilisation of maternal healthcare services (MHS) among Bangladeshi women.SettingsThis is a nationally representative survey that encompassed Dhaka, Rajshahi, Rangpur, Chittagong, Khulna, Barisal and Sylhet in Bangladesh. Sample households were selected by a two-stage stratification technique. First, 207 clusters in urban areas and 393 in rural areas were selected for 600 enumeration areas with proportional probability. In the second stage, on average 30 households were selected systematically from the enumeration areas. Finally, 17 989 households were selected for the survey of which 96% were interviewed successfully.ParticipantsCross-sectional data on 4309 non-pregnant women were collected from Bangladesh demographic and health survey 2014. Decision-making status on respondent's own healthcare, large household purchases, having a say on child’s healthcare and visiting to family or relatives were included in the analysis.ResultsPrevalence of at least four antenatal attendance, facility delivery and postnatal check-up were respectively 32.6% (95% CI 31.2 to 34), 40.6% (95% CI 39.13 to 42.07) and 66.3% (95% CI 64.89 to 67.71). Compared with women who could make decisions alone, women in the urban areas who had to decide on their healthcare with husband/partner had 20% (95% CI 0.794 to 1.799) higher odds of attending at least four antenatal visits and those in rural areas had 35% (95% CI 0.464 to 0.897) lower odds of attending at least four antenatal visits. Women in urban and rural areas had respectively 43% (95% CI 0.941 to 2.169) and 28% (95% CI 0.928 to 1.751) higher odds of receiving postnatal check-up when their health decisions were made jointly with their husband/partner.ConclusionNeither making decisions alone, nor deciding jointly with husband/partner was always positively associated with the utilisation of all three types of MHS. This study concludes that better spousal cooperation on household and health issues could lead to higher utilisation of MHS services.

scholarly journals Smart Cities in Turkey: Approaches, Advances and Applications with Greater Consideration for Future Urban Transport Development

Energies ◽  
2019 ◽  
Vol 12 (12) ◽  
pp. 2308 ◽  
Author(s):  
Can Bıyık
Keyword(s):  
Urban Areas ◽  
Planning Process ◽  
Smart Cities ◽  
Radical Change ◽  
Urban Transport ◽  
Transport Systems ◽  
Structured Interviews ◽  
Policy Makers ◽  
Comprehensive Survey ◽  
Future Vision

The smart city transport concept is viewed as a future vision aiming to undertake investigations on the urban planning process and to construct policy-pathways for achieving future targets. Therefore, this paper sets out three visions for the year 2035 which bring about a radical change in the level of green transport systems (often called walking, cycling, and public transport) in Turkish urban areas. A participatory visioning technique was structured according to a three-stage technique: (i) Extensive online comprehensive survey, in which potential transport measures were researched for their relevance in promoting smart transport systems in future Turkish urban areas; (ii) semi-structured interviews, where transport strategy suggestions were developed in the context of the possible imaginary urban areas and their associated contextual description of the imaginary urban areas for each vision; (iii) participatory workshops, where an innovative method was developed to explore various creative future choices and alternatives. Overall, this paper indicates that the content of the future smart transport visions was reasonable, but such visions need a considerable degree of consensus and radical approaches for tackling them. The findings offer invaluable insights to researchers inquiring about the smart transport field, and policy-makers considering applying those into practice in their local urban areas.

Evaluations for New Healthcare Environment Commissioning and Operational Decision Making Using Simulation and Human Factors: A Case Study of an Interventional Trauma Operating Room

2021 ◽  
pp. 193758672199966
Author(s):  
Mirette Dubé ◽  
Jason Laberge ◽  
Elaine Sigalet ◽  
Jonas Shultz ◽  
Christine Vis ◽  
...  
Keyword(s):  
Decision Making ◽  
Human Factors ◽  
Operating Room ◽  
Healthcare Services ◽  
Healthcare Team ◽  
Healthcare Environment ◽  
New Process ◽  
Timely Access ◽  
Operational Decision Making

Purpose: The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning. Background: Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada. Methods: A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations. Results: The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.

scholarly journals Factors influencing decision making for implementing e-health in light of the COVID-19 outbreak in Gulf Cooperation Council countries

2021 ◽  
Author(s):  
Fahad M Al-Anezi
Keyword(s):  
Decision Making ◽  
United Arab Emirates ◽  
Healthcare Access ◽  
Demographic Factors ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Gulf Cooperation Council ◽  
Factors Influencing ◽  
Electronic Health ◽  
Novel Coronavirus

Abstract Background Electronic health (e-health) approaches such as telemedicine, mobile health, virtual healthcare and electronic health records are considered to be effective in increasing access to healthcare services, reducing operational costs and improving the quality of healthcare services during the coronavirus disease 2019 (COVID-19) outbreak, a pandemic resulting from the spread of a novel coronavirus discovered in December 2019. In this context, the aim of this study was to identify the most important factors influencing decision making on the implementation of e-health in Gulf Cooperation Council (GCC) member states (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates), which are in the process of digitizing healthcare services. Methods This study reviewed the literature to identify the important factors influencing decision making on e-health. In addition, a questionnaire-based survey was conducted in order to identify the most important criteria to be considered in decision making on e-health. The survey link was forwarded to 978 healthcare practitioners and 42 experts (purposive sampling), from which a final sample of 892 (864 practitioners and 28 experts) was achieved, reflecting a response rate of 87.45%. Results Of the 44 factors identified under seven themes (strategic, quality, management, technology, function characteristics, economic, sociocultural and demographic factors), 22 factors were identified to be the most important criteria. Conclusions Findings from this study suggest that decision making in relation to e-health is a complex process that requires consideration of various factors. It was also found that attention should be paid to sociocultural and demographic factors, which may need to be considered in increasing healthcare access during the COVID-19 outbreak.

scholarly journals Health technology assessment in sub-Saharan Africa: a descriptive analysis and narrative synthesis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Samantha Hollingworth ◽  
Ama Pokuaa Fenny ◽  
Su-Yeon Yu ◽  
Francis Ruiz ◽  
Kalipso Chalkidou
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Technical Assistance ◽  
Health Technology ◽  
Sub Saharan Africa ◽  
Main Theme ◽  
Narrative Synthesis ◽  
Policy Makers ◽  
Sub Saharan

Abstract Background Countries in Sub-Saharan Africa (SSA) are moving towards universal health coverage. The process of Health Technology Assessment (HTA) can support decisions relating to benefit package design and service coverage. HTA involves institutional cooperation with agreed methods and procedural standards. We systematically reviewed the literature on policies and capacity building to support HTA institutionalisation in SSA. Methods We systematically reviewed the literature by searching major databases (PubMed, Embase, etc.) until June 2019 using terms considering three aspects: HTA; health policy, decision making; and SSA. We quantitatively extracted and descriptively analysed content and conducted a narrative synthesis eliciting themes from the selected literature, which varied in study type and apporach. Results Half of the 49 papers identified were primary research studies and mostly qualitative. Five countries were represented in six of ten studies; South Africa, Ghana, Uganda, Cameroon, and Ethiopia. Half of first authors were from SSA. Most informants were policy makers. Five themes emerged: (1) use of HTA; (2) decision-making in HTA; (3) values and criteria for setting priority areas in HTA; (4) involving stakeholders in HTA; and (5) specific examples of progress in HTA in SSA. The first one was the main theme where there was little use of evidence and research in making policy. The awareness of HTA and economic evaluation was low, with inadequate expertise and a lack of local data and tools. Conclusions Despite growing interest in HTA in SSA countries, awareness remains low and HTA-related activities are uncoordinated and often disconnected from policy. Further training and skills development are needed, firmly linked to a strategy focusing on strengthening within-country partnerships, particularly among researchers and policy makers. The international community has an important role here by supporting policy- relevant technical assistance, highlighting that sustainable financing demands evidence-based processes for effective resource allocation, and catalysing knowledge-sharing opportunities among countries facing similar challenges.

scholarly journals Research use at the Ministry of Health in Burkina Faso: the decision-makers’ perspective

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Christian Dagenais
Keyword(s):  
Decision Making ◽  
Knowledge Transfer ◽  
Burkina Faso ◽  
Informed Decision ◽  
Communication Strategy ◽  
Decision Makers ◽  
Research Use ◽  
Informed Decision Making ◽  
Ministry Of Health ◽  
Policy Makers

Abstract Background Despite the increased emphasis placed on the use of evidence for policy development, relatively few initiatives have been developed to support evidence-informed decision-making, especially in West Africa. Moreover, studies examining the conditions under which policy-makers use research-based evidence are still scarce, but they show that their attitudes and opinions about research are one of the main determinants of such use. In February 2017, Burkina Faso’s Minister of Health planned to create a unit to promote evidence-informed decision-making within the ministry. Before the unit was set up, documenting the attitudes towards research at the highest levels of his Ministry appeared profitable to the unit’s planning. Method Individual interviews were conducted by the author with 14 actors positioned to consider evidence during decision-making from the Burkina Faso’s Minister of health cabinet. An interview grid was used to explore several themes such as attitudes towards research, obstacles and facilitators to research use, example of research use in decision-making and finally, ways to increase decision-makers’ participation in knowledge transfer activities. Interviews were partially transcribed and analysed by the author. Results The results show a mixed attitude towards research and relatively little indication of research use reported by respondents. Important obstacles were identified: evidence inaccessibility, lack of implementation guidelines, absence of clear communication strategy and studies’ lack of relevance for decision-making. Many suggestions were proposed such as raising awareness, improving access and research communication and prioritizing interactions with researchers. Respondents agree with the low participation of decision-makers in knowledge transfer activities: more leadership from the senior officials was suggested and greater awareness of the importance of their presence. Conclusions The conclusion presents avenues for reflection and action to increase the potential impact of the knowledge transfer unit planned within the Ministry of Health of Burkina Faso. This innovative initiative will be impactful if the obstacles identified in this study and policy-makers’ preferences and needs are taken into account during its development and implementation.

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