Influences of Engaging in a Participatory Monitoring and Evaluation Process on Stakeholder Perceptions of Key Performance Indicators for Trails

Trail use is growing globally. Managers confront the classic dilemma of protecting ecological integrity and providing enriching experiences. They concomitantly face the imperative for sustainability—contemporarily characterized by complexity, uncertainty, conflict, and change. Heightened levels of visitation are cause for immense concerns due to adverse impacts to the environment as well as visitor experiences. COVID-19 exacerbates these challenges as heightened levels of visitation are occurring, while managers simultaneously face decreases in conservation funding, and restrictions on protected area operations. Participatory monitoring and evaluation (PM&E) is an emerging in- novation to collaboratively address social-ecological challenges, such as issues as- sociated with trail use. This research is concerned with exploring the influences of engaging in a PM&E process on stakeholder perceptions of key performance indicators (KPIs) for trails. This study compares stakeholder perceptions of KPIs for trails before and after a PM&E workshop at the Niagara Glen Nature Reserve in Ontario, Canada. Results show that PM&E can facilitate consensus among stakeholders regarding the overall goals of management and associated KPIs for environmental management planning. Stakeholders were shown to experience a real change in their perceptions of KPIs. The PM&E process studied show that participants became more conscious of the wider social realities as well as their perceptions of trail management. The study has important implications for managers concerned with trails and sustainability, including building consensus among key stakeholders to reach management goals, enhancing localized decision making, and building capacity for management towards sustainability. Trails, as well as the wider community can ultimately benefit from participatory approaches to environmental management. Consensus-building through PM&E works to enhance decisions that account for a diversity of perspectives. Stakeholder participation in trail management increases the likelihood that local needs and priorities are met, while allowing stakeholders to build capacity and learn to effectively manage their environments. Furthermore, positive perceptions from being meaningfully involved in PM&E can ensure the support of constituents, which is imperative for the long-term success of management planning.

Importance-Performance Analysis of Tourism Destination Attractiveness

This chapter presents an importance-performance analysis to evaluate the ability of a destination's attributes to attract tourists through tourism stakeholder perceptions. In this case, one of Europe's larger destination cities, Lisbon, was considered. It departs from the proposition that tourists are not the most knowledgeable about a destination while the evaluation of a destination's competitiveness from the supply side perspective is scarce. This stakeholder feedback approach to identifying a destination's attributes to attract tourists showed that only 7 of the 40 attributes (five of them related to accessibility and technological infrastructures as municipality responsibility) fall in the IPA grid Concentrate Here quadrant, results that are consistent with the recently received Best City Destination and Best City Break World Travel Awards. This research shows the relevance of multiple stakeholders' feedback to evaluate a city's attributes, including the feedback about the city's need to improve its technological offer through an integrated digital strategy.

Co-Creating an Occupational Health Intervention within the Construction Industry in Sweden. Stakeholder Perceptions of the Process and Output

One way to prevent work-related stress, is to implement primary occupational health interventions aimed at improving the psychosocial work environment. However, such interventions have shown a limited effect, often due to implementation failure and poor contextual fit. Co-creation, where researchers, together with end-users and other relevant stakeholders, develop the intervention is increasingly encouraged. However, few studies have evaluated the effects of co-created interventions, and participants’ experience of the co-creation process. This is one of the first studies evaluating stakeholder perceptions of co-creating an occupational health intervention. We applied a thematic analysis, with data from 12 semi-structured interviews with stakeholders involved in the co-creation. Our results show that the respondents, in general, were satisfied with engaging in the co-creation, and they reported an increased awareness regarding risk factors of stress and how these should be handled. Additionally, the respondents described trust in the intervention activities and a good fit into the context. The study indicates that co-creating occupational health interventions can enhance the implementation and the contextual fit.

Trauma Communications Center Coordinated Severity-Based Stroke Triage: Protocol of a Hybrid Type 1 Effectiveness-Implementation Study

Background: Mechanical thrombectomy (MT) can improve the outcomes of patients with large vessel occlusion (LVO), but a minority of patients with LVO are treated and there are disparities in timely access to MT. In part, this is because in most regions, including Alabama, the emergency medical service (EMS) transports all patients with suspected stroke, regardless of severity, to the nearest stroke center. Consequently, patients with LVO may experience delayed arrival at stroke centers with MT capability and worse outcomes. Alabama's trauma communications center (TCC) coordinates EMS transport of trauma patients by trauma severity and regional hospital capability. Our aims are to develop a severity-based stroke triage (SBST) care model based on Alabama's trauma system, compare the effectiveness of this care pathway to current stroke triage in Alabama for improving broad, equitable, and timely access to MT, and explore stakeholder perceptions of the intervention's feasibility, appropriateness, and acceptability.Methods: This is a hybrid type 1 effectiveness-implementation study with a multi-phase mixed methods sequential design and an embedded observational stepped wedge cluster trial. We will extend TCC guided stroke severity assessment to all EMS regions in Alabama; conduct stakeholder interviews and focus groups to aid in development of region and hospital specific prehospital and inter-facility stroke triage plans for patients with suspected LVO; implement a phased rollout of TCC Coordinated SBST across Alabama's six EMS regions; and conduct stakeholder surveys and interviews to assess context-specific perceptions of the intervention. The primary outcome is the change in proportion of prehospital stroke system patients with suspected LVO who are treated with MT before and after implementation of TCC Coordinated SBST. Secondary outcomes include change in broad public health impact before and after implementation and stakeholder perceptions of the intervention's feasibility, appropriateness, and acceptability using a mixed methods approach. With 1200 to 1300 total observations over 36 months, we have 80% power to detect a 15% improvement in the primary endpoint.Discussion: This project, if successful, can demonstrate how the trauma system infrastructure can serve as the basis for a more integrated and effective system of emergency stroke care.

Development and testing of the Stakeholder Quality Improvement Perspectives Survey (SQuIPS)

BackgroundTo create a theory-informed survey that quality improvement (QI) teams can use to understand stakeholder perceptions of an intervention.MethodWe created the survey then performed a cross-sectional survey of QI stakeholders of three QI projects. The projects sought to: (1) reduce unplanned extubations in a neonatal intensive care unit; (2) maintain normothermia during colorectal surgery and (3) reduce specimen processing errors for ambulatory gastroenterology procedures. We report frequencies of responses to survey items, results of exploratory factor analysis, and how QI team leaders used the results.ResultsOverall we received surveys from 319 out of 386 eligible stakeholders (83% response rate, range for the three QI projects 57%–86%). The QI teams found that the survey results confirmed existing concerns (eg, the intervention would not make work easier) and revealed unforeseen concerns such as lack of consensus about the overall purpose of the intervention and its importance. The results of our factor analysis indicate that one 7-item scale (Cronbach’s alpha 0.9) can efficiently measure important aspects of stakeholder perceptions, and that two additional Likert-type items could add valuable information for leaders. Two QI team leaders made changes to their project based on survey responses that indicated the intervention made stakeholders’ jobs harder, and that there was no consensus about the purpose of the intervention.ConclusionsThe Stakeholder Quality Improvement Perspectives Survey was feasible for QI teams to use, and identified stakeholder perspectives about QI interventions that leaders used to alter their QI interventions to potentially increase the likelihood of stakeholder acceptance of the intervention.