Conceptual foundations of organizational structure: re-structuring of women's health services

PurposeResearchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services.Design/methodology/approachThe researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into “mainstream” health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis.Findings“Women's marginalization” was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization – that is, merely being at risk of unmet health needs.Originality/valueAs a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.

Loneliness as an active ingredient in preventing or alleviating youth anxiety and depression: a critical interpretative synthesis incorporating principles from rapid realist reviews

Loneliness is a relatively common problem in young people (14–24 years) and predicts the onset of depression and anxiety. Interventions to reduce loneliness thus have significant potential as active ingredients in strategies to prevent or alleviate anxiety and depression among young people. Previous reviews have focused on quantitative evidence and have not examined potential mechanisms that could be targets for intervention strategies. To build on this work, in this review we aimed to combine qualitative and quantitative evidence with stakeholder views to identify interventions that appear worth testing for their potential effectiveness in reducing loneliness, anxiety and depression in young people aged 14–24 years, and provide insights into the potential mechanisms of action. We conducted a Critical Interpretative Synthesis, a systematic review method that iteratively synthesises qualitative and quantitative evidence and is explicitly focused on building theory through a critical approach to the evidence that questions underlying assumptions. Literature searches were performed using nine databases, and eight additional databases were searched for theses and grey literature. Charity and policy websites were searched for content relevant to interventions for youth loneliness. We incorporated elements of Rapid Realistic Review approaches by consulting with young people and academic experts to feed into search strategies and the resulting conceptual framework, in which we aimed to set out which interventions appear potentially promising in terms of theoretical and empirical underpinnings and which fit with stakeholder views. We reviewed effectiveness data and quality ratings for the included randomised controlled trials only. Through synthesising 27 studies (total participants n = 105,649; range 1–102,072 in different studies) and grey literature, and iteratively consulting with stakeholders, a conceptual framework was developed. A range of ‘Intrapersonal’ (e.g. therapy that changes thinking and behaviour), ‘Interpersonal’ (e.g. improving social skills), and ‘Social’ Strategies (e.g. enhancing social support, and providing opportunities for social contact) seem worth testing further for their potential to help young people address loneliness, thereby preventing or alleviating depression and/or anxiety. Such strategies should be co-designed with young people and personalised to fit individual needs. Plausible mechanisms of action are facilitating sustained social support, providing opportunities for young people to socialise with peers who share similar experiences, and changing thinking and behaviour, for instance through building positive attitudes to themselves and others. The most convincing evidence of effectiveness was found in support of Intrapersonal Strategies: two randomised controlled studies quality-rated as ‘good’ found decreases in loneliness associated with different forms of therapy (Cognitive Behavioural Therapy or peer network counselling), although power calculations were not reported, and effect sizes were small or missing. Strategies to address loneliness and prevent or alleviate anxiety and depression need to be co-designed and personalised. Promising elements to incorporate into these strategies are social support, including from peers with similar experiences, and psychological therapy.

Geoparks – learnings from Australia

PurposeThis study aims to provide an overview of the current socio-political geopark situation in Australia and set this into a global context. In addition, the authors consider this information to be useful for all stakeholders involved in geopark research and development. An analysis of constraints is set alongside stakeholder views collected from remote rural Western Australia. The authors also place Australia in a global context in regard to the future of geoparks.Design/methodology/approachVital contextual information regarding the tourism significance of geoparks is sourced from key literature. The authors analyse and report on the situation surrounding the current lack of enthusiasm for the geopark concept by the federal government and states in Australia. The authors also report positive rural community stakeholder views on geopark development from regional Western Australia.FindingsWhile Australian federal, as well as state governments have yet to accept geoparks, stakeholder research in Western Australia supports the idea of geopark development. Learnings articulated in this viewpoint are relevant to any country pursuing and initiating the geopark concept. The authors posit that global geopark development can become a vital strategy in post-COVID-19 tourism recovery planning.Originality/valueAustralia currently does not have a United Nations Educational, Scientific and Cultural Organisation (UNESCO)-recognised geopark. Accordingly, the authors present a case for geopark development, while at the same time exploring the socio-political reasons behind the lack of geopark implementation in Australia. The authors consider the future of geoparks in the global context and reiterate the point that geoparks are important for COVID-19 recovery of tourism and in regard to UNESCO's Sustainable Development Goals for 2030.

Development of clinical guidelines for service provision of functional electrical stimulation to support walking: mixed method exploration of stakeholder views

Background Over the past 20 years Functional Electrical Stimulation (FES) has grown in clinical use to support walking in people with lower limb weakness or paralysis due to upper motor neuron lesions. Despite growing consensus regarding its benefits, provision across the UK and internationally is variable. This study aimed to explore stakeholder views relating to the value of a clinical guideline focusing on service provision of FES to support walking, how people might use it and what should be included. Methods A mixed methods exploration sought the views of key stakeholders. A pragmatic online survey (n = 223) focusing on the study aim was developed and distributed to the email distribution list of the UK Association for Chartered Physiotherapists Interested in Neurology (ACPIN). In parallel, a qualitative service evaluation and patient public involvement consultation was conducted. Two group, and seven individual interviews were conducted with: FES-users (n = 6), their family and carers (n = 3), physiotherapists (n = 4), service providers/developers (n = 2), researchers (n = 1) and distributors of FES (n = 1). Descriptive analysis of quantitative data and framework analysis of qualitative data were conducted. Results Support for clinical guideline development was clear in the qualitative interviews and the survey results. Survey respondents most strongly endorsed possible uses of the clinical guideline as ensuring best practice and supporting people seeking access to a FES service. Data analysis and synthesis provided clear areas for inclusion in the clinical guidelines, including current research evidence and consensus relating to who is most likely to benefit and optimal service provision as well as pathways to access this. Specific areas for further investigation were summarised for inclusion in the first stage of a Delphi consensus study. Conclusions Key stakeholders believe in the value of a clinical guideline that focuses on the different stages of service provision for FES to support walking. A Delphi consensus study is being planned based on the findings.

Creating Stakeholder Legitimacy in the Eyes of Stakeholders: The Case of Havana’s Paladares

In desperation for survival, the Cuban government legalized limited forms of self-employment in the fall of 1993, and the Paladar industry (in home restaurants) was born and their numbers proliferated. For the next 25 years, the state oscillated between legalizing entrepreneurship to outright forbidding it; yet, the paladares thrived. This work explores and documents how different stakeholder evaluations of legitimacy of an entrepreneurial endeavor change over time and how these endeavors shape stakeholder’s evaluations of legitimacy. Utilizing archival data, in addition to firsthand interviews with various stakeholders, this paper documents key stakeholder evaluations of legitimacy in an endeavor’s context, the differences in these evaluations, how they change over time, and how these endeavors responded to and shaped these conflicts. The endeavors in our context shaped stakeholder views of legitimacy in ways that enabled them to gain access to the resources they needed to survive and prosper. This work brings a nuanced understanding of how stakeholders evaluate the legitimacy of entrepreneurial endeavors in contexts that are changing and emerging and how these evaluations are co-created in an iterative process between stakeholders and the endeavor.