What Moves Physicians to Work in Rural Areas? An In-Depth Examination of Physician Practice Location Decisions

This study contributes to the current understanding of what drives physicians to practice in rural areas by analyzing new, comprehensive survey data of practicing physicians in the United States. This research confirmed that rural origin is a powerful and reliable predictor for rural practice and revealed that new and experienced physicians have different priorities regarding location choice. Physicians choosing rural practice locations are more likely to be motivated by compensation, the resemblance of the environment to the one they grew up in, patient needs, and prenegotiated service obligations or visa/immigration status. They are less likely to attribute their location choice to social network proximity. These findings have important implications for salary incentives and policy initiatives aimed at increasing the rural physician workforce. The results of this study will help decrypt the difficulties rural areas face in attracting and retaining medical and other professionals and inform policy development.

Involvement levels of breast cancer patients—Seeking trusted hospital and physician

The active involvement levels of breast cancer patients (BCP) in treatment decisions range from 10% to 81%. We investigated the involvement levels of 179 Israeli breast cancer survivors, aged 30 to 81, in the choice of hospital, surgeon, surgical procedure, chemotherapy, and radiotherapy. High involvement was documented in location decisions (operating hospital 77%, chemotherapy facility 82%) as opposed to low involvement in treatment decisions (chemotherapy 30%–38%, radiotherapy 25%, surgical procedure 31%). Involvement was influenced by hospital and surgeon reputation, education level, and income. BCPs actively choose their treating facility and staff, and then follow their doctor’s recommendations.

Preference Planning and Unsustainable Desires: A Hypothesis toward 'How' Contextual and Psychological Factors Influence Travel Attitudes through Qualitative and Quantitative Measures

<p>Counter to the prevailing view that sees travel attitudes as influencing neighbourhood location decisions, this dissertation sets out to examine if where individuals choose to live has an effect on travel attitudes. To achieve this, both a quantitative and qualitative analysis of the relationship between travel attitudes, place attachment and length of tenure is performed. An association between place attachment and travel attitudes would suggest that travel attitudes, and subsequent travel behaviours, are a result of neighbourhood location considerations rather than an influencing factor on them. This too is the case for an association between length of tenure and travel attitudes. While previous research identifies associations between contextual physical factors or psychological factors and travel behaviour, how these factors exert their influence is relatively undefined. With the proposition of an association between travel attitudes, place attachment and length of tenure, an underlying mechanism to these previous associates is tested. Because place attachment occurs over time and after a decision has been made to reside in a particular neighbourhood, and likewise because length of tenure is time dependent, a connection between either of these factors and travel attitudes supports the hypothesis that travel attitudes may just as likely be a result of residential location choices as they are an influence on them. For this reason, both of these variables are referred to as post-decision reasoning factors and are perceived as the mechanisms through which decisions are justified after they have been made. While travel behaviour literature is currently focused on the role latent travel attitudes have on residential location choices, housing choice literature consistently finds travel attitudes or neighbourhood factors a distant second to dwelling considerations. Dwelling size versus price, housing quality, yard and overall house size all have a greater influence on residential location decisions. Even when neighbourhood considerations are made in addition to dwelling characteristic factors, travel attitudes again rank lower than school quality, perceived safety and even the image of the neighbourhood. This dissertation is placed to add clarity to the discrepancy between travel behaviour and housing choice literature. An initial pilot study examined the relation between liveability and density and guided this dissertation toward travel behaviour, neighbourhood location decisions and the important role of attitudes to these two domains. Typically travel behaviour is compared between two neighbourhood typologies. These are either conventional or traditional. The former reflects status-quo land development with long winding cul-de-sacs, separated uses, a lack of centeredness and low connectivity. The latter is more akin to neighbourhoods developed before the Second World War and have higher densities, mixed uses, and are generally directed towards pedestrians rather than the automobile. Two traditional and two conventional neighbourhoods from Canada and New Zealand were used as case studies for the main research. Three-hundred households in each of the four case studies received a survey that inquired about residents' preferences toward travel modes and neighbourhood types and included psychological variables used for the prediction of travel behaviour as well as typical socio-demographic variables and the two post-decision reasoning factors of place attachment and length of tenure. This survey was analysed using multiple regression to determine the influence of post-decision reasoning variables. In addition to this quantitative survey, an on-line qualitative survey assessed residents' opinions for what motivates their travel and neighbourhood location decisions. The relative discourse patterns that developed from the qualitative survey provide a context against which the quantitative findings are interpreted. This provides validation to the quantitative findings as well as a theoretically robust method to infer causation. Findings indicated that attitudes were not correlated to post-decision reasoning variables but that they may still have formed after a neighbourhood selection decision was made and not prior. Here an unanticipated correlation between perceived behavioural control and travel attitudes was observed. Likewise, another unanticipated result suggests a greater mismatch between travel preferences and behaviours than previous studies have found. While the focus in environmental psychology is on segmenting survey populations into personality cohorts, with the aim of tailoring policy to these subgroups, the findings from the present study suggest a greater concentration should be paid to the context within which diverse populations develop. Here, both the qualitative and quantitative results indicate that rather than attitudes informing environmentally supportive behaviours, such as travel behaviour, an individual's social and physical context may afford them opportunities to hold environmentally supportive attitudes instead of the other way around. While the vast majority of research within this field appears satisfied with correlating varying attitudes to positive environmental behaviour rather than explaining why these differences exist, the present study explores a hypothesis toward this rationalization. Here, post-decision reasoning provides a reliable explanation of travel behaviour and this understanding further informs how to more effectively engage with groups and individuals toward increased sustainable behaviour.</p>

Preference Planning and Unsustainable Desires: A Hypothesis toward 'How' Contextual and Psychological Factors Influence Travel Attitudes through Qualitative and Quantitative Measures

<p>Counter to the prevailing view that sees travel attitudes as influencing neighbourhood location decisions, this dissertation sets out to examine if where individuals choose to live has an effect on travel attitudes. To achieve this, both a quantitative and qualitative analysis of the relationship between travel attitudes, place attachment and length of tenure is performed. An association between place attachment and travel attitudes would suggest that travel attitudes, and subsequent travel behaviours, are a result of neighbourhood location considerations rather than an influencing factor on them. This too is the case for an association between length of tenure and travel attitudes. While previous research identifies associations between contextual physical factors or psychological factors and travel behaviour, how these factors exert their influence is relatively undefined. With the proposition of an association between travel attitudes, place attachment and length of tenure, an underlying mechanism to these previous associates is tested. Because place attachment occurs over time and after a decision has been made to reside in a particular neighbourhood, and likewise because length of tenure is time dependent, a connection between either of these factors and travel attitudes supports the hypothesis that travel attitudes may just as likely be a result of residential location choices as they are an influence on them. For this reason, both of these variables are referred to as post-decision reasoning factors and are perceived as the mechanisms through which decisions are justified after they have been made. While travel behaviour literature is currently focused on the role latent travel attitudes have on residential location choices, housing choice literature consistently finds travel attitudes or neighbourhood factors a distant second to dwelling considerations. Dwelling size versus price, housing quality, yard and overall house size all have a greater influence on residential location decisions. Even when neighbourhood considerations are made in addition to dwelling characteristic factors, travel attitudes again rank lower than school quality, perceived safety and even the image of the neighbourhood. This dissertation is placed to add clarity to the discrepancy between travel behaviour and housing choice literature. An initial pilot study examined the relation between liveability and density and guided this dissertation toward travel behaviour, neighbourhood location decisions and the important role of attitudes to these two domains. Typically travel behaviour is compared between two neighbourhood typologies. These are either conventional or traditional. The former reflects status-quo land development with long winding cul-de-sacs, separated uses, a lack of centeredness and low connectivity. The latter is more akin to neighbourhoods developed before the Second World War and have higher densities, mixed uses, and are generally directed towards pedestrians rather than the automobile. Two traditional and two conventional neighbourhoods from Canada and New Zealand were used as case studies for the main research. Three-hundred households in each of the four case studies received a survey that inquired about residents' preferences toward travel modes and neighbourhood types and included psychological variables used for the prediction of travel behaviour as well as typical socio-demographic variables and the two post-decision reasoning factors of place attachment and length of tenure. This survey was analysed using multiple regression to determine the influence of post-decision reasoning variables. In addition to this quantitative survey, an on-line qualitative survey assessed residents' opinions for what motivates their travel and neighbourhood location decisions. The relative discourse patterns that developed from the qualitative survey provide a context against which the quantitative findings are interpreted. This provides validation to the quantitative findings as well as a theoretically robust method to infer causation. Findings indicated that attitudes were not correlated to post-decision reasoning variables but that they may still have formed after a neighbourhood selection decision was made and not prior. Here an unanticipated correlation between perceived behavioural control and travel attitudes was observed. Likewise, another unanticipated result suggests a greater mismatch between travel preferences and behaviours than previous studies have found. While the focus in environmental psychology is on segmenting survey populations into personality cohorts, with the aim of tailoring policy to these subgroups, the findings from the present study suggest a greater concentration should be paid to the context within which diverse populations develop. Here, both the qualitative and quantitative results indicate that rather than attitudes informing environmentally supportive behaviours, such as travel behaviour, an individual's social and physical context may afford them opportunities to hold environmentally supportive attitudes instead of the other way around. While the vast majority of research within this field appears satisfied with correlating varying attitudes to positive environmental behaviour rather than explaining why these differences exist, the present study explores a hypothesis toward this rationalization. Here, post-decision reasoning provides a reliable explanation of travel behaviour and this understanding further informs how to more effectively engage with groups and individuals toward increased sustainable behaviour.</p>

Multi-Criteria Analysis for Business Location Decisions

Choosing the physical place in which to locate a company or make investments is a strategic decision that managers must make when their business activities begin and as they expand. These decisions are key to firms’ survival. This study sought to shed light on this decision problem and assist managers in making these decisions. The first research objective was to examine the different dimensions that decision makers should consider regarding locations. The second objective was to test the efficacy of multi-criteria analysis methods regarding this decision problem. More specifically, this study applied a combination of the preference ranking organization method for enrichment of evaluations and the geometric analysis for interactive aid method, complemented by the analytical hierarchy process. The last objective was to rank major European cities on their suitability as business locations. The results include a preferential ranking of 66 European cities. London is the best positioned in all dimensions, followed by Paris and Barcelona. The findings’ originality comes from the inclusion of dimensions such as climate, security, and technology, which are given little weight in other similar indices, as well as the fresh approach to this decision problem from a business perspective and the combination of methodologies.

Perceptual Maps to Aggregate Information from Decision Makers

Understanding different perceptions of human being when using linguistic terms is a crucial issue in human-machine interaction. In this paper, we propose the concept of perceptual maps to model human opinions in a group decision-making context. The proposed approach considers a multi-granular structure using unbalanced hesitant linguistic term sets. An illustrative case is presented in the location decisions made by multinationals enterprises of the energy sector within the European smart city context.

51 Flavors: Regional Resource Configurations and Foreign Multinational Market Entry in the U.S. Biopharmaceutical Industry

Creating a sustainable regional economy requires not only attracting new local ventures, but also foreign multinationals. In this regard, understanding which resources are influential in market entry decisions is crucial given that there are different resource needs between developed (DMNE) and emerging market (EMNE) multinationals. Answering calls for more neo-configurational studies in the literature, our study uses a fuzzy-set qualitative comparative analysis (fsQCA) approach to examine foreign multinational entry decisions in 51 regions of the U.S. We constructed a novel dataset comprised of 3287 foreign firms from 61 countries and territories operating in the biopharmaceutical industry. We find that there are substantial differences in the configuration of resources that attract DMNEs and EMNEs to regions. The resource configurations in our models account for over 80% of the factors influencing DMNE and EMNE market entry location decisions. Some resources played a more important role in these decisions, such as FDI stocks, cluster size, and manufacturing intensity. Our findings show that EMNEs seek out regions with a greater abundance of different resources than DMNEs. This study provides practical implications for firms entering foreign markets as well as for policy makers who want to attract these firms to bolster their regional economic development.