What affects how Chinese patients wish to be involved in health care delivery? Perspectives of the Chinese policy and institutional contexts.

INTRODUCTION: The benefits of involving patients and carers include improving health outcomes and safety, reducing costs and enhancing an open, accountable and equitable relationship between service providers and users. However, the willingness for involvement and participation is largely affected by a range of factors, including those at the micro, meso and macro levels. As the previous studies have given much attention to the factors at the individual level, it is worthwhile to explore the factors at the broader levels of the policy and institutional contexts. The objective of the research is to understand how the policy and institutional contexts in China affect how patients wish to be involved in their health care delivery. METHODS: An abductive research strategy was used to generate emergent hypotheses in the first stage of data construction. In the second stage of fieldwork, hypotheses were tested using the deductive approach. Three local hospitals in Shandong Province, China, were selected. The case study method was designed with qualitative methods of policy documents and interviews. Interviews included health professionals, health board managers, local administrators and service users. Thematic analysis and framework analysis were conducted. RESULTS: Four policy and institutional contexts were identified: insufficient policy support, the current institutional design of involving users, the heterogeneity of organisational autonomy and resources, as well as the demography of the population of service users. CONCLUSIONS: As a policy strategy at the state level, there is a lack of policy support for patient involvement and participation in the Chinese health system. The heterogeneity of the institutional context of health facilities plays a key role in affecting how patients wish to be involved in health care delivery.

Young people's health and well-being during the school-to-work transition: a prospective cohort study comparing post-secondary pathways.

BACKGROUND: At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany. METHODS: We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, eliminating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity. RESULTS: Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transitions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations. CONCLUSION: Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers.

Environmental Policy Integration in the Energy Sector of China: The Roles of the Institutional Context.

The rapid growth of China's renewable energy market and production capacity has attracted worldwide attention. Environmental policy integration in the energy sector and the institutional background behind this growth have seen little examination. In this paper, we present an assessment of environmental policy integration (EPI), attempting to reveal how the institutional factors facilitate EPI in the energy sector of China. A qualitative analytical framework involving normative, organizational, and procedural dimensions, incorporating multiple pieces of quantitative evidence, was applied. The results show that an ambitious and long-term normative vision covering political will, social backing, and cultural foundation in China is indispensable to the EPI process in the energy sector. The energy agency's trans-sector cooperation in policy-making has been established to overcome the sectoral compartmentalization. China's EPI in energy has a relatively complete and stable regulating system but, at the same time, it is expected to obtain more benefits from market cultivation and public participation. In this process, advantages such as the co-evolution of the green energy innovation, market, and society do exist; however, this market-oriented approach may bring the risk of economic and societal disturbances when interest-driven production capacity growth far surpasses market and societal requirements. This potential risk needs to be handled and prevented by strong governmental guidance and support. The continuous ambitious and long-term visioning of EPI, sufficient governmental funds, and a proactive industrial plan for renewable energy, are suggested.

Comparing working conditions and job satisfaction in hospitality workers across Europe.

Job satisfaction is important in the tourism sector since workers' satisfaction is key to providing high-quality service, which is very important in determining organizational success. The working conditions that influence job satisfaction depend to a large extent on the institutional context, which shows similarities in some European countries. This research aims to compare working conditions and job satisfaction among European country blocks that have similar institutional characteristics. Unlike previous studies, this research adopts a comprehensive approach by considering institutional and organizational factors in the analysis of employees' perceptions of job satisfaction. The sample is made up of 1633 workers in 16 European countries. The results demonstrate the existence of three different models of working conditions in Europe leading to differing levels of job satisfaction in tourism. These models do not correspond to the clusters identified by the previous literature, which adopts an institutional perspective.

Do Social Values and Institutional Context Shape the Use of Economic Evaluation in Reimbursement Decisions? An Empirical Analysis.

OBJECTIVES: To investigate whether the use of economic evaluation (EE) in healthcare decision making is influenced by the social values and institutional context in a given country. METHODS: We developed and tested a conceptual framework for the 36 Organisation for Economic Co-operation and Development (OECD) countries. The countries were divided into two groups based on the extent of their use of EE in drug reimbursement. The key social values were efficiency, equity, and personal responsibility, measured in an international survey. Countries were classified based on their institutional context in terms of their general welfare paradigm/type of healthcare system and the administrative tradition to which they belong. We performed correlation tests and ran path analysis regression models to test our hypotheses. RESULTS: EE high users included significantly more Beveridge-type systems (50% vs 31%) and fewer Bismarck-type (15% vs 56%). Napoleonic tradition countries seemed to reject personal responsibility in health (r = -0.511, P = .009), whereas Germanic tradition countries embraced it (r = 0.572, P = .003); Anglo-American tradition countries exhibited a significant association with efficiency (r = 0.444, P = .026), whereas Scandinavian tradition countries appeared to reject it as a criterion for rationing in healthcare (r = -0.454, P = .023). No significant direct association was found between social values and use of EE. CONCLUSION: Our exploratory analysis suggests that institutional context and, indirectly, social values may play a role in shaping the use of EE in healthcare decision making. Because of the differences among countries in terms of institutional context, which may in part be influenced by social values, it is unlikely that there will ever be a single, harmonious approach to the use of EE.

Legislation for patient information leaflets in Iran: Focus on lay-friendliness.

Background: Patient information leaflet (PIL) which accompanies medicinal products and informs patients about dosage, side effects, etc., is known as a tool which empowers patients to be more involved in making decisions related to their medications and health. In recent years, policy makers have paid much attention to PIL and its lay-friendliness i.e. being clear,explicit, and easy to read and understand. In various countries, PIL is known as a legal genre and must be prepared in understandable language. The present study aimed to situate PIL within its institutional context and investigate the importance is given to the lay-friendliness of PIL in Iran. Methods: In this observational study, official website of Food and Drug Administration of the Islamic Republic of Iran (IFDA) was consulted. Iran's rules and regulations, legal requirements,linked to PIL production and translation were introduced and discussed in relation to lay-friendliness.. Results: Limited legislation relevant for the production and translation of lay-friendly PIL was found. The IFDA has not issued any documents or guidelines which exclusively concern lay- friendliness of PIL. Any methods which can assess lay-friendliness in original and translated PILs were not observed. Conclusion: The IFDA, the authoritative body in charge of legislation concerning PIL, has given limited importance to the language used in PIL and its lay-friendliness, witnessed by the limited legislation which is relevant for the production and translation of easy-to-understand PIL. It is not clear that how the IFDA assesses quality and lay-friendliness of original and translated PILs.

Contextualizing public stigma: Endorsed mental health treatment stigma on college and university campuses.

Scholars suggest that public mental health stigma operates at a meso-level and is associated with severity of symptoms, disclosure, self-esteem, and treatment-seeking behavior. However, the operationalization of public stigma nearly always comes from an individual-level generalization of what others believe. Using data from over 60,000 students on 75 U.S. college and university campuses between 2009 and 2015, we contextualize public stigma by creating a school-level measure of students' individual-level endorsed mental health treatment stigma. We present multilevel logistic regression models for 21 different dependent variables. We find that even after controlling for individual-level stigma scores, school-level stigma is negatively associated with self-reports of suicidal ideation and self-injury, although not associated with screens for depression or anxiety. Moreover, school-level stigma is negatively associated with medication use, counseling and therapy visits, and to a lesser degree, informal support. We suggest that future research should continue to examine the contextual environment of public stigma, while policymakers may be able to implement changes to significantly reduce stigma at this level.

Women's Experiences of Childbirth in Serbian Public Healthcare Institutions: a Qualitative Study.

PURPOSE: The aim of the present study was to explore how women, users of public maternity healthcare services in Serbia, experience birth and what the most problematic relational aspects of institutional context associated with negative or even traumatic aspects of birth experiences are, as described by the women themselves. METHOD: An exploratory qualitative study was undertaken using semi-structured interviews with 15 primiparous women aged 26 to 49 who have recently given birth in different public healthcare institutions in Belgrade. The basic framework for the analysis of interview transcripts was the interpretative phenomenological analysis (IPA). RESULTS: Through the analysis, four relatively broad and partly interrelated themes emerged: (a) feelings of isolation and abandonment, (b) lack of communication, (c) lack of a caring relationship, and (d) lack of control and agency. The aspects of institutional environment that were considered particularly distressing in most of the childbirth experiences are related to distant and cold relationship with healthcare providers which adds to the feelings of isolation and abandonment, in addition to the lack of insight into and control over the process of birth that is managed in the hospital context without relying on women's subjective involvement in any relevant way. CONCLUSION: The present study emphasized a supportive and caring relationship with medical practitioners, as well as allowing women to be more involved into their birthing process, as crucial for positive experience of birth, which might have profound and long-lasting psychosocial consequences. Recommendations for policy makers and future research are offered.

The Politics of Evidence Use in Health Policy Making in Germany-the Case of Regulating Hospital Minimum Volumes.

This article examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Federal Joint Committee as the regulator. Minimum volumes regulation was inspired by scientific evidence suggesting a positive relationship between service volume and patient outcomes for complex surgical interventions. Federal legislation was introduced in 2002 to delegate the selection of services and the setting of volumes to corporatist decision makers. Yet, despite being represented in the Federal Joint Committee, hospitals affected by its decisions took the Committee to court to seek legal redress and prevent policy implementation. Evidence has been key to support, and challenge, decisions about minimum volumes, including in court. The analysis of the role of scientific evidence in minimum volumes regulation in Germany highlights the dynamic relationship between evidence use and the political and institutional context of health policy making, which in this case is characterized by the legislative nature of policy making, corporatism, and the role of the judiciary in reviewing policy decisions.

General practitioners' decisions about discontinuation of medication: an explorative study.

Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience.

Synthetic Biology R&D Risks: Social-Institutional Contexts Matter!

Factors that shape actual research practices - 'social and institutional context' - typically are missing from considerations of synthetic biology R&D-related risk and containment. We argue that analyzing context is essential in identifying circumstances that create, amplify, or diminish risk, and in revealing new opportunities for avoiding or managing those risks.

Facilitating the implementation of evidence- based practice through contextual support and nursing leadership.

BACKGROUND/PURPOSE: Nurse managers (NMs) play an important role promoting evidence-based practice (EBP) on clinical units within hospitals. However, there is a dearth of research focused on NM perspectives about institutional contextual factors to support the goal of EBP on the clinical unit. The purpose of this article is to identify contextual factors described by NMs to drive change and facilitate EBP at the unit level, comparing and contrasting these perspectives across nursing units. METHODS: This study employed a qualitative descriptive design using interviews with nine NMs who were participating in a large effectiveness study. To stratify the sample, NMs were selected from nursing units designated as high or low performing based on implementation of EBP interventions, scores on the Meyer and Goes research use scale, and fall rates. Descriptive content analysis was used to identify themes that reflect the complex nature of infrastructure described by NMs and contextual influences that supported or hindered their promotion of EBP on the clinical unit. RESULTS: NMs perceived workplace culture, structure, and resources as facilitators or barriers to empowering nurses under their supervision to use EBP and drive change. A workplace culture that provides clear communication of EBP goals or regulatory changes, direct contact with CEOs, and clear expectations supported NMs in their promotion of EBP on their units. High-performing unit NMs described a structure that included nursing-specific committees, allowing nurses to drive change and EBP from within the unit. NMs from high-performing units were more likely to articulate internal resources, such as quality-monitoring departments, as critical to the implementation of EBP on their units. This study contributes to a deeper understanding of institutional contextual factors that can be used to support NMs in their efforts to drive EBP changes at the unit level.

Limpeza urbana: o contexto institucional e a atividade de varrição em belo horizonte / Urban cleaning: the institutional context and street sweeping activity in belo horizonte

O artigo descreve, numa abordagem institucionalista, o processo de gestão da autarquia responsável pela limpeza urbana em Belo Horizonte (de 1973 a 2012), focalizando a atividade de varrição. Realizaram-se a pesquisa documental e as entrevistas semi estruturadas com pessoas chaves e garis de varrição e aplicou-se a análise de conteúdo. Os resultados indicaram que as políticas públicas promoveram mudanças nos marcos institucionais com impactos relevantes para a organização. Os garis as percebem como predominantemente problemáticas. A reflexão sobre os resultados aponta a necessidade de promover a participação dos trabalhadores na gestão da autarquia e valorizar suas experiências para o desenvolvimento e qualidade do serviço de limpeza urbana, e contribuir para o bem-estar social.(AU)

The article describes, in an institutionalist approach, the management process of the municipal institution responsible for urban cleaning in Belo Horizonte (from 1973 to 2012), focusing on street sweeping activity. Documental research and semi-structured interviews with key people and street sweepers were conducted. Content analysis was used. The results indicated that municipal policies promoted changes in the institutional framework with significant impacts for the organization. The street sweepers perceive them as predominantly problematic. The article points out the need to promote workers' participation in the management of the municipal institution, and to benefit from their experience, toward improving operations and quality of the urban cleaning service, and to contribute to social welfare.(AU)

Limpeza urbana: o contexto institucional e a atividade de varrição em belo horizonte / Urban cleaning: the institutional context and street sweeping activity in belo horizonte

O artigo descreve, numa abordagem institucionalista, o processo de gestão da autarquia responsável pela limpeza urbana em Belo Horizonte (de 1973 a 2012), focalizando a atividade de varrição. Realizaram-se a pesquisa documental e as entrevistas semi estruturadas com pessoas chaves e garis de varrição e aplicou-se a análise de conteúdo. Os resultados indicaram que as políticas públicas promoveram mudanças nos marcos institucionais com impactos relevantes para a organização. Os garis as percebem como predominantemente problemáticas. A reflexão sobre os resultados aponta a necessidade de promover a participação dos trabalhadores na gestão da autarquia e valorizar suas experiências para o desenvolvimento e qualidade do serviço de limpeza urbana, e contribuir para o bem-estar social...

The article describes, in an institutionalist approach, the management process of the municipal institution responsible for urban cleaning in Belo Horizonte (from 1973 to 2012), focusing on street sweeping activity. Documental research and semi-structured interviews with key people and street sweepers were conducted. Content analysis was used. The results indicated that municipal policies promoted changes in the institutional framework with significant impacts for the organization. The street sweepers perceive them as predominantly problematic. The article points out the need to promote workers' participation in the management of the municipal institution, and to benefit from their experience, toward improving operations and quality of the urban cleaning service, and to contribute to social welfare...

A commentary on the pluralistic goals, logics of action, and institutional contexts of translational team science.

Teams have emerged as a pivotal form for organizing science efforts. Team goals and issues such as goal alignment are generally considered to be essential to team success. However, given the interdisciplinary and pluralistic goals associated with translational science, team goals become a challenging area for studies that cannot be reconciled without attention to the broader institutional contexts of translational teams. In this commentary, we draw attention to how different goals in team science can be rooted in the broader institutional context and associated logics of action. For the science of team science (SciTS) to impact practice, it is imperative that we be clear about the logic of team goals and their relation to preferred patterns of organizing. We conclude with a reflection on how contextual issues should be at the foreground of SciTS along with the other important issues of team science.

"We Do Science Here": Underrepresented Students' Interactions with Faculty in Different College Contexts.

Faculty members play a key role in the identification and training of the next generation of scientific talent. In the face of the need to advance and diversify the scientific workforce, we examine whether and how specific institutional contexts shape student interactions with faculty. We conducted a mixed methods study to understand institutional contextual differences in the experiences of aspiring scientists. Data from a qualitative five-campus case study and a quantitative longitudinal study of students from over 117 higher education institutions were analyzed to determine how aspiring scientists interact with faculty and gain access to resources that will help them achieve their educational goals. Findings indicate that important structural differences exist between institutions in shaping students' interactions with faculty. For example, students at more selective institutions typically have less frequent, less personal interactions with faculty whereas Black students at HBCUs report having more support and frequent interactions with faculty.