Pharmacist Roles in the Medication Use Process: Qualitative Analysis of Stakeholder Perceptions.

BACKGROUND: Pharmacist roles in the Medication Use Process (MUP) have advanced along with new healthcare delivery models and interprofessional collaborative practice. It is unclear whether stakeholder perceptions of pharmacist roles have evolved simultaneously. OBJECTIVES: Examine patient, pharmacist, and physician perceptions of pharmacist roles in the MUP. METHODS: This IRB-approved study used a cross-sectional design with Qualtrics panels of patients, pharmacists, and physicians. Role Theory was used as a framework to develop 12-item surveys to study pharmacist role perceptions in the MUP: prescribing, transcribing, dispensing, administration, and monitoring. Content analysis was performed on the responses to open-ended questions. RESULTS: From 1004 patients, a total of 7,217 comments were obtained on 9 questions (740-1004 comments), resulting in an average of 802 comments per question or 0.8 comments per question per respondent (CQR). Similarly, 1,620 comments from 205 pharmacists on 11 questions (121-205 comments) averaged 0.72 CQR; and 1,561 comments from 200 physicians on 11 questions (136-200 comments) equated to 0.74 CQR. Content analysis revealed recurring themes across the stakeholders: 'pharmacists', 'physicians', 'insurance', 'technology', 'collaboration', 'time', 'communication', and 'patient's responsibility'. Some role congruence was seen regarding pharmacist roles by all 3 stakeholders; noting pharmacist roles in improving all steps of the MUP, except transcribing. Pharmacists highlighted professional challenges such as staffing issues, burnout, and competing demands; which were not acknowledged by patients and physicians indicating the need to increase awareness. CONCLUSION: This study showed increased visibility and awareness of pharmacist roles in the MUP by all stakeholders, compared to previous research showing pharmacist roles limited to dispensing. Known barriers to pharmacy practice such as lack of provider status and reimbursement were not reported by any of the stakeholders in this study. There is a need to continuously inform stakeholders about pharmacists' expanding roles in the MUP through advocacy and marketing.

Stakeholder perceptions affecting the implementation of teleophthalmology.

PURPOSE: Teleophthalmology has become the subject of heightened interest and scrutiny in the wake of the SARS-CoV-2 global pandemic. A streamlined implementation framework becomes increasingly important as demand grows. This study identified obstacles to teleophthalmology implementation through summative content analysis of key stakeholders' perceptions. DESIGN: Summative content analysis of transcribed interviews with key stakeholders (including patients, technicians, ophthalmic readers, staff, nurses, and administrators at two teleophthalmology clinic sites). METHODS: Keyword Were counted and compared to examine underlying meaning. Two analysts coded text independently using MAXQDA for summative qualitative content analysis to derive themes and hierarchical relationships as a basis for future refinement of TECS implementation. xMind ZEN was used to map conceptual relationships and overarching themes that emerged to identify perceived facilitators and barriers to implementation RESULTS: Analysis revealed two themes common to perceptions: (1) benefits of care, and (2) ease of implementation. Perceived benefits included efficiency, accessibility, and earlier intervention in disease course. The quality and quantity of training was heavily weighted in its influence on stakeholders' commitment to and confidence in the program, as were transparent organizational structure, clear bidirectional communication, and the availability of support staff. CONCLUSION: Using a determinant framework of implementation science, this report highlighted potential hindrances to teleophthalmology implementation and offered solutions in order to increase access to screening, improve the quality of care provided, and facilitate sustainability of the innovation.

The aquaculture supply chain in the time of covid-19 pandemic: Vulnerability, resilience, solutions and priorities at the global scale.

The COVID-19 global pandemic has had severe, unpredictable and synchronous impacts on all levels of perishable food supply chains (PFSC), across multiple sectors and spatial scales. Aquaculture plays a vital and rapidly expanding role in food security, in some cases overtaking wild caught fisheries in the production of high-quality animal protein in this PFSC. We performed a rapid global assessment to evaluate the effects of the COVID-19 pandemic and related emerging control measures on the aquaculture supply chain. Socio-economic effects of the pandemic were analysed by surveying the perceptions of stakeholders, who were asked to describe potential supply-side disruption, vulnerabilities and resilience patterns along the production pipeline with four main supply chain components: a) hatchery, b) production/processing, c) distribution/logistics and d) market. We also assessed different farming strategies, comparing land- vs. sea-based systems; extensive vs. intensive methods; and with and without integrated multi-trophic aquaculture, IMTA. In addition to evaluating levels and sources of economic distress, interviewees were asked to identify mitigation solutions adopted at local / internal (i.e., farm-site) scales, and to express their preference on national / external scale mitigation measures among a set of a priori options. Survey responses identified the potential causes of disruption, ripple effects, sources of food insecurity, and socio-economic conflicts. They also pointed to various levels of mitigation strategies. The collated evidence represents a first baseline useful to address future disaster-driven responses, to reinforce the resilience of the sector and to facilitate the design reconstruction plans and mitigation measures, such as financial aid strategies.

Coastal Stakeholders' Perceptions of Sea Level Rise Adaptation Planning in the Northern Gulf of Mexico.

Planning for sea level rise (SLR) is a complex process that involves scientific uncertainty and local and regional political tradeoffs. As part of a 6-year transdisciplinary research project in the northern Gulf of Mexico, we conducted focus groups with coastal stakeholders (natural resource managers, community planners, and environmental communicators) to gain a better understanding of their planning and adaptation activities for SLR. This paper reports on participants' perceptions about adaptation and their current adaptation activities and strategies. While stakeholders were concerned about SLR and thought adaptation had challenges, they still shared optimism and a commitment to planning. The findings identify different types of SLR adaptation initiatives in which participants were involved as well as types of perceived barriers to adaptation planning, and major recommended strategies to address them. The paper concludes with a discussion of findings, connections to related SLR adaptation literature, practical implications for coastal resiliency, and directions for future research.

Achieving water security in rural Indian Himalayas: A participatory account of challenges and potential solutions.

The complex and diverse factors that influence water security in the Indian Himalayan Region were examined using problem and solution tree (PAST) mapping together with a field study. Five PASTs, each constructed by a different group of stakeholders, namely the state government, the local government, researchers, development agencies, and the local community, were analysed to obtain a holistic and multi-sectoral understanding of water security in the region, and the analysis was supplemented with field data. The systematic study helped in (1) identifying many factors - climatic, geographical, cultural, and socio-economic - that influence water security, (2) assessing their impacts on mountain livelihoods, and (3) documenting thirty-two potential interventions in the form of adaptations (e.g. springshed management programme) and coping strategies (e.g. buying water from informal water markets) to strengthen water security. These strategies followed three main themes namely conserving water resources, improving rural livelihood and sustainable infrastructure development and risk management. The study also helped in building a shared sense of understanding, purpose, and action between the diverse groups of stakeholders. The study suggests that ensuring water security in rural mountain areas requires holistic and multi-sectoral policies, which should be developed by including all actors in the network of stakeholders; that local conditions be given utmost importance in the policy planning cycle (e.g. focus on springs in mountains); and that cultural landscape and local identities be closely examined to reduce the inequalities in access to resources.

A conceptualisation framework for building consensus on environmental sensitivity.

Examination of the intrinsic attributes of a system that render it more or less sensitive to potential stressors provides further insight into the baseline environment. In impact assessment, sensitivity of environmental receptors can be conceptualised on the basis of their: a) quality status according to statutory indicators and associated thresholds or targets; b) statutory protection; or c) inherent risk. Where none of these considerations are pertinent, subjective value judgments can be applied to determine sensitivity. This pragmatic conceptual framework formed the basis of a stakeholder consultation process for harmonising degrees of sensitivity of a number of environmental criteria. Harmonisation was sought to facilitate their comparative and combined analysis. Overall, full or wide agreement was reached on relative sensitivity values for the large majority of the reviewed criteria. Consensus was easier to reach on some themes (e.g. biodiversity, water and cultural heritage) than others (e.g. population and soils). As anticipated, existing statutory measures shaped the outcomes but, ultimately, knowledge-based values prevailed. The agreed relative sensitivities warrant extensive consultation but the conceptual framework provides a basis for increasing stakeholder consensus and objectivity of baseline assessments. This, in turn, can contribute to improving the evidence-base for characterising the significance of potential impacts.

School staff, parent and student perceptions of a Breakfast in the Classroom model during initial implementation.

OBJECTIVE: To understand perspectives of stakeholders during initial district-wide implementation of a Breakfast in the Classroom (BIC) model of the School Breakfast Program. DESIGN: Qualitative data were collected from twenty-nine focus groups and twenty interviews with stakeholders in a school district early in the process of implementing a BIC model of the School Breakfast Program. SETTING: Ten elementary schools within a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students. SUBJECTS: Purposively selected stakeholders in elementary schools that had implemented BIC for 3-6 months: students (n 85), parents/guardians (n 86), classroom teachers (n 44), cafeteria managers (n 10) and principals (n 10). RESULTS: Four primary themes emerged, which were interpreted based on the Diffusion of Innovations model. School staff had changed their perceptions of both the relative disadvantages and costs related to time and effort of BIC over time; the majority of each stakeholder group expressed an appreciation for BIC; student breakfast consumption varied from day to day, related to compatibility of foods with child preferences; and stakeholders held mixed and various impressions of BIC's potential impacts. CONCLUSIONS: The study underscores the importance of engaging school staff and parents in discussions of BIC programming prior to its initiation to pre-emptively address concerns related to cost, relative disadvantages and compatibility with child preferences and school routines/workflow. Effectively communicating with stakeholders about positive impacts and nutritional value of the meals may improve support for BIC. These findings provide new information to policy makers, districts and practitioners that can be used to improve implementation efforts, model delivery and outcomes.

Stakeholder reactions toward iodine biofortified foods. An application of protection motivation theory.

OBJECTIVE/PURPOSE: To use Protection Motivation Theory (PMT) to evaluate stakeholders' intention to adopt iodine biofortified foods as an alternative means to improve children's iodine status and overall school performance. METHODS: A survey was administered with 360 parents of primary school children and 40 school heads. Protection motivation is measured through matching the cognitive processes they use to evaluate iodine deficiency (threat appraisal), as well as iodine biofortified foods to reduce the threat (coping appraisal). Data were analyzed through Robust (Cluster) regression analysis. RESULTS: Gender had a significant effect on coping appraisal for school heads, while age, education, occupation, income, household size and knowledge were significant predictors of threat, coping appraisal and/or protection motivation intention among parents. Nevertheless, in the overall protection motivation model, only two coping factors, namely self-efficacy (parents) and response cost (school heads), influenced the intention to adopt iodine biofortified foods. CONCLUSION: School feeding programs incorporating iodine biofortification should strive to increase not only consumer knowledge about iodine but also its association to apparent deficiency disorders, boost self-efficacy and ensure that the costs incurred are not perceived as barriers of adoption. The insignificant threat appraisal effects lend support for targeting future communication on biofortification upon the strategies itself, rather than on the targeted micronutrient deficiency. PMT, and coping factors in particular, seem to be valuable in assessing intentions to adopt healthy foods. Nevertheless, research is needed to improve the impacts of threat appraisal factors.

Remote Monitoring for Type 2 Diabetes: What Do Patients, Healthcare Professionals, and Executives Think?

The implementation of mobile health interventions is key to the future management of diabetes. A new model of digital care for type 2 diabetes using a Bluetooth-enabled blood glucose monitoring system has been implemented at the Princess Alexandra Hospital. The perceptions of patients, healthcare professionals, and executives involved in the implementation of this model have been assessed to establish the key facilitators and barriers to digital health intervention adoption.

Identifying impacts & adaptation strategies for tropical fruit farms affected by extreme weather events in sub-tropical Australia: Stakeholders' insights.

Extreme weather events (EWEs) have significant effects on the productivity, profitability and sustainability of agricultural enterprises and supply chains. Australia is acknowledged as a highly susceptible developed country in relation to experiencing impacts from global climate change. Particularly, the Central Queensland (CQ) region has experienced several recent severe weather events which has made stakeholders worried about the financial resilience and sustainability of their businesses along with the farmers. Although various Australian research has explored the biophysical effects of extreme weather on pome and citrus fruits, very little is known about the business impacts of EWEs on tropical fruits, and how the perceptions of stakeholders can play significant roles in constructing and implementing policies relevant to the tropical fruit farming sector. To fill this gap, this study explored stakeholder insights relating to the impacts of EWEs and relevant adaptation strategies used in tropical fruit farming businesses in sub-tropical Australia. A qualitative research approach was undertaken, involving in-depth interviews with key stakeholders from the tropical fruit farming supply chain, with data being analysed by thematic content analysis. Stakeholders indicated that in the previous five years, EWEs had impacted tropical fruit farming businesses and their related support industries and organisations in multiple ways. This study revealed that farmers' lack of knowledge about available adaptation options, amongst other things, are obstacles preventing the industry from becoming more resilient. Several steps were identified to improve the speed and effectiveness of adaptation at the farm level, including further strategic planning and collaboration amongst state government, local government, farmers and associated industry parties; as well as the importance of farmers being self-prepared for future EWEs. To achieve the latter, stakeholders noted that farmers required industry-level support, including training, tools, and technologies. These findings will be of interest for fruit farming industry stakeholders, policy makers and relevant researchers, particularly for the many tropical coastal communities across the world, now finding themselves being impacted by EWEs.

Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines.

BACKGROUND:  Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT's fit or what adaptations might be needed to improve its applicability within a resource-constrained setting. OBJECTIVES:  To explore stakeholders' perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT's contextual fit. METHOD:  We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components. RESULTS:  Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families' available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa. CONCLUSION:  Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.

Public acceptance and stakeholder views of gene edited foods: a global overview.

The increasing popularity of gene editing in plants has prompted research on stakeholder views. Gene edited foods are often more accepted than genetically modified foods, though differences occur within target groups, regions, and products. Nevertheless, marketing challenges related to a lack of familiarity with the technology, labeling, and risk perception remain.

Guiding restoration of riparian ecosystems degraded by plant invasions: Insights from a complex social-ecological system in the Global South.

Restoring riparian ecosystems in human-dominated landscapes requires attention to complexity, and consideration of diverse drivers, social actors, and contexts. Addressing a Global North bias, this case study uses a mixed-method approach, integrating historical data, remote sensing techniques and stakeholder perceptions to guide restoration of a river in the Western Cape, South Africa. An analysis of aerial photographs of the riparian zone from 1953 to 2016 revealed that although anthropogenic land conversion happened primarily before the 1950s, several land use and land cover classes showed marked increases in area, including: waterbodies (+ 1074%), urban areas (+ 316%), alien weeds (+ 311%) and terrestrial alien trees (+ 79%). These changes have likely been driven by land fragmentation, disturbance, and agricultural intensification. Stakeholder interviews revealed that despite the clear need for restoration, several barriers exist to successful implementation; these stem from inadequate financial resources, inappropriate funding models, institutional challenges, and a lack of techno-scientific knowledge. We give several recommendations to overcome these barriers.

Swedish Efforts to Contain Antibiotic Resistance in the Environment-A Qualitative Study among Selected Stakeholders.

Antibiotic resistance is a serious global threat to human and animal health. In this study, we explored perceptions of work to contain antibiotic resistance with a focus on the environment. Nine stakeholders from six different areas were interviewed in 2018. A short information update was given by informants from four of the areas in 2021. Interview transcripts were analyzed by conventional content analysis. The stakeholders' perceptions were concluded in three categories: "examples of actions taken to combat antibiotic resistance", "factors influencing work", and "factors hindering work". All informants reported having a role to play. Some of them were very engaged in this issue, whereas among others, antibiotics and resistance were just one part of a general engagement. To be able to act, the policymaker stakeholders asked for more knowledge about antibiotics in the environment and possible actions to take. Actions from the government were requested by several informants. Coordination of the work to combat antibiotic resistance in the environment was not recognized and the One Health approach was known at policy level but not among practitioners. Still, actions seemed to be coordinated, but this was, according to the stakeholders, based on findings from research in their area rather than on strategies developed by national authorities.

Twitter usage during global pandemic and corporate reputation in Nigeria.

This study is a meta-analysis of empirical studies in social media strategies and reputation research. The research goal is to give a clearer idea of the broad directions and paradigm shifts in Twitter usage discourse over the years. Its major goal is to examine thematic trends, theoretical framework and methodology that have characterized the discourse. Sixty relevant articles were identified, coded and content-analyzed. Findings revealed that dominant themes include stakeholder perceptions of communication strategies, social network sites, dynamics of global pandemic (i.e Covid-19 pandemic) and corporate reputation. Also, experiment, case study and survey are the dominant research methods that characterize research in this discourse. Findings also revealed large domination of the Situational Crisis Communication Theory (SCCT) and the Image Repair Theory. However, research in this area lacks significant empirical evidence from Africa and Nigeria in particular, where the global pandemic seems to be a recurring phenomenon. The majority of the reviewed journal articles were conducted in the Western clime, with little attention on Africa. Scholarship needs to move beyond this point to provide a holistic and balanced view on the crisis by exploring cases in Africa and particularly, in Nigeria. This gap will provide an opportunity for understanding the global pandemic (i.e. Covid-19) dynamics in Africa and will further determine whether findings can be consistent across the world.

Humanizing the ICU Patient: A Qualitative Exploration of Behaviors Experienced by Patients, Caregivers, and ICU Staff.

OBJECTIVES: To understand how patients and family members experience dehumanizing or humanizing treatment when in the ICU. DESIGN: Qualitative study included web-based focus groups and open-ended surveys posted to ICU patient/family social media boards. Focus groups were audio recorded and transcribed. Social media responses were collected and organized by stakeholder group. Data underwent qualitative analysis. SETTING: Remote focus groups and online surveys. PATIENTS: ICU patient survivors, family members, and ICU teams. INTERVENTIONS: Not available. MEASUREMENTS AND MAIN RESULTS: Semi-structured questions and open-ended survey responses. We enrolled 40 patients/family members and 31 ICU team members. Focus groups and surveys revealed three primary themes orienting humanizing/dehumanizing ICU experiences: 1) communication, 2) outcomes, and 3) causes of dehumanization. Dehumanization occurred during "communication" exchanges when ICU team members talked "over" patients, made distressing remarks when patients were present, or failed to inform patients about ICU-related care. "Outcomes" of dehumanization were associated with patient loss of trust in the medical team, loss of motivation to participate in ICU recovery, feeling of distress, guilt, depression, and anxiety. Humanizing behaviors were associated with improved recovery, well-being, and trust. "Perceived causes" of dehumanizing behaviors were linked to patient, ICU team, and healthcare system factors. CONCLUSIONS: Behaviors of ICU clinicians may cause patients and families to feel dehumanized when in the ICU. Negative behaviors are noticed by patients and families, possibly contributing to poor outcomes including mental health, recovery, and lack of trust in ICU teams. Supporting ICU clinicians may enable a more empathic environment and in turn more humanizing clinician-patient encounters.

Harmful Algal Blooms in Aquaculture Systems in Ngerengere Catchment, Morogoro, Tanzania: Stakeholder's Experiences and Perception.

The aquaculture sector has experienced fast growth as a result of livelihood diversification initiatives among small-scale farmers in Tanzania. Regrettably, the dynamics of harmful algal blooms (HABs) have been overlooked despite the noticeable forcing of climate variability, the interaction between social-economic activities, and domestic water supply reservoirs. This study aimed at surveying the occurrence, experiences, and perceptions of HABs in aquaculture systems from stakeholders in the Ngerengere catchment, Morogoro, Tanzania. A cross-sectional survey focus group discussion (FDG), key informant interviews, and anecdotal observation were adopted. A convenient and purposive sample population was drawn from pond owners, registered water users, and government officials in the catchment. For data analysis, descriptive statistics and constant comparison were performed. Most respondents (95%) were able to recognize the image of blooms displayed. Approximately 70% of the respondents agreed that water quality has deteriorated over time, and blooms occur during the dry season. Further, 60% of the respondents agreed that water pollution is a serious problem attributed to sources other than industrial discharge. There was no consensus regarding the health impacts associated with HABs. Raising awareness on HABs is of paramount importance as it will provide the basis for the development of HABs management framework and health risk assessment.

Ecosystem services and justice of protected areas: the case of Circeo National Park, Italy.

Protected areas are key instruments for conserving biodiversity and landscapes. Yet, conservation initiatives are still often struggling to accommodate people's needs, provoking conflicts, and lacking support from local communities. Our study combines environmental justice and ecosystem services approaches to provide a critical understanding of trade-offs between people's interests and conservation goals in the case study of Circeo National Park (Italy). Applying a qualitative content analysis of different materials and using a survey of local residents, we focus on three main objectives: analysing the implementation of the ecosystem services framework in policy documents and exploring how different people value benefits from nature; investigating the decision-making process in terms of participation, information and communication strategies; and identifying how conservation policies generated different allocations of benefits, burdens and inequalities among social groups. The integrated approach applied in our study highlights ways to systematically uncover perceived injustices and identifies potential conflict lines. In the long run, this approach might help to increase the public acceptance of protected areas by fostering sustainability also in its often-overlooked social dimension.

Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review.

Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.

Social dimensions of a forest-based bioeconomy: A summary and synthesis.

How perceptions of the forest-based bioeconomy differ across country contexts and social groups is important as it opens possibilities for the development of more inclusive, locally and socially relevant bioeconomy policies and strategies. Therefore, this special section explores the social dimensions of the forest-based bioeconomy by focusing on discourses and perceptions of different actor groups in Europe. We introduce six articles that range from review and discursive approaches to consumer studies. The section adds to the existing literature by focusing not only on political decision makers, stakeholders, and experts but also on the public, media and students. Patterns in the presented discourses and perceptions can be identified but more is needed to validate these and respond to the question of representativeness.