Creating culturally-informed protocols for a stunting intervention using a situated values-based approach (WeValue InSitu): a double case study in Indonesia and Senegal.

International development work involves external partners bringing expertise, resources, and management for local interventions in LMICs, but there is often a gap in understandings of relevant local shared values. There is a widespread need to better design interventions which accommodate relevant elements of local culture, as emphasised by recent discussions in global health research regarding neo-colonialism. One recent innovation is the concept of producing 'cultural protocols' to precede and guide community engagement or intervention design, but without suggestions for generating them. This study explores and demonstrates the potential of an approach taken from another field, named WeValue InSitu, to generate local culturally-informed protocols. WeValue InSitu engages stakeholder groups in meaning-making processes which 'crystallize' their envelope of local shared values, making them communicable to outsiders.Our research context is understanding and reducing child stunting, including developing interventions, carried out at the Senegal and Indonesia sites of the UKRI GCRF Action Against Stunting Hub. Each national research team involves eight health disciplines from micro-nutrition to epigenetics, and extensive collection of samples and questionnaires. Local culturally-informed protocols would be generally valuable to pre-inform engagement and intervention designs. Here we explore generating them by immediately following the group WeValue InSitu crystallization process with specialised focus group discussions exploring: what local life practices potentially have significant influence on the environments affecting child stunting, and which cultural elements do they highlight as relevant. The discussions will be framed by the shared values, and reveal linkages to them. In this study, stakeholder groups like fathers, mothers, teachers, market traders, administrators, farmers and health workers were recruited, totalling 83 participants across 20 groups. Themes found relevant for a culturally-informed protocol for locally-acceptable food interventions included: specific gender roles; social hierarchies; health service access challenges; traditional beliefs around malnutrition; and attitudes to accepting outside help. The concept of a grounded culturally-informed protocol, and the use of WeValue InSitu to generate it, has thus been demonstrated here. Future work to scope out the advantages and limitations compared to deductive culture studies, and to using other formative research methods would now be useful.

Local contextual factors of child stunting found via shared values of stakeholder groups: an exploratory case study in Kaffrine, Senegal.

OBJECTIVE: This work aims to demonstrate an original approach to identify links between locally situated shared values and contextual factors of stunting. Stunting results from multi-factorial and multi-sectoral determinants, but interventions typically neglect locally situated lived experiences, which contributes to problematic designs that are not meaningful for those concerned and/or relatively ineffective. DESIGN: This case study investigates relevant contextual factors in two steps: by first facilitating local stakeholder groups (n 11) to crystallise their shared-values-in-action using a specialised method from sustainability studies (WeValue_InSitu (WVIS)). Secondly, participants (n 44) have focus group discussions (FGD) about everyday practices around child feeding/food systems, education and/or family life. Because the first step strongly grounds participants in local shared values, the FGD can reveal deep links between contextual factors and potential influences on stunting. SETTING: Kaffrine, Senegal, an 'Action Against Stunting Hub' site. December 2020. PARTICIPANTS: Eleven stakeholder groups of mothers, fathers, grandmothers, pre-school teachers, community health workers, farmers, market traders and public administrators. RESULTS: Local contextual factors of stunting were identified, including traditional beliefs concerning eating and growing practices; fathers as decision-makers; health worker trust; financial non-autonomy for women; insufficient water for preferred crops; merchants' non-access to quality produce; religious teachings and social structures affecting children's food environment. CONCLUSIONS: Local contextual factors were identified. Pre-knowledge of these could significantly improve effectiveness of intervention designs locally, with possible applicability at other sites. The WVIS approach proved efficient and useful for making tangible contextual factors and their potential links to stunting, via a lens of local shared values, showing general promise for intervention research.

Economic valuation of wildlife conservation.

This paper reviews concepts and methods for the economic valuation of nature in the context of wildlife conservation and questions them in light of alternative approaches based on deliberation. Economic valuations have been used to set priorities, consider opportunity costs, assess co-benefits of conservation, support the case for conservation in public awareness and advocacy, and drive novel schemes to change incentives. We discuss the foundational principles of mainstream economic valuation in terms of its assumptions about values, markets, and human behaviour; propose a list of valuation studies in relation to wildlife protection; and explain the methods used. We then review critiques of these approaches focusing on the narrow way in which economics conceives of values, and institutional, power, and equity concerns. Finally, we complement conventional approaches commonly used for wildlife valuation with two forms of deliberative valuation: deliberated preferences and deliberative democratic monetary valuation. These are discussed in terms of their potential to address the drawbacks of mainstream economics and to realise the potential of valuation in bridging conservation of nature for its own sake and its important contributions to human well-being. Supplementary Information: The online version contains supplementary material available at 10.1007/s10344-023-01658-2.

"Traditionally you would be passing them from pillar to post": an evaluation exploring the Life Rooms model of partnership working.

BACKGROUND: NHS systems are under increasing, unsustainable pressure. In the context of rising demand, limited resources and changing population needs, partnership working across sectors is crucial. The Liverpool City Region has a richness of voluntary organisations and community based assets that the Life Rooms innovation draws upon to widen the base of health and wellbeing support. The Life Rooms therefore aims to facilitate the collaboration of NHS systems with arts, voluntary and community organisations in the local health economy. This evaluation explores the Life Rooms model of partnership working spread over in excess of one hundred partnerships with voluntary, community, and corporate sector organisations. METHODS: The evaluation drew on thematic analysis of semi-structured interviews with Life Rooms staff members (n = 10), partner organisations (n = 16), and users of the Life Rooms (n = 7). RESULTS: Five overarching themes were identified: Quality of partnerships; Benefits of partnership working; Facilitators; Challenges within the Life Rooms model; and Making things even better. CONCLUSIONS: One of the significant successes of the Life Rooms partnership working model is the way in which the service collaborates with a wide range of organisations with the aim of providing more effective and holistic support. The success of this approach illustrates how, led by NHS Trust innovation, multiple bodies can play a role in supporting health care by bringing unique skills, expertise and programmes together to ensure multiple options to support the multiple different aspects of people's health. These insights may be useful to other NHS organisations that may be considering a similar integration agenda.

How do shared values improve eudaimonic workplace well-being: role of perceived justice and emotional exhaustion among nurses.

PURPOSE: This study aims to explore how shared values improve eudaimonic workplace well-being, the fulfillment that comes from personal development and the utilization of personal capabilities. The authors investigate the serial mediating role that perceived overall justice and emotional exhaustion play in how shared values relate to well-being. DESIGN/METHODOLOGY/APPROACH: Using data collected from three hundred nurses in Turkish healthcare institutions during the COVID-19 pandemic (Male = 113, Female = 187). The age of participants ranged from 19 to 58 and the average age was 34. The snowball sampling method was used to form the sample and self-administered surveys that could be completed online were delivered to the sampled nurses. FINDINGS: The authors analysis using partial least square structural equation modeling (PLS-SEM) supported the expected relationship between shared values and eudaimonic workplace well-being as well as the mediating role of perceived overall justice and emotional exhaustion. The authors also show a serial mediation where shared values are related to justice perceptions which in turn negatively relate to emotional exhaustion which subsequently relates to higher levels of eudaimonic workplace well-being. ORIGINALITY/VALUE: The results of this study suggest that when the shared values between the healthcare institution and the employees are aligned, the eudaimonic well-being of employees is higher. The findings provide implications for the mental health of frontline employees in health organizations to have higher levels of eudaimonic well-being which is especially important in times of intense pressure such as the period during the COVID-19 pandemic.

"How did you stay together so long?" Relationship longevity, a cross-generational qualitative study.

This global qualitative study adopted a cross-generational approach considering key factors contributing to relationship longevity. Relatively few studies consider factors leading to relationship longevity as articulated by couples themselves, and there is a paucity of research considering young couples' questions regarding relationship longevity. This study has two sample groups. In sample one (n = 137) we asked individuals in relationship of 3-15 years questions they would ask couples in marriages of 40+ years. We then asked our second sample of coupled individuals married 40+ years (n = 180) these questions. The primary question from the younger couples to couples in long-term marriages regarded their "secret" to relationship longevity. This study focuses on this one question and coupled individuals' self-articulation of their "secrets" to relationship longevity. The top seven were (1) commitment, (2) altruism, (3) shared values, (4) good communication, (5) compromise: give and take, (6) love, and (7) never give up. The clinical implications for couple therapists are discussed.

A National Mixed-Methods Evaluation of General Surgery Residency Program Responsiveness and the Association with Resident Wellness.

INTRODUCTION: Resident burnout is highly prevalent in general surgery. Burnout is increasingly recognized as a symptom of an unsupportive workplace. The objectives of this study were to describe resident perceptions of program responsiveness and to identify associated factors. METHODS: We used a convergent mixed-methods design. A cross-sectional survey was administered to all U.S. general surgery residents following the 2020 ABSITE, querying resident perceptions of their learning environment (including program responsiveness), burnout, thoughts of attrition and suicide, and career satisfaction. Multivariable logistic regression models adjusting for program/resident characteristics assessed associations of program responsiveness with aspects of the learning environment and resident wellness. 366 interviews and 27 focus groups with residents and faculty were conducted during in-person visits to 15 residency programs. Transcripts were analyzed thematically using inductive and deductive logics until thematic saturation was achieved. RESULTS: Of the 7233 clinically active residents from 323 programs who completed the survey (85.5% response rate), 5256 had data available for all outcomes of interest. 72.1% (n = 3791) reported satisfaction with program responsiveness. These residents were significantly less likely to report 80-hour workweek violations (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.18-0.26), burnout (OR 0.47, 95% CI 0.41-0.53), thoughts of attrition (OR 0.32, 95% CI 0.27-0.38), and suicidality (OR 0.52, 95% CI 0.41-0.65). They were significantly more likely to report satisfaction with career choice, personal life, and work-life balance (all p < 0.001). Factors associated with improved perception of program responsiveness included larger program size (50+ vs. <23 residents; OR 1.48, 95% CI 1.01-2.19), having faculty mentorship (OR 2.64, 95% CI 2.22-3.14), having meaningful input into call and vacation schedules (OR 3.31, 95% CI 2.74-4.00), and feeling comfortable speaking up (OR 4.20, 95% CI 3.47-5.09). We conducted a qualitative analysis to identify the following components of program responsiveness: (1) core values reflecting a shared understanding of the importance of resident voice in shaping the training experience and the program, including mutual trust and respect between residents and faculty, transparency and communication, resident unity, and resident participation in and ownership of program improvement; (2) structural constructs that reflect and support responsiveness; (3) mechanisms for supporting resident agency, including resources and leadership support, faculty advocacy, and resident leadership opportunities. CONCLUSION: Program responsiveness in surgical residency is associated with improved resident wellness. Programs should develop formal channels to elicit and concretely address resident concerns, provide opportunities for resident representation, and entrust residents with the flexibility and autonomy to make decisions that support their own education and wellness.

Building the evidence on Making Health a Shared Value: Insights and considerations for research.

The Robert Wood Johnson Foundation (RWJF)'s Culture of Health Action Framework guides a movement to improve health and advance health equity across the nation. Action Area One of the Framework, Making Health a Shared Value, highlights the role of individual and community factors in achieving a societal commitment to health and health equity, centered around three drivers: Mindset and Expectations, Sense of Community, and Civic Engagement. To stimulate research about how Action Area One and its drivers may impact health, Evidence for Action (E4A), a signature research funding program of RWJF, developed and released a national Call for Proposals (CFP). The process of formulating the CFP and reviewing proposals surfaced important challenges for research on creating and sustaining shared values to foster and maintain a Culture of Health. In this essay, we describe these considerations and provide examples from funded projects regarding how challenges can be addressed.

Users' involvement in mental health services: programme logic model of an innovative initiative in integrated care.

BACKGROUND: Collaboration and partnership are key issues for modern health systems seeking to implement quality integrated care that meets the needs of the population. The Carrefour Communautaire-Institutionnel-Usagers (Connecting Community organisations-Institutions-Users, CCIU), involving community- and institution-based mental health workers, carers and users, is an innovative normative integrated care group (group for shared values, culture and vision) established by the Canadian Mental Health Association-Montreal Branch. A programme evaluation approach was used to conduct a logic analysis of the CCIU in order to understand the relationships between its resources, activities and outcomes, build a common understanding and, allow for its replication. METHODS: Five steps were involved in the creation of a programme logic model. A non-exhaustive literature search for similar initiatives, a review of documents related to the CCIU process and direct observations led to the development of a first model. Then, following a participatory and reflexive process, this model was validated with CCIU participants. RESULTS: A comprehensive model and a simplified model were created. Participants' experiential knowledge and scientific knowledge helped to identify the essential components of the successful operation of the CCIU. CONCLUSIONS: The CCIU, with its eight essential components, including relations based on equality and mutual respect, corresponds to an essential step in normative integration and integrated care that lead to improved quality services.

Teaching hospital performance: towards a community of shared values?

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs.

Metodología de planificación estratégica para instituciones de salud a partir de valores compartidos / Strategic planning methodology for health institutions on the basis of shared values

La sociedad cubana trabaja en el fortalecimiento de la educación en valores lo que implica cambios organizacionales que dependen del cambio del comportamiento de los miembros de la organización y este de sus valores. Para contribuir al logro de lo planteado, se elaboró una metodología para la realización de planes estratégicos a partir de los valores compartidos por los trabajadores de las instituciones de salud. Se obtuvo información sobre metodologías existentes para la elaboración de planes estratégicos generales. Dentro de las encontradas se seleccionó una como patrón por considerarse la más adecuada. Se diseñaron y aplicaron instrumentos para el diagnóstico de los valores actuales y técnicas para la determinación de los valores deseados. La metodología se estructuró en tres etapas: la primera se denominó Análisis Situacional, que se corresponde con el estado presente de la institución, aquí se evalúan los valores actuales compartidos. En la segunda etapa, denominada Prospectiva, se valora el futuro institucional y por tanto tiene en cuenta la determinación de los valores deseados, la tercera etapa se denominó Operacional o de conexión del presente con el futuro, en ella se elaboran los valores instrumentales. Mediante la aplicación de esta metodología los directivos planifican el cambio organizacional a partir de la intención de cambiar el comportamiento moral de los miembros de la organización. Ha sido validada por criterio de expertos y por su empleo en la conformación de 141 planes estratégicos de departamentos, servicios e instituciones de salud de la provincia de Guantánamo, con buenos resultados.

The Cuban society is working in the strengthening of ethical values education, which leads to organizational changes depending on the change of the organization members´s behaviors and values. For achieving the above-mentioned, a methodology was drawn up to carry out strategic plans based on the values that the health institution workers share. Data on already existing methodologies to work out general strategic plans were collected. One methodology was selected as pattern because it was considered the most appropriate. Some diagnostic instruments to identify current values and some techniques to ascertain desired values were designed and applied. The methodology structure involves three phases: the first phase called Situation Analysis covers the present state of the institution and evaluates the current shared values. The second phase called Prospective assesses the institutional future and hence determines the desired values whereas the third phase called Operational or Linking, which relates the present and the future, works out the instrumental values. Through the implementation of this methodology, the managers are able to plan the organizational change on the basis of the intention of changing the moral behavior of the members. This methodology has been validated by expert criteria and use in the drafting of 141 strategic plans at department, service and health institution levels in Guantanamo province, with good results.