'Knowledge exchange' workshops to optimise development of a risk prediction tool to assist conveyance decisions for suspected seizures - Part of the Risk of ADverse Outcomes after a Suspected Seizure (RADOSS) project.

PURPOSE: Suspected seizures present challenges for ambulance services, with paramedics reporting uncertainty over whether or not to convey individuals to emergency departments. The Risk of ADverse Outcomes after a Suspected Seizure (RADOSS) project aims to address this by developing a risk assessment tool utilizing structured patient care record and dispatch data. It proposes a tool that would provide estimates of an individual's likelihood of death and/or recontact with emergency care within 3 days if conveyed compared to not conveyed, and the likelihood of an 'avoidable attendance' occurring if conveyed. Knowledge Exchange workshops engaged stakeholders to resolve key design uncertainties before model derivation. METHOD: Six workshops involved 26 service users and their significant others (epilepsy or nonepileptic attack disorder), and 25 urgent and emergency care clinicians from different English ambulance regions. Utilizing Nominal Group Techniques, participants shared views of the proposed tool, benefits and concerns, suggested predictors, critiqued outcome measures, and expressed functionality preferences. Data were analysed using Hamilton's Rapid Analysis. RESULTS: Stakeholders supported tool development, proposing 10 structured variables for predictive testing. Emphasis was placed on the tool supporting, not dictating, care decisions. Participants highlighted some reasons why RADOSS might struggle to derive a predictive model based on structured data alone and suggested some non-structured variables for future testing. Feedback on prediction timeframes for service recontact was received, along with advice on amending the 'avoidable attendance' definition to prevent the tool's predictions being undermined by potential overuse of certain investigations in hospital. CONCLUSION: Collaborative stakeholder engagement provided crucial insights that can guide RADOSS to develop a user-aligned, optimized tool.

Establishing a standing patient advisory board in family practice research: A qualitative evaluation from patients' and researchers' perspectives.

INTRODUCTION: Patient and public involvement is vital for high-quality research. Integrating patients' and providers' perspectives early in research enhances the feasibility and relevance of study results. Within our family practice-based research network ForN, we established a standing patient advisory board (PAB) to include patients with diverse conditions and experiences. In this paper, we aim to describe the establishment and functioning of a standing PAB in family medicine research from patients' and researchers' perspectives. METHODS: After each PAB meeting, patients and researchers were asked to name anonymously positive and challenging moments in a feedback form with open questions. Researchers were also asked to reflect on how they implemented the discussion content in their research projects. The responses from both groups were transferred to MAXQDA 2018 and analyzed separately using thematic analysis. RESULTS: We analyzed 40 feedback forms from patients and 14 feedback forms from researchers. The dominant theme in the patients' feedback was 'exchange': They positively emphasized the 'exciting and open discussions' and the exchange of perspectives with one another and researchers. The clarity of the researchers' presentations and the research topics were appreciated. Researchers also positively highlighted the open atmosphere of the discussions. Presenting their research to the PAB helped most researchers reflect on their research topics from patients' perspectives and implement changes. However, researchers also mentioned several barriers to the implementation of PAB members' feedback. CONCLUSION: The establishment of a standing PAB in family practice research is feasible and productive both from patients' and researchers' perspectives. PATIENT OR PUBLIC CONTRIBUTION: This study reports the evaluation of the establishment of a standing PAB in family practice research. Board members are involved in the design of studies, the co-production of interventions and information material, and the interpretation of data.

Pressing issues for oral care quality improvement: findings from the EU DELIVER project.

BACKGROUND: While oral health often takes a backseat to other health domains, it silently affects nearly half of the Worldwide population. The DELIVER project, funded by the EU's Horizon Europe program, seeks to develop a blueprint model for improving the quality of oral health care for everyone. METHODS: Applying the Nominal Group Technique (NGT), 17 stakeholders from various backgrounds participated in identifying pressing issues for oral care quality improvement across practice, community, and policy levels. RESULTS: The results revealed significant differences at the different levels, with accessibility emerging as a prominent issue, encompassing affordability, availability, and acceptability of oral healthcare services. CONCLUSIONS: These findings emphasizes the need for policy reforms, increased investments, and a shift towards preventive and patient-centered dental care practices. It highlights the importance of collaborative efforts with multi-stakeholders and prioritizing pressing issues on a multi-level to drive positive change in improving oral care quality.

Challenges in the evaluation of suicide prevention measures and quality of suicide data in Germany, Austria, and Switzerland: findings from qualitative expert interviews.

BACKGROUND: Suicide prevention requires diverse, integrated, and evidence-based measures. Comprehensive evaluation of interventions and reliable suicide data are crucial for guiding policy-making and advancing suicide prevention efforts. This study aimed to analyze current issues and gaps in the evaluation of suicide prevention measures and the quality of suicide data in Germany, Austria, and Switzerland to derive specific recommendations for improvement. METHODS: Online, semi-structured interviews were conducted with 36 experts in suicide prevention from Germany, Austria, and Switzerland, covering insights from policy, science, and practice. The interviews took place between September 2022 and February 2023, were audio-recorded, transcribed verbatim, and analyzed using the Framework method. RESULTS: While solid evidence supports the effectiveness of some suicide prevention interventions, experts indicated that the evaluation of many other measures is weak. Conducting effectiveness studies in suicide prevention presents a range of methodological and practical challenges, including recruitment difficulties, choosing adequate outcome criteria, ethical considerations, and trade-offs in allocating resources to evaluation efforts. Many interviewees rated the quality of national suicide statistics in Germany, Austria, and Switzerland as comparatively high. However, they noted limitations in the scope, timeliness, and reliability of these data, prompting some regions to implement their own suicide monitoring systems. None of the three countries has national routine data on suicide attempts. CONCLUSION: While some challenges in evaluating suicide prevention measures are inevitable, others can potentially be mitigated. Evaluations could be enhanced by combining traditional and innovative research designs, including intermediate outcomes and factors concerning the implementation process, and employing participatory and transdisciplinary research to engage different stakeholders. Reliable suicide data are essential for identifying trends, supporting research, and designing targeted prevention measures. To improve the quality of suicide data, a standardized monitoring approach, including uniform definitions, trained professionals, and cross-sector agreement on leadership and financing, should be pursued. This study provides actionable recommendations and highlights existing good practice approaches, thereby supporting decision-makers and providing guidance for advancing suicide prevention on a broader scale.

A situational and stakeholder analysis of health technology assessment in Zimbabwe.

OBJECTIVES: Systematic priority setting is necessary for achieving high-quality healthcare using limited resources in low- and middle-income countries. Health technology assessment (HTA) is a tool that can be used for systematic priority setting. The objective of this study was to conduct a stakeholder and situational analysis of HTA in Zimbabwe. METHODS: We identified and analyzed stakeholders using the International Decision Support Initiative checklist. The identified stakeholders were invited to an HTA workshop convened at the University of Zimbabwe. We used an existing HTA situational analysis questionnaire to ask for participants' views on the need, demand, and supply of HTA. A follow-up survey was done among representatives of stakeholder organizations that failed to attend the workshop. We reviewed two health policy documents relevant to the HTA. Qualitative data from the survey and document review were analyzed using thematic analysis. RESULTS: Forty-eight organizations were identified as stakeholders for HTA in Zimbabwe. A total of 41 respondents from these stakeholder organizations participated in the survey. Respondents highlighted that the HTA was needed for transparent decision making. The demand for HTA-related evidence was high except for the health economic and ethics dimensions, perhaps reflecting a lack of awareness. Ministry of Health was listed as a major supplier of HTA data. CONCLUSIONS: There is no formal HTA agency in the Zimbabwe healthcare system. Various institutions make decisions on prioritization, procurement, and coverage of health services. The activities undertaken by these organizations provide context for the institutionalization of HTA in Zimbabwe.

The importance of family support to engage and retain girls in male dominated action sports. A qualitative study of young people's perspectives.

ISSUE ADDRESSED: Social support is positively correlated with physical activity (PA), especially amongst girls, but is underexplored in male-dominated action sports (e.g., mountain biking, skateboarding and surfing). This study explored family level social support needs and experiences of girls and boys in three action sports. METHOD: Aspiring, current or former Australian adolescent (12-18 years; girls n = 25; boys n = 17) mountain bikers, skateboarders and/or surfers were individually interviewed (telephone/Skype) in 2018/2020. A socio-ecological framework guided the semi-structured interview schedule. Audio-recordings were transcribed verbatim and data analysed thematically using a constant comparative approach. RESULTS: Family level social support was highly influential in young people's participation in action sports, with its absence a common reason for no or discontinued engagement amongst girls. Parents and siblings were the main social support providers with extended family (e.g., grandparents, aunts/uncles, cousins) also notable. Participation (current/past/co-) was the main social support type followed by emotional (e.g., encouragement), instrumental (e.g., transport, equipment/funding) and informational (e.g., coaching) support. Girls were inspired/encouraged by brothers but boys were not inspired/encouraged by sisters; boys and girls co-participated with both parents but co-participating and being inspired by fathers was most common, especially amongst girls; fathers were more commonly the main transport provider if they co-participated with their child; fathers mostly provided initial coaching; only boys were taught equipment maintenance by parents. CONCLUSIONS AND SO WHAT: Sport-related organisations/groups have numerous opportunities to improve girls' representation in action sports by fostering family level social support through various means. Intervention strategies should be tailored to account for gendered participation differences.

e-Delphi in the outdoors: Stakeholder contributions to the development of a wellbeing-focused outdoor adventure education intervention program.

ISSUE ADDRESSED: Outdoor adventure education (OAE) (programs involving outdoor activities such as rock climbing or white-water canoeing) that participants perceive as risky, conducted in a social support setting, can be utilised by practitioners to elicit changes in educational and psychosocial outcomes to support participant adolescent wellbeing. METHODS: This study garnered the opinions of an expert OAE panel on the content of future programs aiming to impact adolescent wellbeing. The panel consisted of local (Western Australia, n = 7), national (Australia, n = 4), and international (Canada, Germany, New Zealand, United Kingdom, United States, n = 7) experts. A two-round, mixed-methods Delphi approach was employed. Extensive formative work led to the development of a series of open-ended questions requiring qualitative responses for round one. Panellists were also asked to respond to 17 statements using Likert scales in the second round. RESULTS: After analysis, a consensus was reached for all statements, with five statements having high consensus and being considered important by panellists. CONCLUSIONS: The statement 'Equity for all participants requires flexible delivery and facilitation' had the highest level of agreement amongst panellists. Connections, authentic experiences, and equitable experiences developed as key themes. SO WHAT?: Future OAE interventions focused on wellbeing impact could use the findings of this research as a basis for program design.

Improving the Reporting of Primary Care Research: Consensus Reporting Items for Studies in Primary Care-the CRISP Statement.

Primary care (PC) is a unique clinical specialty and research discipline with its own perspectives and methods. Research in this field uses varied research methods and study designs to investigate myriad topics. The diversity of PC presents challenges for reporting, and despite the proliferation of reporting guidelines, none focuses specifically on the needs of PC. The Consensus Reporting Items for Studies in Primary Care (CRISP) Checklist guides reporting of PC research to include the information needed by the diverse PC community, including practitioners, patients, and communities. CRISP complements current guidelines to enhance the reporting, dissemination, and application of PC research findings and results. Prior CRISP studies documented opportunities to improve research reporting in this field. Our surveys of the international, interdisciplinary, and interprofessional PC community identified essential items to include in PC research reports. A 2-round Delphi study identified a consensus list of items considered necessary. The CRISP Checklist contains 24 items that describe the research team, patients, study participants, health conditions, clinical encounters, care teams, interventions, study measures, settings of care, and implementation of findings/results in PC. Not every item applies to every study design or topic. The CRISP guidelines inform the design and reporting of (1) studies done by PC researchers, (2) studies done by other investigators in PC populations and settings, and (3) studies intended for application in PC practice. Improved reporting of the context of the clinical services and the process of research is critical to interpreting study findings/results and applying them to diverse populations and varied settings in PC.Annals "Online First" article.

Challenges developing an electronic patient-reported outcome measurement for palliative home care: A qualitative interview and focus group study.

BACKGROUND: Patient-reported outcome measures have the potential to improve outcomes, quality, and effectiveness of care. Digital use of patient-reported outcome measures could be an option to foster implementation in palliative care. The Palli-MONITOR study focused on developing and testing an electronic patient-reported outcome measure in specialised palliative home care. As part of this study, we examined setting-specific challenges for the development of the measure. AIM: We aimed to identify and explore challenges for the development of electronic patient-reported outcome measures as standardised assessment in specialised palliative home care. DESIGN: Qualitative approach with semi-structured interviews and focus groups. Data were thematically analysed using the framework method. SETTING/PARTICIPANTS: Patients and professionals from five German palliative home care teams. RESULTS: Patients described potential problems in using electronic questionnaires due to their deteriorating health. Answering the electronic questionnaire encouraged patients to reflect on their current palliative situation, which was partly perceived as burdensome. Identified concerns and questions regarding the future roll-out of electronic patient-reported outcome measurement addressed the process of receiving and using the provided information in clinical care routine. Challenging factors on organisational and structural level were the potential undermining of the established 24-h emergency call system and the potential use for patients. CONCLUSIONS: Our results provide a multifaceted picture of challenges developing electronic systems for patient-reported outcome measurement in palliative home care on the individual and organisational level. The study underpins the benefit of stakeholder involvement creating digital health innovations and emphasises the importance to therefore mind setting specific culture.

Eliciting Low-Risk Thyroid Cancer Treatment Preferences Using Clinical Vignettes: A Pilot Study.

OBJECTIVE: While surgical resection has been the traditional standard treatment for small (≤1 cm), differentiated thyroid cancers, active surveillance (AS) and radiofrequency ablation (RFA) are increasingly considered. The aim of this study was to explore patient preferences in thyroid cancer treatment using a series of clinical vignettes. METHODS: Thyroid cancer survivors and general population volunteers were recruited to rank experience-driven clinical vignettes in order of preference. Rankings were compared using Wilcoxon signed rank. Formative qualitative methods were used to develop and refine clinical vignettes that captured 4 treatments-thyroid lobectomy (TL), total thyroidectomy (TT), AS, and RFA-along with 6 treatment complications. Content was validated via interviews with 5 academic subspecialists. RESULTS: Nineteen volunteers participated (10 survivors, 9 general population). Treatment complications were ranked lower than uncomplicated counterparts in 99.0% of cases, indicating excellent comprehension. Counter to our hypothesis, among uncomplicated vignettes, median rankings were 1 for AS, 2 for RFA, 3.5 for TL, and 5 for TT. Trends were consistent between thyroid cancer survivors and the general population. AS was significantly preferred over RFA (P = .02) and TT (P < .01). Among surgical options, TL was significantly preferred over TT (P < .01). CONCLUSION: When treatments for low-risk thyroid cancer are described clearly and accurately through clinical vignettes, patients may be more likely to choose less invasive treatment options over traditional surgical resection.

Community Engagement in Behavioral Medicine: A Scoping Review.

BACKGROUND: Behavioral medicine has made key contributions toward improving health outcomes. Engaging community partners in research is critical to addressing persistent health inequities. The aim of this scoping review was to explore how researchers engaged community partners within the field of behavioral medicine research from 2005 to 2023. METHOD: Publication databases and gray literature were searched for research that engaged community partners to address questions relevant to behavioral medicine. Articles were screened by title and abstract, and then by full text. Articles meeting the inclusion criteria were coded using the framework provided by the Engagement Navigator to identify engagement approaches, methods, and tools and when they were used during the research. RESULTS: Of 1486 articles initially identified, 58 met the inclusion criteria. Most articles used well-known approaches (e.g., community-based participatory research; 67%), methods (e.g., advisory committees; 59%), and tools (e.g., interviews; 41%), and engaged with healthcare service providers (62%) and/or patients (53%). Community partners were most often included in research planning and design (79%), and less often in dissemination (45%). CONCLUSION: Community engagement has considerable potential to address health inequities. Our assessment of the approaches, methods, and tools used by behavioral medicine researchers to engage with a diverse range of community partners points toward promising strategies for enhancing the impact of community engagement. Researchers should incorporate explicit descriptions of community engagement strategies in publications, an outcome that could be facilitated by clear publishing guidelines, structured reporting tools, and clear messaging from funders about the value of community engagement in behavioral medicine research.

Using social media research in health technology assessment: stakeholder perspectives and scoping review.

OBJECTIVES: The aim of this initiative was to examine collaboratively, in a multi-stakeholder team (health technology assessment (HTA) practitioners with patient involvement expertise, health technology industry, patient advocates, health policy experts, patient engagement experts), whether evidence generated through social media research (SMR) fills current information gaps relating to insights on specific aspects of patient experiences, preferences, or patient needs and delivers additional value to HTA. METHODS: The framing of the project was done in a co-creative, deliberative multi-stakeholder process. Challenge and refinement happened through discussions with 25 independent stakeholders from HTA bodies, industry, academia, and patient advocacy. For critical themes identified during the framing phase, scoping literature reviews were performed including the state of methods and examples for the use of SMR in HTA. RESULTS: The framing and stakeholder discussions specified a set of expectations and requirements, and the scoping reviews revealed the current state of methods and usage of SMR in health-policy decision making. CONCLUSIONS: The project concluded that SMR can contribute new, relevant evidence to HTA. It is however recommended to evolve the science through defining best practices when planning, conducting, and using SMR and to conduct multi-stakeholder pilot SMR projects to address questions relevant to current HTAs and to validate and improve the proposed practices.

Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI).

BACKGROUND: Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA. METHODS: This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps. RESULTS: Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed. CONCLUSIONS: This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.

Unravelling the impact of dental workforce training and education programmes on policy evolution: a mixed-method study protocol.

BACKGROUND: The dental workforce plays a crucial role in delivering quality oral healthcare services, requiring continuous training and education to meet evolving professional demands. Understanding the impact of dental workforce training and education programmes on policy evolution is essential for refining existing policies, implementing evidence-based reforms and ensuring the growth of the dental profession. Therefore, this study protocol aims to assess the influence of dental workforce training and education programmes on policy evolution in Malaysia. METHODS: A mixed-method research design will be employed, combining quantitative surveys and qualitative interviews. Stakeholder theory and policy change models will form the theoretical framework of the study. Participants from various stakeholder groups will be recruited using purposive sampling. Data collection will involve surveys and one-on-one semi-structured interviews. Descriptive statistics, inferential analysis and thematic analysis will be used to analyse the data. Integration of quantitative and qualitative data will be used to provide a comprehensive understanding of the data. DISCUSSION: This study will shed light on factors influencing policy decisions related to dental education and workforce development in Malaysia. The findings will inform evidence-based decision-making, guide the enhancement of dental education programmes and improve the quality of oral healthcare services. Challenges related to participant recruitment and data collection should be considered, and the study's unique contribution to the existing body of knowledge in the Malaysian context will be discussed.

Priority setting to support a public health research agenda: a modified Delphi study with public health stakeholders in Germany.

BACKGROUND: Research priority setting (RPS) studies are necessary to close the significant gap between the scientific evidence produced and the evidence stakeholders need. Their findings can make resource allocation in research more efficient. However, no general framework for conducting an RPS study among public health stakeholders exists. RPS studies in public health are rare and no such study has been previously conducted and published in Germany. Therefore, we aimed to investigate which research topics in public health are prioritised by relevant stakeholders in Germany. METHODS: Our RPS study consisted of a scoping stage and a Delphi stage each split into two rounds. Firstly, we invited members of the German Public Health Association to gather expert insights during two initial workshops. Next, we defined the relevant stakeholder groups and recruited respondents. Thereafter, we collected research topics and assessment criteria with the respondents in the first Delphi round and aggregated the responses through content analysis. Finally, we asked the respondents to rate the research topics with the assessment criteria in the second Delphi round. RESULTS: In total, 94 out of the 140 invited public health organisations nominated 230 respondents for the Delphi study of whom almost 90% participated in both Delphi rounds. We compiled a comprehensive list of 76 research topics that were rated and ranked by several assessment criteria. We split the research topics into two types, substantive research topics and methodological-theoretical research topics respectively, to ensure the comparability among the research topics. In both types of research topics-substantive research topics and methodological-theoretical research topics-the respective top five ranked research topics hardly differed between public health researchers and public health practitioners. However, clear differences exist in the priority ranking of many (non-top priority) research topics between the stakeholder groups. CONCLUSIONS: This research demonstrates that it is possible, with limited resources, to prioritise research topics for public health at the national level involving a wide range of pertinent stakeholders. The results can be used by research funding institutions to initiate calls for research projects with an increased relevance for health and/or scientific progress.

Living with suicidal thoughts: A scoping review.

BACKGROUND: There is a significantly higher number of people experiencing severe levels of suicidal thoughts compared to that of suicidal deaths and suicide attempts. In suicide prevention research, there is a shift towards greater emphasis on people's experiences of living with suicidal thoughts. This can expand the existing evidence base, which is dominated by a biomedical approach. The aim of this review was to summarise and disseminate existing research on the lived experiences of living with suicidal thoughts. METHODS: A scoping review by Arksey & O'Malley consisting of six stages: (1) formulating the research question, (2) identifying relevant studies, (3) selecting studies, (4) mapping data, (5) summarising the results and (6) consulting stakeholders. PubMed, PsycINFO and CINAHL were searched for studies in English, Danish, Swedish and Norwegian. Peer-reviewed articles examining people's experiences of living with suicidal thoughts using qualitative methods were included. The search was supplemented with a citation pearl search in the Web of Science database. Twenty-eight studies were included. RESULTS: The findings were organised under two thematic headings: (a) the significance of social connections and (b) a loss of the personal self. CONCLUSION: There is a need for further qualitative research of people's experiences of living with suicidal thoughts from an everyday life perspective. Awareness about social connections and attachment in mental health prevention and governance is crucial. Trauma-informed care could be a useful approach to prevent suicidal thoughts as the review found that many participants had traumatic experiences in both childhood and adulthood. As part of the treatment of suicidal thoughts, it might be useful to have a focus on narrative and communicative methods and their clinical application.

A nature-based solution selection framework: Criteria and processes for addressing hydro-meteorological hazards at open-air laboratories across Europe.

Nature-based solutions (NbS) can be beneficial to help human communities build resilience to climate change by managing and mitigating related hydro-meteorological hazards (HMHs). Substantial research has been carried out in the past on the detection and assessment of HMHs and their derived risks. Yet, knowledge on the performance and functioning of NbS to address these hazards is severely lacking. The latter is exacerbated by the lack of practical and viable approaches that would help identify and select NbS for specific problems. The EU-funded OPERANDUM project established seven Open-Air Laboratories (OALs) across Europe to co-develop, test, and generate an evidence base from innovative NbS deployed to address HMHs such as flooding, droughts, landslides, erosion, and eutrophication. Herein, we detail the original approaches that each OAL followed in the process of identifying and selecting NbS for specific hazards with the aim of proposing a novel, generic framework for selecting NbS. We found that the process of selecting NBS was overall complex and context-specific in all the OALs, and it comprised 26 steps distributed across three stages: (i) Problem recognition, (ii) NbS identification, and (iii) NbS selection. We also identified over 20 selection criteria which, in most cases, were shared across OALs and were chiefly related to sustainability aspects. All the identified NbS were related to the regulation of the water cycle, and they were mostly chosen according to three main factors: (i) hazard type, (ii) hazard scale, and (iii) OAL size. We noticed that OALs exposed to landslides and erosion selected NbS capable to manage water budgets within the soil compartment at the local or landscape scale, while OALs exposed to floods, droughts, and eutrophication selected approaches to managing water transport and storage at the catchment scale. We successfully portrayed a synthesis of the stages and steps followed in the OALs' NbS selection process in a framework. The framework, which reflects the experiences of the stakeholders involved, is inclusive and integrated, and it can serve as a basis to inform NbS selection processes whilst facilitating the organisation of diverse stakeholders working towards finding solutions to natural hazards. We animate the future development of the proposed framework by integrating financial viability steps. We also encourage studies looking into the implementation of the proposed framework through quantitative approaches integrating multi-criteria analyses.

Diversity of perspectives in biodiversity conservation: A case study of port land use in Antwerp and Rotterdam.

Conflicts of interest often undermine conservation initiatives against biodiversity decline. Effective decision-making requires a deeper understanding of the positions, criteria, concerns, and perspectives of stakeholders. However, managing so many perspectives can be difficult, and if not done well, conflicts arise which make it difficult to achieve conservation goals. The purpose of this study is to demonstrate that identifying areas of consensus is a good starting point to generate more effective debates and address complex issues. To do this, we investigate the diversity of perspectives regarding biodiversity conservation schemes among stakeholders in the studied ports of Antwerp and Rotterdam. Using Q-methodology, a semi-quantitative technique that enables us to systematically study the subjective views of stakeholders involved in a topic, we identified and organized a range of shared perspectives into three groups, known as factors. A total of 20 participants sorted 45 statements according to their perceptions and objectives, from -4 'most disagreeable' to 4 'most agreeable'. Then, respondents explained their rankings in a post-sorting interview. Next, the data was analyzed quantitatively and qualitatively. The quantitative analysis was conducted in two parts: (i) Dividing respondents into groups based on similar perspectives and (ii) coupling distinguishing statements with one of the factors characteristic of that viewpoint. Finally, in a qualitative analysis, we used the distinguishing statements and insights from interviews to create narratives and titles for the three factors: (1) Ports are key for our economic wealth, hence port development should continue, (2) Nature first, and (3) Multi-actor governance. Our findings confirm consensuses in three areas: policy, land use, and mitigation tactics. Interestingly, all narratives unanimously agreed on the importance of regulating port development and land use changes via legislation and environmental impact assessments. However, they debated the rigidity of legislation and whether offsetting port expansion (and associated land and resource use claims) should take place locally or internationally. We also found that decision-making mostly followed a human-centered perspective, where economic values were more relevant than intrinsic ones. These insights can serve as a baseline for stakeholders to form coalitions around areas of consensus to depolarize debates and avoid decision-making gridlocks.

Using the Ophelia (Optimising Health Literacy and Access to Health Services) process as a practical tool for health promotion program delivery in various Philippine communities.

ISSUE ADDRESSED: The Ophelia (Optimising Health Literacy and Access to Health Services) process can be used as a practical tool for effective health promotion program delivery because of its multi-sector and pragmatic approach to designing health interventions. An initial case study showed how its first phase was successfully adapted in a pilot community in Leyte, Philippines. In this study, the three phases of the Ophelia process were implemented in Leyte, along with additional communities in Mindoro and Surigao. METHODS: After conducting needs assessment and community profiling in phase 1, the results were transformed into vignettes, hypothetical personas representing the health needs of the community. These were used in phase 2, which involved focus group discussions and workshops to cocreate intervention ideas with government organisations, practitioners, and community representatives. A rapid realist review was conducted in phase 3 to check for the feasibility of interventions. RESULTS: Through this, the top evidence-based health interventions for each life stage were listed and presented for prioritisation. Program implementation and impact evaluation plans were created for the top health intervention prior to implementation. CONCLUSIONS: The Ophelia process ensured that health promotion interventions addressed community needs and were designed using community resources and the wisdom of health practitioners that have been immersed in the local health system. SO WHAT?: The study demonstrated the usefulness of vignettes in presenting data to lay people and how the rapid realist review approach is a practical tool for policy-makers to ensure that program plans designed by the communities and health practitioners are evidence-based without sacrificing the timeliness of implementation.

Applying systems leadership and participatory action research in developing a water contamination management tool.

OBJECTIVE: This research used systems leadership to explore stakeholder engagement regarding requirements, incentives and barriers to adopting a faecal source tracking method to identify contamination sources in surface waters. SETTING: The research comprised two branches, one quantitative, conducted in a food and water laboratory; the other qualitative, conducted within stakeholder organisations and meeting premises. PARTICIPANTS: Ten stakeholder representatives participated in semi-structured interviews and ten in a focus group. Seven individuals participated in both activities while three who were interviewed were replaced by alternate representatives for the focus group. DESIGN: A multimethod participatory action research project was completed, with a quantitative trial of a microbial source tracking method conducted concurrently with two iterations of qualitative research into the needs of the stakeholder system through semi-structured interviews and a focus group. RESULTS: Thematic analysis of stakeholder interviews yielded key incentive and barrier themes, while the laboratory trial created a comparison library and tested the efficacy of the laboratory method. The focus group further explored key themes and identified requirements for collaborative effort across the system, and the need to address misinterpretation of statistical associations. CONCLUSION: Systems leadership was effective in exploring stakeholder interest in the proposed faecal source tracking method. Two iterations of qualitative research helped to identify the needs of individual stakeholders, and then develop collective strategies for addressing the critical incentives and barriers.