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Today, globalization as well as the advancement of technology is narrowing the distances of nations. Vietnam has become an attractive destination of tourists due in part to its charm, natural beauty, as well as its rich history and culture. The aim of this research is to study the effects of emotional experience factors on tourists’ satisfaction and their willingness to recommend the destinations, this study follows revised Destination Emotion Scales (DES) model. The survey was carried out with 224 foreign tourists who have travelled to a few famous places in Vietnam at least one time by both online and offline method. The methodology used in our research is a quantitative method. SPSS software 20 and AMOS 21 with SEM (structural equation modelling) were used to carry out analyzing on data gathered through a survey. This research found that the emotions of joy and love as significant influences on tourists’ satisfaction and its effect on intention to recommend while exploring whether or not the emotion of positive surprise does not support this relationship. The research makes a significant contribution to tourism marketing in Vietnam because some of the empirical findings found in the study deal with aspects of tourists’ satisfaction and their willingness to recommend necessary to improve tourism.

Brand choice has historically played an important role in a wide range of industries, particularly in the private sector, where billions of Rands are invested to entice potential customers. Taking this into consideration, the purpose of this study is to investigate the effect of brand awareness and brand image on first-year student selection of a University of Technology in KwaZulu-Natal. The objectives of the study were to establish and identify the brand preference and image attributes that entice first-year students’ selection of a University of Technology (UoT). The study also examined the biographic variables of those students. To accomplish these objectives, an exploratory study using a quantitative research approach was conducted, in which questionnaires were administered to 500 first-year students at the selected Universities of Technology in KwaZulu-Natal. The study revealed that topics such as investments in brand awareness and brand image, safety and security, the caliber of staff, delays in academic programmes, student-lecturer relationships, and service delivery were identified as factors that influenced the participants' selection and willingness to recommend their institutions to potential students. Thus, the study recommends that UoTs should pay more attention to branding strategies as an agendum to ensuring institutional profitability and viability, relationship management, and human resource. Finally, the findings of this study are limited to KwaZulu-Natal and should not be extrapolated outside this region.

Artificial intelligence (AI) to machines with software and algorithm that can think and perform tasks like humans. AI can dynamically change various aspects of people’s lives, both in business and in a personal context (Loureiro, Guerreiro, & Tussyadiah, 2021; Romero et al., 2021). This technology functions through automation and continuous learning, and the main characteristic that makes it so life-changing and extremely popular is its level of personalization (Kumar et al., 2019). “AI seeks to simplify communication between humans and machines by means of natural language” (Pantano & Pizzi, 2020, p. 3). AI-powered voice assistants, or Intelligent Virtual Assistants (IVA), such as Amazon Alexa, Apple Siri, Google Assistant and others, represent a very relevant subject to research, due to its growth in the most recent years. These smart devices are changing people's daily routine, by completing tasks for them, searching for information, making purchases online, through a simple voice command. In addition, their characteristics and features which make them so human-like, such as their voice, the natural language and the fact that they personalize the content taking into account the user's interests and behaviours (McLean & Osei-Frimpong, 2019), can encourage users to bond with them (Schweitzer et al., 2019). IVA, through machine learning, can better adapt and personalize throughout time, by learning the user’s interests and preferences (Bishop, 2006). Therefore, these smart devices, due to their friend-like characteristics, encourage users to develop feelings like brand warmth and attachment. (Wu et al., 2017). Consumers interact with them by having conversations and through commands and requests, leading to higher levels of engagement. An IVA, being an anthropomorphised product – with human-like characteristics - is not perceived as a static object, instead, users tend to like and value them more, and can even see them as a friend or a companion, being, consequently, more loyal. (Schweitzer et al., 2019). Fashion industry is discovering the potentialities of AI. Indeed, AI-enhanced fashion design and manufacturing and help to promote and sell fashion goods (Forbes, 2021). Fashion brands are interested in leverage conversational assistants through chatbots (Ashfaq et al., 2020) and voice assistant (Loureiro, Japutra, Molinillo, & Bilro, 2021) devices such as Amazon Alexa, Apple Siri, Google Home, and Microsoft Cortana. Using conversational interfaces, they can gather data by understanding consumers desires and trends, purchase patterns, and suggesting related items. Through the interaction, consumers can find the optimal fashion item and achieve satisfaction (Forbes, 2021). The purpose of the present study is to analyse the relationship and interaction between humans and IVA, to better understand how humans connect and bond with these smart devices in a daily basis to take decisions, for instance fashion recommendation, for instance, when giving the weather of the day and stores to purchase fashion items. More specifically, if the attachment strength and intimacy between the user and the smart device influence the level of recommendation the use of IVA for other consumers. The attachment strength depends on how strong the relationship is, it occurs when a person perceives the relationship as irreplaceable and is emotionally immersed (Thomson, 2006). “Intimacy refers to feelings of closeness, connectedness, and bondedness in loving relationships.” (Sternberg, 1997, p. 315). Customer loyalty refers to a long-term relationship between brand and customer. A preference for a specific brand and being loyal to it means not only choosing to (re)purchase a brand among similar brands, over a long period (McMullan & Gilmore, 2003) but also favourable attitudes such as positive word-of-mouth communication and recommendations (Kandampully & Suhartanto, 2003). We consider the component of willingness to recommend for the purpose of the current. A conceptual framework and hypotheses were developed to study the relationship and interaction between humans and IVA. We suggest that: H1: Attachment Strength exercises a positive impact on willingness to recommend; H2: Virtual Intimacy exercises a positive impact on willingness to recommend For data collection, we recruited participants from the United States (US) via Amazon’s Mechanical Turk. Thus, a sample of 200 completed questionnaires was treated. The sample is well-balanced consider age and gender. In what concerns to construct reliability and validity (see Table 1), all are reliable, and the values of AVE indicate discriminant validity. The constructs also have discriminant validity, which was analyzed through the Fornell-Larcker Criterion and Heterotrait-Monotrait Ratio (HTMT) matrix. Regarding the structured model, all hypotheses were supported. The results show that consumers create a relationship of connectedness with the smart device which operates as a personal assistant for them. The more the user is attached to the Intelligent virtual assistant, and the greater the willingness to recommend the IVA to others. Virtual intimacy also affects positively the willingness to recommend the IVA to others. The human-like characteristics make users look at IVA as social beings, hence, strong feelings occur, and a relationship is developed. These feelings of proximity and attachment make users more satisfied with the experience and also more loyal, leading owners to recommend to others and consequently brand managers also benefit from learning more about human-IVA interaction. Fashion brand managers should be aware that attachment strength due to the interactions is even more important than the intimacy developed to in such interactions to activate in customers the desire to spread the word about the brands. These findings are also quite relevant theoretically, since it is the first time that such drivers are compared. info:eu-repo/semantics/publishedVersion

Study Objective To assess whether improving providers’ education by video training using a mobile phone could affect providers’ knowledge and attitude toward long-acting reversible contraceptives (LARCs), and thus further affect adolescents’ and young nulliparous women's decisions to use LARCs. Design, Setting, Participants, Intervention, and Main Outcome Measures This prospective case-control study was performed between 2019 and 2020. A total of 40 healthcare providers participated, of which 20 received “LARC First” video training, whereas the other 20 served as the control group and received no training. Surveys were conducted of 244 adolescents and young women who were consulted by these 2 groups of healthcare providers before abortion surgery. The data were used to analyze the relationship between providers’ knowledge scores and the percentage of women who received counseling on LARCs decided to use LARCs, and what percentage continued to do so 12 months after surgery. Results Providers from the study group scored higher in LARC knowledge than the control group. Compared to the control group, women in the study group reported receiving more counseling on LARCs (81.4% vs 7.9%) and more often chose to use LARCs (24.6% vs 2.4%). Twelve months later, there was no significant difference in contraceptive continuation between study and control groups, but study group participants were more likely to be using LARCs (P Conclusion Video training for providers improved both their knowledge and willingness to recommend LARCs and increased the probability of adolescent and young nulliparous women using these methods to reduce unintended pregnancy.

Many potential destinations are rich in cultural resources. As cultural tourism becomes increasingly important for communities to showcase their cultural capital, it is vital to assess how cultural tourists can be better understood and serviced through planning and marketing to attract more international visitors. The marketing funnel process can help policymakers understand the critical components of tourists' visiting behavior. The process conceptualizes the process of how a consumer purchases a product or service from awareness through to purchase. We augment this marketing funnel process by also noting the importance of postconsumption evaluation: the likelihood to recommend. Cultural heritage tourism is an important feature of India's tourism. Murshidabad, a district of West Bengal, India, situated on the bank of Bhagirathi River, is 220 km away from the State capital, Kolkata. Murshidabad has a large number of cultural resources, both tangible and intangible. The study explores the cultural resources and their potential availability in Murshidabad. This will determine the scope of cultural heritage tourism development. This research assesses tourists' awareness, visitation, and likelihood to recommend cultural heritage resources in Murshidabad. It also assesses residents' perceptions towards cultural heritage tourism development as well as the community's participation level in cultural tourism development. This research uses a quantitative method to sample both tourists and the local community. The findings reveal strong support for cultural tourism development among the local community and high willingness to recommend many cultural attractions, although promotion and awareness of some attractions can be improved.

Vaccination demand and acceptance depends on several factors that are quite broad and complex. The knowledge and attitude of a mother to childhood immunization play a key role in immunization coverage. Low immunization coverage in Nigeria is mostly attributed to poor knowledge, compliance, accessibility and inappropriate attitude among other factors. Poor compliance with full immunization is believed to be the most significant reason for low immunization coverage in the country due to socio-cultural obstacles to the acceptance of immunization. Aim: This study aims to assess the factors that determine the attitude of mothers towards immunization. Methodology: A hundred (100) mothers were recruited into this cross-sectional descriptive study using a simple random sampling technique. Data collection was performed by using a structured questionnaire. This study was carried out in Ukpenu community in Ekpoma, Edo State, Nigeria. This study was carried out in the Ukpenu community in Ekpoma, Edo State, Nigeria. 100 mothers were recruited into the study using a simple random sampling technique. Result: The results showed that the respondents have a positive attitude towards immunization. This was evident in the immunization report. Their record revealed that most of their children were fully immunized. This is seen in their readiness to fully immunize their children against childhood vaccine-preventable diseases (VPDs), their willingness to recommend full immunization of children to their friends, relatives and other women, and their readiness to purchase the vaccines if they are no longer available free of charge to ensure that their children are fully immunized. It was discovered that educational status plays a contributory role in the knowledge and attitude of mothers towards immunization. Conclusion: Maternal health education should be sustained to ensure continuous compliance and a positive attitude of mothers towards immunization.

The aim of this study is to analyze, evaluate and validate the NSE (National Student Enquiry) as a service quality measure helping both higher education institutions (HEIs) and students in their decision making. Every year the Dutch foundation ‘Studiekeuze123’ sends out a survey (the NSE) to collect data on service quality regarding education at HEIs in the Netherlands. We used the 2019 NSE-data from the only e-learning university in the Netherlands, the Open Universiteit (OUNL), containing a sample of 1287 students. PLS-SEM was used to analyze a conceptual model in order to understand the service quality factors that promote students’ level of satisfaction and willingness to recommend the HEI. Overall, the findings reveal that the quality of the NSE is sufficient to be used for performance analysis. Nine out of twelve service components taken into account for the OUNL are found statistically significant affecting students’ satisfaction and willingness to recommend. The results help HEIs promoting and managing students’ perceptions of the quality of education and support students in their decision making process. Since many HEIs had to make a transition from onsite to online education within a short period of time, due to the Covid-19 pandemic, service quality became a major concern for HEIs. As online learning systems are expected to stay, analyzing the service quality of the OUNL as a reputed online HEI can help other HEIs getting their online learning systems on track.

Objective To facilitate optimal hospital experiences and breastfeeding clinical outcomes among women by reducing interruptions during their first 24 hours in the postpartum period. Design Evidence-based practice change initiated by a registered nurse staff member. Setting/Local Problem There was concern that numerous visitor and staff interruptions to women during their early postpartum hours were interfering with establishing breastfeeding and maintaining a restful environment on our 21-bed postpartum unit within a 377-bed, Magnet-recognized, religiously affiliated hospital in suburban southern California. Participants Medically stable women with uncomplicated childbirth during the previous 24 hours and women in the postpartum period whose responses were recorded in facility databases maintained by the departments of Lactation Services and Nursing Research. Intervention/Measurements A daily quiet time from 1:00 p.m. to 3:00 p.m. was instituted on the postpartum unit. Measurements before and after implementing quiet time included data on (a) interruptions, as the number of times someone opened or entered women’s room doors; (b) exclusive breastfeeding rates; and (c) women’s postdischarge reports of their hospital experiences. Results After quiet time was implemented, interruptions fell from an average of 74 to an average of 37 per day (n = 21, p = .02), and the percentage of women breastfeeding rose from 34% to 48% (n = 193, p = .39). Women’s ratings of unit quietness improved significantly (n = 169, p = .008) to above the benchmark, and their overall facility rating and willingness to recommend the facility remained above the benchmark on surveys from the Hospital Consumer Assessment of Healthcare Providers and Systems. Conclusion A daily afternoon quiet time for women hospitalized in the postpartum period may reduce interruptions to women and thereby potentially increase breastfeeding rates and improve women’s perceptions of their hospital experiences. Unsolicited reports from staff suggested that quiet time was well received by nurses providing postpartum care.

Background Cervical cancer screening and vaccination practices is reported to have low coverage in most developing countries. It has been reported that most women are aware of cervical cancer screening and vaccination worldwide. Nevertheless, the rate at which women participate in cervical cancer screening and vaccination was found to be low both locally and internationally. Consequently, in sub-Saharan Africa, cervical cancer screening programs have poor coverage. The aim of this study was to explore the practices of cervical cancer screening and vaccination among females at Oyibi community. Methods The researchers employed a qualitative exploratory design to recruit 35 participants put into five Focus Group Discussions (FGDs). Five FGDs were formed with seven (7) members in each group. The members were purposely recruited. The sample size was based on data saturation. Data was retrieved using a semi-structured interview guide. The researchers served as moderators in the group. Results Two (2) main themes with Eight (8) subthemes were generated from the data analysis. The themes were; (cervical cancer screening and vaccination practices), and (perceived benefits of cervical cancer screening and vaccination). The subthemes that emerged were as follows: types of cervical screening and vaccination done by participants, experiences during cervical cancer screening, experiences during cervical cancer vaccination, decision to go for cervical cancer screening and vaccination, willingness to recommend cervical cancer screening and vaccination to other women, early detection of cervical cancer through early screening, benefits of cervical cancer vaccination, and willingness to receive cervical cancer vaccine. The study also revealed that most of the women who had done the screening and vaccination were young (19-29 years). Conclusion The results from the study indicated that the participants' utilization of cervical cancer screening and vaccination were poor although they were conscious of the benefits of cervical cancer screening and vaccination and were willing to recommend it to their relatives and their loved ones. .

Background: Familial hypercholesterolemia (FH) is a common genetic disorder resulting in high levels of low-density lipoprotein cholesterol and increased risk of atherosclerotic cardiovascular disease. Genetic testing for FH is recommended but is not available in most of Canada. Consequently, there is a paucity of data regarding patient experiences with genetic testing. The objectives of this study were to investigate the attitudes and perspectives of patients with FH who underwent genetic testing. Methods: We administered an anonymous online survey to participants in the British Columbia Familial Hypercholesterolemia Registry who had undergone research-based genetic testing for FH. The survey included 25 questions and explored patients’ experiences with the genetic testing process, willingness to recommend genetic screening, and motivation to lower cholesterol levels. Results: Among 183 respondents, 38 (20.7%) had a positive genetic test result, 27 (14.8%) had a negative result, and 118 (64.4%) were awaiting their results. Compared with individuals awaiting their test results, participants with a positive genetic test were more likely to believe lipid-lowering therapy was highly important (74.3% vs 55.4%; P = 0.05). They were also more likely to strongly agree that a diagnosis of FH was important to them (71.1% vs 46.2%; P = 0.008), and were more likely to recommend genetic screening to their family members (85.9% vs 72.9%; P = 0.04). Conclusions: To our knowledge, this is the first study in Canada to explore the perspectives of patients with FH who underwent genetic testing. These results suggest that genetic testing for FH might offer benefits in important patient-centred outcomes. Résumé: Introduction: L’hypercholestérolémie familiale (HF) est une maladie génétique fréquente qui entraîne des concentrations élevées de cholestérol à lipoprotéines de faible densité et un risque accru de maladies cardiovasculaires athérosclérotiques. L’analyse génétique de l’HF est recommandée, mais n’est pas disponible dans la plupart des régions du Canada. Par conséquent, il existe peu de données sur les expériences des patients ayant subi une analyse génétique. Les objectifs de la présente étude étaient d’enquêter sur les attitudes et les points de vue des patients atteints d’HF qui avaient subi une analyse génétique. Méthodes: Nous avons administré une enquête anonyme en ligne aux participants inscrits dans le registre British Columbia Familial Hypercholesterolemia qui avaient subi une analyse génétique fondée sur la recherche pour l’HF. L’enquête comptait 25 questions et portait sur les expériences des patients sur le processus d’analyse génétique, la volonté de recommander le dépistage génétique et la motivation à abaisser les concentrations de cholestérol. Résultats: Parmi les 183 répondants, 38 (20,7 %) avaient des résultats positifs à l’analyse génétique, 27 (14,8 %) avaient des résultats négatifs et 118 (64,4 %) attendaient leurs résultats. Comparativement aux individus qui attendaient leurs résultats d’analyse, les participants qui avaient des résultats positifs à l’analyse génétique étaient plus susceptibles de penser que le traitement hypolipémiant était très important (74,3 % vs 55,4 %; P = 0,05). Ils étaient aussi plus susceptibles d’être tout à fait d’accord sur le fait que le diagnostic d’HF était important pour eux (71,1 % vs 46,2 %; P = 0,008) et de recommander le dépistage génétique aux membres de leur famille (85,9 % vs 72,9 %; P = 0,04). Conclusions: À notre connaissance, au Canada, c’est la première étude sur les points de vue des patients atteints d’HF qui avaient subi une analyse génétique. Ces résultats indiquent que le dépistage génétique de l’HF pourrait favoriser des résultats importants axés sur le patient.

Context: Approximately 60,000 women in India die annually from cervical cancer. India also has high rates of head and neck cancers (HNCs), with most patients presenting with advanced disease. Uptake of the human papillomavirus (HPV) vaccine, which can prevent both cervical cancer and HNCs, is low in India. Methods and Material: Study setting was Government Medical College, Mysore and it was a Cross-sectional study. Between January to March 2018, a web-based self-administered questionnaire was completed by 498 medical students in Mysore, India. Descriptive statistics were conducted using SPSS. Result: Only 8% of female students and no male students were vaccinated against HPV, and most did not feel susceptible to HPV. Male students were more likely than female students to believe that HPV vaccination can encourage youth to become sexually active (35% vs. 15%; p

This study addresses the following question: For a given managerial, firm, and industry setting, which individual metrics are effective for making marketing-mix decisions that improve perceived performance outcomes? We articulate the key managerial takeaways based on testing a multi-stage behavioral framework that links decision context, metrics selection, and performance outcomes. Our statistical model adjusts for potential endogeneity bias in estimating metric effectiveness due to selection effects and differs from past literature in that managers can strategically choose metrics based on their ex-ante expected effectiveness. The key findings of our analysis of 439 managers making 1287 decisions are that customer-mindset marketing metrics such as awareness and willingness to recommend are the most effective metrics for managers to employ while financial metrics such as target volume and net present value are the least effective. However, relative to financial metrics, managers are more uncertain about the ex-ante effectiveness of customer-mindset marketing metrics, which attenuates their use. A second study on 142 managers helps provide detailed underlying rationale for these key results. The implications of metric effectiveness for dashboards and automated decision systems based on machine learning systems are discussed.

This study aims to determine the influence of in-store promotion in the form of price discount and price package on customer value and purchase intention. The research sample was 120 consumers purchasing the private label products in modern stores using a purposive sampling technique. The data were then analyzed using SEM PLS. The result revealed that all hypotheses were accepted and each variable studied showed a strong and significant influence on each other, especially in terms of its influence on the purchase intention. In-store promotion is a more influencing variable of purchase intention in private label products than customer value. The result also pointed out the three most dominant items forming in-store promotion, customer value, and purchase intention. Those items are the frequency of discount program, the products’ quality, and the reference group that helps the company promoting private label products, usually friends’ recommendation. These findings are expected to be used by decision-makers in retail businesses to formulate in-store promotional activities and create customer value following the target market to increase consumers’ willingness to buy private label products. Acknowledgment The authors would like to express their gratitude to the Doctoral Dissertation Research Grant Program of the Ministry of Research, Technology, and Higher Education for funding this research. The authors highly appreciate the assistance, suggestions, and inputs from both editors and reviewers of this article.

Purpose – The aim of this research was to investigate the relationship between destination loyalty and its determining factors. A central role was attributed to the perception of the destination ethics. Design – Three dimensions of the perceived destination ethics were identified with the potential to influence tourists’ loyalty: the wellbeing of local people, subjective wellbeing and active participation and equality. Methodology – The study is based on a questionnaire targeting international visitors to the city of Quito (Ecuador). A total of 419 returned questionnaires were analysed using the principal component factor analysis to identify the underlying dimensions of the perceived destination ethics and structural equational modelling to measure and test the research hypotheses. Approach – The structural relationship analysis indicates that perceived destination ethics appear to be the principal influence on loyalty, namely the intention to revisit and willingness to recommend. Originality –A pioneering aspect of the research is that it includes the perceived destination ethics as a loyalty predictor, as well as considering the relationship between predictors. The study proves that the perceived destination ethics contributes to tourist loyalty. In the light of the results managerial implications are discussed.

Gamification has been shown to encourage contributions of user-generated reviews (word-of-mouth: WOM) in various domains, including travel and leisure related platforms (Foursquare, TripAdvisor), e-commerce (Amazon), and auctions (eBay). WOM contributors write reviews about products/services provided by business venues and WOM consumers read reviews and use them to form attitudes and make purchase decisions. Gamification elements such as points and badges, awarded to WOM contributors for various reasons, and displayed to WOM consumers, have a dual role in WOM context. First, points awarded for user contributions help motivate WOM contributors to increase their participation. Second, badges awarded to users for visiting business venues signal prior experience or competence, and they help determine how WOM consumers perceive WOM contributors and form their judgments based on the reviews. While the first role of gamification (i.e., motivating users) has been widely studied, the impact of WOM presented along with gamification elements on the perceptions and behavior of the target audience, WOM consumers, has not been examined. This is important to businesses that are looking to attract customers. Drawing on social psychology literature, we show that gamification symbols signaling experience that accompany WOM leads to perceptions of positive WOM contributors as more competent. This leads to important changes in behavioral outcomes such as willingness to visit/buy and willingness to recommend the reviewed outlets.

The present study developed a conceptual research framework for potential predictors of loyalty to intention and loyalty to the action ofinternet service providers. This study examined whether customer loyalty of Indonesia service provider was related to service quality dimensions (namely network quality, customer service, information quality, security, and privacy) by providing empirical evidence of the relationship among there variables. Customer loyaltywas reflected by the indicators of loyalty to intention, loyalty to action, and willingness to recommend to others. This is to fill the research gap generated by the fact that many previous studies have only studied up to the intention phase and/or have jumped to the action phase without looking at the intention phase. A quantitative approach through a questionnaire survey was conducted in primary data collection.Out of 400 internet service provider customers surveyed in this study that collected through internet online survey. The findings and results show: Firstly, network quality directly influences attitudinal loyalty. Secondly, customer service directly influences attitudinal loyalty. Thirdly, information quality directly influences attitudinal loyalty. Fourthly, securityand privacynot only directly influence attitudinal loyalty but also influence behavioral loyalty. Finally, attitudinal loyalty directly influences behavioral loyalty. The contribution to academicians interested in the same research topic was the conceptual model. It contributed to the understanding of the cognition-to action loyalty phase framework, also known as the four-stage loyalty phase framework.

With changing demographics and the potential impact of COVID-19 on enrollment, understanding student satisfaction, student retention, and willingness to recommend a university to prospective studen...

To prevent workplace incivility, scholars encourage organizations to use reference checks to help eliminate uncivil applicants. However, under certain conditions, reference providers may be willing to recommend their rude colleagues for employment. We test this possibility by studying willingness to recommend, which captures a willingness to serve as a professional reference for a colleague. Based on signaling theory, we hypothesized that colleague incivility is negatively related to willingness to recommend, but this relationship is moderated by colleague in-role performance and job-level factors. In study 1, multilevel modeling of multisource data revealed that colleague incivility negatively related to willingness to recommend, but troublingly, this relationship was weaker among colleagues who were high rather than low performers, regardless of job-level moderators. In study 2, we tested whether organizations can intervene and encourage potential reference providers to pay greater attention to incivility. Regression results showed that providers placed greater weight on their colleague’s incivility in relation to willingness to recommend when signals were sent that the hiring organization was unwilling to sacrifice civility for top performance. Our research helps illuminate when incivility instigators are likely to be recommended for employment and demonstrates a way to maximize the use of reference checks for incivility prevention.

Lack of employee engagement and satisfaction and high turnover rate of employees are major problems on some US dairy farms. Farm adoption of human resource management (HRM) practices varies widely. Using feedback from 168 employees from 12 large dairy farms, our objectives were to understand employee perceptions of HRM strengths and weaknesses and their influence on (1) employee satisfaction, (2) retention of employees, (3) willingness of employees to recommend the farm as a place to work, and (4) level of employee engagement on the farm. Employees who rated their employers higher for almost any management-related question (MRQ) were more satisfied in their jobs and more likely to recommend their place of work to other potential employees. Employees reported a higher intention to stay on the farm when employers scored higher on MRQs connected to employer-employee relationships. Employees who rated "Relationships" (a component consisting of 5 MRQs) higher were more likely to have a higher rate of satisfaction, were more likely to intend to stay at their job, and were more likely to recommend their place of work to others. No single management question was positively related to employee engagement (as measured by employees having and sharing ideas to improve the business); however, ethnicity, gender, job role, duration of employment, and employee's self-appraisal of their desire to learn and commitment to the farm were each associated with engagement. Female employees were less likely to provide ideas to their employers (compared with male employees), as were Spanish-speaking employees (compared with English-speaking employees). Differences between Spanish- and English-speaking employees were also present in measures such as intention to stay (shorter) and willingness to recommend the farm as a place to work (higher). Employees who rated themselves higher on their desire to learn and commitment to the farm were more likely to provide ideas to their employers, as were longer-term employees. In conclusion, we inferred that dairy farm management can improve employee retention and engagement through improved use of HRM practices.

This study aimed to assess the knowledge and attitude of medical students toward complementary and alternative medicine. A cross-sectional design was used, in which a total of 319 fourth- to sixth-year medical students at a local university hospital participated in self-administered questionnaires during the academic year of 2018-2019. The questionnaire assessed levels of perceived knowledge, attitude, and willingness to recommend complementary and alternative therapies. It showed that most students (95.6%) have heard of complementary and alternative medicine previously, and 74.6% of students held a positive attitude toward it. The majority had perceived knowledge about nutritional supplements (63.2%), prayer (60.9%), and yoga/meditation (60.9%), but less than 50% had perceived knowledge about other common therapies. Only 8.7% of the participants thought that their current knowledge about complementary and alternative medicine is adequate. Students were willing to recommend therapies that they were most familiar with, namely prayer (82%), massage (74%), and yoga/meditation (72.6%). Most students (60.5%) got their information about complementary and alternative medicine from the university curriculum. Yet, they did not believe that it provided them with adequate information. In conclusion, medical students showed a positive attitude toward complementary and alternative medicine despite their limited perceived knowledge. We recommend incorporating a complementary and alternative medicine course in the medical curricula that focuses on common therapies in Saudi Arabia.

Objective To assess the level of satisfaction of women undergoing transvaginal oocyte retrieval (TOR) without anesthesia as well as the comfort of the gynecologists. Design Single-center, prospective cohort study of women undergoing TOR from July 2017 to January 2018. Setting This study was conducted in an academic public hospital. Patient(s) Women with ≤15 follicles for retrieval were eligible. Women with body mass index > 35, difficult vaginal approach, endometrioma > 5 cm, or pelvic inflammatory disease were excluded. Intervention(s) None. Main Outcome Measure(s) Our primary endpoint was patient satisfaction. Secondary endpoints were women’s willingness to recommend or undergo the procedure again without anesthesia, anxiety levels before the procedure, expected level of pain, actual pain levels during the procedure, and gynecologist’s level of difficulty or technical compromise. Result(s) During the study period, 500 TORs were performed, of which 402 (80%) were screened for study eligibility. Overall, data were analyzed for 50 eligible women who had their first in vitro fertilization cycle (participating in the study) without anesthesia. High rates of satisfaction were reported, and 90% would recommend the procedure without anesthesia to their friends. Physicians graded the difficulty of the procedure as very easy in 35 procedures; in only two procedures was difficulty reported. Conclusion(s) TOR without anesthesia is feasible, with a relatively high satisfaction rate from both patients and gynecologists, suggesting that it should be considered in selected women.

Purpose To evaluate the level of human papilloma virus (HPV)-related knowledge and vaccination willingness of people in Fujian Province, and to explore the factors influencing doctors' recommendation of HPV vaccine. Methods We conducted two cross-sectional surveys in Fujian Province. The study cohort included 248 medical staff and medical students and 1001 community members. Descriptive statistics were used to identify the general demographics of the participants, along with their knowledge and attitudes regarding HPV and vaccination. Analyses were conducted to identify factors associated with willingness to vaccinate and willingness to recommend vaccination. Results The level of HPV knowledge in Fujian province was found to be low, but more than 80% of participants would like to accept HPV vaccine. Medical staff had a higher willingness to recommend HPV vaccine than students (OR= 4.696, CI: 2.698-8.175), which may be related to work experience and acceptance of vaccine price but not to knowledge level. Conclusion Knowledge of HPV in our community population appears to be lower than that in other regions in China. We suggest that a lack of knowledge may not be the main factor affecting the willingness to vaccinate, but we still needed to raise the level of knowledge about HPV to prevent misunderstandings. When the level of knowledge is high, education and per capita household income are not important factors influencing the willingness to vaccinate; only acceptance of vaccine prices significantly affects the willingness to vaccinate. Inclusion of the HPV vaccine in the national immunization program could help to alleviate public concerns regarding the vaccine to change present situation.

BackgroundNurses’ perception towards job satisfaction and willingness to recommend their workplace are relevant to a number of areas including the quality of nursing care delivery. Hence, an increasing number of scholars seek to understand the factors that influence these two concepts. Yet, inclusiveness and openness to innovation are under-investigated.PurposeThe paper focuses on the relative importance that factors like propensity towards innovation, working conditions and inclusion have on nurses’ job satisfaction and their willingness to recommend their workplace.MethodsA large sample of nurses was extracted from the organizational climate survey carried out in all healthcare authorities of nine Italian Regions through the years 2016–2018. Descriptive and multilevel regressions were carried out to investigate the factors that influence nurses’ job satisfaction and their willingness to recommend the hospital in which they work in, analysing both overall and in specific age classes.ResultsWhen recommending a workplace, nurses tend to recommend units showing higher propensity to innovate (OR 2.83), while the most important factor related to job satisfaction is the encouragement after a failure (OR 2.23). Inclusiveness is a key factor for both job satisfaction and willingness to recommend, whilst innovation prone organizations appear to be the most attractive for nurses. The levers mix is slightly different among the age classes. Findings identify the levers to be used in order to attract nurse workforce and increase nurses’ job satisfaction. These levers are partially different for young and senior nurses.

BACKGROUND: Healthcare workers (HCWs) play a key role in the recommendation of HPV vaccination. Our study aimed to understand to what extent a structured health intervention could change the knowledge and attitudes toward HPV and its vaccines among HCWs in Western China. METHODS: This was a multi-center, questionnaire-based interventional study conducted across 12 cities of seven provinces in Western China, from November 2018 to July 2019. Participants were recruited from local health systems by e-invitation. Questionnaires were administered to participants before and after the intervention. RESULTS: A total of 1448 HCWs attended the educational lectures and 1354 participants completed both pre- and post-study questionnaires. In general, HCWs had satisfactory baseline knowledge regarding HPV and its vaccines compared with other populations, and a significantly higher knowledge level was observed after the intervention. However, some more specific knowledge on the vaccination procedures, other HPV-related diseases and whether HPV testing was required before vaccination was relatively poor. Following the educational intervention, the correct responses to the above questions increased (P

The relationship between patient satisfaction with surgical care and their willingness to comply with doctors’ recommendations has not been studied in the country. This study determined the relationship between ambulatory patients’ satisfaction with care and their willingness to adhere to the surgeons’ recommendations in the surgical outpatient clinic (SOPC) of the University Teaching Hospital. This analytical cross-sectional study was conducted among 490 adult respondents at the SOPC selected through a systematic sampling method with a sample interval of 1:2. The short form of the Patient Satisfaction Questionnaire with 7 domains and tool developed for patient willingness to comply with surgeons’ recommendations were used. Descriptive and inferential analyses were performed, and P values of

BACKGROUND: Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians. OBJECTIVE: We examined patients’ views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicians to others. DESIGN: We conducted an online survey of patients in 3 large health systems, June–October 2017. We performed a mixed methods analysis of survey responses regarding a self-selected note. PARTICIPANTS: Respondents were 21,664 patients aged 18 years or older who had read at least 1 open note in the previous 12 months. MAIN MEASURES: We asked to what degree the patient recalled understanding the note, whether it described the visit accurately, whether anything important was missing, for suggestions to improve the note, and whether they would recommend the authoring clinician to others. KEY RESULTS: Nearly all patients (96%) reported they understood all or nearly all of the self-selected note, with few differences by clinician type or specialty. Overall, 93% agreed or somewhat agreed the note accurately described the visit, and 6% reported something important missing from the note. The most common suggestions for improvement related to structure and content, jargon, and accuracy. Patients who reported understanding only some or very little of the note, or found inaccuracies or omissions, were much less likely to recommend the clinician to family and friends. CONCLUSIONS: Patients overwhelmingly report understanding their visit notes and usually find them accurate, with few disparities according to sociodemographic or health characteristics. They have many suggestions for improving their quality, and if they understand a note poorly or find inaccuracies, they often have less confidence in their clinicians.

There has been a fundamental shift in the literature toward recognizing the personal growth capacity of leisure. The aim of this study was to provide an integrated approach to understanding Temples...

PurposeThe use of game-based assessments (GBAs) is growing in selection contexts, yet test-takers have varying reactions to such assessments, which have important implications for applicant behavior. This paper reviews the literature on applicant reactions and explores classic assessment models in the context of GBAs, identifying best practice recommendations and pitfalls for enhancing the candidate experience.Design/methodology/approachA sample of 374 participants from MTurk completed cognitive GBAs and questionnaires regarding test-taker reactions (job-relatedness, perceived opportunity to perform, provision of selection information, face validity, task engagement, task motivation and willingness to refer others to the company), technology self-efficacy, and game/technology experience.FindingsFairness mediated the relationship between procedural justice rules and willingness to recommend the company to others. Technology self-efficacy was significantly related to fairness perceptions and procedural justice perceptions. Males had significantly higher procedural justice perceptions of GBAs than females.Research limitations/implicationsThe study underscores the importance of considering fairness perceptions and individual differences in reactions to GBAs. Future research should study participants within high-stakes hiring situations and examine other individual difference factors such as ethnicity.Practical implicationsGBAs are a viable assessment method for personnel selection, yet organizations must recognize that individuals are more likely to respond positively to GBAs if they perceive such assessments as fair and job-related, and perceive themselves as capable of performing well on the assessment.Originality/valueThis study tests a classic model of procedural fairness in a novel and timely assessment context.

Purpose To assess participants' acceptability of the FOCUS program, a psychoeducational intervention, delivered to multiple patient-caregiver dyads in a small-group format. Participants & setting A total of 72 adults diagnosed with cancer and their caregivers (36 dyads) who participated in 1 of 11 FOCUS programs delivered at two Cancer Support Community affiliates. Methodologic approach A pre-/postintervention design was used to implement the FOCUS program. The FOCUS Satisfaction Instrument measured participants' satisfaction with the program, usefulness of the materials, helpfulness in coping with cancer, duplication of services, willingness to recommend the program to others, and the most and least beneficial aspects. Descriptive statistics, t tests, and content analysis were used. Findings Most participants reported that the program did not duplicate services, that it helped them cope with cancer, and that they would recommend the program to others. The most beneficial aspects of the program were the group format and the dyadic approach. Implications for nursing A group format and dyadic approach to address the psychosocial impact of cancer is highly valued by individuals with cancer and their caregivers. Nurses are well positioned to lead implementation of programs like the FOCUS program that complement other cancer support services.

The rapid increase in the ageing population and health conditions are imposing a higher challenge to the health care system that requires multidisciplinary teamwork utilizing coordinated care approach. This study examined the effects of integrated care model on quality of care received by older hospitalized patients in West Bank. A quantitative interrupted time series design (pretest and posttest multiple time series, quasi-experiment design) was used. The study examined the effects of integrated care model on admitted older patients (n=32) in the West Bank measuring ten dimensions of quality of care and four health indicators. There was a significant improvement in the dimensions of quality of care: dimensions: nurses’ communications with patients, physicians’ communications with patients, staff response to patients’ needs, pain management, explanations on medications, amount of information given on discharge plan, patients' area cleanliness, patients' area quietness, rating of the hospital, and willingness to recommend the hospital. Incidence of falls and incidence of pressure ulcer improved after implementing the model, while readmission rate and average length of stay did not improve. This study contributed to the limited body of knowledge related to the effect of integrated care model on hospitalized older patients’ quality of care in Palestine/ West Bank. Integrated care has the potential to improve care outcomes among hospitalized older patients.