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Background: The ageing population, coupled with the desire to age-in-place, highlight the need for programs that target health promotion as a means of maintaining functional ability, autonomy, and independence among community-dwelling older adults. This paper describes the development of the VIeSA intervention, which aimed to model a healthy ageing trajectory, including the identification of the necessary tools and methods, that would allow people older people, in partnership with health and social care professionals, to define personal health-related goals and the actions to achieve them. A key element of the intervention development was the creation of a support tool intended to assist this process. Methods: The UK Medical Research Council (MRC) guidance on developing and evaluating complex interventions was applied in the development of the intervention and of the support tool. A participatory approach was selected, with stakeholders engaged on different occasions to allow the refinement of the intervention and of the support tool. Following the steps and suggested actions in the MRC development phase, the development process was conducted by identifying (1) the evidence base and (2) the theoretical framework and (3) by modelling the process and outcomes of the intervention. Results: Following a literature review on effective interventions for functional ability, draft 1 of the support tool was designed. Focus groups with stakeholders provided feedback on this draft allowing for its refinement in terms of content, language use, and structure (draft 2). A review of the approaches for health promotion delivery led to further additions to the tool (draft 3) and informed the content of the training of health and social care professionals. After their training, professionals provided feedback on the acceptability, appropriateness, and feasibility of different elements of the intervention. Results suggested that no further major refinement to the intervention or support tool was necessary. Conclusions: The design and development of the VIeSA intervention using the MRC guidance allowed for a clarity of direction, an optimised content in terms of usefulness and accessibility for all concerned stakeholders, and greater opportunities for its implementation and uptake. [ABSTRACT FROM AUTHOR]

This study focuses on the Skalička Waterwork (SWW), a largely debated and media-covered water-related/flood-protection project in the Czech Republic. Relying primarily on stakeholder interviews, we traced back and reconstructed the project's development, including its key tipping points reflecting the changing societal preferences for particular measures, yet also the involvement of individual actors/stakeholders, and their differing views. The case eventually crystallized into the "dam versus polder" dispute; concerned by the repercussions for the local landscape, a joint initiative of NGOs, local activists, and politicians not only opposed the dam variant proposed by the state river basin administration but also succeeded in pushing through the alternative scheme of side dry polder. While in many ways specific (e.g. not entailing local resistance), the case exemplifies recent shifts (and respective struggles) within flood risk management, including the increasing importance attributed to complex, catchment-wide perspectives, joint local and scientific knowledge, participatory decision-making processes, or implementation of nature-based and hybrid solutions. [ABSTRACT FROM AUTHOR]

This study explores the impact of insurance services and the sustainability of businesses in the Nigerian informal sector. The analysis relies on extant literature sourced from various sources to develop an understanding of the current trends of insurance services in the Nigerian informal sector and develop a suggested model for improved insurance service delivery in the Nigerian informal sector. Findings show that stakeholder commitment is necessary for better impact of insurance services in the sector. The conclusion emphasizes the possibility of business sustainability through consolidated insurance services among stakeholders in the sector. Part of the suggestion for further research is the need for a wider focus on insurance practices both in the formal and informal sectors of the Nigerian economy. This is coupled with an exploratory view on the impact of policy development on insurance support to business activities in the Nigerian informal sector. [ABSTRACT FROM AUTHOR]

Background: Co-design with consumers and healthcare professionals is widely used in applied health research. While this approach appears to be ethically the right thing to do, a rigorous evaluation of its process and impact is frequently missing. Evaluation of research co-design is important to identify areas of improvement in the methods and processes, as well as to determine whether research co-design leads to better outcomes. We aimed to build on current literature to develop a framework to assist researchers with the evaluation of co-design processes and impacts. Methods: A multifaceted, iterative approach, including three steps, was undertaken to develop a Co-design Evaluation Framework: 1) A systematic overview of reviews; 2) Stakeholder panel meetings to discuss and debate findings from the overview of reviews and 3) Consensus meeting with stakeholder panel. The systematic overview of reviews included relevant papers published between 2000 and 2022. OVID (Medline, Embase, PsycINFO), EBSCOhost (Cinahl) and the Cochrane Database of Systematic reviews were searched for papers that reported co-design evaluation or outcomes in health research. Extracted data was inductively analysed and evaluation themes were identified. Review findings were presented to a stakeholder panel, including consumers, healthcare professionals and researchers, to interpret and critique. A consensus meeting, including a nominal group technique, was applied to agree upon the Co-design Evaluation Framework. Results: A total of 51 reviews were included in the systematic overview of reviews. Fifteen evaluation themes were identified and grouped into the following seven clusters: People (within co-design group), group processes, research processes, co-design context, people (outside co-design group), system and sustainment. If evaluation methods were mentioned, they mainly included qualitative data, informal consumer feedback and researchers' reflections. The Co-Design Evaluation Framework used a tree metaphor to represent the processes and people in the co-design group (below-ground), underpinning system- and people-level outcomes beyond the co-design group (above-ground). To evaluate research co-design, researchers may wish to consider any or all components in the tree. Conclusions: The Co-Design Evaluation Framework has been collaboratively developed with various stakeholders to be used prospectively (planning for evaluation), concurrently (making adjustments during the co-design process) and retrospectively (reviewing past co-design efforts to inform future activities). [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to develop and apply a structured approach for prioritising topics for systematic reviews in public health, framed according to the readily applicable PICO format, which encourages the involvement of stakeholders' preferences in a transparent matter. Methods: We developed a multi-stage process, consisting of a scoping and two Delphi stages with web-based surveys and invited public health stakeholders in Switzerland to participate: First, respondents specified topics for different public health domains, which were reformulated in a PICO format by content analysis. Second, respondents rated the topics using five stakeholder-refined assessment criteria. Overall rankings were calculated to assess differences between stakeholder groups and rating criteria. Results: In total, 215 respondents suggested 728 topics altogether. The response rate in the two Delphi stages was 91.6% and 77.6%, respectively. Most top-rated review topics focused on the effectiveness of interventions providing education to different target groups, followed by interventions to increase access to specific healthcare services. Conclusion: Our approach encourages involvement of stakeholders in identifying priorities for systematic reviews and highlights disparities between stakeholders and between individual criteria. [ABSTRACT FROM AUTHOR]

Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined. [ABSTRACT FROM AUTHOR]

Background: Involving the public in evidence synthesis research is challenging due to the highly analytic nature of the projects, so it is important that involvement processes are documented, reflected upon, and shared to devise best practices. There is a literature gap on the involvement of the public in individual participant data meta-analyses, particularly in public health projects. We aimed to document and reflect on our collective experiences of involving and being involved as public stakeholders at all stages of a systematic review and individual participant data meta-analysis project. Methods: We formed a stakeholder group made of four members of the public at the beginning of our evidence synthesis project comprising a systematic review, an aggregate data meta-analysis, and an individual participant data meta-analysis of mindfulness-based programmes for mental health promotion in non-clinical adults. Following each group meeting, members and participating researchers completed written reflections; one group member collected and collated these. At the end of the project, a reflective writing workshop was held before all members completed their final reflections. Everyone completed an adapted, open-ended questionnaire which asked about what did and did not work well, the overall experience, what could be improved, and the felt impact the stakeholder group had on the research. Results: Overall, the stakeholders and researchers reported a positive experience of working together. Positives from the stakeholders' point of view included learning new skills, experiencing research, and making new friends. For the researchers, stakeholders helped them focus on what matters to the public and were reinvigorating research partners. The challenges stakeholders experienced included having long gaps between meetings and feeling overwhelmed. The researchers found it challenging to strike the balance between asking stakeholders to be involved and for them to learn research-related skills without overburdening them and making sure that the learning was engaging. When looking back at their experience, stakeholders described seeing their impact on the project in hindsight but that this was not felt while the project was being carried out. Conclusion: Successfully involving the public in complex evidence synthesis projects is possible and valuable from the points of view of the researchers and the stakeholders. However, it requires a significant time, skill, and resource investment that needs to be factored in from project inception. Further guidance and stakeholder training materials would be helpful. Specific suggestions are provided. [ABSTRACT FROM AUTHOR]

With the alarming rise in intercommunal conflicts worldwide, knowledge regarding post-conflict cultural heritage issues must advance to help formulate effective management systems and policies. Through an Actor-Network Theory-inspired approach, this paper explores the actors’ role in protecting religious heritage sites abandoned by displaced communities. Discourse analysis of relevant literature and empirical data from exhaustive fieldwork documenting and categorising the use-status and preservation state of church sites from Northern Cyprus has revealed multiple networks of human and non-human actors and actants. Through ANT concepts of fact-building and translation, a flat platform has been developed showing the positions and interests of the conflicting parties with a focus on the neglected or underestimated dimensions of heritage protection. This platform allows heritage conservation to be viewed from a broader perspective and, in a sense, helps dilute the conflicting parties’ positions and make their stakes less critical. It also emphasises the importance of compromise solutions, including pragmatically negotiating potential alternative uses and actively integrating the local community with the stakeholder group to protect the heritage of the displaced communities. [ABSTRACT FROM AUTHOR]

Corporate social responsibility (CSR) reporting is a communication channel between companies and stakeholders. As the literature has largely been confined to exploring privately-owned enterprises, state-owned enterprises (SOEs)—a typical example of public sector organizations—warrant further investigation. This study examines SOEs' accountability structures and reporting features, which are dominated by state owners and mainly driven by non-financial objectives. Through a content analysis of the CSR reports of 49 SOEs and 111 non-SOEs in China, we analyze the stakeholders and CSR domains involved in the reporting. The findings demonstrate that SOEs disseminate the full coverage of stakeholders and a wider scope of CSR domains in disclosure. We extend the debate on CSR-reporting research by demonstrating how state ownership influences hybrid organizations' self-expression and accountability frame through our finding of a distinctive specialized sub-organization with strong ties to the state that drives CSR internally. [ABSTRACT FROM AUTHOR]

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Abstract Background The ageing population, coupled with the desire to age-in-place, highlight the need for programs that target health promotion as a means of maintaining functional ability, autonomy, and independence among community-dwelling older adults. This paper describes the development of the VIeSA intervention, which aimed to model a healthy ageing trajectory, including the identification of the necessary tools and methods, that would allow people older people, in partnership with health and social care professionals, to define personal health-related goals and the actions to achieve them. A key element of the intervention development was the creation of a support tool intended to assist this process. Methods The UK Medical Research Council (MRC) guidance on developing and evaluating complex interventions was applied in the development of the intervention and of the support tool. A participatory approach was selected, with stakeholders engaged on different occasions to allow the refinement of the intervention and of the support tool. Following the steps and suggested actions in the MRC development phase, the development process was conducted by identifying (1) the evidence base and (2) the theoretical framework and (3) by modelling the process and outcomes of the intervention. Results Following a literature review on effective interventions for functional ability, draft 1 of the support tool was designed. Focus groups with stakeholders provided feedback on this draft allowing for its refinement in terms of content, language use, and structure (draft 2). A review of the approaches for health promotion delivery led to further additions to the tool (draft 3) and informed the content of the training of health and social care professionals. After their training, professionals provided feedback on the acceptability, appropriateness, and feasibility of different elements of the intervention. Results suggested that no further major refinement to the intervention or support tool was necessary. Conclusions The design and development of the VIeSA intervention using the MRC guidance allowed for a clarity of direction, an optimised content in terms of usefulness and accessibility for all concerned stakeholders, and greater opportunities for its implementation and uptake.

Abstract Background Co-design with consumers and healthcare professionals is widely used in applied health research. While this approach appears to be ethically the right thing to do, a rigorous evaluation of its process and impact is frequently missing. Evaluation of research co-design is important to identify areas of improvement in the methods and processes, as well as to determine whether research co-design leads to better outcomes. We aimed to build on current literature to develop a framework to assist researchers with the evaluation of co-design processes and impacts. Methods A multifaceted, iterative approach, including three steps, was undertaken to develop a Co-design Evaluation Framework: 1) A systematic overview of reviews; 2) Stakeholder panel meetings to discuss and debate findings from the overview of reviews and 3) Consensus meeting with stakeholder panel. The systematic overview of reviews included relevant papers published between 2000 and 2022. OVID (Medline, Embase, PsycINFO), EBSCOhost (Cinahl) and the Cochrane Database of Systematic reviews were searched for papers that reported co-design evaluation or outcomes in health research. Extracted data was inductively analysed and evaluation themes were identified. Review findings were presented to a stakeholder panel, including consumers, healthcare professionals and researchers, to interpret and critique. A consensus meeting, including a nominal group technique, was applied to agree upon the Co-design Evaluation Framework. Results A total of 51 reviews were included in the systematic overview of reviews. Fifteen evaluation themes were identified and grouped into the following seven clusters: People (within co-design group), group processes, research processes, co-design context, people (outside co-design group), system and sustainment. If evaluation methods were mentioned, they mainly included qualitative data, informal consumer feedback and researchers’ reflections. The Co-Design Evaluation Framework used a tree metaphor to represent the processes and people in the co-design group (below-ground), underpinning system- and people-level outcomes beyond the co-design group (above-ground). To evaluate research co-design, researchers may wish to consider any or all components in the tree. Conclusions The Co-Design Evaluation Framework has been collaboratively developed with various stakeholders to be used prospectively (planning for evaluation), concurrently (making adjustments during the co-design process) and retrospectively (reviewing past co-design efforts to inform future activities).

Abstract Background Involving the public in evidence synthesis research is challenging due to the highly analytic nature of the projects, so it is important that involvement processes are documented, reflected upon, and shared to devise best practices. There is a literature gap on the involvement of the public in individual participant data meta-analyses, particularly in public health projects. We aimed to document and reflect on our collective experiences of involving and being involved as public stakeholders at all stages of a systematic review and individual participant data meta-analysis project. Methods We formed a stakeholder group made of four members of the public at the beginning of our evidence synthesis project comprising a systematic review, an aggregate data meta-analysis, and an individual participant data meta-analysis of mindfulness-based programmes for mental health promotion in non-clinical adults. Following each group meeting, members and participating researchers completed written reflections; one group member collected and collated these. At the end of the project, a reflective writing workshop was held before all members completed their final reflections. Everyone completed an adapted, open-ended questionnaire which asked about what did and did not work well, the overall experience, what could be improved, and the felt impact the stakeholder group had on the research. Results Overall, the stakeholders and researchers reported a positive experience of working together. Positives from the stakeholders’ point of view included learning new skills, experiencing research, and making new friends. For the researchers, stakeholders helped them focus on what matters to the public and were reinvigorating research partners. The challenges stakeholders experienced included having long gaps between meetings and feeling overwhelmed. The researchers found it challenging to strike the balance between asking stakeholders to be involved and for them to learn research-related skills without overburdening them and making sure that the learning was engaging. When looking back at their experience, stakeholders described seeing their impact on the project in hindsight but that this was not felt while the project was being carried out. Conclusion Successfully involving the public in complex evidence synthesis projects is possible and valuable from the points of view of the researchers and the stakeholders. However, it requires a significant time, skill, and resource investment that needs to be factored in from project inception. Further guidance and stakeholder training materials would be helpful. Specific suggestions are provided.

Abstract Background Although eMental health interventions are a viable solution to address disparities in access to mental healthcare and increase its efficiency, they still face challenges of implementation. Literature highlights numerous barriers such as diffusion of responsibility and unclear expectations of what implementation entails might hinder this process. While research mostly focuses on analyzing these barriers, there is an urgent need to increase uptake in practice. In turn, commercial companies focus mostly on increasing uptake, while overlooking research outputs. To bridge the gap between research and practice, attention to how implementation occurs in practice is required. This study investigates “Make it Happen” (MiH), the implementation model developed by the eMental Health company Minddistrict, aiming to gain more insight into operationalizing implementation frameworks by 1) describing MiH and its conceptual underpinnings, and 2) gaining lessons learned from the development of MiH. Ultimately, this work aims at improving existing scientific frameworks by extending them with knowledge from practice. Methods First, individual interviews and focus groups with Minddistrict implementation managers were performed. Second, individual interviews with project leads in mental healthcare organizations that were involved in the implementation of Minddistrict were conducted. Within Minddistrict, 7 implementation managers and account managers were involved, in addition to 11 project leads from mental healthcare organizations. Data were elaborated with thematic analysis. Results A comprehensive description of MiH and its 5 main phases was achieved. During the 1) Onboarding phase, implementing organizations are guided by Minddistrict to build a team responsible for implementation, which then 2) designs patient and client journeys, 3) builds, tailors and configures their offer, 4) trains key-users and, 5) evaluates the success of implementation. All participants had extensive and aligned definitions and articulated expectations on implementation. Points of improvement for the model such as role ambiguity and excessive workload were identified. As strengths, internal motivation and good relationships with the provider were valued. Conclusion The present study highlights the importance of clear role division and stakeholder engagement in implementation processes, and suggest that a strong collaboration between companies and academia could optimize implementation efforts and ensure a better fit between humans, context, and technologies.

Abstract Background The European Regulation on Health Technology Assessment (EU HTA R), effective since January 2022, aims to harmonize and improve the efficiency of common HTA across Member States (MS), with a phased implementation from January 2025. At “midterms” of the preparation phase for the implementation of the Regulation our aim was to identify and prioritize tangible action points to move forward. Methods During the 2023 Spring Convention of the European Access Academy (EAA), participants from different nationalities and stakeholder backgrounds discussed readiness and remaining challenges for the Regulation’s implementation and identified and prioritized action points. For this purpose, participants were assigned to four working groups: (i) Health Policy Challenges, (ii) Stakeholder Readiness, (iii) Approach to Uncertainty and (iv) Challenges regarding Methodology. Top four action points for each working group were identified and subsequently ranked by all participants during the final plenary session. Results Overall “readiness” for the Regulation was perceived as neutral. Prioritized action points included the following: Health Policy, i.e. assess adjustability of MS laws and health policy processes; Stakeholders, i.e. capacity building; Uncertainty, i.e. implement HTA guidelines as living documents; Methodology, i.e. clarify the Population, Intervention, Comparator(s), Outcomes (PICO) identification process. Conclusions At “midterms” of the preparation phase, the focus for the months to come is on executing the tangible action points identified at EAA’s Spring Convention. All action points centre around three overarching themes: harmonization and standardization, capacity building and collaboration, uncertainty management and robust data. These themes will ultimately determine the success of the EU HTA R in the long run.

Lyazzat Kulembekova,1 David Hailey,2 Maksut Kulzhanov,1 Adlet Tabarov,3 Svetlin Georgiev,4 Magdalena Jaworzynska,5 Antoniya Yordanova Yanakieva,4 Lyazzat Kosherbayeva1,6 1Health Policy and Management Department, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; 2School of Information Sciences and Computer Technology, University of Wollongong, Wollongong, Australia; 3Deputy Director of the National Center for Health Development, Ministry of Health, Astana, Kazakhstan; 4Department HTA, Faculty of Public Health “prof. Tzecomir Vodenitcharov, MD, PhD, Dsc”, Medical University, Sofia, Bulgaria; 5Faculty of Economics, Maria Curie-Sklodowska University, Lublin, Poland; 6Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, KazakhstanCorrespondence: Lyazzat Kosherbayeva, Asfendiyarov Kazakh National Medical University, 88 Tole Bi Street, Almaty, Kazakhstan, Email lyazzat.k@mail.ru; klk.lyazzat@gmail.comBackground: In recent years, involvement of healthcare stakeholders in health technology assessment (HTA) has been discussed as helping the inclusion of social values in the decision-making process. The aim of our research was to identify and compare details from Kazakhstan, Poland and Bulgaria on their stakeholders’ involvement in the HTA process. Information was sought on their identification, responsibilities, and regulation.Methods: We conducted a survey of seven types of stakeholders in the healthcare systems of Kazakhstan, Poland, and Bulgaria. They included patients and the public, providers, purchasers, payers, policy makers, product makers, and principal investigators. They were questioned on their involvement in the HTA process, and on the objectives of their participation.Results: Levels of involvement of different kinds of stakeholder varied between countries, reflecting political and administrative developments. There was full or partial agreement on the objectives of stakeholder participation. All respondents agreed that representatives of the ministry of health should be involved in selection of stakeholders for HTA.Conclusion: Progress has been made in the involvement of stakeholders, with interest in further development in all three countries.Keywords: health priorities, health policy, stakeholder involvement, Universal health coverage, health technology assessment

Stakeholder involvement and preferences are pivotal in the decision-making process for landscape protection within a specific context. However, many decisions regarding landscape protection options still rely on management choices with little or no consideration of all stakeholders. Previous scholars emphasized the importance of establishing an integrated framework to gain an adequate understanding of the process of stakeholders' decision-making in landscape protection. Therefore, a systematic literature review was conducted on the topic of stakeholders' involvement and preferences in landscape protection decision-making. This review included research articles published from 2013 to 2023 using two databases and registers, namely, Science Direct and Google Scholar. A total of 110 research articles were identified and qualified for review based on the screening requirements, with an additional 15 documents for theories and backgrounds to provide a better understanding and outcomes for the study. The results of this study were organized based on concepts from the resulting research articles and were integrated to propose a conceptual framework for Stakeholders' involvement and preferences in landscape protection. Additionally, this study's findings indicate the significance of incorporating diverse stakeholders and their preferences in landscape protection processes to ensure awareness of inclusivity in decision-making and secure long-term support. [ABSTRACT FROM AUTHOR]

Sandy beaches along the North African Mediterranean coast face significant challenges due to accumulating human-made debris (marine litter) and natural debris (beach wrack). Addressing these issues requires awareness of pollution and the ecological relevance of beach wrack, along with stakeholder involvement. This study quantifies beach litter pollution and identifies sources in Tunisia, Morocco, and Egypt, serving as a basis for ecosystem service assessments and further integration into the implementation of mitigation measures. High levels of plastic litter were found, ranging from 1565 to 7778 pieces per 100 m of beach length. Shoreline activities, tourism, and poor waste management were identified as the main sources of litter, with single-use plastics accounting for 41.1% of the debris. Further objectives include providing a list of suitable ecosystem services and developing management scenarios. Local stakeholders' perceptions of the impact of marine litter and beach wrack on ecosystem services were assessed using a scenario approach and different formats (i.e., stakeholder workshop, interviews, teaching). Stakeholders highlighted the negative impact of marine litter on cultural services, while beach wrack was perceived positively for regulating and maintenance services. This approach enhances awareness, interest, and knowledge in data-scarce regions, serving as a valuable tool for stakeholder engagement, elicitation of stakeholder knowledge, and teaching (i.e., learning tool). Limitations include the subjectivity of the results, limited participant reach, and dependence on stakeholder knowledge. Integrating stakeholder-based ecosystem service assessments into measure planning and decision making is essential for effective litter management and beach conservation efforts. [ABSTRACT FROM AUTHOR]

Background: The European Regulation on Health Technology Assessment (EU HTA R), effective since January 2022, aims to harmonize and improve the efficiency of common HTA across Member States (MS), with a phased implementation from January 2025. At "midterms" of the preparation phase for the implementation of the Regulation our aim was to identify and prioritize tangible action points to move forward. Methods: During the 2023 Spring Convention of the European Access Academy (EAA), participants from different nationalities and stakeholder backgrounds discussed readiness and remaining challenges for the Regulation's implementation and identified and prioritized action points. For this purpose, participants were assigned to four working groups: (i) Health Policy Challenges, (ii) Stakeholder Readiness, (iii) Approach to Uncertainty and (iv) Challenges regarding Methodology. Top four action points for each working group were identified and subsequently ranked by all participants during the final plenary session. Results: Overall "readiness" for the Regulation was perceived as neutral. Prioritized action points included the following: Health Policy, i.e. assess adjustability of MS laws and health policy processes; Stakeholders, i.e. capacity building; Uncertainty, i.e. implement HTA guidelines as living documents; Methodology, i.e. clarify the Population, Intervention, Comparator(s), Outcomes (PICO) identification process. Conclusions: At "midterms" of the preparation phase, the focus for the months to come is on executing the tangible action points identified at EAA's Spring Convention. All action points centre around three overarching themes: harmonization and standardization, capacity building and collaboration, uncertainty management and robust data. These themes will ultimately determine the success of the EU HTA R in the long run. [ABSTRACT FROM AUTHOR]

Through a national cross‐sectional survey, the present study investigated the use and content of injury prevention training (IPT), and associated attitudes and beliefs, involving stakeholders in Danish girls' and women's elite football (U14, U16, U18, and Danish Women's League teams). A total of 168 stakeholders (coaches, physical performance coaches, physiotherapists, medical doctors, and club management) from 18 Danish elite clubs were invited to participate. Of these, 158 were eligible to participate, and 110 participants (69.6% response rate) provided 191 valid survey responses, as some provided more than one response due to multiple affiliations within the same club. The use of IPT ranged from 91.1% to 100% across team levels, with approximately 50% reporting up to 1–2 h/week. Interestingly, only 52.9%–72.7% of the responses indicated use of an evidence‐based IPT program, with lowest adoption at the U14 and Danish Women's League teams. The FIFA 11+ was the most used evidence‐based IPT program. The majority of the participants (>72%) had positive perceptions regarding IPT impact on injury reduction. These findings indicate that, while IPT is broadly used across Danish girls' and women's elite football teams, the implementation of evidence‐based IPT programs varies, with lower adoption of these programs among the youngest and senior elite teams. Hence, there is a need to enhance integration of IPT programs proven effective in girls' and women's elite football. Notably, stakeholders expressed positive perceptions regarding the impact of IPT on injury reduction, which provides valuable support for future efforts to strengthen IPT in football practice. [ABSTRACT FROM AUTHOR]

Background: Although eMental health interventions are a viable solution to address disparities in access to mental healthcare and increase its efficiency, they still face challenges of implementation. Literature highlights numerous barriers such as diffusion of responsibility and unclear expectations of what implementation entails might hinder this process. While research mostly focuses on analyzing these barriers, there is an urgent need to increase uptake in practice. In turn, commercial companies focus mostly on increasing uptake, while overlooking research outputs. To bridge the gap between research and practice, attention to how implementation occurs in practice is required. This study investigates "Make it Happen" (MiH), the implementation model developed by the eMental Health company Minddistrict, aiming to gain more insight into operationalizing implementation frameworks by 1) describing MiH and its conceptual underpinnings, and 2) gaining lessons learned from the development of MiH. Ultimately, this work aims at improving existing scientific frameworks by extending them with knowledge from practice. Methods: First, individual interviews and focus groups with Minddistrict implementation managers were performed. Second, individual interviews with project leads in mental healthcare organizations that were involved in the implementation of Minddistrict were conducted. Within Minddistrict, 7 implementation managers and account managers were involved, in addition to 11 project leads from mental healthcare organizations. Data were elaborated with thematic analysis. Results: A comprehensive description of MiH and its 5 main phases was achieved. During the 1) Onboarding phase, implementing organizations are guided by Minddistrict to build a team responsible for implementation, which then 2) designs patient and client journeys, 3) builds, tailors and configures their offer, 4) trains key-users and, 5) evaluates the success of implementation. All participants had extensive and aligned definitions and articulated expectations on implementation. Points of improvement for the model such as role ambiguity and excessive workload were identified. As strengths, internal motivation and good relationships with the provider were valued. Conclusion: The present study highlights the importance of clear role division and stakeholder engagement in implementation processes, and suggest that a strong collaboration between companies and academia could optimize implementation efforts and ensure a better fit between humans, context, and technologies. [ABSTRACT FROM AUTHOR]

In recent years, responsible leadership (RL) practices have become more common across all types of businesses and in those associated with tourism in particular, characterized by micro and small enterprises (MSEs) and where dependence on the leader is even greater. But this style of leadership needs further theoretical development. One way to advance in this theoretical development is to demonstrate empirically the outcomes of RL. This leadership style goes beyond the leader-employee relationship, impacting all stakeholders and, therefore, interacting with the organizational identity. Therefore, the aim of the present study is to analyze the effect of RL practices on business performance in the restaurant sector, where many companies are micro or small, taking into account the moderating effect of organizational culture (OC). The study is conducted on a sample of 141 MSE restaurants in tourist areas of Spain, with the owner or general manager being the key informant. The results show that RL practices contribute to the improvement of both financial and innovation performance among such businesses. This effect is even greater when the restaurant develops an innovative OC. These results show that the impact of RL on business performance is higher in innovative organizations, linking the theoretical developments around RL and OC. [ABSTRACT FROM AUTHOR]

This study explores the strategies employed by public elementary and secondary schools in Masbate City's Schools Division for effective Brigada Eskwela implementation during the COVID-19 pandemic. Objectives include assessing approaches at different stages, identifying challenges, proposing partnership models, and suggesting a plan of action. Using a mixed-methods design, the study collected quantitative data through surveys and qualitative insights through interviews and focus group discussions. Descriptive statistics, thematic analysis, and weighted mean computation were applied for data analysis. The study reveals robust approaches to Brigada Eskwela across stages, emphasizing detailed planning, stakeholder involvement, and adaptive strategies. Challenges, from resource mobilization to coordination issues, were identified, with pragmatic solutions proposed. Areas showing moderate challenges suggest opportunities for targeted training. While noting the resilience and adaptability of Brigada Eskwela implementation in Masbate City, the study suggests areas for improvement. The proposed partnership sustainability model underscores proactive planning, structured committees, and continuous communication. The plan of action outlines steps for capacity building, technology integration, and strategic partnerships, enhancing the resilience of Brigada Eskwela initiatives. This research provides insights for sustaining community engagement in education during challenging times, offering a blueprint for collaborative and resilient educational communities. [ABSTRACT FROM AUTHOR]

Graphical Abstract

ObjectivesThis study aimed to develop and apply a structured approach for prioritising topics for systematic reviews in public health, framed according to the readily applicable PICO format, which encourages the involvement of stakeholders’ preferences in a transparent matter.MethodsWe developed a multi-stage process, consisting of a scoping and two Delphi stages with web-based surveys and invited public health stakeholders in Switzerland to participate: First, respondents specified topics for different public health domains, which were reformulated in a PICO format by content analysis. Second, respondents rated the topics using five stakeholder-refined assessment criteria. Overall rankings were calculated to assess differences between stakeholder groups and rating criteria.ResultsIn total, 215 respondents suggested 728 topics altogether. The response rate in the two Delphi stages was 91.6% and 77.6%, respectively. Most top-rated review topics focused on the effectiveness of interventions providing education to different target groups, followed by interventions to increase access to specific healthcare services.ConclusionOur approach encourages involvement of stakeholders in identifying priorities for systematic reviews and highlights disparities between stakeholders and between individual criteria.

Szigetköz—a large island of the Danube in Hungary—is attracting a new wave of interest in water-related regional development projects from the public and private sectors alike. The revived interest in the Szigetköz floodplain area, which has historically endured the adverse effects of large-scale water management initiatives, draws attention to the necessity for careful consideration and the active involvement of local stakeholders in the decision-making process.In our research, we conducted various stakeholder engagement activities, including interviews, questionnaires, and workshops. These activities helped define the problems and objectives of each stakeholder group. Through collaborative consultations, we gathered over 100 proposed water related development project ideas. Additionally, to address key issues in project development and selection, we evaluated the integrative potential of each proposed project, considering the number of distinct water management issues it addressed. We also assigned an attitude score to each project, derived from the diverse objectives of various stakeholder groups, and analysed these quantities using a multiple-criteria analysis.This paper details a novel approach to assess and rank the proposed water-related regional development project ideas based on the calculated integrative potential and attitude scores. The goal was to prioritise and further develop these proposed projects to benefit Szigetköz and its surrounding areas.Main results of the study have shown the average project scored between 0.33–0.50 in integrative potential out of a maximum of 1.00 For positive attitude score the average was between 0.28–0.43, out of a maximum of 1.00 while for the negative attitude score the average project scored between -0.14–0.00 out of a minimum of -1.00.The ranking of projects that was based on these scores, highlighted three types of proposed projects that need to be further developed in different ways. The top-ranked positive attitude integrative projects need cost-benefit calculations involving all ecosystem services to justify their economic sustainability. Top-ranked opposing attitude integrative projects need conflict resolution to be socially sustainable. Finally, project ideas that scored low on integrative potential need to be developed to make use of blue-green infrastructure, and circular economical advancements to foster their environmental sustainability.

This article discusses the concept of solar neighborhood planning, which aims to optimize solar energy use in cities through the digitalization of the built environment. The research topic focuses on the design of neighborhoods with high solar accessibility for on-site energy production and daylighting. The article highlights the need for regulations and standards to protect solar access and rights, as well as the importance of combining active and passive solar strategies. It also emphasizes the role of digital tools and stakeholder involvement in the planning process. The article includes several papers that explore different aspects of solar neighborhood planning, such as regulatory frameworks, solar potential estimation, challenges in integrating solar energy in heritage areas, and innovative concepts and applications at various scales. Overall, the research topic aims to promote the implementation of solar energy in urban environments and address the barriers and challenges associated with it. [Extracted from the article]

Abstract Background Stakeholder engagement in evaluation of medical devices is crucial for aligning devices with stakeholders’ views, needs, and values. Methods for these engagements have however not been compared to analyse their relative merits for medical device evaluation. Therefore, we systematically compared these three methods in terms of themes, interaction, and time-investment. Methods We compared focus groups, interviews, and an online survey in a case-study on minimally invasive endoscopy-guided surgery for patients with intracerebral haemorrhage. The focus groups and interviews featured two rounds, one explorative focussing on individual perspectives, and one interactive focussing on the exchange of perspectives between participants. The comparison between methods was made in terms of number and content of themes, how participants interact, and hours invested by all researchers. Results The focus groups generated 34 themes, the interviews 58, and the survey 42. Various improvements for the assessment of the surgical procedure were only discussed in the interviews. In focus groups, participants were inclined to emphasise agreement and support, whereas the interviews consisted of questions and answers. The total time investment for researchers of focus groups was 95 h, of interviews 315 h, and survey 81 h. Conclusions Within the context of medical device evaluation, interviews appeared to be the most appropriate method for understanding stakeholder views since they provide a scope and depth of information that is not generated by other methods. Focus groups were useful to rapidly bring views together. Surveys enabled a quick exploration. Researchers should account for these methodological differences and select the method that is suitable for their research aim.

Objectives: Stakeholder involvement has long been considered a success factor for a joint European health technology assessment (HTA) process, and its relevance is now anchored in the EU HTA Regulation’s (EU HTAR) legislative wording. Therefore, we aimed to explore the roles, challenges, and most important activities to increase the level of involvement per stakeholder group. Methods: At the 2022 Fall Convention of the European Access Academy (EAA), working groups addressed the involvement of patients, clinicians, regulators, health technology developers (HTD), and national HTA bodies and payers within the EU HTA process. Each working group revisited the pre-convention survey results, determined key role characteristics for each stakeholder, and agreed on the most important activities to fulfill the role profile. Finally, the activities suggested per group were prioritized by plenary group. Results: The prioritized actions for patients included training and capacity building, the establishment of a patient involvement committee, and the establishment of a patient unit at the EC secretariat. For clinicians, it included alignment on evidence assessment from a clinical vs. HTA point of view, capacity building, and standardization of processes. The most important actions for regulators are to develop joint regulatory-HTA guidance documents, align processes and interfaces under the regulation, and share discussions on post-licensing evidence generation. HTDs prioritized scientific advice capacity and the review of the scoping process, and further development of the scope of the assessment report fact checks. The top three actions for national HTA bodies and payers included clarification on the early HTD dialogue process, political support and commitment, and clarification on financial support. Conclusions: Addressing the activities identified as the most important for stakeholders/collaborators in the EU HTA process (e.g., in the implementation of the EU HTA Stakeholder Network and of the guidance documents developed by the EUnetHTA 21 consortium) will be key to starting an “inclusive civil society dialogue”, as suggested by the European Commission’s Pharmaceutical Strategy.

Abstract Objective The objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders’ views are involved in the inspection. Methods Based on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data. Results Our findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors’ internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector’s decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector’s lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes. Conclusions and implications Our study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public.

Abstract Background Resilience in healthcare is the capacity to adapt to challenges and changes to maintain high-quality care across system levels. While healthcare system stakeholders such as patients, informal carers, healthcare professionals and service managers have all come to be acknowledged as important co-creators of resilient healthcare, our knowledge and understanding of who, how, and in which contexts different stakeholders come to facilitate and support resilience is still lacking. This study addresses gaps in the research by conducting a stakeholder analysis to identify and categorise the stakeholders that are key to facilitating and sustaining resilience in healthcare, and to investigate stakeholder relationships relevant for the enactment of resilient healthcare systems. Methods The stakeholder analysis was conducted using a sample of 19 empirical research projects. A narrative summary was written for 14 of the projects, based on publicly available material. In addition, 16 individual interviews were undertaken with researchers from the same sample of 19 projects. The 16 interview transcripts and 14 narratives made up the data material of the study. Application of stakeholder analysis methods was done in three steps: a) identification of stakeholders; b) differentiation and categorisation of stakeholders using an interest/influence grid; and c) investigation and mapping of stakeholder relationships using an actor-linkage matrix. Results Identified stakeholders were Patients, Family Carers, Healthcare Professionals, Ward/Unit Managers, Service or Case Managers, Regulatory Investigators, Policy Makers, and Other Service Providers. All identified stakeholders were categorised as either ‘Subjects’, ‘Players’, or ‘Context Setters’ according to their level of interest in and influence on resilient healthcare. Stakeholder relationships were mapped according to the degree and type of contact between the various groups of stakeholders involved in facilitating resilient healthcare, ranging from ‘Not linked’ to ‘Fully linked’. Conclusion Family carers and healthcare professionals were found to be the most active groups of stakeholders in the enactment of healthcare system resilience. Patients, managers, and policy makers also contribute to resilience to various degrees. Relationships between stakeholder groups are largely characterised by communication and coordination, in addition to formal collaborations where diverse actors work together to achieve common goals.

Background: Stakeholder engagement in evaluation of medical devices is crucial for aligning devices with stakeholders' views, needs, and values. Methods for these engagements have however not been compared to analyse their relative merits for medical device evaluation. Therefore, we systematically compared these three methods in terms of themes, interaction, and time-investment. Methods: We compared focus groups, interviews, and an online survey in a case-study on minimally invasive endoscopy-guided surgery for patients with intracerebral haemorrhage. The focus groups and interviews featured two rounds, one explorative focussing on individual perspectives, and one interactive focussing on the exchange of perspectives between participants. The comparison between methods was made in terms of number and content of themes, how participants interact, and hours invested by all researchers. Results: The focus groups generated 34 themes, the interviews 58, and the survey 42. Various improvements for the assessment of the surgical procedure were only discussed in the interviews. In focus groups, participants were inclined to emphasise agreement and support, whereas the interviews consisted of questions and answers. The total time investment for researchers of focus groups was 95 h, of interviews 315 h, and survey 81 h. Conclusions: Within the context of medical device evaluation, interviews appeared to be the most appropriate method for understanding stakeholder views since they provide a scope and depth of information that is not generated by other methods. Focus groups were useful to rapidly bring views together. Surveys enabled a quick exploration. Researchers should account for these methodological differences and select the method that is suitable for their research aim. [ABSTRACT FROM AUTHOR]

AbstractThe objective of this article is to understand relevant stakeholders’ perceptions regarding their needs, values, and design requirements for a mHealth asthma management app. This qualitative study adopted the Value Sensitive Design (VSD) approach. Semi-structured interviews were conducted with seven healthcare professionals and twenty asthma patients as consumers. NVivo 12 software was used to code the interview data for qualitative analysis. The persuasive design system model was used for mapping the identified design requirements. Nine values were identified from this study: Safety, Awareness, Credibility, Usability, Accessibility, Autonomy, Competence, Relatedness, and Connectivity. These values have been translated to 59 design requirements and 19 features of the PSD model were mapped to the identified design requirements. All the identified stakeholders’ values were considered to provide comprehensive support, adding value to the mHealth asthma app’s design features. [ABSTRACT FROM AUTHOR]

Introduction: Often, homecare services are task-focused rather than personbased and fragmented instead of integrated. Consequently, several stakeholders have requested a transformation of the service ecosystem for senior citizens living at home. This transformation may be facilitated by an idealized design approach. However, few studies have applied such an approach. Moreover, previous research did not assess the ways in which the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home. Therefore, the purpose of this study is to gain an understanding of how the existing homecare services correspond with the preferred service ecosystem for senior citizens living at home, according to different stakeholders. Methods: Four stakeholder groups (n = 57) from a Norwegian municipality participated in an interview study (2019--2020): senior citizens, carers, healthcare professionals and managers. A directed qualitative content analysis was applied, guided by a four-category framework for the preferred service ecosystem. Results: All stakeholder groups highlighted several limitations that hindered continuity of the services. There was also agreement on deficiencies in professionals' competence, yet professionals themselves did not focus on this as a significant aspect. Managers emphasised the importance of professionals' reablement competence, which was also considered to be deficient in the current homecare services. Contrary to the other stakeholder groups, most senior citizens seemed satisfied with the practical and social support they received. Together with carers, they also explained why they thought some professionals lack compassion. Their dependency on professionals may limit them in sharing honestly their opinions and preferences during care provision. Involvement of senior citizens in improvement of the current services was limited. Insufficient time and resources, as well as a complex organisation impacted the existing homecare services, and therefore served as barriers to the preferred service ecosystem. Discussion: In this study there were different degrees of correspondence between the existing homecare services and the preferred service ecosystem according to four stakeholder groups. To develop the preferred service ecosystem, aspects such as predictability, adaptivity, and relationships are key, as well as continuous involvement of senior citizens and other stakeholders. The four-category framework applied in this study served as a tool to assess the existing homecare services. [ABSTRACT FROM AUTHOR]

Agri-environmental schemes (AES) are important policy instruments within the Common Agricultural Policy (CAP) of the European Union for environmental protection. Due to the voluntary nature of AES, their attractiveness to farmers and stakeholders involved in nature management and protection (nature managers) is essential for high participation levels. This study aims to assess farmers' and nature managers' ideas to improve agri-environmental schemes. We analyzed suggestions of 825 farmers and 118 nature managers for improvements of AES collected in a large-scale survey in Bavaria, Germany. A content analysis was applied to categorize and compare suggestions by farmers (differentiated into two groups through a cluster analysis) and nature managers. The results reveal that stakeholders were highly willing to share ideas and made detailed suggestions for improvements and individual measures. They were aware of the importance of protecting nature and promoting biodiversity in agricultural landscapes and acknowledged the necessity of (financial) support programs. Farmers placed more emphasis on the practicability and profitability of measures on arable land, while nature managers tended to propose policy-related ideas focusing on nature protection, biodiversity, and specific species. Among farmers, suggestions differed with farm characteristics such as the operation mode (full-time, part-time). These findings can support the design of future AES, accounting for different background situations and thereby increasing acceptability. This includes considering perspectives from different stakeholder groups and creating regionally adapted programs with varying levels of flexibility and practicability. [ABSTRACT FROM AUTHOR]

Objective The objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders’ views are involved in the inspection. Methods Based on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data. Results Our findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors’ internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector’s decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector’s lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes. Conclusions and implications Our study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public. [ABSTRACT FROM AUTHOR]

The ethical guidelines for the American Evaluation Association and the principles of community-based participatory evaluation both state the importance of equitable stakeholder involvement. Regardless of the evaluation approach, however, evaluators are often confronted with gatekeepers, or those who control the access to stakeholders, information, or resources. Gatekeepers limit both the participation of key community members and, therefore, the exchange of relevant information related to the evaluation—a process called gatekeeping. Little research attention has been placed on studying gatekeeping, resulting in a dearth of knowledge about the influence of gatekeeping on stakeholder-engaged evaluations and social-structural dynamics that potentially perpetuate gatekeeping practices. In this article, we propose a gatekeeping influence theory grounded in the findings from 14 interviews. With a constructed theory of gatekeeping, we document the emergent social-structural and relational dynamics involved in stakeholder-engaged evaluation, with a focus on evaluations that include community partners and members. [ABSTRACT FROM AUTHOR]

Objectives: Stakeholder involvement has long been considered a success factor for a joint European health technology assessment (HTA) process, and its relevance is now anchored in the EU HTA Regulation's (EU HTAR) legislative wording. Therefore, we aimed to explore the roles, challenges, and most important activities to increase the level of involvement per stakeholder group. Methods: At the 2022 Fall Convention of the European Access Academy (EAA), working groups addressed the involvement of patients, clinicians, regulators, health technology developers (HTD), and national HTA bodies and payers within the EU HTA process. Each working group revisited the pre-convention survey results, determined key role characteristics for each stakeholder, and agreed on the most important activities to fulfill the role profile. Finally, the activities suggested per group were prioritized by plenary group. Results: The prioritized actions for patients included training and capacity building, the establishment of a patient involvement committee, and the establishment of a patient unit at the EC secretariat. For clinicians, it included alignment on evidence assessment from a clinical vs. HTA point of view, capacity building, and standardization of processes. The most important actions for regulators are to develop joint regulatory-HTA guidance documents, align processes and interfaces under the regulation, and share discussions on post-licensing evidence generation. HTDs prioritized scientific advice capacity and the review of the scoping process, and further development of the scope of the assessment report fact checks. The top three actions for national HTA bodies and payers included clarification on the early HTD dialogue process, political support and commitment, and clarification on financial support. Conclusions: Addressing the activities identified as the most important for stakeholders/collaborators in the EU HTA process (e.g., in the implementation of the EU HTA Stakeholder Network and of the guidance documents developed by the EUnetHTA 21 consortium) will be key to starting an "inclusive civil society dialogue", as suggested by the European Commission's Pharmaceutical Strategy. [ABSTRACT FROM AUTHOR]

Background: The COVID pandemic prompted an increase in the use of digital clinical consultations (telephone or video calls) within midwifery and nursing care. This paper reports on a realist review project related to maternity care that seeks to illuminate for whom such consultations can safely and acceptably be used, how, for what purposes and in what contexts. Aims: This paper addresses the first phase of a realist enquiry – initial programme theory development – focusing particularly on the role of stakeholder involvement (including digital transformation leaders, midwives, obstetricians, service users and community organisations). Methods: Three sub-stages of initial programme theory development are described highlighting the contribution of stakeholder groups to each stage: (i) consultation to focus the review question, (ii) focused searching and (iii) further consultation. Results: Realist literature searching strategies yielded limited theory-rich evidence on digital consultations. Stakeholders provided essential additional contributions resulting in the development of 13 initial programme theories and a conceptual framework. Conclusions: More research on the implementation of virtual midwifery/nursing consultations is needed. Nursing/midwifery digital researchers should involve stakeholders to help shape research priorities, deepen contextual understanding and sense-check emerging findings. [ABSTRACT FROM AUTHOR]

The involvement of stakeholders in large scale urban sustainable development projects (LSUSDP.s) has proven difficult. The stakeholders are distributed across the geographical area, and they have stakes not only in the LSUSDP, but in the geographical location where the project takes place. To understand stakeholder management in "distributed projects", we propose abandoning the "inside-out" perspective where the project is the point of departure, and focus on the emergence of stakeholders across time. Adopting such a performative, "outside-in," perspective on the longitudinal and digital study of a LSUSDP, we are able to map how actors became stakeholders in the project through their actions. The paper makes four contributions. First, we reconceptualize stakeholder involvement by adopting a performative perspective, whereby "stakeholders" are envisaged as emergent and non-fixed. Second, we demonstrate how such a reconceptualization may be applied to the analysis of an empirical case. Third, we show that stakeholder involvement is not merely the result of stakeholder management but something that happens over time, through the material and discursive actions of those that become stakeholders. Finally, the paper contributes with an illustration of how the online, digital footprint, of a project may be useful to understand the emergence of a project. [ABSTRACT FROM AUTHOR]

Air transport is the only way to reach Lithuania from abroad in the short and medium term. Despite a well-developed road network in the country, connections to other European capitals are long and inconvenient. 2014 July. Vilnius, Kaunas and Palanga airports were merged into one state-owned company, Lithuanian Airports (LTOU). Since then, the efficiency and overall profitability of LTOU operations have increased significantly. However, maintaining the airport’s current infrastructure is costly and needs upgrading and further investment. The company has repeatedly asked itself whether it can get more benefits by building one new Lithuanian airport or focusing on developing the existing three airports net. Stakeholders’ views and recommendations should be heard to make timely and appropriate decisions without a new airport’s technical and financial feasibility. An in-depth interview and secondary data analysis were selected for the empirical study. Thirteen employees of SE Lithuanian Airports and three of the Ministry of Transport and Communications of the Republic of Lithuania participated in the research. The following was used to analyse secondary data: SE Lithuanian Airport strategic plan, the material of strategic sessions, and a survey of the country’s population on the need for a new airport. The study found that stakeholders positively assess the long-term development projects of SE Lithuanian Airports, fully understanding the importance of airports and their contribution to the welfare of the state. Stakeholders can significantly impact results, so airport managers must consider whether they effectively involve stakeholders and, if not, how they can improve or encourage stakeholder involvement.

The quality of community decisions about the key characteristics of urban services depends on the level of involvement of local stakeholder groups. The identification of the environmental, economic and social impacts of investments to improve urban services is a critical aspect of the decision preparation phase. Assessment of the main stakeholder groups being affected by the impacts of urban services is required to understand what kind of problems they perceive. Based on their demand, different solutions can be provided to create an Information and Communication Technology (ICT) software system to facilitate environmental cooperations. The aim of this research is to propose an ICT system to support citizens’ active involvement in the transformation of the environment with access to essential information, and enable them to make more effective decisions about the investments. Most of the features of the proposed system have the potential to support eco-effective environmental policy implementations and form part of a sustainable policy toolkit. We explore the different interests and what functions should be provided to make access to information easier and more integrated. Our proposed conceptual framework would fulfill the requirements and gives practical examples how to increase eco-efficiency of products, technologies or investments in urban areas.

The second edition of the practical guide for evidence-informed deliberative processes (EDPs) is an important addition to the growing guidance on deliberative processes supporting priority setting in healthcare. While the practical guide draws on an extensive amount of information collected on established and developing processes within a range of countries, EDPs present health technology assessment (HTA) bodies with several challenges. (1) Basing recommendations on current processes that have not been well-evaluated and that have changed over time may lead to weaker legitimacy than desired. (2) The requirement for social learning among stakeholders may require increased resourcing and blur the boundary between moral deliberation and political negotiation. (3) Robust evaluation should be based on an explicit theory of change, and some process outcomes may be poor guides to overall improvement of EDPs. This comment clarifies and reinforces the recommendations provided in the practical guide.

Abstract Background Although stakeholder involvement in policymaking is attracting attention in the fields of medicine and healthcare, a practical methodology has not yet been established. Rare-disease policy, specifically research priority setting for the allocation of limited research resources, is an area where evidence generation through stakeholder involvement is expected to be effective. We generated evidence for rare-disease policymaking through stakeholder involvement and explored effective collaboration among stakeholders. Methods We constructed a space called ‘Evidence-generating Commons’, where patients, family members, researchers, and former policymakers can share their knowledge and experiences and engage in continual deliberations on evidence generation. Ten rare diseases were consequently represented. In the ‘Commons’, 25 consecutive workshops were held predominantly online, from 2019 to 2021. These workshops focused on (1) clarification of difficulties faced by rare-disease patients, (2) development and selection of criteria for priority setting, and (3) priority setting through the application of the criteria. For the first step, an on-site workshop using sticky notes was held. The data were analysed based on KJ method. For the second and third steps, workshops on specific themes were held to build consensus. The workshop agendas and methods were modified based on participants’ feedback. Results The ‘Commons’ was established with 43 participants, resulting in positive effects such as capacity building, opportunities for interactions, mutual understanding, and empathy among the participants. The difficulties faced by patients with rare diseases were classified into 10 categories. Seven research topics were identified as priority issues to be addressed including ‘impediments to daily life’, ‘financial burden’, ‘anxiety’, and ‘burden of hospital visits’. This was performed by synthesising the results of the application of the two criteria that were particularly important to strengthen future research on rare diseases. We also clarified high-priority research topics by using criteria valued more by patients and family members than by researchers and former policymakers, and criteria with specific perspectives. Conclusion We generated evidence for policymaking in the field of rare diseases. This study’s insights into stakeholder involvement can enhance evidence-informed policymaking. We engaged in comprehensive discussions with policymakers regarding policy implementation and planned analysis of the participants’ experiences in this project.