Challenges of a Developmental Idea towards Sustainability

This paper attempts to situate and deconstruct the meanings associated with the term development in the context of the developing world. The arguments made highlights the deeply contested and fragmented terrain of development. The paper provides a historical overview of the changing nature of discourses on development, how the imageries of development have shifted since the postwar period. It deploys diverse meanings associated with development as a concept and as a theory. Thus development without dignity means little for those living in the margins of the society. At the same time the language of development has undergone revolutions and convulsions and the role of buzzwords and catch phrases have only helped to prolong misery in a neoliberal world. Development has become a 'one size fits all' concept shorn of cultural and regional specificities. It has been decontextualised and dehumanised to relate to targets
resulting in greater dissonance than resolution of aim and outcomes. The way forward is a better appreciation of the cultural capacity of the social groups for whom development is critical for survival. The conclusion highlights the endemic contradictions inherent in the meaning and delivery of development as a goal, especially when we seek to achieve resilient and sustainable development.

Keywords: Development, Neoliberalism, growth, participation, empowerment,
efficiency, market, state, societies, entitlements and capabilities, stakeholder, rights, structural adjustments, globalisation, self-help, doing development, freedom and
unfreedom.

Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels

Background
Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients’ adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3).

Methods
We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients’ adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3).

Results
Eight TDF domains were perceived to influence patients’ and HCPs’ behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3).

Conclusions
Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future.

Implications of aligning full registration of doctors with medical school graduation:a qualitative study of stakeholder perspectives

OBJECTIVES: The Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders' views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.

SETTING: Four UK study sites, one in each country.Save

PARTICIPANTS: 185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).

RESULTS: We identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and 'sign off' to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a 'radical review' of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.

CONCLUSIONS: A policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers' decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

Situated regional university incubation: A multi-level stakeholder perspective

From a macro perspective, it is widely acknowledged that University incubation models within a region are important stimulants of economic development through innovation and job creation. With the emergence of quadruple helix innovation ecosystems, universities have had re-evaluate their University incubation activity and models to engage more fully with industry and end users. However, within a given region, the type of University may influence their ability to engage with quadruple helix stakeholders and consequently impact their incubation activity. To date there is a scarcity of research which explores this 'meso' environment and its subsequent impact on University incubation models. Therefore, the aim of this paper is to use a stakeholder lens to explore University Incubation models within unique regional and organisational characteristics and constraints. The research methodology employed was based on a comparative case analysis of incubation of two different Universities within a UK peripheral region. It was found that variances existed in relation to the two universities incubation models which were found to result from both regional (macro environment) and organisational (meso environment) influences (i.e. university type). This research contributes to both regional and national agendas by empirically illustrating the need for appropriate design and tailoring of university incubation models (via acknowledgement of quadruple helix stakeholder influence) to incorporate contextual influences rather than adopting a best practise approach.

IMPLEMENTING BACK PAIN TREATMENT PATHWAYS IN CLINICAL PRACTICE: QUALITATATIVE ANALYSIS OF STAKEHOLDER PERCEPTIONS

Background
Evidence-based practice advocates utilising best current research evidence, while reflecting patient preference and clinical expertise in decision making. Successfully incorporating this evidence into practice is a complex process. Based on recommendations of existing guidelines and systematic evidence reviews conducted using the GRADE approach, treatment pathways for common spinal pain disorders were developed.

Aims
The aim of this study was to identify important potential facilitators to the integration of these pathways into routine clinical practice.

Methods
A 22 person stakeholder group consisting of patient representatives, clinicians, researchers and members of relevant clinical interest groups took part in a series of moderated focus groups, followed up with individual, semi-structured interviews. Data were analysed using content analysis.

Results
Participants identified a number of issues which were categorized into broad themes. Common facilitators to implementation included continual education and synthesis of research evidence which is reflective of everyday practice; as well as the use of clear, unambiguous messages in recommendations. Meeting additional training needs in new or extended areas of practice was also recognized as an important factor. Different stakeholders identified specific areas which could be associated with successful uptake. Patients frequently defined early involvement in a shared decision making process as important. Clinicians identified case based examples and information on important prognostic indicators as useful tools to aiding decisions.

Conclusion
A number of potential implementation strategies were identified. Further work will examine the impact of these and other important factors on the integration of evidence-based treatment recommendations into clinical practice.

Making charity effectiveness transparent: building a stakeholder-focused framework of reporting

Effectiveness in achieving mission is fundamental to evaluating charity performance, and is of central concern to stakeholders who fund, regulate and otherwise engage with such organisations. Exploring the meaning of transparency in the context of stakeholder engagement, and utilising previous research and authoritative sector discussion, this paper develops a novel framework of transparent, stakeholder-focused effectiveness reporting. It is contended that such reporting can assist the charity sector in discharging accountability, gaining legitimacy, and in sharpening mission-centred managerial decision making. Then applying this to UK charities’ publicly-available communications, it highlights significant challenges and weaknesses in current effectiveness reporting.