The Legitimacy Process that Supports the Formation and Development of Cluster Initiatives : The Case of a Tourism Cluster Initiative in Dalarna

Today, large public investments are being made with the aim of creating and developing cooperation between businesses in inter-organizational networks. Such initiatives are commonly denoted cluster initiatives and their underlying purpose are to spur innovation and regional growth. Much research has been conducted in this field, but relatively few studies have examined the process of cluster initiatives. By following the case of a regional cluster project within the tourism industry in the region of Dalarna, Sweden, the objective of this thesis is to deepen the understanding of the formation and development process of cluster initiatives. The investigation has been conducted by examining two main themes; the internal relationships within the cluster initiative and the relationships between the cluster initiative and its external stakeholders, such as funding agencies, regional government and local businesses. The analysis is based on a legitimacy perspective and indicates that the coordinating body of the cluster initiative, the hub, principally deals with a legitimation process. What occurs within the cluster initiative, between the members themselves and between the members and the hub, is legitimation. This also applies to external relationships, between the hub and its external stakeholders. A prerequisite for the realization of its mission is that the hub obtain and sustain legitimacy; legitimacy for itself, for the other members, for the idea, for the different activities and for the industry as such.

Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.