Effect of facilitation of local maternal-and-newborn stakeholder groups on neonatal mortality : cluster-randomized controlled trial

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712. Please see later in the article for the Editors' Summary.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

Bonusar : Mot ett långsiktigt tänkande

Background: The background explains different financial crises and the effect those crises had on the Swedish acquits regarding variable compensation. The resent discussion regarding variable compensation and the main problems with bonuses is also explained. Our theories for this essay is mainly based on the new directions from Finansinspektionen FFFS 2009:6,7 and stakeholder theory. Other theories used are agency theory, stewardship theory and economic man.Purpose: The purpose of this essay is to analyze the new directions for variable compensation and to investigate if these new directions can lead to a more long-term thinking for managers in banks. Method:We used semi-structured interviews with open questions for our survey. During the survey we conducted three personal interviews and one mail interview, respondents represented the stakeholder groups: stakeholder, stakewatcher and stakekeeper. Conclusion: During our survey we found that the directions from Finansinspektionen are still on an early stage and it has been hard to analyze their effects. But it has been shown that the banks experience some difficulty in identifying their risk takers. In our investigation we have found that the new directions can be a step towards a more long-term thinking but it requires the management to change the point of view regarding bonuses.

Factors influencing tourism sustainability : The case of the World Heritage Falun Great Copper Mountain

This thesis focuses on identifying hindrances of achieving a sustainable tourism development on a base of a World Heritage Site. Using a case study of the World Heritage Site Falun Great Copper Mountain, the thesis assesses the situational context by using qualitative methods. Five semi- structured interviews with influential stakeholders were conducted to get an inside view of the current situation and to identify site-specific issues. The thesis identifies a number of factors that determine the successful implementation of measures leading towards sustainable tourism in the long-run; the most important being the lack of clear guidelines for the whole destination and no holistic planning approach within the municipality. The thesis concludes that despite the increased pressures towards establishment of sustainable tourism, the concept remains challenging to operationalize for the World Heritage Site without frameworks and tools from UNESCO.

Reglerad miljöredovisning : Tillståndspliktiga företag i Dalarna 2013

Bakgrund: De verksamheter som bedriver miljöfarlig verksamhet enligt miljöbalkenär anmälnings- eller tillståndspliktiga. Dessa företag ska lämnamiljöinformation i förvaltningsberättelsen. Tidigare studier visar attföretagen inte följer denna regel fullt ut. Som förklaring till företagensval av att miljöredovisa eller att inte redovisa sin miljöpåverkan användervi oss av legitimitetsteorin och intressentteorin.Syfte: Syftet med undersökningen är att för år 2013 se hur väl detillståndspliktiga företagen i Dalarna följer lagen om miljöredovisningoch vilka faktorer som kan förklara deras tillämpning av lagen.Metod: Studien bygger huvudsakligen på kvantitativ metod med inslag avkvalitativ metod. Vi använder en deduktiv ansats för att skapa fyrahypoteser om omsättning, branschtillhörighet, revisionsbyrå ochskuldsättningsgrad. Urvalet är de tillståndspliktiga företagen i Dalarna.Varje företag kan ha flera enheter som är tillståndspliktiga och vårt urval,Dalarna, blir 209 enheter varav 116 är stora enheter.Slutsats: Företagen i Dalarna uppfyller inte lagen om reglerad miljöredovisning tillfullo. Endast 18 av 116 stora enheter uppfyller alla fyra punkterna.Däremot är det 61,2 procent av de stora enheterna som får tre poäng.Som en jämförelse med Ljungdahls studie där nästan 27 procent når trepoäng ser vi en klar förbättring. De faktorer som kan förklara företagenstillämpning av lagen i vår undersökning är omsättning, de som anlitarrevisionsbyrån PwC samt branschtillhörighet avlopp och avfall. Av defyra hypoteser som vi använder är det en som stämmer, två som förkastasoch en som vi inte med säkerhet kan avgöra om den ska vara kvar ellerförkastas.

A framework for ICT-based knowledge sharing in sustainable rural development : the case of Gilgit-Baltistan, Pakistan

Some 50% of the people in the world live in rural areas, often under harsh conditions and in poverty. The need for knowledge of how to improve living conditions is well documented. In response to this need, new knowledge of how to improve living conditions in rural areas and elsewhere is continuously being developed by researchers and practitioners around the world. People in rural areas, in particular, would certainly benefit from being able to share relevant knowledge with each other, as well as with stakeholders (e.g. researchers) and other organizations (e.g. NGOs). Central to knowledge management is the idea of knowledge sharing. This study is based on the assumption that knowledge management can support sustainable development in rural and remote regions. It aims to present a framework for knowledge management in sustainable rural development, and an inventory of existing frameworks for that. The study is interpretive, with interviews as the primary source for the inventory of stakeholders, knowledge categories and Information and Communications Technology (ICT) infrastructure. For the inventory of frameworks, a literature study was carried out. The result is a categorization of the stakeholders who act as producers and beneficiaries of explicit and indigenous development knowledge. Stakeholders are local government, local population, academia, NGOs, civil society and donor agencies. Furthermore, the study presents a categorization of the development knowledge produced by the stakeholders together with specifications for the existing ICT infrastructure. Rural development categories found are research, funding, agriculture, ICT, gender, institutional development, local infrastructure development, and marketing & enterprise. Finally, a compiled framework is presented, and it is based on ten existing frameworks for rural development that were found in the literature study, and the empirical findings of the Gilgit-Baltistan case. Our proposed framework is divided in four levels where level one consists of the identified stakeholders, level two consists of rural development categories, level three of the knowledge management system and level four of sustainable rural development based on the levels below. In the proposed framework we claim that the sustainability of rural development can be achieved through a knowledge society in which knowledge of the rural development process is shared among all relevant stakeholders.

Modeling and illustrating requirement prioritization in public e-service development from a value-based perspective

A major problem in e-service development is the prioritization of the requirements of different stakeholders. The main stakeholders are governments and their citizens, all of whom have different and sometimes conflicting requirements. In this paper, the prioritization problem is addressed by combining a value-based approach with an illustration technique. This paper examines the following research question: How can multiple stakeholder requirements be illustrated from a value-based perspective in order to be prioritizable? We used an e-service development case taken from a Swedish municipality to elaborate on our approach. Our contributions are: 1) a model of the relevant domains for requirement prioritization for government, citizens, technology, finances and laws and regulations; and 2) a requirement fulfillment analysis tool (RFA) that consists of a requirement-goal-value matrix (RGV), and a calculation and illustration module (CIM). The model reduces cognitive load, helps developers to focus on value fulfillment in e-service development and supports them in the formulation of requirements. It also offers an input to public policy makers, should they aim to target values in the design of e-services.

Student Thesis Level: Master’s Thesis in Business Administration Corporate Social Responsibility (CSR) networking : A case study on why members join CSR network and why are they sharing their knowledge

Purpose – This research focuses on finding the reasons, why members from different sectors join a cross-sector/multi-stakeholder CSR network and what motivates them to share (or not to share) their knowledge of CSR and their best practices. Design/methodology/approach – Semi-structured interviews were conducted with members of the largest cross-sector CSR network in Sweden. The sample base of 15 people was chosen to be able to represent a wider variety of members from each participating sectors. As well as the CEO of the intermediary organization was interviewed. The interviews were conducted via email and telephone. Findings – The findings include several reasons linked to the business case of CSR such as stakeholder pressure, competitive advantage, legitimacy and reputation as well as new reasons like the importance of CSR, and the access of further knowledge in the field. Further reasons are in line with members wanting to join a network, such as access to contact or having personal contacts. As to why members are sharing their CSR knowledge, the findings indicate to inspire others, to show CSR commitment, to be visible, it leads to business opportunity and the access of others knowledge, and because it was requested. Reasons for not sharing their knowledge would be the lack of opportunity, lack of time and the lack of experience to do so. Originality/value – The research contributes to existing studies, which focused on Corporate Social Responsibility and cross-sector networking as well as to inter-organizational knowledge sharing in the field of CSR.

Identity and image – the story of expertise in a manufacturing company

This thesis is an investigation on the corporate identity of the firm SSAB from a managerial viewpoint (1), the company communication through press releases (2), and the image of the company as portrayed in news press articles (3). The managerial view of the corporate identity is researched through interviews with a communication manager of SSAB (1), the corporate communication is researched through press releases from the company (2) and the image is researched in news press articles (3). The results have been deducted using content analysis. The three dimensions are compared in order to see if the topics are coherent. This work builds on earlier research in corporate identity and image research, stakeholder theory, corporate communication and media reputation theory. This is interesting to research as the image of the company framed by the media affects, among other things, the possibility for the company to attract new talent and employees. If there are different stories, or topics, told in the three dimensions then the future employees may not share the view of the company with the managers in it. The analysis show that there is a discrepancy between the topics on the three dimensions, both between the corporate identity and the communication through press releases, as well as between the communication through press releases and the image in news press articles.

Exploring the influence of context in a community-based facilitation intervention focusing on neonatal health and survival in Vietnam : a qualitative study

Background In the Neonatal health – Knowledge into Practice (NeoKIP) trial in Vietnam, local stakeholder groups, supported by trained laywomen acting as facilitators, promoted knowledge translation (KT) resulting in decreased neonatal mortality. In general, as well as in the community-based NeoKIP trial, there is a need to further understand how context influences KT interventions in low- and middle-income countries (LMICs). Thus, the objective of this study was to explore the influence of context on the facilitation process in the NeoKIP intervention. Methods A secondary content analysis was performed on 16 Focus Group Discussions with facilitators and participants of the stakeholder groups, applying an inductive approach to the content on context through naïve understanding and structured analysis. Results The three main-categories of context found to influence the facilitation process in the NeoKIP intervention were: (1) Support and collaboration of local authorities and other communal stakeholders; (2) Incentives to, and motivation of, participants; and (3) Low health care coverage and utilization. In particular, the role of local authorities in a KT intervention was recognized as important. Also, while project participants expected financial incentives, non-financial benefits such as individual learning were considered to balance the lack of reimbursement in the NeoKIP intervention. Further, project participants recognized the need to acknowledge the needs of disadvantaged groups. Conclusions This study provides insight for further understanding of the influence of contextual aspects to improve effects of a KT intervention in Vietnam. We suggest that future KT interventions should apply strategies to improve local authorities’ engagement, to identify and communicate non-financial incentives, and to make disadvantaged groups a priority. Further studies to evaluate the contextual aspects in KT interventions in LMICs are also needed.