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Journal of Health Organization and... Feb 2024In this viewpoint article, the authors recognize the increased focus in health systems on co-design for innovation and change. This article explores the role of leaders...
PURPOSE
In this viewpoint article, the authors recognize the increased focus in health systems on co-design for innovation and change. This article explores the role of leaders and mangers in developing and enhancing a culture of trust in their organizations to enable co-design, with the potential to drive innovation and change in healthcare.
DESIGN/METHODOLOGY/APPROACH
Using social science analyses, the authors argue that current co-design literature has limited focus on interactions between senior leaders and managers, and healthcare staff and service users in supporting co-designed innovation and change. The authors draw on social and health science studies of trust to highlight how the value-based co-design process needs to be supported and enhanced. We outline what co-design innovation and change involve in a health system, conceptualize trust and reflect on its importance within the health system, and finally note the role of senior leaders and managers in supporting trust and responsiveness for co-designed innovation and change.
FINDINGS
Healthcare needs leaders and managers to embrace co-design that drives innovation now and in the future through people - leading to better healthcare for society at large. As authors we argue that it is now the time to shift our focus on the role of senior managers and leaders to embed co-design into health and social care structures, through creating and nurturing a culture of trust.
ORIGINALITY/VALUE
Building public trust in the health system and interpersonal trust within the health system is an ongoing process that relies upon personal behavior of managers and senior leaders, organizational practices within the system, as well as political processes that underpin these practices. By implementing managerial, leadership and individual practices on all levels, senior managers and leaders provide a mechanism to increase both trust and responsiveness for co-design that supports innovation and change in the health system.
Topics: Humans; Trust; Health Facilities; Leadership; Social Support
PubMed: 38448232
DOI: 10.1108/JHOM-07-2023-0207 -
The European Journal of Health... Apr 2024Studies report an unexplained variation in physicians' care. This variation may to some extent be explained by differences in their work motivation. However, empirical...
Studies report an unexplained variation in physicians' care. This variation may to some extent be explained by differences in their work motivation. However, empirical evidence on the link between physician motivation and care is scarce. We estimate the associations between different types of work motivation and care. Motivation is measured using validated questions from a nation-wide survey of Danish general practices and linked to high-quality register data on their care in 2019. Using a series of regression models, we find that more financially motivated practices generate more fee-for-services per patient, whereas practices characterised by greater altruistic motivation towards the patient serve a larger share of high-need patients and issue more prescriptions for antibiotics per patient. Practices with higher altruism towards society generate lower medication costs per patient and prescribe a higher rate of narrow-spectrum penicillin, thereby reducing the risk of antimicrobial resistance in the population. Together, our results suggest that practices' motivation is associated with several dimensions of healthcare, and that both their financial motivation and altruism towards patients and society play a role. Policymakers should, therefore, consider targeting all provider motivations when introducing organisational changes and incentive schemes; for example, by paying physicians to adhere to clinical guidelines, while at the same time clearly communicating the guidelines' value from both a patient and societal perspective.
Topics: Humans; Motivation; Physicians; Delivery of Health Care
PubMed: 37353668
DOI: 10.1007/s10198-023-01605-7 -
Journal of Biomedical Informatics Aug 2023Physical inactivity is a leading modifiable cause of death and disease worldwide. Population-based interventions to increase physical activity are needed. Existing...
Increasing physical activity using an just-in-time adaptive digital assistant supported by machine learning: A novel approach for hyper-personalised mHealth interventions.
OBJECTIVE
Physical inactivity is a leading modifiable cause of death and disease worldwide. Population-based interventions to increase physical activity are needed. Existing automated expert systems (e.g., computer-tailored interventions) have significant limitations that result in low long-term effectiveness. Therefore, innovative approaches are needed. This special communication aims to describe and discuss a novel mHealth intervention approach that proactively offers participants with hyper-personalised intervention content adjusted in real-time.
METHODS
Using machine learning approaches, we propose a novel physical activity intervention approach that can learn and adapt in real-time to achieve high levels of personalisation and user engagement, underpinned by a likeable digital assistant. It will consist of three major components: (1) conversations: to increase user's knowledge on a wide range of activity-related topics underpinned by Natural Language Processing; (2) nudge engine: to provide users with hyper-personalised cues to action underpinned by reinforcement learning (i.e., contextual bandit) and integrating real-time data from activity tracking, GPS, GIS, weather, and user provided data; (3) Q&A: to facilitate users asking any physical activity related questions underpinned by generative AI (e.g., ChatGPT, Bard) for content generation.
RESULTS
The detailed concept of the proposed physical activity intervention platform demonstrates the practical application of a just-in-time adaptive intervention applying various machine learning techniques to deliver a hyper-personalised physical activity intervention in an engaging way. Compared to traditional interventions, the novel platform is expected to show potential for increased user engagement and long-term effectiveness due to: (1) using new variables to personalise content (e.g., GPS, weather), (2) providing behavioural support at the right time in real-time, (3) implementing an engaging digital assistant and (4) improving the relevance of content through applying machine learning algorithms.
CONCLUSION
The use of machine learning is on the rise in every aspect of today's society, however few attempts have been undertaken to harness its potential to achieve health behaviour change. By sharing our intervention concept, we contribute to the ongoing dialogue on creating effective methods for promoting health and well-being in the informatics research community. Future research should focus on refining these techniques and evaluating their effectiveness in controlled and real-world circumstances.
Topics: Humans; Exercise; Health Behavior; Telemedicine; Machine Learning; Algorithms
PubMed: 37394024
DOI: 10.1016/j.jbi.2023.104435 -
Archives of Sexual Behavior Jan 2024Persons who have renounced a prior transgender identification, often after some degree of social and medical transition, are increasingly visible. We recruited 78 US...
Persons who have renounced a prior transgender identification, often after some degree of social and medical transition, are increasingly visible. We recruited 78 US individuals ages 18-33 years who previously identified as transgender and had stopped identifying as transgender at least six months prior. On average, participants first identified as transgender at 17.1 years of age and had done so for 5.4 years at the time of their participation. Most (83%) participants had taken several steps toward social transition and 68% had taken at least one medical step. By retrospective reports, fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. In contrast, 53% of participants believed that "rapid-onset gender dysphoria" applied to them. Participants reported a high rate of psychiatric diagnoses, with many of these prior to trans-identification. Most participants (N = 71, 91%) were natal females. Females (43%) were more likely than males (0%) to be exclusively homosexual. Participants reported that their psychological health had improved dramatically since detransition/desistance, with marked decreases in self-harm and gender dysphoria and marked increases in flourishing. The most common reason given for initial trans-identification was confusing mental health issues or reactions to trauma for gender dysphoria. Reasons for detransition were more likely to reflect internal changes (e.g., the participants' own thought processes) than external pressures (e.g., pressure from family). Results suggest that, for some transgender individuals, detransition is both possible and beneficial.
Topics: Male; Female; Humans; Young Adult; Retrospective Studies; Transsexualism; Transgender Persons; Mental Health; Sexual and Gender Minorities; Gender Dysphoria; Gender Identity
PubMed: 38038854
DOI: 10.1007/s10508-023-02716-1 -
Animal Cognition Feb 2024Personality traits drive individual differences in behaviour that are consistent across time and context. Personality limits behavioural plasticity, which could lead to...
Personality traits drive individual differences in behaviour that are consistent across time and context. Personality limits behavioural plasticity, which could lead to maladaptive choices if animals cannot adapt their behavior to changing conditions. Here, we assessed consistency and flexibility in one personality trait, boldness, across non-social and social contexts in eastern gartersnakes (Thamnophis sirtalis sirtalis). Snakes explored a novel open arena either alone or in a pair. Pairs were assigned based on the data from the solo trials, such that each snake was paired once with a bolder and once with a less bold partner. We predicted that snakes would conform when in a social context, displaying plasticity in their personality, and causing boldness scores to converge. We found that snakes were consistent within contexts (solo or paired), but changed their behavior across contexts (from solo to paired). Plasticity in boldness resulted from an interaction between conformity and repeatable individual differences in plasticity. In line with some data on other species, snakes conformed more when they were the less bold partner. Personality reflects a consistent bias in decision-making, but our results highlight that the cognitive processes that drive the expression of personality traits in behavior are flexible and sensitive to social context. We show that both consistency and plasticity combine to shape snake social behavior in ways that are responsive to competition. This pattern of behavior may be particularly beneficial for species in which group-living is seasonal.
Topics: Animals; Social Behavior; Personality; Individuality; Social Environment; Colubridae
PubMed: 38386147
DOI: 10.1007/s10071-024-01859-5 -
BMC Psychology Apr 2024Global climate change is recognized as a major and irreversible challenge for humanity, requiring people's responsible and sustainable behaviors toward the environment....
BACKGROUND
Global climate change is recognized as a major and irreversible challenge for humanity, requiring people's responsible and sustainable behaviors toward the environment. So far, the literature has widely investigated the role of cognitive determinants of ecological outcomes (e.g., pro-environmental behaviors and climate change perception), while less attention has been devoted to emotional processes, such as trait emotional intelligence (TEI). The current double study investigates whether TEI is directly and indirectly associated with climate change perception (CCP, Study 1) and pro-environmental behaviors (PEBs, Study 2) among young adults. Furthermore, the mediating role of connectedness to nature (CN), both as cognitive and emotional factors, was also analyzed. We hypothesized that CN (i.e., cognitive mediator) would positively mediate the relationship between TEI and CCP (H1), and Love and Care for Nature (LCN, i.e., emotional mediator) would positively mediate the relationship between TEI and PEBs (H2).
METHODS
The study involved 342 young adults (F = 60.7%; age 19-40; M=22.99; SD = 2.66) in Study 1 and 365 young adults (F = 71.2%; age 17-35; M=22.2; SD = 3.98) in Study 2. Data were collected through an online tool shared by the snowball method. We administered the following self-reports: Trait Emotional Intelligence Questionnaire- Short Form (TEIQue- SF), Global Climate Change (GCC), and Connectedness to Nature Scale (CNS) (Study 1); Trait Emotional Intelligence Questionnaire- Short Form (TEIQue-SF), General Environmental Behaviors Scale (GEB), and Love and Care for Nature (LCN) (Study 2).
RESULTS
Findings from Study 1 showed that higher TEI levels enhance CN (i.e., cognitive mediator), positively influencing CCP (estimate = 0.14; 95% CI = 0.07 to 0.23). Findings from Study 2 showed that higher TEI levels are associated with higher LCN levels (i.e., emotional mediator), influencing people's engagement in PEBs (estimate = 0.7; 95% CI = 0.03 to 0.11).
CONCLUSION
It is crucial to design environmental education programs that promote greater emotional intelligence ability and encourage individuals' involvement in ecological outcomes.
Topics: Young Adult; Humans; Adult; Adolescent; Emotions; Love; Climate Change; Emotional Intelligence
PubMed: 38609991
DOI: 10.1186/s40359-024-01679-9 -
BMC Public Health Feb 2024In occupational health, the maintenance and promotion of workers' health, especially lifestyle motivation-based interventions, have gained considerable attention and are...
BACKGROUND
In occupational health, the maintenance and promotion of workers' health, especially lifestyle motivation-based interventions, have gained considerable attention and are actively implemented. Motivational theories include self-determination theory, and some studies focus on healthy lifestyles. However, the effectiveness of health promotion interventions varies depending on the health awareness and motivation of the participants. Therefore, this study aimed to clarify the processes by which workers are motivated to improve their health and to identify the need for and type of support according to their motivation.
METHODS
Using a mixed-research design, an initial questionnaire survey of 94 employees (mean age = 40.97 ± 9.65) at a multicenter company in Japan, followed by semi-structured interviews with 16 employees (mean age = 40.13 ± 9.45) from the high- and low-motivation groups, were conducted. Multiple regression analysis followed by modified grounded theory-based analysis of the results of the first stage was used and the quantitative and qualitative results were integrated.
RESULTS
In the first stage, autonomous motivation scores were predicted by the behavioral change stage and relatedness satisfaction/frustration. The second stage revealed that "the process of reflecting and managing one's own health while receiving support and feedback for maintaining and improving health" was the motivational process of workers. Result integration revealed that motivation increased through repeatedly escaping and adjusting to real problems and situational coping until the behavioral change. Despite interruptions during behavioral change, receiving feedback from others could increase motivation and continued behavioral change.
CONCLUSION
Regardless of their level of motivation for health behaviors, workers indicated that support from others was essential. The nature of this support was found to range from providing information to offering feedback. Interventions individualized by the identified process could enable customized motivation-driven health guidance.
Topics: Humans; Adult; Middle Aged; Motivation; Health Behavior; Life Style; Health Promotion; Healthy Lifestyle
PubMed: 38383347
DOI: 10.1186/s12889-024-18081-0 -
Frontiers in Artificial Intelligence 2023Persuasive technologies are designed to change human behavior or attitude using various persuasive strategies. Recent years have witnessed increasing evidence of the... (Review)
Review
Persuasive technologies are designed to change human behavior or attitude using various persuasive strategies. Recent years have witnessed increasing evidence of the need to personalize and adapt persuasive interventions to various users and contextual factors because a persuasive strategy that works for one individual may rather demotivate others. As a result, several research studies have been conducted to investigate how to effectively personalize persuasive technologies. As research in this direction is gaining increasing attention, it becomes essential to conduct a systematic review to provide an overview of the current trends, challenges, approaches used for developing personalized persuasive technologies, and opportunities for future research in the area. To fill this need, we investigate approaches to personalize persuasive interventions by understanding user-related factors considered when personalizing persuasive technologies. Particularly, we conducted a systematic review of 72 research published in the last ten years in personalized and adaptive persuasive systems. The reviewed papers were evaluated based on different aspects, including metadata (e.g., year of publication and venue), technology, personalization dimension, personalization approaches, target outcome, individual differences, theories and scales, and evaluation approaches. Our results show (1) increased attention toward personalizing persuasive interventions, (2) personality trait is the most popular dimension of individual differences considered by existing research when tailoring their persuasive and behavior change systems, (3) students are among the most commonly targeted audience, and (4) education, health, and physical activity are the most considered domains in the surveyed papers. Based on our results, the paper provides insights and prospective future research directions.
PubMed: 37841233
DOI: 10.3389/frai.2023.1125191 -
Sexual & Reproductive Healthcare :... Dec 2023The development of midwives as leaders is a crucial step towards achieving equality in sexual, reproductive, maternal, and neonatal health, Universal Health Coverage... (Review)
Review
The development of midwives as leaders is a crucial step towards achieving equality in sexual, reproductive, maternal, and neonatal health, Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). However, many midwives work only to implement policies made by others rather than being drivers of policy changes. Little is known and researched about why midwives are not involved in decision and policymaking related to sexual, reproductive, maternal, and neonatal health. Hence, with a focus on midwifery leadership within the global community and the limited opportunities for women to hold leadership positions, this research explores the facilitators influencing midwives' opportunities to become leaders in policy development, education and practice. Inspired by Whittemore and Knafl, this integrative literature review was conducted after twenty-two relevant articles were identified through a search of the following databases: PubMed, CINAHL, and Scopus. Inductive content analysis was applied to analyze data. The result indicates that for midwives to become influential leaders, they must be active in strategic planning at the highest level. This inevitably effects how far midwives can act as agents for change, even if they possess the knowledge and skills for a leadership position. Policies and regulations influence how midwives' status in society is acknowledged and recognized. A clearly articulated educational pathway will enable their professional growth and expertise, making them knowledgeable and skillful as leaders. Enabling midwives to step into leadership positions at government level requires reforms which include midwives in decision-making. Excluding midwives from decision-making processes is detrimental to the goal of achieving universal health coverage. The first step is to provide midwives with a protected title, enabling them to work autonomously in an enabling environment with normal pregnancy and birth to achieve the SDG 2030 goals.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Midwifery; Leadership; Educational Status; Reproduction; Policy
PubMed: 37769484
DOI: 10.1016/j.srhc.2023.100917 -
Frontiers in Public Health 2023It is evident that physical activity (PA) programmes implemented in schools were not effective in improving PA behaviours among adolescents. This study investigated...
BACKGROUND
It is evident that physical activity (PA) programmes implemented in schools were not effective in improving PA behaviours among adolescents. This study investigated students' perceptions of barriers to PA among inactive English adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model, the Behaviour Change Wheel (BCW), and Theoretical Domains Framework (TDF). The study compared barriers faced by inactive and active groups participating in sports and PA in secondary schools to identify sources of behaviour contributing to inactivity.
METHODS
A pre-intervention online survey was distributed to affiliated schools by 233 Teaching Schools Alliances (TSAs) as part of the monitoring and evaluation of the Secondary Teacher Training study. Data were cross-tabulated to analyse activity levels and behavioural barriers for active and inactive groups, using the COM-B domains. The research team followed a seven-step process to categorise barriers based on their relevant domain in the TDF mapped to the COM-B.
RESULTS
The findings were derived from one of the most extensive surveys of adolescents ever undertaken involving 200,623 active and 8,231 inactive respondents. The study identified 52 barriers and 68 behaviours that prevent adolescents from participating in PA. Psychological and social barriers were found to affect all activity levels, genders, and ethnic groups, with a lack of confidence and self-consciousness being the most prevalent. Certain demographic groups, such as those from minority ethnic groups and disabled individuals, were found to be overrepresented among inactive populations. The finding of the study indicated that there were common barriers that affected both inactive and active groups, with further similarity when examining barriers between active and inactive girls. The study also found that girls were more likely to experience the main barriers compared to boys, while inactive boys were more likely to encounter these barriers compared to active boys. The findings suggest that common barriers could be addressed across the population, while recognising some differences in demographics, and the need to provide personalised support. Targeted interventions are also suggested for all girls and inactive boys.
CONCLUSION
This study highlights the range of barriers that impact adolescents and provides insight into potential mechanisms for behaviour change, including intervention functions, policy categories, and evidence-based behaviour change tools. The study highlights the need for further research to address the barriers to PA among adolescents, particularly those who are inactive. Utilising the findings of this study, future research should investigate the effectiveness of novel digital exercise interventions and policies in increasing PA levels among children and adolescents. Complex digital exercise interventions, including conversational AI solutions, could provide personalised tools to identify and revolutionise support around the multitude of barriers that impact adolescents globally."For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission."
Topics: Child; Humans; Adolescent; Female; Male; Exercise; Sedentary Behavior; Schools; Motivation; Sports
PubMed: 37655286
DOI: 10.3389/fpubh.2023.1235086