Purpose: Drawing on theories of organisational identity, social exchange and stakeholder engagement, this study aims to investigate the processes and practices involved in the formation and shaping of identities of social enterprises (SEs) that operate in the Malawian hospitality and tourism industry. Design/methodology/approach: Drawing on an interpretive research paradigm, data collected from 22 semi-structured interviews with four founders of case SEs and stakeholders, and SEs’ reports and other publicly available documents were generated and analysed following a grounded theory approach. Findings: The authors show that the trajectory SEs followed and the exchanges that occurred with the external stakeholders allowed three out of four case SEs to swiftly re-evaluate their pre-existing identities and work towards the formation of their new identities. Practical implications: This study provides an opportunity for policymakers and other actors in developing countries to frame and place SEs in line with the wider societal realities in such contexts. This may in turn call for policymakers to increase actors’ engagement with SEs and provide the necessary support that can allow SEs to be an effective force for the public good. Originality/value: This paper highlights the role of exchanges with external stakeholders in identity formation and shaping within SEs in the hospitality and tourism sector in the context of institutional voids. By adopting the social exchange theory, this paper introduces a dynamic lens to identity formation and shaping and helps to explain how, across different tourism ventures, stakeholder engagement and different modes of exchange unfold in the inter-organisational and community domains. It further shows how the ventures’ value orientations on the one hand, and stakeholder engagement practices and the ensuing exchanges, on the other hand, are closely interwoven.
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Objectives : To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). Design : Systematic review with best evidence synthesis. Setting : Primary care. Participants : Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. Review methods: PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. Results : Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. Conclusion :Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
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