Abstract Background. Fever in children is common and mostly caused by self-limiting infections. However, parents of febrile children often consult in general practice, in particular during out-of-hours care. To improve management, it is important to understand experiences of GPs managing these consultations. Objective. To describe GPs’ experiences regarding management of childhood fever during out-ofhours care. Methods. A descriptive qualitative study using purposeful sampling, five focus group discussions were held among 37 GPs. Analysis was based on constant comparative technique using open and axial coding. Results. Main categories were: (i) Workload and general experience; (ii) GPs’ perceptions of determinants of consulting behaviour; (iii) Parents’ expectations from the GP’s point of view; (iv) Antibiotic prescribing decisions; (v) Uncertainty of GPs versus uncertainty of parents and (vi) Information exchange during the consultation. GPs felt management of childhood fever imposes a considerable workload. They perceived a mismatch between parental concerns and their own impression of illness severity, which combined with time–pressure can lead to frustration. Diagnostic uncertainty is driven by low incidences of serious infections and dealing with parental demand for antibiotics is still challenging. Conclusion. Children with a fever account for a high workload during out-of-hours GP care which provides a diagnostic challenge due to the low incidence of serious illnesses and lacking longterm relationship. This can lead to frustration and drives antibiotics prescription rates. Improving information exchange during consultations and in the general public to young parents, could help provide a safety net thereby enhancing self-management, reducing consultations and workload, and subsequent antibiotic prescriptions.
Abstract Background: Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. Methods: This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. Results: In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC. Conclusions: Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By ‘novice’ we mean Master’s students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. This second article addresses FAQs about context, research questions and designs. Qualitative research takes into account the natural contexts in which individuals or groups function to provide an in-depth understanding of real-world problems. The research questions are generally broad and open to unexpected findings. The choice of a qualitative design primarily depends on the nature of the research problem, the research question(s) and the scientific knowledge one seeks. Ethnography, phenomenology and grounded theory are considered to represent the ‘big three’ qualitative approaches. Theory guides the researcher through the research process by providing a ‘lens’ to look at the phenomenon under study. Since qualitative researchers and the participants of their studies interact in a social process, researchers influence the research process. The first article described the key features of qualitative research, the third article will focus on sampling, data collection and analysis, while the last article focuses on trustworthiness and publishing.
Effectiveness of Supported Education for students with mental health problems, an experimental study.The onset of mental health problems generally occurs between the ages of 16 and 23 – the years in which young people follow postsecondary education, which is a major channel in ourso ciety to prepare for a career and enhance life goals. Several studies have shown that students with mental health problems have a higher chance of early school leaving. Supported Education services have been developed to support students with mental health to remain at school. The current project aims to study the effect of an individually tailored Supported Education intervention on educational and mental health outcomes of students with mental health problems at a university of applied sciences and a community college. To that end, a mixed methods design will be used. This design combines quantitative research (Randomized Controlled Trial) with qualitative research (focus groups, monitoring, interviews). 100 students recruited from the two educational institutes will be randomly allocated to either the intervention or control group.
De afgelopen twee decennia is er veel meer aandacht ontstaan bij onderzoekers en beleidsmakers voor het begrip co-creatie. Bijna altijd wordt de rol van co-creatie als positief en essentieel gezien in een proces waarin maatschappelijke of publieke uitdagingen worden onderzocht en opgelost (zogenaamde sociale innovatie). Het meeste onderzoek naar deze twee begrippen is kwalitatief van aard en gebaseerd op ‘case studies’.In zijn promotieonderzoek kijkt Peter Broekema naar de rol van co-creatie binnen sociale innovatie in Europese samenwerkingsprojecten. In zijn eerste artikel heeft hij de begrippen co-creatie en sociale innovatie tussen 1995 en 2018 binnen de EU geanalyseerd en geconcludeerd dat beide begrippen steeds breder gebruikt worden en samen met het begrip impact zijn getransformeerd tot een beleidsparadigma.In het tweede artikel keek Peter Broekema hoe beide begrippen doorwerken in specifieke subsidieoproepen en hoe consortia deze begrippen toepassen en samenwerken. Hierbij bleek dat er weliswaar verschillende typen consortia bestaan, maar dat zij geen specifieke co-creatiestrategie hadden.In zijn laatste twee artikelen zal hij gedetailleerd kijken naar een aantal EU projecten en vaststellen hoe de samenwerking is verlopen en hoe tevreden de verschillende partners zijn met het resultaat. Peter Broekema maakt hiervoor gebruik van projecten waarin hij zelf participeert (ACCOMPLISSH, INEDIT en SHIINE).EU beleidsparadigma van sociale innovatie in combinatie met co-creatie en impact. Co-creatie vindt vaak binnen eigen type stakehodlers plaatsAbstractSocial innovation and co-creation are both relatively new concepts, that have been studied by scholars for roughly twenty years and are still heavily contested. The former emerged as a response to the more technologically focused concept of innovation and the latter originally solely described the collaboration of end-users in the development of new products, processes or services. Between 2010-2015, both concepts have been adapted and started to be used more widely by for example EU policymakers in their effort to tackle so called ‘grand societal challenges’. Within this narrative – which could be called co-creation for social innovation, it is almost a prerequisite that partners – especially citizens - from different backgrounds and sectors actively work together towards specific societal challenges. Relevance and aimHowever, the exact contribution of co-creation to social innovation projects is still unclear. Most research on co-creation has been focussing on the involvement of end-users in the development of products, processes and services. In general, scholars conclude that the involvement of end-users is effective and leads to a higher level of customer satisfaction. Only recently, research into the involvement of citizens in social innovation projects has started to emerge. However, the majority of research on co-creation for social innovation has been focusing on collaborations between two types of partners in the quadruple helix (citizens, governments, enterprises and universities). Because of this, it is still unclear what co-creation in social innovation projects with more different type of partners entails exactly. More importantly however, is that most research has been based on national case studies in which partners from different sectors collaborate in a familiar ‘national’ setting. Normally institutional and/or cultural contexts influence co-creation (for example the ‘poldermodel’in the Netherlands or the more confrontational model in France), so by looking at projects in a central EU and different local contexts it becomes clear how context effects co-creation for social innovation.Therefore this project will analyse a number of international co-creation projects that aim for social innovation with different types of stakeholders in a European and multi-stakeholder setting.With this research we will find out what people in different contexts believe is co-creation and social innovation, how this process works in different contexts and how co-creation contributes to social innovation.Research question and - sub questionsThe project will answer the following question: “What is the added value of co-creation in European funded collaboration projects that aim for social innovation?” To answer the main question, the research has been subdivided into four sub questions:1) What is the assumed added value of co-creation for social innovation?2) How is the added value of co-creation for social innovation being expressed ex ante and ex post in EU projects that aim specifically for social innovation by co-creation?3) How do partners and stakeholders envision the co-creation process beforehand and continuously shape this process in EU projects to maximise social innovation?4) How do partners and stakeholders regard the added value of co-creation for social innovation in EU projects that that aim for social innovation?Key conceptsThe research will focus on the interplay between the two main concepts a) co-creation and b) social innovation. For now, we are using the following working definitions:a) co-creation is a non-linear process that involves multiple actors and stakeholders in the ideation, implementation and assessment of products, services, policies and systems with the aim of improving their efficiency and effectiveness, and the satisfaction of those who take part in the process.b) social innovation is the invention, development and implementation of new ideas with the purpose to (immediately) relieve and (eventually) solve social problems, which are in the long run directed at the social inclusion of individuals, groups or communities.It is clear that both definitions are quite opaque, but also distinguish roughly the same phases (ideation/invention, development, implementation and assessment) and also distinguish different levels (products/services, policies and systems). Both concepts will be studied within the policy framework of the EU, in which a specific value to both concepts has been attributed, mostly because policymakers regard co-creation with universities and end-users almost as a prerequisite for social innovation. Based on preliminary research, EU policies seem to define social innovation in close reation with ‘societal impact’, which could defined as: “the long lasting effect of an activity on society, because it is aimed at solving social problems”, and therefore in this specific context social innovation seems to encompasses societal impact. For now, I will use this working definition of social innovation and will closely look at the entanglement with impact in the first outlined paper.MethodologyIn general, I will use a qualitative mixed method approach and grounded theory to answer the main research question (mRQ). In order to better understand the added value of co-creation for social innovation in an EU policy setting, the research will:SubRQ1) start with an analysis of academic literature on co-creation and social impact. This analysis will be followed by and confronted with an analysis of EU policy documents. SubRQ2) use a qualitative data analysis at nineteen EU funded projects to understand how co-creation is envisoned within social innovation projects by using the quintuple helix approach (knowledge flows between partners and stakeholders in an EU setting) and the proposed social innovation journey model. By contrasting the findings from the QDA phase of the project with other research on social innovation we will be able to find arachetypes of social innovation in relation with the (perceived) added value of co-creation within social innovation. SubRQ3) These archetypes will be used to understand the process of co-creation for social innovation by looking closely at behavioural interactions within two social innovation projects. This close examination will be carried out by carrying out interviews with key stakeholders and partners and participant observation.SubRQ4) The archetypes will also be used to understand the perceived added value by looking closely at behavioural interactions within two social innovation projects. This close examination will be carried out by carrying out interviews with key stakeholders and partners and participant observation.ImpactThe project will contribute to a better understanding of the relationship between co-creation and social innovation on different levels:a) Theoretical: the research will analyse the concepts of co-creation and social innovation in relation to each other by looking at the origins of the concepts, the adaptation in different fields and the uptake within EU policies;b) Methodological: a model will be developed to study and understand the non-lineair process of co-creation within social innovation, by focusing on social innovation pathways and social innovation strategies within a quintuple helix setting (i) academia, ii) enterprises and iii) governments that work together to improve iv) society in an v) EU setting);c) Empirical: the project will (for the first time) collect data on behavioural interactions and the satisfaction levels of these interactions between stakeholders and partners in an EU project.d) Societal: the results of the research could be used to optimize the support for social innovation projects and also for the development of specific funding calls.
This proposal originates from a pilot of the ‘Frontrunners coalition’ on initiatives for the Circular Economy at the city level. This spin off project studies strategizing in hotels, to find innovative solutions how to manage the integration of circularity in the overall business strategy. The theoretical innovation is to better understand the strategizing process by using the theoretical framework of “strategy-as-practices (S-as-P)”. Exploring in two cases the daily challenges of implementing principles of the circular economy at a luxury and a budget hotel (group). The “strategy-as-practices (S-as-P) framework will be used, emphasizing that strategizing is a joint process of (higher) management and other practitioners (within and outside of the company). The data collection and analysis will be executed by Bachelor and Master students of Hotelschool the Hague and faculty of the research centre. The stages of the Design Oriented Research Approach will be used in this project, with a focus on the stages of Analysis & Diagnoses and Solution Design. The hotels will facilitate this research by giving access and support to the operations and (formal) meetings and additional primary data collection. (Small teams of) Student researchers collect qualitative data based on interviews and observations: they will ‘blend’ in during a 10-week period. Faculty of Hotelschool The Hague will safeguard the continuity and alignment in the project in the several rounds in which these steps are executed. The finding will be presented to the participating companies, the coalition in Amsterdam and the Hospitality industry. Direct societal impact is the showcasing of potential initiative and the responsibility of organizations towards circularity in their environment. Another result is the proposal for a larger follow-up project. This larger project will continue this study within a broader set of hotels but will also be studying and developing potential interventions for improvement the strategizing process.
