Development of oral health interventions for inter-professional management of diabetes

PhD ThesisBackground Periodontitis impairs glycaemic control in people with diabetes and diabetes is a major risk factor for periodontitis. Cochrane reviews have reported HbA1c reductions of up to 4 mmol/mol following treatment of periodontitis, yet many clinicians and patients with diabetes are unaware of this. Aims/objectives To develop oral health interventions for delivery in primary medical care and to explore interprofessional communication in the context of management of diabetes and periodontitis. Methods The behaviours of medical and dental practitioners in relation to published diabetes and periodontitis best practice recommendations were surveyed using theoretically designed online questionnaires to assess predictors and determinants. The questionnaires were designed using a novel combination of social cognitive theory and normalisation process theory. The survey findings were discussed in iterations of workshops with patients, and medical and dental professionals to develop and pilot interventions in primary medical care for feasibility and acceptability. Results The self-reported survey findings showed that medical and dental professionals had limited knowledge of best practice recommendations; however, the importance of improved communication to enhance patient care was valued. Clinicians from both professions expressed a preference for indirect referrals, though a case study revealed negative consequences following this approach. Through workshop development, oral health interventions to inform patients about the bidirectional relationship between diabetes and periodontitis and advise those without a dentist to attend for periodontitis assessment and treatment were designed and subsequently experienced as feasible and acceptable by nurses. Conclusions Best practice recommendations to improve the uptake of evidence-based care in the context of diabetes and periodontitis are not widely known and inter-professional communication is problematic. Nurses have an important role in the delivery of oral health interventions and future research should evaluate these interventions formally

The interactional organisation of initial business-to-business sales calls with prospective clients

The aim of this thesis is to break new ground by investigating the interactional organisation of real events that comprise live business-to-business cold calls. Despite being a ubiquitous part of everyday life, we know very little about how cold calls are initiated, progressed, and completed. Cold calls are unsolicited telephone encounters, initiated by salespeople aiming to get prospective clients ( prospects ) interested in their services, with the distal goal of turning them into clients and the proximal goal of getting them to agree to an initial meeting. Cold calls are often treated as a nuisance by call-takers, and salespeople must deal with reluctant gatekeepers, recurrent sales resistance, and the occasional hang-up. The training they receive often draws on outdated theories of communication and is rarely supported by empirical evidence. Thus, this study not only addresses an important domain for interactional research, but also fulfils a practical necessity for empirical research that will inform sales training and improve callers and call-takers experiences. The data comprise 150 recorded calls supplied by three British companies that sell, service, and lease office equipment. The data were collected, transcribed, and analysed within an ethnomethodological framework using conversation analysis and discursive psychology. The first analytic chapter outlines the overall structural organisation of cold calling. It documents the constituent activities within the opening, the business of the call, and the closing. It identifies and describes two types of cold calls. Freezing calls are initiated by salespeople who are contacting a prospect for the very first time. Lukewarm calls feature salespeople who claim to have been in contact with the prospect s organisation in the past. The second chapter excavates the initial turns of lukewarm calls in which salespeople ask to speak to another person within the company, with whom they indicate to be acquainted. The analysis revealed that this third-party acquaintanceship was crucial for establishing the legitimacy of the switchboard request and for improving the chances of getting it granted. The third chapter focused on appointment-making sequences in both freezing and lukewarm calls, showing that they comprise two components: a preamble and a meeting request sequence. I also highlight how salespeople exploit sequential and turn-taking mechanisms to secure meetings with prospects without giving the latter the opportunity to refuse. The final chapter examines two practices for enacting resistance in cold calls blocks and stalls and documents the range of methods salespeople employ for dealing with each type of resistance. Sales blocks expose the salesperson s commercial agenda, attempt to stop the prospecting activity, and move towards call pre-closure. In response, salespeople can challenge, counter, or circumvent blocks as well as redo their initiating actions. Stalls slow down the progress of the sales process by delaying the next phase of the sale or by proposing less commitment-implicative alternatives. Salespeople deal with stalls by either justifying their initial proposal or by spontaneously introducing new action plans, both being more conducive to the progress of the sale. The thesis contributes to a growing body of interactional research on commercial encounters by shedding empirical light on a previously unexamined setting, business-to-business cold calls. It also moves forward discursive psychology s project of respecifying psychological phenomena by documenting the communicative practices associated with persuasion and resistance. Finally, it expands the extant conversation analytic toolkit by examining new practices (such as appointment-making) and by providing new insights into key conversation analytic topics (such as requests, pre-sequences, and accounts for calling). Overall, the findings presented in this thesis challenge existing conceptions of prospecting through cold calling that are prevalent in the sales literature. The thesis puts forward a strong argument for opening the black box of cold calls to better understand these interactions and to identify good practices as the basis for communication training. Research presented in this thesis has already been used in the development of CARM (Conversation Analytic Role-play Method) training for salespeople, who reported having doubled their appointment rates. Based on the findings in this thesis, I plan to develop further training not only for salespeople but also for prospective customers, thus improving the overall outcome of cold call encounters

STAKEHOLDER ENGAGEMENT IN SUSTAINABILITY REPORTING IN INDONESIA

This research aims to understand the ways the preparers of sustainability reports in Indonesia embed stakeholder engagement in sustainability reporting. This research seeks to understand the perceived role of stakeholder engagement in sustainability reporting and examines whether the report preparers decouple their stakeholder engagement disclosures from the actual practices. The neo-institutional theory is used to illuminate the companies’ non-conformity responses to institutional influences. This research utilises mixed methods by deploying questionnaires, sustainability reports and semi-structured interviews. The questionnaire survey was analysed using descriptive statistics. The interviews were conducted face-to-face and analysed using thematic analysis. Content analysis of stakeholder engagement disclosures was also undertaken on the 2007 to 2018 sustainability reports issued by the companies participating in the interviews. The findings of this research reveal that the report preparers attempt to embed stakeholder engagement in the companies’ sustainability reporting in response to coercive, normative and mimetic influences. However, stakeholder engagement is loosely embedded as a result of contextualising the Global Reporting Initiative (GRI)’s conception of stakeholder engagement into Indonesia’s local contexts. Stakeholder engagement is perceived as having important roles in mandatory corporate social responsibility (CSR) programmes and materiality assessment to define the report content. External stakeholders are engaged more inclusively in the former whereas internal stakeholders take control of the latter. It is not evident that the report preparers in Indonesia decouple stakeholder engagement disclosures from practices. However, the ways in which the companies practise their stakeholder engagement (means) deviate from the goals of stakeholder engagement suggested by the GRI’s principles for defining the report content (ends), known as the means-ends decoupling. The report preparers in Indonesia accept the GRI’s concept by meeting the suggested indicators, but unintentionally overlook the GRI’s principles that are required to be implemented as a new institution, rather than intentionally avoiding them. The main contribution of this research to the literature is that it provides insights into the need to embed stakeholder engagement in sustainability reporting in an integral way, including by translating the GRI’s global conception into local context. This research also provides insights into the presumption that ‘companies report the practice’ of stakeholder engagement in sustainability reporting—as suggested by the GRI and the extant literature. Just because the companies report the practice (means) by making reference to the GRI, it does not necessarily follow that the companies have conformed to the goals of stakeholder engagement suggested by the GRI’s principles for defining the report content (ends). Taking into full consideration Indonesia’s politicoeconomic, sociocultural and legal contexts, which can be dissimilar to other local contexts, this research contributes to an understanding of decoupling, especially the means-ends decoupling, which tends to be unintentional in the companies’ non-acquiescent response to institutional influences. The decoupling indicates that the report preparers consider the GRI’s stakeholder engagement indicators as technical prescriptions leading to box-ticking activities, rather than being thoroughly understood and implemented as a new institution. Besides, this research offers a practical contribution in that the companies’ sustainability reporting consultants could shepherd their clients’ stakeholder engagement, guided by the GRI standards (previously called guidelines), to go beyond merely meeting the GRI indicators and producing ‘nice to read’ sustainability reports

Conservation Research, Policy and Practice

Developed following the success of an international symposium, this book examines how to make conservation more effective through strengthening links between science research, policy and practice. Ideal for practitioners, researchers, graduate students and policymakers. This title is also available as Open Access on Cambridge Core

Augmented Reality and Health Informatics: A Study based on Bibliometric and Content Analysis of Scholarly Communication and Social Media

Healthcare outcomes have been shown to improve when technology is used as part of patient care. Health Informatics (HI) is a multidisciplinary study of the design, development, adoption, and application of IT-based innovations in healthcare services delivery, management, and planning. Augmented Reality (AR) is an emerging technology that enhances the user’s perception and interaction with the real world. This study aims to illuminate the intersection of the field of AR and HI. The domains of AR and HI by themselves are areas of significant research. However, there is a scarcity of research on augmented reality as it applies to health informatics. Given both scholarly research and social media communication having contributed to the domains of AR and HI, research methodologies of bibliometric and content analysis on scholarly research and social media communication were employed to investigate the salient features and research fronts of the field. The study used Scopus data (7360 scholarly publications) to identify the bibliometric features and to perform content analysis of the identified research. The Altmetric database (an aggregator of data sources) was used to determine the social media communication for this field. The findings from this study included Publication Volumes, Top Authors, Affiliations, Subject Areas and Geographical Locations from scholarly publications as well as from a social media perspective. The highest cited 200 documents were used to determine the research fronts in scholarly publications. Content Analysis techniques were employed on the publication abstracts as a secondary technique to determine the research themes of the field. The study found the research frontiers in the scholarly communication included emerging AR technologies such as tracking and computer vision along with Surgical and Learning applications. There was a commonality between social media and scholarly communication themes from an applications perspective. In addition, social media themes included applications of AR in Healthcare Delivery, Clinical Studies and Mental Disorders. Europe as a geographic region dominates the research field with 50% of the articles and North America and Asia tie for second with 20% each. Publication volumes show a steep upward slope indicating continued research. Social Media communication is still in its infancy in terms of data extraction, however aggregators like Altmetric are helping to enhance the outcomes. The findings from the study revealed that the frontier research in AR has made an impact in the surgical and learning applications of HI and has the potential for other applications as new technologies are adopted

The Role of Innovation Intermediaries in Developing Healthcare Innovation Ecosystems: Value Co-Creation through Platforms

Thesis (PhD)--Stellenbosch University, 2021.ENGLISH ABSTRACT: Creating sustainable agile innovative environments is a persistent challenge, which has been exacerbated by the COVID-19 global pandemic. The disruption in services has highlighted the need to foster innovation, build resilient health systems, operationalise technology banks and build more domestic capacity whilst harnessing global cooperation. These are the mandates of the 3rd, 9th and 17th Sustainable Development Goals (SDGs). One organisation cannot maintain and develop these systemic dynamics alone, hence ecosystems of actors ranging in structure and size are formed. These are the foundational precepts of this dissertation as it explores how to manage innovation ecosystems. Though such concerns are across diverse industries, this study was in healthcare. The aim was to inform under-resourced countries on how to ensure sustainability on projects often funded by foreign funders, which is rampant in the Global South. This study contributed to the discourse of ecosystems research by developing an Ecosystem Evolution and Emergence Framework that assists in the management of the innovation ecosystem. Ecosystems research has mainly focussed on the structure of ecosystems and less attention has been devoted to the emergence of ecosystems. Thus,this study contributes to shedding some light on ecosystem emergence.The framework has two pillars for the innovation intermediary: outlining the key tasks to undertake at each ecosystem stage and the key aspects that are important to identify, monitor or cultivate in the ecosystem for the ecosystem actors. A constructivist perspective was used to better understand the relationship between innovation intermediation and innovation ecosystems. Conceptually, the framework development process was guided by Soft Systems Methodology with an emphasis on learning from the history of past projects addressing the same issues. These theoretical tools were deduced from established theories in innovation systems and complexity science embedded in a narrative explanation-Event Structure Analysis. This analysis was utilised through applying event colligation and displaying through Causal Loop Diagrams Empirically, a comparison of the emergence sequences from three healthcare innovation ecosystems was undertaken. These are the Maternal Alliance for Mobile Action (MAMA), Mom Connect and the District Health Information System (DHIS2). The activities and functions were mapped in the study across the innovation ecosystem development stages of birth, expansion and self-renewal using the framework. This resulted in the identification of 39 core ecosystem events deemed leverage points–each with a myriad of activities. The evaluated framework culminated in five distinct leverage categories of structural, technological, social, knowledge and political leverage. This is presented as an ecosystem management tool that enables: 1) building of innovation ecosystems; 2) facilitating improvement and sustainability of existing innovation ecosystems; and 3) providing the ecosystem manager with tools to address commonly experienced challenges. The tool’s main aim is to provide guidelines on how ecosystems emerge and are governed. The systematic approach followed in the study lends itself to future development and expansion with various other computerised tools.AFRIKAANSE OPSOMMING: Raadpleeg teks vir opsommingDoctorat