Implementing sustainable tourism: a multi-stakeholder involvement management framework

Within the extensive body of literature on sustainable tourism (ST), its successful implementation is an emerging and important theme. The lack of or ineffective stakeholder participation is a major obstacle to ST realisation and there is little clarity as to how best to resolve this problem. This paper presents the findings of a purposive UK-based case study that evaluated stakeholder involvement in the implementation of ST. Using over fifty stakeholders’ accounts drawn from eight primary stakeholder groups, a ‘multi-stakeholder involvement management’ (MSIM) framework was developed. The MSIM framework consists of three strategic levels: attraction, integration and management of stakeholder involvement. Six stages are embedded within the three levels: scene-setting, recognition of stakeholder involvement capacity, stakeholder relationship management, pursuit of achievable objectives, influencing implementation capacity and monitoring stakeholder involvement. These are supported by the overarching notion of ‘hand-holding’ and key actions [e.g. managing stakeholder adaptability] that enhance stakeholder involvement in ST. Key words: Implementation, Sustainable Tourism, Stakeholder Involvement, Stakeholder framewor

The use of discrete choice experiments to inform health workforce policy: a systematic review.

BACKGROUND: Discrete choice experiments have become a popular study design to study the labour market preferences of health workers. Discrete choice experiments in health, however, have been criticised for lagging behind best practice and there are specific methodological considerations for those focused on job choices. We performed a systematic review of the application of discrete choice experiments to inform health workforce policy. METHODS: We searched for discrete choice experiments that examined the labour market preferences of health workers, including doctors, nurses, allied health professionals, mid-level and community health workers. We searched Medline, Embase, Global Health, other databases and grey literature repositories with no limits on date or language and contacted 44 experts. Features of choice task and experimental design, conduct and analysis of included studies were assessed against best practice. An assessment of validity was undertaken for all studies, with a comparison of results from those with low risk of bias and a similar objective and context. RESULTS: Twenty-seven studies were included, with over half set in low- and middle-income countries. There were more studies published in the last four years than the previous ten years. Doctors or medical students were the most studied cadre. Studies frequently pooled results from heterogeneous subgroups or extrapolated these results to the general population. Only one third of studies included an opt-out option, despite all health workers having the option to exit the labour market. Just five studies combined results with cost data to assess the cost effectiveness of various policy options. Comparison of results from similar studies broadly showed the importance of bonus payments and postgraduate training opportunities and the unpopularity of time commitments for the uptake of rural posts. CONCLUSIONS: This is the first systematic review of discrete choice experiments in human resources for health. We identified specific issues relating to this application of which practitioners should be aware to ensure robust results. In particular, there is a need for more defined target populations and increased synthesis with cost data. Research on a wider range of health workers and the generalisability of results would be welcome to better inform policy