Search results for: provider perceptions
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1875

Search results for: provider perceptions

1335 Enhancing Intercultural Competencies Through Digital Integration in South Africa

Authors: Naziema Begum Jappie

Abstract:

In higher education, particularly within South African universities engaged in regional and global collaborations, the integration of intercultural competencies into teaching, learning, and assessment is essential for student success. Intercultural competencies and the digital platform are intwined in the fabric of teaching, learning, and assessments for student success in higher education. These are integral to virtual learning and exchange within higher education, which are expected to develop these competencies. However, this is not always the case because these are not always explicitly integrated into the academic agenda. Despite the prevalence of international students and exchange programmes, there is often a lack of deliberate integration of these competencies into academic agendas, even for South African students from different cultural, ethnic and language groups. This research addresses this gap by examining the impact of infusing intercultural activities into both face-to-face and digital learning platforms. Adopting an intersectional perspective, the study recognizes how social identities interact to shape individuals' self-perceptions and experiences in a university. Methodologically, this study employs a mixed-methods approach, combining quantitative surveys and qualitative interviews to assess the effectiveness of integrating intercultural competencies into digital platforms. Surveys administered to students and faculty measure changes in intercultural skills and attitudes before and after the implementation of targeted interventions. In-depth interviews with participants will provide further insights into the qualitative aspects of these changes, including their experiences and perceptions of the integration process. The research evaluates whether the strategic integration of intercultural competencies into digital platforms enhances students' intercultural skills and social justice awareness. The findings provide valuable insights for higher education academics and internationalization practitioners seeking to develop effective strategies for cultivating intercultural competencies among students.

Keywords: digital platform, higher education, intercultural competencies, interventions

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1334 Urban Security and Social Sustainability in Cities of Developing Countries

Authors: Taimaz Larimian, Negin Sadeghi

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Very little is known about the impacts of urban security on the level of social sustainability within the cities of developing countries. Urban security is still struggling to find its position in the social sustainability agenda, despite the significant role of safety and security on different aspects of peoples’ lives. This paper argues that urban safety and security should be better integrated within the social sustainability framework. With this aim, this study investigates the hypothesized relationship between social sustainability and Crime Prevention through Environmental Design (CPTED) approach at the neighborhood scale. This study proposes a model of key influential dimensions of CPTED analyzed into localized factors and sub-factors. These factors are then prioritized using pairwise comparison logic and fuzzy group Analytic Hierarchy Process (AHP) method in order to determine the relative importance of each factor on achieving social sustainability. The proposed model then investigates social sustainability in six case study neighborhoods of Isfahan city based on residents’ perceptions of safety within their neighborhood. Mixed method of data collection is used by using a self-administered questionnaire to explore the residents’ perceptions of social sustainability in their area of residency followed by an on-site observation to measure the CPTED construct. In all, 150 respondents from selected neighborhoods were involved in this research. The model indicates that CPTED approach has a significant direct influence on increasing social sustainability in neighborhood scale. According to the findings, among different dimensions of CPTED, ‘activity support’ and ‘image/ management’ have the most influence on people’s feeling of safety within studied areas. This model represents a useful designing tool in achieving urban safety and security during the development of more socially sustainable and user-friendly urban areas.

Keywords: crime prevention through environmental design (CPTED), developing countries, fuzzy analytic hierarchy process (FAHP), social sustainability

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1333 Determinants of Risk Perceptions and Risk Attitude among Flue-Cured Virginia Tobacco Growers: A Case Study of Pakistan

Authors: Wencong Lu, Abdul Latif, Raza Ullah, Subhan Ullah

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Agricultural production is subject to risk and the attitudes of producers toward risk, in turn, may be affected by certain socioeconomic characteristics of producers. Although, it is important to assess the risk attitude of farmers and their perception towards different calamitous risk sources for better understanding of their risk management adoption decisions, to the best of our knowledge no studies have been carried out to analyze the risk attitude and risk perceptions in the context of tobacco production in Pakistan. Therefore the study in hand is conducted with an attempt to overcome the gap in existing literature by analyzing different catastrophic risk sources faced by tobacco growers, their attitude towards risk and the effect of socioeconomic and demographic characteristics, farmers’ participation in contract farming and off-farm diversification on their risk attitude and risk perception. Around 78% of Pakistan’s entire tobacco crop and nearly all of the country’s Flue-Cured Virginia (FCV) tobacco is produced in Khyber Pakhtunkhwa (KPK) province alone. The yield/hectare of tobacco produced in KPK province is 14% higher than the global average and 22 % higher than national average. Khyber Pakhtunkhwa province was selected as main study area as nearly all of the country’s Flue-Cured Virginia (FCV) tobacco is produced in Khyber Pakhtunkhwa (KPK) province alone. Six districts were purposely selected based on their contribution in overall production for the last five years which accounts for more than 94.84% of the tobacco production in KPK province. Specific objectives taken into considerations for this study are the risk attitude of the farmers for growing FCV tobacco crop, farmers’ risk perception for different risk sources related to tobacco production (as far as the incidence and severity of each risk source is concerned) and the effect of socioeconomic characteristics, contract farming participation and off-farm diversification (income) on the risk attitude and risk perception of FCV tobacco growers.

Keywords: risk attitude, risk perception, contract farming, off-farm diversification, probit model

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1332 EFL Teachers’ Sequential Self-Led Reflection and Possible Modifications in Their Classroom Management Practices

Authors: Sima Modirkhameneh, Mohammad Mohammadpanah

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In the process of EFL teachers’ development, self-led reflection (SLR) is thought to have an imperative role because it may help teachers analyze, evaluate, and contemplate what is happening in their classes. Such contemplations can not only enhance the quality of their instruction and provide better learning environments for learners but also improve the quality of their classroom management (CM). Accordingly, understanding the effect of teachers’ SLR practices may help us gain valuable insights into what possible modifications SLR may bring about in all aspects of EFL teachers' practitioners, especially their CM. The main purpose of this case study was, thus, to investigate the impact of SLR practices of 12 Iranian EFL teachers on their CM based on the universal classroom management checklist (UCMC). In addition, another objective of the current study was to have a clear image of EFL teachers’ perceptions of their own SLR practices and their possible outcomes. By conducting repeated reflective interviews, observations, and feedback of the participants over five teaching sessions, the researcher analyzed the outcomes qualitatively through the process of meaning categorization and data interpretation based on the principles of Grounded Theory. The results demonstrated that EFL teachers utilized SLR practices to improve different aspects of their language teaching skills and CM in different contexts. Almost all participants had positive comments and reactions about the effect of SLR on their CM procedures in different aspects (expectations and routines, behavior-specific praise, error corrections, prompts and precorrections, opportunity to respond, strengths and weaknesses of CM, teachers’ perception, CM ability, and learning process). Otherwise stated, results implied that familiarity with the UCMC criteria and reflective practices contributes to modifying teacher participants’ perceptions about their CM procedure and utilizing the reflective practices in their teaching styles. The results are thought to be valuably beneficial for teachers, teacher educators, and policymakers, who are recommended to pay special attention to the contributions as well as the complexity of reflective teaching. The study concludes with more detailed results and implications and useful directions for future research.

Keywords: classroom management, EFL teachers, reflective practices, self-led reflection

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1331 Perceived Procedural Justice and Organizational Citizenship Behavior: Evidence from a Security Organization

Authors: Noa Nelson, Orit Appel, Rachel Ben-ari

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Organizational Citizenship Behavior (OCB) is voluntary employee behavior that contributes to the organization beyond formal job requirements. It can take different forms, such as helping teammates (OCB toward individuals; hence, OCB-I), or staying after hours to attend a task force (OCB toward the organization; hence, OCB-O). Generally, OCB contributes substantially to organizational climate, goals, productivity, and resilience, so organizations need to understand what encourages it. This is particularly challenging in security organizations. Security work is characterized by high levels of stress and burnout, which is detrimental to OCB, and security organizational design emphasizes formal rules and clear hierarchies, leaving employees with less freedom for voluntary behavior. The current research explored the role of Perceived Procedural Justice (PPJ) in enhancing OCB in a security organization. PPJ refers to how fair decision-making processes are perceived to be. It involves the sense that decision makers are objective, attentive to everyone's interests, respectful in their communications and participatory - allowing individuals a voice in decision processes. Justice perceptions affect motivation, and it was specifically suggested that PPJ creates an attachment to one's organization and personal interest in its success. Accordingly, PPJ had been associated with OCB, but hardly any research tested their association with security organizations. The current research was conducted among prison guards in the Israel Prison Service, to test a correlational and a causal association between PPJ and OCB. It differentiated between perceptions of direct commander procedural justice (CPJ), and perceptions of organization procedural justice (OPJ), hypothesizing that CPJ would relate to OCB-I, while OPJ would relate to OCB-O. In the first study, 336 prison guards (305 male) from 10 different prisons responded to questionnaires measuring their own CPJ, OPJ, OCB-I, and OCB-O. Hierarchical linear regression analyses indicated the significance of commander procedural justice (CPJ): It associated with OCB-I and also associated with OPJ, which, in turn, associated with OCB-O. The second study tested CPJ's causal effects on prison guards' OCB-I and OCB-O; 311 prison guards (275 male) from 14 different prisons read scenarios that described either high or low CPJ, and then evaluated the likelihood of that commander's prison guards performing OCB-I and OCB-O. In this study, CPJ enhanced OCB-O directly. It also contributed to OCB-I, indirectly: CPJ enhanced the motivation for collaboration with the commander, which respondents also evaluated after reading scenarios. Collaboration, in turn, associated with OCB-I. The studies demonstrate that procedural justice, especially commander's PJ, promotes OCB in security work environments. This is important because extraordinary teamwork and motivation are needed to deal with emergency situations and with delicate security challenges. Following the studies, the Israel Prison Service implemented personal procedural justice training for commanders and unit level programs for procedurally just decision processes. From a theoretical perspective, the studies extend the knowledge on PPJ and OCB to security work environments and contribute evidence on PPJ's causal effects. They also call for further research, to understand the mechanisms through which different types of PPJ affect different types of OCB.

Keywords: organizational citizenship behavior, perceived procedural justice, prison guards, security organizations

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1330 Machine Learning Framework: Competitive Intelligence and Key Drivers Identification of Market Share Trends among Healthcare Facilities

Authors: Anudeep Appe, Bhanu Poluparthi, Lakshmi Kasivajjula, Udai Mv, Sobha Bagadi, Punya Modi, Aditya Singh, Hemanth Gunupudi, Spenser Troiano, Jeff Paul, Justin Stovall, Justin Yamamoto

Abstract:

The necessity of data-driven decisions in healthcare strategy formulation is rapidly increasing. A reliable framework which helps identify factors impacting a healthcare provider facility or a hospital (from here on termed as facility) market share is of key importance. This pilot study aims at developing a data-driven machine learning-regression framework which aids strategists in formulating key decisions to improve the facility’s market share which in turn impacts in improving the quality of healthcare services. The US (United States) healthcare business is chosen for the study, and the data spanning 60 key facilities in Washington State and about 3 years of historical data is considered. In the current analysis, market share is termed as the ratio of the facility’s encounters to the total encounters among the group of potential competitor facilities. The current study proposes a two-pronged approach of competitor identification and regression approach to evaluate and predict market share, respectively. Leveraged model agnostic technique, SHAP, to quantify the relative importance of features impacting the market share. Typical techniques in literature to quantify the degree of competitiveness among facilities use an empirical method to calculate a competitive factor to interpret the severity of competition. The proposed method identifies a pool of competitors, develops Directed Acyclic Graphs (DAGs) and feature level word vectors, and evaluates the key connected components at the facility level. This technique is robust since its data-driven, which minimizes the bias from empirical techniques. The DAGs factor in partial correlations at various segregations and key demographics of facilities along with a placeholder to factor in various business rules (for ex. quantifying the patient exchanges, provider references, and sister facilities). Identified are the multiple groups of competitors among facilities. Leveraging the competitors' identified developed and fine-tuned Random Forest Regression model to predict the market share. To identify key drivers of market share at an overall level, permutation feature importance of the attributes was calculated. For relative quantification of features at a facility level, incorporated SHAP (SHapley Additive exPlanations), a model agnostic explainer. This helped to identify and rank the attributes at each facility which impacts the market share. This approach proposes an amalgamation of the two popular and efficient modeling practices, viz., machine learning with graphs and tree-based regression techniques to reduce the bias. With these, we helped to drive strategic business decisions.

Keywords: competition, DAGs, facility, healthcare, machine learning, market share, random forest, SHAP

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1329 One-Pot Synthesis and Characterization of Magnesium Oxide Nanoparticles Prepared by Calliandra Calothyrsus Leaf Extract

Authors: Indah Kurniawaty, Yoki Yulizar, Haryo Satriya Oktaviano, Adam Kusuma Rianto

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Magnesium oxide nanoparticles (MgO NP) were successfully synthesized in this study using a one-pot green synthesis mediated by Calliandra Calothyrsus leaf extract (CLE). CLE was prepared by maceration of the leaf using methanol with a ratio of 1:5 for 7 days. Secondary metabolites in CLE, such as alkaloids and flavonoids, served as a weak base provider and capping agent in the formation of MgO NP. CLE Fourier Transform Infra-Red (FTIR) spectra peak at 3255, 1600, 1384, 1205, 1041, and 667 cm-1 showing the presence of vibrations O-H stretching, N-H bending, C-C stretching, C-N stretching and N-H wagging. During the experiment, different CLE volumes and calcined temperatures were used, resulting in a variety of structures. Energy Dispersive X-ray Spectrometer (EDS) and FTIR were used to characterize metal oxide particles. MgO diffraction pattern at 2θ of 36.9°; 42.9°; 62.2°; 74.6°; and 78.5° which can be assigned to crystal planes (111), (200), (220), (311), and (222), respectively. Scanning Electron Microscopy (SEM) was used to characterize the surface morphology. The morphology ranged from sphere to flower-like resulting in crystallite sizes of 28, 23, 12, and 9 nm.

Keywords: MgO, nanoparticle, calliandra calothyrsus, green-synthesis

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1328 The Determinants of Behavioral Intention to Use toward T-Cash Services Provider in Jakarta and Surburban Area

Authors: Stephen Coandadiputra, Chrestella Carissa

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Technology is created to simplify human’s life. One of current technology which being called as the second wave internet generation is the internet of things. Internet of things lets thousands of devices connected each other. In today's marketing world, IOT has brought customer into the next level which helping the customer to shorten every transaction they are conducting from traditional approach to sophisticated approach. However, the implementation of technology has always obstacles. The objective of this paper is to explore the determinants of customer to accepts such technology like the internet of things within their transaction. According to TAM (Technology Acceptance Model), researcher constructs the acceptance of internet of things based on perceived usefulness, perceived ease of use and trust and social factor and the two customer characteristics: perceived enjoyment and perceived behavioral control. This research uses exploratory research design which being facilitated by spreading questionnaire to 145 T-cash users in Jakarta and in its suburban region. At least, 190 samples were observed and questioned accordingly. All the collected data will be analyzed using Lisrel.

Keywords: behavioral intention to use, internet of things, near field communication, technology acceptance model

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1327 Analyzing Behaviour of the Utilization of the Online News Clipping Database: Experience in Suan Sunandha Rajabhat University

Authors: Siriporn Poolsuwan, Kanyarat Bussaban

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This research aims to investigate and analyze user’s behaviour towards the utilization of the online news clipping database at Suan Sunandha Rajabhat University, Thailand. Data is gathered from 214 lecturers and 380 undergraduate students by using questionnaires. Findings show that most users knew the online news clipping service from their friends, library’s website and their teachers. The users learned how to use it by themselves and others learned by training of SSRU library. Most users used the online news clipping database one time per month at home and always used the service for general knowledge, up-to-date academic knowledge and assignment reference. Moreover, the results of using the online news clipping service problems include the users themselves, service management, service device- computer and tools – and the network, service provider, and publicity. This research would be benefit for librarians and teachers for planning and designing library services in their works and organization.

Keywords: online database, user behavior, news clipping, library services

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1326 Alumni Experiences of How Their Undergraduate Medical Education Instilled and Fostered a Commitment to Community-Based Work in Later Life: A Sequential Exploratory Mixed-Methods Study

Authors: Harini Aiyer, Kalyani Premkumar

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Health professionals are the key players who can help achieve the goals of population health equity. Social accountability (SA) of health professionals emphasizes their role in addressing issues of equity in the population they serve. Therefore, health professional education must focus on instilling SA in health professionals. There is limited literature offering a longitudinal perspective of how students sustain the practice of SA in later life. This project aims to identify the drivers of social accountability among physicians. This study employed an exploratory mixed methods design (QUAL-> Quant) to explore alumni perceptions and experiences. The qualitative data, collected via 20 in-depth, semi-structured interviews, provided an understanding of the perceptions of the alumni regarding the influence of their undergraduate learning environment on their SA. This was followed by a quantitative portion -a questionnaire designed from the themes identified from the qualitative data. Emerging themes from the study highlighted community-centered education and a focus on social and preventative medicine in both curricular and non-curricular facilitators of SA among physicians. Curricular components included opportunities to engage with the community, such as roadside clinics, community-orientation programs, and postings at a secondary hospital. Other facilitators that emerged were the faculty leading by example, a subsidized fee structure, and a system that prepared students for practice in rural and remote areas. The study offers a fresh perspective and dimension on how SA is addressed by medical schools. The findings may be adapted by medical schools to understand how their own SA initiatives have been sustained among physicians over the long run.

Keywords: community-based work, global health, health education, medical education, providing health in remote areas, social accountability

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1325 Challenges and Success Factors in Introducing Information Systems for Students' Online Registration

Authors: Stanley Fore, Sharon Chipeperekwa

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The start of the 2011 academic year in South Africa saw a number of Institutions of Higher Learning introducing online registration for their students. The efficiency and effectiveness of Information Systems are increasingly becoming a necessity and not an option for many organizations. An information system should be able to allow end users to access information easily and navigate with ease. The selected University of Technology (UoT) in this research is one of the largest public institution of higher learning in the Western Cape Province and boasts of an enrolment of more than 30000 students per academic year. An observation was made that, during registration students’ stand in long queues waiting to register or for assistance to register. The system tends to ‘freeze’ whilst students are registering and students are in most cases unfamiliar with the system interface. They constantly have to enquire what to do next when going through online registration process. A mixed method approach will be adopted which comprises of quantitative and qualitative approaches. The study uses constructs of the updated DeLone and McLean IS success model (2003) to analyse and explain the student’s perceptions of the online registration system. The research was undertaken to establish the student’s perceptions of the online registration system. This research seeks to identify and analyse the challenges and success factors of introducing an online registration system whilst highlighting the extent to which this system has been able to solve the numerous problems associated with the manual era. The study will assist management and those responsible for managing the current system to determine how well the system is working or not working to achieve user satisfaction. It will also assist them going forward on what to consider before, during and after implementation of an information system. Respondents will be informed of the objectives of the research, and their consent to participate will be sought. Ethical considerations that will be applied to this study include; informed consent and protection from harm, right to privacy and involvement of the research.

Keywords: online registration, information systems, University of Technology, end-users

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1324 Secure Cryptographic Operations on SIM Card for Mobile Financial Services

Authors: Kerem Ok, Serafettin Senturk, Serdar Aktas, Cem Cevikbas

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Mobile technology is very popular nowadays and it provides a digital world where users can experience many value-added services. Service Providers are also eager to offer diverse value-added services to users such as digital identity, mobile financial services and so on. In this context, the security of data storage in smartphones and the security of communication between the smartphone and service provider are critical for the success of these services. In order to provide the required security functions, the SIM card is one acceptable alternative. Since SIM cards include a Secure Element, they are able to store sensitive data, create cryptographically secure keys, encrypt and decrypt data. In this paper, we design and implement a SIM and a smartphone framework that uses a SIM card for secure key generation, key storage, data encryption, data decryption and digital signing for mobile financial services. Our frameworks show that the SIM card can be used as a controlled Secure Element to provide required security functions for popular e-services such as mobile financial services.

Keywords: SIM card, mobile financial services, cryptography, secure data storage

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1323 Assessing an Instrument Usability: Response Interpolation and Scale Sensitivity

Authors: Betsy Ng, Seng Chee Tan, Choon Lang Quek, Peter Looker, Jaime Koh

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The purpose of the present study was to determine the particular scale rating that stands out for an instrument. The instrument was designed to assess student perceptions of various learning environments, namely face-to-face, online and blended. The original instrument had a 5-point Likert items (1 = strongly disagree and 5 = strongly agree). Alternate versions were modified with a 6-point Likert scale and a bar scale rating. Participants consisted of undergraduates in a local university were involved in the usability testing of the instrument in an electronic setting. They were presented with the 5-point, 6-point and percentage-bar (100-point) scale ratings, in response to their perceptions of learning environments. The 5-point and 6-point Likert scales were presented in the form of radio button controls for each number, while the percentage-bar scale was presented with a sliding selection. Among these responses, 6-point Likert scale emerged to be the best overall. When participants were confronted with the 5-point items, they either chose 3 or 4, suggesting that data loss could occur due to the insensitivity of instrument. The insensitivity of instrument could be due to the discreet options, as evidenced by response interpolation. To avoid the constraint of discreet options, the percentage-bar scale rating was tested, but the participant responses were not well-interpolated. The bar scale might have provided a variety of responses without a constraint of a set of categorical options, but it seemed to reflect a lack of perceived and objective accuracy. The 6-point Likert scale was more likely to reflect a respondent’s perceived and objective accuracy as well as higher sensitivity. This finding supported the conclusion that 6-point Likert items provided a more accurate measure of the participant’s evaluation. The 5-point and bar scale ratings might not be accurately measuring the participants’ responses. This study highlighted the importance of the respondent’s perception of accuracy, respondent’s true evaluation, and the scale’s ease of use. Implications and limitations of this study were also discussed.

Keywords: usability, interpolation, sensitivity, Likert scales, accuracy

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1322 A Comprehensive Framework to Ensure Data Security in Cloud Computing: Analysis, Solutions, and Approaches

Authors: Loh Fu Quan, Fong Zi Heng, Burra Venkata Durga Kumar

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Cloud computing has completely transformed the way many businesses operate. Traditionally, confidential data of a business is stored in computers located within the premise of the business. Therefore, a lot of business capital is put towards maintaining computing resources and hiring IT teams to manage them. The advent of cloud computing changes everything. Instead of purchasing and managing their infrastructure, many businesses have started to shift towards working with the cloud with the help of a cloud service provider (CSP), leading to cost savings. However, it also introduces security risks. This research paper focuses on the security risks that arise during data migration and user authentication in cloud computing. To overcome this problem, this paper provides a comprehensive framework that includes Transport Layer Security (TLS), user authentication, security tokens and multi-level data encryption. This framework aims to prevent authorized access to cloud resources and data leakage, ensuring the confidentiality of sensitive information. This framework can be used by cloud service providers to strengthen the security of their cloud and instil confidence in their users.

Keywords: Cloud computing, Cloud security, Cloud security issues, Cloud security framework

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1321 Pallet Tracking and Cost Optimization of the Flow of Goods in Logistics Operations by Serial Shipping Container Code

Authors: Dominika Crnjac Milic, Martina Martinovic, Vladimir Simovic

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The case study method in this paper shows the implementation of Information Technology (IT) and the Serial Shipping Container Code (SSCC) in a Croatian company that deals with logistics operations and provides logistics services in the cold chain segment. This company is aware of the sensitivity of the goods entrusted to them by the user of the service, as well as of the importance of speed and accuracy in providing logistics services. To that end, it has implemented and used the latest IT to ensure the highest standard of high-quality logistics services to its customers. Looking for efficiency and optimization of supply chain management, while maintaining a high level of quality of the products that are sold, today's users of outsourced logistics services are open to the implementation of new IT products that ultimately deliver savings. By analysing the positive results and the difficulties that arise when using this technology, we aim to provide an insight into the potential of this approach of the logistics service provider.

Keywords: logistics operations, serial shipping container code, information technology, cost optimization

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1320 Vulnerable Paths Assessment for Distributed Denial of Service Attacks in a Cloud Computing Environment

Authors: Manas Tripathi, Arunabha Mukhopadhyay

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In Cloud computing environment, cloud servers, sometimes may crash after receiving huge amount of request and cloud services may stop which can create huge loss to users of that cloud services. This situation is called Denial of Service (DoS) attack. In Distributed Denial of Service (DDoS) attack, an attacker targets multiple network paths by compromising various vulnerable systems (zombies) and floods the victim with huge amount of request through these zombies. There are many solutions to mitigate this challenge but most of the methods allows the attack traffic to arrive at Cloud Service Provider (CSP) and then only takes actions against mitigation. Here in this paper we are rather focusing on preventive mechanism to deal with these attacks. We analyze network topology and find most vulnerable paths beforehand without waiting for the traffic to arrive at CSP. We have used Dijkstra's and Yen’s algorithm. Finally, risk assessment of these paths can be done by multiplying the probabilities of attack for these paths with the potential loss.

Keywords: cloud computing, DDoS, Dijkstra, Yen’s k-shortest path, network security

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1319 [Keynote Talk]: From Clinical Practice to Academic Setup, 'Quality Circles' for Quality Outputs in Both

Authors: Vandita Mishra

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From the management of patients, reception, record, and assistants in a clinical practice; to the management of ongoing research, clinical cases and department profile in an academic setup, the healthcare provider has to deal with all of it. The victory lies in smooth running of the show in both the above situations with an apt solution of problems encountered and smooth management of crisis faced. Thus this paper amalgamates dental science with health administration by means of introduction of a concept for practice management and problem-solving called 'Quality Circles'. This concept uses various tools for problem solving given by experts from different fields. QC tools can be applied in both clinical and academic settings in dentistry for better productivity and for scientifically approaching the process of continuous improvement in both the categories. When approached through QC, our organization showed better patient outcomes and more patient satisfaction. Introduced in 1962 by Kaoru Ishikawa, this tool has been extensively applied in certain fields outside dentistry and healthcare. By exemplification of some clinical cases and virtual scenarios, the tools of Quality circles will be elaborated and discussed upon.

Keywords: academics, dentistry, healthcare, quality

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1318 The Evaluation of a Mobile Proximity Payment Application through Its Legitimacy and Social Acceptability

Authors: Intissar Abbes, Yousra Hallem, Jean-michel Sahut

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The purpose of this research is to explore the legitimacy of a proximity mobile payment (PMP) system by taking into account the social aspects related to its use (social acceptability). We have chosen to focus on the acceptability process of a PMP application (‘Flashplay’) from the first testing to the adoption in a service context. This PMP solution is a pilot program developed as part of a global strategy of disintermediation in various sectors (retail, catering, and entertainment). This case is particularly interesting for two reasons: the context and environment are suitable to the adoption of innovation in payment like other African countries and the possibility to study different stages of the social acceptability process of that PMP system. The neo-institutional theory is mobilized to identify the three pillars of legitimacy: cognitive, normative and regulatory. A longitudinal qualitative study was conducted with 27 customers using the PMP service. Results highlighted the importance of the consumption system and the service provider as institutions. Recommendations are thus proposed to PMP service providers in order to rethink the design and implementation strategies of their PMP system to ensure their adoption and promote the institutionalization of this type of consumption practice.

Keywords: legitimacy, payment, acceptability, mobility

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1317 Farmers’ Perception and Response to Climate Change Across Agro-ecological Zones in Conflict-Ridden Communities in Cameroon

Authors: Lotsmart Fonjong

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The livelihood of rural communities in the West African state of Cameroon, which is largely dictated by natural forces (rainfall, temperatures, and soil), is today threatened by climate change and armed conflict. This paper investigates the extent to which rural communities are aware of climate change, how their perceptions of changes across different agro-ecological zones have impacted farming practices, output, and lifestyles, on the one hand, and the extent to which local armed conflicts are confounding their efforts and adaptation abilities. The paper is based on a survey conducted among small farmers in selected localities within the forest and savanna ecological zones of the conflict-ridden Northwest and Southwest Cameroon. Attention is paid to farmers’ gender, scale, and type of farming. Farmers’ perception of/and response to climate change are analysed alongside local rainfall and temperature data and mobilization for climate justice. Findings highlight the fact that farmers’ perception generally corroborates local climatic data. Climatic instability has negatively affected farmers’ output, food prices, standards of living, and food security. However, the vulnerability of the population varies across ecological zones, gender, and crop types. While these factors also account for differences in local response and adaptation to climate change, ongoing armed conflicts in these regions have further complicated opportunities for climate-driven agricultural innovations, inputs, and exchange of information among farmers. This situation underlines how poor communities, as victims, are forced into many complex problems outsider their making. It is therefore important to mainstream farmers’ perceptions and differences into policy strategies that consider both climate change and Anglophone conflict as national security concerns foe sustainable development in Cameroon.

Keywords: adaptation policies, climate change, conflict, small farmers, cameroon

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1316 Exploring Women Perceptions on the Benefit Package of the Free Maternal Health Policy under the Universal Health Coverage of the National Health Insurance Scheme in Rural Upper West Region of Ghana: A Qualitative study

Authors: Alexander Suuk Laar, Emmanuel Bekyieriya, Sylvester Isang, Benjamin Baguune

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Introduction: In Ghana, despite the implementation of strategies and initiatives to ensure universal access to reproductive health and family planning (FP) services for the past two decades, interventions have not adequately addressed the access and utilization needs of women of reproductive age, especially in rural Ghana. To improve access and use of reproductive and maternal health services in Ghana, a free maternal care exemption policy under the universal health coverage of the National Health Insurance Scheme was implemented in 2005. Despite the importance of FP, this service was left out of the benefit package of the policy. Low or no use of FP services is often associated with poor health among women. However, to date, there has been limited research on perspectives of women for not making FP services as part of the benefit package of the free maternal health services. This qualitative study explored perceptions of women on the comprehensiveness of the free maternal health benefit package and the effects on utilisation of services in the rural Upper West region of Ghana to improve services. Methods: This exploratory qualitative study used focus group discussions with pregnant and lactating women in three rural districts in the Upper West region of Ghana. Six focus groups were held with both pregnant women and lactating mothers at the time of the interview. Three focus group discussions were organised with the same category of women in each district. We used a purposive sampling procedure to select the participants from the districts. The interviews with the written consent of the participants lasted between 60 minutes and 120 minutes. Interviews were audio-recorded and transcribed verbatim. Data were analysed using Braun and Clarke thematic framework guidelines. Results: This research presents an in-depth account of women's perceptions on the effects associated with the uptake of FP services and its exclusion from the benefit package of the free maternal health policy. Our study found that participants did not support the exclusion of FP services in the benefit package. Participants mentioned factors hampering their access to and use of FP and contraceptive services to include the cost of services, distance and cost of transport to health facilities, lack of knowledge about FP services, socio-cultural norms and negative attitude of healthcare professionals. Participants are of the view that making FP services part of the benefit package could have addressed the cost aspect of services which act as the main barrier to improve the use of services by poor rural women. Conclusion: Women of reproductive age face cost barriers that limit their access to and use of FP and contraception services in the rural Upper West region of Ghana and need health policymakers to revise the free maternal health package to include FP services. It is essential for policymakers to begin considering revising the free maternal health policy benefit package to include FP services to help address the cost barrier for rural poor women to use services.

Keywords: benefit package, free maternal policy, women, Ghana, rural Upper West Region, Universal Health Coverage.

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1315 A New Distributed Computing Environment Based On Mobile Agents for Massively Parallel Applications

Authors: Fatéma Zahra Benchara, Mohamed Youssfi, Omar Bouattane, Hassan Ouajji, Mohamed Ouadi Bensalah

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In this paper, we propose a new distributed environment for High Performance Computing (HPC) based on mobile agents. It allows us to perform parallel programs execution as distributed one over a flexible grid constituted by a cooperative mobile agent team works. The distributed program to be performed is encapsulated on team leader agent which deploys its team workers as Agent Virtual Processing Unit (AVPU). Each AVPU is asked to perform its assigned tasks and provides the computational results which make the data and team works tasks management difficult for the team leader agent and that influence the performance computing. In this work we focused on the implementation of the Mobile Provider Agent (MPA) in order to manage the distribution of data and instructions and to ensure a load balancing model. It grants also some interesting mechanisms to manage the others computing challenges thanks to the mobile agents several skills.

Keywords: image processing, distributed environment, mobile agents, parallel and distributed computing

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1314 Perceptions of Community Members in Lephalale Area, Limpopo Province, Towards Water Conservation: Development of a Psychological Model

Authors: M. L. Seretlo-Rangata, T. Sodi, S. Govender

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Despite interventions by various governments to regulate water demand and address water scarcity, literature shows that billions of people across the world continue to struggle with access because not everyone contributes equally to conservation efforts. Behavioral factors such as individual and collective aspects of cognition and commitment have been found to play an important role in water conservation. The aim of the present study was to explore the perceptions of community members in the Lephalale area, Limpopo province, towards water conservation with a view to developing an explanatory psychological model on water conservation. Twenty (20) participants who relied on communal taps to access water in Lephalale Local Municipality, Limpopo province, were selected through purposeful sampling. In-depth, semi-structured, individual face-to-face interviews were used to gather data and were analyzed utilizing thematic content analysis (TCA). The research findings revealed that there are various psychological effects of water scarcity on communities, such as emotional distress, interpersonal conflicts and disruptions of daily activities of living. Additionally, the study results showed that the coping strategies developed by participants to deal with water scarcity included adopting alternative water use behaviors as well as adjusting current behaviors and lifestyles. Derived from the study findings, a psychological model of water conservation was developed. The model incorporates some ideas from the Value-Belief-Norm (VBN) theory and the Afrocentric theory. The model suggests that people’s worldviews, including their values, beliefs and culture, are significant determinants of their pro-environmental behaviors. The study concludes by recommending that authorities and policymakers should consider psychological factors when developing water management programs, strategies and interventions with the consultation of psychology experts.

Keywords: water conservation, psychological model, pro-environmental behaviour, conservation psychology, water-use behaviour

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1313 The 'Ineffectiveness' of Teaching Research Methods in Moroccan Higher Education: A Qualitative Study

Authors: Ahmed Chouari

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Although research methods has been an integral part of the curriculum in Moroccan higher education for decades, it seems that the research methods teaching pedagogy that teachers use suffers from a serious absence of a body of literature in the field. Also, the various challenges that both teachers and students of research methods face have received little interest by researchers in comparison to other fields such as applied linguistics. Therefore, the main aim of this study is to remedy to this situation by exploring one of the major issues in teaching research methods – that is, the phenomenon of students’ dissatisfaction with the research methods course in higher education in Morocco. The aim is also to understand students’ attitudes and perceptions on how to make the research methods course more effective in the future. Three qualitative research questions were used: (1) To what extent are graduate students satisfied with the pedagogies used by the teachers of the research methods course in Moroccan higher education? (2) To what extent are graduate students satisfied with the approach used in assessing research methods in Moroccan higher education? (3) What are students’ perceptions on how to make the research methods course more effective in Moroccan higher education? In this study, a qualitative content analysis was adopted to analyze students’ views and perspectives about the major factors behind their dissatisfaction with the course at the School of Arts and Humanities – University of Moulay Ismail. A semi-structured interview was used to collect data from 14 respondents from two different Master programs. The results show that there is a general consensus among the respondents about the major factors behind the ineffectiveness of the course. These factors include theory-practice gap, heavy reliance on theoretical knowledge at the expense of procedural knowledge, and ineffectiveness of some teachers. The findings also reveal that teaching research methods in Morocco requires more time, better equipment, and more competent teachers. Above all, the findings indicate that today there is an urgent need in Morocco to shift from teacher-centered approaches to learner-centered approaches in teaching the research methods course. These findings, thus, contribute to the existing literature by unraveling the factors that impede the learning process, and by suggesting a set of strategies that can make course more effective.

Keywords: competencies, learner-centered teaching, research methods, student autonomy, pedagogy

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1312 The Dark History of American Psychiatry: Racism and Ethical Provider Responsibility

Authors: Mary Katherine Hoth

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Despite racial and ethnic disparities in American psychiatry being well-documented, there remains an apathetic attitude among nurses and providers within the field to engage in active antiracism and provide equitable, recovery-oriented care. It is insufficient to be a “colorblind” nurse or provider and state that call care provided is identical for every patient. Maintaining an attitude of “colorblindness” perpetuates the racism prevalent throughout healthcare and leads to negative patient outcomes. The purpose of this literature review is to highlight the how the historical beginnings of psychiatry have evolved into the disparities seen in today’s practice, as well as to provide some insight on methods that providers and nurses can employ to actively participate in challenging these racial disparities. Background The application of psychiatric medicine to White people versus Black, Indigenous, and other People of Color has been distinctly different as a direct result of chattel slavery and the development of pseudoscience “diagnoses” in the 19th century. This weaponization of the mental health of Black people continues to this day. Population The populations discussed are Black, Indigenous, and other People of Color, with a primary focus on Black people’s experiences with their mental health and the field of psychiatry. Methods A literature review was conducted using CINAHL, EBSCO, MEDLINE, and PubMed databases with the following terms: psychiatry, mental health, racism, substance use, suicide, trauma-informed care, disparities and recovery-oriented care. Articles were further filtered based on meeting the criteria of peer-reviewed, full-text availability, written in English, and published between 2018 and 2023. Findings Black patients are more likely to be diagnosed with psychotic disorders and prescribed antipsychotic medications compared to White patients who were more often diagnosed with mood disorders and prescribed antidepressants. This same disparity is also seen in children and adolescents, where Black children are more likely to be diagnosed with behavior problems such as Oppositional Defiant Disorder (ODD) and White children with the same presentation are more likely to be diagnosed with Attention Hyperactivity Disorder. Medications advertisements for antipsychotics like Haldol as recent as 1974 portrayed a Black man, labeled as “agitated” and “aggressive”, a trope we still see today in police violence cases. The majority of nursing and medical school programs do not provide education on racism and how to actively combat it in practice, leaving many healthcare professionals acutely uneducated and unaware of their own biases and racism, as well as structural and institutional racism. Conclusions Racism will continue to grow wherever it is given time, space, and energy. Providers and nurses have an ethical obligation to educate themselves, actively deconstruct their personal racism and bias, and continuously engage in active antiracism by dismantling racism wherever it is encountered, be it structural, institutional, or scientific racism. Agents of change at the patient care level not only improve the outcomes of Black patients, but it will also lead the way in ensuring Black, Indigenous, and other People of Color are included in research of methods and medications in psychiatry in the future.

Keywords: disparities, psychiatry, racism, recovery-oriented care, trauma-informed care

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1311 Perceptions and Experiences of Learners on the Banning of Corporal Punishment in South African Schools

Authors: Londeka Ngubane

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The use of corporal punishment is not a new phenomenon in the South African education system as it was, for a long time, recognised as a fitting form of punishment for ill-disciplined and disobedient children. The growing recognition that corporal punishment is an act of violence against children has resulted in the abolishment of this form of punishment in society and particularly in schools. However, regardless of criminalising corporal punishment, it appears to be a disciplinary measure that is persistently used by some educators. Historically and currently, the intimate connection between corporal punishment and discipline has not merely been a convention of human thinking, as this practice is given recognition in various definitions in dictionaries. ‘To discipline’ is habitually stated to mean ‘to punish’. The notion of ‘disciplining children’ also comes from entrenched common conceptions about children and their relationship with adults. Corporal punishment has, for a long time, been associated with the rearing and education of children, and this practice thus pervades schooling across nations. In many societies, punishment is a term that is closely linked with the self-perception of teachers who feel that they must be ‘in control’ and have ‘the upper hand’ in order to be respected. This impression of control is evident in the widespread conception of education which is to ‘socialize’ children in ‘desirable ways’ of ‘sitting in a formal classroom’, ‘behaving’ in school, ‘following instructions’ from the teacher, talking only when asked to, and finishing tasks on time. It was against this backdrop that a comprehensive review of relevant literature was undertaken and that individual interviews were conducted with fifty learners from four schools (two junior secondary and two senior secondary schools) in a selected township area in KwaZulu-Natal Province. The main aim of the study was to explore and thus understand learners’ views on the administration of corporal punishment regardless of the fact that it was legally abolished. It was envisaged that the interviews with the learners would elicit rich data that would enhance the researcher’s insight into their perceptions of the persistent use of corporal punishment as a disciplinary measure in their schools. The study was thus premised on the assumption, which had been strengthened by anecdotal and media evidence, that corporal punishment was still administered in some schools in South Africa and in schools in the study area in particular.

Keywords: corporal punishment, ban, school learners, South Africa

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1310 Impact of Social Media in Shaping Perceptions on Filipino Muslim Identity

Authors: Anna Rhodora A. Solar, Jan Emil N. Langomez

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Social Media plays a crucial role in influencing Philippine public opinion with regard to a variety of socio-political issues. This became evident in the massacre of 44 members of the Special Action Force (SAF 44) tasked by the Philippine government to capture one of the US Federal Bureau of Investigation’s most wanted terrorists. The incident was said to be perpetrated by members of the Moro Islamic Liberation Front and the Bangsamoro Islamic Freedom Fighters. Part of the online discourse within Philippine cyberspace sparked intense debates on Filipino Muslim identity, with several Facebook viral posts linking Islam as a factor to the tragic event. Facebook is considered to be the most popular social media platform in the Philippines. As such, this begs the question of the extent to which social media, specifically Facebook, shape the perceptions of Filipinos on Filipino Muslims. This study utilizes Habermas’ theory of communicative action as it offers an explanation on how public sphere such as social media could be a network for communicating information and points of view through free and open dialogue among equal citizens to come to an understanding or common perception. However, the paper argues that communicative action which is aimed at reaching understanding free from force, and strategic action which is aimed at convincing someone through argumentation may not necessarily be mutually exclusive since reaching an understanding can also be considered as a result of convincing someone through argumentation. Moreover, actors may clash one another in their ideas before reaching common understanding, hence the presence of force. Utilizing content analysis on the Facebook posts with Islamic component that went viral after the massacre of the SAF 44, this paper argues that framing the image of Filipino Muslims through Facebook reflects both communicative and strategic actions. Moreover, comment threads on viral posts manifest force albeit implicit.

Keywords: communication, Muslim, Philippines, social media

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1309 A Case Study on Vocational Teachers’ Perceptions on Their Linguistically and Culturally Responsive Teaching

Authors: Kirsi Korkealehto

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In Finland the transformation from homogenous culture into multicultural one as a result of heavy immigration has been rapid in the recent decades. As multilingualism and multiculturalism are growing features in our society, teachers in all educational levels need to be competent for encounters with students from diverse cultural backgrounds. Consequently, also the number of multicultural and multilingual vocational school students has increased which has not been taken into consideration in teacher education enough. To bridge this gap between teachers’ competences and the requirements of the contemporary school world, Finnish Ministry of Culture and Education established the DivEd-project. The aim of the project is to prepare all teachers to work in the linguistically and culturally diverse world they live in, to develop and increase culturally sustaining and linguistically responsive pedagogy in Finland, increase awareness among Teacher Educators working with preservice teachers and to increase awareness and provide specific strategies to in-service teachers. The partners in the nationwide project are 6 universities and 2 universities of applied sciences. In this research, the linguistically and culturally sustainable teaching practices developed within the DivEd-project are tested in practice. This research aims to explore vocational teachers’ perceptions of these multilingualism and multilingual educational practices. The participants of this study are vocational teachers in of different fields. The data were collected by individual, face-to-face interviews. The data analysis was conducted through content analysis. The findings indicate that the vocational teachers experience that they lack knowledge on linguistically and culturally responsive pedagogy. Moreover, they regard themselves in some extent incompetent in incorporating multilingually and multiculturally sustainable pedagogy in everyday teaching work. Therefore, they feel they need more training pertaining multicultural and multilingual knowledge, competences and suitable pedagogical methods for teaching students from diverse linguistic and cultural backgrounds.

Keywords: multicultural, multilingual, teacher competence, vocational school

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1308 Living Together Apart: Gender Differences in Transnational Couple Living Perceptions in the Ghanaian Context

Authors: Rodlyn Remina Hines

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Males and Females respond differently to life situations, including transnational living. Being in a transnational marriage relationship may put a strain on the relationship requiring partners to adjust their behaviors and expectancies of the other partner to accommodate the disruptions in the relationship. More so, when one partner is an immigrant to a new geographic location with the other in the native country, these disruptions may be intensive. This qualitative study examined gender differences in how married Ghanaian couples respond to making a life together as a couple while living across international borders. The study asked two questions: (1) What are the perceptions of males and females on transnational living? and (2) how do married males and females respond to transnational living situations? To answer these questions, semi-structured interviews were conducted with 24 married couples- with one partner living in the United States (U.S.) and the other spouse in Ghana via purposive and snowball sampling techniques. Participants were aged 26 to 59 years with an average age of 40; the average age of relationship: 10.41; and average years of living apart: 6.7. Induction and deduction hybrid analysis strategies were used to derive emerging themes. The results highlight significant gender differences in response to transnational living status and practices. The data indicate that transnational couples with the male spouse residing in the U.S. experience more relationship strains than is the case when the female partner is the immigrant. Three couples who were in divorce proceedings at the time of the interview had the male partner residing in the U.S. and the female spouse in Ghana. These gender differences also reflected spousal visitation frequency, duration of spousal reunification, amount of and frequency of spousal remittance(s), and immigration processing procedures. Finally, the data show female immigrant partners as better managers of transnational living stresses and strains than their male counterparts. Findings from this study have implications for marriage and family practitioners and immigration policy makers.

Keywords: gender differences, , ghanaian couples, ghanaian immigrants, transnational living

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1307 Role of Web Graphics and Interface in Creating Visitor Trust

Authors: Pramika J. Muthya

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This paper investigates the impact of web graphics and interface design on building visitor trust in websites. A quantitative survey approach was used to examine how aesthetic and usability elements of website design influence user perceptions of trustworthiness. 133 participants aged 18-25 who live in urban Bangalore and engage in online transactions were recruited via convenience sampling. Data was collected through an online survey measuring trust levels based on website design, using validated constructs like the Visual Aesthetic of Websites Inventory (VisAWI). Statistical analysis, including ordinal regression, was conducted to analyze the results. The findings show a statistically significant relationship between web graphics and interface design and the level of trust visitors place in a website. The goodness-of-fit statistics and highly significant model fitting information provide strong evidence for rejecting the null hypothesis of no relationship. Well-designed visual aesthetics like simplicity, diversity, colorfulness, and craftsmanship are key drivers of perceived credibility. Intuitive navigation and usability also increase trust. The results emphasize the strategic importance for companies to invest in appealing graphic design, consistent with existing theoretical frameworks. There are also implications for taking a user-centric approach to web design and acknowledging the reciprocal link between pre-existing user trust and perception of visuals. While generalizable, limitations include possible sampling and self-report biases. Further research can build on these findings to deepen understanding of nuanced cultural and temporal factors influencing online trust. Overall, this study makes a significant contribution by providing empirical evidence that reinforces the crucial impact of thoughtful graphic design in fostering lasting user trust in websites.

Keywords: web graphics, interface design, visitor trust, website design, aesthetics, user experience, online trust, visual design, graphic design, user perceptions, user expectations

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1306 The Establishment of Primary Care Networks (England, UK) Throughout the COVID-19 Pandemic: A Qualitative Exploration of Workforce Perceptions

Authors: Jessica Raven Gates, Gemma Wilson-Menzfeld, Professor Alison Steven

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In 2019, the Primary Care system in the UK National Health Service (NHS) was subject to reform and restructuring. Primary Care Networks (PCNs) were established, which aligned with a trend towards integrated care both within the NHS and internationally. The introduction of PCNs brought groups of GP practices in a locality together, to operate as a network, build on existing services and collaborate at a larger scale. PCNs were expected to bring a range of benefits to patients and address some of the workforce pressures in the NHS, through an expanded and collaborative workforce. The early establishment of PCNs was disrupted by the emerging COVID-19 pandemic. This study, set in the context of the pandemic, aimed to explore experiences of the PCN workforce, and their perceptions of the establishment of PCNs. Specific objectives focussed on examining factors perceived as enabling or hindering the success of a PCN, the impact on day-to-day work, the approach to implementing change, and the influence of the COVID-19 pandemic upon PCN development. This study is part of a three-phase PhD project that utilized qualitative approaches and was underpinned by social constructionist philosophy. Phase 1: a systematic narrative review explored the provision of preventative healthcare services in UK primary settings and examined facilitators and barriers to delivery as experienced by the workforce. Phase 2: informed by the findings of phase 1, semi-structured interviews were conducted with fifteen participants (PCN workforce). Phase 3: follow-up interviews were conducted with original participants to examine any changes to their experiences and perceptions of PCNs. Three main themes span across phases 2 and 3 and were generated through a Framework Analysis approach: 1) working together at scale, 2) network infrastructure, and 3) PCN leadership. Findings suggest that through efforts to work together at scale and collaborate as a network, participants have broadly accepted the concept of PCNs. However, the workforce has been hampered by system design and system complexity. Operating against such barriers has led to a negative psychological impact on some PCN leaders and others in the PCN workforce. While the pandemic undeniably increased pressure on healthcare systems around the world, it also acted as a disruptor, offering a glimpse into how collaboration in primary care can work well. Through the integration of findings from all phases, a new theoretical model has been developed, which conceptualises the findings from this Ph.D. study and demonstrates how the workforce has experienced change associated with the establishment of PCNs. The model includes a contextual component of the COVID-19 pandemic and has been informed by concepts from Complex Adaptive Systems theory. This model is the original contribution to knowledge of the PhD project, alongside recommendations for practice, policy and future research. This study is significant in the realm of health services research, and while the setting for this study is the UK NHS, the findings will be of interest to an international audience as the research provides insight into how the healthcare workforce may experience imposed policy and service changes.

Keywords: health services research, qualitative research, NHS workforce, primary care

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