Search results for: net income margin
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1908

Search results for: net income margin

78 Knowledge, Attitude and Beliefs Towards Polypharmacy Amongst Older People Attending Family Medicine Clinic at the Aga Khan University Hospital, Nairobi, Kenya (AKUHN) Sub-Saharan Africa-Qualitative Study

Authors: Maureen Kamau, Gulnaz Mohamoud, Adelaide Lusambili, Njeri Nyanja

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Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. These multiple chronic conditions are managed with polypharmacy. Polypharmacy has numerous adverse effects including non-adherence, poor compliance to the various medications, reduced appetite, and risk of fall. Studies on polypharmacy and ageing are few and poorly understood especially in low and middle - income countries. The aim of this study was to explore the knowledge, attitudes and beliefs of older people towards polypharmacy. A qualitative study of 15 patients aged 60 years and above, taking more than five medications per day were conducted at the Aga Khan University using Semi-structured in-depth interviews. Three interviews were pilot interviews, and data analysis was performed on 12 interviews. Data were analyzed using NVIVO 12 software. A thematic qualitative analysis was carried out guided by Braun and Clarke (2006) framework. Themes identified; - knowledge of their co-morbidities and of the medication that older persons take, sources of information about medicines, and storage of the medication, experiences and attitudes of older patients towards polypharmacy both positive and negative, older peoples beliefs and their coping mechanisms with polypharmacy. The study participants had good knowledge on their multiple co-morbidities, and on the medication they took. The patients had positive attitudes towards medication as it enhanced their health and well-being, and enabled them to perform their activities of daily living. There was a strong belief among older patients that the medications were necessary for their health. All these factors enhanced compliance to the multiple medication. However, some older patients had negative attitudes due to the pill burden, side effects of the medication, and stigma associated with being ill. Cost of healthcare was a concern, with most of the patients interviewed relying on insurance to cover the cost of their medication. Older patients had accepted that the medication they were prescribed were necessary for their health, as it enabled them to complete their activities of daily living. Some concerns about the side effects of the medication arose, and brought about the need for patient education that would ensure that the patients are aware of the medications they take, and potential side effects. The effect that the COVID 19 pandemic had in the healthcare of the older patients was evident by the number of the older patients avoided coming to the hospital during the period of the pandemic. The relationship with the primary care physician and the older patients is an important one, especially in LMICs such as Kenya, as many of the older patients trusted the doctors wholeheartedly to make the best decision about their health and about their medication. Prescription review is important to avoid the use of potentially inappropriate medication.

Keywords: polypharmacy, older patients, multiple chronic conditions, Kenya, Africa, qualitative study, indepth interviews, primary care

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77 Globalization of Pesticide Technology and Sustainable Agriculture

Authors: Gagandeep Kaur

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The pesticide industry is a big supplier of agricultural inputs. The uses of pesticides control weeds, fungal diseases, etc., which causes of yield losses in agricultural production. In agribusiness and agrichemical industry, Globalization of markets, competition and innovation are the dominant trends. By the tradition of increasing the productivity of agro-systems through generic, universally applicable technologies, innovation in the agrichemical industry is limited. The marketing of technology of agriculture needs to deal with some various trends such as locally-organized forces that envision regionalized sustainable agriculture in the future. Agricultural production has changed dramatically over the past century. Before World War second agricultural production was featured as a low input of money, high labor, mixed farming and low yields. Although mineral fertilizers were applied already in the second half of the 19th century, most f the crops were restricted by local climatic, geological and ecological conditions. After World War second, in the period of reconstruction, political and socioeconomic pressure changed the nature of agricultural production. For a growing population, food security at low prices and securing farmer income at acceptable levels became political priorities. Current agricultural policy the new European common agricultural policy is aimed to reduce overproduction, liberalization of world trade and the protection of landscape and natural habitats. Farmers have to increase the quality of their productivity and they have to control costs because of increased competition from the world market. Pesticides should be more effective at lower application doses, less toxic and not pose a threat to groundwater. There is a big debate taking place about how and whether to mitigate the intensive use of pesticides. This debate is about the future of agriculture which is sustainable agriculture. This is possible by moving away from conventional agriculture. Conventional agriculture is featured as high inputs and high yields. The use of pesticides in conventional agriculture implies crop production in a wide range. To move away from conventional agriculture is possible through the gradual adoption of less disturbing and polluting agricultural practices at the level of the cropping system. For a healthy environment for crop production in the future there is a need for the maintenance of chemical, physical or biological properties. There is also required to minimize the emission of volatile compounds in the atmosphere. Companies are limiting themselves to a particular interpretation of sustainable development, characterized by technological optimism and production-maximizing. So the main objective of the paper will present the trends in the pesticide industry and in agricultural production in the era of Globalization. The second objective is to analyze sustainable agriculture. Companies of pesticides seem to have identified biotechnology as a promising alternative and supplement to the conventional business of selling pesticides. The agricultural sector is in the process of transforming its conventional mode of operation. Some experts give suggestions to farmers to move towards precision farming and some suggest engaging in organic farming. The methodology of the paper will be historical and analytical. Both primary and secondary sources will be used.

Keywords: globalization, pesticides, sustainable development, organic farming

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76 Concealing Breast Cancer Status: A Qualitative Study in India

Authors: Shradha Parsekar, Suma Nair, Ajay Bailey, Binu V. S.

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Background: Concealing of cancer-related information is seen in many low-and-middle-income countries and may be associated with multiple factors. Comparatively, there is lack of information about, how breast cancers diagnosed women disclose cancer-related information to their social contacts and vice versa. To get more insights on the participant’s experience, opinions, expectations, and attitudes, a qualitative study is a suitable approach. Therefore, this study involving in-depth interviews was planned to lessen this gap. Methods: Interviews were conducted separately among breast cancer patients and their caregivers with semi-structured qualitative interview guide. Purposive and convenient sampling was being used to recruit patients and caregivers, respectively. Ethical clearance and permission from the tertiary hospital were obtained and participants were selected from the Udupi district, Karnataka, India. After obtaining a list of breast cancer diagnosed cases, participants were contacted in person and their willingness to take part in the study was taken. About 39 caregivers and 35 patients belonging to different breast cancer stages were recruited. Interviews were recorded with prior permission. Data was managed by Atlas.ti 8 software. The recordings were transcribed, translated and coded in two cycles. Most of the patients belonged to stage II and III cancer. Codes were grouped together into to whom breast cancer status was concealed to and underneath reason for the same. Main findings: followings are the codes and code families which emerged from the data. 1) Concealing the breast cancer status from social contacts other than close family members (such as extended family, neighbor and friends). Participants perceived the reasons as, a) to avoid questions which people probe (which doesn’t have answers), b) to avoid people paying courtesy visit (to inquire about the health as it is Indian culture to visit the sick person) making it inconvenient for patient and caregivers have to offer something and talk to them, c) to avoid people getting shocked (react as if cancer is different from other diseases) or getting emotional/sad, or getting fear of death d) to avoid getting negative suggestion or talking anything in front of patient as it may affect patient negatively, e) to avoid getting stigmatized, f) to avoid getting obstacle in child’s marriage. 2) Participant concealed the breast cancer status of young children as they perceived that it may a) affect studies, b) affect emotionally, c) children may get scared. 3) Concealing the breast cancer status from patients as the caregivers perceived that they have fear of a) worsening patient’s health, b) patient getting tensed, c) patient getting shocked, and d) patient getting scared. However, some participants stressed important in disclosing the cancer status to social contact/patient to make the people aware of the disease. Conclusion: The news of breast cancer spreads like electricity in the wire, therefore, patient or family avoid it for many reasons. Although, globally, due to physicians’ ethical obligations, there is an inclination towards more disclosure of cancer diagnosis and status of prognosis to the patient. However, it is an ongoing argument whether patient/social contacts should know the status especially in a country like India.

Keywords: breast cancer, concealing cancer status, India, qualitative study

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75 Climate Change and Rural-Urban Migration in Brazilian Semiarid Region

Authors: Linda Márcia Mendes Delazeri, Dênis Antônio Da Cunha

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Over the past few years, the evidence that human activities have altered the concentration of greenhouse gases in the atmosphere have become stronger, indicating that this accumulation is the most likely cause of climate change observed so far. The risks associated with climate change, although uncertain, have the potential to increase social vulnerability, exacerbating existing socioeconomic challenges. Developing countries are potentially the most affected by climate change, since they have less potential to adapt and are those most dependent on agricultural activities, one of the sectors in which the major negative impacts are expected. In Brazil, specifically, it is expected that the localities which form the semiarid region are among the most affected, due to existing irregularity in rainfall and high temperatures, in addition to economic and social factors endemic to the region. Given the strategic limitations to handle the environmental shocks caused by climate change, an alternative adopted in response to these shocks is migration. Understanding the specific features of migration flows, such as duration, destination and composition is essential to understand the impacts of migration on origin and destination locations and to develop appropriate policies. Thus, this study aims to examine whether climatic factors have contributed to rural-urban migration in semiarid municipalities in the recent past and how these migration flows will be affected by future scenarios of climate change. The study was based on microeconomic theory of utility maximization, in which, to decide to leave the countryside and move on to the urban area, the individual seeks to maximize its utility. Analytically, we estimated an econometric model using the modeling of Fixed Effects and the results confirmed the expectation that climate drivers are crucial for the occurrence of the rural-urban migration. Also, other drivers of the migration process, as economic, social and demographic factors were also important. Additionally, predictions about the rural-urban migration motivated by variations in temperature and precipitation in the climate change scenarios RCP 4.5 and 8.5 were made for the periods 2016-2035 and 2046-2065, defined by the Intergovernmental Panel on Climate Change (IPCC). The results indicate that there will be increased rural-urban migration in the semiarid region in both scenarios and in both periods. In general, the results of this study reinforce the need for formulations of public policies to avoid migration for climatic reasons, such as policies that give support to the productive activities generating income in rural areas. By providing greater incentives for family agriculture and expanding sources of credit for the farmer, it will have a better position to face climate adversities and to settle in rural areas. Ultimately, if migration becomes necessary, there must be the adoption of policies that seek an organized and planned development of urban areas, considering migration as an adaptation strategy to adverse climate effects. Thus, policies that act to absorb migrants in urban areas and ensure that they have access to basic services offered to the urban population would contribute to the social costs reduction of climate variability.

Keywords: climate change, migration, rural productivity, semiarid region

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74 Mapping the State of the Art of European Companies Doing Social Business at the Base of the Economic Pyramid as an Advanced Form of Strategic Corporate Social Responsibility

Authors: Claudio Di Benedetto, Irene Bengo

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The objective of the paper is to study how large European companies develop social business (SB) at the base of the economic pyramid (BoP). BoP markets are defined as the four billions people living with an annual income below $3,260 in local purchasing power. Despite they are heterogeneous in terms of geographic range they present some common characteristics: the presence of significant unmet (social) needs, high level of informal economy and the so-called ‘poverty penalty’. As a result, most people living at BoP are excluded from the value created by the global market economy. But it is worth noting, that BoP population with an aggregate purchasing power of around $5 trillion a year, represent a huge opportunity for companies that want to enhance their long-term profitability perspective. We suggest that in this context, the development of SB is, for companies, an innovative and promising way to satisfy unmet social needs and to experience new forms of value creation. Indeed, SB can be considered a strategic model to develop CSR programs that fully integrate the social dimension into the business to create economic and social value simultaneously. Despite in literature many studies have been conducted on social business, only few have explicitly analyzed such phenomenon from a company perspective and their role in the development of such initiatives remains understudied with fragmented results. To fill this gap the paper analyzes the key characteristics of the social business initiatives developed by European companies at BoP. The study was performed analyzing 1475 European companies participating in the United Nation Global Compact, the world’s leading corporate social responsibility program. Through the analysis of the corporate websites the study identifies companies that actually do SB at BoP. For SB initiatives identified, information were collected according to a framework adapted from the SB model developed by preliminary results show that more than one hundred European companies have already implemented social businesses at BoP accounting for the 6,5% of the total. This percentage increases to 15% if the focus is on companies with more than 10.440 employees. In terms of geographic distribution 80% of companies doing SB at BoP are located in western and southern Europe. The companies more active in promoting SB belong to financial sector (20%), energy sector (17%) and food and beverage sector (12%). In terms of social needs addressed almost 30% of the companies develop SB to provide access to energy and WASH, 25% of companies develop SB to reduce local unemployment or to promote local entrepreneurship and 21% of companies develop SB to promote financial inclusion of poor. In developing SB companies implement different social business configurations ranging from forms of outsourcing to internal development models. The study identifies seven main configurations through which company develops social business and each configuration present distinguishing characteristics respect to the involvement of the company in the management, the resources provided and the benefits achieved. By performing different analysis on data collected the paper provides detailed insights on how European companies develop SB at BoP.

Keywords: base of the economic pyramid, corporate social responsibility, social business, social enterprise

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73 Impact of Informal Institutions on Development: Analyzing the Socio-Legal Equilibrium of Relational Contracts in India

Authors: Shubhangi Roy

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Relational Contracts (informal understandings not enforceable by law) are a common feature of most economies. However, their dominance is higher in developing countries. Such informality of economic sectors is often co-related to lower economic growth. The aim of this paper is to investigate whether informal arrangements i.e. relational contracts are a cause or symptom of lower levels of economic and/or institutional development. The methodology followed involves an initial survey of 150 test subjects in Northern India. The subjects are all members of occupations where they frequently transact ensuring uniformity in transaction volume. However, the subjects are from varied socio-economic backgrounds to ensure sufficient variance in transaction values allowing us to understand the relationship between the amount of money involved to the method of transaction used, if any. Questions asked are quantitative and qualitative with an aim to observe both the behavior and motivation behind such behavior. An overarching similarity observed during the survey across all subjects’ responses is that in an economy like India with pervasive corruption and delayed litigation, economy participants have created alternative social sanctions to deal with non-performers. In a society that functions predominantly on caste, class and gender classifications, these sanctions could, in fact, be more cumbersome for a potential rule-breaker than the legal ramifications. It, therefore, is a symptom of weak formal regulatory enforcement and dispute settlement mechanism. Additionally, the study bifurcates such informal arrangements into two separate systems - a) when it exists in addition to and augments a legal framework creating an efficient socio-legal equilibrium or; b) in conflict with the legal system in place. This categorization is an important step in regulating informal arrangements. Instead of considering the entire gamut of such arrangements as counter-development, it helps decision-makers understand when to dismantle (latter) and when to pivot around existing informal systems (former). The paper hypothesizes that those social arrangements that support the formal legal frameworks allow for cheaper enforcement of regulations with lower enforcement costs burden on the state mechanism. On the other hand, norms which contradict legal rules will undermine the formal framework. Law infringement, in presence of these norms, will have no impact on the reputation of the business or individual outside of the punishment imposed under the law. It is especially exacerbated in the Indian legal system where enforcement of penalties for non-performance of contracts is low. In such a situation, the social norm will be adhered to more strictly by the individuals rather than the legal norms. This greatly undermines the role of regulations. The paper concludes with recommendations that allow policy-makers and legal systems to encourage the former category of informal arrangements while discouraging norms that undermine legitimate policy objectives. Through this investigation, we will be able to expand our understanding of tools of market development beyond regulations. This will allow academics and policymakers to harness social norms for less disruptive and more lasting growth.

Keywords: distribution of income, emerging economies, relational contracts, sample survey, social norms

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72 An Exploratory Factor and Cluster Analysis of the Willingness to Pay for Last Mile Delivery

Authors: Maximilian Engelhardt, Stephan Seeck

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The COVID-19 pandemic is accelerating the already growing field of e-commerce. The resulting urban freight transport volume leads to traffic and negative environmental impact. Furthermore, the service level of parcel logistics service provider is lacking far behind the expectations of consumer. These challenges can be solved by radically reorganize the urban last mile distribution structure: parcels could be consolidated in a micro hub within the inner city and delivered within time windows by cargo bike. This approach leads to a significant improvement of consumer satisfaction with their overall delivery experience. However, this approach also leads to significantly increased costs per parcel. While there is a relevant share of online shoppers that are willing to pay for such a delivery service there are no deeper insights about this target group available in the literature. Being aware of the importance of knowing target groups for businesses, the aim of this paper is to elaborate the most important factors that determine the willingness to pay for sustainable and service-oriented parcel delivery (factor analysis) and to derive customer segments (cluster analysis). In order to answer those questions, a data set is analyzed using quantitative methods of multivariate statistics. The data set was generated via an online survey in September and October 2020 within the five largest cities in Germany (n = 1.071). The data set contains socio-demographic, living-related and value-related variables, e.g. age, income, city, living situation and willingness to pay. In a prior work of the author, the data was analyzed applying descriptive and inference statistical methods that only provided limited insights regarding the above-mentioned research questions. The analysis in an exploratory way using factor and cluster analysis promise deeper insights of relevant influencing factors and segments for user behavior of the mentioned parcel delivery concept. The analysis model is built and implemented with help of the statistical software language R. The data analysis is currently performed and will be completed in December 2021. It is expected that the results will show the most relevant factors that are determining user behavior of sustainable and service-oriented parcel deliveries (e.g. age, current service experience, willingness to pay) and give deeper insights in characteristics that describe the segments that are more or less willing to pay for a better parcel delivery service. Based on the expected results, relevant implications and conclusions can be derived for startups that are about to change the way parcels are delivered: more customer-orientated by time window-delivery and parcel consolidation, more environmental-friendly by cargo bike. The results will give detailed insights regarding their target groups of parcel recipients. Further research can be conducted by exploring alternative revenue models (beyond the parcel recipient) that could compensate the additional costs, e.g. online-shops that increase their service-level or municipalities that reduce traffic on their streets.

Keywords: customer segmentation, e-commerce, last mile delivery, parcel service, urban logistics, willingness-to-pay

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71 Provider Perceptions of the Effects of Current U.S. Immigration Enforcement Policies on Service Utilization in a Border Community

Authors: Isabel Latz, Mark Lusk, Josiah Heyman

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The rise of restrictive U.S. immigration policies and their strengthened enforcement has reportedly caused concerns among providers about their inadvertent effects on service utilization among Latinx and immigrant communities. This study presents perceptions on this issue from twenty service providers in health care, mental health, nutrition assistance, legal assistance, and immigrant advocacy in El Paso, Texas. All participants were experienced professionals, with fifteen in CEO, COO, executive director, or equivalent positions, and based at organizations that provide services for immigrant and/or low-income populations in a bi-national border community. Quantitative and qualitative data were collected by two primary investigators via semi-structured telephone interviews with an average length of 20 minutes. A survey script with closed and open-ended questions inquired about participants’ demographic information and perceptions of impacts of immigration enforcement policies under the current federal administration on their work and patient or client populations. Quantitative and qualitative data were analyzed to produce descriptive statistics and identify salient themes, respectively. Nearly all respondents stated that their work has been negatively (N=13) or both positively and negatively (N=5) affected by current immigration enforcement policies. Negative effects were most commonly related to immigration enforcement-related fear and uncertainty among patient or client populations. Positive effects most frequently referred to a sense of increased community organizing and greater cooperation among organizations. Similarly, the majority of service providers either reported an increase (N=8) or decrease (N=6) in service utilization due to changes in immigration enforcement policies. Increased service needs were primarily related to a need for public education about immigration enforcement policy changes, information about how new policies impact individuals’ service eligibility, legal status, and civil rights, as well as a need to correct misinformation. Decreased service utilization was primarily related to fear-related service avoidance. While providers observed changes in service utilization among undocumented immigrants and mixed-immigration status families, in particular, participants also noted ‘spillover’ effects on the larger Latinx community, including legal permanent and temporary residents, refugees or asylum seekers, and U.S. citizens. This study reveals preliminary insights into providers’ widespread concerns about the effects of current immigration enforcement policies on health, social, and legal service utilization among Latinx individuals. Further research is necessary to comprehensively assess impacts of immigration enforcement policies on service utilization in Latinx and immigrant communities. This information is critical to address gaps in service utilization and prevent an exacerbation of health disparities among Latinx, immigrant, and border populations. In a global climate of rising nationalism and xenophobia, it is critical for policymakers to be aware of the consequences of immigration enforcement policies on the utilization of essential services to protect the well-being of minority and immigrant communities.

Keywords: immigration enforcement, immigration policy, provider perceptions, service utilization

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70 Circulating Public Perception on Agroforestry: Discourse Networks Analysis Using Social Media and Online News Media in Four Countries of the Sahel Region

Authors: Luisa Müting, Wisnu Harto Adiwijoyo

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Agroforestry systems transform the agricultural landscapes in the Sahel region of Africa, providing food and farming products consumed for subsistence or sold for income. In the incrementally dry climate of the Sahel region, the spreading of agroforestry practices is integral for policymaker efforts to counteract land degradation and provide soil restoration in the region. Several measures on agroforestry practices have been implemented in the region by governmental and non-governmental institutions in recent years. However, despite the efforts, past research shows that awareness of how policies and interventions are being consumed and perceived by the public remains low. Therefore, interpreting public policy dilemmas by analyzing the public perception regarding agroforestry concepts and practices is necessary. Public perceptions and discourses can be an essential driver or constraint for the adoption of agroforestry practices in the region. Thus, understanding the public discourse behavior of crucial stakeholders could assist policymakers in developing inclusive and contextual policies that are relevant to the context of agroforestry adoption in Sahel region. To answer how information about agroforestry spreads and is perceived by the public. As internet usage increased drastically over the past decade, reaching a share of 33 percent of the population being connected to the internet, this research is based on online conversation data. Social media data from Facebook are gathered daily between April 2021 and April 2022 in Djibouti, Senegal, Mali, and Nigeria based on their share of active internet users compared to other countries in the Sahel region. A systematic methodology was applied to the extracted social media using discourse network analysis (DNA). This study then clustered the data by the types of agroforestry practices, sentiments, and country. Additionally, this research extracted the text data from online news media during the same period to pinpoint events related to the topic of agroforestry. The preliminary result indicates that tree management, crops, and livestock integration, diversifying species and genetic resources, and focusing on interactions and productivity across the agricultural system; are the most notable keywords in agroforestry-related conversations within the four countries in the Sahel region. Additionally, approximately 84 percent of the discussions were still dominated by big actors, such as NGO or government actors. Furthermore, as a subject of communication within agroforestry discourse, the Great Green Wall initiative generates almost 60 percent positive sentiment within the captured social media data, effectively having a more significant outreach than general agroforestry topics. This study provides an understanding for scholars and policymakers with a springboard for further research or policy design on agroforestry in the four countries of the Sahel region with systematically uncaptured novel data from the internet.

Keywords: sahel, djibouti, senegal, mali, nigeria, social networks analysis, public discourse analysis, sentiment analysis, content analysis, social media, online news, agroforestry, land restoration

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69 Harnessing Renewable Energy as a Strategy to Combating Climate Change in Sub Saharan Africa

Authors: Gideon Nyuimbe Gasu

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Sub Saharan Africa is at a critical point, experiencing rapid population growth, particularly in urban areas and young growing force. At the same time, the growing risk of catastrophic global climate change threatens to weaken food production system, increase intensity and frequency of drought, flood, and fires and undermine gains on development and poverty reduction. Although the region has the lowest per capital greenhouse gas emission level in the world, it will need to join global efforts to address climate change, including action to avoid significant increases and to encourage a green economy. Thus, there is a need for the concept of 'greening the economy' as was prescribed at Rio Summit of 1992. Renewable energy is one of the criterions to achieve this laudable goal of maintaining a green economy. There is need to address climate change while facilitating continued economic growth and social progress as energy today is critical to economic growth. Fossil fuels remain the major contributor of greenhouse gas emission. Thus, cleaner technologies such as carbon capture storage, renewable energy have emerged to be commercially competitive. This paper sets out to examine how to achieve a low carbon economy with minimal emission of carbon dioxide and other greenhouse gases which is one of the outcomes of implementing a green economy. Also, the paper examines the different renewable energy sources such as nuclear, wind, hydro, biofuel, and solar voltaic as a panacea to the looming climate change menace. Finally, the paper assesses the different renewable energy and energy efficiency as a propeller to generating new sources of income and jobs and in turn reduces carbon emission. The research shall engage qualitative, evaluative and comparative methods. The research will employ both primary and secondary sources of information. The primary sources of information shall be drawn from the sub Saharan African region and the global environmental organizations, energy legislation, policies and related industries and the judicial processes. The secondary sources will be made up of some books, journal articles, commentaries, discussions, observations, explanations, expositions, suggestions, prescriptions and other material sourced from the internet on renewable energy as a panacea to climate change. All information obtained from these sources will be subject to content analysis. The research result will show that the entire planet is warming as a result of the activities of mankind which is clear evidence that the current development is fundamentally unsustainable. Equally, the study will reveal that a low carbon development pathway in the sub Saharan African region should be embraced to minimize emission of greenhouse gases such as using renewable energy rather than coal, oil, and gas. The study concludes that until adequate strategies are devised towards the use of renewable energy the region will continue to add and worsen the current climate change menace and other adverse environmental conditions.

Keywords: carbon dioxide, climate change, legislation/law, renewable energy

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68 Reinventing Business Education: Filling the Knowledge Gap on the Verge of the 4th Industrial Revolution

Authors: Elena Perepelova

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As the world approaches the 4th industrial revolution, income inequality has become one of the major societal concerns. Displacement of workers by technology becomes a reality, and in return, new skills and competencies are required. More important than ever, education needs to help individuals understand the wider world around them and make global connections. The author argues for the necessity to incorporate business, economics and finance studies as a part of primary education and offer access to business education to the general population with the primary objective to understand how the world functions. The paper offers a fresh look at existing business theory through an innovative program called 'Usefulnomics'. Realizing that the subject of Economics, Finance and Business are perceived as overwhelming for a large part of the population, the author has taken a holistic approach and created a program that simplifies the definitions of the existing concepts and shifts from the traditional breakdown into subjects and specialties to a teaching method that is based exclusively on real-life example case studies and group debates, in order to better grasp the concepts and put them into context. The paper findings are the result of a two-year project and experimental work with students from UK, USA, Malaysia, Russia, and Spain. The author conducted extensive research through on-line and in-person classes and workshops as well as in-depth interviews of primary and secondary grade students to assess their understanding of what is a business, how businesses operate and the role businesses play in their communities. The findings clearly indicate that students of all ages often understood business concepts and processes only in an intuitive way, which resulted in misconceptions and gaps in knowledge. While knowledge gaps were easier to identify and correct in primary school students, as students’ age increased, the learning process became distorted by career choices, political views, and the students’ actual (or perceived) economic status. While secondary school students recognized more concepts, their real understanding was often on par with upper primary school age students. The research has also shown that lack of correct vocabulary created a strong barrier to communication and real-life application or further learning. Based on these findings, each key business concept was practiced and put into context with small groups of students in order to design the content and format which would be well accepted and understood by the target group. As a result, the final learning program package was based on case studies from daily modern life and used a wide range of examples: from popular brands and well-known companies to basic commodities. In the final stage, the content and format were put into practice in larger classrooms. The author would like to share the key findings from the research, the resulting learning program as well as present new ideas on how the program could be further enriched and adapted so schools and organizations can deliver it.

Keywords: business, finance, economics, lifelong learning, XXI century skills

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67 Destruction of History and the Syrian Conflict: Upholding the Cultural Integrity of Dura Europos

Authors: Justine A. Lloyd

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Since the onset of the Syrian Civil War in 2011, the ancient city of Dura-Europos has faced widespread destruction and looting. The site is one of many places in the country the terrorist group ISIS has specifically targeted, allegedly due to its particular representations of Syrian history and culture. However, looted art and artifacts are the extremist group’s second largest source of income, only after oil. The protection of this site is important to both academics and the millions who have called Syria a home, as it aids in the nation’s sense of identity, reveals developments in the arts, and contributes to humanity’s collective history. At a time when Syria’s culture is being flattened, this sense of cultural expression is especially important to maintain. Creating an awareness of the magnitude of the issue at hand begins with an examination of the rich history of the ancient fortress city. Located on the western bank of the Euphrates River, Dura-Europos contains artifacts dating back to the Hellenistic, Parthian, and Roman periods. Though a great deal of the art and artifacts have remained safe in institutions such as the National Museum of Damascus and the Yale University Art Gallery, hundreds of looting pits and use of heavy machinery on the site has severely set back the investigative progress made by archaeologists over the last century, as well as the prospect of future excavation. Further research draws on the current destruction of the site by both ISIS and opportunists involved with the black market. Because Dura-Europos is located in a war stricken region, the acquisition of data and possibility of immediate action is particularly challenging. Resources gained from local reports, in addition to technology such as satellite imagery, however, have provided a firm starting point for the evaluation of the state of the site. The Syrian Ministry of Culture, UNESCO, and numerous Syrian and global organizations provide insight into the historic city’s past, present issues, and future plans to ensure that the cultural integrity of the site is upheld. Though over seventy percent of Dura-Europos has been completely decimated, this research challenges the notion that physically destroyed sites are lost forever. This paper assesses preventative measures that can take place to ensure the preservation of the site’s art and architecture, including examining possible solutions to the damage, such as digital reconstruction, replication, and distribution of information through exhibitions and other forms of publically accessible information. In order to investigate any possible retribution, research also includes the necessary information pertaining the global laws and regulations dealing with cultural heritage, as it directly affects the ways in which this situation can be dealt with. With the countless experts and citizens dedicated to the importance of cultural heritage, the prospect of honoring and valuing elements of Dura-Europos is possible—whether physically preserved or otherwise.

Keywords: antiquities law, archaeological sites, restitution, Syrian Civil War

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66 Longitudinal impact on Empowerment for Ugandan Women with Post-Primary Education

Authors: Shelley Jones

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Assumptions abound that education for girls will, as a matter of course, lead to their economic empowerment as women; yet. little is known about the ways in which schooling for girls, who traditionally/historically would not have had opportunities for post-primary, or perhaps even primary education – such as the participants in this study based in rural Uganda - in reality, impacts their economic situations. There is a need forlongitudinal studies in which women share experiences, understandings, and reflections of their lives that can inform our knowledge of this. In response, this paper reports on stage four of a longitudinal case study (2004-2018) focused on education and empowerment for girls and women in rural Uganda, in which 13 of the 15 participants from the original study participated. This paper understands empowerment as not simply increased opportunities (e.g., employment) but also real gains in power, freedoms that enable agentive action, and authentic and viable choices/alternatives that offer ‘exit options’ from unsatisfactory situations. As with the other stages, this study used a critical, postmodernist, global feminist ethnographic methodology, multimodal and qualitative data collection. Participants participated in interviews, focus group discussions, and a two-day workshop, which explored their understandings of how/if they understood post-primary education to have contributed to their economic empowerment. A constructivist grounded theory approach was used for data analysis to capture major themes. Findings indicate that although all participants believe that post-primary education provided them with economic opportunities they would not have had otherwise, the parameters of their economic empowerment were severely constrained by historic and extant sociocultural, economic, political, and institutional structures that continue to disempower girls and women, as well as additional financial responsibilities that they assumed to support others. Even though the participants had post-primary education, and they were able to obtain employment or operate their own businesses that they would not likely have been able to do without post-primary education, the majority of the participants’ incomes were not sufficient to elevate them financially above the extreme poverty level, especially as many were single mothers and the sole income earners in their households. Furthermore, most deemed their working conditions unsatisfactory and their positions precarious; they also experienced sexual harassment and abuse in the labour force. Additionally, employment for the participants resulted in a double work burden: long days at work, surrounded by many hours of domestic work at home (which, even if they had spousal partners, still fell almost exclusively to women). In conclusion, although the participants seem to have experienced some increase in economic empowerment, largely due to skills, knowledge, and qualifications gained at the post-primary level, numerous barriers prevented them from maximizing their capabilities and making significant gains in empowerment. There is need, in addition to providing education (primary, secondary, and tertiary) to girls, to address systemic gender inequalities that mitigate against women’s empowerment, as well as opportunities and freedom for women to come together and demand fair pay, reasonable working conditions, and benefits, freedom from gender-based harassment and assault in the workplace, as well as advocate for equal distribution of domestic work as a cultural change.

Keywords: girls' post-primary education, women's empowerment, uganda, employment

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65 Co-management Organizations: A Way to Facilitate Sustainable Management of the Sundarbans Mangrove Forests of Bangladesh

Authors: Md. Wasiul Islam, Md. Jamius Shams Sowrov

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The Sundarbans is the largest single tract of mangrove forest in the world. This is located in the southwest corner of Bangladesh. This is a unique ecosystem which is a great breeding and nursing ground for a great biodiversity. It supports the livelihood of about 3.5 million coastal dwellers and also protects the coastal belt and inland areas from various natural calamities. Historically, the management of the Sundarbans was controlled by the Bangladesh Forest Department following top-down approach without the involvement of local communities. Such fence and fining-based blue-print approach was not effective to protect the forest which caused Sundarbans to degrade severely in the recent past. Fifty percent of the total tree cover has been lost in the last 30 years. Therefore, local multi-stakeholder based bottom-up co-management approach was introduced at some of the parts of the Sundarbans in 2006 to improve the biodiversity status by enhancing the protection level of the forest. Various co-management organizations were introduced under co-management approach where the local community people could actively involve in various activities related to the management and welfare of the Sundarbans including the decision-making process to achieve the goal. From this backdrop, the objective of the study was to assess the performance of co-management organizations to facilitate sustainable management of the Sundarbans mangrove forests. The qualitative study followed face-to-face interview to collect data using two sets of semi-structured questionnaires. A total of 40 respondents participated in the research that was from eight villagers under two forest ranges. 32 representatives from the local communities as well as 8 official representatives involved in co-management approach were interviewed using snowball sampling technique. The study shows that the co-management approach improved governance system of the Sundarbans through active participation of the local community people and their interactions with the officials via the platform of co-management organizations. It facilitated accountability and transparency system to some extent through following some formal and informal rules and regulations. It also improved the power structure of the management process by fostering local empowerment process particularly the women. Moreover, people were able to learn from their interactions with and within the co-management organizations as well as interventions improved environmental awareness and promoted social learning. The respondents considered good governance as the most important factor for achieving the goal of sustainable management and biodiversity conservation of the Sundarbans. The success of co-management planning process also depends on the active and functional participation of different stakeholders including the local communities where co-management organizations were considered as the most functional platform. However, the governance system was also facing various challenges which resulted in barriers to the sustainable management of the Sundarbans mangrove forest. But still there were some members involved in illegal forest operations and created obstacles against sustainable management of the Sundarbans. Respondents recommended greater patronization from the government, financial and logistic incentives for alternative income generation opportunities with effective participatory monitoring and evaluation system to improve sustainable management of the Sundarbans.

Keywords: Bangladesh, co-management approach, co-management organizations, governance, Sundarbans, sustainable management

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64 Compromising Quality of Life in Low Income Settlement's: The Case of Ashrayan Prakalpa, Khulna

Authors: Salma Akter, Md. Kamal Uddin

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This study aims to demonstrate how top-down shelter policy and its resultant dwelling environment leads to ‘everyday compromise’ by the grassroots according to subjective (satisfaction) and objective (physical design elements and physical environmental elements) indicators, which are measured across three levels of the settlement; macro (Community), meso (Neighborhood or shelter/built environment) and micro (family). Ashrayan Prakalpa is a resettlement /housing project of Government of Bangladesh for providing shelters and human resources development activities like education, microcredit, and training programme to landless, homeless and rootless people. Despite the integrated nature of the shelter policies (comprises poverty alleviation, employment opportunity, secured tenure, and livelihood training), the ‘quality of life’ issue at the different levels of settlements becomes questionable. As dwellers of shelter units (although formally termed as ‘barracks’ rather shelter or housing) remain on the receiving end of government’s resettlement policies, they often involve with spatial-physical and socio-economic negotiation and assume curious forms of spatial practice, which often upholds contradiction with policy planning. Thus, policy based shelter force dwellers to persistently compromise with their provided built environments both in overtly and covertly. Compromising with prescribed designed space and facilities across living places articulated their negotiation with the quality of allocated space, built form and infrastructures, which in turn exert as less quality of life. The top-down shelter project, Dakshin Chandani Mahal Ashrayan Prakalpa at Dighalia Upazila, the study area located at the Eastern fringe area of Khulna, Bangladesh, is still in progress to resettle internally displaced and homeless people. In terms of methodology, this research is primarily exploratory and adopts a case study method, and an analytical framework is developed through the deductive approach for evaluating the quality of life. Secondary data have been obtained from housing policy analysis and relevant literature review, while key informant interview, focus group discussion, necessary drawings and photographs and participant observation across dwelling, neighborhood, and community level have also been administered as primary data collection methodology. Findings have revealed that various shortages, inadequacies, and negligence of policymakers force to compromise with allocated designed space, physical infrastructure and economic opportunities across dwelling, neighborhood and mostly community level. Thus, the outcome of this study can be beneficial for a global-level understating of the compromising the ‘quality of life’ under top-down shelter policy. Locally, for instance, in the context of Bangladesh, it can help policymakers and concerned authorities to formulate the shelter policies and take initiatives to improve the well-being of marginalized.

Keywords: Ashrayan Prakalpa, compromise, displaced people, quality of life

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63 Exploring Suicidal Behaviors among Transgender and Gender Nonconforming Youth in China

Authors: Krystal Wang, Chongzheng Wei, Runsen Chen, Shufang Sun

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Suicide is a global public mental health issue and is the tenth leading cause of death globally. Approximately 75% of suicides occur in low- and middle-income countries (LMIC). Compared to the general population, transgender and gender nonconforming (TGNC) young people have higher suicidal risks. Research has shown that the prevalence of suicidal behaviors among TGNC populations was high in both the United States and China. However, studies were mostly embedded within Western cultures. Limited data and research were available to assess suicidal behaviors among TGNC youth in LMIC countries and to consider various types of TGNC youth. The goal of the current project is to 1) investigate the prevalence of lifetime and past-year suicidal ideations, plans, and attempts among Chinese TGNC youth, 2) explore the relationship between gender identity and suicidal outcomes among TGNC youth in China, 3) identify individual, school, and family level risk and protective factors for suicidal behaviors. The study used data from a cross-sectional survey conducted by Beijing LGBTQ Center in 2021. The survey was the largest TGNC population study in China to understand the health conditions of TGNC individuals. Of the 7612 individuals who completed the survey, a total of 5632 youth (aged 10 to 19) was included in the final analysis. 2259 (40.11%) participants were categorized as transfeminine youth, 1034 (18.36%) as transmasculine youth, 1169 (20.76%) as nonbinary youth AFAB, 568 (10.09%) as nonbinary youth AMAB, 344 (6.11%) as questioning youth AFAB and 258 (4.58%) as questioning youth AMAB. Suicidal behaviors were assessed by asking about lifetime suicidal ideation and attempts, past 12 months suicidal ideation, plan and attempts, and suicidal methods. To achieve the aims, we conducted statistical analysis in Stata/SE 17.0 to 1) describe the prevalence of suicidal outcomes and 2) assess the relationship between gender identity and suicidal outcomes by performing crosstabs, bivariate and multivariate logistic regressions, and adjusting for covariates. The lifetime prevalence of suicidal ideations and attempts for the whole sample was 85.13% and 51.7%. Transfeminine youth had a significantly higher risk for lifetime suicidal ideations (Odds Ratios (OR) = 1.67, CI:1.28,2.18) and attempts than transmasculine youth (OR=1.66, CI: 1.35,2.03), adjusting for age and past year binge drinking, known risk factors of suicide behavior. Past-year prevalence of suicidal behaviors was also high among TGNC youth, with 75.69% in suicidal ideation, 88.77% in suicidal plans, and 57.96% in suicidal attempts. Transfeminine youth, among six subgroups, had the highest risk for past-year suicidal ideations and attempts compared to transmasculine youth. Non-binary youth, regardless of sex assigned at birth, also had a significantly higher risk for suicidal ideations. The prevalence of lifetime and past-year suicidal behaviors was alarming among TGNC youth in China. Among different categories of TGNC youth, transfeminine youth reported the most elevated suicidal risk. The findings indicated a compelling need for researchers and practitioners to address the mental health risks for this specific group and target interventions for TGNC youth in China.

Keywords: child and adolescent mental health, gender minority health, cross-cultural perspective, preventing suicide in youth

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62 Public-Private Partnership for Better Protection of Trafficked Victims in Thailand: Case Study on Public Protection and Welfare Center in Cooperation with Jim Thompson Foundation in Occupational Development on Silk Sewing and Tailoring

Authors: Aungkana Kmonpetch

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Protection of trafficked victims and partnership among stakeholders are established as core principles in 5P’ strategies in international and national anti-human trafficking policies. In this article, it is of interest to discuss how the role of public-private partnerships in promoting the occupation development for employment in wage will enhance the better protection for victims of trafficking who affirmatively decide they want a criminal justice intervention, using Thailand as a case. Most of the victims who have accepted to be witness in the criminal justice system have lost income during their absence from work. The analysis of Thailand case is based on two methodological approaches: 1) interview with victims of trafficking, protection authorities, service providers, trainers and teachers, social workers, NGOs, police, prosecutors, business owners and enterprises, ILO, UNDP etc.; 2) create collaborative effort through workshops/consultation meetings in participation of all stakeholders – governmental agencies, private organizations, UN and international agencies. The linking of protection and partnership is anchored in international conventions and human trafficking directives. While this is actually framed as a responsive advantage for 5P strategies of anti-human trafficking – prevention, protection, persecution, punishment, and partnership, in reality, there might have more practical requirements of care and support. The article addresses how the partnership between governmental agencies and private organizations provide opportunities for trafficked victims to engage in high-skilled occupational development such as Silk-Sewing and Tailoring. The discussion is also focused how this approach of capacity building of the trainer for trainee, be enable the trafficked victims to cultivate the practices of high-skilled training to engage them into the business of social enterprise with employment in wage. The partnership coordination draws specifically to two aspects: firstly, to formulate appropriate assistance for promotion and protection of human rights of the trafficked victims in response to the 5P’ strategies of anti-human trafficking policy; secondly, to empower them to settle some economic stability for livelihood opportunity in the country of origin on their return and reintegration. Therefore, they can define how they want to move forward to prevent them at risk of vulnerable situations where they might being trafficked again or going on to work in exploitative conditions. It strengthens proper access to protection and assistance, depending on how the incentive of protection for cooperation is perceived to be and how useful the capacity building in occupation development for employment in wage will be implemented practically both in the host country and in the country of origin. This also brings into question how the victim of trafficking are able to access to the trade of market and are supported the employment opportunity according to the concept of decent work as they are constituted as witnesses. We discuss these issues in the area of a broader literature on social protection, economic security, gender, law, and victimhood.

Keywords: employment opportunity, occupation development, protection for victim of trafficking, public-private partnership

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61 Rainwater Harvesting is an Effective Tool for City’s Storm Water Management and People’s Willingness to Install Rainwater Harvesting System in Buildings: A Case Study in Kazipara, Dhaka, Bangladesh

Authors: M. Abu Hanif, Anika Tabassum, Fuad Hasan Ovi, Ishrat Islam

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Water is essential for life. Enormous quantities of water are cycled each year through hydrologic cycle but only a fraction of circulated water is available each year for human use. Dhaka, the capital of Bangladesh is the 19th mega city in the world with a population of over 14 million (World City Information, 2011). As a result the growth of urban population is increasing rapidly; the city is not able to manage with altering situations due to resource limitations and management capacity. Water crisis has become an acute problem faced by the inhabitants of Dhaka city. It is found that total water demand in Dhaka city is 2,240 million liter per day (MLD) whereas supply is 2,150 (MLD). According to Dhaka Water Supply and Sewerage Authority about 87 percent of this supply comes from groundwater resources and rest 13 percent from surface water. According to Dhaka Water Supply and Sewerage Authority it has been found that the current groundwater depletion rate is 3.52 meter per year. Such a fast depletion of the water table will result in intrusion of southern saline water into the groundwater reservoir, depriving this mega city of pure drinking water. This study mainly focus on the potential of Rainwater Harvesting System(RWHS) in Kazipara area of Dhaka city, determine the perception level of local people in installation of rainwater harvesting system in their building and identify the factors regarding willingness of owner in installing rainwater harvesting system. As most of the residential area of Dhaka city is unplanned with small plots, Kazipara area has been chosen as study area which depicts similar characteristics. In this study only roof top area is considered as catchment area and potential of rainwater harvesting has been calculated. From the calculation it is found that harvested rainwater can serve the 66% of demand of water for toilet flushing and cleaning purposes for the people of Kazipara. It is also observed that if only rooftop rainwater harvesting applied to all the structures of the study area then two third of surface runoff would be reduced than present surface runoff. In determining the perception of local people only owners of the buildings were. surveyed. From the questionnaire survey it is found that around 75% people have no idea about the rainwater harvesting system. About 83% people are not willing to install rainwater harvesting system in their dwelling. The reasons behind the unwillingness are high cost of installation, inadequate space, ignorance about the system, etc. Among 16% of the willing respondents who are interested in installing RWHS system, it was found that higher income, bigger size of buildings are important factors in willingness of installing rainwater harvesting system. Majority of the respondents demanded for both technical and economical support to install the system in their buildings. Government of Bangladesh has taken some initiatives to promote rainwater harvesting in urban areas. It is very much necessary to incorporate rainwater harvesting device and artificial recharge system in every building of Dhaka city to make Dhaka city self sufficient in water supply management and to solve water crisis problem of megacity like as Dhaka city.

Keywords: rainwater harvesting, water table, willingness, storm water

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60 Sustainable Urbanism: Model for Social Equity through Sustainable Development

Authors: Ruchira Das

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The major Metropolises of India are resultant of Colonial manifestation of Production, Consumption and Sustenance. These cities grew, survived, and sustained on the basic whims of Colonial Power and Administrative Agendas. They were symbols of power, authority and administration. Within them some Colonial Towns remained as small towns within the close vicinity of the major metropolises and functioned as self–sufficient units until peripheral development due to tremendous pressure occurred in the metropolises. After independence huge expansion in Judiciary and Administration system resulted City Oriented Employment. A large number of people started residing within the city or within commutable distance of the city and it accelerated expansion of the cities. Since then Budgetary and Planning expenditure brought a new pace in Economic Activities. Investment in Industry and Agriculture sector generated opportunity of employment which further led towards urbanization. After two decades of Budgetary and Planning economic activities in India, a new era started in metropolitan expansion. Four major metropolises started further expansion rapidly towards its suburbs. A concept of large Metropolitan Area developed. Cities became nucleus of suburbs and rural areas. In most of the cases such expansion was not favorable to the relationship between City and its hinterland due to absence of visualization of Compact Sustainable Development. The search for solutions needs to weigh the choices between Rural and Urban based development initiatives. Policymakers need to focus on areas which will give the greatest impact. The impact of development initiatives will spread the significant benefit to all. There is an assumption that development integrates Economic, Social and Environmental considerations with equal weighing. The traditional narrower and almost exclusive focus on economic criteria as the determinant of the level of development is thus re–described and expanded. The Social and Environmental aspects are equally important as Economic aspect to achieve Sustainable Development. The arrangement of opportunities for Public, Semi – Public facilities for its citizen is very much relevant to development. It is responsibility of the administration to provide opportunities for the basic requirement of its inhabitants. Development should be in terms of both Industrial and Agricultural to maintain a balance between city and its hinterland. Thus, policy is to formulate shifting the emphasis away from Economic growth towards Sustainable Human Development. The goal of Policymaker should aim at creating environments in which people’s capabilities can be enhanced by the effective dynamic and adaptable policy. The poverty could not be eradicated simply by increasing income. The improvement of the condition of the people would have to lead to an expansion of basic human capabilities. In this scenario the suburbs/rural areas are considered as environmental burden to the metropolises. A new living has to be encouraged in the suburban or rural. We tend to segregate agriculture from the city and city life, this leads to over consumption, but this urbanism model attempts both these to co–exists and hence create an interesting overlapping of production and consumption network towards sustainable Rurbanism.

Keywords: socio–economic progress, sustainability, social equity, urbanism

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59 Academic Mobility within EU as a Voluntary or a Necessary Move: The Case of German Academics in the UK

Authors: Elena Samarsky

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According to German national records and willingness to migrate surveys, emigration is much more attractive for better educated citizens employed in white-collar positions, with academics displaying the highest migration rate. The case study of academic migration from Germany is furthermore intriguing due to the country's financial power, competitive labour market and relatively good life-standards, working conditions and high wage rates. Investigation of such mobility challenges traditional economic view on migration, as it raises the question of why people chose to leave their highly-industrialized countries known for their high life-standards, stable political scene and prosperous economy. Within the regional domain, examining mobility of Germans contributes to the ongoing debate over the extent of influence of the EU mobility principle on migration decision. The latter is of particular interest, as it may shed the light on the extent to which it frames individual migration path, defines motivations and colours the experiences of migration action itself. The paper is based on the analysis of the migration decisions obtained through in-depth interviews with German academics employed in the UK. These retrospective interviews were conducted with German academies across selected universities in the UK, employed in a variety of academic fields, and different career stages. Interviews provide a detailed description of what motivated people to search for a post in another country, which attributes of such job are needed to be satisfied in order to facilitate migration, as well as general information on particularities of an academic career and institutions involved. In the course of the project, it became evident that although securing financial stability was non-negotiable factor in migration (e.g., work contract singed before relocation) non-pecuniary motivations played significant role as well. Migration narratives of this group - the highly skilled, whose human capital is transferable, and whose expertise is positively evaluated by countries, is mainly characterised by search for personal development and career advancement, rather than a direct increase in their income. Such records are also consistent in showing that in case of academics, scientific freedom and independence are the main attributes of a perfect job and are a substantial motivator. On the micro level, migration is rather depicted as an opportunistic action addressed in terms of voluntary and rather imposed decision. However, on the macro level, findings allow suggesting that such opportunities are rather an outcome embedded in the peculiarities of academia and its historical and structural developments. This, in turn, contributes significantly to emergence of a scene in which migration action takes place. The paper suggest further comparative research on the intersection of the macro and micro level, and in particular how both national academic institutions and the EU mobility principle shape migration of academics. In light of continuous attempts to make the European labour market more mobile and attractive such findings ought to have direct implications on policy.

Keywords: migration, EU, academics, highly skilled labour

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58 A Data-Driven Compartmental Model for Dengue Forecasting and Covariate Inference

Authors: Yichao Liu, Peter Fransson, Julian Heidecke, Jonas Wallin, Joacim Rockloev

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Dengue, a mosquito-borne viral disease, poses a significant public health challenge in endemic tropical or subtropical countries, including Sri Lanka. To reveal insights into the complexity of the dynamics of this disease and study the drivers, a comprehensive model capable of both robust forecasting and insightful inference of drivers while capturing the co-circulating of several virus strains is essential. However, existing studies mostly focus on only one aspect at a time and do not integrate and carry insights across the siloed approach. While mechanistic models are developed to capture immunity dynamics, they are often oversimplified and lack integration of all the diverse drivers of disease transmission. On the other hand, purely data-driven methods lack constraints imposed by immuno-epidemiological processes, making them prone to overfitting and inference bias. This research presents a hybrid model that combines machine learning techniques with mechanistic modelling to overcome the limitations of existing approaches. Leveraging eight years of newly reported dengue case data, along with socioeconomic factors, such as human mobility, weekly climate data from 2011 to 2018, genetic data detecting the introduction and presence of new strains, and estimates of seropositivity for different districts in Sri Lanka, we derive a data-driven vector (SEI) to human (SEIR) model across 16 regions in Sri Lanka at the weekly time scale. By conducting ablation studies, the lag effects allowing delays up to 12 weeks of time-varying climate factors were determined. The model demonstrates superior predictive performance over a pure machine learning approach when considering lead times of 5 and 10 weeks on data withheld from model fitting. It further reveals several interesting interpretable findings of drivers while adjusting for the dynamics and influences of immunity and introduction of a new strain. The study uncovers strong influences of socioeconomic variables: population density, mobility, household income and rural vs. urban population. The study reveals substantial sensitivity to the diurnal temperature range and precipitation, while mean temperature and humidity appear less important in the study location. Additionally, the model indicated sensitivity to vegetation index, both max and average. Predictions on testing data reveal high model accuracy. Overall, this study advances the knowledge of dengue transmission in Sri Lanka and demonstrates the importance of incorporating hybrid modelling techniques to use biologically informed model structures with flexible data-driven estimates of model parameters. The findings show the potential to both inference of drivers in situations of complex disease dynamics and robust forecasting models.

Keywords: compartmental model, climate, dengue, machine learning, social-economic

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57 Service Quality, Skier Satisfaction, and Behavioral Intentions in Leisure Skiing: The Case of Beijing

Authors: Shunhong Qi, Hui Tian

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Triggered off by the forthcoming 2022 Winter Olympics, ski centers are blossoming in China, the number being 742 in 2018. Although the number of skier visits of ski resorts soared to 19.7 million in 2018, one-time skiers account for a considerable portion therein. In light of the extremely low return rates and skiing penetration level (0.5%) of leisure skiing in China, this study proposes and tests a leisure ski service performance framework which assesses the ski resorts’ service quality, skier satisfaction, as well as their impact on skiers’ behavioral intentions, with an aim to assess the success of ski resorts and provide suggestions for improvement. Three self-administered surveys and 16 interviews were conducted upon a convenience sample of leisure skiers in two major ski destinations within two hours’ drive from Beijing – Nanshan and Jundushan ski resorts. Of the 680 questionnaires distributed, 416 usable copies were returned, the response rate being 61.2%. The questionnaire used for the study was developed based on the existing literature of 'push' factors of skiers (intrinsic desire) and 'pull' factors (attractiveness of a destination), as well as leisure sport satisfaction. The scale comprises four parts: skiers’ demographic profiles, their perceived service quality (including ski resorts’ infrastructure, expense, safety and comfort, convenience, daily needs support, skill development support, and accessibility), their overall levels of satisfaction (satisfaction with the service and the experience), and their behavioral intentions (including loyalty, future visitation and greater tolerance of price increases). Skiers’ demographic profiles show that among the 220 males and 196 females in the survey, a vast majority of the skiers are age 17-39 (87.2%). 64.7% are not married, and nearly half (48.3%) of the skiers have a monthly family income exceeding 10,000 yuan (USD 1,424), and 80% are beginners or intermediate skiers. The regression examining the influence of service quality on skier satisfaction reveals that service quality accounts for 44.4% of the variance in skier satisfaction, the variables of safety and comfort, expense, skill development support, and accessibility contributing significantly in descending order. Another regression analyzing the influence of service quality as well as skier satisfaction on their behavioral intentions shows that service quality and skier satisfaction account for 39.1% of the variance in skiers’ behavioral intentions, and the significant predictors are skier satisfaction, safety and comfort, expense, and accessibility, in descending order, though a comparison between groups also indicates that for expert skiers, the significant variables are skier satisfaction, skill development support, safety, and comfort. Suggestions are thus made for ski resorts and other stakeholders to improve skier satisfaction and increase visitation: developing diversified ski courses to meet the demands of skiers of different skiing skills and to reduce crowding, adopting enough chairlifts and magic carpets, reinforcing safety measures and medical force; further exploring their various resources and lower the skiing expense on ski pass, equipment renting, accommodation and dining; adding more bus lines and/or develop platforms for skiers’ car-pooling, and offering diversified skiing activities with local flavors for better entertainment.

Keywords: behavioral intentions, leisure skiing, service quality, skier satisfaction

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56 Testing Two Actors Contextual Interaction Theory in a Multi Actors Context: Case of COVID-19 Disease Prevention and Control Policy

Authors: Muhammad Fayyaz Nazir, Ellen Wayenberg, Shahzadaah Faahed Qureshi

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Introduction: The study is based on the Contextual Interaction Theory (CIT) constructs to explore the role of policy actors in implementing the COVID-19 Disease Prevention and Control (DP&C) Policy. The study analyzes the role of healthcare workers' contextual factors, such as cognition, motives, and resources, and their interactions in implementing Social Distancing (SD). In this way, we test a two actors policy implementation theory, i.e., the CIT in a three-actor context. Methods: Data was collected through document analysis and semi-structured interviews. For a qualitative study design, interviews were conducted with questions on cognition, motives, and resources from the healthcare workers involved in implementing SD in the local context in Multan – Pakistan. The possible interactions resulting from contextual factors of the policy actors – healthcare workers were identified through framework analysis protocol guided by CIT and supported by trustworthiness criterion and data saturation. Results: This inquiry resulted in theory application, addition, and enrichment. The theoretical application in the three actor's contexts illustrates the different levels of motives, cognition, and resources of healthcare workers – senior administrators, managers, and healthcare professionals. The senior administrators working in National Command and Operations Center (NCOC), Provincial Technical Committees (PTCs), and Districts Covid Teams (DCTs) were playing their role with high motivation. They were fully informed about the policy and moderately resourceful. The policy implementors: healthcare managers working on implementing the SD within their respective hospitals were playing their role with high motivation and were fully informed about the policy. However, they lacked the required resources to implement SD. The target medical and allied healthcare professionals were moderately motivated but lack of resources and information. The interaction resulted in cooperation and the need for learning to manage the future healthcare crisis. However, the lack of resources created opposition to the implementation of SD. Objectives of the Study: The study aimed to apply a two actors theory in a multi actors context. We take this as an opportunity to qualitatively test the theory in a novel situation of the Covid-19 pandemic and make way for its quantitative application by designing a survey instrument so that implementation researchers can apply CIT through multivariate analyses or higher-order statistical modeling. Conclusion: Applying two actors' implementation theory in exploring a complex case of healthcare intervention in three actors context is a unique work that has never been done before, up to the best of our knowledge. So, the work will contribute to the policy implementation studies by applying, extending, and enriching an implementation theory in a novel case of the Covi-19 pandemic, ultimately fulfilling the gap in implementation literature. Policy institutions and other low or middle-income countries can learn from this research and improve SD implementation by working on the variables with weak significance levels.

Keywords: COVID-19, disease prevention and control policy, implementation, policy actors, social distancing

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55 Prevalence and Risk Factors of Cardiovascular Diseases among Bangladeshi Adults: Findings from a Cross Sectional Study

Authors: Fouzia Khanam, Belal Hossain, Kaosar Afsana, Mahfuzar Rahman

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Aim: Although cardiovascular diseases (CVD) has already been recognized as a major cause of death in developed countries, its prevalence is rising in developing countries as well, and engendering a challenge for the health sector. Bangladesh has experienced an epidemiological transition from communicable to non-communicable diseases over the last few decades. So, the rising prevalence of CVD and its risk factors are imposing a major problem for the country. We aimed to examine the prevalence of CVDs and socioeconomic and lifestyle factors related to it from a population-based survey. Methods: The data used for this study were collected as a part of a large-scale cross-sectional study conducted to explore the overall health status of children, mothers and senior citizens of Bangladesh. Multistage cluster random sampling procedure was applied by considering unions as clusters and households as the primary sampling unit to select a total of 11,428 households for the base survey. Present analysis encompassed 12338 respondents of ≥ 35 years, selected from both rural areas and urban slums of the country. Socio-economic, demographic and lifestyle information were obtained through individual by a face-to-face interview which was noted in ODK platform. And height, weight, blood pressure and glycosuria were measured using standardized methods. Chi-square test, Univariate modified Poisson regression model, and multivariate modified Poisson regression model were done using STATA software (version 13.0) for analysis. Results: Overall, the prevalence of CVD was 4.51%, of which 1.78% had stroke and 3.17% suffered from heart diseases. Male had higher prevalence of stroke (2.20%) than their counterparts (1.37%). Notably, thirty percent of respondents had high blood pressure and 5% population had diabetes and more than half of the population was pre-hypertensive. Additionally, 20% were overweight, 77% were smoker or consumed smokeless tobacco and 28% of respondents were physically inactive. Eighty-two percent of respondents took extra salt while eating and 29% of respondents had deprived sleep. Furthermore, the prevalence of risk factor of CVD varied according to gender. Women had a higher prevalence of overweight, obesity and diabetes. Women were also less physically active compared to men and took more extra salt. Smoking was lower in women compared to men. Moreover, women slept less compared to their counterpart. After adjusting confounders in modified Poisson regression model, age, gender, occupation, wealth quintile, BMI, extra salt intake, daily sleep, tiredness, diabetes, and hypertension remained as risk factors for CVD. Conclusion: The prevalence of CVD is significant in Bangladesh, and there is an evidence of rising trend for its risk factors such as hypertension, diabetes especially in older population, women and high-income groups. Therefore, in this current epidemiological transition, immediate public health intervention is warranted to address the overwhelming CVD risk.

Keywords: cardiovascular diseases, diabetes, hypertension, stroke

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54 The Senior Traveler Market as a Competitive Advantage for the Luxury Hotel Sector in the UK Post-Pandemic

Authors: Feyi Olorunshola

Abstract:

Over the last few years, the senior travel market has been noted for its potential in the wider tourism industry. The tourism sector includes the hotel and hospitality, travel, transportation, and several other subdivisions to make it economically viable. In particular, the hotel attracts a substantial part of the expenditure in tourism activities as when people plan to travel, suitable accommodation for relaxation, dining, entertainment and so on is paramount to their decision-making. The global retail value of the hotel as of 2018 was significant for tourism. But, despite indications of the hotel to the tourism industry at large, very few empirical studies are available to establish how this sector can leverage on the senior demographic to achieve competitive advantage. Predominantly, studies on the mature market have focused on destination tourism, with a limited investigation on the hotel which makes a significant contribution to tourism. Also, several scholarly studies have demonstrated the importance of the senior travel market to the hotel, yet there is very little empirical research in the field which has explored the driving factors that will become the accepted new normal for this niche segment post-pandemic. Giving that the hotel already operates in a highly saturated business environment, and on top of this pre-existing challenge, the ongoing global health outbreak has further put the sector in a vulnerable position. Therefore, the hotel especially the full-service luxury category must evolve rapidly for it to survive in the current business environment. The hotel can no longer rely on corporate travelers to generate higher revenue since the unprecedented wake of the pandemic in 2020 many organizations have invented a different approach of conducting their businesses online, therefore, the hotel needs to anticipate a significant drop in business travellers. However, the rooms and the rest of the facilities must be occupied to keep their business operating. The way forward for the hotel lies in the leisure sector, but the question now is to focus on the potential demographics of travelers, in this case, the seniors who have been repeatedly recognized as the lucrative market because of increase discretionary income, availability of time and the global population trends. To achieve the study objectives, a mixed-method approach will be utilized drawing on both qualitative (netnography) and quantitative (survey) methods, cognitive and decision-making theories (means-end chain) and competitive theories to identify the salient drivers explaining senior hotel choice and its influence on their decision-making. The target population are repeated seniors’ age 65 years and over who are UK resident, and from the top tourist market to the UK (USA, Germany, and France). Structural equation modelling will be employed to analyze the datasets. The theoretical implication is the development of new concepts using a robust research design, and as well as advancing existing framework to hotel study. Practically, it will provide the hotel management with the latest information to design a competitive marketing strategy and activities to target the mature market post-pandemic and over a long period.

Keywords: competitive advantage, covid-19, full-service hotel, five-star, luxury hotels

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53 A Shift in Approach from Cereal Based Diet to Dietary Diversity in India: A Case Study of Aligarh District

Authors: Abha Gupta, Deepak K. Mishra

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Food security issue in India has surrounded over availability and accessibility of cereal which is regarded as the only food group to check hunger and improve nutrition. Significance of fruits, vegetables, meat and other food products have totally been neglected given the fact that they provide essential nutrients to the body. There is a need to shift the emphasis from cereal-based approach to a more diverse diet so that aim of achieving food security may change from just reducing hunger to an overall health. This paper attempts to analyse how far dietary diversity level has been achieved across different socio-economic groups in India. For this purpose, present paper sets objectives to determine (a) percentage share of different food groups to total food expenditure and consumption by background characteristics (b) source of and preference for all food items and, (c) diversity of diet across socio-economic groups. A cross sectional survey covering 304 households selected through proportional stratified random sampling was conducted in six villages of Aligarh district of Uttar Pradesh, India. Information on amount of food consumed, source of consumption and expenditure on food (74 food items grouped into 10 major food groups) was collected with a recall period of seven days. Per capita per day food consumption/expenditure was calculated through dividing consumption/expenditure by household size and number seven. Food variety score was estimated by giving 0 values to those food groups/items which had not been eaten and 1 to those which had been taken by households in last seven days. Addition of all food group/item score gave result of food variety score. Diversity of diet was computed using Herfindahl-Hirschman index. Findings of the paper show that cereal, milk, roots and tuber food groups contribute a major share in total consumption/expenditure. Consumption of these food groups vary across socio-economic groups whereas fruit, vegetables, meat and other food consumption remain low and same. Estimation of dietary diversity show higher concentration of diet due to higher consumption of cereals, milk, root and tuber products and dietary diversity slightly varies across background groups. Muslims, Scheduled caste, small farmers, lower income class, food insecure, below poverty line and labour families show higher concentration of diet as compared to their counterpart groups. These groups also evince lower mean intake of number of food item in a week due to poor economic constraints and resultant lower accessibility to number of expensive food items. Results advocate to make a shift from cereal based diet to dietary diversity which not only includes cereal and milk products but also nutrition rich food items such as fruits, vegetables, meat and other products. Integrating a dietary diversity approach in food security programmes of the country would help to achieve nutrition security as hidden hunger is widespread among the Indian population.

Keywords: dietary diversity, food Security, India, socio-economic groups

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52 Pursuing Knowledge Society Excellence: Knowledge Management and Open Innovation Platforms for Research, Industry and Business Collaboration in Singapore

Authors: Irina-Emily Hansen, Ola Jon Mork

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The European economic growth strategy and supporting it framework for research and innovation highlight the importance of nurturing new open innovation in order to strengthen Europe’s competitiveness. One of the main approaches to enhance innovation in European society is the Triple Helix model that centres on science- industry collaboration where the universities are assigned the managerial role. In spite of the defined collaboration strategy, the collaboration between academics and in-dustry in Europe has still many challenges. Many of them are explained by culture difference: academic culture aims towards scientific knowledge, while businesses are oriented towards pro-duction and profitable results; also execution of collaborative projects is seen differently by part-ners involved. That proves that traditional management strategies applied to collaboration between researchers and businesses are not effective. There is a need for dynamic strategies that can support the interaction between researchers and industry intensifying knowledge co-creation and contributing to development of national innovation system (NIS) by incorporating individual, organizational and inter-organizational learning. In order to find a good subject to follow, the researchers of a given paper have investigated one of the most rapidly developing knowledge-based, innovation society, Singapore. Singapore does not dispose much land- or sea- resources that normally provide income for any country. Therefore, Singapore was forced to think differently and build society on resources that are available: talented people and knowledge. Singapore has during the last twenty years developed attracting high rated university camps, research institutions and leading industrial companies from all over the world. This article elucidates and elaborates Singapore’s national innovation strategies from Knowledge Management perspective. The research is done on the variety of organizations that enable and support knowledge development in this state: governmental research and development (R&D) centers in universities, private talent incubators for entrepreneurs, and industrial companies with own R&D departments. The research methods are based on presentations, documents, and visits at a number of universities, research institutes, innovation parks, governmental institutions, industrial companies and innovation exhibitions in Singapore. In addition, a literature review of science articles is made regarding the topic. The first finding is that objectives of collaboration between researchers, entrepreneurs and industry in Singapore correspond primary goals of the state: knowledge- and economy growth. There are common objectives for all stakeholders on all national levels. The second finding is that Singapore has enabled system on a national level that supports innovation the entire way from fostering or capturing the new knowledge, providing knowledge exchange and co-creation to application of it in real-life. The conclusion is that innovation means not only new idea, but also the enabling mechanism for its execution and the marked-oriented approach in order that new knowledge can be absorbed in society. The future research can be done with regards to application of Singapore knowledge management strategy in innovation to European countries.

Keywords: knowledge management strategy, national innovation system, research industry and business collaboration, knowledge enabling

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51 Dietary Intakes and Associated Demographic, Behavioural and Other Health-Related Factors in Mexican College Students

Authors: Laura E. Hall, Joel Monárrez-Espino, Luz María Tejada Tayabas

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College students are at risk of weight gain and poor dietary habits, and health behaviours established during this period have been shown to track into midlife. They may therefore be an important target group for health promotion strategies, yet there is a lack of literature regarding dietary intakes and associated factors in this group, particularly in middle-income countries such as Mexico. The aim of this exploratory research was to describe and compare reported dietary intakes among nursing and nutrition college students at two public universities in Mexico, and to explore the relationship between demographic, behavioural and other health-related factors and the risk of low diet quality. Mexican college students (n=444) majoring in nutrition or nursing at two urban universities completed questionnaires regarding dietary and health-related behaviours and risks. Dietary intake was assessed via 24-hour recall. Weight, height and abdominal circumference were measured. Descriptive statistics were reported and nutrient intakes were compared between colleges and study tracks using Student’s t tests, odds ratios and Pearson chi square tests. Two dietary quality scores were constructed to explore the relationship between demographic, behavioural and other health-related factors and the diet quality scores using binary logistic regression. Analysis was performed using SPSS statistics, with differences considered statistically significant at p<0.05. The response rate to the survey was 91%. When macronutrients were considered as a percentage of total energy, the majority of students had protein intakes within recommended ranges, however one quarter of students had carbohydrate and fat intakes exceeding recommended levels. Three quarters had fibre intakes that were below recommendations. More than half of the students reported intakes of magnesium, zinc, vitamin A, folate and vitamin E that were below estimated average requirements. Students studying nutrition reported macronutrient and micronutrient intakes that were more compliant with recommendations compared to nursing students, and students studying in central-north Mexico were more compliant than those studying in southeast Mexico. Breakfast skipping (Adjusted Odds Ratio (OR) = 5.3; 95% Confidence Interval (CI) = 1.2-22.7), risk of anxiety (OR = 2.3; CI = 1.3-4.4), and university location (OR = 1.6; CI = 1.03-2.6) were associated with a greater risk of having a low macronutrient score. Caloric intakes <1800kcal (OR = 5.8; CI = 3.5-9.7), breakfast skipping (OR = 3.7; CI = 1.4-10.3), vigorous exercise ≤1h/week (OR = 2.6; CI = 1.3-5.2), soda consumption >250mls/day (OR = 2.0; CI = 1.2-3.3), unhealthy diet perception (OR = 1.9; CI = 1.2-3.0), and university location (OR = 1.8; CI = 1.1-2.8) were significantly associated with greater odds of having a low micronutrient score. College students studying nursing and nutrition did not report ideal diets, and these students should not be overlooked in public health interventions. Differences in dietary intakes between universities and study tracks were evident, with more favourable profiles evident in nutrition compared to nursing, and North-central compared to Southeast students. Further, demographic, behavioural and other health-related factors were associated with diet quality scores, warranting further research.

Keywords: college student, diet quality, nutrient intake, young adult

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50 Measuring Urban Sprawl in the Western Cape Province, South Africa: An Urban Sprawl Index for Comparative Purposes

Authors: Anele Horn, Amanda Van Eeden

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The emphasis on the challenges posed by continued urbanisation, especially in developing countries has resulted in urban sprawl often researched and analysed in metropolitan urban areas, but rarely in small and medium towns. Consequently, there exists no comparative instrument between the proportional extent of urban sprawl in metropolitan areas measured against that of small and medium towns. This research proposes an Urban Sprawl Index as a possible tool to comparatively analyse the extent of urban sprawl between cities and towns of different sizes. The index can also be used over the longer term by authorities developing spatial policy to track the success or failure of specific tools intended to curb urban sprawl. In South Africa, as elsewhere in the world, the last two decades witnessed a proliferation of legislation and spatial policies to limit urban sprawl and contain the physical expansion and development of urban areas, but the measurement of the successes or failures of these instruments intending to curb expansive land development has remained a largely unattainable goal, largely as a result of the absence of an appropriate measure of proportionate comparison. As a result of the spatial political history of Apartheid, urban areas acquired a spatial form that contributed to the formation of single-core cities with far reaching and wide-spreading peripheral development, either in the form of affluent suburbs or as a result of post-Apartheid programmes such as the Reconstruction and Development Programme (1995) which, in an attempt to assist the immediate housing shortage, favoured the establishment of single dwelling residential units for low income communities on single plots on affordable land at the urban periphery. This invariably contributed to urban sprawl and even though this programme has since been abandoned, the trend towards low density residential development continues. The research area is the Western Cape Province in South Africa, which in all aspects exhibit the spatial challenges described above. In academia and popular media the City of Cape Town (the only Metropolitan authority in the province) has received the lion’s share of focus in terms of critique on urban development and spatial planning, however, the smaller towns and cities in the Western Cape arguably received much less public attention and were spared the naming and shaming of being unsustainable urban areas in terms of land consumption and physical expansion. The Urban Sprawl Index for the Western Cape (USIWC) put forward by this research enables local authorities in the Western Cape Province to measure the extent of urban sprawl proportionately and comparatively to other cities in the province, thereby acquiring a means of measuring the success of the spatial instruments employed to limit urban expansion and inefficient land consumption. In development of the USIWC the research made use of satellite data for reference years 2001 and 2011 and population growth data extracted from the national census, also for base years 2001 and 2011.

Keywords: urban sprawl, index, Western Cape, South Africa

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49 The Perceptions of Patients with Osteoarthritis at a Public Community Rehabilitation Centre in the Cape Metropole for Using Digital Technology in Rehabilitation

Authors: Gabriela Prins, Quinette Louw, Dawn Ernstzen

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Background: Access to rehabilitation services is a major challenge globally, especially in low-and-middle income countries (LMICs) where resources and infrastructure are extremely limited. Telerehabilitation (TR) has emerged in recent decades as a highly promising method to dramatically expand accessibility to rehabilitation services globally. TR provides rehabilitation care remotely using communication technologies such as video conferencing, smartphones, and internet-connected devices. This boosts accessibility to underprivileged regions and allows for greater flexibility for patients. Despite this, TR is hindered by several factors, including limited technological resources, high costs, lack of digital access, and the unavailability of healthcare systems, which are major barriers to widespread adoption among LMIC patients. These barriers have collectively hindered the potential implementation and adoption of TR services in LMICs healthcare settings. Adoption of TR will also require the buy-in of end users and limited information is known on the perspectives of the SA population. Aim: The study aimed to understand patients' perspectives regarding the use of digital technology as part of their OA rehabilitation at a public community healthcare centre in the Cape Metropole Area. Methods: A qualitative descriptive study design was used on 10 OA patients from a public community rehabilitation centre in South Africa. Data collection included semi-structured interviews and patient-reported outcome measures (PSFS, ASES-8, and EuroQol EQ-5D-5L) on functioning and quality of life. Transcribed interview data were coded in Atlas.ti. 22.2 and analyzed using thematic analysis. The results were narratively documented. Results: Four themes arose from the interviews. The themes were Telerehabilitation awareness (Use of Digital Technology Information Sources and Prior Experience with Technology /TR), Telerehabilitation Benefits (Access to healthcare providers, Access to educational information, Convenience, Time and Resource Efficiency and Facilitating Family Involvement), Telerehabilitation Implementation Considerations (Openness towards TR Implementation, Learning about TR and Technology, Therapeutic relationship, and Privacy) and Future use of Telerehabilitation (Personal Preference and TR for the next generation). The ten participants demonstrated limited awareness and exposure to TR, as well as minimal digital literacy and skills. Skepticism was shown when comparing the effectiveness of TR to in-person rehabilitation and valued physical interactions with health professionals. However, some recognized potential benefits of TR for accessibility, convenience, family involvement and improving community health in the long term. Willingness existed to try TR with sufficient training. Conclusion: With targeted efforts addressing identified barriers around awareness, technological literacy, clinician readiness and resource availability, perspectives on TR may shift positively from uncertainty towards endorsement of this expanding approach for simpler rehabilitation access in LMICs.

Keywords: digital technology, osteoarthritis, primary health care, telerehabilitation

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