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Using a complexity-informed approach, we aim to understand why introduction of a mobile service delivery model for osteoporosis across diverse organisational and country contexts in the UK National Health Service (NHS) met with variable success.

Six comparative case studies; three prospectively in Scotland using an action research-informed approach; and three retrospectively in England with variable degrees of success. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework explored interactions between multi-level contextual factors and their influence on efforts to introduce and sustain services.

Cross-boundary service development was a continuous process of adaptation and evolution in rapidly shifting healthcare context. Whilst the outer healthcare policy context differed significantly across cases, inner contextual features predominated in shaping the success or otherwise of service innovations. Technical and logistical issues, organisational resources, patient and staff actions combined in unpredictable ways to shape the lifecycle of service change. Patient and staff thoughts about place and access to services actively shaped service development. The use of tacit “soft intelligence” and a sense of “chronic unease” emerged as important in successfully navigating around awkward people and places.

“Chronic unease” and “soft intelligence” can be used to help individuals and organisations “tame” complexity, identify hidden threats and opportunities to achieving change in a particular context, and anticipate how these may change over time. Understanding how patients think and feel about where, when and how care is delivered provides unique insights into previously unseen aspects of context, and can usefully inform development and sustainability of patient-centred healthcare services.

This study has uniquely traced the fortunes of a single service innovation across diverse organisational and country contexts. Novel application of the NASSS framework enabled comparative analysis across real-time service change and historical failures. This study also adds to theories of context and complexity by surfacing the neglected role of patients in shaping healthcare context.

Our goals were to explore the pedagogies applied by instructors that supported Black, Indigenous and People of Color (BIPOC) student learning in a leadership course and the leadership behaviors BIPOC students identified as being applicable after the course.

Through survey research and qualitative data analysis, three prominent themes emerged.

High-quality, purposeful pedagogy created opportunities for students to learn. Second, a supportive, interactive community engaged students with the instructor, each other and the course material to support participation in learning. As a result, students reported experiencing big shifts, new growth and increased confidence during their leadership courses.

We discuss our findings and offer specific recommendations for leadership educators to better support BIPOC students in their leadership courses and classrooms and for further research with BIPOC students.

The Agents of Change program is a two-year, project-based learning program to develop Extension Professionals’ capacity to engage in Adaptive and Transformative Leadership. Its primary goal is to develop the capacity of Extension Professionals to engage in leadership to create more diverse, equitable, inclusive and just Extension programs and community change initiatives. This manuscript describes the program and an initial evaluation and results.

Results of an evaluation of the first year of the program indicate that regular training sessions and support are appropriate for leadership development and that Extension Professionals are using the learning, awareness and tools from this program to address challenges with Adaptive and Transformative Leadership elements. Also, Extension professionals demonstrated commitment to personal growth, community engagement and understanding of their multifaceted roles as change agents.

Participants are sharing resources from the program with colleagues, leading meetings differently, questioning the status quo and pushing others to try new ways forward.

Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.

Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.

It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.

Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.

The purpose of this paper is to offer original ideas into a potential future cannabis industry in the UK. This paper presents novel approaches regarding the potential existence of cannabis for the tourism industry. It presents an idea in which the UK Government could produce, distribute and control the industry. The proposed idea presents a scheme in which the UK could encourage regional tourism (inclusive to domestic and international travellers) through a controlled but innovative cannabis market scheme. This paper presents a future scenario aiming to encourage dialogue and critique, at a time when attitudes to cannabis are changing.

This research takes a scenario narrative approach in presenting and exploring a potential future cannabis market in the UK. The importance of narrative writing as a method is recognised by Lindgren and Bandhold (2009), who identify the significance in telling a story to the reader. Taking a pragmatic approach, embracing diverse philosophical methods, this research explores past and current trends via a mixture of secondary data sources to create and present a scenario narrative of the future.

This paper identified that trends in legalising cannabis for cultivation, medical and recreational purposes continue to become more liberal globally. However, cannabis laws mainly focus on the use for residents. Consequently, domestic tourism markets have the potential to grow. However, there is limited consideration regarding the potential for international tourism cannabis markets. Thus, the findings of this research are based on the potential for the UK to implement and promote a cannabis industry for international travellers.

This paper offers original ideas in exploring a future cannabis market in the UK, one where regional tourism is considered. The paper presents a novel approach that encourages domestic and international tourists to engage with the cannabis industry by navigating a well-managed, local approach to supplying cannabis in the UK.

Importance of corporate social responsibility (CSR) in marketing domain is increasing immensely. The effect of CSR perception on the purchase intention differs on the basis of mediators and contexts. The objective of this study is to examine the consumer behaviour of young consumers. For this, impact of CSR perception on purchase intention, satisfaction and price fairness of Generation Z is studied.

Preliminary data analysis is run to check normality, skewness and common method bias. PLS-SEM is deployed to examine the relationships amongst the research variables. Sequential mediation through PLS bootstrapping helped in exploring new and exciting research results which are supported with literature.

The CSR perception of Generation Z does not have a direct effect on their purchase intention. Interestingly, satisfaction and price fairness fully mediate the relationship between CSR perception and purchase intentions separately, i.e. CSR perception of Generation Z influences purchase intention only through satisfaction and price fairness. Furthermore, satisfaction and price fairness are also found to sequentially mediate the relationship between CSR perception and purchase intentions.

The research will aid not only the fast-food industry but the industries that are looking to focus on what Generation Z consumers expect in emerging markets including India. Understanding consumer expectations out of CSR initiatives will help them to incorporate social considerations into their marketing strategies and increase their profitability. Generation Z is regarded as the most challenging consumer demographic to market due to their proclivity for conducting extensive research and comparison shopping before making a purchase decision. As a result, the companies that want to use CSR as a strategy may find it advantageous to investigate how marketing of their CSR initiatives will lead to competitive edge and influence purchase decisions of this generational cohort.

This study adds to the academic literature by developing and evaluating a research model for consumer responses of a very important generation cohort to CSR in an emerging economy setting. CSR activities alone may not be enough to improve purchase intention of Generation Z adults. Sequential mediation for Generation Z adults' relationship between CSR and price fairness flows through satisfaction and finally to purchase intention is interesting because it clearly establishes a link amongst belief, attitude and actions of the target audience under study in a meaningful way within the framework given by cognitive consistency theory.

The purpose of this paper is to explore the emergence of “Roma health and wellbeing” as a focus of attention in European research and in policy and the possible detrimental consequences of action founded on a generic representation of “Roma health.”

Based on discussions with and research conducted by scholars who work directly with Roma communities across European regions from a wide range of academic disciplines it suggests how future research might inform: a more nuanced understanding of the causes of poor health and wellbeing among diverse Roma populations and; actions that may have greater potential to improve the health and wellbeing among these populations.

In summary, the authors promote three types of research: first critical analyses that unpick the implications of current and past representations of “Roma” and “Roma health.” Second, applied participatory research that meaningfully involves people from specific self-defined Roma populations to identify important issues for their health and wellbeing. Third, learning about processes that might impact on the health and wellbeing of Roma populations from research with other populations in similarly excluded situations.

The authors provide a multidisciplinary perspective to inform research that does not perpetuate further alienation and prejudice, but promotes urgent action to redress the social and health injustices experienced by diverse Roma populations across Europe.

The purpose of this paper is to describe progress in an across sectorial approach to primary health care at the district health service (DHS) level in Thailand in response to recent innovative national public policy directions which have been enshrined in constitutional doctrine and publicly endorsed by the Prime Minister. This paper describes one response to the Prime Minister’s challenge for Thailand to become the centre of learning in the sub-region in health management.

The authors utilised a descriptive case study approach utilising an analysis of the Naresuan University initiative of establishing the College of Health Systems Management (NUCHSM). Within that case study, there is a focus on challenges relevant to the socio-economic determinants of health (SOED) and an emphasis on utilising Sustainable Development Goals (SDGs) within the DHS structure.

The findings describe the establishment of the NUCHSM. A Master of Science (Health Systems Management) by research and a PhD degree have been created and supported by an international faculty. The Thailand International Cooperation Agency recognised NUCHSM by providing scholarships. International students are from Bangladesh, Bhutan, Kenya, Malawi and Timor Leste. Research consultancy projects include two in Lao People’s Democratic Republic; plus, a prototype DHS management system responsive to SDG attainment; and a project to establish a sustainable Ageing Society philosophy for a Thai municipality.

The case study on NUCHSM and its antecedents in its development have demonstrated originality in a long-standing international collaboration, and it has been recognised by the national government to provide scholarships to citizens of the countries in the sub-region to undertake postgraduate studies in health management. The concept of learning from each other and together, simultaneously as a group, through action research projects funded to enhance the evolution of DHSs is innovative.

The purpose of this study is to develop new type of reverse mortgage contract. How to provide adequate services and housing for an increasing number of people that are dependent on the help of others is a crucial question in the European Union (EU). The housing stock in Europe is not fit to support a shift from institutional care to the home-based independent living. Some 90% of houses in the UK and 70%–80% in Germany are not adequately built, as they contain accessibility barriers for people with emerging functional impairments. The available reverse mortgage contracts do not allow for relocation to their own adapted facilities. How to finance the adaptation from housing equity is discussed.

The authors have extended the existing loan reverse mortgage model. Actuarial methods based on the equivalence of the actuarial present values and the multiple decrement approach are used to evaluate premiums for flexible longevity and lifetime long-term care (LTC) insurance for financing adequate facilities.

The adequate, age-friendly housing provision that is appropriate to support the independence and autonomy of seniors with declining functional capacities can lower the cost of health care and improve the well-being of older adults. For financing the development of this kind of facilities for seniors, the authors developed the reverse mortgage scheme with embedded longevity and LTC insurance as a possible financial instrument for better LTC services and housing with care in assisted-living facilities. This kind of facilities should be available for the rapid growth of older cohorts.

The numerical example is based on rather crude numbers, because of lack of data, as the developed reverse mortgage product with LTC insurance is a novelty. Intensity of care and probabilities of care in certain category of care will change after the introduction of this product.

The model results indicate that it is possible to successfully tie an insurance product to the insured and not to the object.

The introduction of this insurance option will allow many older adult with low pension benefits and a substantial home equity to safely opt for a reverse mortgage and benefit from better social care.

While currently available reverse mortgage contracts lapse when the homeowner moves to assisted-living facilities in any EU Member State, in the paper a new method is developed where multiple adjustments of housing to the functional capacities with relocation is possible, under the same insurance and reverse mortgage contract. The case of Slovenia is presented as a numerical example. These insurance products, as a novelty, are portable, so the homeowner can move in own specialised housing unit in assisted-living facilities and keep the existing reverse mortgage contract with no additional costs, which is not possible in the current insurance products. With some small modifications, the method is useful for any EU Member State.