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This chapter presents the outcome of an empirical study titled ‘Knowledge Sharing and Transfer (KST) that Really Works: An exploration of KST in Sub-Saharan South African Public Sector Institutions’. Enablers of KST were explored through the lens of lived experiences of managers working at Gautrain Management Agency (GMA), a rail transport public sector operator in South Africa. Qualitative data were collected from 15 managers and analysed using Thematic and Trans Positional Cognition Approach (TPCA) qualitative analytical tools. Four themes, essential originating antecedent factors, complementary people enabling factors, organisational enabling factors and effective KST implementing factors emerged. Rahman’s KST model was adopted as a theoretical framework and used to better understand the study findings. The current study affirms two elements within the theoretical framework, namely, complementary people enabling factors and organisational enabling factors, while the remaining two, essential originating antecedent factors and effective KST implementing factors, were not affirmed. This study contributes a new KST framework that helps business managers understand KST from the South African public sector practitioners’ perspectives, which represents this study’s contribution to the business performance measurement body of knowledge and practice.

Immigrants’ access to health services is a widely researched topic, yet few studies examine immigrants’ use of complementary and alternative medicine (CAM). This study uses the Behavioral Model to compare overall CAM use and use of acupuncture, chiropractic, herbs, yoga, and relaxation by immigrant status (nativity and time in the United States). It then explains the nativity gap in use by assessing knowledge, cost, and need as potential reasons for not using these modalities. Results show that controlling for predisposing, enabling, and need factors, recent immigrants use CAM less than the U.S.-born. Lack of knowledge of CAM modalities partially explains why some recent immigrants do not use acupuncture, chiropractic, or relaxation, while established immigrants cite lack of need as a reason for not using yoga. Cost does not explain immigrants’ lower use of these five modalities. Finally, ethnicity moderates the association between immigrant status and reasons for not using CAM.

To determine gendered patterns of preventive medical care (physical and dental/optical) use among pan-ethnic U.S. Asian and Latino adults.

Using National Latino and Asian American Study (2004) data, we apply Andersen’s (1995) Behavioral Model of Health Services Use to assess how preventive care use among Asian and Latino men and women varies as a function of predisposing, enabling, and need-based characteristics. We explore whether adjustment for these factors mediates gender disparities in both physical and dental/optical check-ups, and test whether certain factors operate differently among men versus women.

A higher proportion of women reported a routine care visit last year, especially among Latinos. Adjusting for predisposing, enabling, and need-based factors explained the gender difference in reporting a dental/optician check-up, but not a physical check-up, among both Asian and Latino adults.

Our findings illustrate how gender patterns in routine care use differ by race/ethnicity, and highlight the fundamental importance of enabling characteristics (especially health insurance and having a regular doctor) for shaping routine care use between men and women, both Asian and Latino. Limitations of this chapter are that the data are cross-sectional and were collected before the implementation of the Affordable Care Act, and measures are self-reported.

This chapter focuses on Asian and Latinos because they represent the fastest growing minority populations in the United States, yet few studies have evaluated gender differences in preventative health care use among these groups.

The purpose of this study was to re-examine racial and gender differences in home and community-based services utilization. Using the 1999 National Long Term Care Survey, the Anderson-Newman (1995) health behavioral model, social supports and structural factors were used to examine predictors of service use among four in-home and two community-based services. The results showed that race did not have a significant main effect on service use, but gender had a significant main effect for housework, home delivered meals, and congregate meals. Using an interaction term, older white women reported higher usage of housework. Among the predictors, enabling factors had the strongest effect on the use of personal care/nursing, home delivered meals, transportation and senior centers’ services. The results also indicated the importance of social supports and structural factors, particularly service awareness, in predicting service use. Implications for policies and practice to improve community outreach, access and utilization of services by different racial groups of elders are discussed.

Purpose – This chapter draws on the previous chapters and institutional case studies to identify and discuss the necessary conditions and facilitating factors which contribute to institutional transformation to engage a diverse student body.

Methodology /approach – This chapter is based on thematic analysis of the previous chapters and institutional case studies. It utilises national contextual information, details of changes undertaken and reflections on the process of change. The key ideas are illustrated by quotes from the case studies.

Findings – The following necessary conditions and facilitative factors are identified and discussed:i.Commitment to a transformational approachii.Sharing understanding and meaningiii.Institutional strategy for change: senior leadership, policy alignment, creating a facilitating infrastructure across the student lifecycle and co-ordinating changeiv.Engaging staff and creating an inclusive culturev.Developing students' capacity to engagevi.Taking an evidence-informed approachvii.Linking change to other institutional priorities and developmentsviii.An enabling policy and funding context

Research limitations – It is based on the chapters and case studies presented in this book rather than a wider analysis.

Practical implications – This chapter offers institutions insight into the conditions and factors that enable and smooth institutional transformation.

Social implications – This chapter is designed to support the promotion of social justice in higher education.

Originality/value – This chapter draws on international research and institutional examples and identifies common conditions and factors which contribute to managing change to engage a diverse student body. Its value is practical insights into change from an international perspective.

Health-seeking behaviors (HSB) for infertility are influenced my multiple factors. The Behavioral Model of Health Services Utilization states that enabling resources and predisposing factors are essential in predicting HSB, and this study examined the relationship between state-level mandates that insurance providers cover infertility service on the rates of HSB for infertility among a nationally representative sample of women.

This study used data from the National Survey of Family Growth, identified 15 states with state-level mandates as enabling resources, and used sociodemographic characteristics as predisposing resources. Using discrete-time event-history analyses, and retrospective accounts of infertility HSB, these variables were examined to determine if residing in a state with state-level insurance mandates would increase the likelihood of HSB for infertility.

Results indicated an impact of state-level mandates on HSB for infertility. Specifically, the rates of HSB for infertility were higher among women residing in states with state-level mandates.

A limitation in this research stems from a data restriction that forced identifying a place-of-residence before or after 2000. To overcome this, multiple analyses, and a nested model comparison were tested to measure the effect of state-level mandates on HSB.

The comparative analysis of the rates of HSB for women residing in states with state-level mandates has not been considered before, and the results provide further detail into the infertility experience for women and their partners.

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.

To investigate ethnic group differences in the utilization of preventive medical care services among U.S. Asian and Latino immigrant adults.

Using data from the 2002–2003 National Latino and Asian American Study, we examined whether differences exist in the reporting of any preventive physical care or dental/optician visit during the last year across Asian and Latino immigrant groups. Following, we applied Andersen’s (1995) Behavioral Model of Health Services Use to assess how ethnic disparities in preventive care use are a function of predisposing, enabling/impeding, and need-based factors.

Descriptive results showed that among Latinos, a much lower proportion of Mexican immigrants reported a preventive medical care visit during the last year than either Cuban or Puerto Rican immigrants. Asian immigrants show less variation in use, but significant differences still exist with Filipino immigrants reporting the highest level of use, followed by Vietnamese and then Chinese immigrants. Logistic regression models also indicated that predisposing characteristics, especially aspects of acculturation status, contribute strongly to ethnic group differences in preventive care use, while enabling/disabling and need-based characteristics are less important.

While studies of medical care use often treat Asians and Latinos as homogeneous groups, our findings illustrate the need for a more detailed view of the foreign-born population. Findings also highlight the role of acculturation status in shaping group differences in preventive medical care use – and as such, the importance of considering these differences when promoting the use of timely preventive care services among immigrant populations.