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In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

The purpose of this research project was to improve public awareness to improve public awareness of the importance of energy conservation and to improve the use of simple conservation strategies. A thorough evaluation of the net gain from the numerous energy campaigns rolled out to the public every year is lacking. This study conducted pre- and post-campaign surveys and focus groups to evaluate one campaign’s impact on self-reported energy behaviors.

The campaign used television public service announcements and a website to improve awareness of the city’s efforts to conserve energy and to increase individual energy conservation practices. Focus groups (n = 40) were used to identify common barriers to conservation, and pre- and post-surveys (n = 533, 479) were conducted to evaluate the campaign’s effectiveness.

Results indicated that the campaign increased positive changes in changing light bulbs and confidence in taking action to turn down thermostats, unplug devices and turn off lights. While follow-up research is needed on the precise mechanism of the psychological process at work, the findings are consistent with the concepts of self and response efficacy as needed components of any behavior change. The authors advocate the adoption of research-informed message design to maximize communication campaign effects.

This paper demonstrates how the combination of three prominent persuasion theories can be used to develop behavior change campaigns. Also, it is one of the few studies to evaluate the effectiveness of the Energy Star campaign.

The purpose of this paper is to postulate that the technique of Importance-Performance Analysis (IPA) is currently underutilised in visitor management studies reported in the peer-reviewed marine wildlife tourism (MWT) research literature. Further, this paper provides insight into how IPA could inform future research and management of tourism experiences at marine wildlife destinations.

This paper synthesises learning gained from the natural area tourism and recreation literature that report the application of IPA in MWT and insights from a recent study at the Dolphin Discovery Centre in Bunbury, Western Australia.

Although currently underutilized in MWT research, IPA is a relatively straightforward, easy to interpret, and, if correctly applied, a powerful tool that managers and researchers can employ to investigate and enhance visitor satisfaction in the short-term and for longer-term sustainability of the industry through visitor-informed tourism management.

Having identified the opportunity to enhance visitor experiences, site management and target species welfare through increased IPA research, this review provides a plain language introduction to the application of IPA and direct access to comprehensible academic discourses and exemplars for the technique. Moreover, in light of increasing tourism demand, IPA can assist in determining management options for the future.

The study aims to explore the validity of the modern renewable energy-environmental Kuznets curve (REKC) while considering the relevance of financial development in the consumption of modern renewable energy in East Africa Community (EAC). Modern renewable energy in this study includes all other forms of renewable energy except traditional use of biomass. The authors controlled for the effects of urbanization, governance, foreign direct investment (FDI) and trade openness.

Panel data of the five EAC countries of Burundi, Kenya, Rwanda, Tanzania and Uganda for the period 1996–2019 were used. The analysis relied on the use of the autoregressive distributed lag–pooled mean group (ARDL-PMG) model, and the data were sourced from the World Development Indicators (WDI), World Governance Indicators (WGI) and International Energy Agency (IEA).

The REKC hypothesis is supported for modern renewable energy consumption in the EAC region. Financial development positively and significantly affects modern renewable energy consumption, whereas urbanization, FDI and trade openness reduce modern renewable energy consumption. Governance is insignificant.

The concept of the REKC, although explored in other contexts such as aggregate renewable energy and in other regions, has not been used to explain the consumption of modern renewable energy in the EAC.

This study aims to examine the relationship between medication for opioid use disorder (MOUD) among pregnant individuals, referral source, mental health, political affiliation and substance use policies in all 50 states in the USA.

This study describes MOUD receipt among pregnant people with an opioid use disorder (OUD) in 2018. The authors explored sociodemographic differences in MOUD receipt, referrals and co-occurring mental health disorders. The authors included a comparison of MOUD receipt among states that have varying substance use policies and examined the impact of these policies and the political affiliation on MOUD. The authors used multilevel binary logistic regression to examine effects of individual and state-level characteristics on MOUD.

Among 8,790 pregnant admissions with OUD, the majority who received MOUD occurred in the Northeast region (71.52%), and 14.99% were referred by the criminal justice system (n = 1,318). Of those who were self-referred, 66.39% received MOUD, while only 30.8% of referrals from the criminal justice system received MOUD. Those referred from the criminal justice system or who had a co-occurring mental health disorder were least likely to receive MOUD. The multilevel model showed that while policies were not a significant predictor, a state’s political affiliation was a significant predictor of MOUD.

The study has some methodological limitations; a state-level analysis, even when considering the individual factors, may not provide sufficient description of community-level or other social factors that may influence MOUD receipt. This study adds to the growing literature on the ineffectiveness of prenatal substance use policies designed specifically to increase the use of MOUD. If such policies are consistently assessed as not contributing to substantial increase in MOUD among pregnant women over time, it is imperative to investigate potential mechanisms in these policies that may not facilitate MOUD access the way they are intended to.

Findings from this study aid in understanding the impact that a political affiliation may have on treatment access; states that leaned more Democratic were more likely to have higher rates of MOUD, and this finding can lead to research that focuses on how and why this contributes to greater treatment utilization. This study provides estimates of underutilization at a state level and the mechanisms that act as barriers, which is a stronger assessment of how state-specific policies and practices are performing in addressing prenatal substance use and a necessary step in implementing changes that can improve the links between pregnant women and MOUD.

To the best of the authors’ knowledge, this is the first study to explore individual-level factors that include mental health and referral sources to treatment that lead to MOUD use in the context of state-level policy and political environments. Most studies estimate national-level rates of treatment use only, which can be useful, but what is necessary is to understand what mechanisms are at work that vary by state. This study also found that while substance use policies were designed to increase MOUD for pregnant women, this was not as prominent a predictor as other factors, like mental health, being referred from the criminal justice system, and living in a state with more Democratic-leaning affiliations.

The purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.

The novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.

The “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.

To the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

In the early 2010s, the University of Wisconsin-Madison (UW-Madison) became increasingly concerned about incidents of academic workplace “bullying” on the campus, and in 2014–2016 created policies designed to address such behavior at the University. The new policies and accompanying initiatives were implemented in 2017, defining a new term to describe these behaviors as “hostile and intimidating behavior” (HIB). We use data from three sources to explore the outcomes of the new HIB policies and initiatives to date. Evaluation data from training sessions show the importance of educating the campus community about HIB, providing evidence that the training sessions increase HIB knowledge. Data from two campus-wide surveys measure incidence of HIB for different groups on campus (e.g., analysis by gender, race/ethnicity, sexual orientation, disability status, rank, job duty, and/or the intersection of these characteristics), as well as changes in the knowledge about HIB as reported by faculty and staff. These data show that UW-Madison faculty and staff are increasing their knowledge of HIB as a problem and also increasing their knowledge about what to do about it. Underrepresented groups who more commonly experience HIB agree that this culture is improving. At the same time, we are seeing slow and uneven progress in reduction of actual incidence of HIB at UW-Madison. We close with some “lessons learned” about instituting such a sweeping, campus-wide effort to reduce HIB, in the hopes that other campuses can learn from our experience.

Cognitive dysfunctions are a common clinical feature of schizophrenia and represent important indicators of outcome among patients who are affected. Therefore, a randomized, controlled, monocentric, single-blind trial was carried out to compare two different rehabilitation strategies adopted for the restoration and recovery of cognitive functioning of residential patients with schizophrenia. A sample of 110 residential patients were selected and, during the experimental period, a group of 55 patients was treated with sets of domain-specific exercises (SRT+CRT), whereas an equal control group was treated with sets of non-domain-specific exercises (SRT+PBO) belonging to the Cogpack® software. The effects on the scores (between T0 and T1) of the variables treatment and time and of the interaction time X treatment were analyzed: for the total BACS, the main effect of the between-factors variable treatment is statistically significant (F=201.562 P=0.000), as well as the effect of the within-factors variable “time” (F=496.68 P=0.000).The interaction of these two factors is also statistically significant (F=299.594 P=0.000). The addition of cognitive remediation therapy (CRT) to a standard treatment of metacognitive training (MCT) resulted in a significant improvement in global neurocognitive functioning and has reported positive effects with regard to the strengthening of verbal and working memory, selective and sustained attention at T1. A relevant result is the statistically significance of “time X treatment” for all the tests administered: we can assume that the domain-specific cognitive training amplifies the effects of SRT, as the primary and secondary goals of the present study were achieved.

University students are a unique population with great potential to adopt eating habits that promote positive human and planetary health outcomes. The purpose of this study is to illustrate the current perceptions of sustainable eating behaviours among the students and to examine the determinants of sustainable eating behaviours.

Data were collected from December 2020 to May 2021 through focus group discussions among university students in Ontario, facilitated through synchronous online sessions. There were 21 student participants during the course of five focus group sessions (4–5 participants per session) from various departments within the university. The discussions were transcribed and analyzed for main themes and concepts using open coding; deductive coding based on the framework by Deliens et al. as well as the literature; and inductive coding for emerging themes.

The students had different perceptions about what constituted sustainable eating behaviours, some of which were not based on fact. A variety of individual, environmental (macro, micro and social) and university characteristics were mentioned as factors influencing sustainable food choices, with “food literacy” and “campus food” being the top two factors.

This study presents a novel and holistic overview of how sustainable eating behaviours and sustainable foods are perceived among university students and identifies the perceived determinants of adopting sustainable eating behaviours. This study helps with identifying opportunities to promote sustainable eating behaviours among university students and the design/implementation of informed interventions and policies aimed at improving eating behaviours.

This study aims to explore the psychological effects of lockdown during the early stages of the COVID-19 pandemic on people living in an Italian prison. The suspension of family visits and most activities, along with the difficulties in applying social distancing to this vulnerable population was associated with increased psychological distress. Riots broke out over two days in more than 22 prisons across Italy at the beginning of March 2020, highlighting the negative psychological impact of the pandemic and the country’s emergency policies.

The research involves 17 men (Italians and foreigners) detained in a Lombardy prison from 1 March to 4 May 2020, corresponding to the lockdown phase in Italy. The qualitative content analysis (CA) of 27 posts, written by participants during that period and published on the blog “L’Oblò”, were analysed. The analysis allowed the identification of topics and subtopics that are related to two major categories of content: cognitions and emotional connotations about the COVID-19 lockdown in prison.

Analysis showed that blog post content was predominately negative in terms of emotional connotations. The most frequent coded negative emotional connotations were: missing, worry, psychological pain and fear, whilst the most frequent coded positive emotional connotations were: hope and gratitude for the support they received from prison workers. The rest of the blog content was coded as “cognitions”. Cognitions were coded as descriptions of lockdown effect on detention; prison during the COVID-19 emergency; the pandemic situation in general; and comparison between inside and outside prison.

The current study is original as it describes through blog CA the psychological condition of prisoners during the first COVID-19 pandemic lockdown in the most affected region in Italy.