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Three important lessons can be drawn from the health situation in developing and democratizing world. First lesson is that the societal health does not occur in the vacuum of societal life or social structures, but it simultaneously inspires development of all major spheres of political, economic, and cultural life of society. Second, health policy transpires simultaneously in all major social institutions, including economy, political institutions, and culture. Furthermore, because all social institutions are interconnected, the initiation of health reforms causes enormous, multilevel changes in all social strata and affects the performance of all essential institutions. Third, according to the World Health Organization, health is considered an integral part of human security, human rights, and peace. Consequently, societal health is determined and depends on the fullest cooperation of governments, world-scale communities, and local health care providers.

This study aims to examine how the relative importance of a search versus a credence attribute, strategically addressed in a flu vaccination advertisement, varies as a function of message sidedness. A search attribute was designed to highlight the affordability of flu shots, and a credence attribute addressed the potential health benefits of flu vaccination.

Two experiments were designed to explore how the relative persuasiveness of search versus credence attributes varies as a function of message sidedness in the context of flu vaccination advertising. In Experiment 1, the search–credence attribute type was manipulated by addressing either the affordability (e.g. “Get free flu shots”) or indirect health benefits of flu vaccines (e.g. “Improve herd immunity/community health”). In Experiment 2, an individual-level credence attribute (e.g. “Strengthen your immune system”) was created and compared to the other two attribute conditions used in Experiment 1: a search versus a societal credence versus an individual credence attribute.

Experiment 1 (N = 114) revealed the relative advantage of a search attribute (free flu shots) in the two-sided persuasion. Experiment 2 (N = 193) indicated that the persuasive impact of a societal credence attribute (herd immunity/community health) was greater in the two-sided message condition (vs one-sided message condition).

Relatively little research has examined how consumers respond to strategic flu prevention and vaccination messages promoting either credence or search attributes. Motivated by the need to investigate the relative effectiveness of stressing “herd immunity” versus “free flu shots” in flu vaccination advertising, this study examines how the effects of these distinct attributes on flu vaccination judgments differ between two-sided (e.g. “No vaccine is 100% effective”) and one-sided persuasion.

Purpose – This chapter frames the topic of organizing for sustainable health care in terms of the environmental trends that have rendered current health care approaches unsustainable, the embeddedness of health care in society's triple bottom line, and the need to build adaptive capability within the complex health care ecosystem.

Design/methodology/approach – We synthesize documented trends and empirical findings regarding the viability of current approaches to health care, and provide a theoretically framed treatment of the adaptation process in the complex health care system that can lead to the emergence of sustainable approaches.

Findings – There is a misfit between current approaches to delivering health care and the requirements and trends in contemporary society. Fundamental transformation is required that entails a broadening of purpose, a future orientation, and a rethinking of how health care adds value and how it is embedded in society.

Originality/value – By reconceptualizing health care reform as intricately related to societal sustainability and the triple bottom line, we open the possibility of transcending a narrow focus on reengineering to create more efficient organizations and work processes that consume fewer resources and deliver greater value. We invite health care practitioners and scholars to rethink all the connections in the health care ecosystem, and the need to build in self-organizing capabilities and adaptive capacity. The cases in this book provide knowledge from systems engaged in fundamental transformation, analyzed through the lenses of theoretical frameworks that help us better understand essential dynamics involved in creating sustainable health care systems.

The aim of this paper is to distinguish pedagogies supporting critical health literacy development in adolescent populations. Specifically, for sun safety education in schools.

The paper draws on an exploratory intrinsic case study design to qualitatively examine the learning conditions that Pre-Service Teachers' (PsTs) mobilise to advance Health Literary (HL) in learning activities.

This paper presents data that shows the different ways thirty Pre-Service Teachers (PsTs) in Western Australia conceptualise HL in sun safety education for Year 7 students (12–13 years old). Examination of three consecutive lesson plans categorised learning activities (n = 444) according to HL competencies. Data shows that the PsTs pedagogically advance HL but are constrained when conceptualising learning to support critical HL. Further examination of the lesson plans of the 11 PsTs who pedagogically advanced learning to support a critical level of health literacy, distinguished the learning conditions and pedagogies supporting critically health literate adolescents.

By distinguishing pedagogies to situate individual and social health within broader societal goals, the paper identifies teacher education institutions as key players enabling young people to socially advocate healthier living, particularly, regarding melanoma and non-melanoma incidence.

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of the healthcare system. Since independence from the Soviet Union in 1991, Moldova has undergone significant challenges and reforms throughout the society. Healthcare has been no exception. Changes in family structures due to migration, a decreased birthrate, and an aging population have placed strain on the healthcare system which is working to both modernize and provide specialized care. Legislation has helped to streamline and reform the healthcare system but systemic challenges are still faced by at-risk populations including the elderly, women, and rural populations.

Information presented in this paper is based on a review of independent research, United Nations and government reports.

Findings show that progress has been made through legislative reform, new government programming, and most recently volunteer/nonprofit involvement in healthcare reform. Currently, the government is working to establish holistic patient centered care and to bridge the healthcare divide between rural and urban populations. Healthcare reforms include basic universal health care services and family support programming. Additionally, there has been a renewed emphasis on how environmental factors, like housing and nutrition, interact with health quality.

Moldova faces an increasing challenge of caring for elderly populations at the family and societal level due to the increased number of elderly, shifts in family structures, and international migration for employment. A discussion of the developing role of nonprofit and nongovernment organizations is included.

The overall objective of this research was to elucidate the ecosystem of women’s health social enterprises (WHSEs) based in the United States. The Aim I was to conduct a secondary data analysis of a random national sample of non-profit WHSEs based in the United States regarding their characteristics and areas of intervention. Aim II was to conduct a qualitative assessment of a sample of WHSEs based in the United States regarding their perspectives on the ecosystem of WHSEs. Aim I utilized the GuideStar database and assessed enterprise size, geographic location, financial distress, health intervention area, and health activity category using descriptive statistics, statistical tests, and multivariable regression analysis via SPSS. Aim II utilized in-depth interviewing and grounded theory analysis via MAXQDA 2018 to identify novel themes and core categories while using an established framework for mapping social enterprise ecosystems as a scaffold.

Aim I findings suggest that WHSE activity is more predominant in the south region of the United States but not geographically concentrated around cities previously identified as social enterprise hubs. WHSEs take a comprehensive approach to women’s health, often simultaneously focusing on multiple areas of health interventions. Although most WHSEs demonstrate a risk for financial distress, very few exhibited severe risk. Risk for financial distress was not significantly associated with any of the measured enterprise characteristics. Aim II generated four core categories of findings that describe the ecosystem of WHSE: (1) comprehensive, community-based, and culturally adaptive care; (2) interdependent innovation in systems, finances, and communication; (3) interdisciplinary, cross-enterprise collaboration; and (4) women’s health as the foundation for family and population health. These findings are consistent with the three-failures theory for non-profit organizations, particularly that WHSEs address government failure by focusing on the unmet women’s health needs of the underserved populations (in contrast to the supply of services supported by the median voter) and address the market failure of over exclusion through strategies such as cross-subsidization and price discrimination. While WHSEs operate with levels of financial risk and are subject to the voluntary sector failure of philanthropic insufficiency, the data also show that they act to remediate other threats of voluntary failure.

Aim I findings highlight the importance of understanding financial performance of WHSEs. Also, lack of significant associations between our assessed enterprise characteristics and their financial risk suggests need for additional research to identify factors that influence financial performance of WHSE. Aim II findings show that WHSEs are currently engaged in complex care coordination and comprehensive biopsychosocial care for women and their families, suggesting that these enterprises may serve as a model for improving women’s health and health care. The community-oriented and interdisciplinary nature of WHSE as highlighted by our study may also serve as a unique approach for research and education purposes. Additional research on the ecosystem of WHSE is needed in order to better inform generalizability of our findings and to elucidate how WHSE interventions may be integrated into policies and practices to improve women’s health.

The purpose of this paper is to empirically test whether individuals’ internal factors (prior knowledge, resources, and capability) and environmental factors (stimuli, limitation) have any influence on the development of personal health information management (PHIM) literacy skills and which constructs are statistically associated with general health-related outcomes.

Survey responses were collected from Amazon’s Mechanical Turk (mTurk), a crowdsourcing internet service, in December 2013. A total of 578 responses were analyzed using partial-least squares structural equation modeling technique.

The model as a whole exhibited 62.8 percent of variance in health-related outcomes. The findings suggest that prior knowledge has a direct effect on health literacy (HL) skills (H3: β=0.212, p<0.001). The PHIM stimuli (H4: β=0.475, p<0.001) have a direct impact on HL skills, and they have an indirect effect on the comprehension of stimuli (H6: β=0.526, p<0.001) through the mediator of stimuli and the knowledge variable.

One possible limitation of this study is that the study may include a highly technology literate group, as survey respondents were recruited from the online service mTurk.

The study poses implications for further research and practice. This research was an exploratory work for further model development so future studies should investigate deeper into real personal health record (PHR) user groups (e.g. patients and caregivers). For example, studies by White and Horvitz (2009a, b) conducted real-time user studies that the authors could apply to the authors’ future PHR studies. Since the findings cannot be generalizable to these specific groups, similar research may be conducted. Using caregiver groups of PHR users in comparison to patient groups could determine the similarities and differences of their PHIM activities and related outcomes for optimal design of self-care management.

Further, it is suggested to conduct large scale, real-time-based studies using a PHR transaction log analysis to achieve conclusiveness and generalizability. Additionally, future studies should address not only diverse real-time user groups, but also various PHR data sources and their presentation issues.

This study model offers an important perspective on PHIM and its causal pathway for use not only by patient educators and healthcare providers but also information providers, personal health record (PHR) system developers, and PHR users.