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This qualitative study was conducted to answer two questions concerning service learning in youth populations: Do teens understand their roles in the process of service learning? How do teens perceive service opportunities within their communities or organizations? The intent was to investigate these issues in order to provide depth to the research on youth voice and perceptions in service learning activities. Focus groups were conducted with teens involved in various organizations. Findings included that teens were able to articulate a strong definition of service learning as well as identify service activities. Most felt they had a voice in planning and implementation and saw adults as key to the evaluation of projects. Some teens felt, however, that adults often have too great a voice in the planning stages. Recommendations include professional development for adults on working with teens and evaluating current programs to make certain that youth voice is present.

The increasing size of the elderly population is emerging as a primary catalyst for the escalation of healthcare expenditure, and a sense of urgency is manifest. However, the complexity of the health- and elderly care systems provides challenges in improving system efficiency. Hence, the system-level understanding of the main obstacles to integration care needs further exploration. In order to better integrate health- and elderly care, the study needs to identify the actual misalignments underpinning the issue. This study provides the theoretical foundations for resource misalignments and provides empirical examples of these.

Semi-structured interviews with multiple stakeholders on various hierarchical levels were carried out to create a more complete view of the system and resources deployed in health- and elderly care. The application of user-centered design methods and co-creation with employees have also been crucial to the outcomes of the study.

Results show that health- and elderly care is a large-scale complex system. The overlapping and mutually reinforcing misalignments are: (1) regulation and policy differences, (2) stakeholder quantity and variation, (3) external control of health- and elderly care, (3) decreasing collaboration and (4) communication channels and IT development.

This qualitative study builds on institutional theory and resource integration theory and contributes with empirical descriptions of misalignments in the health- and elderly care system. These descriptions will serve as points of departure for systems design to improve the efficiency and effectiveness of health- and elderly care.