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Prof. Federica Angeli
University of York Management School, University of York, York YO10, United Kingdom

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0 Social Network Analysis
0 Sustainable Development
0 Complex adaptive systems
0 Organisational adaptation and learning
0 Healthcare policy and systems

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Social Network Analysis
Complex adaptive systems

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Comment
Published: 30 June 2021 in Humanities and Social Sciences Communications
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While the world was facing a rapidly progressing COVID-19 second wave, a policy paradox emerged. On the one side, much more was known by Autumn 2020 about the mechanisms underpinning the spread and lethality of Sars-CoV-2. On the other side, how such knowledge should be translated by policymakers into containment measures appeared to be much more controversial and debated than during the first wave in Spring. Value-laden, conflicting views in the scientific community emerged about both problem definition and subsequent solutions surrounding the epidemiological emergency, which underlined that the COVID-19 global crisis had evolved towards a full-fledged policy “wicked problem”. With the aim to make sense of the seemingly paradoxical scientific disagreement around COVID-19 public health policies, we offer an ethical analysis of the scientific views encapsulated in the Great Barrington Declaration and of the John Snow Memorandum, two scientific petitions that appeared in October 2020. We show that how evidence is interpreted and translated into polar opposite advice with respect to COVID-19 containment policies depends on a different ethical compass that leads to different prioritization decisions of ethical values and societal goals. We then highlight the need for a situated approach to public health policy, which recognizes that policies are necessarily value-laden, and need to be sensitive to context-specific and historic socio-cultural and socio-economic nuances.

ACS Style

Federica Angeli; Silvia Camporesi; Giorgia Dal Fabbro. The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values? Humanities and Social Sciences Communications 2021, 8, 1 -8.

AMA Style

Federica Angeli, Silvia Camporesi, Giorgia Dal Fabbro. The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values? Humanities and Social Sciences Communications. 2021; 8 (1):1-8.

Chicago/Turabian Style

Federica Angeli; Silvia Camporesi; Giorgia Dal Fabbro. 2021. "The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?" Humanities and Social Sciences Communications 8, no. 1: 1-8.

Discussion
Published: 02 August 2020 in World Development
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Governments worldwide are under enormous pressure to effectively and promptly address the increasingly complex crisis presented by the Covid-19 pandemic. To understand the difficulties inherent to policymakers’ sensemaking and learning processes during this unprecedented challenge, this article develops a perspective rooted in complexity theory. We highlight that, just as complex adaptive systems, societies affected by the pandemic and by the subsequent containment policies present non-linear and unpredictable outcomes, which highly depend on the social systems’ initial states and on the behavioral rules governing the actions and interactions of the agents composing the systems. This analysis underlines that any decision-making process in a highly complex crisis such as the Covid-19 pandemic is inherently inaccurate and short-sighted. Far, however, from suggesting a policy paralysis, with this perspective we highlight the need to embed complexity thinking in policy decision-making and we present a roadmap for learning based on a flexible and adaptive approach, locally optimal solutions, and the need for international cooperation and transparent dissemination of data.

ACS Style

Federica Angeli; Andrea Montefusco. Sensemaking and learning during the Covid-19 pandemic: A complex adaptive systems perspective on policy decision-making. World Development 2020, 136, 105106 -105106.

AMA Style

Federica Angeli, Andrea Montefusco. Sensemaking and learning during the Covid-19 pandemic: A complex adaptive systems perspective on policy decision-making. World Development. 2020; 136 ():105106-105106.

Chicago/Turabian Style

Federica Angeli; Andrea Montefusco. 2020. "Sensemaking and learning during the Covid-19 pandemic: A complex adaptive systems perspective on policy decision-making." World Development 136, no. : 105106-105106.

Original article
Published: 15 March 2020 in Sociology of Health & Illness
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Disembarking from a traditional approach of narrow hazardous environmental and structural conditions in understanding urban slums’ health problems and moving towards a new notion of what constitutes health for slum dwellers will open a new avenue to recognise whether and how health is being prioritised in disadvantaged settings. Drawing on in‐depth semi‐structured interviews with a total of 67 men and 68 women from Kolkata slums and 62 men and 48 women from Bangalore slums, this study explored how knowledge, social realities, material and symbolic drivers of a place interweave in shaping slum‐dwellers’ patterned way of understanding health, and the ways health and illnesses are managed. The current study adds to the growing evidence that ordinary members of the urban slums can articulate critical linkages between their everyday sociocultural realities and health conditions, which can support the design and delivery of interventions to promote wellbeing. The concept of health is not confined to an abstract idea but manifested in slum‐dwellers’ sporadic practices of preventive and curative care as well as everyday living arrangements, where a complex arrangement of physical, psychological, financial, sociocultural and environmental dimensions condition their body and wellbeing.

ACS Style

Moumita Das; Federica Angeli; Onno C. P. van Schayck. Understanding self‐construction of health among the slum dwellers of India: a culture‐centred approach. Sociology of Health & Illness 2020, 42, 1001 -1023.

AMA Style

Moumita Das, Federica Angeli, Onno C. P. van Schayck. Understanding self‐construction of health among the slum dwellers of India: a culture‐centred approach. Sociology of Health & Illness. 2020; 42 (5):1001-1023.

Chicago/Turabian Style

Moumita Das; Federica Angeli; Onno C. P. van Schayck. 2020. "Understanding self‐construction of health among the slum dwellers of India: a culture‐centred approach." Sociology of Health & Illness 42, no. 5: 1001-1023.

Journal article
Published: 29 October 2019 in International Journal of Integrated Care
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Organisational culture is believed to be an important facilitator for better integrated care, yet how organisational culture impacts integrated care remains underspecified. In an exploratory study, we assessed the relationship between organisational culture in primary care centres as perceived by primary care teams and patient-perceived levels of integrated care. We analysed a sample of 2,911 patient responses and 17 healthcare teams in four primary care centres. We used three-level ordered logistic regression models to account for the nesting of patients within health care teams within primary care centres. Our results suggest a non-linear relationship between organisational culture at the team level and integrated care. A combination of different culture types-including moderate levels of production-oriented, hierarchical and team-oriented cultures and low or high levels of adhocracy cultures-related to higher patient-perceived levels of integrated care. Organisational culture at the level of healthcare teams has significant associations with patient-perceived integrated care. Our results may be valuable for primary care organisations in their efforts to compose healthcare teams that are predisposed to providing better integrated care.

ACS Style

Maike V. Tietschert; Federica Angeli; Arno J.A. Van Raak; Jonathan Clark; Sara J. Singer; Dirk Ruwaard. Can Organisational Culture of Teams Be a Lever for Integrating Care? An Exploratory Study. International Journal of Integrated Care 2019, 19, 10 .

AMA Style

Maike V. Tietschert, Federica Angeli, Arno J.A. Van Raak, Jonathan Clark, Sara J. Singer, Dirk Ruwaard. Can Organisational Culture of Teams Be a Lever for Integrating Care? An Exploratory Study. International Journal of Integrated Care. 2019; 19 (4):10.

Chicago/Turabian Style

Maike V. Tietschert; Federica Angeli; Arno J.A. Van Raak; Jonathan Clark; Sara J. Singer; Dirk Ruwaard. 2019. "Can Organisational Culture of Teams Be a Lever for Integrating Care? An Exploratory Study." International Journal of Integrated Care 19, no. 4: 10.

Research article
Published: 10 January 2019 in PLoS ONE
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The shortage of doctors, especially in rural areas, is a major concern in India, which in turn affects the effective delivery of health care services. To support new policies able to address this issue, a study was conducted to determine the discouraging and encouraging factors affecting medical students’ interests towards working in rural areas. This cross-sectional, descriptive qualitative study has been conducted in three states of North India. It comprised six focus group discussions, each consisting of 10–20 medical students of six government medical colleges. The verbatim and thematic codes have been transcribed by using a ‘categorical aggregation approach’. The discussions were thematically analyzed. Ninety medical students participated in the study. The discouraging factors were grouped under two broad themes namely unchallenging professional environment (poor accommodation facilities and lack of necessary infrastructure; lack of drug and equipment supplies; inadequate human resource support; lesser travel and research opportunities) and gap between financial rewards and social disadvantages (lower salary and incentives, social isolation, political interference, lack of security). Similarly, the encouraging factors were congregated under three main themes namely willingness to give back to disadvantaged communities (desire to serve poor, underprivileged and home community), broader clinical exposure (preferential admission in post-graduation after working more than 2–3 years in rural areas) and higher status and respect (achieving higher social status). This qualitative study highlights key factors affecting medical students’ interest to work in rural areas. A substantial similarity was noted between the factors which emerge from the current study and those documented in other countries. These findings will help policymakers and medical educators to design and implement a comprehensive human resource strategy that shall target specific factors to encourage medical students to choose job positions in rural areas.

ACS Style

Sonu Goel; Federica Angeli; Nonita Dhirar; Garima Sangwan; Kanchan Thakur; Dirk Ruwaard. Factors affecting medical students’ interests in working in rural areas in North India—A qualitative inquiry. PLoS ONE 2019, 14, e0210251 .

AMA Style

Sonu Goel, Federica Angeli, Nonita Dhirar, Garima Sangwan, Kanchan Thakur, Dirk Ruwaard. Factors affecting medical students’ interests in working in rural areas in North India—A qualitative inquiry. PLoS ONE. 2019; 14 (1):e0210251.

Chicago/Turabian Style

Sonu Goel; Federica Angeli; Nonita Dhirar; Garima Sangwan; Kanchan Thakur; Dirk Ruwaard. 2019. "Factors affecting medical students’ interests in working in rural areas in North India—A qualitative inquiry." PLoS ONE 14, no. 1: e0210251.

Journal article
Published: 10 December 2018 in Sustainability
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Delivery of affordable healthcare services to communities is a necessary precondition to poverty alleviation. Co-creation approaches to the development of business models in the healthcare industry proved particularly suitable for improving the health-seeking behavior of BOP patients. However, scant research was conducted to understand BOP consumers’ decision-making process leading to specific healthcare choices in slum settings, and the relative balance of socio-cultural and socio-economic factors underpinning patients’ preferences. This article adopts a mixed-method approach to investigate the determinants of BOP patients’ choice between private and public hospitals. Quantitative analysis of a database, composed of 436 patients from five hospitals in Ahmedabad, India, indicates that BOP patients visit a public hospital significantly more than top-of-the-pyramid (TOP) patients. However, no significant difference emerges between BOP and TOP patients for inpatient or outpatient treatments. Qualitative findings based on 21 interviews with BOP consumers from selected slum areas led to the development of a grounded theory model, which highlights the role of aspirational demand of BOP patients toward private healthcare providers. Overall, healthcare provider choice emerges as the outcome of a collective socio-cultural decision-making process, which often assigns preference for private healthcare services because of the higher perceived quality of private providers, while downplaying affordability concerns. Implications for healthcare providers, social entrepreneurs, and policy-makers are discussed.

ACS Style

Federica Angeli; Shila Teresa Ishwardat; Anand Kumar Jaiswal; Antonio Capaldo. Socio-Cultural Sustainability of Private Healthcare Providers in an Indian Slum Setting: A Bottom-of-the-Pyramid Perspective. Sustainability 2018, 10, 4702 .

AMA Style

Federica Angeli, Shila Teresa Ishwardat, Anand Kumar Jaiswal, Antonio Capaldo. Socio-Cultural Sustainability of Private Healthcare Providers in an Indian Slum Setting: A Bottom-of-the-Pyramid Perspective. Sustainability. 2018; 10 (12):4702.

Chicago/Turabian Style

Federica Angeli; Shila Teresa Ishwardat; Anand Kumar Jaiswal; Antonio Capaldo. 2018. "Socio-Cultural Sustainability of Private Healthcare Providers in an Indian Slum Setting: A Bottom-of-the-Pyramid Perspective." Sustainability 10, no. 12: 4702.

Conference paper
Published: 01 August 2018 in Academy of Management Proceedings
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In the context of increasing public demand on high-quality and accessible care, and predictions of unmanageable costs in healthcare provision, social entrepreneurship holds the promise of making a cost-effective, social impact in healthcare. Although research in the field is rapidly increasing, the process of social entrepreneurial action is poorly understood. This paper hopes to contribute to our understanding of the emergence of social entrepreneurial action in healthcare by conducting an exploratory study of the antecedents of social entrepreneurial action by Ashoka Fellows. Build upon a qualitative paradigm, we used Gioia’s two-step methodology to analyze the online available profiles of 57 Ashoka Fellows active in healthcare. We were able to reveal fourteen antecedents grouped into four interlinked aggregate dimensions. Our study suggests the dimensions of multi-disciplinarity, exposure, connectedness and pro-social orientation synergize antecedents into a social entrepreneurial pathway, composed out of combinations of antecedents accumulated into a portfolio of tangible and intangible resources available to individuals. Although our study has focused only on the profiles of highly successful social entrepreneurs, we argue our research holds enough robust evidence to warrant further exploration of our suggested model in order to gain a deeper understanding on the emergence of social entrepreneurial action.

ACS Style

Jeroen Gruiskens; Jarrod Ormiston; Federica Angeli; Onno Van Schayck. Understanding the emergence of social entrepreneurial action in healthcare. Academy of Management Proceedings 2018, 2018, 1 .

AMA Style

Jeroen Gruiskens, Jarrod Ormiston, Federica Angeli, Onno Van Schayck. Understanding the emergence of social entrepreneurial action in healthcare. Academy of Management Proceedings. 2018; 2018 (1):1.

Chicago/Turabian Style

Jeroen Gruiskens; Jarrod Ormiston; Federica Angeli; Onno Van Schayck. 2018. "Understanding the emergence of social entrepreneurial action in healthcare." Academy of Management Proceedings 2018, no. 1: 1.

Conference paper
Published: 01 August 2018 in Academy of Management Proceedings
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Hospital markets are becoming increasingly consolidated despite mixed evidence regarding the desirability of hospital mergers. This study seeks to advance the understanding of hospital mergers by studying both their perceived and measured effects on quality of care. We used a mixed-methods approach to study hospital mergers in the Netherlands. In the quantitative stage we tested the effect of hospital mergers (approved between 2008 and 2014) on 82 quality indicators (11 at hospital level, 28 at department level, and 43 at disease level) using a difference-in-difference approach. Qualitatively, three case studies were conducted to study how hospital executives, hospital managers, and healthcare professionals perceive a merger to have impacted quality of care. Fifteen quality indicators proved significantly worse in merged hospitals (three after applying Bonferroni correction) and two quality indicators proved significantly better in merged hospitals (none after applying Bonferroni correction). The majority of respondents in the case studies indicate that they perceive scale- and shock- effects to have had a positive influence on quality of care. However, several respondents caution that these effects might be asymptotic, specialty-specific, or have a negative influence on quality of care. Perceived effects of hospital mergers on quality of care are thus mainly positive while the measured effects are primarily negative. Hence, hospital mergers do not have an unequivocally positive effect on quality of care. Hospital manager could hence carefully consider alternatives to merging to improve quality of care.

ACS Style

Daan Westra; Federica Angeli; Ron Kemp; Maarten Batterink; Jan Reitsma. If you say so: Perceived and measured effects of hospital mergers on quality of care (WITHDRAWN). Academy of Management Proceedings 2018, 2018, 1 .

AMA Style

Daan Westra, Federica Angeli, Ron Kemp, Maarten Batterink, Jan Reitsma. If you say so: Perceived and measured effects of hospital mergers on quality of care (WITHDRAWN). Academy of Management Proceedings. 2018; 2018 (1):1.

Chicago/Turabian Style

Daan Westra; Federica Angeli; Ron Kemp; Maarten Batterink; Jan Reitsma. 2018. "If you say so: Perceived and measured effects of hospital mergers on quality of care (WITHDRAWN)." Academy of Management Proceedings 2018, no. 1: 1.

Monograph
Published: 03 July 2018 in Healthcare Entrepreneurship
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ACS Style

Ralf Wilden; Massimo Garbuio; Federica Angeli; Daniele Mascia. Healthcare Entrepreneurship. Healthcare Entrepreneurship 2018, 1 .

AMA Style

Ralf Wilden, Massimo Garbuio, Federica Angeli, Daniele Mascia. Healthcare Entrepreneurship. Healthcare Entrepreneurship. 2018; ():1.

Chicago/Turabian Style

Ralf Wilden; Massimo Garbuio; Federica Angeli; Daniele Mascia. 2018. "Healthcare Entrepreneurship." Healthcare Entrepreneurship , no. : 1.

Book chapter
Published: 03 July 2018 in Healthcare Entrepreneurship
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Healthcare organizations and their managers operate in highly complex environments. Whereas they are subject to a wide variety of constraining contextual characteristics, they are also highly in need of innovation to be able to deliver high-quality care and compete in a highly dynamic environment. In this chapter, we utilize a dynamic capabilities perspective to describe how four important contextual characteristics—financial constraints, monitoring needs, bureaucracy and pluralism—may affect the innovation process of healthcare organizations. We zoom into how these contextual characteristics may impact three key activities of organizations that seek to innovate: sensing, seizing, and reconfiguring activities. In addition, we magnify the impact of these contextual characteristics on three key underlying components of the ability of managers to innovate: managerial social capital, managerial human capital, and managerial cognition. As we practically identify and address both threats and opportunities of healthcare sector’s contextual characteristics, comprehension of this chapter is vital for those pursuing successful healthcare innovation.

ACS Style

Emre Karali; Federica Angeli; Jatinder S. Sidhu; Henk Volberda. Understanding Healthcare Innovation Through a Dynamic Capabilities Lens. Healthcare Entrepreneurship 2018, 108 -143.

AMA Style

Emre Karali, Federica Angeli, Jatinder S. Sidhu, Henk Volberda. Understanding Healthcare Innovation Through a Dynamic Capabilities Lens. Healthcare Entrepreneurship. 2018; ():108-143.

Chicago/Turabian Style

Emre Karali; Federica Angeli; Jatinder S. Sidhu; Henk Volberda. 2018. "Understanding Healthcare Innovation Through a Dynamic Capabilities Lens." Healthcare Entrepreneurship , no. : 108-143.

Book chapter
Published: 03 July 2018 in Healthcare Entrepreneurship
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In order to be successful, entrepreneurial ventures in the healthcare sector need to be innovative in the way they create and deliver value to healthcare stakeholders. However, different constituencies might hold a wide array of different views on what constitutes “value,” which creates potentially conflicting claims for healthcare providers and entrepreneurial ventures, ultimately undermining their effectiveness and survival chances. This chapter first provides an overview of the multifaceted concept of value in healthcare, and brings the reader to appreciate the new paradigm of “value-based healthcare.” Once the concept of value has been clarified, the lens of hybrid organizations is used to highlight the challenges faced by different types of organizations along the healthcare provision value chain. A gradient of complexity emerges among organizational actors, which pinpoints areas that might be more or less attractive for entrepreneurial attention.

ACS Style

Federica Angeli; Daan Westra. Delivering Value in the Healthcare Sector Through the Lens of Hybrid Organizing. Healthcare Entrepreneurship 2018, 27 -45.

AMA Style

Federica Angeli, Daan Westra. Delivering Value in the Healthcare Sector Through the Lens of Hybrid Organizing. Healthcare Entrepreneurship. 2018; ():27-45.

Chicago/Turabian Style

Federica Angeli; Daan Westra. 2018. "Delivering Value in the Healthcare Sector Through the Lens of Hybrid Organizing." Healthcare Entrepreneurship , no. : 27-45.

Journal article
Published: 19 June 2018 in BMC Health Services Research
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Severe underutilization of healthcare facilities and lack of timely, affordable and effective access to healthcare services in resource-constrained, bottom of pyramid (BoP) settings are well-known issues, which foster a negative cycle of poor health outcomes, catastrophic health expenditures and poverty. Understanding BoP patients’ healthcare choices is vital to inform policymakers’ effective resource allocation and improve population health and livelihood in these areas. This paper examines the factors affecting the choice of health care provider in low-income settings, specifically the urban slums in India. A discrete choice experiment was carried out to elicit stated preferences of BoP populations. A total of 100 respondents were sampled using a multi-stage systemic random sampling of urban slums. Attributes were selected based on previous studies in developing countries, findings of a previous exploratory study in the study setting and qualitative interviews. Provider type and cost, distance to the facility, attitude of doctor and staff, appropriateness of care and familiarity with doctor were the attributes included in the study. A random effects logit regression was used to perform the analysis. Interaction effects were included to control for individual characteristics. The relatively most valued attribute is appropriateness of care (β=3.4213, p = 0.00), followed by familiarity with the doctor (β=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (β=1.8132, p = 0.00). As expected, respondents prefer shorter distance (β= − 0.0722, p = 0.00) but the relatively low importance of the attribute distance to the facility indicate that respondents are willing to travel longer if any of the other statistically significant attributes are present. Also, significant socioeconomic differences in preferences were observed, especially with regard to the type of provider. The analyses did not reveal universal preferences for a provider type, but overall the traditional provider type is not well accepted. It also became evident that respondents valued appropriateness of care above other attributes. Despite the study limitations, the results have broader policy implications in the context of Indian government’s attempts to reduce high healthcare out-of-pocket expenditures and provide universal health coverage for its population. The government’s attempt to emphasize the focus on traditional providers should be carefully reconsidered.

ACS Style

Vilius Černauskas; Federica Angeli; Anand Kumar Jaiswal; Milena Pavlova. Underlying determinants of health provider choice in urban slums: results from a discrete choice experiment in Ahmedabad, India. BMC Health Services Research 2018, 18, 473 .

AMA Style

Vilius Černauskas, Federica Angeli, Anand Kumar Jaiswal, Milena Pavlova. Underlying determinants of health provider choice in urban slums: results from a discrete choice experiment in Ahmedabad, India. BMC Health Services Research. 2018; 18 (1):473.

Chicago/Turabian Style

Vilius Černauskas; Federica Angeli; Anand Kumar Jaiswal; Milena Pavlova. 2018. "Underlying determinants of health provider choice in urban slums: results from a discrete choice experiment in Ahmedabad, India." BMC Health Services Research 18, no. 1: 473.

Journal article
Published: 14 February 2018 in International Journal for Equity in Health
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Empirical evidence shows that the relationship between health-seeking behaviour and diverse gender elements, such as gendered social status, social control, ideology, gender process, marital status and procreative status, changes across settings. Given the high relevance of social settings, this paper intends to explore how gender elements interact with health-seeking practices among men and women residing in an Indian urban slum, in consideration of the unique socio-cultural context that characterises India’s slums. The study was conducted in Sahid Smriti Colony, a peri-urban slum of Kolkata, India. The referral technique was used for selecting participants, as people in the study area were not very comfortable in discussing their health issues and health-seeking behaviours. The final sample included 66 participants, 34 men and 32 women. Data was collected through individual face-to-face in-depth interviews with a semi-structured questionnaire. The data analysis shows six categories of reasons underlying women’s preferences for informal healers, which are presented in the form of the following themes: cultural competency of care, easy communication, gender-induced affordability, avoidance of social stigma and labelling, living with the burden of cultural expectations and geographical and cognitive distance of formal health care. In case of men ease of access, quality of treatment and expected outcome of therapies are the three themes that emerged as the reasons behind their preferences for formal care. Our results suggest that both men and women utilise formal and informal care, but with different motives and expectations, leading to contrasting health-seeking outcomes. These gender-induced contrasts relate to a preference for socio-cultural (women) versus technological (men) therapies and long (women) versus fast (men) treatment, and are linked to their different societal and familial roles. The role of women in following and maintaining socio-cultural norms leads them to focus on care that involves long discussions mixed with socio-cultural traits that help avoid economic and social sanctions, while the role of men as bread earners requires them to look for care that ensures a fast and complete recovery so as to avoid financial pressures.

ACS Style

Moumita Das; Federica Angeli; Anja J. S. M. Krumeich; Onno C. P. Van Schayck. The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India. International Journal for Equity in Health 2018, 17, 1 -14.

AMA Style

Moumita Das, Federica Angeli, Anja J. S. M. Krumeich, Onno C. P. Van Schayck. The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India. International Journal for Equity in Health. 2018; 17 (1):1-14.

Chicago/Turabian Style

Moumita Das; Federica Angeli; Anja J. S. M. Krumeich; Onno C. P. Van Schayck. 2018. "The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India." International Journal for Equity in Health 17, no. 1: 1-14.

Review
Published: 07 February 2018 in PLOS ONE
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Interactions between pharmaceutical companies and healthcare providers are increasingly scrutinized by academics, professionals, media, and politicians. Most empirical studies and professional guidelines focus on unilateral donor-recipient types of interaction and overlook, or fail to distinguish between, more reciprocal types of interaction. However, the degree of goal alignment and potential for value creation differs in these two types of interactions. Failing to differentiate between these two forms of interaction between pharmaceutical companies and healthcare providers could thus lead to biased conclusions regarding their desirability. This study reviews the empirical literature regarding the effects of bilateral forms of interactions between pharmaceutical companies and healthcare providers in order to explore their effects. We searched two medical databases (i.e. PubMed and Cochrane Library) and one business database (i.e. EBSCO) for empirical, peer-reviewed articles concerning any type of bilateral interaction between pharmaceutical companies and healthcare providers. We included quantitative articles which were written in English and published between January 1st, 2000 and October 31st, 2016, and where the title or abstract included a combination of synonyms of the following keywords: pharmaceutical companies, healthcare providers, interaction, and effects. Our search results yielded 10 studies which were included in our analysis. These studies focused on either research-oriented interaction or on education-oriented interaction. The included studies reported various outcomes of interaction such as prescribing behavior, ethical dilemmas, and research output. Regardless of the type of interaction, the studies either reported no significant effects or ambivalent outcomes such as affected clinical practice or ethical issues. The effects of bilateral interactions reported in the literature are similar to those reported in studies concerning unilateral interactions. The theoretical notion that bilateral interactions between pharmaceutical companies and healthcare providers have different effects given their increased level of goal alignment thus does not seem to hold. However, most of the empirical studies focus on intermediary, provider-level, outcomes such as altered prescribing behavior. Outcomes at the health system level such as overall costs and quality of care are overlooked. Further research is necessary in order to disentangle various forms of value created by different types of interactions between pharmaceutical companies and healthcare providers.

ACS Style

Tom Latten; Daan Westra; Federica Angeli; Aggie Paulus; Marleen Struss; Dirk Ruwaard. Pharmaceutical companies and healthcare providers: Going beyond the gift – An explorative review. PLOS ONE 2018, 13, e0191856 .

AMA Style

Tom Latten, Daan Westra, Federica Angeli, Aggie Paulus, Marleen Struss, Dirk Ruwaard. Pharmaceutical companies and healthcare providers: Going beyond the gift – An explorative review. PLOS ONE. 2018; 13 (2):e0191856.

Chicago/Turabian Style

Tom Latten; Daan Westra; Federica Angeli; Aggie Paulus; Marleen Struss; Dirk Ruwaard. 2018. "Pharmaceutical companies and healthcare providers: Going beyond the gift – An explorative review." PLOS ONE 13, no. 2: e0191856.

Review
Published: 17 January 2018 in BMC Medical Education
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There is a significant shortage of health workers across and within countries. It is of utmost importance to determine the factors that motivate students to opt for medical studies. The objective of this study is to group and review all the studies that investigated the motivational factors that underpin students’ selection of medical study in recent years. The literature search was carried out by two researchers independently in PubMed, Google Scholar, Wiley and IndMED databases for articles published from year 2006 till 2016. A total of 38 combinations of MeSH words were used for search purpose. Studies related to medical students and interns have been included. The application of inclusion and exclusion criteria and PRISMA guidelines for reporting systematic review led to the final selection of 24 articles. The majority of the studies (n = 16; 66.6%) were from high-income countries followed by an equal number from upper-middle and lower-middle income countries (n = 4,16.7%). None of the studies were from low-income countries. All of the studies were cross-sectional in nature. The main motivating factors that emerged were scientific (interest in science / medicine, social interest and academia, flexible work hours and work independence), societal (prestige, job security, financial security) and humanitarian (serving the poor and under priviledged) in high-, upper-middle and lower-middle income countries, respectively. The findings were comparable to Maslow’s hierarchy of needs theory of motivation. This systematic review identifies the motivational factors influencing students to join medical studies in different parts of the globe. These factors vary per country depending on the level of income. This study offers cues to policy makers and educators to formulate policy in order to tackle the shortage of health workers, i.e. medical doctors. However, more research is needed to translate health policy into concrete and effective measures.

ACS Style

Sonu Goel; Federica Angeli; Nonita Dhirar; Neetu Singla; Dirk Ruwaard. What motivates medical students to select medical studies: a systematic literature review. BMC Medical Education 2018, 18, 16 .

AMA Style

Sonu Goel, Federica Angeli, Nonita Dhirar, Neetu Singla, Dirk Ruwaard. What motivates medical students to select medical studies: a systematic literature review. BMC Medical Education. 2018; 18 (1):16.

Chicago/Turabian Style

Sonu Goel; Federica Angeli; Nonita Dhirar; Neetu Singla; Dirk Ruwaard. 2018. "What motivates medical students to select medical studies: a systematic literature review." BMC Medical Education 18, no. 1: 16.

Journal article
Published: 16 January 2018 in BMC International Health and Human Rights
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Slum dwellers display specific traits when it comes to disclosing their illnesses to professionals. The resulting actions lead to poor health-seeking behaviour and underutilisation of existing formal health facilities. The ways that slum people use to communicate their feelings about illness, the type of confidants that they choose, and the supportive and unsupportive social and cultural interactions to which they are exposed have not yet been studied in the Indian context, which constitutes an important knowledge gap for Indian policymakers and practitioners alike. To that end, this study examines the patterns of illness disclosure in Indian slums and the underpinning factors which shape the slum dwellers' disclosing attitude. In-depth, semi-structured interviews were conducted among 105 men and 113 women who experienced illness in the year prior to the study period. Respondents were selected from four urban slums in two Indian cities, Bangalore and Kolkata. Findings indicate that women have more confidants at different social levels, while men have a limited network of disclosures which is culturally and socially mediated. Gender role limitations, exclusion from peer groups and unsupportive local situations are the major cause of disclosure delay or non-disclosure among men, while the main concerns for women are a lack of proper knowledge about illness, unsupportive responses received from other people on certain occasions, the fear of social stigma, material loss and the burden of the local situation. Prompt sharing of illness among men is linked with prevention intention and coping with biological problems, whereas factors determining disclosure for women relate to ensuring emotional and instrumental safety, preventing collateral damage of illness, and preventing and managing biological complications. The findings reveal that patterns of disclosure are not determined by the acknowledgment of illness but largely depend on the interplay between individual agency, disclosure consequences and the socio cultural environment. The results of this study can contribute significantly to mitigating the pivotal knowledge gap between health policymakers, practitioners and patients, leading to the formulation of policies that maximise the utilisation of health facilities in slums.

ACS Style

Moumita Das; Federica Angeli; Anja J. S. M. Krumeich; Onno C. P. Van Schayck. Patterns of illness disclosure among Indian slum dwellers: a qualitative study. BMC International Health and Human Rights 2018, 18, 3 .

AMA Style

Moumita Das, Federica Angeli, Anja J. S. M. Krumeich, Onno C. P. Van Schayck. Patterns of illness disclosure among Indian slum dwellers: a qualitative study. BMC International Health and Human Rights. 2018; 18 (1):3.

Chicago/Turabian Style

Moumita Das; Federica Angeli; Anja J. S. M. Krumeich; Onno C. P. Van Schayck. 2018. "Patterns of illness disclosure among Indian slum dwellers: a qualitative study." BMC International Health and Human Rights 18, no. 1: 3.

Review
Published: 01 January 2018 in Medicine
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The sharply uneven distribution of human resources for health care across urban and rural areas has been a long-standing concern globally. The present study aims to develop and validate an instrument measuring the factors deterring final year students of Bachelor of Medicine and Bachelor of Surgery (MBBS) in 3 northern states of India, from working in rural areas.The medical student's de-motivation to work in rural India (MSDRI) scale was developed using extensive literature review followed by Delphi technique. The psychometric properties of the questionnaire were assessed in terms of content validity, construct validity, data quality and reliability. Exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) was performed to identify the primary deterrents.Thirty-three items were generated from literature search followed by Delphi exercise. After assessing psychometric properties, the final instrument included 29 items whereas the EFA and CFA highlighted 5 main factors, namely lack of professional challenge, social segregation, socio-cultural gap, hostile professional environment, and lack of financial incentives as underpinning students' demotivation towards working in rural areas.The MSDRI instrument is the first valid and reliable measure for identifying deterring factors for MBBS students to work in rural areas of India. The use of it may be very helpful for policymakers as well as healthcare organizations in formulating effective measures to encourage medical students to work in rural areas, which suffer from a chronic shortage of medical personnel.

ACS Style

Sonu Goel; Federica Angeli; Neetu Singla; Dirk Ruwaard. Measuring the reasons that discourage medical students from working in rural areas. Medicine 2018, 97, e9448 .

AMA Style

Sonu Goel, Federica Angeli, Neetu Singla, Dirk Ruwaard. Measuring the reasons that discourage medical students from working in rural areas. Medicine. 2018; 97 (2):e9448.

Chicago/Turabian Style

Sonu Goel; Federica Angeli; Neetu Singla; Dirk Ruwaard. 2018. "Measuring the reasons that discourage medical students from working in rural areas." Medicine 97, no. 2: e9448.

Journal article
Published: 11 September 2017 in BMC Public Health
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A multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005-06 to 2012-13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities. An explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012-13), during (2007-08) and pre- (2002-04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level. The MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas. MCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas.

ACS Style

Madhu Gupta; Hans Bosma; Federica Angeli; Manmeet Kaur; Venkatesan Chakrapani; Monica Rana; Onno C.P. Van Schayck. A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India. BMC Public Health 2017, 17, 698 .

AMA Style

Madhu Gupta, Hans Bosma, Federica Angeli, Manmeet Kaur, Venkatesan Chakrapani, Monica Rana, Onno C.P. Van Schayck. A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India. BMC Public Health. 2017; 17 (1):698.

Chicago/Turabian Style

Madhu Gupta; Hans Bosma; Federica Angeli; Manmeet Kaur; Venkatesan Chakrapani; Monica Rana; Onno C.P. Van Schayck. 2017. "A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India." BMC Public Health 17, no. 1: 698.

Conference paper
Published: 01 August 2017 in Academy of Management Proceedings
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Organizational culture is considered critical for improving health system outcomes. Yet, empirical evidence confirming this relationship is limited. This may be due to the prevailing way that studies conceptualize culture using a consensus perspective, which assumes that more agreement among members is better. However, to meet multiple healthcare needs of patients with complex conditions, diverse providers with various disciplinary backgrounds increasingly must work together. Given the need for multidisciplinary collaboration, using what Chan (1998) calls a dispersion model may be more suitable to explain variations in team performance. A dispersion model conceptualizes organizational culture through heterogeneity among groups instead of within group agreement. To recognize the heterogeneity in values and skills that different healthcare professionals introduce to multidisciplinary teams, we assess whether heterogeneity in team cultures is associated with the degree to which patients perceive care to be more or less integrated. We analyze a sample of 2,911 patient responses and 17 healthcare teams. Results from two-level ordered logistic regression analyses suggest that intermediate levels of heterogeneity in perceived culture among healthcare team members is significantly, positively related to integrated care. These findings contribute to better understanding how culture can facilitate multidisciplinary team performance.

ACS Style

Maike Vanessa Tietschert; Federica Angeli; Arno J A Van Raak; Dirk Ruwaard; Sara Singer. Agree to Disagree: The Relationship of Heterogeneity in Team Culture with Integrated Patient Care. Academy of Management Proceedings 2017, 2017, 15789 .

AMA Style

Maike Vanessa Tietschert, Federica Angeli, Arno J A Van Raak, Dirk Ruwaard, Sara Singer. Agree to Disagree: The Relationship of Heterogeneity in Team Culture with Integrated Patient Care. Academy of Management Proceedings. 2017; 2017 (1):15789.

Chicago/Turabian Style

Maike Vanessa Tietschert; Federica Angeli; Arno J A Van Raak; Dirk Ruwaard; Sara Singer. 2017. "Agree to Disagree: The Relationship of Heterogeneity in Team Culture with Integrated Patient Care." Academy of Management Proceedings 2017, no. 1: 15789.

Journal article
Published: 01 August 2017 in Social Science & Medicine
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Cooperative inter-organizational relations are salient to healthcare delivery. However, they do not match with the pro-competitive healthcare reforms implemented in several countries. Healthcare organizations thus need to balance competition and cooperation in a situation of 'coopetition'. In this paper we study the individual and organizational determinants of coopetition versus those of cooperation in the price-competitive specialized care sector of the Netherlands. We use shared medical specialists as a proxy of collaboration between healthcare organizations. Based on a sample of 15,431 medical specialists and 371 specialized care organizations from March 2016, one logistic multi-level model is used to predict medical specialists' likelihood to be shared and another to predict their likelihood to be shared to a competitor. We find that different organizations share different specialists to competitors and non-competitors. Cooperation and coopetition are hence distinct organizational strategies in health care. Cooperation manifests through spin-off formation. Coopetition occurs most among organizations in the price-competitive market segment but in alternative geographical markets. Hence, coopetition in health care does not appear to be particularly anti-competitive. However, healthcare organizations seem reluctant to share their most specialized human resources, limiting the knowledge-sharing effects of this type of relation. Therefore, it remains unclear whether coopetition in health care is beneficial to patients.

ACS Style

Daan Westra; Federica Angeli; Martin Carree; Dirk Ruwaard. Coopetition in health care: A multi-level analysis of its individual and organizational determinants. Social Science & Medicine 2017, 186, 43 -51.

AMA Style

Daan Westra, Federica Angeli, Martin Carree, Dirk Ruwaard. Coopetition in health care: A multi-level analysis of its individual and organizational determinants. Social Science & Medicine. 2017; 186 ():43-51.

Chicago/Turabian Style

Daan Westra; Federica Angeli; Martin Carree; Dirk Ruwaard. 2017. "Coopetition in health care: A multi-level analysis of its individual and organizational determinants." Social Science & Medicine 186, no. : 43-51.