Browsing by Subject "DECISION-MAKING"

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  • Wennlund, Klara Torlen; Kurland, Lisa; Olanders, Knut; Castren, Maaret; Bohm, Katarina (2022)
    Background The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition. Methods A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. chi(2)-test was used for comparisons. P-levels < 0.05 were regarded as significant. Results A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01). Conclusions A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.
  • Barnieh, Lianne; Clement, Fiona; Harris, Anthony; Blom, Marja; Donaldson, Cam; Klarenbach, Scott; Husereau, Don; Lorenzetti, Diane; Manns, Braden (2014)
  • Mobile Airways Sentinel Network M; Bousquet, Jean; Hellings, Peter W.; Agache, Ioana; Haahtela, T.; Toppila-Salmi, S.; Kuitunen, M.; Valovirta, E.; Salimäki, Johanna; Vasankari, Tuula; Eklund, P.; Karjalainen, J.; Zuberbier, Torsten (2019)
    Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.
  • Oinio, Ville; Sundström, Mikko; Bäckström, Pia; Uhari-Väänänen, Johanna; Kiianmaa, Kalervo; Raasmaja, Atso; Piepponen, Petteri (2018)
    Comorbidity with gambling disorder (GD) and alcohol use disorder (AUD) is well documented. The purpose of our study was to examine the influence of genetic alcohol drinking tendency on reward-guided decision making behavior of rats and the impact of dopamine releaser D-amphetamine on this behavior. In this study, Alko alcohol (AA) and Wistar rats went through long periods of operant lever pressing training where the task was to choose the profitable of two options. The lever choices were guided by different-sized sucrose rewards (one or three pellets), and the probability of gaining the larger reward was slowly changed to a level where choosing the smaller reward would be the most profitable in the long run. After training, rats were injected (s.c.) with dopamine releaser D-amphetamine (0.3, 1.0 mg/kg) to study the impact of rapid dopamine release on this learned decision making behavior. Administration of D-amphetamine promoted unprofitable decision making of AA rats more robustly when compared to Wistar rats. At the same time, D-amphetamine reduced lever pressing responses. Interestingly, we found that this reduction in lever pressing was significantly greater in Wistar rats than in AA rats and it was not linked to motivation to consume sucrose. Our results indicate that conditioning to the lever pressing in uncertain environments is more pronounced in AA than in Wistar rats and indicate that the reinforcing effects of a gambling-like environment act as a stronger conditioning factor for rats that exhibit a genetic tendency for high alcohol drinking.
  • Laakasuo, Michael; Sundvall, Jukka (2016)
    Utilitarian versus deontological inclinations have been studied extensively in the field of moral psychology. However, the field has been lacking a thorough psychometric evaluation of the most commonly used measures. In this paper, we examine the factorial structure of an often used set of 12 moral dilemmas purportedly measuring utilitarian/deontological moral inclinations. We ran three different studies (and a pilot) to investigate the issue. In Study 1, we used standard Exploratory Factor Analysis and Schmid-Leimann (g factor) analysis; results of which informed the a priori single-factor model for our second study. Results of Confirmatory Factor Analysis in Study 2 were replicated in Study 3. Finally, we ran a weak invariance analysis between the models of Study 2 and 3, concluding that there is no significant difference between factor loading in these studies. We find reason to support a single-factor model of utilitarian/deontological inclinations. In addition, certain dilemmas have consistent error covariance, suggesting that this should be taken into consideration in future studies. In conclusion, three studies, pilot and an invariance analysis, systematically suggest the following. (1) No item needs to be dropped from the scale. (2) There is a unidimensional structure for utilitarian/deontological preferences behind the most often used dilemmas in moral psychology, suggesting a single latent cognitive mechanism. (3) The most common set of dilemmas in moral psychology can be successfully used as a unidimensional measure of utilitarian/deontological moral inclinations, but would benefit from using weighted averages over simple averages. (4) Consideration should be given to dilemmas describing infants.
  • Quarto, Tiziana; Blasi, Giuseppe; Maddalena, Chiara; Viscanti, Giovanna; Lanciano, Tiziana; Soleti, Emanuela; Mangiulli, Ivan; Taurisano, Paolo; Fazio, Leonardo; Bertolino, Alessandro; Curci, Antonietta (2016)
    The human ability of identifying, processing and regulating emotions from social stimuli is generally referred as Emotional Intelligence (EI). Within EI, Ability EI identifies a performance measure assessing individual skills at perceiving, using, understanding and managing emotions. Previous models suggest that a brain "somatic marker circuitry" (SMC) sustains emotional sub-processes included in EI. Three primary brain regions are included: the amygdala, the insula and the ventromedial prefrontal cortex (vmPFC). Here, our aim was to investigate the relationship between Ability EI scores and SMC activity during social judgment of emotional faces. Sixty-three healthy subjects completed a test measuring Ability EI and underwent fMRI during a social decision task (i.e. approach or avoid) about emotional faces with different facial expressions. Imaging data revealed that EI scores are associated with left insula activity during social judgment of emotional faces as a function of facial expression. Specifically, higher EI scores are associated with greater left insula activity during social judgment of fearful faces but also with lower activity of this region during social judgment of angry faces. These findings indicate that the association between Ability EI and the SMC activity during social behavior is region- and emotionspecific.
  • Kaikkonen, Laura; Parviainen, Tuuli; Rahikainen, Mika; Uusitalo, Laura; Lehikoinen, Annukka (2021)
    Human activities both depend upon and have consequences on the environment. Environmental risk assessment (ERA) is a process of estimating the probability and consequences of the adverse effects of human activities and other stressors on the environment. Bayesian networks (BNs) can synthesize different types of knowledge and explicitly account for the probabilities of different scenarios, therefore offering a useful tool for ERA. Their use in formal ERA practice has not been evaluated, however, despite their increasing popularity in environmental modeling. This paper reviews the use of BNs in ERA based on peer‐reviewed publications. Following a systematic mapping protocol, we identified studies in which BNs have been used in an environmental risk context and evaluated the scope, technical aspects, and use of the models and their results. The review shows that BNs have been applied in ERA, particularly in recent years, and that there is room to develop both the model implementation and participatory modeling practices. Based on this review and the authors’ experience, we outline general guidelines and development ideas for using BNs in ERA. Integr Environ Assess Manag 2021;17:62–78. © 2020 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC)
  • Kunnari, Anton; Sundvall, Jukka R. I.; Laakasuo, Michael (2020)
    The process dissociation procedure (PDP) for moral cognition was created to separately measure two dispositions of moral judgment based on the dual-process theory of moral reasoning: deontological and utilitarian inclinations. In this paper we raise some concerns from a psychometrics perspective regarding the structure, reliability, and validity of the moral PDP as a measure of individual differences. Using two simulation studies as well as a real sample of N = 1,010, we investigate the psychometric properties of the moral PDP. We present novel evidence showing that (1) some correlations between PDP parameters are mathematical artifacts, and as such cannot be taken as evidence in support of a theory, (2) there are severe response inconsistencies within dilemma batteries, and (3) reliability estimates for these scores seem to be far below the accepted standards. We discuss some potential theoretical and content-related reasons for these statistical issues and their implications. We conclude that in their current form, PDP measures of utilitarian and deontological tendencies are sub-optimal for assessing individual differences.
  • Isoaho, K.; Burgas, D.; Janasik, N.; Mönkkönen, M.; Peura, Maiju; Hukkinen, J. (2019)
    This paper explores whether the perceptions of forest owners and professionals could be nudged towards more sustainable management practices by adjusting a policy text's metaphorical content. Recent research has demonstrated a link between information interventions and preference change, but there is a need to further explore individuals' reactions to information on forest-based ecosystem services and to link these to the design of policy instruments. We contribute to narrowing this gap by nudging the content of a policy text comparing rotation forest management (RFM) and continuous cover forestry (CCF), and exposing it to forest stakeholders. The research is carried out in Finland, the so-called 'forest nation' of Europe, whose economy and culture is closely tied to forests. The results highlight a deep-rooted opinion divide between Finnish forest owners and professionals: the professionals reacted significantly more negatively towards policy text emphasising continuous cover practice than forest owners. Our results support the use of linguistic nudging as a complement to other policy instruments, but they also highlight the challenges of using one-fits-all approaches to make policies more palatable. In our study, the stakeholders' different reaction to nudge was also explained by their age, and type and degree of prior knowledge on forest management.
  • Olaleye, Sunday; Sanusi, I.T.; Fanning, Stephen; Salo, Jari (2020)
  • Wennlund, Klara Torlen; Kurland, Lisa; Olanders, Knut; Khoshegir, Amanda; Al Kamil, Hussein; Castren, Maaret; Bohm, Katarina (2022)
    Objectives To explore the emergency medical dispatchers (EMDs) experiences of managing emergency medical calls. Design A qualitative interview study with an inductive approach. EMDs were interviewed individually using a semistructured interview guide. The verbatim transcripts were analysed using a qualitative content analysis. Setting EMDs, without a professional background as registered nurses, were recruited from emergency medical communication centers (EMCCs) within Sweden. Participants To achieve a varied description of EMDs' experiences, participants were included from several EMCCs nationally, using a convenience sampling. Interviews were performed up until saturation of data, resulting in 13 EMDs from 7 EMCCs being interviewed. All the EMDs were women, ranging in age from 28 to 61 years (mean 42 years), and had worked in emergency medical dispatching between 1 and 13.5 years (mean 6.5 years). Results The analysis revealed the main category-to attentively manage a multifaceted, interactive task-made up of three categories: utilize creativity to gather information, continuously process and assess complex information, and engage in the professional role. The content of each category was reflected in several subcategories further described and illustrated with representative quotes. Conclusions Managing emergency medical calls was experienced by EMDs to attentively manage a multifaceted interactive task. Core parts were described as: the ability to utilize creativity to gather information, continuously process and asses complex information, and engage in the professional role. Our results could be beneficial for emergency care managers when designing training programmes and organising EMD work and the EMD work environment, including further development of dispatch protocols and implementation of regular feedback sessions. Moreover, the results indicate that aspects such as self-awareness and emotional challenges encountered during EMD work could be important matters to discuss during staff evaluations.
  • Clarke, Angus J.; Wallgren-Pettersson, Carina (2019)
    Difficult ethical issues arise for patients and professionals in medical genetics, and often relate to the patient’s family or their social context. Tackling these issues requires sensitivity to nuances of communication and a commitment to clarity and consistency. It also benefits from an awareness of different approaches to ethical theory. Many of the ethical problems encountered in genetics relate to tensions between the wishes or interests of different people, sometimes even people who do not (yet) exist or exist as embryos, either in an established pregnancy or in vitro. Concern for the long-term welfare of a child or young person, or possible future children, or for other members of the family, may lead to tensions felt by the patient (client) in genetic counselling. Differences in perspective may also arise between the patient and professional when the latter recommends disclosure of information to relatives and the patient finds that too difficult, or when the professional considers the genetic testing of a child, sought by parents, to be inappropriate. The expectations of a patient’s community may also lead to the differences in perspective between patient and counsellor. Recent developments of genetic technology permit genome-wide investigations. These have generated additional and more complex data that amplify and exacerbate some pre-existing ethical problems, including those presented by incidental (additional sought and secondary) findings and the recognition of variants currently of uncertain significance, so that reports of genomic investigations may often be provisional rather than definitive. Experience is being gained with these problems but substantial challenges are likely to persist in the long term.
  • Paananen, Jenny; Stevanovic, Melisa; Valkeapää, Taina (2021)
    This paper focuses on the stancetaking formats used to express personal thoughts, namely Finnish ma aattelen/aattelin 'I think/thought', ma mietin 'I think/wonder', and mun mielesta/musta 'I think/in my opinion'. We study how these first-person formats are used in mental health rehabilitation group meetings, which aim to promote joint decision-making. In particular, we analyze whether the institutional asymmetry between support workers and clients is reflected in the use of these thought expressions. Our data comprise 23 video-recorded rehabilitation meetings, and the adopted methods are conversation analysis and interactional linguistics. Most of the stancetaking formats in our data are produced by support workers (106/129). The results of a sequential analysis conducted in this study demonstrate that support workers' thought expressions are embedded in their institutional actions, which are beyond the clients' authority. Moreover, our data suggest that support workers' and rehabilitants' thought expressions generate different participation dynamics. Although previous research has considered I think-formats typically as calls for other views, in institutional settings such as ours, these formats can also be interpreted as highlighting an institutional agent's controlling position. Acknowledging the existence of such differences in stancetaking practices can advance the design of new protocols to facilitate client participation.
  • Chen, An; Tenhunen, Henni; Torkki, Paulus; Peltokorpi, Antti; Heinonen, Seppo; Lillrank, Paul; Stefanovic, Vedran (2018)
    Background: Population-based prenatal screening has become a common and widely available obstetrical practice in majority of developed countries. Under the patient autonomy principle, women should understand the screening options, be able to take their personal preferences and situations into account, and be encouraged to make autonomous and intentional decisions. The majority of the current research focuses on the prenatal screening uptake rate, women's choice on screening tests, and the influential factors. However, little attention has been paid to women's choice-making processes and experiences in prenatal screening and their influences on choice satisfaction. Understanding women's choice-making processes and experiences in pregnancy and childbirth is the prerequisite for designing women-centered choice aids and delivering women-centered maternity care. This paper presents a pilot study that aims to investigate women's experiences when they make choices for screening tests, quantify the choice making experience, and identify the experiential factors that affect women's satisfaction on choices they made. Method: We conducted a mixed-method research at Helsinki and Uusimaa Hospital District (HUS) in Finland. First, the women's choice-making experiences were explored by semi-structured interviews. We interviewed 28 women who participated in prenatal screening. The interview data was processed by thematic analysis. Then, a cross-sectional self-completion survey was designed and implemented, assessing women's experiences in choice-making and identifying the experiential factors that influence choice satisfaction. Of 940 distributed questionnaires, 185 responses were received. Multivariable linear regression analysis was used to detect the effects of the variables. Results: We developed a set of measurements for women's choice-making experiences in prenatal screening with seven variables: activeness, informedness, confidence, social pressure, difficulty, positive emotion and negative emotion. Regression revealed that activeness in choice-making (beta = 0.176; p = 0.023), confidence in choice-making (beta = 0.388; p <0.001), perceived social pressure (beta = -0.306; p <0.001) and perceived difficulty (beta = -0.274; p <0.001) significantly influenced women's choice satisfaction in prenatal screening. Conclusions: This study explores the experiential dimension of women's choice-making in prenatal screening. Our result will be useful for service providers to design women-centered choice environment. Women's willingness and capabilities of making active choices, their preferences, and social reliance should be well considered in order to facilitate autonomous, confident and satisfying choices.
  • Helve, Jaakko; Kramer, Anneke; Abad-Diez, Jose M.; Couchoud, Cecile; de Arriba, Gabriel; de Meester, Johan; Evans, Marie; Glaudet, Florence; Grönhagen-Riska, Carola; Heaf, James G.; Lezaic, Visnja; Nordio, Maurizio; Palsson, Runolfur; Pechter, Ülle; Resic, Halima; Santamaria, Rafael; Santiuste de Pablos, Carmen; Massy, Ziad A.; Zurriaga, Oscar; Jager, Kitty J.; Finne, Patrik (2018)
    Background. The incidence of renal replacement therapy (RRT) in the general population >= 75 years of age varies considerably between countries and regions in Europe. Our aim was to study characteristics and survival of elderly RRT patients and to find explanations for differences in RRT incidence. Methods. Patients >= 75 years of age at the onset of RRT in 2010-2013 from 29 national or regional registries providing data to the European Renal Association-European Dialysis and Transplant Association Registry were included. Chi-square and Mann-Whitney U tests were used to assess variation in patient characteristics and linear regression was used to study the association between RRT incidence and various factors. Kaplan-Meier curves and Cox regression were employed for survival analyses. Results. The mean annual incidence of RRT in the age group >= 75 years of age ranged from 157 to 924 per million age-related population. The median age at the start of RRT was higher and comorbidities were less common in areas with higher RRT incidence, but overall the association between patient characteristics and RRT incidence was weak. The unadjusted survival was lower in high-incidence areas due to an older age at onset of RRT, but the adjusted survival was similar [relative risk 1.00 (95% confidence interval, 0.97-1.03)] in patients from low- and high-incidence areas. Conclusions. Variation in the incidence of RRT among the elderly across European countries and regions is remarkable and could not be explained by the available data. However, the survival of patients in low-and high-incidence areas was remarkably similar.
  • Virtanen, Mikko J.; Salmivaara, Saara (2021)
    In the present study, we examine socio-cultural and practical aspects of human papillomavirus vaccination (HPVV) through a multi-sited study of framings. We ask how HPVV is framed in the daily lives of vaccination-aged Finnish girls and in school nurses' everyday work. We then mirror these framings against both each other and Finland's official vaccination campaign. Based on analysis of interviews with 24 nurses and 12 girls and the campaign materials, we argue first that the campaign frames vaccination as an individual, knowledge-based decision reflecting the informed consent principle. Second, however, the vaccination is framed in the everyday lives of eligible girls through gendered social ties and as a gendered and cohort-specific event pivoting around the needle prick. Third, HPVV is not primarily framed in the school nurses' work as preparing the girls for the vaccination decision by sharing official information but through trust-based social relationships with the girls and their parents. We conclude that, as the vaccination is not an issue of individually reflected and knowledge-based decision-making for the two interviewed key groups, the official Finnish HPVV campaign and the undergirding informed consent principle drift into problems in their practical implementation.
  • Wagner, Paul M.; Ylä-Anttila, Tuomas; Gronow, Antti; Ocelik, Petr; Schmidt, Luisa; Delicado, Ana (2021)
    Scientifically informed climate policymaking starts with the exchange of credible, salient, and legitimate scientific information between scientists and policymakers. It is therefore important to understand what explains the exchange of scientific information in national climate policymaking processes. This article applies exponential random graph models to network data from the Czech Republic, Finland, Ireland, and Portugal to investigate which types of organizations are favored sources of scientific information and whether actors obtain scientific information from those with similar beliefs as their own. Results show that scientific organizations are favored sources in all countries, while only in the Czech Republic do actors obtain scientific information from those with similar policy beliefs. These findings suggest that actors involved in climate policymaking mostly look to scientific organizations for information, but that in polarized contexts where there is a presence of influential denialists overcoming biased information exchange is a challenge.
  • Saarikoski, Heli; Primmer, Eeva; Saarela, Sanna-Riikka; Antunes, Paula; Aszalos, Reka; Baro, Francesc; Berry, Pam; Garcia Blanko, Gemma; Gomez-Baggethun, Erik; Carvalho, Laurence; Dick, Jan; Dunford, Robert; Hanzu, Mihail; Harrison, Paula A.; Izakovicova, Zita; Kertesz, Miklos; Kopperoinen, Leena; Kohler, Berit; Langemeyer, Johannes; Lapola, David; Liquete, Camino; Luque, Sandra; Mederly, Peter; Niemelä, Jari; Palomo, Ignacio; Martinez Pastur, Guillermo; Luis Peri, Pablo; Preda, Elena; Priess, Joerg A.; Santos, Rui; Schleyer, Christian; Turkelboom, Francis; Vadineanu, Angheluta; Verheyden, Wim; Vikstrom, Suvi; Young, Juliette (2018)
    The promise that ecosystem service assessments will contribute to better decision-making is not yet proven. We analyse how knowledge on ecosystem services is actually used to inform land and water management in 22 case studies covering different social-ecological systems in European and Latin American countries. None of the case studies reported instrumental use of knowledge in a sense that ecosystem service knowledge would have served as an impartial arbiter between policy options. Yet, in most cases, there was some evidence of conceptual learning as a result of close interaction between researchers, practitioners and stakeholders. We observed several factors that constrained knowledge uptake, including competing interests and political agendas, scientific disputes, professional norms and competencies, and lack of vertical and horizontal integration. Ecosystem knowledge played a small role particularly in those planning and policy-making situations where it challenged established interests and the current distribution of benefits from ecosystems. The factors that facilitated knowledge use included application of transparent participatory methods, social capital, policy champions and clear synergies between ecosystem services and human well-being. The results are aligned with previous studies which have emphasized the importance of building local capacity, ownership and trust for the long-term success of ecosystem service research. (C) 2017 The Authors. Published by Elsevier B.V.
  • Dunford, Rob; Harrison, Paula; Smith, Alison; Dick, Jan; Barton, David N.; Martín-López , Berta; Kelemen, Eszter; Jacobs, Sander; Saarikoski, Heli; Turkelboom, Francis; Verheyden, Wim; Hauck, Jennifer; Antunes, Paula; Aszalos, Reka; Badea, Ovidiu; Baro, Francesc; Berry, Pam; Carvalho, Laurence; Conte, Giulio; Czucz, Balint; Garcia Blanco, Gemma; Howard, Dave; Giuca, Relu; Gomez-Baggethun, Erik; Grizetti, Bruna; Izakovicova, Zita; Kopperoinen, Leena; Langemeyer, Johannes; Luque, Sandra; Lapola, David M.; Martinez Pastur, Guillermo J.; Mukhopadhyay, Raktima; Roy, S.B.; Niemelä, Jari Kalevi; Norton, Lisa; Ochieng, John; Odee, David; Palomo, Ignacio; Pinho, Patricia; Priess, Joerg; Rusch, Graciela; Saarela, Sanna-Riikka; Santos, Rui; Tjalling van der Wal, Jan; Vadineanu, Angheluta; Vari, Agnes; Woods, Helen; Yli-Pelkonen, Vesa Johannes (2018)
    The Ecosystem Services (ES) concept highlights the varied contributions the environment provides to humans and there are a wide range of methods/tools available to assess ES. However, in real-world decision contexts a single tool is rarely sufficient and methods must be combined to meet practitioner needs. Here, results from the OpenNESS project are presented to illustrate the methods selected to meet the needs of 24 real-world case studies and better understand why and how methods are combined to meet practical needs. Results showed that within the cases methods were combined to: i) address a range of ES; ii) assess both supply and demand of ES; iii) assess a range of value types; iv) reach different stake-holder groups v) cover weaknesses in other methods used and vi) to meet specific decision context needs. Methods were linked in a variety of ways: i) as input-output chains of methods; ii) through learning; iii) through method development and iv) through comparison/triangulation of results. The paper synthesises these case study-based experiences to provide insight to others working in practical contexts as to where, and in what contexts, different methods can be combined and how this can add value to case study analyses. (C) 2017 Published by Elsevier B.V.