The importance of community gardens in a healthy urban environment has been extensively documented, while the garden building involving communities has not been much explored in fast-developing cities. This study examines community engagement in garden building activities in a rapid urbanization context, aiming to explore the application of community-engaged research methods for the promotion of neighbourhood environments. The Community Garden Initiative consisting of an array of progressive actions is formulated by the research team, featuring a process of increasing involvement of community members and decreasing intensity of external interventions. These activities have been launched based on community-university partnerships in Shanghai since 2014, synchronising with a transformation of urban regeneration paradigm in China where people-oriented approaches are more emphasized. Five actions covering 70 community gardens are analysed through surveys on participants’ attitudes and perceptions towards the activities. The results of the study presented people’s rapid acceptance of participation in public affairs, reflected possible measures to promote public participation, and confirmed the positive impacts of the garden building on the neighbourhood environmental health as well as on the community-building. Taking into account that residents generally lack the consciousness and capacities required to implement actions at the initial stage of community engagement, we proposed in the conclusion to start with external interventions and capacity buildings carried out by professionals as a supplement to the ‘community-driven’ principle of CBPR methods.  Community gardens, a type of urban green space managed by residents of a neighbourhood, have gained recognition for their positive impacts on public health and neighbourhood cohesion ,2,3,4. PImplementation Measures of Shanghai Urban Regeneration, proposing people-oriented approaches to improve public space and neighbourhood revitalization, marked a transformation of urban regeneration paradigm from the expansion of urban land to the improvement of the quality and efficiency of land use in old urban areas [In China, community gardens that involve citizens in their construction and management started to appear only this decade . Public an areas ,25. The an areas .We, the research team, have launched the Community Garden Initiative in more than sixty communities in Shanghai through community-university partnerships since 2014. This community-engaged experiment aims to improve neighbourhood environments and residents’ health through collaborative horticultural activities . In the In this study, we focus on exploring the application of community-engaged research methods in the garden building domain. Community involvement has been carried out in practice in fast-urbanising areas, but such areas have received limited coverage in theoretical research. To the best of our knowledge, only a few studies have employed community-engaged research methodologies, and these studies generally focused on medicine and social works . ArticleThis study took place over a period of five years and was synchronised with the transformation of urban regeneration, reflecting the rapid development of people’s acceptance of participation in public affairs in China. This study not only delivers references for the growing field of community-based research and practices related to neighbourhood regeneration, but it also provides international research with rich samples and valuable analyses of community participation in healthy environment-building in cities undergoing rapid urbanisation. Meanwhile, the long-time expansion, multi-case, and progressive design of the research also contribute to the design and application of participatory research methodologies.In this article, we analysed five actions that represented a progressive process in which external interventions were gradually reduced and powers of self-governance were gradually increased. We conducted questionnaire and interview surveys regarding participants’ attitudes and feelings towards the community garden activities. In conclusion, taking into account that residents generally lack the consciousness and capacities required to implement actions at the initial stage of community engagement in fast-urbanising cities, we proposed to start with external interventions by professionals to carry out capacity buildings as a supplement to the ‘community-driven’ principle of CBPR methods. We also confirmed the positive impacts of the garden building on the neighbourhood environmental health as well as to the community-building. We carried out this research on the basis of community-university partnerships. Researchers from the Landscape Architecture Department at T University have collaborated with neighbourhoods mainly in Shanghai to conduct community garden experiments. Most neighbourhoods have neither the initiative to organise such activities nor the technology for landscape projects; thus, they require professional support to both the organisation and technology assistance of the projects. Meanwhile, universities need locations to instigate practice for the instruction of students and citizens, to conduct research, and to transform research into verifiable outcomes. These complementary motivations facilitate cooperation between communities and universities.We employed multiple cooperative methods of community-university partnerships in the implementation process of the Community Garden Initiative from June 2014 to June 2019, including service cooperation through instructions and consultations, teaching cooperation through service-learning and community training, and researching cooperation through CBPR methods .We adopted a strategy which divided the Initiative into progressive actions with increasing extent of communities’ involvement and decreasing intensity of external interventions for each step. We formed a framework of five phases: first, launching an experimental community garden in a neighbourhood with the support from the government; second, introducing more groups of participants such as enterprises and NGOs; third, facilitating to expand neighbourhoods coverage of the Initiative in the city; fourth, encouraging residents to organize garden building by themselves; fifth, promoting and spreading community gardens to the whole country.We conducted community garden activities mainly in old residential neighbourhoods constructed before 2000, where the relationships between residents are normally closer than that in new ones. Meanwhile, the quality of green space in these neighbourhoods are relatively poor and residents’ demands for improving their living environment are high. However, new neighbourhoods or other types of communities are not excluded. We identified sample neighbourhoods through consultations with Sub-district governments and resident committees.The Herb Garden, built in 2014, represents the first case of Community Garden Initiative. The project aimed to transform a monotonic central green space into a shared space where residents could be productive and enjoy nature through participation in landscaping and gardening. The Herb Garden is located in an old neighbourhood next to T University and comprises an area of 210 square metres. This high-density residential neighbourhood was first established in the 1950s with little public space and a high rate of the ageing population at present, but the relationships between residents are harmonious and sound where the general demographics remains stable. The neighbourhood committee also functions well. Many seniors in the neighbourhood who are interested in gardening had already formed a self-governing horticulture group. After holding discussions with the neighbourhood committee, we selected a barren plot that has relatively little impact on residents to implement the garden construction. The design and construction of the garden were mainly conducted by designers in the research team after discussions with residents. The garden contains three areas for leisure activities, parent-child interactions, and nature education. The research group sought residents’ advice after the draft plan was completed. The team also organised ‘Young Landscape Designer’ activities to provide children with opportunities to express their visions and expectations. The construction procedure was separated into several steps, including shaping terrain, cultivating soil, sodding, planting, seeding, paving, and covering the bed. Residents could participate in construction while having access to trainings from the professionals . ResidenThe process of building a community garden enhanced the cohesiveness of the community. By holding various educational activities on nature and other community-building activities related to the Herb Garden, we identified active and capable residents who could act as community leaders to mobilize others’ participation. Two self-governed teams now manage the Herb Garden: the seniors’ horticulture team and the young volunteer team. The horticulture team conduct maintenance through a match of the members’ skills with the demands at different maintenance phases; for example, they have formed groups in charge of different duties such as watering and fertilising, garbage collection, and weeding. These team members also exchange experience in maintenance and management with other residents. The young volunteer team has more than 40 members who conduct simple maintenance tasks in the Herb Garden, such as creating raised beds for vegetables and watering and fertilising plants. They have all played an important role in community-building and garden maintenance. After developing the Herb Garden, we launched community garden building activities by the same approach in another 45 communities in central districts of Shanghai.After two years of practice, the Community Garden Initiative formed a certain broader social influence in Shanghai. Companies and non-governmental organisations joined the residents in the building of community gardens. A typical case is the Knowledge and Innovation Community Garden (KIC Garden), which is located between an existing gated neighbourhood . This action mobilized residents to propose plans of community garden to improve their neighbourhood environment; meanwhile, engaged young students into the activities by practising their professional skills. At the same time, LCCT allows residents’ requests to be heard by the entire society via academic communities represented by universities. According to the plan, both undergraduate students and the group of residents can propose the theme, location, scale, and scheme on their own . When thAmong more than ten proposals, the proposal ‘The History of the Disappearance of the Wall’ reminds the public of the magic door in KIC case. The proposal plans to make a documentary about the magic door’s origin and current status and to facilitate the door’s continuous design and maintenance . From prThese efforts to develop the Community Garden Initiative have received attentions from all over the country, in addition to online inquiries from numerous individuals and groups. The research team then started the Self-seeding Plan in 2018, which encompasses a series of plans aiming to provide guidance to the individuals and groups who are interested in constructing community garden and equipping them with necessary knowledge to take the first step towards the garden building. Cooperating with a non-governmental organisation, we enacted the Self-seeding Plan through online Q&A sessions and offline trainings. Three sessions have now taken place involving sustainable planting techniques, ecological garden design, and garden construction plans with professional knowledge. Trainees from more than ten provinces have attended these sessions. By cultivating these citizens who are fond of gardening, we encouraged them to influence more residents in their communities to voluntarily join in constructing gardens, forming growing on-site social organisations. The participants embraced the broader goal to create a better environment and to achieve community cohesion.Create a Beautiful Homeland Together: Pamphlet for Community Garden’s Practice, which demonstrates the types of community garden; preparatory surveys that should be undertaken before construction; potential difficulties; bullet points of design, maintenance, and management; and self-governed group-building. The pamphlet illustrated in lively and clearly designed images and concise language, which is easy to understand and to promote the dissemination of community garden building in society.Through the compiling online and offline Q&As and combining practices from other projects as mentioned above, the research team published the An integral part of community-engaged participatory research is the inclusion of community members in the interpretation of results ,41. AfteThe research team published questionnaires on the website of Wenjuan.com, then shared the link in the WeChat groups  of the participants in five representative activities. The completed surveys were collected online in anonymity two days later. The following table showed the number of received effective questionnaires and the amount of the participants as the targeted population . The comFive sample projects received 161 effective questionnaires in total. The graph allows us to profile the social attributes of the participants in the five cases . OverallThe Herb Garden was the first experiment of the Community Garden Initiative. The government was also in the embryonic stage of encouraging communities to adopt self-governing policies. We selected a community with a relatively good governing foundation to launch the garden construction. We conducted the site selection, design and construction, consulting with residents at each step. We also cultivated residents’ horticultural skills and fostered residents’ self-governing capacity to make sure the follow-up maintenance and management of the garden after the project was completed. For KIC Garden, real estate and property management agency was involved in and provided financial support for the first stage of construction. At the same time, an NGO joined the follow-up improvement, operation, and management, with the principle of community engagement. The measure of training community leader in Puxing Sub-district motivated competent personnel to mobilise more residents to join garden building, facilitating the community garden’s propagation and self-governing cultivation. The LCCT was designed to foster autonomous garden building activities; thus, the research group intentionally stepped back from providing guidance for the project. The Self-seeding Plan mainly provided technical support and training for people who intended to launch garden-building activities by themselves. It intended to break geographical restrictions and extend the Initiative into a much wide scale.The five actions to develop community-based garden building demonstrated a progressive process with decreasing interventions from the outside . In the As the research moving forward, the participants expanded from the nearby community of T University to other districts in Shanghai, and then to the whole country, with overlapping time frames . The resThe corresponding participation level of each action is reflected in Sherry Arnstein’s ladder of participation in the following image : the HerThe rapid increase of community gardens, the quick expansion in a vase geographical scale, and the fast development of their management models within the past five years have reflected the society’s quick understanding and acceptance of participation in community public affairs.We applied multiple measures to increase communities’ involvement in the garden building activities:(1) Cultivating community teams for self-governance. One of the criteria that indicate a community garden’s maturity is whether it has formed organisations with self-governing abilities . The Her(2) Organising diverse activities based on the garden to create a shared space with an inclusive atmosphere. For this reason, we designed a moveable architecture in the KIC Garden. The NGO involved in the management of the KIC Garden developed both indoor and outdoor activities such as a reading club, academic lectures, parent-child cooking, and nature education to attract people of different ages, occupations, and interests. Through these activities, the intention of building such a garden into space ‘by and for all’ in the first place has been realised, and environmental equity is promoted.(3) Looking into local culture to build community identity. Exploring the cultural characteristics and residents’ collective memory of their community creates a sense of belonging for residents, making them more enthusiastic about community events. The design and construction communication process in the LCCT groups helps explore local culture and residents’ common concerns, through which residents get to know their neighbourhood better and actively participate in community public affairs.(4) Disseminating and promoting research outcomes effectively. The experiment of Puxing indicated that raining community leaders to provide instructions for the community garden building is an effective method of propagation. The published brochure for the community garden’s practice in the Self-seeding Plan is another successful example for spreading the research outcomes. The brochure includes diagrams with concise language that can be understood by residents at all ages.Contrary to the progressive increase of resident participation in each action, participants’ subjective feelings in the five case generally turned negative. According to the questionnaire statistics, the differences between ‘before’ and ‘after’ are decreasing from the Herb Garden to the Self-seeding Plan . That isWe further interviewed participants in response to this contradictory phenomenon. Participants in the Herb Garden and KIC generally stated that each stage of the projects was well-organised and led by experts and neighbourhood committees, with their opinions respected and adopted. They felt encouraged, relaxed, and the atmosphere was harmonious in collective activities. However, in the Puxing, LCCT, and Self-seeding Plan, the participants somehow experienced a sense of uncertainty regarding their gardening skills to complete the project and felt stressful regarding the organisation. This indicates that these groups still rely on the organisation from the outside as they used to. When granted with a higher degree of decision-making power and lower external interventions, the participants showed lower satisfaction for the experience. Mr Li, one of the community leaders in Puxing Sub-district, said that he had thought it was simple in the training class, but when he returned to his neighbourhood to act as a leader in horticultural activities, he encountered various unexpected situations in term of the organization. Some neighbours wanted the garden to be as close as possible to their homes while others preferred to be in distance to avoid noise. A neighbour asked if they could enjoy certain privileges because they might contribute more than those who won’t involve in gardening. Some people suggested that regulations on long-term maintenance should be established before the garden was constructed. Although he felt that many of the questions were interesting and inspiring, he felt stressful in those days. The Herb Garden project was carried out under the guidance of researchers and the local government when self-governance at the community level was just in the initial stages. After two years of operation, it gradually stepped into a self-governing state. The differences in impressions before and after participation ranked the highest in this survey. In the interview, when looking back to the garden’s development in the past five years, the residents present a clear sense of pride.The score distributions of all the participants’ perceptions of personal health, neighbourhood health, and physical environment health before and after participation in five cases are shown in the following graph .According to the Weber-Fechner Law, the difference threshold is logarithmically proportional to the actual objective variable. Therefore, in the statistics of analysing objective changes through subjective feelings, the full score rate, that is, the ratio of the upper threshold, reflects the influence of changes in objective conditions precisely. Taking full score rate into account, the rate of physical health (the number of respondents scoring 5 divided by the number of questionnaires of 161) increases from 36% to 68%, two items of mental health increase from 33%/31% to 73%/72%, three items of neighbourhood health increase from 31%/26%/26% to 72%/71%/72%, and 3 items in environmental health increase from 22%/19%/20% to 75%/70/63% . TherefoComparing the scores on the eight sub-factors that demonstrate of participant’s attitudes towards the community gardens projects , we can The community-engaged research process begins with a given phenomenon that plays an important role in the community, and the community identifies, analyses, and solves problems. The ultimate goal is to “integrate knowledge gained with action to benefit the community involved” . This stThrough this research, a cooperative network of community gardens for research and practice has been formed, based on community-university partnerships linking government, enterprises, NGOs, and self-governing community groups. In particular, we conducted service-learning and achieved the goal of two-way participation of community-university partnerships by engaging undergraduates in community garden design and construction. These community garden activities have gained recognition through society and acquired governmental support; they have also facilitated the development of NGOs in China.The six principles of CBPR suggested by NIEHS, mentioned in the Introduction section have been employed in this study. First, we use multiple measures such as building community team and the organising diverse activities to promote positive collaborations and encourage participation in each phase of the experiments. Second, we foster co-learning between researchers and communities through which residents acquire skills to design, construct and manage garden while researchers better understand the practical needs as well as various creative ideas of the community in garden construction. In addition, students practice what they have learned at school. Third, residents’ common concerns regarding the garden are fully respected in all cases, and in some cases such as the LCCT and the Self-seeding Plan, researchers employed community-driven approaches. Fourth, we have compiled a concise brochure to explain the steps and skills required for community garden building as an effective way to disseminate research results. Fifth, we create an inclusive environment by encouraging residents at all ages, from different occupations, and educational backgrounds to become involved and explore the features of their communities. Sixth, we recreate community identity by connecting residents from other neighbourhoods, organisations and universities through the garden building, as what has been done in the KIC garden.This study also supplemented the third principle of ‘ensure projects are community-driven’ of the CBPR methods. According to a comparison of participants’ feelings towards the project’s effects, the community-driven principle is hard to apply or may not bring noble experiences in communities where the basis of self-governance is relatively weak. Often, in the initial stage of community-building, residents tend to request for their own sake; thus it is difficult to identify common concerns. Moreover, some residents lack the motivation to participate and expect the government or other parties to arrange everything for them. Therefore, two more points are necessary to supplement the principle of ‘community-driven’. First, capacity-building should be emphasised in the preliminary phase of self-governance, where external interventions are essential to boost local enthusiasm and confidence among the residents. Second, interventions from the experts or other organisations should be adjusted and adaptive to changes of self-governing capacities. That is, when the community’s ability to self-governing is weak, external support for management and guidance need to be comprehensive and strong; while with the strengthening of the capacity, external forces should step back to allow the community to develop at its own wills. Taking KIC Garden as an example, at the start of the project, the old neighbourhood lacked enthusiasm while the new one had no clear requests. Thus, the design and construction work was dominated by researchers and the enterprise in the initial phase. During the construction and maintenance process, residents in the two neighbourhoods were linked together through various activities, fostering residents’ enthusiasm for participation, which even attracted and involved people living farther away. Along with the improvement of the garden, many activities were directly initiated by residents, with minimum technical external interventions from the professionals.The improvement in the community’ environmental health is evident when vacant barren plots are transformed one after another into gardens shared by residents with aesthetic, ecological, and social functions. The increased social exchange among neighbours and people’s proximity to nature promoted the harmonious neighbourhood relations, community cohesion and residents’ mental health. Responding to this result, we are now launching a series of Healing Garden experiments to provide auxiliary environmental treatment for people with autism, depression, and other mental problems. Six communities in Shanghai have joined the experiments.According to the result of the surveys on residents’ attitudes, the community garden, rooted in the daily life of the community, is one of the least controversial issues among neighbourhood public affairs. Promoting residents’ interaction through the construction and management of a garden can activate residents’ enthusiasm for public issues and engage their sense of community. The community-engaged research methods in this study apply not only to community gardens but also to spatial rehabilitation, healthy environment building, and community affairs in other areas. In the absence of an officially registered system for community planners in China, the government from the district where the university is located was driven by these initiatives to conduct registered community planner system starting in 2018. Several Professors in T University have been employed as community planners for community planning and environment micro-regeneration.The Community Garden Initiative has been rapidly promoted by universities, communities and the government of Shanghai, but the practice is still not fully popularised or conducted nationwide. Although the above five actions from Shanghai represent a momentum of this growing trend, samples from other cities need to be included in further research. In addition, distributing questionnaires for the five cases at the same time had certain limitations, because the timing of each case varies from 2014 to 2019 while the impressions and attitudes of participants often improve with the continuous evolution of the gardens. Another limitation exists in the weak analysis of garden’ impact on environmental health, but this study focuses more on the facilitation of healthy environments through participating in community garden activities, as well as the application and reflection on participatory research methods. As leading experimental research with community participation in the field of community garden building, further study will be needed to focus on more detailed discussions of community-engaged research methods.


The predictor variables include job tenure and psychological contract breach. Criterion variables are employees’ emotional exhaustion and health complaints. Our findings showed that job tenure and contract breaches significantly explain both emotional exhaustion and health complaints. Despite these general findings, some differences emerge as a function of the organizations. Significance levels were higher for prison officers than for firemen and Spanish soldiers. Results are discussed, suggesting conceptual integration and direction for future risk prevention in this kind of public organization. Occupations focused on helping others, guaranteeing people’s security, and defending societal values can be stressful and risky for the workers involved. Emotional exhaustion and health complaints usually emerge as indicators of the stress suffered by these workers in undertaking their roles. This research aims to explore the effects of psychological contract breach on both emotional exhaustion and health complaints among three kinds of Spanish workers, namely firefighters ( Some occupations are highly relevant in modern societies because of the wide range of services  that they provide for the general population ,2. AlthoIn Spain, beyond the stressful features of the activities themselves, firefighters, prison officers, and professional soldiers are workers embedded in public firms . As diffOn the one hand, during the recent economic crisis, some restructuring  has been conducted in these organizations, exerting a potential negative pressure on employee’s well-being . MoreoveThe psychological contract is understood as a series of individual beliefs referring to the terms of an exchange agreement between a person and another part, in this case, between the employee and the firm . This coNevertheless, most of the studies have focused on employees of private firms and there are very few empirical works analyzing these relations in the public sphere . MoreoveSpecifically, to date, few empirical works have been published analyzing the results of the perception of contract breach among public employees in the European setting and even less so with respect to these specific risky professional activities . The empBurnout, which was considered a response to chronic occupational stress, includes three components: high emotional exhaustion, low feelings of professional efficacy, and high levels of cynicism towards the task performed. Currently, however, diverse theoretical approaches consider emotional exhaustion as the core of the syndrome and propose that cynicism is rather a worker’s coping strategy in work situations where he feels he must redefine his relationships with the client and with his employers . Few studies have empirically explored the relations between the perception of psychological contract breach and burnout. One investigation  showed tBased on the reviewed studies, this work will analyze the relations between the perception of psychological contract breach and employees’ emotional exhaustion, on the one hand, and health complaints, on the other. In the present study, we hypothesize that employees’ perception of psychological contract breach will be positively related to their emotional exhaustion (Hypothesis 1) and that the employees’ perception of psychological contract breach will be positively related to their health complaints (Hypothesis 2). Moreover, in most of the public organizations, job tenure can be considered a variable with explanatory power over job satisfaction and the indicators of personal well-being. And this has a double meaning. Firstly, job tenure may be considered a proxy for the position in the organizational hierarchy, while favoring workers’ development of adaptation strategies to job demands and occupational stressors. Consequently, in the present study, we hypothesize that job tenure will be negatively related to emotional exhaustion (Hypothesis 3). Secondly, job tenure will positively correlate with age, and older workers can be expected to have more health complaints. Therefore, in the present study, we hypothesize that job tenure will be positively related to employees’ health complaints (Hypothesis 4). Since the kind of duties and job design are slightly different among the three organizations, the length of the workday that the employees devote to the services’ recipients can affect the results. Hence, the percentage of the workday invested in this kind of activities will be included as a control variable. n = 80), the second includes professional soldiers of the Spanish army (n = 77), and the third includes prison officers (n = 107). Agencies were in five different administrative regions. The Ethical Committee of the National Distance Education University (UNED) approved the study design and collection procedures. Data collection was done by means of questionnaires with diverse scales that were distributed to the participants, who completed them anonymously and handed them into the collaborators of the research team. Beforehand, the participants were informed verbally about the purpose of the investigation and they gave their written consent to survey and to the global treatment of the data. The present study was carried out with three samples of Spanish public employees. The first sample includes firemen (SD = 8.53) and for prison officers, it was 38.3 years (SD = 7.2), professional soldiers were younger . Overall, 61.5% of the participants were male. Regarding the percentage of the workday the workers spent in contact with the recipients of their services—clients, patients, prisoners, or victims, 64.1% spent at least 50% of their day, whereas the rest spent most of their workday dedicated to these tasks. Among the sociodemographic variables, the mean age of the sample revealed differences between the three organizations. While the mean age for firemen was 40.44 years  (The Brief Burnout Questionnaire) of Moreno et al. [o et al.  was usedHealth complaints: The reduced Spanish version of the Subjective Health Complaints Inventory (SHC), created by Eriksen et al. [n et al. , was useThe dependent variables were emotional exhaustion and subjective health complaints’. The predictor variables were perceived psychological contract breach and job tenure in the organization and we controlled for the influence of percentage of workday dedicated to attending the recipients of the service. To operationalize the variables, the following instruments were used.Job tenure was measured by asking participants how many years they had worked in the present job, and workday was measured as a percentage (ranging from 0 to 100) of the workday spent in contact with prisoners, clients or victims. To test the hypotheses of the study, we first performed bivariate correlational analysis (Pearson product-moment correlations) among the variables and analysis of variance as a function of membership in the diverse organizations. Secondly, we conducted multiple linear regression analysis of the predictor variable separately on the different criteria, controlling for the influence of workday contact with the service recipients. The relations among the target variables were analyzed for the global sample and for each organization, enabling us to refine the explanatory hypotheses of the study.The descriptive statistics of the variables and the correlation matrix are presented in F  = 4.58, p < 0.01), for emotional exhaustion  = 35.16, p < 0.001) and for health complaints  = 17.798, p < 0.001).We used analysis of variance, with membership in different organizations as the predictor to detect possible significant differences among the organizations in the target variables. The analysis of variance was significant for contract breach (Multiple linear regression analysis was used to test two models: the first one incorporated workday, to control for their effects on the dependent variables, and the first predictor variable job tenure. In the second model, we added the other predictor variable psychological contract breach. This analysis was conducted first with the global sample and then with each organization separately. Job tenure in the organization had a significant and negative regression weight in the prediction of emotional exhaustion, indicating that the newest staff members suffered the greatest emotional exhaustion. The model improved notably when adding psychological contract breach, which is an efficacious predictor, as it explained 20% of the variance of emotional exhaustion. When applying the same procedure to each subsample, all the results point in the hypothesized direction, because contract breach was a statistically significant predictor for firemen, soldiers, and prison officers. Nevertheless, the model with contract breach explained nearly 30% of the variance of emotional exhaustion among soldiers and prison offers, but less so with the firemen sample. In the prediction of health complaints, job tenure in the organization had predictive power in the first model, but when adding contract breach, its standardized regression weight dropped significantly. Contract breach, in contrast, had a considerable impact on employees’ health complaints, predicting 25% of the total variance in the regression model. In this case, the regression Model was considered more adequate for the samples of firemen and prison officers, where it explained more than 20% of the variance of health complaints, but this percentage dropped to 14% among the professional soldiers. Summing up, we can state that this study found support for the proposed hypotheses. The present study analyzed the incidence of certain psychosocial variables, such as the psychological contract breach, on the workers’ perceived outcomes in a sample of Spanish public employees. These results corroborate and extend prior findings. Firstly, we verified the impact of psychological contract breach on undesirable outcomes such as employees’ emotional exhaustion and health complaints. Secondly, previous findings are extended, revealing that this pattern of relations is maintained even in work spheres that are, to some extent, protected by their occupational stability, their high degree of syndication, and the scarce presence of human resource management practices that are typical of private firms. Specifically, it is interesting to observe that on emotional exhaustion, both job tenure and contract breach showed similar statistical power, whereas the effect was the opposite direction. In this sense, although the present study did not assess this aspect, one could speculate that employees who had worked longer in the institutions had developed more effective coping strategies for their workplace stressors and were, to some extent, safe from them. Accordingly, various authors have indicated that professional cynicism—understood as a critical and mistrusting attitude towards the utility of their task at the mid and long-term—is a coping strategy of workers in situations of prolonged stress. In contrast, when assessing employees’ health complaints, the data support the importance of contract breach and the reduced importance of job tenure in the post. This finding again reveals that the soft factors, although more difficult to conceptualize and measure operationally, have a great impact on outcomes at the personal, group, and organizational levels. Considering the different organizations to which the employees belonged, the analyses conducted reveal the differences among them. Although the activities carried out by these groups of workers are similar—most of them attend to people in emergency situations—the differences found may be due to the existence of specific organizational variables, either associated with specific task characteristics or with the defining traits of the diverse organizational cultures. Other studies have explored the influence of organizational cultures like those considered herein on relevant outcomes at the personal and organizational level, such as job satisfaction and organizational commitment among the positive outcomes, and mobbing among the negative ones ,25.In general, it can be stated that psychological contract breach is a relevant variable to explain undesirable outcomes of public sector employees. These relations make sense when considering that contract breach, since it consists of the perception of breaking the promises made when the worker joined the organization, can imply the employee’s loss of control of the situation, first leading to feelings of disorientation and subsequently to feel anger or betrayal. In this sense, it would also involve an increase in uncertainty and, thus, we can better understand its potential value as a stressor, even in work settings that seem more stable and less subject to change, like the ones studied herein.Future studies should explore the prior health status of the participants, based on organizational records because controlling their influence on later health complaints can provide stronger conclusions. From the viewpoint of intervention, we think that this study can contribute relevant information with a view to improvement in human resources management of public firms. Currently, psychological contracts have changed and evolved towards individual agreements between employers and workers, especially when concerning knowledge professionals . This imIn this vein, employees that longer remain in these organizations usually experienced a re-socialization process when they advance in their careers or change from one department from another. These events mean a review of the psychological contract’s agreements, and they can result in a new breach. Hence, human resources departments should be very vigilant on the changing work conditions that can negatively affect employees’ wellbeing. At the same time, our findings have strong implications for workers. Each employee must be aware of his or her own responsibility for the management of the professional career. Hence, the development of his or her intrapreneurial self-capital can be a promissory individual resource for coping the ongoing changes in the work environment . Despite the great difficulty to access this type of organizations, we think that the results can contribute to improving the human resources management of public firms, as well as prevention and treatment of occupational diseases .


Musculoskeletal (MSK) complaints comprise approximately 20% of primary care and emergency department visits annually in the United States. At the same time, there is a shortage of MSK specialists specifically trained to evaluate and treat these conditions. Improper management of patients with MSK diagnoses increases morbidity and undesirable outcomes for patients and leads to higher health care costs resulting from extraneous tests and imaging.This resource consists of a set of four modules reviewing ankle, hip, shoulder, and wrist injuries and their initial treatment. Each module is a PowerPoint presentation formulated as a self-study guide for the evaluation of common MSK injuries by primary care and emergency medicine providers . Each module includes material on physical examination, imaging, and management, including reduction and splinting, as well as indications for referral to an orthopedic specialist.The efficacy of the course for 43 first-year residents in internal medicine, orthopedic surgery, and the emergency department was measured using an external instrument. Pre- and posttest scores improved by 28% for knowledge of the material and by 30% for confidence level with the disposition of these injuries. All participants stated they were moderately to extremely satisfied with the course.Completion of this course will result in improved evaluation and management of injuries by initial providers, including—where appropriate—improved communication between these providers and treating surgeons. Concurrently, there is a shortage of MSK specialists specifically trained to evaluate and treat these conditions.3 Improper management of patients with MSK diagnoses increases morbidity and undesirable outcomes for the patients and leads to higher health care costs resulting from extraneous tests and imaging.Musculoskeletal (MSK) complaints comprise approximately 20% of primary care and emergency department visits annually in the United States.4 In a 1998 study, 82% of medical graduates failed a test of MSK competency, and a similar study in 2012  reported negligible improvement, with an 81% failure rate.5 Baseline knowledge of simple fracture care is lacking even among incoming orthopedic residents, as was demonstrated by a multisite survey presented at the Orthopaedic Trauma Association's 2013 annual meeting.6Establishing competence in this field should be a priority for all medical graduates, especially those entering primary care and emergency medicine fields. MSK education at the medical school level in the United States has been notoriously lacking. In 2003, only 65 (45%) of 122 medical schools required MSK courses as part of their curricula. Over the last decade, this has improved to 93% of schools having some MSK requirement, but quantity may not translate to quality.7 A more-recent study found that among primary care physicians, there was a statistically significant difference between their level of comfort with medical issues and MSK issues.8Finally, standardized measures of competence are only one aspect of effective patient care and mean little in the absence of physician confidence and comfort in managing these patients. Perhaps the most telling data show that practicing physicians do not feel properly trained to appropriately treat orthopedic complaints. In one survey, only 51% of respondents felt their MSK training in medical school was adequate.This resource was created to provide a foundation for management of common MSK injuries that primary care and emergency medicine providers  may be routinely exposed to in their practice. It was created by an attending orthopedic trauma surgeon with the goal of improving both evaluation and urgent management of this patient population. In addition, communication between these initial providers and orthopedic surgeons is facilitated by using the same terminology. Finally, the urgency of care of these patients is noted to avoid unnecessarily urgent office visits or hospital stays while continuing to maintain patient safety.7The resource was developed based on the experience of orthopedic trauma surgeons on the most important points of the urgent assessment and management of these patients necessary to instruct the learner and improve the knowledge of referring physicians in these areas. As the surgeons who are ultimately responsible for the long-term treatment of these patients, referring physicians should understand that these are the points to provide the best possible care initially. The material may be of particular utility to initial providers in settings where orthopedic surgeons may not be an immediately accessible resource. The self-assessment questions were derived from consensus from orthopedic surgeons, commonly tested areas on orthopedic board examinations, and MSK testing tools that have previously been published in the literature.This resource is designed as a set of independent self-study modules, recognizing that the principal target audience is adult, self-directed learners. It was designed as a tool to be studied in its entirety or quickly implemented as a refresher for providers who are managing these common injuries in an emergency, urgent, or primary care setting. It may be used as a way to check on management or as a reminder of anatomic and physical examination pointers that are necessary for providers to work through. It is also a resource for appropriate radiographic imaging, although initial providers taking this course should already be versed in radiographic imaging and reading radiographs is not a main learning point of the resource per se. The resource covers the most significant aspects of urgent handling of injury: physical exam, imaging, management, and referral. Each module—ankle , hip Ap, shouldeNote that with respect to the physical exam, the ankle and hip modules share six slides, and the shoulder and wrist modules share eight slides. Completion of each module in the resource on any electronic device capable of running PowerPoint should normally take no more than 1 hour.After creation of this resource, the course was given to our incoming residents to test its efficacy. We specifically wanted to confirm that the course material was understandable, that participants were getting the material they needed from it in order to improve on related examination questions, and that they felt they were getting useful information from it by evaluating their comfort level with the knowledge and treatment of these injuries before and after using the resources. The efficacy of the course was shown based on testing of 43 first-year residents in internal medicine, orthopedic surgery, and the emergency department, as previously discussed. Pre- and posttest scores improved by 28% for knowledge of the material and by 30% for confidence level with the disposition of these injuries. All participants stated they were moderately to extremely satisfied with the course.This resource was originally designed to resolve a practice gap in the management of common MSK injuries identified by practicing orthopedic surgeons when reviewing the performance of referring physicians. As indicated in the Results section, the use of the resource has resulted in improvements in performance for its target audience. Nevertheless, to address suggestions for improvement by learners and other reviewers, it has been significantly enhanced since its original implementation, primarily in the presentation of the sections on physical exam and radiographic imaging of injuries.The main limitation of the resource at this time is the lack of hands-on experience in the reduction of any displaced fracture or dislocation. Thus, additional benefits for the intended audience might accrue from using the resource in a small-group, workshop setting  facilitated by a practicing orthopedic surgeon and/or MSK-trained sports medicine physician. Such a setting would also be conducive to a more-objective assessment of gains in both knowledge and skill.Other populations  might also benefit from completing this course, though they may need assistance from an attending physician with experience in MSK medicine to achieve a full understanding of the material. Interpretation of the radiographic images may require assistance from a practicing radiologist.A. Evaluation of Common Musculoskeletal Injuries in the Urgent Setting.pptxB. Evaluation of Ankle Injuries in the Urgent Setting.pptxC. Evaluation of Hip Injuries in the Urgent Setting.pptxD. Evaluation of Shoulder Injuries in the Urgent Setting.pptxE. Evaluation of Wrist Injuries in the Urgent Setting.pptxAll appendices are peer reviewed as integral parts of the Original Publication.


The last few decades testify that consumers’ concerns for healthier lifestyles and environment care are driving forces for reshaping food buying intentions and their perspectives on food quality. The present study identifies the importance that consumers attach to quality, health, and environment selected cues of purchased food products. More precisely, to elicit preferences for social, environmental, and qualitative food cues, a survey instrument was developed and applied on 797 Belgian and Romanian consumers. Our findings suggest that investigated consumers most frequently use freshness, taste, and appearance to evaluate food quality. The use frequency of food quality cues related to health is primarily influenced by the attention paid to food quality. The most relevant cues of food healthiness are ingredients, nutrition facts, and additives and for food environmental impact are packaging, food origin, and production type. It is concluded that food quality receives high attention both from Belgian and Romanian consumers and health and environment related cues can be used as a means of improving consumer health and environmental protection. The demand for high quality food has constantly increased during recent decades, as has the interest in the food quality issue both in response to market pressure (such as requests from increasingly demanding and knowledgeable consumers) and also as a reaction to other factors, for example health and environmental concerns . The conBased on the premise that food quality is formed by the perceptions held by consumers , the preGenerally, quality evaluation of food consists of two stages. The first one, which is the focus of the current study, precedes the purchasing act, and the second one is related to what happens after the purchasing act while consuming the food. Regarding the first stage, at the point-of-purchase, consumers use both explicit cues  and subtle cues that are communicated by packaging design, like graphic design, material, and color . EuropeaConsumers are generally unable to assess the quality of food without the reflection of different traits , and as The main novelty of this study relies on revealing which are the food quality cues most frequently used by consumers. Furthermore, the study empirically establishes which are the cues used by consumers to evaluate the health and environment characteristics of food, thus informing sustainability related marketing theory and practice. A third element of originality stands in casting light on a set of variables that can predict the use frequency of several food quality cues related to health .Comparatively, a similar study by Mascarello et al.  aimed toOther studies investigated the influence of one or more specific variables on food quality perception  and not Regarding the focus on Belgian and Romanian consumers, this is the first study to scrutinize the use frequency of quality, health, and environmental cues by these consumers. The paper of Januszewska et al.  was the As posited by Lancaster , Kramer The elements that consumers use when they evaluate food quality have received different names in the literature, and they have been classified into specific groups according to their nature or the context of their utilization. Thus, Nelson ,41 namedThe term “cue” is used with different meanings in the literature. For instance, Caputo et al.  used theOur review generated 59 items for quality evaluation. The synopsis of the cues with the corresponding studies where they were mentioned is included in Ajzen  demonstrA wide variety of instruments has been used in practice to explain how consumers evaluated food quality, and they usually contained experience qualities such as taste and credence qualities like environmental impact and healthiness . FollowiThe conceptual framework for this study was adapted from the literature as follows. The authors developed a systematic search in electronic databases . Papers containing the following terms and their combinations were searched: food, quality, consumer, evaluation, model, perception/perceived, cues, and attributes. Around 400 manuscripts were initially retrieved based on several criteria: English language, peer reviewed, and presence in journals with an impact factor. Out of these, half were selected for a deeper analysis. Firstly, the most cited food quality evaluation models were analyzed, and the quality cues present in them were extracted. These were: quality perception process conceptual model , perceivIn the section dedicated to food quality, firstly, the level of attention paid to food quality was assessed on a 7 point scale . Then, an open ended question was aimed at capturing consumers’ unaided awareness of the cues that are most frequently used by consumers for evaluating food quality. This question preceded the list with quality cues and requested that they indicate a maximum of five cues. Secondly, they received a list with the 59 quality cues, and they were requested to indicate how often each of them was used for the evaluation of food quality. A 7 point scale with answer options was attached to this question . Out of the 59 cues, at least 34 could be related to health and environmental aspects. Two open ended questions were asked to find out which cues were used by consumers to evaluate the healthiness of food and the environmental impact of food. A maximum of five cues was allowed to be mentioned in each case. Another question assessed consumers’ perception of their capacity to evaluate food quality reliably. For a deeper understanding of this perception, a comparative context was used in this question by asking consumers to evaluate also the reliability of food quality information obtained from another five additional information sources: “Producers of the food you buy, through their website”, “Producers of the food you buy, through the information on the label and package”, “Sellers/shopping assistants in the shops where you buy the food”, “Your family and friends”, and “Other consumers”. These five sources were selected through the focus groups. The answer options for the reliability of all these six information sources ranged on a scale from 1 to 7 . Following the same reasoning, consumers’ perception of their capacity to influence their health through food consumption was studied by taking into account three possibilities: their power to maintain their current health state by eating the right foods, to improve their health state significantly by eating the right foods, and to damage their health significantly by eating improper food. The answer options were 1= no power to do so, 2 =…, 3 =…., 4 = average power, 5 =…, 6 =…, 7 = very high power to do so. The final section of the questionnaire collected socio-demographic data: gender, height and weight ), health status , and country of residence (Belgium or Romania). In total, 797 valid questionnaires were collected: 441 from Belgium and 356 from Romania. It was suggested that 5–10 responses per each estimated parameter would result in an appropriate sample size . TherefoSeveral different statistical methods were used to understand how consumers evaluated food quality. These included descriptive statistics, bivariate analyses (Mann–Whitney U test and Wilcoxon signed rank test), and regression analysis. Standard linear regression was performed using SPSS to test the relationship between the attention paid to food quality, confidence in self-capacity to evaluate food quality, the power to maintain, improve, and damage health through food choices, and BMI (independent variables), on the one hand, and the use frequency of food quality cues related to health (dependent variable). The cues tested were: ingredient list, fat content, salt content, and sugar content. Analyses were performed with the software Excel and SPSS. Food quality received high attention from consumers, reaching 78.3% of the maximum level, with 5.7 points. The average score for the Romanian sample was 5.9 and for the Belgian one 5.5. A statistically significant difference was indicated by the Mann–Whitney U test between the Romanian and Belgian samples, with higher attention from Romanians. No statistically significant difference was generated by the existence of health problems of the respondent or of his/her family, and no correlation was observed between the attention paid to food quality and the BMI. Men and women did not statistically differ regarding the level of attention paid to food quality.Relying on the assumption that not all 59 food quality cues were used in food quality evaluation at the same time, the answers to an open ended question about the most frequently used cues for food quality evaluation helped in discovering the most important ones. The number of quality cues mentioned by tested consumers in the open ended question was high , covering 80% of the maximum number of answers . They were aggregated into 39 groups, detailed in The present research revealed that “appearance”, “price”, and “ingredients” formed the winning trio that dominated consumers’ judgment concerning food quality . This fiResults on the frequency use of the 59 tested quality ques showed that at the sample level, freshness and taste were among the most frequently used to assess food quality . A statiIn many cases, the scores assigned by the Romanian group to the use frequency of cues for food quality evaluation were higher than the ones given by Belgians. This difference was probably the consequence of an overall higher appreciation of the cues involved in food quality evaluation and of higher attention given to the food quality assessment process. The latter assumption seemed to be supported by consumers’ answers to the question about attention assigned to food quality (higher for Romanians). However, it should be considered that other factors besides interest (attention) intervene in explaining the use frequency of quality cues, similarly to the case of the intention–behavior gap for various food related behaviors ,118.Consumer’s sources of information are generally grouped into internal versus and external sources  and persThe Mann–Whitney U test revealed that the existence of health problems (for the consumer or his/her family) did not generate a statistically significant difference in the use frequency of the food quality cues.The number of cues that consumers most frequently used to assess food healthiness covered 70% of the maximum number of answers . In the first case, the cues mentioned in the open ended question were aggregated into 41 groups, detailed in Many factors can influence the healthy/unhealthy categorization of foods, such as ingredients, fat content , nutritiKnowledge of how consumers evaluate food healthiness is an important piece of information for any education campaign aimed at improving eating habits in order to make them healthier. At the same time, it can be observed that the same cues are also frequently used for food quality assessment , stressiConsumer perceived control of the capacity to influence health towards one of the three possible directions, maintain, improve, or damage, was high in all cases . The higStandard linear regression was performed four times in order to observe how well six independent variables  could predict the use frequency of several food quality cues related to health (dependent variable). The tested cues were: ingredient list, fat content, salt content, and sugar content .The use frequency of all tested health cues was influenced to the strongest degree by the attention paid to food quality. In the case of salt, sugar, and fat content, the influence of the perceived control to improve health by eating the right foods and of the BMI was also present. Regarding the use frequency of ingredient list, it was observed that the belief that he/she could damage his/her health by eating the wrong foods influenced the use frequency of this cue . It coulEnvironmental concern is gaining importance in consumer food choices, generating changes in production and supply and thus demonstrating how the consumer can contribute to environmental health.In this study, the three most important cues used for the evaluation of the environmental impact of food were packaging, origin, and production type. This was not in line with research showing that 85 Swiss participants indicated that organic labels and provenance were among the main predictors of the products’ perceived environmental friendliness . In the The number of cues that consumers most frequently took into account to assess food impact on the environment represented 50.3% of the maximum number of answers. These cues (mentioned in an open ended question) were aggregated into 45 groups, detailed in From a practical perspective, this investigation could provide useful information for the study of the intention to buy a food product by revealing the cues that are the most frequently used by consumers, with implications on consumer health and a cleaner environment. The presence of health and environmental cues can support the efforts of stakeholders interested in these directions to increase the efficiency of their actions that target food consumption behavior. For example, the information can be used in education-information  campaignSumming up, this paper highlighted some important cues in Romanian and Belgian consumers’ understanding of food quality referring to food in general and not to a specific food product. This is critical for marketing researchers and practitioners to define marketing programs fitting the increasing high quality food demand. The results of the present study should be regarded in the context of their limitations. The number of potential determinants of the use frequency of food quality cues can be increased in future research in order to discover more about this relationship. Furthermore, the investigation of consumer understanding of food healthiness and environmental impact can be extended through the use of other variables such as level of healthiness, environmental damage, and water footprint. The understanding of freshness should be clarified, as it can embed attributes that differ among consumers. The sample was not statistically representative at the country level, and a future study could fill in this gap. The present study focused on the perception of quality in general; therefore, some product characteristics such as freshness or fair trade certification may have high relevance for specific foods and low for others. Future research could consider investigating whether and to what extent different quality cues differ among specific types of products. Additional statistical analyses should be run in future research in order to identify segments of consumers according to the food quality cues that they use. Despite these limitations, the results of this study can contribute to the efforts of informing and educating consumers to adopt healthier and more environmentally friendly food choices.Much depends on consumers’ food quality perception: profits, health, and nature. The economic benefits resulting from food purchasing acts are contributory toward consumers’ quality evaluation. Perception of food quality influences dietary patterns with implicit consequences on health both at the individual and society level. The environmental impact of the entire food chain, from farm to garbage bin, is influenced by consumers’ choices.The present study placed a strong emphasis on food quality cues related to health and environmental protection. The reason why we proceeded in this way was on the one hand that it is widely accepted that health and environmental concerns are important factors in consumer decisions . On the This contribution highlighted the importance of food quality evaluation for health and environment protection, and it developed a framework for the understanding of food quality evaluation based on the investigation of Romanian and Belgian food consumers. The results emphasized that the investigated consumers assigned high attention to food quality and used freshness, taste, and appearance the most frequently to evaluate food quality. The use frequency of food quality cues related to health was primarily influenced by the attention paid to food quality. The packaging was the main indicator of the environmental impact of food, thus highlighting a possible intervention for less pollution and resource consumption related to packaging, which can be more easily accepted by consumers.Environmental protection, healthy diets, and human progress are inter-dependent, and that is why building a sustainable food system that prioritizes consumers’ needs and preferences can support the shift towards a sustainable consumption paradigm. As long as quality is a central concept in food choices, the insights into consumers’ understanding of food quality is one of the building blocks that lays the foundation of a sustainable consumption pattern.