Purpose-The purpose of this paper is to (1) propose a typology of institutions enabling or constraining customer centricity and value co-creation in service ecosystems; (2) illustrate the various types of institutions with examples from healthcare; (3) provide case study evidence on how pharmaceutical companies react to and induce institutional change. Design/methodology/approach-First, a typology of institutions enabling or constraining customer centricity and value co-creation is proposed and illustrated with examples from healthcare. Next, to clarify how companies deal with these institutions by reacting to or inducing institutional change, two case companies from the pharmaceutical industry are described. Findings-The research identifies and illustrates nine types of institutions (culture, structure, processes, metrics, language, practices, IP, legislation and general beliefs) grouped by three levels of analysis (micro, meso and macro). Furthermore, the case study findings indicate that companies react to, but also proactively induce, institutional change. Research limitations-The investigation is limited to two case studies. Practical implications-Organizations need to (1) understand the micro-, meso-, and macrolevel institutions of their service ecosystem; (2) react to institutional changes imposed by other actors; and (3) proactively change institutions by breaking, making, or maintaining them. Social implications-Pharmaceutical companies can improve patient wellbeing by inducing institutional change. Originality/value-This research develops a mid-range theory of service ecosystem institutions by developing a typology. This typology is empirically examined in a healthcare context.

The goal of this research is to acknowledge the elements which hinder or facilitate the transition from linear to the circular economy in the textile and apparel sector in Romania by identifying current and desired interactions among the ecosystem’s stakeholders. Two strands of literature, one on circular economy and one on the textile and apparel sector, provide the theoretical background for this research. Currently, the way we design, produce, and use clothing has drawbacks that are becoming increasingly clear. The circular economy principles have the potential to transform the way textiles are produced, consumed and disposed of. More and more social entrepreneurs are pioneering the future of the apparel industry by offering sustainable solutions to tackling systemic problems. However, their efforts have to be elevated and amplified, as such to pave the way for creating business models that allow for both economic performance and social impact. A comprehensive mapping of ongoing activities and stakeholders in the textile and apparel sector in Romania is required to understand the roadblocks to industry transformation in the context of moving toward circular economy and to implement envisioned sustainable solutions. In the paper we used a database of 27 stakeholders, developed by applying the snowball method, to investigate current and future interactions between the main actors who operate in the textile and apparel sector. To meet its research objectives, the paper employed a phenomenological research design and built upon a workshop activity. First, we designed an online survey to understand the profile and knowledge of the circular economy of the stakeholders included in our database. Second, we employed the world café method to understand in depth the level of knowledge of the actors who attended the workshop on the circular economy in the textile and apparel sector. Third, we used the structural systemic constellations method in assessing the stakeholders’ current and future desired interactions. Last, we formulated conclusions and recommendations about future research needed to deepen the understanding of the circular economy in the textile and apparel sector. Findings showed that there is a vicious circle of different actions feeding isolation and preventing collaboration among stakeholders. Also, we found that there is a lack of collaborative spaces where stakeholders can meet, connect and explore the various opportunities to collaborate, and a lack of general awareness on “circular economy and textile and apparel” and its mechanisms. The intended audiences of the research are decision-makers and practitioners in the textile and apparel sector, as well as researchers focused on the circular economy.

Health literacy improves knowledge and builds skills to help individuals make appropriate decisions regarding their health. Over the past 20 years, several studies have described associations between health literacy and health outcomes. With respect to Romania, evidence is scarce on the level of health literacy, as well as on its determinants. Thus, the objectives of this study were to briefly screen functional health literacy levels in a sample of rural inhabitants, to assess the relationship between health literacy and reported health status, as well as to explore health literacy determinants within this population. Data were collected between September-November 2010, in four villages in Cluj County, Romania, using a cross-sectional survey. The mean age of respondents in the sample was 56 years, with roughly half of respondents being retired. The brief screening of health literacy suggested inadequate to marginal levels within the sample. Significant associations were observed between health literacy score and education, and self-perceived health status, whereas the relationship between health literacy and gender, and the presence of a chronic disease was not statistically significant. Limited health literacy has been shown to be common in people who rated their health as poor, those who attended only middle school, and individuals lacking basic information about their body. In order to minimize the adverse effects of low health literacy on health and health outcomes, efforts should be invested in identifying and addressing the health needs of adults with low and marginal health literacy, especially in underserved areas such as rural and remote settings, where access to health-related information is limited.

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The paper aims to assess the propensity for entrepreneurship among rural populations in ten Central and Eastern European (CEE) countries. The entrepreneurship propensity is measured against four dimensions: entrepreneurial potential, desirability of self-employment, feasibility of selfemployment and the comfort with acquiring customers. In addition, we analysed key motivations for self-employment among rural populations in the sample countries, namely: the prospects of second income; self-fulfilment and possibility to realize own dreams and ideals; and return to job market as alternative to unemployment. The objectives of the paper are three-folded: (1) To determine how likely are the rural populations in the CEE countries studied to take on a self-employment activity; (2) To understand the perception of rural populations in the CEE countries about entrepreneurship and selfemployment; and (3) To identify the apparent similarities and differences in the countries studied among the rural populations in terms of their perception about entrepreneurship and motivations for self-employment. The study interprets the data collected in 2016 through the Amway Global Entrepreneurship Report. The research is meant to foster and popularize the rural entrepreneurship career model among rural communities in the sample CEE countries. This is important in order to know what can be done to encourage the business continuation and growth of rural entrepreneurs.