Purpose Social return on investment (SROI) is a systematic way of incorporating social values of different stakeholders into public sector decision-making on sustainability. This study aims to identify salient factors that influence SROI implementation. Design/methodology/approach The interactions of four Dutch municipalities and their social enterprises were examined, by analyzing relevant documents and interviewing key actors. Findings External forces appear to have little influence on SROI implementation. Management systems, legal restrictions in relation to privacy and the administrative burden appear to hinder SROI implementation. Findings suggest that trust among the parties involved and their representatives is a major driver for SROI development. SROI is not measured well enough, which complicates analyzing and reporting its development. Research limitations/implications Achieving collaboration through trust is a characteristic of stewardship theory, and therefore useful for studying social sustainability. Combining agency and stewardship theory provides useful insights concerning the application of control mechanisms versus empowerment. Practical implications Barriers can be overcome by informing and engaging suppliers in SROI initiatives. Furthermore, findings of this study suggest that it is easier for municipalities to incorporate SROI when social firm activities are insourced. An independent procurement function stimulates SROI development. Engaged professionals can make the difference in SROI policy implementation, more so than written policies. Social implications SROI enables social sustainability. SROI can be used by public agencies to provide meaningful activities for the long-term unemployed and underprivileged adolescents. Originality/value The study is the first empirical work that relates public procurement to SROI implementation and its effect on suppliers. The findings provide valuable insights into government influence on social enterprises.

Introduction Current cardiac telerehabilitation (CTR) interventions are insufficiently tailored to the preferences and competences of individual patients, which raises the question whether their implementation will increase overall participation and adherence to cardiac rehabilitation. However, research on patient-specific factors that influence participation and adoption of CTR interventions is scarce. Objective The aim of this study was to evaluate which patient-related characteristics influence participation in a novel CTR intervention in patients with coronary artery disease. Methods This prospective observational substudy of the SmartCare-CAD randomised controlled trial evaluated patient characteristics of study participants as proxy for participation in a CTR intervention. We compared demographic, geographic and health-related characteristics between trial participants and non-participants to determine which characteristics influenced trial participation. Results A total of 699 patients (300 participants and 399 non-participants; 84% male, mean age 64.3 ± 10.5 years) were included. Most of the non-participants refused participation because of insufficient technical skills or lack of interest in digital health (26%), or preferred centre-based cardiac rehabilitation (CR) (21%). Variables independently associated with non-participation included: higher age, lower educational level, shorter traveling distance, smoking, positive family history for cardiovascular disease, having undergone coronary artery bypass grafting; and a higher blood pressure, worse exercise capacity and higher risk of depression before the start of CR. Conclusion Participation in CTR is strongly influenced by demographic and health-related factors such as age, educational level, smoking status and both physical and mental functioning. CTR interventions should therefore be redesigned with the involvement of these currently underrepresented patient subgroups.

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