Sage Journals: Discover world-class research

Abstract

The aim of this paper is to study the power dynamics that unfold as part of communicative processes in place marketing collaboration, as exemplified in the EU’s developed but peripheral regional settings. The paper applies positioning theory to analyse how power dynamics are constructed through the distribution of rights and duties between participating stakeholders in two regional-level place marketing projects carried out in Eastern Finland between 2011 and 2014. The analysis of 24 interviews reveals story lines that unfold as part of a collaborative process between steering group representatives. Focus is given to the attribution of rights and duties to the stakeholders within these story lines, and the power dynamics that manifest as a result. Two central story lines are identified. In the formal story line positioning is related to the distribution of funding, regional scope of the projects, and the formal roles of stakeholders. In the spatial story line positioning concerned the dominance of regional centres and the spatial proximity between stakeholders. While the paper underlines the potential of positioning theory for understanding power dynamics in place marketing contexts, the findings are limited to specific geographical and institutional contexts. However, the paper presents a novel approach to the analysis of power dynamics in place marketing and branding by bringing attention to the normative aspects of power in communicative processes. This helps to identify and address the tension caused by power dynamics in place marketing and branding collaborations, which has been identified as a central challenge in recent literature.

Keywords

Positioning theory power dynamics inter-organisational collaboration place marketing regional development

Introduction

European sparsely populated regions are facing a trend of migration to more populated regions and cities. Because of this, local stakeholders as actors within such regions have had to come up with ways of developing their human and economic capital. The European Union has supported this with funding instruments such as the ERDF (European Regional Development Fund), resulting in an abundant stream of projects intended to support the economic and social development of these regions. Such projects most commonly take the form of partnerships, where local stakeholders from public and private sectors work together towards set goals.

In recent decades, place marketing and branding has become a popular means for places such as regions, cities and even countries to attract economic and human capital, with the ultimate goal of increasing the economic well-being of a place. In practice, place marketing is a collaborative activity between various organizations from both the public and private sectors, who can contribute for example by financing, managing or participating in marketing activities. In the place marketing and branding literature, stakeholder relations have been raised as an important variable in managing successful projects (Eshuis and Edwards, 2013; Houghton and Stevens, 2011; Kavaratzis, 2012; Klijn et al., 2012; Stubbs and Warnaby, 2015). However, managing stakeholder relations in the context of place marketing and branding has been considered as problematic as it deals with cross-sector stakeholders who have potentially conflicting interests and understandings of the practice. Indeed, issues such as power struggles and the inclusion-exclusion bias of stakeholder groups has been identified (Boisen et al., 2011; Kavaratzis, 2012; Messely et al., 2015; Warnaby, 2009; Warnaby and Medway, 2013). As a response, finding common ground between stakeholders that can accommodate multiple interests has been found to mitigate such tensions (Botschen et al., 2017; Kavaratzis and Hatch, 2013). Kavaratzis and Hatch (2013) have suggested that place branding is best understood as a platform for dialogue, debate and contestation. Recently, more studies have paid attention to communicative processes between stakeholders in order to find ways to facilitate collaboration (Halme, 2020; Lucarelli and Giovanardi, 2016; Ripoll Gonzalez and Lester, 2018). However, these studies have not yet fully addressed the influence of the power dynamics that exist between stakeholders in these communicative processes. As Kasabov and Sundaram (2013) have pointed out, there is distinct lack of empirical research on the types of power that legitimize the voice of select stakeholder groups in setting agendas, and in acting as gatekeepers in the marketing and branding of places. Towards this end, the purpose of this paper is to study the power dynamics that unfold within communicative processes in place marketing collaborations.

‘Positioning theory’ was introduced by Harré and Van Langenhove (1999), and has emerged as a prominent approach by which to study power dynamics in interpersonal and group relations, and has also been applied to study the conflict between the impersonal entities of places such as regions (Slocum and Van Langenhove, 2004). It conceptualises power dynamics between persons or groups by focusing on their entitlement for action and participation, where more dominant groups are entitled to have more rights to speak and to be heard, while weaker groups, are rather positioned with duties and obligations (Andreouli, 2010; Tan and Moghaddam, 1999). In positioning theory, this discrepancy over which rights and duties are attributed to actors has been considered to be at the heart of conflicts seen between groups (Slocum-Bradley, 2010b). Positioning theory presents an analytical triangle with three interdependent angles: speech acts, story lines and positions. Speech acts refer to utterances or gestures with a certain culturally understandable function such as critique or praise. Speech acts become sensible within the social context, which in positioning theory is conceptualized as story lines that are jointly constructed by actors during social episodes. Finally, positions refer to a group of rights and duties which are attributed to actors through speech acts along story lines. Strong positions are related with the presence of rights, while more weaker positions are connected with duties.

Focusing on the construction of stakeholder positions in the context of place marketing, this study presents empirical findings from two regional-level place marketing projects carried out between 2011–2014 in Eastern Finland. In order to address the power dynamics in these projects, the following research questions were posed: What are the story lines that unfold in collaborative process between steering group representatives? How do representatives attribute their own and other participating organizations’ positions within these story lines? How does this positioning process reflect the power dynamics seen in the projects? Subsequently, this study contributes to the place marketing literature by bringing attention to the power dynamics in communicative processes between stakeholders.

Firstly, the discussion of positioning in this paper brings attention to the normative aspects of power in the place marketing context, which further adds to the knowledge on the types of power that influence collaborative processes between stakeholders (Kasabov and Sundaram, 2013; Lucarelli and Giovanardi, 2016; Marzano and Scott, 2009). Secondly, it introduces positioning as an important part of the communicative process in place marketing and branding collaborations, in order to understand how certain stakeholders are more entitled to express their opinions in collaborative processes. Thus, it contributes to the literature on the discursive aspects of place marketing and branding activities (Flowerdew, 2004; Halme, 2017, 2020; Jensen, 2007; Lucarelli and Giovanardi, 2016; Marzano and Scott, 2009). Finally, the study posits good practices that can be applied in managing collaborative processes between stakeholders by highlighting the significance of story lines as a pivotal aspect of the power dynamics between them.

The paper is structured as follows: In the first section, the relevant literature is reviewed and the theoretical framework is introduced. The second section presents the overall design of the study followed by methodological considerations. The third section discusses the empirical findings and explores power dynamics through central story lines. Finally, the major findings on the topic are presented and conclusions are drawn.

Literature review

This section reviews the relevant literature and introduces the theoretical framework for the study. The first subsection reviews the literature on stakeholder representation and the problems relating to it in a place marketing and branding context. The second subsection reviews literature on stakeholder representation as a socially constructed process. The last subsection presents a theoretical framework for the study based on positioning theory.

Representation of stakeholders in place marketing

In management literature, actors and agency in inter-organizational collaborations (IOCs) are generally understood as ‘stakeholders’, representing “groups and individuals, who can affect, or are affected by the achievement of an organization’s mission” (Freeman, 1984: 53)¹. The importance of broad stakeholder participation has been emphasised in previous place marketing and branding literature (Braun et al., 2013; Eshuis et al., 2018; Hanna and Rowley, 2011; Houghton and Stevens, 2011; Kalandides, 2011; Kavaratzis, 2012; Kavaratzis and Hatch, 2013; Kavaratzis and Kalandides, 2015; Klijn et al., 2012; Ooi and Pedersen, 2010; Rinaldi and Cavicchi, 2016; Stubbs and Warnaby, 2015). Previous literature has argued that the multiplicity of perspectives brought to the different stakeholders can contribute to the strategic selections that are made and the content of the activity, thus helping to produce a clearer brand (Eshuis et al., 2018; Klijn et al., 2012). Literature has also addressed the fact that broad participation contributes to the internal approval and democratic legitimacy of the activity (Eshuis and Edwards, 2013; Eshuis and Klijn, 2012; Kavaratzis, 2012).

Broad stakeholder participation has also been considered as problematic because of the sheer number of potential stakeholders within places, each with different interpretation of it. As Kalandides (2011) has pointed out, too much participation by stakeholders can have a negative influence on the effectiveness of place marketing activities. Another issue that has been addressed are the conflicting interests between stakeholders, which have been shown to have negative effects on the content of the place marketing activity (Eshuis et al., 2018; Halme, 2020). At the core of these conflicts is often the fact that place marketing and branding is inherently a selective process where certain symbolic and geographic aspects of the place are chosen to represent the place, in order to create a unified core message or brand (Boisen et al., 2011; Clegg and Kornberger, 2010; Messely et al., 2015; Warnaby and Medway, 2013). Inherent selectivity also means that place marketing collaboration is susceptible to power struggles between stakeholders (Clegg and Kornberger, 2010; Kasabov and Sundaram, 2013; Messely et al., 2015; Warnaby and Medway, 2013). This discussion underlines the notion of space and place (including regions) as being socially constructed, and endlessly produced and reproduced via spoken and written word in different ways by different people, through a process of conflicts of interests and power struggles (Flyvbjerg, 1998; Massey, 2009; Warnaby and Medway, 2013).

The place marketing literature has addressed various ways that power struggles influence collaborations. Marzano and Scott (2009) examined different forms of power that were salient in stakeholder participation processes for destination branding. They concluded that the main forms of power are persuasion and authority. Echoing communicative planning theory (Healey, 2007), Kavaratzis (2012) argued that power struggles between stakeholders should be taken as creative tensions that can contribute to bringing forward various perspectives. More recently, the literature has also highlighted more processual aspects of power regarding negotiation and decision-making processes in place marketing collaborations (Dinnie, 2018; Goulart Sztejnberg and Giovanardi, 2017; Halme, 2020; Lucarelli and Giovanardi, 2016; Ripoll Gonzalez and Lester, 2018). However, the recognized importance of processual aspects in power dynamics in studies focusing on place marketing and branding negotiations has not fully addressed how power dynamics influence these communicative processes between stakeholders. As Kasabov and Sundaram (2013) note, there remains a gap in the literature on empirical research on types of power which legitimizes the voice of select stakeholder groups in setting agendas and restricting points of view regarding place marketing and branding. Hence, the purpose of this paper is to study the power dynamics that unfold within the communicative processes in place marketing collaboration.

Discursive construction of stakeholders and their roles in collaboration

Collaboration studies have shown various approaches towards who or what constitutes as a stakeholder. A central question has been what constitutes having a ‘legitimate stake’ in collaborations. Gray and Hay (1986) have suggested that participants’ legitimacy stems from the perception of other participants regarding the right and capacity of the participant to participate. By capacity they mean a control of certain power over the organizational domain, and by right they mean the perception of impact that the issue of collaboration has upon the actor. Hardy and Phillips (1998) have later refined the conceptualisation of a ‘legitimate stake’, emphasizing formal authority, control of critical resources and discursive legitimacy. By formal authority they mean recognized and legitimate rights to make decisions that can be either centralised, or as in the case of IOCs, divided between organizations. Control of critical resources refers to the control of resources such as funding, expertise, etc., on which the collaboration is dependent. Finally, discursive legitimacy signifies the right to voice opinions regarding issues of collaboration coming from the stakeholders ability to mobilise broader societal support beyond the collaboration at hand (Fairclough, 1992; Hardy and Phillips, 1998).

Studies have highlighted that the perception of a ‘legitimate stake’ is not a matter of passive attribution, but rather a communicative process. For example, Lawrence et. al(1999) have suggested that stakeholders and their roles are constructed during negotiation processes, where available concepts are attached to stakeholders to justify and explain their legitimate right to participate. This is a highly political process, since power is involved in the ability to construct roles in a discourse, and the actions associated with those roles (Hardy and Phillips, 1998). As a result, stakeholders do not necessarily have equal means for constructing their roles in collaboration. As Hardy and Phillips (1999) have highlighted, within the discourse, some stakeholders have a “louder” voice than others, while other voices can be totally omitted. This means that communicative processes in collaboration can be conceptualized as discursive struggles where participants have access to varying sets of discursive and non-discursive resources that can be strategically utilized in collaboration.

Positioning theory

A theoretical approach that has significantly added to the knowledge on discursive construction by actors in interactive situations is positioning theory. Developed by Harré and Van Langenhove (1999), it aims to understand the socially constructed nature of meaning creation. Positioning theory has been applied in studies of social interaction on wide ranging scales such as intergroup relationships (Tan and Moghaddam, 1999), small group interaction (Hirvonen, 2016), regional integration (Slocum and Van Langenhove, 2003), identity construction in Europe (Slocum-Bradley, 2010a; Slocum-Bradley and Van Langenhove, 2006), and international conflict resolution (Moghaddam et al., 2007).

Positioning theory uses the concept of positioning to describe the discursive process of attributing positions to actors during social episodes. In contrast to role theory (Ritzer, 2005: 651), positions cannot be passively received, but instead have to be negotiated and gained in ongoing communicative processes (Tan and Moghaddam, 1999). This means that positions are not fixed, but can be momentary and ephemeral, and can be readily challenged and transformed. Therefore, they have to be achieved through active negotiations or other forms of social interaction (Harré et al., 2009).

Davies and Harré (1999) have made a distinction between two main types of positioning: interactive positioning which is used to position others, and reflexive positioning which is used to position oneself in a story line. While these are analytically separated, they are still related. Harré and Van Langenhove (1999: 2) point out that when attaching a strong position to someone, others consequentially have to be attached to weaker positions. Another difference to role theory is the notion that positions are not necessarily associated with persons, but can be also attached to more abstract entities to which “actor-like” qualities at the level of discourse can be attributed (Slocum and Van Langenhove, 2003: 221). For example, geographical entities such as regions, cities or countries can be attributed positions in story lines. Despite these differences, positioning theory does contain a role-like element in the form of ‘prepositioning’ which means the assigning of rights and duties on the basis of, for example, the institutional context of the interactive situation (Hirvonen, 2016).

Positioning triangle

Positioning theory proposes three main concepts arranged in a “positioning triangle” consisting of interdependent angles. These angles are “speech acts”, “story lines” and “positions”.

First, positioning is based on speech acts, which are utterances or gestures that have a culturally understandable function (Austin, 1961). For example, expressing critique or giving an order are both types of speech acts, which have a certain socially recognizable function. In positioning analysis, attention is especially paid to what kind of social task the speech acts refer to, and how they can be used to reach certain ends (Slocum and Van Langenhove, 2003).

Second, speech acts become sensible only in relation to the context in which they are realized. In positioning theory, this context has been conceptualized as “story lines”. According to Harré and Van Langenhove (1999), story lines are discursive tools to make sense of a certain delineated sequence of actions, events or episodes. Their narrative structure follows certain culturally meaningful forms, which underline their jointly constructed nature (Slocum-Bradley, 2010b). In addition to being sense making tools, Slocum-Bradley (2010b) have pointed out that story lines contain teleological elements, that is, an interpretation about the purpose of actions, events or episodes that the story line talks about. It should be made clear that story lines are not “real”, but rather an interpretation of social episodes (Slocum-Bradley and Van Langenhove, 2006).

Thirdly, ‘position’ refers to the rights and duties assigned to an actor through speech acts. ‘Rights’ refer to the range of opportunity for an actor to say or do things, while ‘duties’ are responsibilities or obligations that an actor is expected to fulfil. These are “type A” positions, which are attributed to actors in the context of story lines, while secondary “type B” positions are evaluations of whether actors have fulfilled their ascribed rights and duties (Slocum and Van Langenhove, 2004). Powerful positions are signified by the predominance of rights for expressing an opinion, while weaker positions are signified by the predominance of duties.

Limitations of positioning and relation to power

According to Van Langenhove and Harré (1999), positioning is not an equality-based social practice, meaning that there are differences in positioning opportunities for actors based on individual characteristics such as discursive skills and willingness, and social characteristics such as the position of actors in the local moral order and networks. This results in a situation where rights and duties are not distributed equally, which according to Slocum-Bradley (Slocum-Bradley, 2010b) is one of the main causes of conflicts.

Firstly, the discursive skills of an actor can limit access to the discourse at hand, which means that all of the actors are not necessarily able to articulate their interests in an equal manner. Secondly, the moral orders behind an unfolding story line can limit actors’ possibilities for acting, because they prescribe what positions are supported and legitimate in the situation at hand (Moghaddam et al., 2007: 13). Moral orders here refer to the normative aspects of story lines, which create on one hand, expectations or guidelines on what should or should not happen, or what actions are considered appropriate in the situation at hand. On the other hand, they also impose limits or biases on what positions and speech acts are considered legitimate in social episodes. This means that story lines can be used to support certain institutions and work in maintaining certain structures of power, and legitimising power relations between groups (Tan and Moghaddam, 1999). Indeed, as Tan and Moghaddam (1999) have pointed out, an important function of positioning acts is to reposition yourself and others in a way that certain positions are legitimised, which renders oneself as a powerful and effective actor. Therefore, positioning acts can be considered as part of a constant discursive struggle on securing an advantaged position.

The normative function of story lines would suggest that positions that are available for actors are determined by the story lines at hand, echoing the post-structuralist theory of discourse of Foucault (1972), who emphasized that “subject positions” are determined by discourses that distribute subjects in terms of status, power, legitimate knowledge and practices they are allowed to perform. However, the interactional approach behind positioning theory suggests positions are not directly determined by discourse (or story lines), but are rather co-constructed by people interacting with each other through their actions (Depperman, 2015). A similar approach has also been suggested in collaboration studies which have highlighted the strategic function of discourse. For example, Lawrence et al. (1999) have argued that actors in collaboration can utilise discourse strategically to their favour by aligning with certain discourses or utilising certain discourses to their benefit.

Study design

In order to study power dynamics in place marketing collaborations, a multi-case study was carried out, using two regional level place marketing projects from Eastern Finland selected as research sites. Case selection followed the principle of literal replication (Yin, 2014), since the story lines were predicted to be similar because of the geographical and organizational proximity of the cases (Knoben and Oerlemans, 2006). The selected projects were the “Regional attractiveness program of North Karelia and Joensuu” of North Karelia (2011–2013) and the “Mission Future: Regional marketing program” of Northern Savonia (2012–2015). The study areas represent welfare-type Nordic areas where regional policy has existed for decades to mitigate economic restructuring and out-migration. Stakeholder collaboration is an established procedure in regional policy, but this study utilising positioning theory is expected to reveal the tensions that lie within this policy-setting. The case study areas are developed but peripheral regions in the EU, and were selected to represent place marketing collaboration in this type of area.

The regions of Northern Savonia (NS hereon) and North Karelia (NK hereon) are sparsely populated regions characterised by forests and lakes. Similar to other sparsely populated regions, the population in NS and NK is decreasing and ageing rapidly, but the number of rural residents and businesses have increased in urban-adjacent rural areas. This change has its background mainly in the decreasing number of jobs in primary industry, which have not been substituted by other branches of the economy. This long-standing demographic trend has dominated development in sparsely populated regions, and is likely to continue in the future.

Both of the projects examined here were funded through the European Regional Development Fund (ERDF), which is one of the funding instruments of the European Union’s (EU) regional policy, which aims to reduce economic and social disparities among Member States and their regions. ERDF funding is mainly targeted at the development of physical infrastructure and the opportunities for economic growth. The projects at hand represent a general trend of ERDF funded place marketing projects by bringing together several public and private actors in regional partnerships. Both selected projects received a major part of their funding from the ERDF, while the remaining part was collected from the organizations participating in the projects.

The management of the projects under investigation was in both cases divided into steering and executive groups. Executive groups focused on planning activities and producing materials, while steering groups were in charge of strategic decision-making and managing the projects. Steering groups consisted of high-level representatives of stakeholders that were participating in the funding of the projects (with one exception of an organization from the educational sector in the case of NK). These stakeholders stemmed from public administration (cities, municipalities), public service (health care and educational organizations), sub-regional economic development organizations (EDOs hereon), a tourism management organization (in NK), and also private companies. In the case of NK, the project was divided into three separate sub-projects with respective budgets and action plans. These were general place marketing (Regional Council of NK, regional development authority), tourism marketing (Karelia Expert, tourism management organization), and business and investment marketing (JOSEK, EDO of the sub-region of Joensuu). The NS project was divided into different executive work groups, which had autonomous planning but were under the control of the project management. All of the interviewed representatives were participants of the steering groups, but some were participants in other working groups and sub-projects in case of NK.

Methodology

The data collection method used in this study was face-to-face semi-structured interviews, which is a suitable method for positioning theory as it allows sufficient space for interviewees to give accounts of the story lines regarding their projects. Although interview transcripts do not give access to the first order positioning between representatives (i.e. face-to-face interactions), it is possible to understand the positioning process retrospectively through second order or accountative positioning (i.e. talk about the talk) (Van Langenhove and Harré, 1999: 20).

Research data was collected from 23 semi-structured interviews (11 in NS and 12 in NK) with representatives of stakeholders from both the public and private sector. Interviews were conducted in spring 2015. Representatives of the steering groups were asked by email to express their interest to be interviewed regarding their participation in the respective place marketing projects. They were also offered the possibility to view the interview questions before the personal interviews took place. The interview questions centred around the formal roles of the stakeholders, their perception of the collaborative process with other stakeholders and the coordinator of the project, and their opinions on their opportunities for participation.

Research procedure

Positioning theory does not propose a fixed methodological procedure, and while it provides a theoretical framework, it does not restrict how findings are interpreted (Moghaddam et al., 2007: 290). The research procedure applied in this study consisted of the following steps. First, recorded interviews were transcribed into text files. After this, computer assisted qualitative data analysis software (TAMS analyzer) was used to code parts of the text with a hierarchy of codes grounded in the analytical concepts of positioning theory, namely speech acts, positions and story lines. The coding process consisted of finding passages in the interviews containing speech acts in which representatives of the steering groups implicitly or explicitly attributed rights or duties to their organization or other stakeholders within the collaboration. These passages were coded inductively in order to form coherent story lines, which included similar positioning acts. Finally, the story lines gave structure for further interpretative analysis of the positioning acts and power dynamics in the studied cases.

Findings

This section presents the findings of the analysis. The main subsections are divided into two story lines in which representatives positioned their organization and other stakeholder organizations with regard to collaboration in the projects. The first subsection describes the positioning acts in the “formal story line” and the second subsection describes positioning acts in the “spatial story line”.

Formal story line

The first prominent story line in the interviews in which positioning of participating stakeholders occurred was related to the formal and financial background of the projects. Both of the studied cases were projects funded by the European Regional Development Fund (ERDF), which sets conditions regarding the geographical scope, funding model and organizational form of the projects. These conditions influenced the distribution of rights and duties of the stakeholders. Three sets of positioning acts were identified which related to 1) the distribution of funding between stakeholders, 2) the regional scope of the projects and 3) the formal roles of stakeholders in the steering groups.

Distribution of funding

A condition for ERDF funding was that half of the funding needed to come from participating organizations. Organizations participated in the projects with varying funding portions. This variance in funding portions aligned with the attribution of positions: stakeholders with higher funding portions were attributed with the right for having a stronger voice and more visibility in the collaboration, while stakeholders with less funding were attributed with the duty of respecting this. This positioning was expressed by a representative of the business sector from NK:

(Excerpt 1) “We are participating with different proportions [to the project]. we have to acknowledge that somebody else has brought the money to the table and we have to respect that.”

In a similar manner, a municipal representative from NS attributed a strong voice to the regional centre of NS in the project, referring to its high funding portion:

(Excerpt 2) “Of course, the city of Kuopio has invested a lot also in terms of funding, and because of that it is clear that their voice counts more than others’ … if one provides ten times more funding than another, it should be accepted that their voice counts more.”

The regional centres (cities) in both cases were the largest funders of the projects adding to the ERDF funding. As such, they were attributed with strong rights of voice in the steering group collaboration. This was generally accepted by representatives in both cases, but in the case of NK there was indication that a low funding portion was also linked to low possibilities to influence the collaboration. This was expressed by a representative of a sub-regional EDO, who attributed themselves with low possibilities to influence compared to the regional centre with higher funding portion:

(Excerpt 3) “Well, we didn’t have much leverage… it was kind of Joensuu-centric, occasionally … our share of funding was also very low, and sometimes there was reference made to the fact that Joensuu provides this and this much funding to the project.”

However, the connection between a low funding portion and weaker rights was not straightforward. For example, a municipal representative from NS attributed his/her organization with strong rights of influence, despite a low funding portion:

(Excerpt 4) “There were possibilities to influence the process despite the fact that we are a small municipality and provided a small share of the funding. By being active one can surely participate and influence … we can’t really complain.”

This indicates that while funding portion was considered in both cases as a central basis for strong positions, it did not necessarily restrict the participation rights of the stakeholders with lower funding.

Regional scope

A second significant condition for ERDF funding was that both projects had to be carried out as regional-level projects. As a result, municipal stakeholders from various parts of the region were attributed with representative rights. This was expressed by a municipal representative from NS, who attributed various municipalities from NS with rights for representation:

(Excerpt 5) “Siilinjärvi, Leppävirta, [municipalities in NS] and other municipalities joined the project, so it expanded to be a regional project, it changed according to the wishes of the funder, it is quite understandable, we are talking about the entire region here, this has been the background.”

The municipal representative pointed to the “funder’s wishes” as being the rationale behind this positioning. This indicated that ERDF funding was aimed at the development of the entire region, rather than a specific place within it. Pointing to the same thing, a representative from the tourism sector in NK, underlined the regional scope of the project:

(Excerpt 6) “In this place marketing project … it is about the region of North Karelia, we did not focus on a specific place, it wasn’t only Koli [a national park] or Ruunaa [a hiking centre], it was the entire North Karelia.”

In the case of NK, the regional scope was more pronounced as the project was coordinated by the Regional Council, a regional development authority with a central duty of safeguarding regional interests (Ministry of EA and Employment, 2014). This link between the regional focus of the project and the formal duty of the coordinator was addressed by a representative of the business sector from NK:

(Excerpt 7) “The Regional Council as a co-ordinator of the project which receives their funding from all municipalities in North Karelia, means that the way of doing place marketing is that everything is being done for everybody.”

On the other hand, the duty of ensuring that regional stakeholders are represented in the project was attributed to the project coordinators. This was, for example, addressed by a municipal representative from NS who underlined the administrative duty of the regional centre, hence stressing the regional scope of the project and the rights of surrounding area to be represented:

(Excerpt 8) “It is not just Kuopio’s project, it is only administered from there, so it’s wrong to say that it is Kuopio’s project. It is a joint regional project, which happens to be administered by Kuopio.”

Formal organization of the projects

A third set of positioning acts in this story line was related to the formal organization of the projects. All of the interviewed representatives were members of the steering groups, but in the case of NK, some representatives also had other responsibilities in the management of the project. The NK project was divided into three relatively autonomous sub-projects, with their own respective budgets and management. This was reflected in the attribution of additional rights for the organizations in charge of the sub-projects. For example, a representative of a local EDO in charge of one of the sub-projects pointed this out:

(Excerpt 9) “We had our own budget, so our own … kind of project, which was part of the larger project, which was divided into parts, and one of these parts was JOSEK.”

The positioning of sub-projects with autonomous rights within the project can be considered as particularly relevant for the power dynamics in collaboration. In the words of Himmelman and Arthur (1996), the autonomous right of budget and management is the “purest conception of the power for perspective”. Although these rights were attributed to sub-projects, they were not considered as absolute. For example, a representative of the regional center of Joensuu pointed out the discussion regarding the rights of sub-projects:

(Excerpt 10) “There were different emphases, concerning for example the role of JOSEK [EDO in charge of a sub-project] … how much of an independent role they could have, if they could have had a bigger role with two other EDOs, and how much autonomy could be granted to them, and then on the other hand how much the regional council is pulling the strings.”

As pointed out by the representative, this debate related to tension between the coordinator of the project and the sub-projects regarding formal authority to carry out decisions. In the case of NS, such tension did not occur since the project was coordinated only by the regional center of Kuopio.

Spatial story line

The second story line in the interviews revolved around the spatial locations of the participating organizations. This story line went beyond the formal context of the project towards a discussion on spatial aspects of the place marketing activity. The central dynamic in this story line related to the balance between the positions of stakeholders within and outside regional centres. The sets of positioning acts identified in this story line relate to 1) the dominance of regional centres, and 2) physical proximity as a determinant for the distribution of positions.

Dominance of regional centers

Regional centres were positioned with a strong right to influence and to have visibility in the projects, which went beyond their large funding portions. For example, a representative from the educational sector in NS attributed regional centres with strong weight, more generally referring to their importance for the development of the surrounding region:

(excerpt 11) “The weight of the central city is important, because in today’s world it is like that … when we look at a large enough area, there is always the central city, and its success is also very important for the surrounding area” … Taking a very decentralised approach is not getting the message across in southern Finland. One needs to have a hook.”

In a similar manner, a representative from the educational sector in NK positioned regional centres with a strong right for visibility when discussing the focus of the place marketing activity:

(Excerpt 12) “If we look at [the project in] Northern Savonia, they have a different model, which focuses on the internationalisation of [the regional center of] Kuopio, which includes Tahko [a local skiing resort]. It is a conscious choice to talk about Kuopio [instead of Northern Savonia], while here we talk about North Karelia. In Northern Savonia it is accepted that the external view is dependent on the regional center and its image.”

Both representatives pointed to the broader discourse on the importance of growing urban centres for the external visibility and development of the regions. Relating to this, a recent OECD report (OECD, 2017) acknowledged that economic growth concentrates in a smaller number of cities that are normally capitals of their regions. According to report, the concentration process benefits the regions by increasing the size of functional labour markets by diversifying economics, as well as making the cities/regions more attractive for working age people. This indicates that the strong positioning of regional centres was not only based on the control of resources, but was also based on the more generally acknowledged significance of regional centres. This can be interpreted as form of discursive legitimacy (Hardy and Phillips, 1998). Indeed, regional centres were also attributed with a strong right for visibility in the projects by the representatives from outside the regional centres. For example, a municipal representative from NS, while expressing disillusionment, emphasised the significance of the regional center and its significance for the external image of the region:

(Excerpt 13) “Well, the emphasis is on Kuopio, that is, the Kuopio-Tahko axis … it doesn’t stir much passion here, and that is a problem: yes, I understand that when we talk about our region abroad or in Helsinki, we are kind of profiled as Kuopio-Tahko, I understand that.”

In a similar manner, a representative from an educational organization in NS referred to the discussion on the choice between concentrating on the regional centre or the region at large, and considered that a focus on the regional center was inevitable:

(Excerpt 14) “Interviewer: So, in a way the lead of [the regional centre of] Kuopio was accepted?” “Yes, this really has to be accepted, another option would have been to use the word “Northern Savonia” in this thing [the project] which maybe would have been easier to find from the map, but well.”

Spatial proximity to regional center

The second set of positioning acts in the spatial story line related to the positions attributed to stakeholders located outside of regional centres. While the strong regional centre was considered to reflect the benefits of the project for the region at large, these benefits appeared to decline with a growing distance from the centre. For example, a municipal representative from NS raised the point that the benefits of the project would go especially to those stakeholders located within a close spatial proximity to the regional centre:

(excerpt 15) “Of course, there is the matter of proximity, kind of a core perimeter. When we think about the Kuopio area, then it is probably 20–30 km around the centre of Kuopio, that is a more effective area where the positive effects are more visible … then when we go one hour’s distance away, the influence is more indirect”

The scepticism regarding the benefits of projects emanating beyond the regional centre was shared to some degree by most of the representatives in both cases. Indeed, many representatives located far from the regional centre considered that because of their peripheral location they have a duty to work more independently in order to get benefit out of the project. For example, a municipal representative from NS emphasised the relevance of independent effort in carrying out the place marketing activity:

(excerpt 16) “We should have our own themes that we want to highlight, and which we as a city are of course responsible for ourselves. Of course, we have tried to include our main themes in this regional marketing, and I suppose they are there in some form, but there have been different opinions on how visible they are in the end.”

Attributing positions to the stakeholders that are located outside of regional centres with a duty for independent effort was also visible in the case of NK. For example, a representative from the economic sector in NK brought this to attention, while discussing the role of sub-regional EDO’s in the project:

(excerpt 17) “Well let’s say, that [their] role has been a bit different, in a way, when we think about [the regional center of] Joensuu, as a working environment … physically present there is JOSEK, there is Karelia Expert and the Regional Council, and so forth. Then there are many organiations that are not physically present [in the regional center] - they are in Kitee [municipality in NK], in Pielinen-Karelia [a sub-region of NK], which, in a way, probably makes their role more peripheral, that’s how I see it, that physical proximity here provides for a clearer distribution of roles. Maybe these [sub-regional] EDO’s have to look after [themselves], because these other organizations are not physically present there.”

The representative attributed EDO’s located far from the regional center with a duty to ‘look after themselves’, in contrast with stakeholders located in the regional centre with access to the working environment and networks. The proximity between stakeholders also had an influence on the potential for a transfer of knowledge between them. For example, a representative of a sub-regional EDO raised this to attention by pointing out problems in the transfer of knowledge between stakeholders:

(excerpt 18) “That was probably the negative aspect [of the project] … when the Regional Council was raising funds [from local businesses] and had discussions with the companies, we did not really know what companies they had been visiting and what kind of conversations they had. I think in the future it would be important that the representative of a local EDO would be present.”

The representative pointed out problems in the flow of information coming from the project coordinator regarding the collecting of funding from local enterprises and the planning of the project. While this could be counted as an instance of inefficient communication on the part of the coordinator of the project, it further underlined the bias that exists with regard to access (or non-access) to face-to-face networks and the flow of information between stakeholders in collaboration in this story line. A geographical proximity between partners in the context of IOCs has been shown to facilitate face-to-face interaction (both planned and serendipitous), and also the transfer of knowledge (Torre and Rallet, 2005). The relevance of face-to-face interaction was also highlighted in recent place marketing literature by Omholt (2019) who emphasised the importance of face-to-face interaction for inclusive place marketing collaboration. This underlines the benefit of being physically located at the (physical) core of decision-making in the collaboration process, where the majority of partners are located.

Conclusions

The place marketing and branding literature has stressed the importance of stakeholder engagement for the success of place marketing and branding activities. However, tensions and biases have been identified in participation processes. Indeed, power dynamics between stakeholders have been considered as one of the most pressing issues in recent place marketing and branding literature. This study adds to this discussion on power dynamics in place marketing and branding by bringing attention to the normative aspects of power dynamics. Previous literature has emphasised the importance of communicative processes between stakeholders as a way of building common ground between them, but has not yet fully addressed the question of how power dynamics between stakeholders influence these processes. However, the question of why certain groups have a more privileged voice than others has been posed in the literature (Kasabov and Sundaram, 2013). In order to fill this gap, this study helps to uncover the power dynamics that unfold in communicative processes in place marketing collaboration. By applying positioning theory (Van Langenhove and Harré, 1999), the focus is on the distribution of positions, i.e. the sets of rights and duties in jointly constructed story lines, and their significance for power dynamics in inter-organizational place marketing collaborations. Hence, the study further adds to the literature by emphasising the importance of discourse in communicative processes between stakeholders (Lucarelli and Giovanardi, 2016).

The study at hand identified two prevalent story lines that concerned the formal and spatial aspects of the projects concerned. In the formal story line, positions between stakeholders were distributed by drawing from the formal and financial frames of the projects. Firstly, funding of the project required that half of the funding was covered by participating stakeholders. Thus, participating stakeholders granted varying portions of funding to the projects. The largest funders, which in case of both projects were regional centres, were attributed rights to exert influence in the projects, while stakeholders with lesser portions were attributed with the duty of respecting their voice. Secondly, both cases were specifically regional-scale projects based on ERDF funding, which resulted in that stakeholders from various parts of the region were formally entitled to be represented in the project, while project coordinators were attributed with the duty of ensuring this representation took place. Third, in the case of NK, the management of the project was distributed between separate sub-projects, which formed distinct centres of formal authority in the larger project. This meant that sub-projects were positioned with autonomous rights of budget and planning within the project. This led to a discussion on the degree of autonomy granted to sub-projects at the level of the whole project.

The second story line was based on the same premises as the first, but diverted focus to the spatial context of the projects. Firstly, regional centres were attributed with strong rights for influence and visibility across the board in both projects. This positioning was supported by broader societal discourse emphasising the significance of regional centres for the external visibility of the regions. Due to the societal influence of this discourse, stakeholders outside the regional centres were obliged to accept this positioning of the regional centres as inevitable. Secondly, the strong positioning of the regional center was extended also to the stakeholders in proximity to the regional centres, but diminished with growing distance. This became visible as scepticism regarding the benefits of the project by the stakeholders located far from regional center, who were attributed with a duty of working independently in order to gain benefits. Finally, the spatial proximity between stakeholders also influenced access to the face-to-face network and the transfer of knowledge, which was stronger with stakeholders in the regional center, and weaker with stakeholders outside of it.

The study has theoretical and practical implications for place marketing and branding practice. It highlights the normative aspects of power in inter-organizational place marketing collaborations. This adds to the knowledge on why certain groups are considered to have a more advantaged position than others, and why disadvantaged groups consider their positions as legitimate (Tan and Moghaddam, 1999). Secondly, the study brings attention to the relation between power dynamics and jointly constructed story lines. This offers a venue to understand how power dynamics are constructed within communicative processes between stakeholders in place marketing activities. Thirdly, story lines identified in the cases studied relate to formal and spatial contexts of the place marketing projects. Due to their general nature, they can also provide insights for the study of power dynamics in other contexts. Finally, the findings show the relevance of funding models, formal organization of projects, broader societal discourses and the spatial proximity between stakeholders as determining factors for the distribution of positions in collaborations. These findings indicate focal areas that can assist in identifying the underlying causes of power struggles in inter-organizational place marketing collaborations.

This study has some limitations that could be addressed in further research. Firstly, the potential of positioning theory to understand power dynamics in the context of place marketing collaboration is evident. However, the scope of the study was limited to certain a geographical and institutional context. While the findings are applicable to different contexts, this does not exclude the possibility of alternative story lines. Future studies on the communicative aspects of power dynamics could compare the findings of this paper to different geographic and institutional contexts, in order to find alternative story lines that may lie behind power dynamics. Secondly, while the significance of story lines behind power dynamics is emphasized in this paper, the ways in which they can be influenced by changing story lines is not addressed. Therefore, the study presents a call to evaluate what kind of story lines are supported in place marketing theory and practice, in order to provide a means to challenge the power dynamics that feature in place marketing and branding collaboration, and so mitigate the danger of place marketing becoming a tool for dominant groups to impose their views (Broudehoux, 2001). This also corresponds with a call for more inclusive place marketing and branding practices to be developed.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Juha Halme

Note

Juha Halme is a PhD candidate of human geography in the Department of Historical and Geographical studies at the University of Eastern Finland. His doctoral dissertation concentrates on the discursive dynamics in stakeholder collaboration in regional level place marketing projects. His academic interests include inter-organizational collaboration, qualitative methods, and discourse theory. His previous work has been presented at various international conferences and published in peer-reviewed journals, such as Journal of Place Management and Development and Qualitative Market Research.

References

Andreouli

(2010) Identity, positioning and self-other relations. Papers on Social Representations 19(1): 14.1–14.13.

Austin

(1961) How to Do Things with Words. Oxford: Clarendon Press.

Boisen

Terlouw

van

G B

(2011) The selective nature of place branding and the layering of spatial identities. Journal of Place Management and Development 4(2): 135–147.

Botschen

Promberger

Bernhart

(2017) Brand-driven identity development of places. Journal of Place Management and Development 10(2): 152–172.

Braun

Kavaratzis

Zenker

(2013) My city – My brand: The different roles of residents in place branding. Journal of Place Management and Development 6(1): 18–28.

Broudehoux

(2001) Image making, place marketing and the aesthetization of social inequality in Rio de Janeiro. In: Alsayyad

(ed.) Consuming Tradition, Manufacturing Heritage: Global Norms and Urban Forms in the Age of Tourism. London: Routledge, pp. 273–297.

Clegg

Kornberger

(2010) An organizational perspective on space and place branding. In: Go

Govers

(eds) International Place Branding Yearbook 2010: Place Branding in the New Age of Innovation. London: Palgrave Macmillan, pp. 3–11.

Davies

Harré

(1999) Positioning and personhood. In: Harré

Van Langenhove

(eds) Positioning Theory: Moral Contexts of Intentional Action. Oxford, UK: Blackwell. pp. 32–53.

Depperman

(2015) Positioning. In: De Fina

Georgakopoulou

(eds) The Handbook of Narrative Analysis. Chichester, UK: Wiley. pp. 369–387.

10.

Dinnie

(2018) Contingent self-definition and amorphous regions. Marketing Theory 18(1): 31–53.

11.

Eshuis

Edwards

(2013) Branding the city: The democratic legitimacy of a new mode of governance. Urban Studies 50(5): 1066–1082.

12.

Eshuis

Klijn

E-H

(2012) Branding in Governance and Public Management. London: Routledge.

13.

Eshuis

Braun

Klijn

, et al. (2018) The differential effect of various stakeholder groups in place marketing. Environment and Planning C: Politics and Space 36(5): 916–936.

14.

Fairclough

(1992) Discourse and text: Linguistic and intertextual analysis within discourse analysis. Discourse & Society 3(2): 193–217.

15.

Flowerdew

(2004) The discursive construction of a world-class city. Discourse & Society 15(5): 579–605.

16.

Flyvbjerg

(1998) Rationality and Power: Democracy in Practice. Chicago, IL: Chicago University Press.

17.

Foucault

(1972) The Archaeology of Knowledge. London: Tavistock.

18.

Freeman

(1984) Strategic Management: A Stakeholder Perspective. Boston: Pitman.

19.

Goulart Sztejnberg

Giovanardi

(2017) The ambiguity of place branding consultancy: Working with stakeholders in Rio de Janeiro. Journal of Marketing Management 33(5-6): 1–25.

20.

Gray

Hay

(1986) Political limits to interorganizational consensus and change. The Journal of Applied Behavioral Science 22(2): 95–112.

21.

Halme

(2017) Discursive construction of the legitimacy of a place marketing project: The case of North Karelia. Journal of Place Management and Development 10(1): 61–72.

22.

Halme

(2020) Constructing consensus and conflicts: Discursive dynamics in regional place marketing collaboration. Qualitative Market Research: An International Journal Epub ahead of print 31 March 2020. DOI: 10.1108/QMR-12-2017-0172.

23.

Hanna

Rowley

(2011) Towards a strategic place brand-management model. Journal of Marketing Management 27(5-6): 458–476.

24.

Hardy

Phillips

(1998) Strategies of engagement: Lessons from the critical examination of collaboration and conflict in an interorganizational domain. Organization Science 9(2): 217–230.

25.

Hardy

Phillips

(1999) No joking matter: Discursive struggle in the Canadian refugee system. Organization Studies 20(1): 1–24.

26.

Harré

Van Langenhove

The dynamics of social episodes. In: Harré R and Van Langenhove L (eds) Posi. (1999) Tioning Theory: Moral Contexts of Intentional Action. Blackwell. pp. 1–13.

27.

Harré

Moghaddam

Cairnie

, et al. (2009) Recent advances in positioning theory. Theory & Psychology 19(1): 5–31.

28.

Healey

(2007) On the social nature of planning. Planning Theory & Practice 8(2): 133–136.

29.

Himmelman

Arthur (1996) On the theory and practice of transformational collaboration: From social service to social justice. In: Huxham C (ed.) Creating Collaborative Advantage. SAGE, pp. 19–44.

30.

Hirvonen

(2016) Positioning theory and small-group interaction. SAGE Open 6(3): 215824401665558–215824401665515.

31.

Houghton

Stevens

(2011) City branding and stakeholder engagement city branding. In: Dinnie K (ed.) City Branding: Theory and Cases. Basingstoke: Palgrave Macmillan.

32.

Jensen

(2007) Culture stories. Planning Theory 6(3): 211–236.

33.

Kalandides

(2011) City marketing for Bogotá: A case study in integrated place branding. Journal of Place Management and Development 4(3): 282–291.

34.

Kasabov

Sundaram

(2013) A stakeholder approach to branding clusters: Pointers to a research agenda. Regional Studies 47(4): 530–543.

35.

Kavaratzis

(2012) From ‘necessary evil’ to necessity: Stakeholders’ involvement in place branding. Journal of Place Management and Development 5(1): 7–19.

36.

Kavaratzis

Hatch

(2013) The dynamics of place brands: An identity-based approach to place branding theory. Marketing Theory 13(1): 69–86.

37.

Kavaratzis

Kalandides

(2015) Rethinking the place brand: The interactive formation of place brands and the role of participatory place branding. Environment and Planning A: Economy and Space 47(6): 1368–1382.

38.

Klijn

E-H

Eshuis

Braun

(2012) The influence of stakeholder involvement on the effectiveness of place branding. Public Management Review 14(4): 499–519.

39.

Knoben

Oerlemans

LAG

(2006) Proximity and inter-organizational collaboration: A literature review. International Journal of Management Reviews 8(2): 71–89.

40.

Lawrence

Phillips

Hardy

(1999) Watching whale watching: Exploring the discursive foundations of collaborative relationships. The Journal of Applied Behavioral Science 35(4): 479–502.

41.

Lucarelli

Giovanardi

(2016) The political nature of brand governance: A discourse analysis approach to a regional brand building process. Journal of Public Affairs 16(1): 16–27.

42.

Marzano

Scott

(2009) Power in destination branding. Annals of Tourism Research 36(2): 247–267.

43.

Massey

(2009) Concepts of space and power in theory and in political practice. Documents D’anàlisi Geogràfica 55: 15–26.

44.

Messely

Dessein

Rogge

(2015) Behind the scenes of place branding: Unraveling the selective nature of regional branding. Tijdschrift Voor Economische en Sociale Geografie 106(3): 291–306.

45.

Ministry of EA and Employment (2014), Laki alueiden kehittämisestä [law on regional development]. Available at: www.finlex.fi/fi/laki/alkup/2014/20140007 (accessed 13 February 2020).

46.

Moghaddam

Harré

Lee

(eds) (2007) Global Conflict Resolution through Positioning Analysis. New York: Springer.

47.

OECD (2017) OECD Territorial Reviews: Northern Sparsely Populated Areas. Paris: OECD Publishing.

48.

Omholt

(2019) Strategies for inclusive place making. Journal of Place Management and Development 12(1): 2–19.

49.

Ooi

C-S

Pedersen

(2010) City branding and film festivals: Re-evaluating stakeholder’s relations. Place Branding and Public Diplomacy 6(4): 316–332.

50.

Rinaldi

Cavicchi

(2016) Cooperative behaviour and place branding: A longitudinal case study in Italy. Qualitative Market Research: An International Journal 19(2): 156–172.

51.

Ripoll Gonzalez

Lester

(2018) All for one, one for all’: Communicative processes of cocreation of place brands through inclusive and horizontal stakeholder collaborative networks. Communication & Society 31(4): 59–78.

52.

Ritzer

(ed.) (2005) Encyclopedia of Social Theory Volume 1. London: SAGE.

53.

Slocum

Van Langenhove

(2003) Integration speak: Introducing positioning theory in regional integration studies. In: Harré

Moghaddam

(eds) The Self and Others: Positioning Individuals and Groups in Personal, Political, and Cultural Contexts. Westport, CT: Praeger. pp. 219–210.

54.

Slocum

Van Langenhove

(2004) The meaning of regional integration: Introducing positioning theory in regional integration studies. Journal of European Integration 26(3): 227–252.

55.

Slocum-Bradley

(2010a) Identity construction in Europe: A discursive approach. Identity 10(1): 50–68.

56.

Slocum-Bradley

(2010b) The positioning diamond: A trans-disciplinary framework for discourse analysis. Journal for the Theory of Social Behaviour 40(1): 79–107.

57.

Slocum-Bradley

Van Langenhove

(2006) Legitimisation and expressions of identity and attitude: A discursive approach. UNU-CRIS Occasional Papers O-2006/12.

58.

Stubbs

Warnaby

(2015) Rethinking place branding from a practice perspective: Working with stakeholders. In: Kavaratzis

Warnaby

, and Ashworth

(eds) Rethinking Place Branding: Comprehensive Brand Development for Cities and Regions. Cham: Springer. pp. 101–118.

59.

Tan

S-L

Moghaddam

(1999) Positioning in intergroup relations. In. : Harré R and Langenhove L van (eds) Positioning Theory: Moral Contexts of Intentional Action. Oxford, UK: Blackwell. pp. 178–194.

60.

Torre

Rallet

(2005) Proximity and localization. Regional Studies 39(1): 47–59.

61.

Van Langenhove

Harré

(1999) Introducing positioning theory. In. Harré R and Langenhove L van (eds) Positioning Theory: Moral Contexts of Intentional Action. Oxford, UK: Blackwell. pp. 14–32.

62.

Warnaby

(2009) Towards a service-dominant place marketing logic. Marketing Theory 9(4): 403–423.

63.

Warnaby

Medway

(2013) What about the ‘place’ in place marketing. Marketing Theory 13(3): 345–363.

64.

Yin

(2014) Case Study Research: Design and Methods. Los Angeles: SAGE.

Representation and power – Discursive constructions of stakeholder positions in regional place marketing collaboration

Abstract

Keywords

Introduction

Literature review

Representation of stakeholders in place marketing

Discursive construction of stakeholders and their roles in collaboration

Positioning theory

Positioning triangle

Limitations of positioning and relation to power

Study design

Methodology

Research procedure

Findings

Formal story line

Distribution of funding

Regional scope

Formal organization of the projects

Spatial story line

Dominance of regional centers

Spatial proximity to regional center

Conclusions

Footnotes

Declaration of conflicting interests

Funding

ORCID iD

Note

References