Attitudes to living and working in pandemic conditions among emergency prehospital medical care personnel

Introduction: Little is known about the risk perceptions and attitudes of healthcare personnel, especially of emergency prehospital medical care personnel, regarding the possibility of an outbreak or epidemic event. Problem: This study was designed to investigate pre-event knowledge and attitudes of a national sample of the emergency prehospital medical care providers in relation to a potential human influenza pandemic, and to determine predictors of these attitudes. Methods: Surveys were distributed to a random, cross-sectional sample of 20% of the Australian emergency prehospital medical care workforce (n = 2,929), stratified by the nine services operating in Australia, as well as by gender and location. The surveys included: (1) demographic information; (2) knowledge of influenza; and (3) attitudes and perceptions related to working during influenza pandemic conditions. Multiple logistic regression models were constructed to identify predictors of pandemic-related risk perceptions. Results: Among the 725 Australian emergency prehospital medical care personnel who responded, 89% were very anxious about working during pandemic conditions, and 85% perceived a high personal risk associated with working in such conditions. In general, respondents demonstrated poor knowledge in relation to avian influenza, influenza generally, and infection transmission methods. Less than 5% of respondents perceived that they had adequate education/training about avian influenza. Logistic regression analyses indicate that, in managing the attitudes and risk perceptions of emergency prehospital medical care staff, particular attention should be directed toward the paid, male workforce (as opposed to volunteers), and on personnel whose relationship partners do not work in the health industry. Conclusions: These results highlight the potentially crucial role of education and training in pandemic preparedness. Organizations that provide emergency prehospital medical care must address this apparent lack of knowledge regarding infection transmission, and procedures for protection and decontamination. Careful management of the perceptions of emergency prehospital medical care personnel during a pandemic is likely to be critical in achieving an effective response to a widespread outbreak of infectious disease.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Knowledge and attitudes of paediatric nurses related to breastfeeding

Introduction: Almost 90% of Australian mothers are exclusively breastfeeding when they discharge from maternity hospitals but by six months of age breastfeeding infants have reduced to 32% nationally and 19% in Queensland, far below the national target of 80%. Many factors influence the choice to breastfeed, including health care provision, therefore the knowledge and attitudes of paediatric nurses have the potential to affect breastfeeding duration. Aims: To assess current breastfeeding knowledge and attitudes of paediatric nurses in metropolitan and regional Queensland settings. Method: The study used a cross-sectional survey design. The tool was developed from several documented health professional questionnaires about breastfeeding, with permission from authors. Survey items relating breastfeeding physiology, factors relating to breastfeeding success, and local, national and international policies were also included. Ethics approval was granted from the appropriate Ethics Committees to conduct the survey through tertiary metropolitan and regional hospital settings. Results: A total of 241 surveys were returned, achieving a response rate of 53%. Nurses acknowledged breastmilk as the best source of nutrition for infants (99%, n=238) and that mothers should be encouraged to breastfeed (92%, n=221). However, many respondents considered infant formula a nutritional equivalent (44%, n=105) and (47%, n=113) were unaware that supplemental formulas interfered with successful breastfeeding. Most nurses recognised that stress (e.g. infant hospitalisation) impacts on the success of breastfeeding (90%, n=216). Knowledge of breastfeeding anatomy and physiology was poor and a substantial number of nurses did not identify correct attachment in response to two diagrammatic representations (76%, n=183 and 45%, n=109). Survey results demonstrated deficiencies in knowledge that would impact on support provided to breastfeeding mothers. Knowledge deficits were also identified relating to local, national and international policies and protocols concerning breastfeeding and breastmilk substitutes. Conclusion: Breastfeeding knowledge and attitudes were exceptional in areas related to general breastfeeding knowledge. However, in areas directly related to nursing practice, considerable deficits in paediatric nurses' knowledge and attitudes were identified. Lack of appropriate skills, knowledge and varying attitudes amongst paediatric nurses has the potential to negatively impact on the education, advice and support provided to breastfeeding mothers and their families whilst their infant is in hospital. These study findings will guide future research and strategies to improve knowledge and policy statements to assist paediatric nurses in fulfilling their role.

Ambulance use is associated with higher self-rated illness seriousness : user attitudes and perceptions

Objectives The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia. Methods A cross-sectional survey was conducted of patients (n = 911) presenting via ambulance or self-transport at eight public hospital emergency departments (EDs). The survey included perceived illness severity, attitudes toward ambulance, and reasons for using ambulance. A theoretical framework was developed to inform this study. Results Ambulance users had significantly higher self-rated perceived seriousness, urgency, and pain than self-transports. They were also more likely to agree that ambulance services are for everyone to use, regardless of the severity of their conditions. In compared to self-transports, likelihood of using an ambulance increased by 26% for every unit increase in perceived seriousness; and patients who had not used an ambulance in the 6 months prior to the survey were 66% less likely to arrive by ambulance. Patients who had presented via ambulance stated they considered the urgency (87%) or severity (84%) of their conditions as reasons for calling the ambulance. Other reasons included requiring special care (76%), getting higher priority at the ED (34%), not having a car (34%), and financial concerns (17%). Conclusions Understanding patients' perceptions is essential in explaining their actions and developing safe and effective health promotion programs. Individuals use ambulances for various reasons and justifications according to their beliefs, attitudes, and sociodemographic conditions. Policies to reduce and manage demand for such services need to address both general opinions and specific attitudes toward emergency health services to be effective.

Carers' hope, wellbeing and attitudes regarding recovery

Carers are important to the recovery of their relatives with serious mental disorder however, it is unclear whether they are aware of, or endorse recent conceptualisations of recovery. This study compared carers’ and mental health workers’ recovery attitudes, and undertook multivariate predictions of carers’ wellbeing, hopefulness and recovery attitudes. Participants were 82 Australian family members caring for a relative with psychosis. Carers’ average recovery attitudes were less optimistic than for previously surveyed staff. Carers’ recovery attitudes were predicted by perceptions that their relative’s negative symptoms were more severe. Hopefulness and wellbeing was predicted by more positive and less negative caregiving experiences. Hopefulness was also predicted by less frequent contacts with their affected relative, and unexpectedly, by perceptions of more severe psychotic symptoms. Carers’ wellbeing was further predicted by having a partner and having no lifetime history of a mental disorder. Hope and wellbeing are affected by everyday challenges and positive experiences of caregiving.

Like? Advertising practitioners views of social media as an advertising research tool

Given that both academics and marketers are dissatisfied with the current state of advertising research (Kerr and Schultz, 2010; Neff, 2011), the objective of this exploratory paper is to determine the position of world-leading advertising professionals on the use of social media to test, track and evaluate campaigns. Using Delphi methodology, an international panel of Cannes Gold Lion winners acknowledged that social media research has both strengths and weaknesses, the same as any research. Its strengths are its intimacy and spontaneity, bringing the brand and consumer closer. The real risk is the loss of control in this research environment.

Self-reported likelihood of speeding : the effects of attitudes, personality, and perceived legitimacy of enforcement

The positive relationship between speed and crash risk and severity is robust and well-established. While excessive speeding is typically regarded by the public as a common contributing factor in road crashes, speeding remains a common traffic infringement and an arguably socially acceptable behaviour, particularly at low levels over the speed limit. This suggests that other factors potentially contribute to this disparity between crash perceptions and actual behaviours. Previous work has described associations between perceptions of the legitimacy of speed enforcement, attitudes, and how they relate to the likelihood of speeding. This study sought to more closely examine the nature of the relationships between these variables. In total, 293 Queensland drivers participated in a study that examined how demographics, personality variables, attitudes, and perceptions of the legitimacy of enforcement contributed to drivers’ self-reported likelihood of speeding. Results suggested that positive attitudes towards speeding had the greatest impact on likelihood of speeding behaviours. Being younger and higher levels of the personality trait of extraversion were also associated with greater levels of self-reported likelihood of speeding. Attitudes were found to mediate the relationship between perceived legitimacy of speed enforcement and self-reported likelihood of speeding. A subgroup analysis of participants with positive and negative attitudes towards speeding revealed that a differential set of variables were predictive of self-reported likelihood of speeding for the two subgroups. This highlights the potential importance of attitudes in understanding the influence of perceptions of legitimacy of speed enforcement on speeding behaviour, and the need for targeted rather than a ‘one size fits all’ approach to changing attitudes and ultimately behaviour. The findings of the current study help to further understand why some drivers continue to speed.

Impact of a school-based food garden on attitudes and identification skills regarding vegetables and fruit : a 12-month intervention trial

Objective To determine changes in ability to identify specific vegetables and fruits, and attitudes towards vegetables and fruit, associated with the introduction of a school-based food garden. Design A 12-month intervention trial using a historical control (control n 132, intervention n 120), class-based, self-administered questionnaires requiring one-word answers and 3-point Likert scale responses. Setting A state primary school (grades 4 to 7) in a low socio-economic area of Brisbane, Australia. Intervention The introduction of a school-based food garden, including the funding of a teacher coordinator for 11 h/week to facilitate integration of garden activities into the curriculum. Main outcome measures Ability to identify a series of vegetables and fruits, attitudes towards vegetables and fruit. Analysis Frequency distributions for each item were generated and χ2 analyses were used to determine statistical significance. Exploratory factor analysis was employed to detect major trends in data. Results The intervention led to enhanced ability to identify individual vegetables and fruits, greater attention to origins of produce (garden-grown and fresh), changes to perceived consumption of vegetables and fruits, and enhanced confidence in preparing fruit and vegetable snacks, but decreased interest in trying new fruits. Conclusions The introduction of this school-based food garden was associated with skill and attitudinal changes conducive to enhancing vegetable and fruit consumption. The ways in which such changes might impact on dietary behaviours and intake require further analysis.

I’m friends with Louie the Fly, not Mortein : Conceptualising the new brand relationships on social media

Spokes-characters are ‘...animated beings or objects, created to promote a product, service or idea’ (Phillips 1996, p.155). They were first used in the late 1800s when they emerged as registered trademarks, but the use of spokes-characters for marketing communications has since grown, owing to their ability to remind consumers about a product, transfer positive associations to a brand, and give a corporate company a more ‘personal’ face (Callcott and Lee 1995). One example is the Michelin Man, who has served as spokes-character for Michelin tyres since 1898, after starting out in print advertising. Spokes-characters have become important brand representatives, no longer seen as simply entertaining cartoons featured in television and magazine advertisements. Corporations have now extended their use to interactive, social media platforms, where a consumer can be ‘friends’ with a spokes-character via Facebook, read their comments on the latest iPhone release through Twitter, and watch their family histories being documented on YouTube (see Figure 1). The interactions that consumers once had with two-dimensional spokes-characters have undergone significant transformation in the digital space. With spokes-character Facebook pages achieving significant numbers of ‘likes’ and interactions with consumers, one question concerns whether this strategy is creating characters that are more engaging than the brands they represent, and what impact this has on brand outcomes.

A survey of the Queensland healthcare workforce : attitudes towards dementia care and training

Background Positive attitudes of healthcare staff towards people with dementia promote higher quality care, although little is known about important factors that underlie positive attitudes. Key aims of this project were to explore the relationships between staff attitudes towards dementia, self-confidence in caring for people with dementia, experience and dementia education and training. Method A brief online survey was developed and widely distributed to registered nurses and allied health professionals working in Queensland in 2012. Regression analyses were performed to identify important predictors of self-confidence in caring for people with dementia and positive attitudes towards people with dementia. Results Five hundred and twenty-four surveys were completed by respondents working in a range of care settings across Queensland. Respondents were predominantly female (94.1%), and most were registered nurses (60%), aged between 41 and 60 years (65.6%). Around 40% regularly worked with people with dementia and high levels of self-confidence in caring for this population and positive attitudes towards people with dementia were reported. The majority of respondents (67%) had participated in a dementia education/training activity in the past 12 months. More experience working with people with dementia predicted greater self-confidence while recent participation in a dementia education/training and higher self-confidence in caring for a person with dementia significantly predicted more positive attitudes towards people with dementia. Conclusion These results confirm the importance of self-confidence and dementia education in fostering positive attitudes and care practices towards people with dementia. Our results also indicate that the demand for ongoing dementia education is high amongst health care workers and it is recommended that regular dementia education/ training be provided and promoted for all healthcare personnel who work with people with dementia.

Understanding service firms brand value creation : a multilevel perspective including the overarching role of service brand marketing capability

Purpose This study seeks to extend the existing literature on value creation by specifically focusing on service brand value creation (SBVC) and the role of brand marketing. Design/methodology/approach The authors first develop a model of SBVC and simultaneously investigate SBVC from the firm perspective (service brand value offering – SBVO) and from the customer perspective (service brand perceive value-in use – SBPVI). Subsequently, they investigate the effects of SBVO on SBPVI and integrate the moderation role of service brand marketing capability (SBMC) on the relationship between SBVO-SBPVI outcomes. SBVO is viewed as the firms' interpretation of and responsiveness to customer requirements via the delivery of superior performance the value offering through the service brand and SBPVI customers' perceived value from the firms' service brand. The contributions of SBVC to customer-based performance outcomes are then investigated. Hypotheses were tested using a sample of the senior managers of service firms in Cambodia and their customers. A survey was used to gather data via a drop-and-collect approach. Findings Results indicated that SBVO is positively related to SBPVI and SBPVI is positively related to customer-based performance. Noticeably, the results revealed that SBMC enhances the positive relationship between the firm SBVO and the customers SBPVI. Originality/value The paper extends the previous literature on value creation to capture SBVC. More significantly, the premise of the theoretical framework provides a breakthrough in the current SBVC literature which has so far neglected to take into account the dyadic approach (firm-customer) in understanding value creation and more specifically SBVC. The model is expanded by looking at the contingency role of SBMC in communicating value to customers.

Children's advertising literacy for advergames : perception of the game as advertising

This study examined whether children recognized advergames as a type of advertising and the efficacy of an advertising literacy program. Results indicated that without the advertising literacy education, about three-quarters of the children did not recognize advergames as a type of advertising. However, those with advertising literacy education showed a significantly enhanced understanding. Also, a series of mediation tests showed that recognition of advertising was an indirect-only mediator between the advertising literacy and skeptical attitudes toward advertising. Only those who viewed the advergame as a type of advertising demonstrated more skeptical attitudes toward it.

An exploration of advertising engagement, advertising avoidance and privacy concerns on social networking sites

This thesis examines perceptions of advertising on social networking sites (SNS), in particular consumers' privacy concerns, advertising engagement and advertising avoidance. It contributes to the understanding of social media by providing results of a longitudinal investigation of consumer perceptions of advertising, a topography of engagement and avoidance triggers and a three dimensional model of advertising avoidance on SNS. This research used a mixed methodology, employing Critical Incident Technique, In-depth interviews and online surveys.

Experiential brand deployment : improving tourism brand evaluations

This article examines the use of an experiential branding process to help leisure resort businesses evaluate their brand. We integrate experiential marketing and the quality function development approach in combination to help understand the brand from the perspectives of both the consumer and firm, to help resort service businesses build their experience-oriented competitive brands. The value of this study is that it provides a real-world brand framework, especially those resorts with limited resources. Much is spoken about the influence of the brand and why it is important, but little is known about decisions related to developing a brand, especially for firms that have limited resources such as resort tourism operators. Tourism operators tend to be small-to-medium enterprises that do not necessarily have the capacity to do everything suggested. Therefore, we explore how firms assess the critical elements of their brand by using an integrated approach. For example, the study finds that, first, by using the quality function development method resorts can identify the most critical brand elements, and second, we identify the associated strengths of each brand element and confirm the identified resort’s critical brand elements for investment. Results show the potential strategies to create a more holistic set of experiences.

Organisational age cultures: The interplay of chief executive officers age and attitudes toward younger and older employees

This article investigates the interactive effects of chief executive officer (CEO) age and CEO attitudes toward younger and older employees on organisational age cultures. Data was collected from 66 CEOs of small and medium-sized businesses and 274 employees. Results were consistent with expectations based on organisational culture and upper echelons theories. The relationship between CEO age and organisational age culture for younger employees was negative for CEOs with a less positive attitude toward younger employees and positive for those with a more positive attitude toward younger employees. The relationship between CEO age and organisational age culture for older employees was positive for CEOs with a more positive attitude toward older employees and non-significant for those with a less positive attitude toward older employees. The findings provide initial support for the existence of organisational age cultures, suggesting that these cultures can be predicted by the interplay of CEO age and age-related attitudes.