When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

Grounded theory of nursing's contribution to inpatient rehabilitation

There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution. Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory. The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity. From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.

Investigation into the diffusion of innovation in technical and further education : implementing e-mail through action research

This research project examined the diffusion of change within one Victorian TAFE Institute by engaging action research to facilitate implementation of e-mail technology. The theoretical framework involving the concepts of technology innovation and action research was enhanced with the aid of Rogers's (1983) model of the diffusion of the innovation process. Political and cultural factors made up the initiation phase of innovation, enabling the research to concentrate on the implementation phase of e-mail Roger's (1983) model also provided adopter categories that related to the findings of a Computer Attitude Survey that was conducted at The School of Mines and Industries Ballarat (SMB), now the University of Ballarat—TAFE Division since amalgamation on 1st January 1998. Despite management rhetoric about the need to utilise e-mail, Institute teaching staff lacked individual computers in their work areas and most were waiting to become connected to the Internet as late as 1997. According to the action research reports, many staff were resistant to the new e-mail facilities despite having access to personal computers whose numbers doubled annually. The action research project became focussed when action researchers realised that e-mail workshop training was ineffective and that staff required improved access. Improvement to processes within education through collaborative action research had earlier been achieved (McTaggart 1994), and this project actively engaged practitioners to facilitate decentralised e-mail training in the workplace through the action research spiral of planning, acting, observing and reflecting, before replanning. The action researchers * task was to find ways to improve the diffusion of e-mail throughout the Institute and to develop theoretical constructs. My research task was to determine whether action research could successfully facilitate e-mail throughout the Institute. A rich literature existed about technology use in education, technology teaching, gender issues, less about computerphobia, and none about 'e-mailphobia \ It seemed appropriate to pursue the issue of e-mailphobia since it was marginalised, or ignored in the literature. The major political and cultural influences on the technologising of SMB and e-mail introduction were complex, making it impossible to ascertain the relative degrees of influence held by Federal and State Governments, SMB's leadership or the local community, Nonetheless, with the implementation of e-mail, traditional ways were challenged as SMB's culture changed. E-mail training was identified as a staff professional development activity that had been largely unsuccessful. Action research is critical collaborative inquiry by reflective practitioners who are accountable for making the results of their inquiry public and who are self-evaluating of their practice while engaging participative problem-solving and continuing professional development (Zuber-Skerritt 1992, 1993). Action research was the methodology employed in researching e-mail implementation into SMB because it involved collaborative inquiry with colleagues as reflective practitioners. Thoughtful questions could best be explored using deconstructivist philosophy, in asking about the noise of silence, which issues were not addressed, what were the contradictions and who was being marginalised with e-mail usage within SMB. Reviewing literature on action research was complicated by its broad definition and by the variability of research (King & Lonnquist 1992), and yet action research as a research methodology was well represented in educational research literature, and provided a systematic and recognisable way for practitioners to conduct their research. On the basis of this study, it could be stated that action research facilitated the diffusion of e-mail technology into one TAFE Institute, despite the process being disappointingly slow. While the process in establishing the action research group was problematic, action researchers showed that a window of opportunity existed for decentralised diffusion of e-mail training,in preference to bureaucratically motivated 'workshops. Eight major findings, grouped under two broad headings were identified: the process of diffusion (planning, nature of the process, culture, politics) and outcomes of diffusion (categorising, e-mailphobia, the survey device and technology in education). The findings indicated that staff had little experience with e-mail and appeared not to recognise its benefits. While 54.1% did not agree that electronic means could be the preferred way to receive Institute memost some 13.7% admitted to problems with using the voice answering service on telephones. Some 43.3% thought e-mail would not improve their connectedness (how they related) to the Institute. A small percentage of staff had trouble with telephone voice-mail and a number of these were anxious computer users. Individualised tuition and peer support proved helpful to individual staff whom action researchers believed to be 'at risk', as determined from the results of a Computer Attitude Survey. An instructional strategy that fostered the development of self-regulation and peer support was valuable, but there was no measure of the effects of this action research program, other than in qualitative terms. Nevertheless, action research gave space to reflect on the nature of the underlying processes in adopting e-mail. Challenges faced by TAFE action researchers are integrally affected by the values within TAFE, which change constantly and have recently been extensive enough to be considered as a 'new paradigm'. The influence of competition policy, the training reform agenda and technologisation of training have challenged traditional TAFE values. Action research reported that many staff had little immediate professional reason to use e-mail Theoretical answers were submerged beneath practical professional concerns, which related back to how much time teachers had and whether they could benefit from e-mail. A need for the development of principles for the sound educational uses of e-mail increases with the internationalisation of education and an increasing awareness of cultural differences. The implications for conducting action research in TAFE are addressed under the two broad issues of power and pedagogy. Issues of power included gaining access, management's inability to overcome staff resistance to technology, changing TAFE values and using technology for conducting action research. Pedagogical issues included the recognition of educational above technological issues and training staff in action research. Finally, seventeen steps are suggested to overcome power and pedagogical impediments to the conduct of action research within TAFE. This action research project has provided greater insight into the difficulties of successfully introducing one culture-specific technology into one TAFE Institute. TAFE Institutes need to encourage more action research into their operations, and it is only then that -we can expect to answer the unanswered questions raised in this research project.

Helping teachers surf the information and communication technology tsunami

A range of factors, both internal and external, is creating changes in teaching and teachers’ professional lives. Information and Communication Technology (ICT) is just one of the major changes impacting on the teaching profession. As teachers face intense pressure to adapt to this tsunami, this study aims to investigate ways in which teachers can be helped. In South Australia, where this study is set, all teachers in Government schools are expected to be "ICT Smart", i.e. able to use appropriate forms of ICT to enhance the teaching and learning environment of their classrooms. From the researcher’s involvement for over a decade in professional development for teachers, and from visits to many schools, it appears that numerous teachers have not reached this standard. The greatest need is in Reception to Year 7 schools where the average age of teachers is nearly 50. Because no state-wide data exists, this study is intended to establish if there is a problem and if there is, to identify specific needs and offer possible solutions. The study is comprised of four parts: Part A, the Introduction gives an overview of the inter-relationships between these parts and the overall Folio. It establishes the setting and provides a rationale for the study and its focus on Professional Development in Information and Communication Technology. Part B, the Elective Research Studies, follows the writer’s involvement in this field since the 1980s. It establishes the theme of "Moving best practice in ICT from the few to the many" which underlies the whole study. Part C, the Dissertation, traces the steps taken to investigate the need for professional development in ICT. This is achieved by analysing and commenting on data collected from a state-wide survey and a series of interviews with leading figures, and by providing a review of the relevant literature and past and existing models of professional development. Part D, Final Comments, provides an overview of the whole Folio and a reflection on the research that has been conducted. The findings are that there is widespread dissatisfaction with existing models and that there is an urgent need for professional development in this area, because nearly 20% of teachers either do not use computers or are considered to be novice users. Another 25% are considered to be below not yet "ICT Smart". Less than 10% of ICT co-ordinators have a formal qualification in the field but more than 85% of them are interested in a Masters program. The study offers solutions in Part B where there is a discussion of a range of strategies to provide on-going professional development for teachers. Chapter 9 provides an outline of a proposed Masters level program and offers suggestions on how it could be best delivered. This program would meet the identified needs of ICT co-ordinators. The study concludes with a series of recommendations and suggestions for further research. The Education Department must address these urgent professional development needs of teachers, particularly those in the more remote country regions. There needs to be a follow-up survey to establish to what extent teachers in South Australia are now "ICT Smart ".

Getting your life back on track after stroke : a phase II multi-centered, single-blind, randomized, controlled trial of the Stroke Self-Management Program vs. the Stanford Chronic Condition Self-Management Program or standard care in stroke survivors

Background Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease. There are no established and evidence-based stroke-specific chronic disease self-management programs. Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II randomized-controlled clinical trial.
Methods Stroke survivors are recruited from a variety of sources including: hospital stroke services, local paper advertisements, Stroke South Australia newsletter (volunteer peer support organization), Divisions of General Practice, and community service providers across Adelaide, South Australia. Subjects are invited to participate in a multi-center, single-blind, randomized, controlled trial. Eligible participants are randomized to either;
• standard care,
• standard care plus a six week generic chronic condition self-management group education program, or,
• standard care plus an eight week stroke specific self-management education group program.
Interventions are conducted after discharge from hospital. Participants are assessed at baseline, immediate post intervention and six months.
Study Outcomes The primary outcome measures determine study feasibility and safety, measuring, recruitment, participation, compliance and adverse events.
Secondary outcomes include:
• positive and active engagement in life measured by the Health Education Impact Questionnaire,
• improvements in quality of life measured by the Assessment of Quality of Life instrument,
• improvements in mood measured by the Irritability, Depression and Anxiety Scale,
• health resource utilization measured by a participant held diary and safety.

Conclusion The results of this study will determine whether a definitive Phase III efficacy trial is justified.

Chronic disease self-management programs : perspectives on enablers and barriers to GP and patient engagement

Aims & rationale/Objectives : Chronic disease self-management programs (CDSMP) are increasingly being integrated into the health system to improve the care of people with chronic conditions. Despite activity at both policy and program levels, GPs as the 'gatekeepers' to the health system have generally not been well informed or engaged in this process. This study, in collaboration with 3 Victorian Divisions of General Practice, sought both GP and patient perspectives on enablers and barriers to engagement in self-management programs.
Methods : Interviews were conducted with GPs (n=20) and consumers (n=45) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.
Principal findings : Lack of education/information and uncertainty about the effectiveness of self-management programs were key barriers for both GP and patient engagement. Programs that were sustainable and utilised existing community resources were viewed as enablers to increase uptake. GP and patient preferences for disease specific or generic CDSMP differed.
Discussion : Outcomes from the recent Council of Australian Governments' meeting suggest that self-management will be a centerpiece in forthcoming chronic disease initiatives. International evidence has highlighted the need for GP and patient engagement as critical in ensuring the recruitment of a critical mass of individuals to participate in CDSMP to ensure the sustainability of such initiatives. Insight from this study indicates that GPs and patients are not well informed about self-management, have different preferences to current policy trends and identifies several other barriers which need to be addressed if CDSMP are to be successful.
Implications : Identification of barriers and enablers of GP and patient engagement in self-management is essential in shaping current policy initiatives and delivery of future programs. This is supported by international evidence which indicates strongly that GP engagement in particular is crucial to the success of these programs.
Presentation type : Paper

Acceptability, impact and sustainability of the national pilot quality assurance system for self management programs

Chronic condition self-management education and training interventions such as the Stanford Self Management Programs (SMP) have the capacity to improve health and quality of life of people with chronic conditions whilst reducing the use of health services. This is in line with the outcomes from the recent Council of Australian Governments’ meeting where it was indicated that self-management will be a centrepiece in forthcoming chronic disease initiatives.
Aim: report on a large national pilot quality assurance program involving the implementation and of an evaluation and quality monitoring system for SMPs including the provision of structured feedback to courses course leaders and service providers. During 2005/06 the quality assurance program was implemented at 11 diverse organisations across Australia. The program involved assisting organisations apply the 42-item Health Education Impact Questionnaire (HEIQ), a chronic disease health education outcome measure, and then observe and evaluate the value and impact of the quality program. Interviews with course leaders (n=60) and course participants (n=35) have elicited views about course quality and feedback processes.
Results: The evaluation revealed enablers and barriers to effective implementation and sustainability. Important enablers were:
- Course Leaders and organisations valued an Australia-wide system that provided feedback on course
quality and the impact on participants.
- Course Leaders were strongly personally motivated to respond appropriately to HEI-Q course
report feedback.
- Completing the questionnaire provided participants with the opportunity to reflect on issues that
emerge in the course content and reflect on their progression at the end of the SSMP.
Sustainability issues included:
- Organisations and course leaders require support, training and flexibility on how to administer and
manage the use of the HEI-Q.
- Availability of administrative resources in organisations to support the quality assurance activities.
- The requirement that course leaders are trained in interpreting HEI-Q course report data.
A quality improvement framework was developed which identified the actions required of key stakeholders to
support effective implementation.
Discussion: With the increasing endorsement of SMP across sectors it is important that course quality is known, is acceptable, and is communicated to stakeholders to inform and engender confidence in the SSMP. To effectively implement and sustain a quality improvement program for SMP, the processes and tools for measuring outcomes need to be responsive, flexible and easily integrated into the organisation and delivery of programs.

Who benefits most from participating in chronic disease self-management programs?

Objectives: To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.
Research Design: People with a wide range of chronic conditions attending self-management courses (N=1,341 individuals) were administered the generic Health Education Impact Questionnaire (HEI-Q). Data were collected before the first session (baseline) and at the end of courses (follow-up) resulting in 842 complete responses. The median (interquartile range) age was 64 (54 to 73) years and most participants were female (75%). Outcomes were categorized as Substantial improvement (Effect Size, ES ≥ 0.5), Minimal/No change (ES -0.49 to 0.49) and Substantial decline (ES ≤ -0.5).
Results: On average, one third of participants reported substantial benefits after attending a self-management course. Proportions of participants reporting substantial benefits ranged from 49% in Skill and technique acquisition to 27% in Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.
Conclusions: Given that the health of people with chronic diseases tends to decline, this evaluation is reassuring in that about one third of participants coming from a wide range of backgrounds receive substantial improvements in their self-management skills.

Protecting web services from distributed denial of service attacks

The outcome of the research was the development of three network defence systems to protect corporate network infrastructure. The results showed that these defences were able to detect and filter around 94% of the DDoS attack traffic within a matter of seconds.

Self-taught approach to teaching with computers : a case study

The study has investigated the pedagogy of teachers with litle or no training in computer use. The value of a self-taught approach to teacher learning about teaching with computers was scrutinised, and a range of practical implications for the professional development of such teachers was identified.

Improving contaminated land remediation practices for service station sites in Queensland

The research aims to provide improvements to remediation practices for land contaminated by service station activities in the period 1988-2004 by assessing previous methods of remediation. Thirty-four such Queensland sites were examined. The resultes will be useful to government, developers, land holders, consultants and the community.

Effects of online professional development on the integration of technology in schools

This thesis examined how involvement in an online network (The Education Network of Ontario / Reseau educatif de l'Ontario) affected teachers professionally. Findings indicated that the network had supported an online community of practice which encouraged development of information and communication skills but that the community had eventually succombed to social and professional tensions.

Self-aware virtualised autonomic self-management of non-dedicated clusters

This research aims at improving the accessibility of cluster computer systems by introducing autonomic self-management facilities incorporating; 1) resource discovery and self awareness, 2) virtualised resource pools, and 3) automated cluster membership and self configuration. These facilities simplify the user's programming workload and improve system usability.

An examination of the range of self-funding options available to regional galleries and an assessment of their suitability for use in those institutions

Researches the suitability of a variety of self-funding options available to regional galleries in Australia. An overview of the range of current self-funding practices is given. Each option is mapped according to its impact on core/value added services and its effect on primary/secondary users and assessed for suitability using these criteria.