Determinants of skin self-examination (SSE) in men aged 50 years or older

Background: Queensland men aged 50 years and older are at high risk for melanoma. Early detection via skin self examination (SSE) (particularly whole-body SSE) followed by presentation to a doctor with suspicious lesions, may decrease morbidity and mortality from melanoma. Prevalence of whole-body SSE (wbSSE) is lower in Queensland older men compared to other population subgroups. With the exception of the present study no previous research has investigated the determinants of wbSSE in older men, or interventions to increase the behaviour in this population. Furthermore, although past SSE intervention studies for other populations have cited health behaviour models in the development of interventions, no study has tested these models in full. The Skin Awareness Study: A recent randomised trial, called the Skin Awareness Study, tested the impact of a video-delivered intervention compared to written materials alone on wbSSE in men aged 50 years or older (n=930). Men were recruited from the general population and interviewed over the telephone at baseline and 13 months. The proportion of men who reported wbSSE rose from 10% to 31% in the control group, and from 11% to 36% in the intervention group. Current research: The current research was a secondary analysis of data collected for the Skin Awareness Study. The objectives were as follows: • To describe how men who did not take up any SSE during the study period differed from those who did take up examining their skin. • To determine whether the intervention program was successful in affecting the constructs of the Health Belief Model it was aimed at (self-efficacy, perceived threat, and outcome expectations); and whether this in turn influenced wbSSE. • To determine whether the Health Action Process Approach (HAPA) was a better predictor of wbSSE behaviour compared to the Health Belief Model (HBM). Methods: For objective 1, men who did not report any past SSE at baseline (n=308) were categorised as having ‘taken up SSE’ (reported SSE at study end) or ‘resisted SSE’ (reported no SSE at study end). Bivariate logistic regression, followed by multivariable regression, investigated the association between participant characteristics measured at baseline and resisting SSE. For objective 2 proxy measures of self-efficacy, perceived threat, and outcome expectations were selected. To determine whether these mediated the effect of the intervention on the outcome, a mediator analysis was performed with all participants who completed interviews at both time points (n=830) following the Baron and Kenny approach, modified for use with structural equation modelling (SEM). For objective 3, control group participants only were included (n=410). Proxy measures of all HBM and HAPA constructs were selected and SEM was used to build up models and test the significance of each hypothesised pathway. A likelihood ratio test compared the HAPA to the HBM. Results: Amongst men who did not report any SSE at baseline, 27% did not take up any SSE by the end of the study. In multivariable analyses, resisting SSE was associated with having more freckly skin (p=0.027); being unsure about the statement ‘if I saw something suspicious on my skin, I’d go to the doctor straight away’ (p=0.028); not intending to perform SSE (p=0.015), having lower SSE self-efficacy (p<0.001), and having no recommendation for SSE from a doctor (p=0.002). In the mediator analysis none of the tested variables mediated the relationship between the intervention and wbSSE. In regards to health behaviour models, the HBM did not predict wbSSE well overall. Only the construct of self-efficacy was a significant predictor of future wbSSE (p=0.001), while neither perceived threat (p=0.584) nor outcome expectations (p=0.220) were. By contrast, when the HAPA constructs were added, all three HBM variables predicted intention to perform SSE, which in turn predicted future behaviour (p=0.015). The HAPA construct of volitional self-efficacy was also associated with wbSSE (p=0.046). The HAPA was a significantly better model compared to the HBM (p<0.001). Limitations: Items selected to measure HBM and HAPA model constructs for objectives 2 and 3 may not have accurately reflected each construct. Conclusions: This research added to the evidence base on how best to target interventions to older men; and on the appropriateness of particular health behaviour models to guide interventions. Findings indicate that to overcome resistance those men with more negative pre-existing attitudes to SSE (not intending to do it, lower initial self-efficacy) may need to be targeted with more intensive interventions in the future. Involving general practitioners in recommending SSE to their patients in this population, alongside disseminating an intervention, may increase its success. Comparison of the HBM and HAPA showed that while two of the three HBM variables examined did not directly predict future wbSSE, all three were associated with intention to self-examine skin. This suggests that in this population, intervening on these variables may increase intention to examine skin, but not necessarily the behaviour itself. Future interventions could potentially focus on increasing both the motivational variables of perceived threat and outcome expectations as well as a combination of both action and volitional self-efficacy; with the aim of increasing intention as well as its translation to taking up and maintaining regular wbSSE.

The development of a program to assist international nursing students to be prepared for clinical practice in the Australian health care context

Health education in Western Countries has grown considerably in the last decade and this has occurred for a number of reasons. Specifically Universities actively recruit International students as the health workforce becomes global; also it is much easier for students to move and study globally. Internationally there is a health workforce shortage and if students gain a degree in a reputable university their ability to work globally is improved significantly. However, when studying to practice in the health care field the student must undertake clinical practice in an acute or aged care setting. This can be a significant problem for students who are culturally and linguistically diverse in an English speaking country such as Australia. The issues that can arise stem from the language differences where communication, interpretation understanding and reading the cultural norms of the health care setting are major challenges for International students. To assist international students to be successful in their clinical education, an extra curriculum workshop program was developed to provide additional support. The program which runs twice each year includes on-campus interactive workshops that are complemented by targeted support provided for students and clinical staff who are supervising students’ practice experience in the workplace. As this is an English speaking country the workshop is based on practicing reading, writing, listening and speaking, as well as exploring basic health care concepts and cultural differences. This enables students to gain knowledge of and practice interpretation of cultural norms and expectations in a safe environment. This innovative series of interactive workshops in a highly student-centred learning environment combine education with role play and discussion with peers who are supported by culturally aware and competent Educators. Over the years it has been running, the program has been undertaken by an increasing number of students. In 2011, more than 100 students are expected to participate. Student evaluation of the program has confirmed that it has assisted the majority of them to be successful in their clinical studies. Effectiveness of the project is measured throughout the program and in follow up sessions. This ongoing information allows for continuous development of the program that serves to meet individual needs of the International student, the University and Service providers such as the hospitals. This feedback from students regarding their increased comprehension of the Australian colloquial Language, healthcare terminology, critical thinking and clinical skill development and a cultural awareness also enables them to maintain their feelings of self confidence and self esteem.

Positive emotional responses to hybridised writing about a socio-scientific issue

In order to understand better the role of affect in learning about socio-scientificissues (SSI), this study investigated Year 12 students’ emotional arousal as they participated in an online writing-to-learn science project about the socio-scientific issue of biosecurity. Students wrote a series of hybridised scientific narratives, or BioStories, that integrate scientific information about biosecurity with narrative storylines, and uploaded these to a dedicated website. Throughout their participation in the project, students recorded their emotional responses to the various activities (N=50). Four case students were also video recorded during selected science lessons as they researched, composed and uploaded their BioStories for peer review. Analysis of these data, as well as interview data obtained from the case students, revealed that pride, strength, determination, interest and alertness were among the positive emotions most strongly elicited by the project. These emotions reflected students’ interest in learning about a new socio-scientific issue, and their enhanced feelings of self-efficacy in successfully writing hybridised scientific narratives in science. The results of this study suggest that the elicitation of positive emotional responses as students engage in hybridised writing about SSI with strong links to environmental education, such as biosecurity, can be valuable in engaging students in education for sustainability.

Hybridized writing for scientific literacy : pedagogy and evidence

Disengagement of students in science and the scientific literacy of young adults are interrelated international concerns. One way to address these concerns is to engage students imaginatively in activities designed to improve their scientific literacy. Our ongoing program of research has focused on the effects of a sequence of activities that require students to transform scientific information on important issues for their communities from government websites into narrative text suitable for a lay reader. These hybridized stories we call BioStories. Students upload their stories for peer review to a dedicated website. Peer reviews are intended to help students refine their stories. Reviewing BioStories also gives students access to a wider range of scientific topics and writing styles. We have conducted separate studies with students from Grade 6, Grade 9 and Grade 12, involving case study and quasi-experimental designs. The results from the 6th grade study support the argument that writing the sequence of stories helped the students become more familiar with the scientific issue, develop a deeper understanding of related biological concepts, and improve their interest in science. Unlike the Grade 6 study, it was not possible to include a control group for the study conducted across eight 9th grade classes. Nevertheless, these results suggest that hybridized writing developed more positive attitudes toward science and science learning, particularly in terms of the students’ interest and enjoyment. In the most recent case study with Grade 12 students, we found that pride, strength, determination, interest and alertness were among the positive emotions most strongly elicited by the writing project. Furthermore, the students expressed enhanced feelings of self-efficacy in successfully writing hybridized scientific narratives in science. In this chapter, we describe the pedagogy of hybridized writing in science, overview the evidence to support this approach, and identify future developments.

Skin Awareness DVD

The Skin Awareness DVD is a component of the research project 'The Skin Awareness Study'. This study is a randomozed controlled trial assessing the effectiveness of a video-delivered intervention designed to increase the prevalence of skin self-examinations and rapid presentation to a doctor among men 50 years and above.

Email as an arena for authoring a dialogical self among gifted young adolescents : a qualitative study

This paper describes a qualitative study that investigated young adolescents’ self-constructions within the context of online (email) communication. Drawing from dialogical perspectives of self as multiply-situated and complex phenomena, the study focused on the everyday narratives of individual young adolescents interpreted as different “I” voices. With the assumption that computer mediation offers cultural relevance and empowerment to young adolescents, techniques of personal journal writing were used in combination with email as an alternative to face-to-face methods. Twelve participants aged 10 to 14 years were recruited online and by word-of-mouth with an invitation to write freely about their lives over a six month period in a participant-led email journal project. The role of the researcher was to develop a supportive voice of listener/responder that was intended to facilitate the emergence of participants’ own ‘self’ voices within an interactive space for relatively autonomous self-expression. Data as email texts were analysed using a close listening method that synchronised with the theory by revealing multi-layered patterns and shifts of voices in order to give a nuanced understanding of participants’ self and other evaluations. The paper shows that narrative methods used online and in concert with dialogical concepts have potential to heighten self-reflection and strengthen agency as a means to access rich and nuanced data from young adolescent individuals. The study’s findings contribute to a growing interest in the use of dialogical concepts to explore the ways people engage in active meaning-making while embedded in their specific social and cultural environments.

Building shared situational awareness in surgery through distributed dialogue

Background Failure to convey time-critical information to team members during surgery diminishes members’ perception of the dynamic information relevant to their task, and compromises shared situational awareness. This research reports the dialog around clinical decisions made by team members in the time-pressured and high-risk context of surgery, and the impact of these communications on shared situational awareness. Methods Fieldwork methods were used to capture the dynamic integration of individual and situational elements in surgery that provided the backdrop for clinical decisions. Nineteen semi structured interviews were performed with 24 participants from anaesthesia, surgery, and nursing in the operating rooms of a large metropolitan hospital in Queensland, Australia. Thematic analysis was used. Results: The domain “coordinating decisions in surgery” was generated from textual data. Within this domain, three themes illustrated the dialog of clinical decisions, i.e., synchronizing and strategizing actions, sharing local knowledge, and planning contingency decisions based on priority. Conclusion Strategies used to convey decisions that enhanced shared situational awareness included the use of “self-talk”, closed-loop communications, and “overhearing” conversations that occurred at the operating table. Behaviours’ that compromised a team’s shared situational awareness included tunnelling and fixating on one aspect of the situation.

Context-aware device self-configuration using self-organizing maps

Modern mobile computing devices are versatile, but bring the burden of constant settings adjustment according to the current conditions of the environment. While until today, this task has to be accomplished by the human user, the variety of sensors usually deployed in such a handset provides enough data for autonomous self-configuration by a learning, adaptive system. However, this data is not fully available at certain points in time, or can contain false values. Handling potentially incomplete sensor data to detect context changes without a semantic layer represents a scientific challenge which we address with our approach. A novel machine learning technique is presented - the Missing-Values-SOM - which solves this problem by predicting setting adjustments based on context information. Our method is centered around a self-organizing map, extending it to provide a means of handling missing values. We demonstrate the performance of our approach on mobile context snapshots, as well as on classical machine learning datasets.

Towards a model for student selection in clinical psychology

Background Selection of candidates for clinical psychology programmes is arguably the most important decision made in determining the clinical psychology workforce. However, there are few models to inform the development of selection tools to support selection procedures. The study, using a factor analytic structure, has operationalised the model predicting applicants' capabilities. Method Eighty-eight clinical applicants for entry into a postgraduate clinical psychology programme were assessed on a series of tasks measuring eight capabilities: guided reflection, communication skills, ethical decision making, writing, conceptual reasoning, empathy, and awareness of mind and self-observation. Results Factor analysis revealed three capabilities: labelled “awareness” accounting for 35.71% of variance; “reflection” accounting for 20.56%; and “reasoning” accounting for 18.24% of variance. Fourth year grade point average (GPA) did not correlate with performance on any of the selection capabilities other than a weak correlation with performance on the ethics capability. Conclusions Eight selection capabilities are identified for the selection of candidates independent of GPA. While the model is tentative, it is hoped that the findings will stimulate the development and validation of assessment procedures with good predictive validity which will benefit the training of clinical psychologists and, ultimately, effective service delivery.

Capturing the 'authentic voice' : challenges and opportunities for voice and self-representation in two ABC storytelling projects

In recent years there has been a noticeable move by various public institutions, such as public service broadcasters and community media organisations, to capture and disseminate the voices and viewpoints of ‘ordinary people’ through inviting them to share stories about their lives. One of the foremost objectives of many such projects is to provide under-represented individuals and groups with an opportunity to express and represent themselves; as such, the capture and broadcast of ‘authentic voices’ is a central value. This paper discusses the notion of ‘authentic voice’, and questions the framing role of public media organisations in storytelling projects that aim to provide individuals with space for self-expression and self-representation. It considers the ways in which tensions arise on multiple levels when individuals are asked to express and represent themselves within projects and spaces that are managed by institutions. This paper begins by discussing the challenges and opportunities that arise within storytelling projects that are facilitated by public institutions and community media arts organisations, and that aim to amplify the voices of “ordinary people” (Thumim, 2009). It examines ways in which ‘voice’ is facilitated, curated, broadcast and distributed within such projects, particularly questioning the ways in which project facilitation and the curation of stories for public broadcast can both help and hinder the amplification of ‘authentic voice’. Furthermore, we seek to discuss how ‘authentic voice’ is defined, and what is involved in the process of amplification. The paper moves on to discuss a case study in order to demonstrate some of the tensions that are evident within a storytelling project that is managed by a public institution – Australia’s national broadcaster – and the ways these tensions impact upon the capture and broadcast of an ‘authentic voice’ for project participants. The Australian Broadcasting Corporation’s (ABC) ‘Heywire’ project is a storytelling competition and website that aims to ‘give voice’ to 16-22 year olds who live in rural, regional and remote parts of Australia. Looking at tensions that exist on organisational, political and philosophical levels within the Heywire project reveals a number of conflicts of interest and objectives between the institution and project participants. This leads us to question whether institutionally-managed storytelling projects can effectively support individuals to have an ‘authentic voice’, and whether struggles of aims and objectives diminish the personal benefits that people may derive from expressing and representing themselves within such projects.

Awareness of risky behaviour among Chinese drivers

Background In China, as in many developing countries, rapid increases in car ownership and new drivers have been coupled with a large trauma burden. The World Health Organization has identified key risk factors including speeding, drink-driving, helmet and restraint non-use, overloaded vehicles, and fatigued-driving in many rapidly motorising countries, including China. Levels of awareness of these risk factors among road users are not well understood. Although research identifies speeding as the major factor contributing to road crashes in China, there appears to be widespread acceptance of it among the broader community. Purpose To assess self-reported speeding and awareness of crash risk factors among Chinese drivers in Beijing. Methods Car drivers (n=299) were recruited from car washing locations and car parks to complete an anonymous questionnaire. Perceptions of the relative risk of drink-driving, fatigued-driving and speeding, and attitudes towards speeding and self-reported driving speeds were assessed. Results Overall, driving speeds of >10km/hr above posted limits on two road types (60 and 80 km/hour zones) were reported by more than one third of drivers. High-range speeding (i.e., >30 km/hour in a 60 km/hour zone and >40 km/hour in an 80 km/hour zone) was reported by approximately 5% of the sample. Attitudinal measures indicated that approximately three quarters of drivers reported attitudes that were not supportive of speeding. Drink-driving was identified as the most risky behaviour; 18% reported the perception that drink-driving had the same level of danger as speeding and 82% reported it as more dangerous. For fatigued-driving, 1% reported the perception that it was not as dangerous as speeding; 27.4% reported it as the same level and 71.6% perceived it as more dangerous. Conclusion Driving speeds well above posted speed limits were commonly reported by drivers. Speeding was rated as the least dangerous on-road behaviour, compared to drink-driving and fatigued-driving. One third of drivers reported regularly engaging in speeds at least 10km/hr above posted limits, despite speeding being the major reported contributor to crashes. Greater awareness of the risks associated with speeding is needed to help reduce the road trauma burden in China and promote greater speed limit compliance.

Capturing the ‘authentic voice’ : challenges and opportunities for voice and self-representation in two ABC storytelling projects

This paper discusses the opportunities and challenges that arise within storytelling projects that are facilitated by public service broadcasters and that aim to amplify the voices of ‘ordinary people’. In particular, it focuses on two of the Australian Broadcasting Corporation’s current life storytelling projects: ABC Open and Heywire.

Being social @ work: designing for playfully mediated social awareness in work environments

Awareness within work environments should not be seen limited to important work-related information, activities and relationships. Mediating somewhat casual and engaging encounters related to non-work issues could also lead to meaningful and pleasurable experiences. This paper explores a design approach to support playfully mediated social awareness within an academic environment. Using ethnographic exploration and understanding the current and aspired practices, we provide details of two broad (and some times overlapping) categories of interaction for supporting and enhancing playfully mediated social awareness amongst staff members: 1) Self-Reflections and 2) Casual Encounters. We implement these two categories of interaction in an intelligent, asynchronous, large screen display called Panorama, for the staff room of our computer science department. Panorama attempts to mediate non-critical, non-work related information about the staff-members in an engaging manner to enhance social awareness within the department. We particularly emphasize on the soft design issues like reflections, belonging, care, pleasure and playfulness utilized in our design approach. The result of a two-phase assessment study suggests that our conceptualization of social awareness and the Panorama application has the potential to be easily incorporated into our academic environment.

Author in waiting : self-portrait of Peter Goldsworthy as a boy

Review of His Stupid Boyhood by Peter Goldsworthy (Hamish Hamilton, 2013).

Writing Indigenous vampires: Aboriginal gothic or Aboriginal fantastic?

The usual postmodern suspicions about diligently deciphering authorial intent or stridently seeking fixed meaning/s and/or binary distinctions in an artistic work aside, this self-indulgent essay pushes the boundaries regarding normative academic research, for it focusses on my own (minimally celebrated) published creative writing’s status as a literary innovation. Dedicated to illuminating some of the less common denominators at play in Australian horror, my paper recalls the creative writing process involved when I set upon the (arrogant?) goal of creating a new genre of creative writing: that of the ‘Aboriginal Fantastic’. I compare my work to the literary output of a small but significant group (2.5% of the population), of which I am a member: Aboriginal Australians. I narrow my focus even further by examining that creative writing known as Aboriginal horror. And I reduce the sample size of my study to an exceptionally small number by restricting my view to one type of Aboriginal horror literature only: the Aboriginal vampire novel, a genre to which I have contributed professionally with the 2011 paperback and 2012 e-book publication of That Blackfella Bloodsucka Dance! However, as this paper hopefully demonstrates, and despite what may be interpreted by some cynical commentators as the faux sincerity of my taxonomic fervour, Aboriginal horror is a genre noteworthy for its instability and worthy of further academic interrogation. (first paragraph)