Application of an appearance-based intervention to improve sun protection outcomes of outdoor workers in Queensland, Australia

Outdoor workers are exposed to high levels of ultraviolet radiation (UVR) and may thus be at greater risk to experience UVR-related health effects such as skin cancer, sun burn, and cataracts. A number of intervention trials (n=14) have aimed to improve outdoor workers’ work-related sun protection cognitions and behaviours. Only one study however has reported the use of UV-photography as part of a multi-component intervention. This study was performed in the USA and showed long-term (12 months) improvements in work-related sun protection behaviours. Intervention effects of the other studies have varied greatly, depending on the population studied, intervention applied, and measurement of effect. Previous studies have not assessed whether: - Interventions are similarly effective for workers in stringent and less stringent policy organisations; - Policy effect is translated into workers’ leisure time protection; - Implemented interventions are effective in the long-term; - The facial UV-photograph technique is effective in Australian male outdoor workers without a large additional intervention package, and; - Such interventions will also affect workers’ leisure time sun-related cognitions and behaviours. Therefore, the present Protection of Outdoor Workers from Environmental Radiation [POWER]-study aimed to fill these gaps and had the objectives of: a) assessing outdoor workers’ sun-related cognitions and behaviours at work and during leisure time in stringent and less stringent sun protection policy environments; b) assessing the effect of an appearance-based intervention on workers’ risk perceptions, intentions and behaviours over time; c) assessing whether the intervention was equally effective within the two policy settings; and d) assessing the immediate post-intervention effect. Effectiveness was described in terms of changes in sun-related risk perceptions and intentions (as these factors were shown to be main precursors of behaviour change in many health promotion theories) and behaviour. The study purposefully selected and recruited two organisations with a large outdoor worker contingent in Queensland, Australia within a 40 kilometre radius of Brisbane. The two organisations differed in the stringency of implementation and reinforcement of their organisational sun protection policy. Data were collected from 154 male predominantly Australian born outdoor workers with an average age of 37 years and predominantly medium to fair skin (83%). Sun-related cognitions and behaviours of workers were assessed using self-report questionnaires at baseline and six to twelve months later. Variation in follow-up time was due to a time difference in the recruitment of the two organisations. Participants within each organisation were assigned to an intervention or control group. The intervention group participants received a one-off personalised Skin Cancer Risk Assessment Tool [SCRAT]-letter and a facial UV-photograph with detailed verbal information. This was followed by an immediate post-intervention questionnaire within three months of the start of the study. The control group only received the baseline and follow-up questionnaire. Data were analysed using a variety of techniques including: descriptive analyses, parametric and non-parametric tests, and generalised estimating equations. A 15% proportional difference observed was deemed of clinical significance, with the addition of reported statistical significance (p<0.05) where applicable. Objective 1: Assess and compare the current sun-related risk perceptions, intentions, behaviours, and policy awareness of outdoor workers in stringent and less stringent sun protection policy settings. Workers within the two organisations (stringent n=89 and less stringent n=65) were similar in their knowledge about skin cancer, self efficacy, attitudes, and social norms regarding sun protection at work and during leisure time. Participants were predominantly in favour of sun protection. Results highlighted that compared to workers in a less stringent policy organisation working for an organisation with stringent sun protection policies and practices resulted in more desirable sun protection intentions (less willing to tan p=0.03) ; actual behaviours at work (sufficient use of upper and lower body protection, headgear, and sunglasses (p<0.001 for all comparisons), and greater policy awareness (awareness of repercussions if Personal Protective Equipment (PPE) was not used, p<0.001)). However the effect of the work-related sun protection policy was found not to extend to leisure time sun protection. Objective 2: Compare changes in sun-related risk perceptions, intentions, and behaviours between the intervention and control group. The effect of the intervention was minimal and mainly resulted in a clinically significant reduction in work-related self-perceived risk of developing skin cancer in the intervention compared to the control group (16% and 32% for intervention and control group, respectively estimated their risk higher compared to other outdoor workers: , p=0.11). No other clinical significant effects were observed at 12 months follow-up. Objective 3: Assess whether the intervention was equally effective in the stringent sun protection policy organisation and the less stringent sun protection policy organisation. The appearance-based intervention resulted in a clinically significant improvement in the stringent policy intervention group participants’ intention to protect from the sun at work (workplace*time interaction, p=0.01). In addition to a reduction in their willingness to tan both at work (will tan at baseline: 17% and 61%, p=0.06, at follow-up: 54% and 33%, p=0.07, stringent and less stringent policy intervention group respectively. The workplace*time interaction was significant p<0.001) and during leisure time (will tan at baseline: 42% and 78%, p=0.01, at follow-up: 50% and 63%, p=0.43, stringent and less stringent policy intervention group respectively. The workplace*time interaction was significant p=0.01) over the course of the study compared to the less stringent policy intervention group. However, no changes in actual sun protection behaviours were found. Objective 4: Examine the effect of the intervention on level of alarm and concern regarding the health of the skin as well as sun protection behaviours in both organisations. The immediate post-intervention results showed that the stringent policy organisation participants indicated to be less alarmed (p=0.04) and concerned (p<0.01) about the health of their skin and less likely to show the facial UV-photograph to others (family p=0.03) compared to the less stringent policy participants. A clinically significantly larger proportion of participants from the stringent policy organisation reported they worried more about skin cancer (65%) and skin freckling (43%) compared to those in the less stringent policy organisation (46%,and 23% respectively , after seeing the UV-photograph). In summary the results of this study suggest that the having a stringent work-related sun protection policy was significantly related to for work-time sun protection practices, but did not extend to leisure time sun protection. This could reflect the insufficient level of sun protection found in the general Australian population during leisure time. Alternatively, reactance caused by being restricted in personal decisions through work-time policy could have contributed to lower leisure time sun protection. Finally, other factors could have also contributed to the less than optimal leisure time sun protection behaviours reported, such as unmeasured personal or cultural barriers. All these factors combined may have lead to reduced willingness to take proper preventive action during leisure time exposure. The intervention did not result in any measurable difference between the intervention and control groups in sun protection behaviours in this population, potentially due to the long lag time between the implementation of the intervention and assessment at 12-months follow-up. In addition, high levels of sun protection behaviours were found at baseline (ceiling effect) which left little room for improvement. Further, this study did not assess sunscreen use, which was the predominant behaviour assessed in previous effective appearance-based interventions trials. Additionally, previous trials were mainly conducted in female populations, whilst the POWER-study’s population was all male. The observed immediate post-intervention result could be due to more emphasis being placed on sun protection and risks related to sun exposure in the stringent policy organisation. Therefore participants from the stringent policy organisation could have been more aware of harmful effects of UVR and hence, by knowing that they usually protect adequately, not be as alarmed or concerned as the participants from the less stringent policy organisation. In conclusion, a facial UV-photograph and SCRAT-letter information alone may not achieve large changes in sun-related cognitions and behaviour, especially of assessed 6-12 months after the intervention was implemented and in workers who are already quite well protected. Differences found between workers in the present study appear to be more attributable to organisational policy. However, against a background of organisational policy, this intervention may be a useful addition to sun-related workplace health and safety programs. The study findings have been interpreted while respecting a number of limitations. These have included non-random allocation of participants due to pre-organised allocation of participants to study group in one organisation and difficulty in separating participants from either study group. Due to the transient nature of the outdoor worker population, only 105 of 154 workers available at baseline could be reached for follow-up. (attrition rate=32%). In addition the discrepancy in the time to follow-up assessment between the two organisations was a limitation of the current study. Given the caveats of this research, the following recommendations were made for future research: - Consensus should be reached to define "outdoor worker" in terms of time spent outside at work as well as in the way sun protection behaviours are measured and reported. - Future studies should implement and assess the value of the facial UV-photographs in a wide range of outdoor worker organisations and countries. - More timely and frequent follow-up assessments should be implemented in intervention studies to determine the intervention effect and to identify the best timing of booster sessions to optimise results. - Future research should continue to aim to target outdoor workers’ leisure time cognitions and behaviours and improve these if possible. Overall, policy appears to be an important factor in workers’ compliance with work-time use of sun protection. Given the evidence generated by this research, organisations employing outdoor workers should consider stringent implementation and reinforcement of a sun protection policy. Finally, more research is needed to improve ways to generate desirable behaviour in this population during leisure time.

Like our page : using Facebook to support first year students in their transition to higher education

Facebook is approaching ubiquity in the social habits and practice of many students. However, its use in higher education has been criticised (Maranto & Barton, 2010) because it can remove or blur academic boundaries. Despite these concerns, there is strong potential to use Facebook to support new students to communicate and interact with each other (Cheung, Chiu, & Lee, 2010). This paper shows how Facebook can be used by teaching staff to communicate more effectively with students. Further, it shows how it can provide a way to represent and include beginning students’ thoughts, opinions and feedback as an element of the learning design and responsive feed-forward into lectures and tutorial activities. We demonstrate how an embedded social media strategy can be used to complement and enhance the first year curriculum experience by functioning as a transition device for student support and activating Kift’s (2009) organising principles for first year curriculum design.

Challenges for researchers investigating contraceptive use and pregnancy intentions of young women living in urban and rural Australia : face-to-face discussions to increase participation in a web-based survey

Background: It is imperative to understand how to engage young women in research about issues that are important to them. There is limited reliable data on how young women access contraception in Australia especially in rural areas where services may be less available. Objective: This paper identifies the challenges involved in engaging young Australian women aged 18-23 years to participate in a web-based survey on contraception and pregnancy and ensure their ongoing commitment to follow-up web-based surveys. Methods: A group of young women, aged 18-23 years and living in urban and rural New South Wales, Australia, were recruited to participate in face-to-face discussions using several methods of recruitment: direct contact (face-to-face, telephone or email)and snowball sampling by potential participants inviting their friends. All discussions were transcribed verbatim and analyzed using thematic analysis. Results: Twenty young women participated (urban, n=10: mean age 21.6 years; rural, n=10: 20.0 years) and all used computers or smart phones to access the internet on a daily basis. All participants were concerned about the cost of internet access and utilized free access to social media on their mobile phones. Their willingness to participate in a web-based survey was dependent on incentives with a preference for small financial rewards. Most participants were concerned about their personal details and survey responses remaining confidential and secure. The most appropriate survey would take up to 15 minutes to complete, be a mix of short and long questions and eye-catching with bright colours. Questions on the sensitive topics of sexual activity, contraception and pregnancy were acceptable if they could respond with “I prefer not to answer”. Conclusions: There are demographic, participation and survey design challenges in engaging young women in a web-based survey. Based on our findings, future research efforts are needed to understand the full extent of the role social media and incentives play in the decision of young women to participate in web-based research.

Personalised electronic messages to improve sun protection in young adults

The incidence of all skin cancers, including melanoma, continues to rise. It is well known that ultraviolet (UV) radiation is the main environmental risk factor for skin cancer, and excessive exposure at a young age increases the risk of developing skin cancer. The aim of this study was to determine the acceptability and feasibility of delivering sun protection messages via electronic media such as short message services (SMS) to people 18-40 years, and explore factors associated with their acceptability. Overall, 80% of participants agreed that they would like to receive some form of sun protection advice; of these, 20% prefer to receive it via SMS and 42% via email. Willingness to receive electronic messages about the UV index was associated with being unsure about whether a suntanned person would look healthy and greater use of sun protection in the past. Careful attention to message framing and timing of message delivery and focus on short-term effects of sun exposure such as sunburn and skin ageing should increase the acceptability of such messages to young people. We conclude that sun protection messages delivered to young adults via electronic media appear feasible and acceptable.

Can a childcare practicum encourage degree qualified staff to enter the childcare workforce?

Concern to ensure that all children have access to high quality educational experiences in the early years of life has instigated moves to increase qualifications of staff in the childcare workforce, in particular to increase the number of degree qualified teachers. However existing data suggest that work in the childcare sector is viewed less favourably by those undertaking early childhood education degrees. For most, childcare is not a preferred place of employment. This study asked whether a practicum in a childcare setting would improve attitudes to childcare and willingness to consider working in childcare settings. In a study of a cohort of Bachelor of Education (Early Childhood) students, measures of attitudes to childcare and willingness to work in childcare were taken before and after practicum. Additionally students provided accounts of their practicum experiences. Results indicate a trend in which there was a group increase in positive attitudes and willingness to consider work in childcare but considerable individual differences influenced by the quality of the practicum experience. The relationship with, and model provided by, centre directors and the group leader in the practicum class was identified as key influencing factors. Results are discussed in term of models of pedagogical leadership.

Using 3D visualisation to understand human articular cartilage deterioration

Understanding complex systems within the human body presents a unique challenge for medical engineers and health practitioners. One significant issue is the ability to communicate their research findings to audiences with limited medical knowledge or understanding of the behaviour and composition of such structures. Much of what is known about the human body is currently communicated through abstract representations which include raw data sets, hand drawn illustrations or cellular automata. The development of 3D Computer Graphics Animation has provided a new medium for communicating these abstract concepts to audiences in new ways. This paper presents an approach for the visualisation of human articular cartilage deterioration using 3D Computer Graphics Animation. The animated outcome of this research introduces the complex interior structure of human cartilage to audiences with limited medical engineering knowledge.

Are Malaysian Teachers Ready to Assume the Duties of Reporting Child Abuse and Neglect?

Mandatory child abuse and neglect reporting laws apply to teachers in many countries of the world. However, such laws have not yet been introduced for teachers in Malaysia, and there is debate about whether the laws should be extended to teachers at all. This paper aimed to investigate the level of support among teachers to assume mandatory reporting duties and to identify factors determining this support in Malaysia. A total of 668 teachers from 14 randomly selected public primary schools completed an anonymous self-administered questionnaire. Results showed that 44.4 per cent of the respondents supported legislation requiring teachers to report child abuse. Teachers of Indian ethnicity, those with a shorter duration of service in teaching (< 5 years), the availability of knowledgeable and supportive school staff and a higher level of commitment to reporting were significant factors affecting teachers' support for mandatory reporting. This study provides important insights into factors influencing teachers' support for the introduction of mandatory reporting legislation for teachers in Malaysia. Teachers do not unanimously support these laws and there is a lack of clarity about what such laws will mean for teachers. The data highlight the need for specific training programmes to raise teachers' awareness, build their confidence and enhance their willingness to report child abuse.

Barriers to the adoption of health information technology

Information Technology (IT) is successfully applied in a diverse range of fields. Though, the field of Medical Informatics is more than three decades old, it shows a very slow progress compared to many other fields in which the application of IT is growing rapidly. The spending on IT in health care is shooting up but the road to successful use of IT in health care has not been easy. This paper discusses about the barriers to the successful adoption of information technology in clinical environments and outlines the different approaches used by various countries and organisations to tackle the issues successfully. Investing financial and other resources to overcome the barriers for successful adoption of HIT is highly important to realise the dream of a future healthcare system with each customer having secure, private Electronic Health Record (EHR) that is available whenever and wherever needed, enabling the highest degree of coordinated medical care based on the latest medical knowledge and evidence. Arguably, the paper reviews barriers to HIT from organisations’ alignment in respect to the leadership; with their stated values when accepting or willingness to consider the HIT as a determinant factor on their decision-making processes. However, the review concludes that there are many aspects of the organisational accountability and readiness to agree to the technology implementation.

Outdoor Worker Sun Protection Project : a mixed methods intervention to improve sun safety among outdoor workers

Queensland, Australia has one of the highest rates of skin cancer in the world. Outdoor workers are regularly exposed to high doses of ultraviolet radiation, and are at increased risk to develop non-melanoma and melanoma skin cancers. In 2010, a health promotion intervention to improve sun protection among outdoor workers in Queensland commenced. The intervention employed a mixed methods approach and a participatory action research framework. Fourteen workplaces were recruited from building and construction, rural and farming, local government, and public sector organisations. Management and workers were engaged in cycles of assessment, reflection and discussion, planning, implementation and reassessing, over a 14-month intervention period. Overall, at least one workplace representative from each workplace (range 1-3) and in depth focus groups were held with a subset of workers (range 3-16) to assess sun safe behaviours pre and post intervention. Workers’ attitudes, beliefs, knowledge and willingness to engage in sun protection differed depending on workplace characteristics and support. A familiar theme among workers spoke of sun safety as being “common sense” and the “workers individual responsibility”. Often there was a discrepancy in the perceptions of the workers, compared to the view of workplace representatives and the workplaces position or policy on sun safety. In larger workplaces, especially Government Departments, workers were more aware and followed sun safe practices compared to smaller workplaces where sun safety was not a high priority. These results indicate that a workplace culture which places high values on safety and polices more broadly may also have a positive effect on sun safety among outdoor workers as well. In addition, the specific characteristics of the workplace and the outdoor work tasks influence workers willingness to engage in sun safety measures.

Why disaster survivors speak to reporters

Practice-led journalism research techniques were used in this study to produce a ‘first draft of history’ recording the human experience of survivors and rescuers during the January 2011 flash flood disaster in Toowoomba and the Lockyer Valley in Queensland, Australia. The study aimed to discover what can be learnt from engaging in journalistic reporting of natural disasters, using journalism as both a creative practice and a research methodology. (Lindgren and Phillips, 2011, 75). The willingness of a very high proportion of severely traumatised flood survivors to participate in the flood research was unexpected but made it possible to document a relatively unstudied question within the literature about journalism and trauma – when and why disaster survivors will want to speak to journalists. The study reports six categories of reasons interviewees gave for their willingness to speak to the media: for their own personal recovery; their desire for the public to know what had happened; that lessons need to be learned from the disaster; their sense of duty to make sure warning systems and disaster responses are improved in future; the financial disinterest of reporters in listening to survivors; and the timing of the request for an interview. In addition, traumatised flood survivors found both the opportunity to speak to the media and the journalistic outputs of the research cathartic in their recovery.

Evaluation and social impact measurement amongst small to medium social enterprises : process, purpose and value

In recent years, the imperative to communicate organisational impacts to a variety of stakeholders has gained increasing importance within all sectors. Despite growing external demands for evaluation and social impact measurement, there has been limited critically informed analysis about the presumed importance of these activities to organisational success and the practical challenges faced by organisations in undertaking such assessment. In this paper, we present the findings from an action research study of five Australian small to medium social enterprises’ practices and use of evaluation and social impact analysis. Our findings have implications for social enterprise operators, policy makers and social investors regarding when, why and at what level these activities contribute to organisational performance and the fulfilment of mission.

The challenge to know and control: Disease outbreak surveillance and alerts in China and India

Since the revisions to the International Health Regulations (IHR) in 2005, much attention has been turned to how states, particularly developing states, will address core capacity requirements. The question often examined is how states with poor health systems can strengthen their capacity to identify and verify public health emergencies of international concern. A core capacity requirement is that by 2012 states will have a surveillance and response network that operates from the local community to the national level. Much emphasis has turned to the health system capacity required for this task. In this article, I seek to understand the political capacity to perform this task. This article considers how the world's two most populous states,1 1. For the purposes of this paper, I use the word ‘state’ as a shorthand for the nation-state of China and India, or member state as used by the United Nations. View all notes China and India, have sought to communicate outbreak events in times of crisis and calm. I consider what this reporting performance tells us of their capacity to meet their IHR obligations given the two countries differing political institutions.

Design after design to bridge between people living with cognitive or sensory impairments, their friends and proxies

A carer or teacher often plays the role of proxy or spokesperson for a person living with an intellectual disability or form of cognitive or sensory impairment. Our research undertook co-design with people living with cognitive and sensory impairments and their proxies in order to explore new ways of facilitating communication. We developed simple functioning interactive prototypes to support people with a diverse range of competencies to communicate and explore their use. Deployment of the prototypes enabled use, appropriation and design after design by our two participant groups; adults living with cognitive or sensory impairments and children identified with language delays and autism spectrum disorder. The prototypes supported concrete expression of likes, dislikes, capabilities, emotional wants and needs and forms of expression that hitherto had not been fostered, further informing design. Carers and designers were surprised at the ways in which the technology was used and how it fostered new forms of social interaction and expression. We elaborate on how design after design can be an effective approach for engaging people living with intellectual disabilities, giving them greater capacity for expression and power in design and offering the potential to expand and deepen their social relationships.

Teacher and student readiness to use Facebook for learning in an adult vocational educational setting

The factors influencing both teacher and student readiness to use Facebook as part of their teaching and learning in a vocational educational institution were studied through a qualitative case study. Data included teacher and student questionnaire and focus group interviews. While it was found that the students demonstrated readiness and willingness to incorporate Facebook into their current learning, the teachers were more reluctant. Different perceptions around control of learning, time, and concerns around compartmentalisation of learning and social lives would need to be addressed before Facebook could be used as a formal learner engagement strategy.

Non-market use and non-use values for preserving ecosystem services over time : a choice experiment application to coral reef ecosystems in New Caledonia

Non-use values (i.e. economic values assigned by individuals to ecosystem goods and services unrelated to current or future uses) provide one of the most compelling incentives for the preservation of ecosystems and biodiversity. Assessing the non-use values of non-users is relatively straightforward using stated preference methods, but the standard approaches for estimating non-use values of users (stated decomposition) have substantial shortcomings which undermine the robustness of their results. In this paper, we propose a pragmatic interpretation of non-use values to derive estimates that capture their main dimensions, based on the identification of a willingness to pay for ecosystem protection beyond one's expected life. We empirically test our approach using a choice experiment conducted on coral reef ecosystem protection in two coastal areas in New Caledonia with different institutional, cultural, environmental and socio-economic contexts. We compute individual willingness to pay estimates, and derive individual non-use value estimates using our interpretation. We find that, a minima, estimates of non-use values may comprise between 25 and 40% of the mean willingness to pay for ecosystem preservation, less than has been found in most studies.