Patient influences on satisfaction and loyalty for GP services

Little is known about the influence that patients themselves have on their loyalty to a general practitioner (GP). Consequently, a theoretical framework that draws on diverse literature is proposed to suggest that along with satisfaction, patient loyalty is an important outcome for GPs. Comprising 174 Australian patients, this study identified that knowledgeable patients reported lower levels of loyalty while older patients and patients visiting a GP more frequently reported higher levels of loyalty. The results suggest that extending patient-centred care practices to encompass all patients may be warranted in order to improve patient satisfaction and loyalty. Further, future research opportunities abound, with intervention and dyadic research methodologies recommended.

Social influences on Chinese drivers : cultural context and traffic law enforcement

Reducing road crashes and associated trauma is a critical focus as the Decade of Action for Road Safety commences. China is one of many rapidly-motorizing nations to experience recent increases in private-vehicle ownership and an associated escalation in novice drivers. Unfortunately, however, China also experiences a high rate of death and injury from road crashes. Several key pieces of legislation have been introduced in recent decades in China to deal with these changes. While managing the legal aspects of road use is important, social influences on driver behaviour may offer additional avenues for promoting safe driving, particularly in a culture where such factors carry high importance. To date, there is limited research on the role of social influence factors on driver behaviour in China, yet we know that Chinese society is strongly based on social rules, customs, and relationships. There is reason to assume therefore, that road use and driving-related issues may also be strongly influenced by social relationships. One previous study that has investigated such issues highlighted the need to consider culturally-specific issues such as interpersonal networks and social hierarchy when examining driver behaviour in China (Xie & Parker, 2002). Those authors suggested that there are some concepts relating to Chinese driving culture that may not necessarily have been identified from research conducted in western contexts and that research conducted in China must be considered in light of such concepts. The current paper reports qualitative research conducted with Beijing drivers to investigate such social influence factors. Findings indicated that family members, friends, and driving instructors appear influential on driver behaviour and that some novice drivers seek additional assistance after obtaining their licence. The finding relating to the influence of driving instructors was not surprising, given the substantial number of new drivers in China. In Beijing, driving instruction is conducted off-road in purpose-specific driving facilities rather than on the road network. Once licensed, it is common for new drivers to have little or no experience driving in complex traffic situations. This learning situation is unlikely to provide all the skills necessary to successfully negotiate crowded city streets and assess the related risk associated with such driving. Therefore, it was not surprising to find that one reported strategy to assist new drivers was to employ the services of an ‘accompanying driver’ to provide ongoing driving instruction once licensed. In more highly motorised countries supervised practice is part of a graduated licensing system where it is compulsory for new drivers to be supervised by a more experienced driver for a requisite period of time before progressing to solo driving. However, as this system is not in place in China, it appears that some drivers seek out and pay for additional support once they commence on-road driving. Additionally, strategies to avoid detection and penalties for inappropriate road use were discussed, many of which involve the use of a third person. These findings indicate potential barriers to implementing effective traffic enforcement and highlight the importance of understanding culturally-specific social factors relating to driver behaviour.

Influences on student learning in engineering : some results from case study fieldwork

This paper closely examines factors affecting students’ progression in their engineering programs through fieldwork conducted at three Australian universities. To extract clues on how specific teaching methods can be used to maximize learning, the investigation considered factors such as understanding how students take in, process and present information. A number of focus groups were conducted with students and the data gathered was combined with survey results of students’ and academics’ learning styles. The paper reports on the process followed, and provides some analysis of the gathered data, as part of an Australian Learning and Teaching Council, ALTC, Associate Fellowship program.

Influences of green star rating tool on HVAC system design

Buildings are one of the most significant infrastructures in modern societies. The construction and operation of modern buildings consume a considerable amount of energy and materials, therefore contribute significantly to the climate change process. In order to reduce the environmental impact of buildings, various green building rating tools have been developed. In this paper, energy uses of the building sector in Australia and over the world are first reviewed. This is then followed by discussions on the development and scopes of various green building rating tools, with a particular focus on the Green Star rating scheme developed in Australia. It is shown that Green Star has significant implications on almost every aspect of the design of HVAC systems, including the selection of air handling and distribution systems, fluid handling systems, refrigeration systems, heat rejection systems and building control systems.

Ingroup and role identity influences on the initiation and maintenance of students' voluntary attendance at peer study sessions for statistics

Background: Although class attendance is linked to academic performance, questions remain about what determines students’ decisions to attend or miss class. Aims: In addition to the constructs of a common decision-making model, the theory of planned behaviour, the present study examined the influence of student role identity and university student (in-group) identification for predicting both the initiation and maintenance of students’ attendance at voluntary peer-assisted study sessions in a statistics subject. Sample: University students enrolled in a statistics subject were invited to complete a questionnaire at two time points across the academic semester. A total of 79 university students completed questionnaires at the first data collection point, with 46 students completing the questionnaire at the second data collection point. Method: Twice during the semester, students’ attitudes, subjective norm, perceived behavioural control, student role identity, in-group identification, and intention to attend study sessions were assessed via on-line questionnaires. Objective measures of class attendance records for each half-semester (or ‘term’) were obtained. Results: Across both terms, students’ attitudes predicted their attendance intentions, with intentions predicting class attendance. Earlier in the semester, in addition to perceived behavioural control, both student role identity and in-group identification predicted students’ attendance intentions, with only role identity influencing intentions later in the semester. Conclusions: These findings highlight the possible chronology that different identity influences have in determining students’ initial and maintained attendance at voluntary sessions designed to facilitate their learning.

Cyberinfrastructure inside out : definition and influences shaping its emergence, development, and implementation in the early 21st century

The authors provide a theoretically generative definition of cyberinfrastructure (CI) by drawing from existing definitions and literature in social sciences, law, and policy studies. They propose two models of domestic and international influencers on CI emergence, development, and implementation in the early 21st century. Based on its historical emergence and computational power, they argue that cyberinfrastructure is built on, and yet distinct from the current notion of the internet. The authors seek to answer two research questions: firstly, what is cyberinfrastructure? And secondly, what national and international influencers shape its emergence, development and implementation (in e-science) in the early 21st century? Additionally, consideration will be given to the implications of the proposed definition and models, and future directions on CI research in Internet studies will be suggested.

“They’re lunatics on the road” : Exploring the normative influences of parents, friends, and police on young novices’ risky driving decisions

Purpose: Young novice drivers experience significantly greater risk of being injured or killed in car crashes than older more experienced drivers. This research utilised a qualitative approach guided by the framework of Akers’ social learning theory. It explored young novice drivers’ perspectives on risky driving including rewards and punishments expected from and administered by parents, friends, and police, imitation of parents’ and friends’ driving, and advantages and disadvantages of risky driving. Methods: Twenty-one young drivers (12 females, 9 males) aged 16–25 years (M = 17.71 years, SD = 2.15) with a Learner (n = 11) or Provisional (n = 10) driver licence participated in individual or small group interviews. Findings and conclusions: Content analysis supported four themes: (1) rewards and (2) punishments for risky driving, and the influence of (3) parents and (4) friends. The young novice drivers differed in their vulnerability to the negative influences of friends and parents, with some novices advising they were able to resist risky normative influences whilst others felt they could not. The authority of the police as enforcers of road rules was either accepted and respected or seen as being used to persecute young novices. These findings suggest that road safety interventions should consider the normative influence of parents and friends on the risky and safe behaviour of young novices. Police were also seen as influential upon behaviour. Future research should explore the complicated relationship between parents, friends, the police, young novices, and their risky driving behaviour.

The microRNA expression signature on modified titanium implant surfaces influences genetic mechanisms leading to osteogenic differentiation

Topographically and chemically modified titanium implants are recognized to have improved osteogenic properties; however, the molecular regulation of this process remains unknown. This study aimed to determine the microRNA profile and the potential regulation of osteogenic differentiation following early exposure of osteoprogenitor cells to sand-blasted, large-grit acid-etched (SLA) and hydrophilic SLA (modSLA) surfaces. Firstly, the osteogenic characteristics of the primary osteoprogenitor cells were confirmed using ALP activity and Alizarin Red S staining. The effect of smooth (SMO), SLA and modSLA surfaces on the TGF-β/BMP (BMP2, BMP6, ACVR1) and non-canonical WNT/Ca2+ (WNT5A, FZD6) pathways, as well as the integrins ITGB1 and ITGA2, was determined. It was revealed that the modified titanium surfaces could induce the activation of TGF-β/BMP and non-canonical WNT/Ca2+ signaling genes. The expression pattern of microRNAs (miRNAs) related to cell differentiation was evaluated. Statistical analysis of the differentially regulated miRNAs indicated that 35 and 32 miRNAs were down-regulated on the modSLA and SLA surfaces respectively, when compared with the smooth surface (SMO). Thirty-one miRNAs that were down-regulated were common to both modSLA and SLA. There were 10 miRNAs up-regulated on modSLA and nine on SLA surfaces, amongst which eight were the same as observed on modSLA. TargetScan predictions for the down-regulated miRNAs revealed genes of the TGF-β/BMP and non-canonical Ca2+ pathways as targets. This study demonstrated that modified titanium implant surfaces induce differential regulation of miRNAs, which potentially regulate the TGF-β/BMP and WNT/Ca2+ pathways during osteogenic differentiation on modified titanium implant surfaces.

Measuring the effect of motorcycle rider training on psychosocial influences for risk taking

Aim: Whilst motorcycle rider training is commonly incorporated into licensing programs in many developed nations, little empirical support has been found in previous research to prescribe it as an effective road safety countermeasure. It has been posited that the lack of effect of motorcycle rider training on crash reduction may, in part, be due to the predominant focus on skills-based training with little attention devoted to addressing attitudes and motives that influence subsequent risky riding. However, little past research has actually endeavoured to measure attitudinal and motivational factors as a function of rider training. Accordingly, this study was undertaken to assess the effect of a commercial motorcycle rider training program on psychosocial factors that have been shown to influence risk taking by motorcyclists. Method: Four hundred and thirty-eight motorcycle riders attending a competency-based licence training course in Brisbane, Australia, voluntarily participated in the study. A self-report questionnaire adapted from the Rider Risk Assessment Measure (RRAM) was administered to participants at the commencement of training, then again at the conclusion of training. Participants were informed of the independent nature of the research and that their responses would in no way effect their chance of obtaining a licence. To minimise potential demand characteristics, participants were instructed to seal completed questionnaires in envelopes and place them in a sealed box accessible only by the research team (i.e. not able to be viewed by instructors). Results: Significant reductions in the propensity for thrill seeking and intentions to engage in risky riding in the next 12 months were found at the end of training. In addition, a significant increase in attitudes to safety was found. Conclusions: These findings indicate that rider training may have a positive short-term influence on riders’ propensity for risk taking. However, such findings must be interpreted with caution in regard to the subsequent safety of riders as these factors may be subject to further influence once riders are licensed and actively engage with peers during on-road riding. This highlights a challenge for road safety education / training programs in regard to the adoption of safety practices and the need for behavioural follow-up over time to ascertain long-term effects. This study was the initial phase of an ongoing program of research into rider training and risk taking framed around Theory of Planned Behaviour concepts. A subsequent 12 month follow-up of the study participants has been undertaken with data analysis pending.

Mum or bub? Which influences breastfeeding loyalty

The need for social marketing research in the area of breastfeeding is highlighted by the failure of campaigns to increase breastfeeding rates over the past two decades in developed countries. This is despite evidence of the health benefits of longer breastfeeding duration to both baby and mother, and the high levels of expenditure on these campaigns. Whilst past campaign approaches typically focus on baby-oriented factors, breastfeeding is a complex behaviour that for many women involves barriers that influence their commitment to continued breastfeeding. Using social marketing, this research investigates the role of mother-centred factors on loyalty to breastfeeding. A sample of 405 Australian women completed an online survey. The data were analysed using structural equation modelling, which revealed that mother-oriented, rather than baby-oriented, factors influence attitudinal and behavioural loyalty to breastfeeding.

Normative influences across cultures : conceptual differences and potential confounders among drivers in Australia and China

Normative influences on road user behaviour have been well documented and include such things as personal, group, subjective and moral norms. Commonly, normative factors are examined within one cultural context, although a few examples of exploring the issue across cultures exist. Such examples add to our understanding of differences in perceptions of the normative factors that may exert influence on road users and can assist in determining whether successful road safety interventions in one location may be successful in another. Notably, the literature is relatively silent on such influences in countries experiencing rapidly escalating rates of motorization. China is one such country where new drivers are taking to the roads in unprecedented numbers and authorities are grappling with the associated challenges. This paper presents results from qualitative and quantitative research on self-reported driving speeds of car drivers and related issues in Australia and China. Focus group interviews and questionnaires conducted in each country examined normative factors that might influence driving in each cultural context. Qualitative findings indicated perceptions of community acceptance of speeding were present in both countries but appeared more widespread in China, yet quantitative results did not support this difference. Similarly, with regard to negative social feedback from speeding, qualitative findings suggested no embarrassment associated with speeding among Chinese participants and mixed results among Australian participants, yet quantitative results indicated greater embarrassment for Chinese drivers. This issue was also examined from the perspective of self-identity and findings were generally similar across both samples and appear related to whether it is important to be perceived as a skilled/safe driver by others. An interesting and important finding emerged with regard to how Chinese drivers may respond to questions about road safety issues if the answers might influence foreigners’ perceptions of China. In attempting to assess community norms associated with speeding, participants were asked to describe what they would tell a foreign visitor about the prevalence of speeding in China. Responses indicated that if asked by a foreigner, people may answer in a manner that portrayed China as a safe country (e.g., that drivers do not speed), irrespective of the actual situation. This ‘faking good for foreigners’ phenomenon highlights the importance of considering ‘face’ when conducting research in China – a concept absent from the road safety literature. An additional noteworthy finding that has been briefly described in the road safety literature is the importance and strength of the normative influence of social networks (guanxi) in China. The use of personal networks to assist in avoiding penalties for traffic violations was described by Chinese participants and is an area that could be addressed to strengthen the deterrent effect of traffic law enforcement. Overall, the findings suggest important considerations for developing and implementing road safety countermeasures in different cultural contexts.

Educational stress among Chinese adolescents : individual, family, school and peer influences

Educational stress is common among school children and adolescents, especially in Asian countries. This study aims to identify factors associated with perceived educational stress among students in China. A cross-sectional questionnaire survey was conducted with 1627 students (Grades 7–12) from six secondary schools in rural and urban areas of Shandong Province. A wide range of individual, family, school and peer factors were associated with stress measured using the Educational Stress Scale for Adolescents (ESSA). Rural school location, low school connectedness, perceived poor academic grades, female gender, older age and frequent emotional conflicts with teachers and peers were among the strongest correlates, and most of them are school- or study-related. Unexpectedly, family and parental factors were found to have little or no association with children’s perceived educational stress. These findings may offer directions for interventions in secondary school settings.

A qualitative investigation of older pedestrian views of influences on their road crossing safety

With Australia’s population rapidly ageing, older pedestrian safety has begun to receive greater attention from road safety researchers. However, reliance on simulator studies and observational techniques has limited current understanding of why older pedestrians adopt particular crossing behaviours, and how they perceive crossing the road. The current study aimed to investigate the psychological factors that may contribute to older pedestrians’ crash risk by examining their perceptions of the issues they encounter on the road. Qualitative semi-structured interviews with 18 pedestrians aged 55 years and older were conducted, and the interview transcripts underwent thematic analysis. From this analysis, four key themes emerged. Firstly, the physical design of the road was perceived as posing a significant threat for older pedestrians, particularly sloped, semi-mountable kerbs and designated crossings. Secondly, declines in older pedestrians’ confidence in their ability to cross the road were evident through fewer reported risks being taken. Additionally, older pedestrians sensed an increased threat from other road users when crossing the road, particularly from drivers and cyclists. Finally, older pedestrians referred to the informal rules and strategies used to guide their road crossing. The results suggest that the road environment is perceived as increasingly dangerous and hazardous environment for older pedestrians. Implications regarding the physical road design in areas with an existing high proportion of elderly people are discussed.