The development of a model of continuing professional development for teachers of primary science

A new science curriculum was introduced to primary schools in the Republic of Ireland in 2003. This curriculum, broader in scope than its 1971 predecessor (Curaclam na Bunscoile, 1971), requires teachers at all levels of primary school to teach science. A review carried out in 2008 of children’s experiences of this curriculum found that its implementation throughout the country was uneven. This finding, together with the increasing numbers of teachers who were requesting support to implement this curriculum, suggested the need for a review of Irish primary teachers’ needs in the area of science. The research study described in this thesis was undertaken to establish the extent of Irish primary teachers’ needs in the area of science by conducting a national survey. The data from this survey, together with data from international studies, were used to develop a theoretical framework for a model of Continuing Professional Development (CPD). This theoretical framework was used to design the Whole- School, In-School (WSIS) CPD model which was trialled in two case-study schools. The participants in these ‘action-research’ case-studies acted as co-researchers, who contributed to the development and evolution of the CPD model in each school. Analysis of the data gathered as part of the evaluation of the Whole-School, In- School (WSIS) model of CPD found an improved experience of science for children and improved confidence for teachers teaching at all levels of the primary school. In addition, a template for the establishment of a culture of collaborative CPD in schools has been developed from an analysis of the data

Development of an intervention to support medication management in patients with multimorbidity in primary care

The overarching aim of this thesis was to develop an intervention to support patient-centred prescribing in the context of multimorbidity in primary care. Methods A range of research methods were used to address different components of the Medical Research Council, UK (MRC) guidance on the development and evaluation of complex interventions in health care. The existing evidence on GPs’ perceptions of the management of multimorbidity was systematically reviewed. In qualitative interviews, chart-stimulated recall was used to explore the challenges experienced by GPs when prescribing for multimorbid patients. In a cross-sectional study, the psychosocial issues that complicate the management of multimorbidity were examined. To develop the complex intervention, the Behaviour Change Wheel (BCW) was used to integrate behavioural theory with the findings of these three studies. A feasibility study of the new intervention was then conducted with GPs. Results The systematic review revealed four domains of clinical practice where GPs experienced difficulties in multimorbidity. The qualitative interview study showed that GPs responded to these difficulties by ‘satisficing’. In multimorbid patients perceived as stable, GPs preferred to ‘maintain the status quo’ rather than actively change medications. In the cross-sectional study, the significant association between multimorbidity and negative psychosocial factors was shown. These findings informed the development of the ‘Multimorbidity Collaborative Medication Review and Decision-making’ (MY COMRADE) intervention. The intervention involves peer support: two GPs review the medications prescribed to a complex multimorbid patient together. In the feasibility study, GPs reported that the intervention was appropriate for the context of general practice; was widely applicable to their patients with multimorbidity; and recommendations for optimising medications arose from all collaborative reviews. Conclusion Applying theory to empirical data has led to an intervention that is implementable in clinical practice, and has the potential to positively change GPs’ behaviour in the management of medications for patients with multimorbidity.