EXPLORING THE EFFECTS OF THE RELATIONSHIP BETWEEN SCHOOL CHARACTERISTICS, TEACHER CHARACTERISTICS, ADMINISTRATIVE SUPPORT, AND SCHOOL CLIMATE ON VOLUNTARY INTRA-DISTRICT TEACHER MIGRATION

This quantitative research study utilized a binary logistic regression in a block design to investigate exogenous and endogenous factors influencing a teacher’s decision to make an intra-district move. The research focused on the following exogenous factors: classroom characteristics (size of class, percent minority, percent of students with an individualized education plan, and percent of students that are English language learners) and teacher characteristics (experience and gender). The following endogenous factors were examined: direct administrative influence (administrative support, rules enforced, school vision, teacher recognition, and job security) and indirect administrative influence (school climate, student misbehavior, parental support, materials, staff collaboration). The research was conducted by using information available from the National Center for Educational Statistics, the SASS from 2011-2012 and TFS from 2012-2013. The 2012-2013 Teacher Follow-up Survey identified 60 teachers who made a voluntary intra-district move. Results illustrate there is a statistically significant relationship between percentage of English Language Learners and overall job satisfaction and teachers choosing to make an intra-district move.

Predictors of Patient Activation Among Underserved Patients in a Nurse-managed Health Center: A Pilot Study

The concept of patient activation has gained traction as the term referring to patients who understand their role in the care process and have “the knowledge, skills and confidence” necessary to manage their illness over time (Hibbard & Mahoney, 2010). Improving health outcomes for vulnerable and underserved populations who bear a disproportionate burden of health disparities presents unique challenges for nurse practitioners who provide primary care in nurse-managed health centers. Evidence that activation improves patient self-management is prompting the search for theory-based self-management support interventions to activate patients for self-management, improve health outcomes, and sustain long-term gains. Yet, no previous studies investigated the relationship between Self-determination Theory (SDT; Deci & Ryan, 2000) and activation. The major purpose of this study, guided by the Triple Aim (Berwick, Nolan, & Whittington, 2008) and nested in the Chronic Care Model (Wagner et al., 2001), was to examine the degree to which two constructs– Autonomy Support and Autonomous Motivation– independently predicted Patient Activation, controlling for covariates. For this study, 130 nurse-managed health center patients completed an on-line 38-item survey onsite. The two independent measures were the 6-item Modified Health Care Climate Questionnaire (mHCCQ; Williams, McGregor, King, Nelson, & Glasgow, 2005; Cronbach’s alpha =0.89) and the 8-item adapted Treatment Self-Regulation Questionnaire (TSRQ; Williams, Freedman, & Deci, 1998; Cronbach’s alpha = 0.80). The Patient Activation Measure (PAM-13; Hibbard, Mahoney, Stock, & Tusler, 2005; Cronbach’s alpha = 0.89) was the dependent measure. Autonomy Support was the only significant predictor, explaining 19.1% of the variance in patient activation. Five of six autonomy support survey items regressed on activation were significant, illustrating autonomy supportive communication styles contributing to activation. These results suggest theory-based patient, provider, and system level interventions to enhance self-management in primary care and educational and professional development curricula. Future investigations should examine additional sources of autonomy support and different measurements of autonomous motivation to improve the predictive power of the model. Longitudinal analyses should be conducted to further understand the relationship between autonomy support and autonomous motivation with patient activation, based on the premise that patient activation will sustain behavior change.