UPTAKE OF THE PERIODIC HEALTH EXAM AMONG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES FROM 2003 TO 2015

Background: Over the past decade, annual heath exams have been de-emphasized for the general population but emphasized for adults with intellectual and developmental disabilities (IDD). The purpose of this project was to determine if there has been an increase in the uptake of the health exam among adults with IDD in Ontario, to what extent, and the effect on the quality of preventive care provided. Methods: Using administrative health data, the proportion of adults (18-64 years old) with IDD who received a health exam (long appointment, general assessment, and “true” health exam), a high value on the primary care quality composite score (PCQS), and a health exam or high PCQS each year was compared to the proportion in a propensity score matched sample of the general population. Negative binomial and segmented negative binomial regression controlling for age and sex were used to determine the relative risk of having a health exam/high PCQS/health exam or PCQS over time. Results: Pre joinpoint, the long appointment and general assessment health exam definitions saw a decrease and the “true” health exam saw an increase in the likelihood of adults having a health exam. Post joinpoint, all health exam definitions saw a decrease in the likelihood of adults having a health exam. Pre joinpoint, all PCQS measures (high PCQS, long appointment or high PCQS, “true” health exam or high PCQS) saw an increase in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Post joinpoint, all PCQS measures saw a decrease in the likelihood for adults to achieve a high PCQS or high PCQS/have a health exam. Achieving a high PCQS was strongly associated with having a health exam regardless of health exam definition or IDD status. Conclusions: Despite the publication of guidelines, only a small proportion of adults with IDD are receiving health exams. This indicates that the publication of guidelines alone was not sufficient to change practice. More targeted measures, such as the implementation of an IDD-specific health exam fee code, should be considered to increase the uptake of the health exam among adults with IDD.

Proving My Competency One Test at a Time: Internationally Educated Nurses and the Canadian English Language Benchmark Assessment for Nurses

Abstract Professional language assessment is a new concept that has great potential to benefit Internationally Educated Professionals and the communities they serve. This thesis reports on a qualitative study that examined the responses of 16 Canadian English Language Benchmark Assessment for Nurses (CELBAN) test-takers on the topic of their perceptions of the CELBAN test-taking experience in Ontario in the winter of 2015. An Ontario organization involved in registering participants distributed an e-mail through their listserv. Thematic analyses of focus group and interview transcripts identified 7 themes from the data. These themes were used to inform conclusions to the following questions: (1) How do IENs characterize their assessment experience? (2) How do IENs describe the testing constructs measured by the CELBAN? (3) What, if any, potential sources of construct irrelevant variance (CIV) do the test-takers describe based on their assessment experience? (4) Do IENs feel that the CELBAN tasks provide a good reflection of the types of communicative tasks required of a nurse? Overall, participants reported positive experiences with the CELBAN as an assessment of their language skills, and noted some instances in which they felt some factors external to the assessment impacted their demonstration of their knowledge and skill. Lastly, some test-takers noted the challenge of completing the CELBAN where the types of communicative nursing tasks included in the assessment differed from nursing tasks typical of an IENs country or origin. The findings are discussed in relation to literature on high-stakes large-scale assessment and IEPs, and a set of recommendations are offered to future CELBAN administration. These recommendations include (1) the provision of a webpage listing all licensure requirements (2) monitoring of CELBAN location and dates in relation to the wider certification timeline for applicants (3) The provision of additional CELBAN preparatory materials (4) Minor changes to the CELBAN administrative protocols. Given that the CELBAN is a relatively new assessment format and its widespread use for high-stakes decisions (a component of nursing certification and licensure), research validating IEN-test-taker responses to construct representation and construct irrelevant variance is critical to our understanding of the role of competency testing for IENs.

An exploration of students’ perceptions and attitudes towards creativity in engineering education

This study used a mixed methods approach to develop a broad and deep understanding of students’ perceptions towards creativity in engineering education. Studies have shown that students’ attitudes can have an impact on their motivation to engage in creative behavior. Using an ex-post facto independent factorial design, attitudes of value towards creativity, time for creativity, and creativity stereotypes were measured and compared across gender, year of study, engineering discipline, preference for open-ended problem solving, and confidence in creative abilities. Participants were undergraduate engineering students at Queen’s University from all years of study. A qualitative phenomenological methodology was adopted to study students’ understandings and experiences with engineering creativity. Eleven students participated in oneon- one interviews that provided depth and insight into how students experience and define engineering creativity, and the survey included open-ended items developed using the 10 Maxims of Creativity in Education as a guiding framework. The findings from the survey suggested that students had high value for creativity, however students in fourth year or higher had less value than those in other years. Those with preference for open-ended problem solving and high confidence valued creative more than their counterparts. Students who preferred open-ended problem solving and students with high confidence reported that time was less of a hindrance to their creativity. Males identified more with creativity stereotypes than females, however overall they were both low. Open-ended survey and interview results indicated that students felt they experienced creativity in engineering design activities. Engineering creativity definitions had two elements: creative action and creative characteristic. Creative actions were associated with designing, and creative characteristics were predominantly associated with novelty. Other barriers that emerged from the qualitative analysis were lack of opportunity, lack of assessment, and discomfort with creativity. It was concluded that a universal definition is required to establish clear and aligned understandings of engineering creativity. Instructors may want to consider demonstrating value by assessing creativity and establishing clear criteria in design projects. It is recommended that students be given more opportunities for practice through design activities and that they be introduced to design and creative thinking concepts early in their engineering education.