The self-management approach of health education in the treatment of chronic illnesses

Health education is essential to the successful treatment of individuals with chronic illnesses. Self-management is a philosophical model of health education that has been shown to be effective in teaching individuals with chronic arthritis to manage their illness as part of their daily lives. Despite the proven results of arthritis self-management programs, some limitations of this form of health education were apparent in the literature. The present study attempted to address the problems of the self-management approach of health education such as reasons for lack of participation in programs and poor course outcomes. In addition, the study served to investigate the relationship between course outcomes and participation in programs with the theory upon which arthritis self-management programs are based, known as self-efficacy theory. Through a combination of qualitative and quantitative methodologies, data collection, and analysis, a deeper understanding of the self-management phenomenon in the treatment of chronic arthritic conditions was established. Findings of the study confirm findings of previous studies that suggest that arthritis self-management programs result in enhanced levels of self-efficacy and are effective in teaching individuals with arthritis to self-manage their health and health care. Findings of the study suggest that there are many factors that determine the choice of participants to participate in programs and the outcomes for the individuals who do choose to participate in programs. Some of the major determinants of enrollment and outcomes of programs include: the participant's personality, beliefs, attitudes and abilities, and the degree of emotional acceptance of the illness. Other determinants of course enrollment and outcomes included class size and length of time, timing of participation, and ongoing support after the program. The results of the study are consistent with the self-management literature and confirm the relationship between the underlying philosophies of adult education and Freire's model of education and self-management.

Teacher-Student Rapport: Investigating its Impact on the Dropout Rate in Physical and Health Education

This study was an investigation into whether strong teacher-student rapport relates to the drop-out rates of students in grade 9 and 10 health and physical education (HPE). In the study, One hundred and thirty-six grade 9 students from five high schools in Ontario participated in this study. Findings of whether or not rapport related to students’ decision to take an additional HPE credit beyond grade 9 did not prove conclusive. A significant multivariate interaction effect was not found; however, tests of between-subject effects on sex and grade 10 dropouts showed some interesting trends. More research is needed to further illuminate the link between teacher-student rapport and students’ enrollment in optional HPE classes.

Participation factors in optional high school health and physical education

Student enrolment rates in optional health and physical education (HPE) classes have been steadily declining, to the point where most Ontario students stop taking HPE after completion of their one required credit, typically taken in grade nine. This study looked at factors that could contribute to HPE enrolment, sampling 227 grade ten students from five schools. These factors included selfefficacy (SE), perceived autonomy support (PAS), task value (TV), motivational regulation (autonomous, AR; controlled, CR), HPE grade average and body size discrepancy (BSD). Qualitative information was also gathered from students regarding likes and dislikes ofHPE, as well as reasons for their HPE enrolment choice. Cronbach Alpha values of each scale fell within acceptable values. ANOVA analysis revealed differences between enrolment groups in SE, TV, AR, HPE grade average, and BSD (p < .05). Reasons students reported for not taking HPE included a dislike of health classes, scheduling challenges, not needing HPE for future endeavors, concerns about social self-presentation, and a dislike of sports and/or competition. This research shows important differences between students and their HPE class choices and calls for a re-evaluation of how HPE classes are structured, advertised and scheduled by high school practitioners. Future works should look toward what other factors could be at play in students' decisions for or against optional HPE and how those factors interact with the constructs that were found to be of significance in this study. Keywords: Health and physical education, high school students, participation.

Mentorships and co-op placements as a means of heightening the need for a secondary school diploma to the education of at-risk students.--

Both educators and politicians appear to be quite concerned about a dropout rate in Ontario's public schools of some 30 percent. With the basic understanding that a high dropout rate is costly both in economic terms and in human terms, something quite obviously needs to be done to reduce the dropout rate in Ontario schools and, in doing so, ensuring Ontario and its graduates an active role in a growing global economy. This study is an exploratory pilot study in that it examined mentoring and the role that mentoring can play in assisting a student in staying in school and graduating from secondary school. Also incorporated in this is co-operative education and the role it can play, through mentoring, in making students aware of lifestyle level of employment, and of the skills necessary to obtain gainful, meaningful employment. In order to gain information on student attitudes, needs and expectations of a mentoring situation, a series of three questionnaires was used. Also, a questionnaire was distributed to the various co-operative education employers. The intent of this questionnaire was to probe the attitudes, needs and expectations of a mentoring situation from the perspective of an employer. The findings of this study indicated that co-operative education and mentoring are a very valuable and useful component in education. There exist certain factors in a co-operative education setting that serve to enhance and to augment the traditional or "theoretical" setting of the classroom. In addition, a mentoring situation tends to add a sense of relevance to education that students seem to require. Also, an opportunity is offered that allows a student to practice and further refine the skills that have been taught over the course of the student's academic life. Results from this study suggested that a mentoring situation, occurring through a co-operative education situation, adds relevance and a sense of "application" to the traditional or classroom schooling situation. The whole idea of mentoring bodes well for the future of education and of the student. Many advantages are identified in a mentoring situation. One of the advantages is that the schools are able to work quite closely with the community and business in order to stay current and informed on the needs and expected needs of the business community. Co-operative education has now gone beyond being an "experimental" mode of education. All students can benefit from being involved in the program. Certainly at-risk students are aided with staying in school. Those students who are said to be not at-risk can also benefit from being enrolled in the program by gaining hands-on work experience and some of the necessary skills to ensure a place in a growing world economy.

Improving the oral health status of functionally independent and dependent seniors residing in long-term care facilities through dental hygiene education /

The purpose of this study was to evaluate the oral health status of residents residing in 2 long-term care facilities and determine if dental hygiene education was required in order to improve their current oral health. The oral health status of 6 independent and 4 dependent individuals residing in 2 long-term care facilities was evaluated. In addition, the current oral health and disease prevention practices employed by 4 caregivers who were responsible for providing oral care to dependent residents in the long-term care facilities were evaluated. Furthermore, an evaluation of the oral care practices of independent residents who were responsible for providing their own care was conducted. Finally, the challenges that caregivers and independent residents faced when performing oral care were determined, and methodological changes were proposed. Using a generic qualitative research methodology, data collection was comprised of semi structured interviews, field observations, and documentation. The oral health status of the residents was reevaluated 3 months later. The findings of this study demonstrated an increase in plaque accumulation, gingival inflammation, and unhealthy gingival tissue colour changes among the residents over the 3-month period. The study revealed that poor oral health among the residents was a result of inadequate oral hygiene care techniques, difficulties accessing oral health care, financial limitations, insufficient care staff, insufficient time for personal care duties, lack of professional development, minimal interprofessional collaboration of health disciplines, and lack of perseverance on the part of the caregivers and residents. Overall, oral health is essential, and maintaining optimal oral health requires increased collaboration and communication between health care providers.

A case study of the implementation of experiential education in Yukon K-12 schools

This qualitative case study explored the process of implementing Experiential Education (EXED) in Yukon Territory Kindergarten to Grade 12 (K-12) schools with a particular focus on investigating: (a) understandings of EXED and the drivers behind its implementation, (b) factors contributing to EXED's suitability for Yukon schools, and (c) factors supporting and challenging the implementation of EXED in Yukon schools. Data collection involved interviews with Yukon Department of Education (YDE) staff members, principals and teachers, document collection, and reflective note collection. Findings indicated that EXED was understood as more of a me~odology than a philosophy for teaching and learning. EXED implementation was primarily driven by bottom-up (school! teacher) initiatives and was secondarily supported by top-down (YDE) efforts. The process of implementation was supported by three main factors and was challenged primarily by six factors. The results also pointed to three factors that made EXED suitable for implementation in Yukon schools.

Employer Perspectives on Secondary School Cooperative Education in a Southern Ontario City in Canada

Despite 2 Ontario Ministry of Education policy documents which mandate that regular program effectiveness surveys be completed in secondary school co-op programs, research was either not occurring or data were not being made available. A lack of co-op research also existed at the postsecondary level. The primary reason for this study was to determine the perspectives of current secondary school co-op employers in the Hamilton-Wentworth District School Board (HWDSB) and to identify any program strengths as well as any areas in which improvement can be made. A secondary aim of the study was to discover the reasons that some employers decline to participate in the co-op program, and why other employers decide to discontinue their co-op partnerships. An online survey was utilized with 2 Likert scales and open-ended questions to solicit responses from the 100 participants. The findings from this study strongly supported previous secondary and postsecondary co-op research. Overall, the HWDSB co-op program was found to be very strong, and employer satisfaction very high. There were, however, areas in which improvement could be made. Although most employers felt supported by institutions and felt that expectations were clearly communicated and were reasonable, there was evidence that many employers perceived a lack of institutional support which included factors such as communication, student placement and fit, and institutional responsiveness. In addition, some employers felt that students were underprepared for the workplace and lacked basic employability skills such as dependability and responsibility.

Cardiovascular health risk profiling of Niagara Region grade 9 students : implications for elementary curriculum /

The purpose of this study was to determine if Ontario's health and physical education curriculum contributes sufficiently to ensure the health of our children and young adults. To determine the curriculum effect, the health risk profile of Niagara Region's grade 9 students was compared to Canada's adolescent population. All subjects completed a "Heart Health Lifestyle" survey and were measured for height, weight, percent body fat, blood pressure, and total cholesterol and performed the 20-metre shuttle run test as part of their physical and health education classes. The Niagara Region grade 9 population had a healthy risk profile. Aerobic power was inversely related, and cholesterol levels were positively associated to body mass index and percent body fat in the whole group analysis. These results indicate that physical education can offer unique and essential aspects allowing individuals a means to learn and control body movements and keep physically fit while providing protection against modern disease. Ontario's health and physical education curriculum does contribute to the health of our children and adolescents; however, there is a need to implement a stronger mandate for daily vigorous physical activity.

Migrations and gradations : reappraising the health profile of immigrants to Canada

New immigrants to Canada typically have a more favourable health profile than the non-immigrant population. This phenomenon, known as the 'healthy immigrant effect', has been attributed to both the socioeconomic advantage (ie. educational attainment, occupational opportunity) of non-refugee immigrants and existing screening protocols that admit only the healthiest of persons to Canada. It has been suggested that this health advantage diminishes as the time of residence in Canada increases, due in part to the adoption of health-risk behaviours such as alcohol and cigarette use, an increase in excess body weight, and declining rates of physical activity. However, the majority of health research concerning immigrants to Canada has been limited to cross-sectional studies (Dunn & Dyck, 2000; Newbold & Danforth, 2003), which may mask an immigrant-specific cohort effect. Furthermore, the practice of aggregating foreign-bom persons by geographical regions or treating all immigrants as a homogeneous group may also obfuscate intra-immigrant differences in health. Accordingly, this study uses the Canadian National Population Health Surveys (NPHS) and data from the United Nations Development Program (UNDP) to prospectively evaluate factors that predict health status among immigrants to Canada. Each immigrant in the NPHS was linked to the UNDP Human Development Index of their country of birth, which uses a combined measure of health, education, and per capita income of the populace. The six-year change in health function, psychological distress, and self-rated health were considered from a population health perspective (Evans, 1994), using generalized-estimating equations (GEE) to examine the compounding effect of past and recent predictors of health. Demographic

Comprehensive school health, the social determinants of health, and the health status of children

As children are becoming increasingly inactive and obese, there is an urgent need for effective early prevention and intervention programs. One solution is a comprehensive school health (CSH) program, a health promotion initiative aimed at educating students about healthy behaviours and lifestyles, which also provides a link between the school, students, families, and the surrounding community. The purpose of this study was to explore the relationship between different components of CSH programs, as well as three determinants of health (gender, social support, socio-economic status), and physical activity, on the aerobic fitness and body mass index (BMI) of children. A newly developed and pilot-tested survey derived from Health Canada's fourpart CSH model (instruction, social support, support services, and a healthy physical environment) was sent to elementary school principals. Data on the gender, physical activity, parental education, and social support levels of students from these schools were gathered from a previous study. Multiple regression procedures were conducted to estimate the relationships between CSH components, the social determinants of health, physical activity, and BMI and aerobic fitness. Results showed that three CSH components were significantly associated with both BMI and aerobic fitness values in children, but accounted for less than 5% of the variance in both variables. Physical activity partially mediated the relationship between the significant CSH components, BMI, and particularly aerobic fitness. Furthermore, the social determinant and physical activity variables played independent roles in aerobic fitness values. No moderating effects of the social determinants were discovered.

Teachers' perceptions of effects of terminal examinations on teaching and learning at the secondary school level in Zimbabwe

This study was particularly aimed at the examinations and the effect they have on schooling at the secondary school level in Zimbabwe. The views and opinions of teachers on the use of terminal examinations for certification and the influence they are seen to have on teachers' approach to the curriculum were examined. The literature has shown that there is widespread criticism of the justice and effects of terminal examinations. It is argued that they lead to an over-emphasis of that which is measured, knowledge and intellectual ability, at the expense of that kind of education progress which is almost impossible to measure in an end-of-the-course assessment. Three hundred and six secondary school teachers responded to a survey which asked for teachers' perceptions of examinations and the curriculum. The findings of this study indicated that teaching is structured towards examinations. Although teachers are trying to teach and develop reasoning skills and other activities, the pressure of examinations and the importance of doing well in them force teachers to restrict themselves to examination requirements.

The impact of the Canadian Standardized Test of Fitness and of health counselling on health attitudes and behaviour

The purpose of this research study was to determine whether or not the use of a single day of Personal Wellness Evaluations would be meaningful enough to change the attitudes of participants toward adopting a healthier lifestyle, or if it was necessary to include regular planned health counselling alon-g with the Personal Wellness Evaluations in order to'observe changes in beliefs, attitudes and behaviours toward active living and the adoption of a healthier lifestyle. Attitudes and behaviours toward physical fitness and healthy lifestyle choices were assessed through a questionnaire composed of the following instruments: Fishbein and Ajzen Attitude and Behaviour Questionnaire, Leisure Behaviour Questionnaire, Ten Centimeter Bipolar Health Continuum, Neugarten Life Satisfaction Assessment, Job Description Index, Selected questions from the Ontario Health Survey, and the Symptom Reporting Questionnaire. Physical fitness evaluation consisted of the Canadian Standardized Test of Fitness, measures of blood pressure, and total cholesterol. The participants were divided into three groups: Group 1- CSTF & health counselling, Group 2- CSTF only, and Group 3- a control group. All three groups received the questionnaire both at the beginning and at the end of the study. Group 1 and Group 2 also participated in fitness testing at these same times, with a three-month time interval between test times. Group 1 also received weekly one-hour health education sessions during the three months between fitness testing. While there were some differences found between the three groups in this study, the results of this study suggested that this three-month workplace wellness program had no impact on the participants' attitudes and behaviours toward health and physical activity. There were no significant differences in the physical fitness measures between Group 1 and Group 2 , nor in the participants' questionnaire responses. These results may be due to the participants' lack of compliance to this wellness program. Employees who 11 participate in a workplace weIlness program must be self-motivated to comply with the program in order to receive the full benefits the program has to offer. Some participants in this study did not have the internal motivation necessary to remain in the study for the three-month period. Future research may consider implementing a workplace wellness program for a longer duration as well as incorporating a specific physical fitness program for the participants to follow. An exercise program could improve the participants' physical fitness, while the health counselling would give the individuals the health education necessary to lead a healthy lifestyle.

Understanding the portfolio in the secondary school classroom

Four secondary school teachers were involved in this case study. Individual interviews, group reflective sessions, and participant portfolios were transcribed verbatim and analyzed. The use of the portfolio in the secondary school classroom was then discussed in relation to emergent themes. These themes included teacher attitude, portfolio structure, portfolio purpose, challenges, effect, and professional development. Teachers were able to individualize the portfolio structure to meet both program and students' needs. The portfolio structure enabled both teachers and students to assume control over the learning process. The portfolio informed teachers about their teaching. This, in tum, challenged them to reflect on their teaching practices and enabled them to redesign curriculum implementation. A collaborative professional development structure fostered a learning environment that enabled teachers to experience success, despite the challenges that they inevitably encountered. These findings were related to contemporary literature. Finally, implications for theory and practice related to portfolio use in the secondary school classroom and professional development for secondary school teachers were considered.

Comprehensive school health : an ethnographic case study

The purpose of this ethnographic case study was to describe the characteristics of one school's Comprehensive School Health (CSH) initiative and to explore the experiences of school community members in order to gain an understanding of how one school embraced a Comprehensive School Health approach. An elementary school (grades Junior Kindergarten to six) in Burlington, Ontario was the research site for this study. Multiple methods of data collection (observations, document analysis, interviews) were used in keeping with the ethnographic and case study approach. The data were coded using both a deductive and then inductive process (Merriam, 1998). From a deductive perspective, the coding system and the subsequent identification of categories were based on a priori categories identified by using the elements of CSH based on the Comprehensive School Health Consensus Statement prepared by the Canadian Association of School Health and the research questions. Findings included the role that various school community members as well as the implementation of different programs and policies played in applying a CSH approach. The impact ofthe physical environment was described as well as successes and challenges related to the school's experience in implementing CSH. Three main themes emerged that characterized this school's experience. The first theme relates to the fundamental question about CSH which is the school community's understanding o/the concept. The second theme focused on positive school culture and the third and most diverse theme was that of capacity. Engaging in CSH is a complex and long-term undertaking involving both the school and greater community. Based on the experiences of this school's community members, recommendations address the different levels of influence on the health of children.