Patient engagement strategies used for hypertension and their influence on self-management attributes

Background. Several effective methods to facilitate patient self-management of hypertension are available in primary care. These include direct support from community pharmacists and general practice, and the use of home blood pressure (BP) monitoring. The aim of this study is to establish the prevalence of use of key strategies and to determine their independent relationship with patient self-management attributes.

Methods. A survey of patients with treated hypertension was undertaken in 27 community pharmacies. This established recent use of BP monitoring and advice from health professionals. Patient awareness of BP and targets, appropriateness of BP targets and adherence to anti-hypertensive medications were assessed as indicative self-management outcomes. Predictors of outcomes were determined using binary logistic regression.

Results. Overall, 215 surveys were returned. Two-thirds of patients were aged >65 years, and 45% had conditions warranting tighter BP control (<130/80 mmHg). Almost all patients reported monitoring of their BP in the previous year and 63% could report their most recent BP reading. Just 36% reported knowing a target BP, and 78% of reported targets were within guidelines recommendations. One-fifth (22%) monitored their own BP, and 15% reported non-adherence to medication. Doctors provided the large majority of professional advice. Self-monitoring or documentation of BP readings was independently associated with increased likelihood of BP and target BP being known.

Conclusions. Regular monitoring of BP does not automatically translate to professional advice. Increased uptake of patient self-monitoring should be promoted as a means of enabling self-management.

Principal led school improvement and teacher capacity building in the Barwon South Network : final report, May 2013

The period of interest for this report is the beginning of 2011 to the end of 2012. The period commenced when the Regional Network Leader of the Barwon South Network of schools in the Barwon South Region of the Department of Education and Early Childhood contacted the School of Education at Deakin University, Waurn Ponds Campus Geelong. The Regional Network Leader outlined a desire to engage with Deakin University to research a short-term-cycle model of school improvement to be implemented in the region. While the model was expected to be taken on by all schools in the region the research was limited to the 23 schools in the Barwon South Network with four schools to be investigated more closely for each of two years (2001 & 2012) – eight focus schools in total.

Many positive outcomes flowed from the implementation of short-term-cycle school improvement plans and their associated practices but there was wide variation in the nature and degrees of success and of the perception of the process. The research team asked the following questions of the data:

1. What aspects of the School Improvement Plan (SIP) approach were important for initiating and supporting worthwhile change?
2. What might we take from this, to provide guidance on how best to support change in teaching and learning processes in schools?

The School Improvement Plan (SIP) worked in a range of ways. At one level it was strongly focused on school leadership, and a need to improve principals’ capacity to initiate worthwhile teaching and learning processes in their schools. Underlying this intent, one might think an assumption is operation is that the leadership process involves top down decision-making and a willingness to hold staff accountable for the quality of their practice.

The second strong focus was on the translation into practice and the consequent effect on student learning, involving an emphasis on data and evidence led practice. Hence, along with the leadership focus there was a demand for the process of school improvement to reach down into students and classrooms. Thus, the SIP process inevitably involved a chain of decision-making by which student learning quality drove the intervention, and teachers responsible for this had a common view. The model therefore should not be seen as an intervention only on the principal, but rather on the school decision-making system and focus. Even though it was the principal receiving the SIP planning template, and reporting to the network, the reporting was required to include description of the operation of the school processes, of classroom processes, and of student learning. This of course placed significant constraints on principals, which may help explain the variation in responses and outcomes described above.

The findings from this study are based on multiple data sources: analysis of both open and closed survey questions which all teachers in the 23 schools in the network were invited to complete; interviews with principals, teachers and leaders in the eight case study schools; some interviews with students in the case study schools; and interviews with leaders who worked in the regional network office; and field notes from network meetings including the celebrations days. Celebrations days occurred each school term when groups of principals came together to share and celebrate the improvements and processes happening in their schools. Many of the themes emerging from the analysis of the different data sources were similar or overlapping, providing some confidence in the evidence-base for the findings.

The study, conducted over two years of data collection and analysis, has demonstrated a range of positive outcomes in at the case study schools relating to school communication and collaboration processes, professional learning of principals, leadership teams and classroom teachers. There was evidence in the survey responses and field notes from ‘celebration days’ that these outcomes were also represented in other schools in the network. The key points of change concerned the leadership processes of planning for improvement, and the rigorous attention to student data in framing teaching and learning processes. This latter point of change had the effect of basing SIP processes on a platform of evidence-based change. The research uncovered considerable anecdotal and observational evidence of improvements in student learning, in teacher accounts in interview, and presentations of student work. Interviews with students, although not as representative as the team would have liked, showed evidence of student awareness of learning goals, a key driver in the SIP improvement model. It was, however, not possible over this timescale to collect objective comparative evidence of enhanced learning outcomes.

A number of features of the short-term-cycle SIP were identified that supported positive change across the network. These were: 1) the support structures represented by the network leader and support personnel within schools, 2) the nature of the SIP model – focusing strongly on change leadership but within a collaborative structure that combined top-down and bottom-up elements, 3) the focus on data-led planning and implementation that helped drill down to explicit elements of classroom practice, and 4) the accountability regimes represented by network leader presence, and the celebration days in which principals became effectively accountable to their peers. We found that in the second year of the project, momentum was lost in the case study schools, as the network was dismantled. This raised issues also for the conduct of research in situations of systemic change.

Alongside the finding of evidence of positive outcomes in the case study schools overall, was the finding that the SIP processes and outcomes varied considerably across schools. A number of contextual factors were identified that led to this variation, including school histories of reform, principal management style, and school size and structure that made the short-term-cycle model unmanageable. In some cases there was overt resistance to the SIP model, at least in some part, and this led to an element of performativity in which the language of the SIP was conscripted to other purposes. The study found that even with functioning schools the SIP was understood differently and the processes performed differently, raising the question of whether in the study we are dealing with one SIP or many. The final take home message from the research is that schools are complex institutions, and models of school improvement need to involve both strong principled features, and flexibility in local application, if all schools’ interests in improving teaching and learning processes and outcomes are to be served.

Social engagement among migrant youth: attitudes and meanings

This article explores migrant young people’s engagement, participation and involvement in socially meaningful activi-ties, events and experiences. This type of social participation is approached in the social inclusion literature using the notions of social capital and active citizenship (Bourdieu, 1986; Coleman, 1988; Putnam, 1993; Putnam, 2000). A key objective, therefore, is to explore the attitudes, values and perceptions associated with social participation for young people. They include the meanings that social engagement has for migrant young people, along with drivers and inhibi-tions to active participation. The article focuses on both the motives for being actively engaged as well as perceived barriers to social engagement. It is based on a large study conducted among migrant young people of African, Arabic-speaking and Pacific Islander backgrounds in Melbourne and Brisbane, and presents both quantitative and qualitative (discursive) snapshots from the overall findings, based on interviews and focus groups. While many studies have cen-tred on the management of migration and migrants, this article draws attention to the individuals’ active position in negotiating, interpreting and appropriating the conditions of social inclusion. Accounting for the multidimensional and multilayered nature of social inclusion, the paper highlights the heuristic role of social engagement in fostering the feel-ings of belonging and personal growth for migrant youth.

Dynamics and spatio-temporal variability of environmental factors in Eastern Australia using functional principal component analysis

This paper introduces a new technique in ecology to analyze spatial and temporal variability in environmental variables. By using simple statistics, we explore the relations between abiotic and biotic variables that influence animal distributions. However, spatial and temporal variability in rainfall, a key variable in ecological studies, can cause difficulties to any basic model including time evolution. The study was of a landscape scale (three million square kilometers in eastern Australia), mainly over the period of 19982004. We simultaneously considered qualitative spatial (soil and habitat types) and quantitative temporal (rainfall) variables in a Geographical Information System environment. In addition to some techniques commonly used in ecology, we applied a new method, Functional Principal Component Analysis, which proved to be very suitable for this case, as it explained more than 97% of the total variance of the rainfall data, providing us with substitute variables that are easier to manage and are even able to explain rainfall patterns. The main variable came from a habitat classification that showed strong correlations with rainfall values and soil types. © 2010 World Scientific Publishing Company.

Transitions in reflective practice: exploring student development and preferred methods of engagement

Aim: Health-care professional students are required to demonstrate their reflective practice skills during their degree training programme. Online and digital technologies are increasingly being used to support this skill development. Our study aimed to explore whether different technology-based methods supported student growth and skill development in reflective practice at separate developmental time points (novice and competent). Methods: Third- (n = 23) and fourth-year undergraduate dietetic students (n = 22) from a single university were cross-sectionally surveyed via an online anonymous questionnaire at the end of the academic year. The mixed methods survey of 37 questions investigated the student experience of different reflective practice activities, their effect on a student's ability to self-reflect and whether using them aided a student's perceived transition towards becoming a competent dietitian. The data analysis included brief thematic enquiry, descriptive and independent t-test statistical examination. Results: Differences emerged in the way students engaged in reflection over time. Fourth-year students preferred to use more independent methods such as e-journaling (fourth- vs third-year students, P = 0.003) and engaged in reflection for reasons outside assessment (fourth- vs third-years, P = 0.027). Fourth-year students also identified fewer negative barriers to participating in reflection and reported being comfortable engaging in reflective practice. Conclusions: Overall, offering students a range of ways to engage in reflective practice over time supported their understanding and increased confidence in their reflective practice skills, thus potentially enabling a smoother transition into their profession where reflective practice is an essential and autonomous skill. © 2014 Dietitians Association of Australia.

Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings

Background : Communication problems contribute enormously to medication errors and adverse events. Encouraging patient engagement can help to facilitate effective medication management.

Objectives : To examine barriers and enablers affecting how patients engage with managing their medications in specialty hospital settings.

Design : An exploratory qualitative design was used involving in-depth interviews with doctors, nurses, pharmacists, patients and family members.

Setting : An Australian public, metropolitan teaching hospital was the study site and five specialty hospital settings were used, including cardiac care, emergency care, intensive care, oncology care and perioperative care.

Results : In all, 21 health professionals, 11 patients and 12 family members participated in the study (n = 44). Barriers and enablers involved intrapersonal, interpersonal and environmental aspects, and differences in perceptions and experiences were found between the various settings. Health professionals had preconceived notions of what was appropriate behaviour in conveying information about medications. Many health professionals stated that they deliberately chose not to provide medication-related knowledge. Different barriers for patient engagement existed in various settings – in emergency care, patients could only stay for 4 h; in intensive care, medication changes regularly happened; in cardiac care, patients were discharged prematurely due to urgent need of beds; in oncology, there was lack of availability of oncology consultants; while in perioperative care, surgeons and anaesthetists were available just before surgery.

Conclusions : Complex barriers and enablers are associated with patient engagement in specialty clinical settings. By developing an understanding of these barriers and enablers, health professionals can help patients to understand and participate in their medication management.

The OPtimising HEalth LIterAcy (Ophelia) process: study protocol for using health literacy profiling and community engagement to create and implement health reform

Health literacy is a multi-dimensional concept comprising a range of cognitive, affective, social, and personal skills and attributes. This paper describes the research and development protocol for a large communities-based collaborative project in Victoria, Australia that aims to identify and respond to health literacy issues for people with chronic conditions. The project, called Ophelia (OPtimising HEalth LIterAcy) Victoria, is a partnership between two universities, eight service organisations and the Victorian Government. Based on the identified issues, it will develop and pilot health literacy interventions across eight disparate health services to inform the creation of a health literacy response framework to improve health outcomes and reduce health inequalities.