Customer repurchase intention: a general structural equation model

This paper develops a general service sector model of repurchase intention from the consumer theory literature. A key contribution of the structural equation model is the incorporation of customer perceptions of equity and value and customer brand preference into an integrated repurchase intention analysis. The model describes the extent to which customer repurchase intention is influenced by seven important factors – service quality, equity and value, customer satisfaction, past loyalty, expected switching cost and brand preference. The general model is applied to customers of comprehensive car insurance and personal superannuation services. The analysis finds that although perceived quality does not directly affect customer satisfaction, it does so indirectly via customer equity and value perceptions. The study also finds that past purchase loyalty is not directly related to customer satisfaction or current brand preference and that brand preference is an intervening factor between customer satisfaction and repurchase intention. The main factor influencing brand preference was perceived value with customer satisfaction and expected switching cost having less influence.

General practitioners' perspectives regarding competence and confidentiality in an adolescent with suspected anorexia nervosa: legal and ethical considerations

In Victoria, Australia, the legal position regarding young people's competence to make medical treatment decisions has not been clarified in legislation, and a number of often vague common law decisions must be relied on for guidance. This situation produces a degree of uncertainty about appropriate professional practice, while also potentially impeding young people's rights claims in health care settings. With this in mind, the present research explored general practitioners' competence and confidentiality decisions regarding a 17-year-old female who presented with symptoms of an eating disorder. Questionnaires were sent to a random sample of 500 Victorian general practitioners, of whom 190 responded. After reading a case vignette, general practitioners indicated whether they would find the hypothetical patient competent and if they would maintain her confidentiality. Seventy-three per cent of respondents found the patient competent and most would have maintained confidentiality, at least initially. However, subsequent analysis of the rationales supplied for these decisions revealed a wide diversity in general practitioners' understandings and implementations of extant legal authority. This research highlights the need for general practitioners to be exposed to up-to-date and clinically relevant explanations of contemporary legal positions.

General practitioners' competence and confidentiality determinations with a minor who requests the oral contraceptive pill

The right of minors to make medical treatment decisions is an issue that is not explicitly addressed in the legislation of most Australian jurisdictions. While recent common law decisions allow competent minors to consent to treatment, current legislation in Victoria does not provide adequate guidelines on how competence is to be measured. It is also unclear whether the duty of confidentiality is extended to competent minors. The current study explored general practitioners' competence and confidentiality decisions with a hypothetical 14-year-old patient who requests the oral contraceptive pill (OCP). Questionnaires were sent to 1,000 Victorian general practitioners, 305 of whom responded. General practitioners were asked to determine whether "Liz" was competent to request the OCP, and whether they would maintain her confidentiality. A total of 81% of respondents found the patient competent, while 91% would have maintained her confidentiality. Results indicate that the majority of general practitioners used rationales that generally did not conform to current legal principles when making competence and confidentiality determinations regarding this patient.

Evaluation of a brief pilot nutrition and exercise intervention for the prevention of weight gain in general practice patients

Objective To pilot-test a brief written prescription recommending lifestyle changes delivered by general practitioners (GPs) to their patients.

Design The Active Nutrition Script (ANS) included five nutrition messages and personalised exercise advice for a healthy lifestyle and/or the prevention of weight gain. GPs were asked to administer 10 scripts over 4 weeks to 10 adult patients with a body mass index (BMI) of between 23 and 30 kg m− 2. Information recorded on the script consisted of patients' weight, height, waist circumference, gender and date of birth, type and frequency of physical activity prescribed, and the selected nutrition messages. GPs also recorded reasons for administering the script. Interviews recorded GPs views on using the script.

Setting General practices located across greater Melbourne.

Subjects and results Nineteen GPs (63% female) provided a median of nine scripts over 4 weeks. Scripts were administered to 145 patients (mean age: 54 ± 13.2 years, mean BMI: 31.7 ± 6.3 kg m− 2; 57% female), 52% of whom were classified as obese (BMI >30 kg m− 2). GPs cited ‘weight reduction’ as a reason for writing the script for 78% of patients. All interviewed GPs (90%, n = 17) indicated that the messages were clear and simple to deliver.

Conclusions GPs found the ANS provided clear nutrition messages that were simple to deliver. However, GPs administered the script to obese patients for weight loss rather than to prevent weight gain among the target group. This has important implications for future health promotion interventions designed for general practice.

Freud, civilization, religion and stoicism

Freud's debt to stoicism has been seldom discussed. His attitude toward science had a distinct ethical slant taken from the ancient world, via Freud's humanistic education. Freud's method involved detachment but did not imply moral coldness and indifference any more than stoicism did. The stoics wanted to be therapists of the mind just as physicians cared for the body. For both Freud and the stoics, reason was in battle with the passions and required clear sight to have a chance of prevailing over them. In contrasting religious worldviews with the scientific approach, Freud failed to see his own approach as ethical. Freud made extensive forays at individual and collective levels but in the years since Freud's death, the psychoanalytic vision has narrowed. At 150 years after his birth, the authors can still admire Freud's exceptional ethical courage and recognize that if psychoanalysis is to survive, it needs to regain his cultural range and spirit of critical inquiry

Living family, studying family : exploring the tensions

Whilst the role and value of education is extremely contested, there are some areas of common agreement: that educational experiences and activities give meaning to features of the world other than themselves; that education helps individuals to see the world differently; that it is a fluid process, moving in and out from general to specific; and, that it provides understanding and meaning for the learner and teacher. The dynamics result is reciprocity in relationships between the knowledge and the known and between the subject and the object of the learning. This reciprocity results in significant change. For instance, what is learned changes the individual and thus their relationships, which, in tum, results in new learning and thus new relationships. The reverse is also the case - relationships affect learning. This paper will explore the changes that occur when the learner is studying family studies/relationships education and is simultaneously living them as a mature woman with a family. It will consider the tensions, assumptions and expectations for self as student, partner, worker and community member and the reciprocal links to relationships within the family.

The nature and development of the general insurance industry in Australia to 1973

The development of the insurance industry in Australia in the twentieth century was fundamentally shaped by a collusive code of conduct called the tariff. This arrangement, established to overcome problems of uncertainty, initially benefited both tariff and non-tariff firms by enhancing market stability. It also reduced competition. The collusive agreements gradually broke down, however, as new entrants and products entered the market in the 1950s. Self-regulation gradually gave way as the 'rules of the game' changed. The result was a period of instability before new competitive practices, and more direct and specific regulatory requirements emerged in the 1970s.

Fun or profit : primary students' perceptions of mathematics and science

As the number of students pursuing mathematics and science in higher education decline, it becomes imperative· that we look for the causes of the decline. As part of the Australian Improving Middle Years Mathematics and Science (IMYMS) project, students were asked to rate their perceptions of classroom practice in mathematics and science and their attitudes to these subjects. Results of this survey reveal little difference in perceptions of classroom practice, but significant differences in students' attitudes between mathematics and science. Differences were particularly evident for items relating to the usefulness of mathematics and science (mathematics was more useful) and enjoyment of the subjects (science is more fun). If teachers are aware of such perspectives, it may be possible to change students' attitudes.

Effective student engagement depends on students enjoying their studies in mathematics and science, being confident in their ability and recognising the relevance of these subjects to everyday life, now and in the future.
(Education Training Committee, 2006, p. xvii)

Science and technology are the widely acknowledged foundation of Australia's future development. Underpinning these are the key learning areas of mathematics and science. However, Australia is experiencing a decline in numbers of mathematics and science students in higher education. Moreover, studies over the last two decades have shown a general decline in Australian students' interest and enjoyment of science across the compulsory secondary school years, with a particularly sharp decline across the primary to secondary school transition (e.g. Adams, Doig, & Rosier 1991; Goodrum, Hackling, & Rennie, 200 I) and a decline in the numbers of students studying' advanced mathematical courses in upper secondary school (Thomas, 2000).

Improving teaching and learning in the middle years of schooling (Years 5 to 9) is receiving particular attention because of the coincidence of the disengagement of students with the significance of these years for the preparation of students for their future role in society. Thus the Improving Middle Years Mathematics and Science: The role of subject cultures in school and teacher change (IMYMS) project, which is the source of data for this paper, is investigating the role of mathematics and science' knowledge and subject cultures in mediating change processes in the middle years of schooling.

Mathematics and science are sometimes seen as "love-hate" subjects, rating highest for subjects disliked, but also rating relatively highly among preferred subjects (Hendley & Stables, 1996). Students, even primary aged students, can often shed light on what constitutes good practice (see, for example, 'van den Heuvel-Panhuizen, 2005). Students' attitudes towards mathematics and science and their perceptions of what they regard as positive aspects of classroom practice have been shown to decline from the primary years to junior secondary (Race, 2000). The decline in interest in science in the early years of secondary school is of particular concern, since it is in these years that attitudes to the pursuit of science subjects and careers are formed (Speering & Rennie, 1996). Students' negative attitude towards the relevance of science ,content for their lives was a strong theme in the report by Goodrum, Hackling, & Rennie (2001) on the status and quality of teaching and learning of science.

As part of the IMYMS project, the IMYMS Student Survey was administered to all students in 2004 and 2005. The survey included a 36 item section on students' perceptions of classroom practice and attitudes towards mathematics and science, and a 24 item section on students' learning preferences. Students completed separate, parallel surveys for mathematics and science.

This paper focuses on students' perceptions and attitudes. It explores the differences in 700 Year 5 and 6 students' perceptions of their learning environment and their attitudes to mathematics and science during 2005, the second (and final) year of schools , involvement in the IMYMS project.

Barriers to effective management of depression in general practice

Objective: The aim of this study was to investigate the effects of prior general practice training in mental health and practice location on general practitioner (GP) attitudes toward depression, self-confidence in assessing and treating depressed patients, identification of doctor, patient and practice barriers to the effective care of depressed patients in general medical practice and GP-reported current clinical practice.

Method: Fifty-two (out of 123) Divisions of General Practice that responded to an invitation to participate in the study distributed 608 anonymous surveys to a representative sample of GPs; 420 (69%) were returned. The questionnaire focused on current clinical practice, perceived barriers to care of depressed patients and doctors' self-efficacy for assessing and treating depressed patients. It also consisted of two scales, based upon previous research, designed to assess doctors' attitudes towards depression and depressed patients.

Results: General practitioners who had undertaken mental health education and training more often used non-pharmacological treatments (p = 0.00), as did female GPs (p = 0.00). Male GPs (p = 0.00) and those in rural settings (p = 0.01) more often prescribed medication for depression. Those without mental health training more often identified incomplete knowledge about depression as a barrier to its effective management (p = 0.00). Urban-based GPs (p = 0.04) and those with prior mental health training (p = 0.00) were more confident in the use of non-pharmacological treatments. Female GPs without mental health training were the least confident in the use of these methods (p = 0.01). Overall, GPs with mental health training were more positive in their attitudes toward depression and their treatment of these patients (p = 0.00). Female GPs appeared more positive in their attitudes toward depression than male GPs (p = 0.01), although the results were not entirely consistent.

Conclusions: Participation in mental health training by GPs appears to be related to their attitudes toward depressed patients and to their confidence and abilities to diagnose and manage the common mental disorders effectively.

Political Islam and human security

In the wake of the September 11 and subsequent terrorist attacks, the academic and media commentaries on 'Islam the religion' and 'Islam the basis for political ideology' has received an unprecedented high level of attention. This book deals with such questions as the nature of Islamism, the impact of the 'war on terror' on militancy, and more.

Promotion of exercise prescriptions in general practice for older populations

Regular physical activity in older populations reduces the risks of cardiovascular diseases, diabetes, osteoporosis and falls and also improves mental health. Some programs of written exercise prescriptions by general practitioners have been shown to significantly increase physical activity levels over the medium-term (six to 12 months). Increasing the confidence and skills of general practitioners to prescribe and monitor exercise programs is important. However, the more challenging barriers to the widespread uptake of exercise prescription programs are the structural and economic constraints within general practice, as well as the competing promotion of prescribing pharmaceutical products. Implementation research on overcoming these barriers is urgently needed.

Procedural trained, procedural remain : the first report from 'A census of doctors who have been awarded the Graduate Diploma in Rural General Practice (GDRGP)'

Aims & rationale/Objectives : To document the practice of initial cohorts receiving the Graduate Diploma in Rural General Practice
Methods : With the co-operation of the National Rural Faculty (NRF) of Royal Australian College of General Practitioners (RACGP), a census by questionnaire was conducted on 279 graduates. The response rate was 70%.
Principal findings : The target doctors are young (65% < 40 years old). Under half (42.3%) have completed Advanced Rural Skills terms in >1 discipline. Of the total 272 posts recorded from 174 respondents, the most popular advanced skill is anaesthetics, followed by obstetrics. The ARSP increased confidence in 96.3% of respondents. Two thirds of doctors trained in a procedural skill remain practicing procedural General Practice.
Discussion : The GDRGP was the qualification developed to recognise competency gained as a result of a series of rural training initiatives begun within the RACGP Training Program in 1992. Its delivery has continued under the new GPET Training Program. Outcomes from the range of initiatives leading to the GDRGP are currently emerging in an environment which has seen significant changes within vocational training, and within the context of a rising focus on indemnity. Doctors who undertook this training have mostly retained procedural practice. In addition, RACGP rural initiatives successfully achieved increase confidence prior to rural work in advanced areas of practice, with >95% reporting an increase.
Implications : Changes within vocational training were accelerated without analysis of existing initiatives such as the GDRGP. Funding for the GDRGP was, as a result, withdrawn prematurely. These changes also saw the entrant of a second College with an interest in rural procedural practice. This research show that the GDRGP offers, and offered, a clear vocational pathway that will guide a doctor to a career as a rural doctor, and provide them with the advanced skills they need to practice confidently in the bush. It is important to capitalise on past success before deconstructing professional concepts of practice further.
Presentation type : Paper

Synchronicity, science, and religion

In this sixth and final part of the anthology I will discuss major areas of concern about synchronicity from the perspectives of science, religion, archetypes, causality, meaning, and psi. For convenience, I have spread these major areas across three chapters. In this first chapter I will briefly consider the synchronicity construct from the perspective of its definitions and how it sits epistemologically in the framework of science and the everyday world. I also review the lives of Jung and Pauli, rind discuss their joint effort to integrate science and religion through the principle of synchronicity.

A cross-cultural study into peer evaluations of women's leadership effectiveness

Purpose: The present paper is based on a cross-cultural exploration of middle managers in two diverse cultures and aims to focus on how the leadership styles of managerial women are perceived and evaluated. In particular, female and male peer evaluations of leadership effectiveness in Malaysia and Australia are to be explored.

Design/methodology/approach: Surveys from 324 middle managers from Malaysia and Australia were quantitatively analysed. The sample for the study was drawn from organisations in four industry types in both countries.

Findings:  Findings suggest that evaluations of female managers' leadership styles in general, and within the respondent's own organisations, were strongly culture specific, especially in Malaysia. The results reflected the strongly held values, attitudes and beliefs of each country. While this is not unexpected, it does highlight a need to be cautious when interpreting Western research results and attempting to transplant those into other cultures. In Malaysia, female managers were not seen as effective in the leadership styles they adopted in their roles when compared to the Australian female managers' evaluations. Such an evaluation may have had little to do with an objective appraisal of the female managers' capability, but rather with a strongly held cultural belief about the appropriate role of women in society, and in organisations in particular.

Research limitations/implications:  It is suggested that national culture manifests itself in the values, attitudes and behaviours of people. Cultural influences are therefore likely to impact on the way women and men behave in the workplace, particularly when roles of authority and power are evident, and the way in which that behaviour will be evaluated by others. Further research using different samples in different cultures are recommended. In addition, the influence of ethnicity, race or religion in plural countries such as Malaysia and Australia is also worthy of investigation.

Practical implications:  This research suggests that values and attitudes are strongly culture-specific and therefore have the ability to influence evaluations at an organisational level. Such an awareness of cultural influences should guide appropriate human resource practices, particularly within a globalized environment.

Originality/value:  The inclusion of a gender comparison in the data analysis in this paper is a significant attempt to add to the extant knowledge of the cross-cultural research. This is a unique contribution because of the omission of a gender perspective in the previous two seminal studies in culture literature (i.e. Hofstede and House et al.). In addition, the findings suggest that culture-specific influences are important determinants that impose expectations on the role of women differently from men in society and within organisations hence, making the gender comparison of the findings more significant.

A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist

Background: Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly.

Objective: To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance.

Design: Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy.

Methods: Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment.

Results: The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment.

Conclusions: When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.