Factor structure and measurement invariance of the Health Education Impact Questionnaire: does the subjectivity of the response perspective threaten the contextual validity of inferences?

Objective:
On-going evidence is required to support the validity of inferences about change and group differences in the
evaluation of health programs, particularly when self-report scales requiring substantial subjectivity in response generation are used as outcome measures. Following this reasoning, the aim of this study was to replicate the factor structure and investigate the measurement invariance of the latest version of the Health Education Impact Questionnaire, a widely used health program evaluation measure.
Methods:
An archived dataset of responses to the most recent version of the English-language Health Education Impact
Questionnaire that uses four rather than six response options (N=3221) was analysed using exploratory structural equation
modelling and confirmatory factor analysis appropriate for ordered categorical data. Metric and scalar invariance were
studied following recent recommendations in the literature to apply fully invariant unconditional models with minimum
constraints necessary for model identification.
Results:
The original eight-factor structure was replicated and all but one of the scales (Self Monitoring and Insight) was
found to consist of unifactorial items with reliability of ⩾0.8 and satisfactory discriminant validity. Configural, metric and scalar
invariance were established across pre-test to post-test and population sub-groups (sex, age, education, ethnic background).
Conclusion:
The results support the high level of interest in the Health Education Impact Questionnaire, particularly for use as a pre-test/post-test measure in experimental studies, other pre–post evaluation designs and system-level monitoring and evaluation.

Career progression, human capital and pay equity in Australian public sector labour markets

This study uses data from the Victorian Public Sector Census 2004 to identify the extent of equity in pay and career progression (promotion). A system of three equations is developed to capture the endogeneity between human capital and promotion and the interdependence between promotion, pay and human capital. The results indicate that there are substantial differences in the average wages earned by public sector employees in different Equal Employment Opportunity (EEO) groups. While some of these differences arise from factors beyond the control of the public sector employers, others arise from bias in the public sector employment system and procedures. The earnings of individual employees in the public sector are determined in a systematic way by the wage structures in the different sub-sectors, the skill base of the employee on recruitment, sub-sector specific promotion rates, acquisition of formal and informal training and the apparent bias within recruitment and promotion systems in dealing with particular groups. The apparent bias of recruitment and promotion systems is complex in makeup and varies within EEO groups as well as between EEO groups. Most of the difference in pay across employees can be explained as an outcome of individual choice and labour market conditions external to the public sector. After adjusting for sectoral wage differences, skill base when recruited, sectoral promotion rate differences, experience in the public sector, whether individuals are employed on a full-time or part-time basis and individual training decisions, the statistical evidence is consistent with the finding that public sector recruitment and promotion systems tends to be biased, on average, against females and those from culturally diverse backgrounds. Achievements in formal education are important for salary progression. This is particularly the case for women. The main drivers of participation in formal education were employer support in both financial and non-financial terms. Promotion rates were important factors in explaining wage differences. Women tended to receive slightly fewer promotions than men, but women received, on average, greater rewards for each promotion.

Steric control over molecular structure and supramolecular association exerted by tin- and ligand-bound groups in diorganotin carboxylates

Structural data (X-ray and solution and solid-state ^₁₁₉Sn NMR) show that skew-trapezoidal-bipyramidal diorganotin compounds of 2-quinaldate are invariably monomeric, owing to the steric bulk of the carboxylate ligand. In contrast, most of the analogous compounds of 2-picolinate (2-pic) can increase their coordination number by polymerization or the incorporation of solvent in their coordination sphere in the solid state. The exceptional compound is tBu₂Sn(2-pic)₂ (3), for which no increase in coordination number is apparent, a result that is correlated with the bulky tert-butyl groups. Thus, judicious choice of tin or ligand substituents can be exploited to dictate coordination number and/or the degree of supramolecular aggregation in the investigated systems.

A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population

Background : Efficiency and equity are both important policy objectives in resource allocation. The discipline of health economics has traditionally focused on maximising efficiency, however addressing inequities in health also requires consideration. Methods to incorporate equity within economic evaluation techniques range from qualitative judgements to quantitative outcomes-based equity weights. Yet, due to definitional uncertainties and other inherent limitations, no method has been universally adopted to date. This paper proposes an alternative cost-based equity weight for use in the economic evaluation of interventions delivered from primary health care services.

Methods : Equity is defined in terms of 'access' to health services, with the vertical equity objective to achieve 'equitable access for unequal need'. Using the Australian Indigenous population as an illustrative case study, the magnitude of the equity weight is constructed using the ratio of the costs of providing specific interventions via Indigenous primary health care services compared with the costs of the same interventions delivered via mainstream services. Applying this weight to the costs of subsequent interventions deflates the costs of provision via Indigenous health services, and thus makes comparisons with mainstream more equitable when applied during economic evaluation.

Results : Based on achieving 'equitable access', existing measures of health inequity are suitable for establishing 'need', however the magnitude of health inequity is not necessarily proportional to the magnitude of resources required to redress it. Rather, equitable access may be better measured using appropriate methods of health service delivery for the target group. 'Equity of access' also suggests a focus on the processes of providing equitable health care rather than on outcomes, and therefore supports application of equity weights to the cost side rather than the outcomes side of the economic equation.

Conclusion : Cost-based weights have the potential to provide a pragmatic method of equity weight construction which is both understandable to policy makers and sensitive to the needs of target groups. It could improve the evidence base for resource allocation decisions, and be generalised to other disadvantaged groups who share similar concepts of equity. Development of this decision-making tool represents a potentially important avenue for further health economics research.

Redox voltammetry of sub-parts per billion levels of Cu2+ at polyaspartate-modified gold electrodes

An electrochemical sensor for the detection of Cu2+ is reported which incorporates poly-l-aspartic acid (PLAsp) with 32–96 aspartate units as a selective ligand for the metal ion. PLAsp is covalently attached to a gold electrode modified with a monolayer of 3-mercaptopropionic acid using carbodiimide coupling via an N-hydroxysuccinimide (NHS) ester intermediate. The acid side groups and deprotonated peptide nitrogens on two aspartate moieties are thought to be primarily responsible for chelation of Cu2+, which remains bound when reduced to Cu+. A consequence of the multiple binding points that are available with a polypeptide is the low detection limit. The lowest concentration detected was 3 nM (0.2 ppb) achieved with Osteryoung square wave voltammetry. This detection limit compares favourably with that of ICP-OES and previously reported cysteine-modified electrodes. Analysis of tap and lake water samples using the PLAsp-modified electrode agreed well with ICP-OES analysis of the same samples.

Mobility, aspiration, voice : a new structure of feeling for student equity in higher education

There is a changed ‘structure of feeling’ emerging in higher education systems, particularly in OECD nations, in response to changed social, cultural and economic arrangements. Taking a student equity perspective, the paper names this change in terms of ‘mobility’, ‘aspiration’ and ‘voice’. It argues that (1) new kinds and degrees of mobility are now a significant factor in sustaining unequal access to and experience of higher education for different student groups, (2) despite government and institutional aspirations to expand higher education, students' desires for university are not a given among new target populations and (3) while universities are seeking to enroll different students in greater numbers, the challenge now is how to give greater voice to this difference. Drawing on these themes of mobility, aspiration and voice and taking recent changes to higher education policy in Australia as the case, the paper presents a new conceptual framework for thinking about student equity in HE. The framework extends from established approaches that focus on barriers to accessing higher education in order to focus on people's capacities in relation to higher education participation.

Student equity's starring role in Australian higher education : not yet centre field

The field of Australian higher education has changed, is changing and is about to change, repositioned in relation to other ‘‘fields of power’’. It is a sector now well defined by its institutional groupings and by their relative claims to selectivity and exclusivity, with every suggestion of their differentiation growing. The potential of a ‘‘joined-up’’ tertiary education system, of vocational education and training (VET) and universities, has the potential to further rework these relations within Australian higher education, as will lifting the volume caps on university student enrolments. Moreover, Australian universities now compete within an international higher education marketplace, ranked by THES and Shanghai Jiao Tiong league tables. ‘‘Catchment areas’’ and knowledge production have become global. In sum, Australian universities (and agents within them) are positioned differently in the field. And being so variously and variably placed, institutions and agents have different stances available to them, including the positions they can take on student equity. In this paper I begin from the premise that our current stance on equity has been out-positioned, as much by a changing higher education field as by entrenched representations of social groups across regions, institutions, disciplines and degrees. In taking a new stance on equity, the paper is also concerned with the positioning in the field of a new national research centre with a focus on student equity in higher education. In particular, the paper asks what stance this new centre can take on student equity that will resonate on a national and even international scale. And, given a global field of higher education, what definitions of equity and propositions for policy and practice can it offer? What will work in the pursuit of equity?

Influencing health equity : role of the effective consumer scale in measuring skills and abilities in a middle income country

The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients’ involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.

Income support best way of fixing equity : Go8

The Go8 has broken ranks with other university groups in suggesting that base funding shouldn’t have an equity component.

Has equity's time come for VET? Observations and principles for equity policy and practice in Australian education

Equity has a long history in education. When compulsory schooling was first introduced in industrialising nations in the mid 1800s, many advocates saw it as a way of improving the circumstances of the poorest and most disadvantaged in their communities. But access to schooling did not prove to be the great equaliser that some had hoped. Instead, it became central in the reproduction of social and economic inequalities (Bourdieu & Passeron 1977). High academic achievement became highly correlated with high socioeconomic status, and vice versa (Teese & Polesel 2003). In Australia, the Karmel Report (1973) proved to be a watershed moment in naming the equity problem in schooling and, among other things, gave rise to the Disadvantaged Schools Program (DSP): an attempt to level the playing field albeit by ‘running twice as hard’ (Connell at al. 1991). Almost two decades later, A Fair Chance for All (1990) signalled official concern for equity in Australian higher education. While access to university was not to be universal, it was to be equitable; all social groups in the Australian population were to be proportionally represented among its university students. Today, Australia is still grappling with the inequities in its schooling and higher education systems, highlighted by renewed interest by governments to address the issues. Although not of the same order of magnitude, there now appears to be an emerging policy agenda around equity in VET. Has equity’s time come for VET? This paper canvasses the history of equity in Australian schooling and higher education, with a view to drawing out principles to inform a rejuvenated equity agenda in vocational education and training.

Best practice for prevention and treatment of cardiovascular disease through an equity lens : a review

Background Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced.

Aims To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD.

Methods Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES).

Results Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions.

Conclusion Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.

Towards a southern theory of student equity in Australian higher education : enlarging the rationale for expansion

Student equity in Australian higher education is a numbers game. While university student recruitment departments focus on ‘bums on seats’, equity advocates draw attention to which bums, in what proportions and, more to the point, which seats, where. But if the counting of ‘bums’ is crude, so is the differentiation of seats. Just distinguishing between courses and universities and scrutinizing the distribution of groups is a limited view of equity. This paper proposes an expanded conception for student equity and an enlarged regard for what is being accessed by students who gain entry to university. Drawing on Connell’s notion of ‘southern theory’, the paper highlights power/knowledge relations in higher education and particularly for ‘southerners’: those under-represented in universities, often located south of cut-off scores, and whose cultural capital is similarly marginalised and discounted. The paper concludes that taking account of marginalized forms of knowledge requires thinking differently about what higher education is and how it gets done.

Gender difference in treatment and mortality of patients with ST-segment elevation myocardial infarction admitted to Victorian public hospitals: A retrospective database study.

BACKGROUND: Death from acute coronary syndrome (ACS) is avoidable with early reperfusion therapy, however, evidence suggests inequity in women's ACS treatment within a number of international healthcare systems, when compared to men's. Research indicates mortality rates are higher in some age groups of women when compared to men for the sub-group of ACS known as ST-segment elevation myocardial infarction (STEMI). OBJECTIVE: To determine whether patient sex was associated with patterns of reperfusion treatment variation or increased inhospital mortality in patients with STEMI. METHODS: We undertook retrospective analyses on a government database for patients admitted to Victorian public hospitals with STEMI. Patients were categorised into two age groups: 18-64 and 65-84 years (inclusive), to determine whether patient sex and these age groups influenced treatment from 2005 to 2008 and mortality from 2005 to 2010. RESULTS: Both younger and older women received less frequent angioplasty with stent and more often received no reperfusion treatment than men in corresponding younger and older age groups (p=0.006 and p<0.001, respectively). Overall, women in both age groups were more likely to die inhospital than men from equivalent age groups with STEMI (p<0.001, both groups). CONCLUSIONS: Proportionately, both younger and older women received less interventional reperfusion therapy for STEMI than their male cohorts, and died more often during admission than men. Further research needs to be undertaken to verify the findings and causes, and guide future research to ensure application of evidence to treatment in patients with STEMI.

Equity, social justice and ethics in mathematics education

The performativity policy mindset driving national and international testing highlights issues of equity in access and success according to socio-economic status, geographic location, ethnicity, gender and combinations of these factors. Researchers seek explanations for these inequities in terms encompassing engagement, participation and achievement to identify socially just and ethical practices at system, school and classroom level. The emergence of a theoretical perspective involving redistribution, recognition and participation (Fraser, 2013) is evident in a range of studies concerning leadership, professional learning, pre-service teacher education, and pedagogies that focus on equity and social justice in mathematics education. The challenge of ethical and socially just practices at all levels and social groups is in providing access to deep learning in mathematics and success in “knowledge making” (Jorgensen, 2014).

Liveable & just: a toolkit for local governments to address the social and equity impacts of climate change

The Liveable & Just Toolkit is the culmination of a project to explore how local governments across Victoria are responding to the social and equity impacts of climate change.In June 2009 the Victorian Local Governance Association (VLGA) and Melbourne University’s McCaughey Centre travelled across the state to hear directly from local governments about issues of priority, success stories, challenges, and lessons learned in addressing the social and equity impacts of climate change. Workshops covered crucial issues such as heatwaves and bushfires, rising costs of water, energy and transport, physical and mental health, and the heightened vulnerability of groups such as the mentally ill, homeless, aged, and infants. In response to workshop outcomes and recommendations, the Liveable & Just Toolkit provides a practical framework to help integrate responses to the social and equity impacts of climate change across council activities. It also presents ideas and suggestions for local government to respond to climate change in ways that simultaneously promote social justice.