How parents manage the risk of child sexual abuse: a grounded theory

The aim of this study is to understand how parents manage the risk of child sexual abuse, including prevention as well as early intervention and detection strategies. Using a social constructivist theoretical foundation and grounded theory methods, qualitative in-depth interviews were conducted with Australian parents between 2006 and 2008. Based on the data, a balance theory was developed, which explains how parents attempt to balance the type of information given to children in order to protect their children from sexual abuse without scaring them as well as how parents manage sexual boundary crossing incidents experienced by their children in the context of complex social relationships. Implications for prevention programs as well as reporting of child sexual abuse are discussed.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Background

Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.

Methods

The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.

Results

The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

Conclusion

The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.

Communicating change in organizational restructuring: a grounded theory case study

Literature has shown that planned change is accompanied by excitement and hope. People affected by change require qualityinformation. Failure to communicate change may lead to resistance. This paper presents a change involving the amalgamation oftwo university faculties into one. Within the framework of a case study research design and the used of the ConstructivistGrounded Theory for data collection and analysis, the theme of communication during the change process is presented throughthe experiences and life accounts of faculty members involved and affected by it. The paper ends with useful suggestions forchange agents in today’s complex organization.

Tail conditional expectation for multivariate distributions : a game theory approach

This paper proposes using the Shapley values in allocating the total tail conditional expectation (TCE) to each business line (X j, j = 1, ... , n) when there are n correlated business lines. The joint distributions of X j and S (S = X1 + X2 + ⋯ + X n) are needed in the existing methods, but they are not required in the proposed method.

Mapping site-based construction workers' motivation: expectancy theory approach

The aim of this study is to apply a recently proposed model of motivation based on expectancy theory to site-based workers in construction and confirm the validity of this model for the construction industry. The study drew upon data from 194 site-based construction workers in Iran to test the proposed model of motivation. To this end, the structural equation modelling (SEM) approach based on the confirmatory factor analysis (CFA) technique was deployed. The study reveals that the proposed model of expectancy theory incorporating five indicators (i.e. intrinsic instrumentality, extrinsic instrumentality, intrinsic valence, extrinsic valence and expectancy) is able to map the process of construction workers' motivation. Nonetheless, the findings posit that intrinsic indicators could be more effective than extrinsic ones. This proffers the necessity of construction managers placing further focus on intrinsic motivators to motivate workers.

Challenging the handover : recommendations for research and practice

Communicating nursing care during the patient's total hospital stay is a difficult task to achieve within the context of high patient turnover, a lack of overlap time between shifts, and time constraints. Clear and accurate communication is pivotal to delivering high quality care and should be the gold standard in any clinical setting. Handover is a commonly used communication medium that requires review and critique. This study was conducted in five acute care settings at a major teaching hospital. Using a grounded theory approach, it explored the use of three types of handover techniques (verbal in the office, tape-recorded, and bedside handovers). Data were obtained from semi-structured interviews with nurses and participant field observations. Textual data were managed using NUD-IST. Transcripts were critically reviewed and major themes identified from the three types of handovers that illustrated their strengths and weaknesses. The findings of this study revealed that handover is more than just a forum for communicating patient care. It is also used as a place where nurses can debrief, clarify information and update knowledge. Overall, each type of handover had particular strengths and limitations; however, no one type of handover was appraised as being more effective. Achieving the multiple goals of handover presents researchers and clinicians with a challenging task. It is necessary to explore more creative ways of conducting the handover of patient care, so that an important aspect of nursing practice does not get classified as just another ritual.

Nurse academics meeting the challenges of scholarship and research

This research study explored nurse academics' perceptions and experiences of scholarship and research. Interviews were carried out with 20 nurse academics in four Australian states. A grounded theory approach was used to explore issues they faced. The paper discusses how academics engaged in research and scholarship integrate it into their work practices. The participants spoke of problems encountered, such as the difficulty of gaining higher degrees whilst undertaking additional research. They indicated they felt under significant pressure to publish. The organisational structures that a small number of institutions put in place to facilitate the development of a scholarly research culture are illustrated.

Understanding parental motivators and barriers to uptake of child poison safety strategies: a qualitative study

Objectives: To develop an understanding of factors acting as barriers and motivators to parental uptake of child poison safety strategies.

Design: A qualitative study involving semistructured interviews and focus groups. A grounded theory approach was used for the collection and analysis of data.

Participants: Sixty five parents of children under 5 years of age, some of whom had experienced an unintentional child poisoning incident.

Results: A range of knowledge based, environmental, and behavioral barriers to comprehensive parental uptake of poison safety practices were identified. As a result there tended to be only partial implementation of safety initiatives in the home. Selection of safety practices was often guided by the interests and behaviors of the child. This made the child vulnerable to changes in the home environment, inadequate supervision, and/or shifts in their own behavior and developmental ability. Personal or vicarious exposure of a parent to a child poisoning incident was a significant motivator for parental review of safety practices.

Conclusion: Environmental measures targeting child resistant containers, warning labels, and lockable poisons cupboards will support parents’ efforts to maintain poison safety. Additional education campaigns using stories of actual poisoning incidents may help to increase awareness of risk and encourage increased uptake.

The road to internet banking: understanding emerging customer issues

This paper presents findings from an empirical study of banking customer experiences with the adoption of Internet banking. Using a qualitative, interpretive grounded theory approach and single and group interviews, the study explores customer perceptions and experiences and provides an understanding of how and why specific factors affect their decision whether or not to bank on the Internet in the current era. The findings are used to develop a theoretical framework which conceptualizes and links consumer issues influencing the adoption of this application, and we also provide a set of recommendations for banks. Specifically, the findings suggest that convenience – in particular, time savings – is the major motivator to bank on the Internet, while there are a range of other influential factors which could be modulated by banks. The results also highlight increasing online risk acceptance by customers and the growing importance of deep levels of customer support for online services. Key gender differences in attitudes to Internet banking are highlighted. This study suggests that organizations will improve their management of customer attitudes to new Internet service applications by understanding the need to proactively address customer fears and misconceptions about the technologies involved.

The attraction, retention/transition and nurturing process of sport development : some Australian evidence

The purpose of this study was to explore and map the sport development processes in Australia. A grounded theory approach identified sport development processes by examining 74 annual reports from 35 national sporting organizations (NSOs) over a period of 4 years, before and after the Sydney Olympic Games. The 3 frameworks presented in this article representing the attraction, retention/ transition, and nurturing process illustrate the generic processes and strategies described by NSOs. The results show that each sport development process requires human and financial input from various stakeholders. These stakeholders initiate or implement sport development strategies for each process and each process has different sport development outputs. These results contribute to the extant literature of sport development by demonstrating that sport development is more complex and encompassing than previously described. It is proposed that the generic frameworks derived from this study be subject to more specific testing using other sport systems, as context and case studies could lead to tailoring the frameworks to represent specific sport development processes and systems.

The role of cultural capital towards the development of a sustainable business model for design firm internationalization

This paper reports the results of three case studies of firms involved with design for the built environment who have been working in international markets for more than two decades. The first two firms are architectural practices and the third is a construction firm which designs and constructs. Their markets are diverse and their strategies have evolved over the two decades. There are numerous differences between countries including cultural, social, project governance structures, regulatory, procurement strategies, terminology, codes, etc. What is it that makes these firms able to develop sustainable business models in internationalisation? A grounded theory approach was used to examine the three case studies and develop a reflexive capability model drawing from the sociological theory of reflexivity to interpret the characteristics of the firms' ability to be able to adapt different international conditions. Twenty-two interviews were conducted across the three firms. Results indicated that sustainable business models rely upon the management of social, cultural and intellectual capital. The strategic management of capital leads to the development of increasing reflexive capability within the processes related to internationalisation. Reflexive capability is a characteristic of the three successful case study firms internationalising and working within global models of practice. This paper focuses on the role of cultural capital in a reflexive capability model for sustainable internationalisation.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

When the whole 'bloke' thing starts to crumble : men's access to chronic illness (arthritis) self management programs

This thesis explores the issue of men's access to chronic illness self management programs from a social constructionist perspective. A combination of research methodologies was used; a quantitative analysis to confirm gender differences in levels and patterns of service use; a qualitative analysis to gain an increased understanding of the factors affecting men's access; and a trial to test the application of the research findings. The clients and services of Arthritis Victoria were chosen as the setting for this research. The quantitative analyses were conducted on contingency tables and odds ratios and confirmed that men were under-represented as service users. The analyses also identified gender differences in patterns of service use. The qualitative analysis was based on a series of in-depth, semi-structured interviews. It was undertaken from a grounded theory approach to allow for the development of theoretical explanations grounded in the data. It was found that men's decisions to access chronic illness self management programs were strongly influenced by dominant social constructions of masculinity which constrained help-seeking and health management behaviour. However, the restrictive influence of hegemonic masculinity was progressively undermined by the increasing severity of the chronic condition until a crisis point was reached in terms of the severity of the condition or its impact on lifestyle. This resulted in a reformulation or rejection of hegemonic masculinity. The described conceptual framework was consistent for men from diverse social groupings, although it appeared less prominent in both younger and older men, suggesting that dominant social constructions of masculinity have the greatest influence on health decisions during the middle stage of adulthood when work and family obligations are greatest. The thesis findings informed the development of some guiding principles for reviewing the structure and delivery of chronic illness self management services for men. The guiding principles will have direct application in the planning of Arthritis Victoria programs, and implications for other chronic illness self management programs in Australia, and also in Western countries with a similar health and sociocultural setting to Australia.

Promoting social support and social networks among Irish pensioners in South London, UK

This paper explores the activities of an Irish-led voluntary sector project that sought to minimise social isolation and build social networks among Irish elderly people living in a socio-economically deprived borough in South London, UK. The study from which this paper is drawn aimed to explore the nature and extent of unmet mental health needs among Irish pensioners. Using a naturalistic and exploratory design, data were collected through 19 semi-structured interviews, observation of project activities and analysis of members' case files. The paper presents findings in relation to the significant themes that emerged from the data analysis, which used a grounded theory approach. It discusses the social support systems within the project and examines the ways in which they maintained the mental wellbeing of the projects' members and interconnected with other areas of the project's activities. The study's findings demonstrated that the project provided space for social interaction among otherwise isolated Irish pensioners, many of whom experienced multiple morbidity. The project worked successfully to overcome the sense of stigma that prevented many of its members accessing statutory services; it also identified needs among carers. There was an Irish cultural ambience at the project centre, which generated a sense of belonging among members, and assisted in the development of social networks. The project initiated other forms of social support through the use of volunteers and developed befriending and telephone support services. The project developed partnership working with other agencies, particularly community mental health services, in order to provide support to elderly people who might otherwise have been institutionalised. The project engaged with the cultural norms of this marginalised white minority ethnic community to promote both social interaction and social networks. It offered a model of good practice for agencies working with isolated elderly members of minority ethnic communities.