Health literacy: applying current concepts to improve health services and reduce health inequalities

The concept of 'health literacy' refers to the personal and relational factors that affect a person's ability to acquire, understand and use information about health and health services. For many years, efforts in the development of the concept of health literacy exceeded the development of measurement tools and interventions. Furthermore, the discourse about and development of health literacy in public health and in clinical settings were often substantially different. This paper provides an update about recently developed approaches to measurement that assess health literacy strengths and limitations of individuals and of groups across multiple aspects of health literacy. This advancement in measurement now allows diagnostic and problem-solving approaches to developing responses to identified strengths and limitations. In this paper, we consider how such an approach can be applied across the diverse range of settings in which health literacy has been applied. In particular, we consider some approaches to applying health literacy in the daily practice of health-service providers in many settings, and how new insights and tools--including approaches based on an understanding of diversity of health literacy needs in a target community--can contribute to improvements in practice. Finally, we present a model that attempts to integrate the concept of health literacy with concepts that are often considered to overlap with it. With careful consideration of the distinctions between prevailing concepts, health literacy can be used to complement many fields from individual patient care to community-level development, and from improving compliance to empowering individuals and communities.

FASD: From isolation to inclusion in Australian schools.

This research investigated pedagogical approaches required for the successful inclusion of children and young people living with Fetal Alcohol Spectrum Disorders. The research applied an Indigenist constructivist qualitative method working with one school community. The development of a National Framework for Achieving Inclusion for Australian Students with FASD demands urgent policy and support for educators to meet the complex learning needs of students with FASD.

Community development and enterprise culture : prospects and dilemmas

Community Development as a form of practice promotes empowerment and social justice. Its origins lie in people's collective struggle to be heard, recognised and accorded full citizenship in society. It has developed strategies to achieve social change that challenge dominant ways of thinking, policy and resource allocation in society. 'Enterprise culture has its origins in the individualism and competitiveness of capitalism. These essentially neo-liberalist concepts have been remoulded into a radical political program of change sponsored by the state under the guise of new managerialism, competitive tendering and privatization. This research seeks to examine the interface between community development and enterprise culture as a potential site of tension and contestation through an analysis of discourse. The initial task, therefore, was to elaborate the concept of enterprise culture and examine the ways enterprise culture has been manifested in community development. The focus has been on practitioners committed to community development through a qualitative, empirical approach with a view to discerning their views on the relevance and impact of enterprise culture on their work. Community development provides a useful domain for interrogating the infiltration of the concept of the enterprise culture because of its history of opposition and mobilisation. The research seeks to understand the ways in which the forms of enterprise culture as an essentially cultural project are manifested in practice contexts and to analyse the nature of the response to its various manifestations. As a result, it constitutes more than just a critique of any one of these forms, eg, privatisation, tendering out, managerialism, and instead seeks to investigate the degree to which a cultural shift may be occurring towards notions of greater individualism and away from collective notions of responsibility, obligation and citizenship. The research critically analyses the impact of enterprise culture on Australian social policy through the case study of community development practice. The manifestations of enterprise culture are investigated at various levels, with an emphasis on the responses of practitioners. A related aim is to reveal the range of possible responses to the infiltration of the enterprise culture in terms of values, language and practice into community development. Are new forms of practice emerging or is the field being steadily co-opted by government social and educational policy? Finally, the research should enable some future directions to be identified for the field of community development. The findings represent an initial attempt in an Australian context to establish the degree of influence that enterprise culture has had and/or will have on social policy. Chapter 1 examines the concept of enterprise culture and a background to its impact on community development as a domain of practice. The meaning of enterprise culture and its origins will be examined in Chapter 2. Its influence on Australian social policy is then discussed with particular reference to recent changes in Victoria regarding family services. In Chapter 3, the main features of critical discourse analysis are outlined as a framework for subsequent analysis of the links between discourse and hegemony. The work of Fairclough (1992, 1995) is utilised to highlight the relevance of discourse analysis to an examination of the infiltration of ideas associated with enterprise culture into the domain of community development. Chapter 4 provides an overview of the origins and defining characteristics of community development practice. The diverse beginnings and philosophical underpinnings are discussed and the main features of community development outlined in order to establish meanings attached to key concepts such as empowerment and participation. In Chapter 5, the findings of initial interviews with sixteen community development practitioners are discussed in terms of their perceptions of the impact of enterprise culture on their practice and the organisational culture within which they operate. These initial interviews were conducted in November-December 1996. A primary focus of the interviews was to establish the key words in their lexicon of practice and to provide an opportunity for reflection on the relative influence of discourse and practices associated with enterprise culture. A framework for analysing and making sense of the forms of response to enterprise culture is applied to the responses. Four forms of possible response are proposed and discussed in the context of the data. Follow up interviews were conducted in November-December 1997 and the findings of these interviews are discussed in Chapter 6. A particular emphasis in these interviews was on any changes in the lexicon of practice and indications of a change in the impact of discourse and practices associated with enterprise culture. The forms of response suggested in the framework outlined in Chapter 5 are discussed in the light of any movement in the responses of participants in the study. The implications of the findings are discussed in the context of the framework of responses or forms of embrace of enterprise culture analysed in earlier chapters. Finally, in Chapter 7, the potential for community development as a form of practice to transcend or at least accommodate the impact of enterprise culture through strategic forms of embrace is discussed and possible strategies based on the research that may assist in the development of this response are proposed.

Cultural heritage and development in South East Asia

This chapter discusses research undertaken into the developmental role of museums and heritage sites in Thailand and the Greater Mekong Subregion, a geographical area that also includes Cambodia, Laos PDR and Myanmar. It contextualizes an international project, the Lampang Temples Project, to explore the potential role that museums and heritage sites can play in place-based development work, particularly in an Asian context where sacred places are simultaneously valued by local members of the community and as desinations for religious pilgrims and international tourists. The discussion of the Lampang Temples Project is located within an understanding of the international discourse concerning the roles of museums in development, including those contributions to the discourse that have originated in the Asia-Pacific region. It is also situated within an understanding of the roles of international agencies and local governments in the promotion of programmes and infrastructure for the preservation of Buddhist heritage and the relationship of this development strategy with tourism. Furthermore, due to the participatory and observational experience of the authors in the Lampang Temples Project, the chapter also considers the issues involved in applying cross-cultural pedagogies to the management of cultural tourism sites, including UNESCO World Heritage Sites. The results of the Lampang Temples Project support the contention that colaborative training models and pedagogies can be adapted, provided that differing cultural contexts and suppositions are appropriately articulated and integrated. Further, it suggests that this type of collaborative approach to the management of cultural tourism sites has the potential to play an important role in Buddhist heritage development processes.

Exploring cultural inclusion: perspectives from a community arts organisation

Using focus group interviews and individual stories of participants from secondary data, we  illuminate the role of Multicultural Arts Victoria (MAV) in Australia in how it promotes cultural  inclusion through programs of social and civic service. Our findings confirm the significance of  cultural inclusion and the potentially useful role of arts in creating inclusive organisations and  communities. We further develop a framework of cultural inclusion in the workplace to provide  a holistic understanding of the cultural inclusion process that can lead to the development of  inclusive workplaces. As social inclusion is central to Australia’s national identity, this article helps  researchers and practitioners to understand how cultural inclusion and inclusive organisational  theories collide and complement each other to create inclusive organisations.

Justice, community, and dialogue in international relations

This book is concerned with the issue of cultural diversity and international morality. The author asks whether cultural diversity presents an obstacle to the development of ethical codes which could be acceptable to cultures around the world. He argues that the human capacity to engage in conversation and the ability to understand each other despite linguistic and cultural differences can provide the basis for the development of a world-wide, cosmopolitan moral community. Conversation can be a moral act, in which participants treat each other as equals despite their differences.

Analysis of cultural conflict in the development of web-enabled information systems

The advent of the World Wide Web (WWW) and the emergence of Internet commerce have given rise to the web as a medium of information exchange. In recent years, the phenomenon has affected the realm of transaction processing systems, as organizations are moving from designing web pages for marketing purposes, to web-based applications that support business-to-business (WEB) and business-to-consumer (B2C) interactions, integrated with databases and other back-end systems (Isakowitz, Bieber et al., 1998). Furthermore, web-enabled applications are increasingly being used to facilitate transactions even between various business units within a single enterprise. Examples of some of the more popular web-enabled applications in use today include airline reservation systems, internet banking, student enrollment systems in universities, and Human Resource (HR) and payroll systems. The prime motive behind the adoption of web-enabled applications are productivity gains due to reduced processing time, decrease in the usage of paper-based documentation and conventional modes of communication (such as letters, fax, or telephone), and improved quality of services to clients. Indeed, web-based solutions are commonly referred to as customer-centric (Li, 2000), which means that they provide user interfaces that do not necessitate high level of computer proficiency. Thus, organizations implement such systems to streamline routine transactions and gain strategic benefits in the process (Nambisan & Wang, 1999), though the latter are to be expected in the long-term. Notwithstanding the benefits of web technology adoption, the web has ample share of challenges for initiators and developers. Many of these challenges are associated with the unique nature of web-enabled applications. Research in the area of web-enabled information systems has revealed several differences with traditional applications. These differences exist with regards to system development methodology, stakeholder involvement, tasks, and technology (Nazareth, 1998). According to Fraternali (1999), web applications are commonly developed using an evolutionary prototyping approach, whereby the simplified version of the application is deployed as a pilot first, in order to gather user feedback. Thus, web-enabled applications typically undergo continuous refinement and evolution (Ginige, 1998; Nazareth, 1998; Siau, 1998; Standing, 2001). Prototype-based development also leads web-enabled information systems to have much shorter development life cycles, but which, unlike traditional applications, are regrettably developed in a rather adhoc fashion (Carstensen & Vogelsang, 2001). However, the principal difference between the two kinds of applications lies in the broad and diverse group of stakeholders associated with web-based information systems (Gordijn, Akkermans, et al., 2000; Russo, 2000; Earl & Khan, 2001; Carter, 2002; Hasselbring, 2002; Standing, 2002; Stevens & Timbrell, 2002). Stakeholders, or organizational members participating in a common business process (Freeman, 1984), vary in their computer competency, business knowledge, language and culture. This diversity is capable of causing conflict between different stakeholder groups with regards to the establishment of system requirements (Pouloudi & Whitley, 1997; Stevens & Timbrell, 2002). Since, web-based systems transcend organizational, departmental, and even national boundaries, the issue of culture poses a significant challenge to the web systems’ initiators and developers (Miles & Snow, 1992; Kumar & van Dissel, 1996; Pouloudi & Whitley, 1996; Li & Williams, 1999).

Is creativity a matter for cultural leaders?

A climate of change in the arts in the 1990s, including a growing recognition of the need for creative management, has raised the issue of how not-for-profit art museum directors use creativity in their managerial role. Traditionally, the prime function of art museums has been to gather, preserve and study objects. The perception of directors as keepers of collections and creativity as residing in the object has evolved. Creativity is increasingly seen as residing in the managers of organizations. A survey of Australian and New Zealand art museum directors revealed six strategic responses to change, indicating the extent to which they used creativity in their leadership role: economic emphasis, market orientation, audience development, collaboration, accessibility and community relations. The question this paper poses is whether the change in the director's role has overturned the traditional view of creativity as focused on the art work rather than on management initiatives. The proposed answer is that it has been not so much overturned as extended: directors now balance the development and preservation of creative art works with creative management of the art museum as a market-facing organization.

Tensions and dilemmas in community development: new discourses, new Trojans?

This paper begins by noting the range of contradictions and dilemmas facing those involved in community development today. It then draws on research into the operating frameworks that set the stage for much current community development activity. It discusses four key operating frameworks and how each framework can affect community development practice. The final section deals with the ways in which the frameworks, and the discourses associated with them, come together.

Australia, Asia and cultural anxiety : inaugural AHA Anniversary Public Lecture, given at the Grand Hotel, Mildura on 29 September (2003).

My theme tonight is the recurrent idea that Australia could be expected to have an Asian future. From the 1880s there developed a speculative literature around the notion that Asia ('generic Asia' as I prefer to call it) would exert an increasing influence, possibly a determining influence, on the development and settlement of the Australian continent. There is a certain pathos about this story of a young, newly formed community on the threshold of nationhood finding Asia blocking its path. Would the ensuing contest be the making of white Australia; would the young nation define its national purpose and assert its right to exist or would it succumb to a force more powerful? Would white Australia become nothing more than a faint historical memory, a failed experiment in the complex and uncertain business of nation building? In short, would white Australia fail?

'Motor magic' : evaluation of a community capacity-building approach to supporting the development of preschool children (part 2)

Background and Aims: This paper is the second in a series of two that presents and discusses an exploratory evaluation study of the 'Motor Magic' program conducted in Adelaide, South Australia.

Methods: A realist evaluation approach was used, and two focus groups (one with parents and one with kindergarten staff) were held to identify program outcomes and to develop and refine key hypotheses about how these outcomes occurred.

Results and Conclusions: Results for kindergarten staff involved in the program are presented and discussed in this paper, including improved early identification and early intervention for children with, or at risk of, fine motor developmental difficulties; increased confidence in the effectiveness of their practice with these children; improved practice of kindergarten staff with both targeted and all children; improved empathy with, and support for, parents; and increased interagency links and ongoing advocacy for further resources. These results suggest that the program provides an effective model for building the capacity of kindergarten staff to support children with, or at risk of, developmental difficulties.

From policy to practice: the development of an integrated health promotion plan for children's services at Plenty Valley Community Health Inc.

Current changes in the funding of health promotion in community health in Victoria require community health agencies to integrate health promotion with service delivery. This provides both opportunities and challenges for community health staff. Members of the Children’s Service Team at Plenty Valley Community Health Inc. addressed these changes by developing an integrated health promotion plan. The approach used involved identifying client pathways and then integrating opportunities for health promotion interventions into these pathways. Staff perceptions of the process involved in developing the plan were examined. The use of client pathways to integrate health promotion into everyday practice proved a successful approach for members of the Children’s Services Team, and provides a useful model for health promotion planning in community health that helps staff to see the relevance of health promotion to their practice, and engages staff in the planning process. Members of the Children’s Services Team reported that the process involved in developing their integrated health promotion plan was a very worthwhile experience that allowed them a strong sense of ownership of the plan.