Governing the working population : knowledge, self and power in workplace health programs

This paper reports a case study of a workplace health programme in an international information technology company. Discourse analysis was used to identify how specific forms of knowledge create understandings of health and influence power relations between employee and organization. These forms of knowledge are shown to make employee health both visible and invisible in particular ways. Workplace health discourse encourages the employee to take responsibility for self-assessment and behaviour adjustment to become healthier employees. This is shown to be an ethical project which results in the alignment of personal and corporate goals.

Evaluating the outcomes of adolescent day programs in an Australian child and adolescent mental health service

Adolescent day programs (ADPs) are an increasingly used approach to treating adolescents with mental health issues. However, there is a dearth of studies empirically examining the outcomes of adolescent day programs. This study retrospectively examined the mental health functioning of 84 adolescents, pre- and post-treatment, who in addition to their ongoing outpatient treatment had participated in an ADP during a five-year period. Their functioning was compared to matched adolescents who participated only in outpatient treatment during the same time period. Statistical and clinical examinations revealed the reported outcomes following ADP treatment were at least comparable, and sometimes significantly better, when compared to the reported outcomes following outpatient treatment excluding ADP involvement. This study, while having some methodological shortcomings, provides some evidence for the efficacy of ADPs.

The economic analysis of prevention in mental health programs

This article introduces the role economics can play in deciding whether programs designed to prevent mental disorders, which carry large disease and economic burdens, are a worthwhile use of limited healthcare resources. Fortunately, preventive interventions for mental disorders exist; however, which interventions should be financed is a common issue facing decision makers, and economic evaluation can provide answers. Unfortunately, existing economic evaluations of preventive interventions have limited applicability to local healthcare contexts. An approach to priority setting largely based on economic techniques— Assessing Cost-Effectiveness (ACE)—has been developed and used in Australia to answer questions regarding the economic credentials of competing interventions. Eleven preventive interventions for mental disorders and suicide, mostly psychological in nature, have been evaluated using this approach, with many meeting the criteria of good value for money. Interventions targeting the prevention of suicide, adult and childhood depression, childhood anxiety, and early psychosis have particular merit.

Assessment of proximal outcomes of self-management programs : translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQtm)

Purpose This paper describes the translation, cultural adaption, and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ™), a widely used generic instrument assessing a wide range of proximal outcomes of self-management programs.

Methods The translation was carried out according to international standards and included forward and backward translations. Comprehensibility and content validity were tested using cognitive interviews with 10 rehabilitation inpatients. Psychometric properties were examined in rehabilitation inpatients (n = 1,202) with a range of chronic conditions. Factorial validity was assessed using confirmatory factor analysis; concurrent validity was explored by correlations with comparator scales.

Results The items of the German heiQ™ were well understood by rehabilitation inpatients. The structure of the eight heiQ™ scales was replicated after minor adjustment. heiQ™ scales had higher correlations with comparator scales with similar constructs, particularly mental health concepts than with physical health. Moreover, all heiQ™ scales differentiated between individuals across different levels of depression.

Conclusion The German heiQ™ is comprehensible for German-speaking patients suffering from different types of chronic conditions; it assesses relevant outcomes of self-management programs in a reliable and valid manner. Further studies involving its practical application are warranted.

Developing programs for African families, by African families: engaging African migrant families in Melbourne in health promotion interventions

Obesity is an emerging problem for African migrants in Australia, but few prevention programs incorporate their cultural beliefs and values. This study reports on the application of community capacity-building and empowerment principles in 4 workshops with Sudanese families in Australia. Workshop participants prioritized health behaviors, skill and knowledge gaps, and environments for change to identify culturally centered approaches to health promotion. The workshops highlighted a need for culturally and age-appropriate interventions that build whole-of-family skills and knowledge around the positive effects of physical activity and nutrition to improve health within communities while reducing intergenerational and gender role family conflicts.

Portfolio careers for medical graduates: implications for postgraduate training and workforce planning.

Portfolio careers in medicine can be defined as significant involvement in one or more portfolios of activity beyond a practitioner's primary clinical role, either concurrently or in sequence. Portfolio occupations may include medical education, research, administration, legal medicine, the arts, engineering, business and consulting, leadership, politics and entrepreneurship. Despite significant interest among junior doctors, portfolios are poorly integrated with prevocational and speciality training programs in Australia. The present paper seeks to explore this issue. More formal systems for portfolio careers in Australia have the potential to increase job satisfaction, flexibility and retention, as well as diversify trainee skill sets. Although there are numerous benefits from involvement in portfolio careers, there are also risks to the trainee, employing health service and workforce modelling. Formalising pathways to portfolio careers relies on assessing stakeholder interest, enhancing flexibility in training programs, developing support programs, mentorship and coaching schemes and improving support structures in health services.

How do postgraduate qualifications in medical education impact on health professionals?

Background and Purpose: The number of degree-awarding programmes in medical education is steadily increasing. Despite the popularity and extensive investment in these courses, there is little research into their impact. This study investigated the perceived impact of an internationally-renowned postgraduate programme in medical education on health professionals’ development as educators.

Methods: An online survey of the 2008–12 graduates from the Centre for Medical Education, University of Dundee was carried out. Their self-reported shifts in various educational competencies and scholarship activities were analysed using non-parametric statistics. Qualitative data were also collected and analysed to add depth to the quantitative findings.

Results: Of the 504 graduates who received the online questionnaire 224 responded. Participants reported that a qualification in medical education had significantly (p < 0.001) improved their professional educational practices and engagement in scholarly activities. Masters graduates reported greater impact compared to Certificate graduates on all items, including ability to facilitate curriculum reforms, and in assessment and feedback practices. Masters graduates also reported more engagement in scholarship activities, with significantly greater contributions to journals. These qualifications equally benefited all participants regardless of age. International graduates reported greater impact of the qualification than their UK counterparts.

Conclusion: A postgraduate medical education programme can significantly impact on the practices and behaviours of health professionals in education, improving self-efficacy and instilling an increased sense of belonging to the educational community.

Preventive social health programs : are they Australia's answer to rising health care costs in rural communities?

Although we have good evidence to support the notion that early intervention, prevention and community education programs can mitigate the impact of preventable disease, expanded primary health care is also being promoted by Australian governments as a panacea for reducing growth in demand generally. While preventive programs do reduce acute demand, they may not do so the extent that resources, currently allocated to the acute sector, can be substituted to provide the additional primary care services necessary to reduce acute demand permanently. These developments have particular relevance for rural and isolated communities where access to acute services is already very limited. What appears to be occurring, in rural South Australia at least, is that traditional acute services are being reduced and replaced with lower level care and social intervention programs. This is well and good, but eventually the acute care being provided in rural health units now will still need to be provided by other units elsewhere and probably at much higher cost to the system and to consumers. Where rural communities have previously managed much of their own acute service demand, they may now be forced to send patients to more distant centres for care but at much greater social and economic cost to individuals and the system.

Aligning multiple knowledge perspectives in a health services system : a case study

This chapter reports the results of a feasibility study into electronic collection of service data at “point of delivery” for disability programs. The investigation revealed that while the proposed system would have produced more fine-grained data, it would not have improved any actor’s knowledge of service delivery. The study illustrated the importance of context in the transition from data to knowledge; the diffused and fragmented organisational structure of social service administration was shown to be a major barrier to effective building and sharing of knowledge. There was some value in the collection of detailed service data but this would have damaged the web of relationships which underpinned the system of service delivery and on which the smooth functioning of that system depended. The study recommended an approach to managing the informal and tacit knowledge distributed among many stakeholders, which was not especially technologically advanced but which supported, in a highly situated manner, the various stakeholders in this multi-organisational context.

School health policies and practices in Victoria- a comparison involving socio-economic status

Issue addressed: Health programs have been part of the responsibility of Victorian school education for 90 years. Yet rarely have there been studies to identify what is happening in school health promotion, or what the differences between schools might be, particularly in relation to the socioeconomic status of the school community and whether the school is in a metropolitan or regional area. Methods: In 1997 all Victorian schools (primary and secondary) in the State, Catholic and Independent systems were sent questionnaires in order to promote broader awareness about health promotion, and to identify what health programs, policies and activities the schools believed existed within their school community. A response rate of 43% was achieved, and results were collated under the six domains of the Health Promoting School model as outlined by the Western Pacific Regional Office of the World Health Organisation. Data analysed in this paper compared highest versus lowest quartiles for socioeconomic status (SES), and schools in metropolitan Melbourne versus regional areas. Results: Most differences between schools based on socioeconomic status occurred in secondary schools and were related mainly to environmental policies and practices, use of back packs, the presence of safety policies, involvement of parents in school activities and the provision of services for mental and social health needs. All differences were in favour of the highest SES quartile schools. Environmental policies and procedures, and school-based health and welfare services were present more often in metropolitan schools than in regional and rural schools. Conclusion: Although there were notable differences between schools, the audit results pointed to more similarities than differences between schools in the highest and lowest SES quartiles for health-related policies and practices; there were even fewer differences between metropolitan and non-metropolitan schools. So what: Regardless of the actual advantages and disadvantages schools experience with respect to location or socioeconomic status, it is important to understand that school staff perceive that they can and do have reasonably comprehensive health policies, procedures and practices to address health issues. Nevertheless, clear differences between schools did emerge in certain health areas and findings will assist policy making and the allocation of limited resources.

The impetus for the development of hospital in the home (HITH) programs: a literature review

Alternative health care delivery models such as Hospital in the Home (HITH) are proliferating in Australia and in most Western countries. Such models facilitate patients who would otherwise be hospitalised to be cared for in their own homes. This paper reports a review of the literature related to the development of HITH programs. It reveals that the driving force behind the implementation of acute care programs comes from political and managerial aims to reduce health care spending. Home is clearly an appropriate care option for certain acute patients however, there is no strong evidence to suggest that it suits everyone. Very little attention has been given to the patient's experience of home care and the ethical and social consequences are largely ignored.

Health Diaries in a Rural Australian Study

The authors designed a study around the use of health diaries comprising both open- and closed-ended questions and kept over a 16-week period by 118 rural and remote-dwelling families in Victoria, Australia. Participants documented their use of health services, episodes of illness, actions taken to keep healthy, and reflections on services and programs. In this article, the authors report on the health diary method. They discuss the qualitative ways in which the participants used their study involvement to enrich their lives: accessing health information and advice, furthering their concerns about rural health, and using the research process for social support. The authors discuss issues surrounding the rural and remote context of the study and the length of time over which the diaries were kept.

Postgraduate management study options for engineers

Most professional engineers will spend a significant proportion of their careers as managers of technology, and large numbers of engineers seek formal education in management at the postgraduate level. Study options include the Master of Business Administration, Master of Engineering Management, and management of technology programs. This paper reviews the literature on postgraduate engineering management education to examine the documented claims for and against particular options. The diversity of engineers and engineering practice will ensure a diversity of postgraduate management education needs, which will be best served by a diversity of options for study. Diversity of options is a strength not a weakness; there is not a single ''best'' option for management education for engineering graduates. As long as they offer relevance, convenience, interest and value, the various postgraduate management study options with their particular distinctions and emphasis on technology or management will find a ready audience.