Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.

Effects of differential methods of compensation and employee empowerment on customer satisfaction and loyalty in service recovery

This research examined the effects of varying compensation (refund and replacement) and employee empowerment (empowered and non-empowered) in service recover situations, using a 2x2 experiment. Analysis was undertaken using mean contrasts and ANOVA's. Findings suggest that empowerment and refund independently impact on post recovery consumer loyalty and satisfaction, but there is no interaction effect.

Exploring the links between relational bonds and customer loyalty : the case of loyal Arabic guests at five-star hotels

Relationship marketing aims to build and maintain relationships between customers and organizations. While building strong bonds is a key objective of relationship marketing, limited empirical attention has been paid to the role of relational bonds on enhancing loyalty. This study explores the impact of financial, social and structural bonds on consumer loyalty, using a sample of loyal Arabic hotel guests. The results of this study suggest that structural bonds increase loyalty, although financial and social bonds were not found to have a significant impact on loyalty.

Relational bonds and loyalty : the bonds that tie

This paper explores the effect of financial, social and structural bonds on the loyalty of Arabic five star hotel guests. Three different measures of loyalty are used; attitudinal, behavioural and combined to identify how the three relational bonds affect loyalty. The results show that social and structural bonds increase all types of loyalty whereas financial bonds only increase attitudinal and combined loyalty. It is also found that bonds are perceived to be more important for high-loyal consumers as compared to low-loyal consumers. This all suggests that firms seeking to increase loyalty may need different strategies depending on the consumers being targeted.

The nature and implications of support in graduate nurse transition programs : an Australian study

It is widely recognized that support is critical to graduate nurse transition from novice to advanced beginner-level practitioner and to the integration of neophyte practitioners into safe and effective organizational processes. Just what constitutes support, however, and why (if at all) support is important, when, ideally, support should be given, by whom, how, and for how long, have not been systematically investigated. Building on the findings (previously reported) of a yearlong study that had, as its focus, an exploration and description of processes influencing the successful integration of new graduate nurses into safe and effective organizational processes and systems, the findings presented in this article strongly suggest that support is critical to the process of graduate nurse transition, and that integration into “the system” is best provided during the first 4 weeks of a graduate nurse transition program and thereafter at the beginning of each ward rotation; that “informal teachers” and the graduate nurses themselves are often the best sources of support; and that the most potent barriers to support being provided are the untoward attitudes of staff toward new graduates. Drawing on the overall findings of the study, a new operational definition of support is proposed and recommendations are made for future comparative research on the issue.

Designing effective training programs for investigative interviewers of children

'Best-practice' guidelines for conducting investigative interviews with children are well established in the literature, yet few investigative interviewers actually adhere to such guidelines in the field. One of the problems is that little discussion has focused on how such guidelines are learned and sustained by professionals. To address this concern, the current article reviews the key elements of interview training programs that are known to promote competent interviewing. These elements include: (i) the establishment of key principles or beliefs that underpin effective interviewing, (ii) the adoption of an interview framework that maximises narrative detail, (iii) clear instruction in relation to the application of the interview framework, (iv) effective ongoing practice, (v) expert feedback and (vi) regular evaluation of interviewer performance. A description and justification of each element is provided, followed by broad recommendations regarding how these elements can be implemented by police and human service organisations in a cost-effective manner.

Weight concerns among elementary school children : a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8–12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

Exploring the barriers and enablers to attendance at rural cardiac rehabilitation programs

Objective: The objectives of this study were to: (i) identify local barriers and enablers to the uptake of hospital-based cardiac rehabilitation (CR) programs, and (ii) identify preferred alternatives for the delivery of CR.

Design: A questionnaire administered by local CR coordinators and focus groups facilitated by the research team.

Setting: Six regional hospitals in south-west Victoria offering hospital-based CR programs.

Participants: Patients and their carers referred to and eligible for local CR programs; health professionals working within local CR programs.

Main outcomes measures: CR attendees and decliners demographics, patient and health professional perceived factors which contribute to enabling hospital-based CR attendance, patient and health professional perceived barriers to CR attendance, and receptiveness and preferences for alternative modes of CR delivery.

Results: This study identified distance to travel to hospital-based CR programs the only statistically significant factor in determining uptake of CR. Easy access to transport (63%) and to a lesser extent family support (49%) and work flexibility (43%) were the primary enablers to attendance. Of the 97 study participants, 38% were receptive to alternative CR methods such as programs in outlying communities, evening facility-based programs, home and GP based programs, telephone support and a patient manual/workbook.

Conclusions: The results of this study provide valuable information for designing strategies to increase utilisation and improve patient acceptability of existing hospital-based CR programs. It provides a basis for pilot testing alternative modes of CR program delivery for cardiac patients in rural areas unable to access hospital-based CR.

An investigation of corporate image, customer satisfaction and loyalty-more than just monkey business

Prior research into corporate branding, of which corporate image is a key construct, has focused primarily on products. There has, however, been limited academic research focusing on corporate branding in the leisure services sector. However, in an increasingly competitive environment, leisure services need to treat branding and image management as more than just "monkey business". This study addresses this by developing a model and empirically testing the relationships between corporate image, the dimensions of corporate image, customer satisfaction and loyalty in the context of a Zoological garden. As predicted, a strong relationship was found between corporate image, customer satisfaction and customer loyalty. Our results also suggest that three dimensions of corporate image (adventure, mission/vision and agreeableness) explain a significant propOliion of the variance in satisfaction and loyalty.

Investigation of stakeholders commitment to information security awaremess programs

Organisations have become increasingly dependent on technology in order to compete in their respective markets. As IT technology advances at a rapid pace, so does its complexity, giving rise to new IT security vulnerabilities and methods of attack. Even though the human factors have been recognized to have a crucial role in information security management, the effects of weakness of will and lack of commitment on the stakeholders (i.e., employers and employees) parts has never been factored into the design and delivery of awareness programs. To this end, this paper investigates the impacts of the availability of awareness programs and end-user drive and lack of commitment to information security awareness program design, delivery and success.

Developing recreation programs for disadvantaged sectors of the community

Physical activity participation can provide benefits for both the health and well-being of the community. Many people, however, are not active enough to achieve these health and well-being outcomes. The Victorian Health Promotion Foundation’s (VicHealth) 2001 Active Recreation Scheme funded 27 projects designed to provide recreation programs to address the active recreation needs of disadvantaged groups who are often the least physically active members of Victorian communities. This research aimed to identify themes and strategies of these projects that increased participation or reduced barriers to participation in active recreation. Site visit interviews were conducted with representatives of 11 projects to become familiar with successful program strategies and barriers to recreation program development. Following the site visits a focus group discussion with representatives from all 27 funded projects was conducted to explore ways in which barriers to recreation participation could be minimized and what strategies were effective in increasing recreation participation. Nine general dimensions that were identified as strategic approaches to increase the participation of disadvantaged groups in recreation programs were relationships, resources, community values/attitudes, communication (promotion and education), participant awareness/motivation, autonomy supportive, planning, program design, and mentors/role models. It was found that a focus on a community coalitions and complementary policy developments had positive effects on creating active communities. Four themes that guided the community and policy developments were i) community partnerships, ii) community support, iii) focus on the participants and iv) program design elements. The study also showed that the management and manipulation of these themes assisted agencies to develop programs that increased recreation participation.

Change of perspective: a measurable and desired outcome of chronic disease self-management intervention programs that violates the premise of preintervention/postintervention assessment

Objective: To determine if participants in chronic disease self-management courses have a change of perspective of their health status (a response shift), and if this is measurable with a paper-based questionnaire.

Methods: Nine items were developed to measure potential benefits of self-management courses. These were based on the constructs of a previous questionnaire, the Health Education Impact Questionnaire (HEI-Q). Cognitive interviews elicited spontaneous statements about the reasons for paper-based answers. Sensitivity, specificity, and overall accuracy of items were calculated using the interview as a relative gold standard. Response shift can be negative (i.e., after the course, participants realize that, before the course, they were worse than they thought they were), positive (i.e., participants now realize they were better than they thought they were), or absent (no change).

Results: Interviews (n = 39) reflected that true response shift occurred in approximately half the replies to questionnaire items. Of these, 31% were negative response shift, 20% were positive response shift. Response shift was absent in 32% of replies. Presence or absence of response shift could not be determined in 17% of replies across items. Significant concordance between questionnaires and cognitive interviews (average overall accuracy 0.79) indicated that the HEI-Q Perspective questionnaire detects response shift in participants of self-management courses. The questionnaire revealed that 87% of participants had response shift in at least 1 item.

Conclusion: This study suggests that preintervention/postintervention assessments of interventions such as self-management courses are confounded by a change in perspective of a large proportion of respondents. It also indicates response shift is a valuable outcome of self-management courses that can be measured with a paper-based questionnaire.