The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions

Objective: This paper describes the development and validation of the Health Education Impact Questionnaire (heiQ). The aim was to develop a user-friendly, relevant, and psychometrically sound instrument for the comprehensive evaluation of patient education programs, which can be applied across a broad range of chronic conditions.

Methods: Item development for the heiQ was guided by a Program Logic Model, Concept Mapping, interviews with stakeholders and psychometric analyses. Construction (N = 591) and confirmatory (N = 598) samples were drawn from consumers of patient education programs and hospital outpatients. The properties of the heiQ were investigated using item response theory and structural equation modeling.

Results: Over 90 candidate items were generated, with 42 items selected for inclusion in the final scale. Eight independent dimensions were derived: Positive and Active Engagement in Life (five items, Cronbach's alpha (α) = 0.86); Health Directed Behavior (four items, α = 0.80); Skill and Technique Acquisition (five items, α = 0.81); Constructive Attitudes and Approaches (five items, α = 0.81); Self-Monitoring and Insight (seven items, α = 0.70); Health Service Navigation (five items, α = 0.82); Social Integration and Support (five items, α = 0.86); and Emotional Wellbeing (six items, α = 0.89).

Conclusion:The heiQ has high construct validity and is a reliable measure of a broad range of patient education program benefits.

Practice Implications: The heiQ will provide valuable information to clinicians, researchers, policymakers and other stakeholders about the value of patient education programs in chronic disease management.

Outcomes and costs of primary care surveillance and intervention for overweight or obese children : the LEAP 2 randomised controlled trial

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children.

Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment.

Setting 45 family practices (66 general practitioners) in Melbourne, Australia.

Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score 3.0) were excluded.

Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials.

Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.

Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention – control) at 6 and 12 months were, for BMI, –0.12 (95% CI –0.40 to 0.15, P=0.4) and –0.11 (–0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (–4 to 52, P=0.09) and 11 (–26 to 49, P=0.6); and, for nutrition score, 0.2 (–0.03 to 0.4, P=0.1) and 0.1 (–0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.

Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia.

Patient outcomes in the acute revovery phase following robotic-assisted prostate surgery : a prospective study

Background: Robotic-assisted minimally invasive urologic surgery was developed to minimise surgical trauma resulting in quicker recovery. It has many potential benefits for patients with localised prostate cancer over traditional surgical techniques without taking a risk with the oncological result.

Objectives: To report the specific surgical outcomes for the first Australian cohort of patients with localised prostate cancer that had undergone robotic-assisted radical prostatectomy (RARP) surgery. The outcomes represent the acute (in-hospital) recovery phase and include pain, length of stay (LOS), urinary catheter management and wound management.

Methods: Prospective descriptive survey of 214 consecutive patients admitted to a large metropolitan private hospital in Melbourne, Australia between December 2003 and June 2005. Patients had undergone RARP surgery for localised prostate cancer. Data were collected from the medical records and through interview at the time of discharge. Descriptive statistics were used to describe the frequency and proportion of outcomes. Patient characteristics were tabulated using cross tabulation frequency distribution and measures of central tendency.

Results: The findings from this study are highly encouraging when compared to outcomes associated with traditional surgical techniques. Transurethral catheter duration (median 7 days (IQ range 2)) and LOS (median 3 days (IQ range 2)) were considerably reduced. While operation time (median 3.30 h (IQ range 1.07)) was marginally reduced we would expect a further reduction as the surgical team becomes more skilled.

Conclusion: The findings from this study contribute to building a comprehensive picture of patient outcomes in the acute (in-hospital) recovery phase for a cohort of Australian patients who have undergone RARP surgery for localised prostate cancer. As such, these findings will provide valuable information with which to plan care for patients’ who undergo robotic-assisted surgery.

Reviewing the reviewers : has the education review unit contributed to improved student learning outcomes?

This article looks at the contribution the South Australian Education Review Unit (ERU). It provides a perspective from a secondary school that has undergone and ERU review. It describes ERU procedures and methodology, explains what happened with the Le Fevre High School review, and 'reviews the reviewers' and answer the question posed in the article title.

Effectiveness of a modified mother–infant transaction program on outcomes for preterm infants from 3 to 24 months of age

Mothers of hospitalised preterm infants were randomised into an intervention or control condition. Intervention mothers received a modified Mother–Infant Transaction Program over seven sessions prior to infant discharge and two sessions over the next 3 months. Infant temperament, mother–infant interaction and parenting stress were assessed at 3 and 6 months and infant development was measured by parental report at 24 months. Intervention compared with control dyads showed enhanced mother–infant interactions, infants were temperamentally more “approaching” and “easier”, had fewer regulatory problems (colic, sleep, excessive crying), and had more developed communication skills, while mothers were less stressed by their infant at 3 months. These early gains in the development of preterm infants and in the relationship with and adjustment of their mothers, may explain the process by which intervention infants in the original study showed increasing cognitive advantages to 9 years of age [Rauh, V. A., Nurcombe, B., Achenbach, T., & Howell, C. (1990). The mother–infant transaction program. Clinical Perinatology, 17, 31–45].

Justice, gender and employee cognitive outcomes

This study used the four factor model of organizational justice to investigate gender differences in the employee outcome cognitive variables of job satisfaction,commitment and turnover intentions. Survey respondents were 301 male and 147 female currently working employees in a variety of occupations. Structural equation modeling was used for the analyses. There were significant relationships from distributive justice to job satisfaction and commitment for both men and women. Informational justice significantly predicted job satisfaction. For women, informational justice predicted commitment and turnover intentions. Procedural justice predicted turnover intentions and interpersonal justice predicted commitment for men. Gender differences were found for procedural, interpersonal and informational justices. Men and women gave differing responses to justice perceptions, implying consideration of a range of views when allocation decisions are made and communicated. For both genders, distributive and informational justices play a central role in predicting employee outcomes, although the other justice types also have an effect for males. Justice had a diffuse effect for males, but not females.

Predictors of the attitudinal and health outcomes of aged care nurses

This study examines the predictive capacity of the Demand-Control-Support (DCS) model in combination with organizational justice variables on attitudinal- and health-related outcomes for aged care nurses. Multiple regression analyses of aged care nurses (n=168) from a medium to large Australian healthcare organization. The DCS model explains the largest amount of variance across both the attitudinal and health outcomes with 27% of job satisfaction and 44% of organizational commitment, and 33% of psychological distress and 35% of wellbeing, respectively. Additional variance was explained by the justice variables for job satisfaction, organizational commitment and psychological distress. The addition of the organizational justice variables to the DCS model proved to be a valuable step in understanding the work conditions of aged care nurses. The inclusion of curvilinear effects clarified the potentially artefactual nature of certain interaction variables. The results provide practical implications for managers of aged care nurses in developing and maintaining levels of job control, support and fairness, as well as monitoring levels of job demands. The results particularly highlight the importance of the nurses’ supervisor.

Brief anger management programs with offenders : outcomes and predictors of change

Anger management interventions with offenders, particularly violent offenders, are a common form of rehabilitative activity. The rationale for addressing anger problems is clear-cut and there is good evidence that anger management can be effective with some client populations. Information relating to effectiveness with serious offenders, however, is sparse. An intervention study is reported in which offenders receiving anger management were compared with waiting list controls on a range of dependent measures. In general, the degree of pre-treatment/post-treatment change was small and experimental versus control differences were not statistically significant. The degree of improvement was found to be predictable from pre-treatment measures of anger and treatment readiness. Explanations of the low impact of anger management on violent offenders are discussed and recommendations made for improving outcomes.

Supervisors are central to work characteristics affecting nurse outcomes

Purpose: To examine the predictive capability of the demand-control-support (DCS) model, augmented by organizational justice variables, on attitudinal- and health-related outcomes for nurses caring for elderly patients.

Design: The study is based on a cross-sectional survey design and involved 168 nurses working with elderly patients in facilities of a medium to large Australian organization.

Method: Participants were asked to complete a questionnaire consisting of scales designed for measuring independent (e.g., demand, control, support, organizational justice) and dependent (e.g., job satisfaction, organizational commitment, wellbeing and psychological distress) variables. Multiple regression analyses were undertaken to identify significant predictors of the outcome variables.

Findings: The DCS model explains the largest amount of variance across both the attitudinal and health outcomes with 27% of job satisfaction and 49% of organizational commitment, and 33% of psychological distress and 35% of wellbeing, respectively. Additional variance was explained by the justice variables for job satisfaction (5%), organizational commitment (4%), and psychological distress (23%).

Conclusions: Using organizational justice variables to augment the DCS model was valuable in better understanding the work conditions experienced by nurses caring for elderly patients. Inclusion of curvilinear effects added clarity to the potentially artifactual nature of certain interaction variables.

Clinical Relevance: The results indicated practical implications for managers of nurses caring for elderly patients in terms of developing and maintaining levels of job control, support, and fairness, as well as monitoring levels of job demands. The results particularly show the importance of nurses' immediate supervisors.