Internet content regulation, public drug websites and the growth in hidden Internet services

Governments have traditionally censored drug-related information, both in traditional media and, in recent years, in online media. We explore Internet content regulation from a drug-policy perspective by describing the likely impacts of censoring drug websites and the parallel growth in hidden Internet services. Australia proposes a compulsory Internet filtering regime that would block websites that ‘depict, express or otherwise deal with matters of… drug misuse or addiction’ and/or ‘promote, incite or instruct in matters of crime’. In this article, we present findings from a mixed-methods study of online drug discussion. Our research found that websites dealing with drugs, that would likely be blocked by the filter, in fact contributed positively to harm reduction. Such sites helped people access more comprehensive and relevant information than was available elsewhere. Blocking these websites would likely drive drug discussion underground at a time when corporate-controlled ‘walled gardens’ (e.g. Facebook) and proprietary operating systems on mobile devices may also limit open drug discussion. At the same time, hidden Internet services, such as Silk Road, have emerged that are not affected by Internet filtering. The inability for any government to regulate Tor websites and the crypto-currency Bitcoin poses a unique challenge to drug prohibition policies.
Read More: http://informahealthcare.com/doi/full/10.3109/09687637.2012.745828

Reasoned versus reactive prediction of behaviour: a meta-analysis of the prototype willingness model

The prototype willingness model (PWM) was designed to extend expectancy-value models of health behaviour by also including a heuristic, or social reactive pathway, to better explain health-risk behaviours in adolescents and young adults. The pathway includes prototype, i.e., images of a typical person who engages in a behaviour, and willingness to engage in behaviour. The current study describes a meta-analysis of predictive research using the PWM and explores the role of the heuristic pathway and intentions in predicting behaviour. Eighty-one studies met inclusion criteria. Overall, the PWM was supported and explained 20.5% of the variance in behaviour. Willingness explained 4.9% of the variance in behaviour over and above intention, although intention tended to be more strongly related to behaviour than was willingness. The strength of the PWM relationships tended to vary according to the behaviour being tested, with alcohol consumption being the behaviour best explained. Age was also an important moderator, and, as expected, PWM behaviour was best accounted for within adolescent samples. Results were heterogeneous even after moderators were taken into consideration. This meta-analysis provides support for the PWM and may be used to inform future interventions that can be tailored for at-risk populations.

Transitions in reflective practice: exploring student development and preferred methods of engagement

Aim: Health-care professional students are required to demonstrate their reflective practice skills during their degree training programme. Online and digital technologies are increasingly being used to support this skill development. Our study aimed to explore whether different technology-based methods supported student growth and skill development in reflective practice at separate developmental time points (novice and competent). Methods: Third- (n = 23) and fourth-year undergraduate dietetic students (n = 22) from a single university were cross-sectionally surveyed via an online anonymous questionnaire at the end of the academic year. The mixed methods survey of 37 questions investigated the student experience of different reflective practice activities, their effect on a student's ability to self-reflect and whether using them aided a student's perceived transition towards becoming a competent dietitian. The data analysis included brief thematic enquiry, descriptive and independent t-test statistical examination. Results: Differences emerged in the way students engaged in reflection over time. Fourth-year students preferred to use more independent methods such as e-journaling (fourth- vs third-year students, P = 0.003) and engaged in reflection for reasons outside assessment (fourth- vs third-years, P = 0.027). Fourth-year students also identified fewer negative barriers to participating in reflection and reported being comfortable engaging in reflective practice. Conclusions: Overall, offering students a range of ways to engage in reflective practice over time supported their understanding and increased confidence in their reflective practice skills, thus potentially enabling a smoother transition into their profession where reflective practice is an essential and autonomous skill. © 2014 Dietitians Association of Australia.

Current state of China tourism research

Along with the tremendous growth of tourism development in China after its successful hosting of two international mega-events (i.e. the 2010 Shanghai World Expo and the 2010 Guangzhou Asian Games), a modest body of academic research on tourism in China has been developed since the start of the second decade of the new millennium. To supplement the continuous development of China's tourism industry, this study presents a review of 147 research articles from tourism journals during the period 2010-2012. Through content analysis, the empirical findings indicate that tourist behaviour and experience was the most researched theme, followed by culture and heritage studies. The trend of research collaboration, particularly international collaboration, was evident among the analysed studies. This study also presents the diversity in recent research in the realm of tourism in China in terms of research context, geographical coverage, data collection and analysis method, and institutional contribution.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting

 Background: The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.
Methods: The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health.
Results: In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making.
Conclusions: This study makes an important contribution to understanding how evidence is used within the public health LG context.

Qualitative synthesis and systematic review in health professions education

Context  Formal qualitative synthesis is the process of pooling qualitative and mixed-method research data, and then drawing conclusions regarding the collective meaning of the research. Qualitative synthesis is regularly used within systematic reviews in the health professions literature, although such use has been heavily debated in the general literature. This controversy arises in part from the inherent tensions found when generalisations are derived from in-depth studies that are heavily context-dependent.Methods  We explore three representative qualitative synthesis methodologies: thematic analysis; meta-ethnography, and realist synthesis. These can be understood across two dimensions: integrative to interpretative, and idealist to realist. Three examples are used to illustrate the relative strengths and limitations of these approaches.Discussion  Against a backdrop of controversy and diverse methodologies, readers must take a critical stand when reading literature reviews that use qualitative synthesis to derive their findings. We argue that notions of qualitative rigour such as transparency and acknowledgment of the researchers’ stance should be applied to qualitative synthesis.

Cancer patients' perceptions of the barriers and facilitators to patient participation in symptom management during an episode of admission

BACKGROUND:: Symptoms by definition are subjective, and patients' role in their assessment and management will impact on patient outcomes; thus, symptom management is an area of acute care practice where facilitation of patient participation is vital if quality outcomes are to be achieved. OBJECTIVE:: This study originated from a large multimethod research program exploring patient participation in symptom management in an acute oncology setting. The purpose of this article is to explore patients' perceptions of the barriers and facilitators to participating in their symptom management during an episode of admission to an acute oncology ward and the relationships between these perceptions and patients' preference for participation. METHODS:: One hundred seventy-one cancer inpatients consented and completed an interview-administered questionnaire. Patients' preference for participation was measured using the Control Preference Scale. Responses to open-ended survey questions were evaluated using content analysis. RESULTS:: Ten categories were identified in the analyses of patient perceptions of the barriers and facilitators to participating in care decisions relating to their symptoms. Patients, irrespective of their Control Preference, reported multiple barriers and facilitators to participating in their symptom management. CONCLUSIONS:: Patients overall perceived information as the most critical component of participation. Irrespective of patients' preference for participation, there were similarities in the barriers and facilitators to the operationalization of participation in the acute care setting reported. IMPLICATIONS FOR PRACTICE:: Understanding patient perceptions of barriers and facilitators of participating in symptom management has provided important insights into person and system factors in the acute care sector impacting quality patient symptom outcomes.

Ongoing challenges responding to behavioural and psychological symptoms of dementia

BACKGROUND: Mid- to late-stage dementia is often characterized by behavioural and psychological symptoms, including, but not limited to physical and verbal aggression. INTRODUCTION: Although there is a considerable research about the prevalence, aetiology, and management of behavioural and psychological symptoms of dementia, there is limited research about the experience of caring for people with such symptoms in long-term aged care facilities. AIM: The aims of the study were to describe: (i) nurses' experiences of caring for people with behavioural and psychological symptoms of dementia in long-term aged care facilities, and (ii) strategies nurses used to deal with these symptoms. METHODS: A qualitative exploratory and descriptive design, involving focus group interviews with 30 nurses from three long-term aged care units in Australia. The transcripts were analysed using inductive content analysis. RESULTS: The findings revealed five interrelated themes: (i) working under difficult conditions, (ii) behavioural and psychological symptoms of dementia: an everyday encounter, (iii) making sense of behavioural and psychological symptoms of dementia, (iv) attempting to manage behavioural and psychological symptoms of dementia, and (v) feeling undervalued. CONCLUSION: This study highlighted the difficult conditions under which nurses worked and the complexity of caring for individuals who have behavioural and psychological symptoms of dementia. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Organizational efforts to enhance the quality of care for individuals with behavioural and psychological symptoms of dementia in long-term aged care facilities should extend beyond staff education to heed nurses' concerns about organizational barriers to interpersonal care.

Patients' perceptions of participation in nursing care on medical wards

BACKGROUND: Patient participation benefits the patient and is a core concept of patient-centred care. Patients believe in their ability to prevent errors; thus, they may play a vital role in combating adverse event rates in hospitals. AIMS AND OBJECTIVES: To explore hospitalised medical patients' perceptions of participating in nursing care, including the barriers and facilitators for this activity. RESEARCH METHODS: This interpretive study was conducted on four medical wards, in two hospitals. Purposeful maximum variation sampling was operationalised to recruit patients that differed in areas such as age, gender and mobility status. In-depth semi-structured audiotaped interviews were undertaken and analysed using inductive content analysis. RESULTS: Twenty patients participated in the study. Four categories were uncovered in the data. First, valuing participation showed patients' willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients' knowledge was built and shared with health professionals. Third, on the lookout was a type of participation where patients monitored their care, showing an attentive approach towards their own safety. Fourth, power imbalance was characterised by patients feeling their opportunities for participation were restricted. CONCLUSIONS: Patients were motivated to participate and valued participation. Cultivating this motivation may be crucial to patient empowerment and practices of safety monitoring, a fundamental strategy to addressing patient safety issues in hospitals. Engaging nurse-patient relationships, inclusive of knowledge sharing, is required in practice to empower patients to participate. Educating patients on the consequences of non-participation may motivate them, while nurses may benefit from training on patient-centred approaches. Future research should address ways to increase patient motivation and opportunities to participate.

A tale of two events? Media analysis of the Melbourne 2008 Homeless World Cup

In 2008, Melbourne became the first Australian city to host the Homeless World Cup (HWC), an annual international sporting event that aims to raise the profile of homelessness and social marginalisation. This article first examines relevant print media articles relating to the HWC by identifying key themes through thematic and content analysis. It then examines the polarised reporting of the HWC by two print media outlets, The Age and the Herald Sun, and argues that each outlet's coverage served to reinforce its own established position on the key political and social issues, in this instance homelessness, asylum seeking and immigration. The divergence in the discourses constructed in each paper provides a demonstrative example of the capacity of the media to use events of all sorts to consolidate their political and commercial positions.

Change in schools it’s more like sort of turning an oil tanker : creating readiness for health promoting schools

Purpose – The purpose of this paper is to add to the evidence of best practice in the implementation of the Health Promoting Schools (HPS) framework by examining the process of creating readiness for change in a large international school in South-East Asia. Using a settings-based approach and guided by readiness for change theory the data collected reflects which factors were most influential in the decision of the leadership team (LT) to adopt a comprehensive HPS model. It follows the process of creating readiness in the early stages of adopting a HPS approach and captures the critical factors effecting leader’s beliefs and support for the program. Design/methodology/approach – This research is a case study of a large pre-K-12 international school in South-East Asia with over 1,800 students. A mixed methods qualitative approach is used including semi-structured interviews and document analysis. The participants are the 12 members of the LT. Findings – Readiness for change was established in the LT who adopted a HPS approach. That is, they adopted a comprehensive model to address health-related priorities in the school and changed the school’s mission and accountability processes to specifically include health. Uncovering the reasons why the LT supported this change was the primary focus of this research. Building the motivation to change involved establishing a number of key beliefs three of which were influential in bringing about readiness for change in this case study. These included the belief that leadership support existed for the proposed change, a belief that there was a need for change with a clear discrepancy in the present and preferred operations in relation to addressing the health issues of the school and the belief that HPS was the appropriate solution to address this discrepancy. Research limitations/implications – Adopting a HPS approach is the first phase of implementation. Long-term research may show if the integrity of the chosen model is maintained as implementation continues. The belief construct of valence, that is, the belief that the change will benefit the change recipient, was not reliably assessed in this research. Further research needs to be conducted to understand how this construct is interpreted in the school setting. The belief construct of valence was not reliably assessed in this research. Further research needs to be done to understand how this construct fits in the school setting. Practical implications – This paper provides a promising example of how health can be integrated into the school’s Mission and Strategic Learning Plan. The example presented here may provide strategies for others working in the field of HPS. Originality/value – Creating readiness is an often over-looked stage of building sustainable change. International schools cater to more than three million students are a rarely researched in regards to health education. It is predicted that the numbers of students in international schools will grow to more than six million in the next ten years.

Eat, drink and gamble: marketing messages about 'risky' products in an Australian major sporting series

BACKGROUND: To investigate the alcohol, gambling, and unhealthy food marketing strategies during a nationally televised, free to air, sporting series in Australia. METHODS/APPROACH: Using the Australian National Rugby League 2012 State of Origin three-game series, we conducted a mixed methods content analysis of the frequency, duration, placement and content of advertising strategies, comparing these strategies both within and across the three games. RESULTS: There were a total of 4445 episodes (mean = 1481.67, SD = 336.58), and 233.23 minutes (mean = 77.74, SD = 7.31) of marketing for alcoholic beverages, gambling products and unhealthy foods and non-alcoholic beverages during the 360 minutes of televised coverage of the three State of Origin 2012 games. This included an average per game of 1354 episodes (SD = 368.79) and 66.29 minutes (SD = 7.62) of alcohol marketing; 110.67 episodes (SD = 43.89), and 8.72 minutes (SD = 1.29) of gambling marketing; and 17 episodes (SD = 7.55), and 2.74 minutes (SD = 0.78) of unhealthy food and beverage marketing. Content analysis revealed that there was a considerable embedding of product marketing within the match play, including within match commentary, sporting equipment, and special replays. CONCLUSIONS: Sport is increasingly used as a vehicle for the promotion of range of 'risky consumption' products. This study raises important ethical and health policy questions about the extent and impact of saturation and incidental marketing strategies on health and wellbeing, the transparency of embedded marketing strategies, and how these strategies may influence product consumption.

Nurses' views of patient participation in nursing care

AIMS: To explore nurses' views of patient participation in nursing care on medical wards. BACKGROUND: Nurses have frequent contact with patients, highlighting their potential role in enabling patient participation. However, some nurses' actions and attitudes act as barriers, failing to achieve core requirements of patient participation. Discovering nurses' views may assist in developing strategies to encourage patient participation in hospitals. DESIGN: Interpretive study. METHODS: Twenty nurses were recruited from four medical wards, located in two Australian hospitals. In-depth semi-structured interviews were conducted between November 2013-March 2014 and analysed using content analysis. FINDINGS: Five categories emerged from the nurses' views. The first category, acknowledging patients as partners, showed nurses respected patients as legitimate participants. In the second category, managing risk, nurses emphasized the need to monitor participation to ensure rules and patient safety were maintained. Enabling participation was the third category, which demonstrated nurses' strategies that enhanced patients' participation. The fourth category was hindering participation; encapsulating nurses' difficulty in engaging patients with certain characteristics. In the final category, realizing participation, nurses believed patients could be involved in physical activities or clinical communication. CONCLUSION: Nurses have a crucial role in promoting patient participation. Through acknowledging and enabling participation, nurses may facilitate patient participation in a range of nursing activities. The nurse's role in enacting participation is complex, having to accommodate each patient's risks and characteristics, highlighting the need for good assessment skills. Education, policy and research strategies are essential to foster nurses' pivotal role in patient participation.

Lessons in building capacity in sexuality education using the health promoting school framework: from planning to implementation

Purpose – The health promoting school model is rarely implemented in relation to sexuality education. This paper reports on data collected as part of a five-year project designed to implement a health promoting and whole school approach to sexuality education in a five campus year 1-12 college in regional Victoria, Australia. Using a community engagement focus involving local and regional stakeholders and with a strong research into practice component, the project is primarily concerned with questions of capacity building, impact and sustainability as part of whole school change. The paper aims to discuss this issue. Design/methodology/approach – Using an action research design, data were collected from parents, students, teachers and key community stakeholders using a mixed methods approach involving surveys, interviews, document analysis and participant observation. Findings – Sexuality education has become a key school policy and has been implemented from years 1 to 9. Teachers and key support staff have engaged in professional learning, a mentor program has been set up, a community engagement/parent liaison position has been created, and parent forums have been conducted on all five campuses. Research limitations/implications – The translation of research into practice can be judged by the impact it has on teacher capacity and the students’ experience. Classroom observation and more longitudinal research would shed light on whether the espoused changes are happening in reality. Originality/value – This paper reports on lessons learned and the key enabling factors that have built capacity to ensure that sexuality education within a health promoting, whole school approach will remain sustainable into the future. These findings will be relevant to others interested in building capacity in sexuality education and health promotion more generally.

Selecting, training and assessing new general practice community teachers in UK medical schools

Background: Standards for undergraduate medical education in the UK, published in Tomorrow’s Doctors, include the criterion ‘everyone involved in educating medical students will be appropriately selected, trained, supported and appraised’. Aims: To establish how new general practice (GP) community teachers of medical students are selected, initially trained and assessed by UK medical schools and establish the extent to which Tomorrow’s Doctors standards are being met. Method: A mixed-methods study with questionnaire data collected from 24 lead GPs at UK medical schools, 23 new GP teachers from two medical schools plus a semi-structured telephone interview with two GP leads. Quantitative data were analysed descriptively and qualitative data were analysed informed by framework analysis. Results: GP teachers’ selection is non-standardised. One hundred per cent of GP leads provide initial training courses for new GP teachers; 50% are mandatory. The content and length of courses varies. All GP leads use student feedback to assess teaching, but other required methods (peer review and patient feedback) are not universally used. Conclusions: To meet General Medical Council standards, medical schools need to include equality and diversity in initial training and use more than one method to assess new GP teachers. Wider debate about the selection, training and assessment of new GP teachers is needed to agree minimum standards.