Chronic disease self-management programs : perspectives on enablers and barriers to GP and patient engagement

Aims & rationale/Objectives : Chronic disease self-management programs (CDSMP) are increasingly being integrated into the health system to improve the care of people with chronic conditions. Despite activity at both policy and program levels, GPs as the 'gatekeepers' to the health system have generally not been well informed or engaged in this process. This study, in collaboration with 3 Victorian Divisions of General Practice, sought both GP and patient perspectives on enablers and barriers to engagement in self-management programs.
Methods : Interviews were conducted with GPs (n=20) and consumers (n=45) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.
Principal findings : Lack of education/information and uncertainty about the effectiveness of self-management programs were key barriers for both GP and patient engagement. Programs that were sustainable and utilised existing community resources were viewed as enablers to increase uptake. GP and patient preferences for disease specific or generic CDSMP differed.
Discussion : Outcomes from the recent Council of Australian Governments' meeting suggest that self-management will be a centerpiece in forthcoming chronic disease initiatives. International evidence has highlighted the need for GP and patient engagement as critical in ensuring the recruitment of a critical mass of individuals to participate in CDSMP to ensure the sustainability of such initiatives. Insight from this study indicates that GPs and patients are not well informed about self-management, have different preferences to current policy trends and identifies several other barriers which need to be addressed if CDSMP are to be successful.
Implications : Identification of barriers and enablers of GP and patient engagement in self-management is essential in shaping current policy initiatives and delivery of future programs. This is supported by international evidence which indicates strongly that GP engagement in particular is crucial to the success of these programs.
Presentation type : Paper

Getting below the surface of the principal recruitment 'crisis' in New Zealand primary schools

Since 1989 in New Zealand, the work of the primary school principal has been transformed in official policy texts from that of leading professional to chief executive officer. Surveys document the changing nature of the role and the workload and other pressures that have resulted, particularly for principals with teaching responsibilities in smaller schools. There is a generally accepted crisis of preparation, recruitment, development and retention. Below the surface, however, are deeper-seated, structural difficulties: women comprise the majority of teachers, yet are a minority of principals and their career advancement is largely limited to small schools and those in poorer socioeconomic areas. This article reviews the situation and examines the reasons why dominant images of the primary school principalship may be both partial and counterproductive.

Embryonic stem cell research: the principal ethical issue-when does life begin?

Embryonic stem cell research is perhaps the most controversial ethical issue of the new century. This is not surprising. It promises unprecedented potential benefits to human health but arguably comes at the expense of violating the most fundamental moral virtue - the right to life. The debate has become increasingly emotive. The Catholic Church has labelled stem cell research as cannibalism.1 This has led perhaps the world's most famous moral philosopher, Peter Singer, to label the Church, which has over a billion followers, as irrelevant.2 The principal purpose of this paper is not to  discuss all of the relevant moral issues in the embryonic stem cell debate. Considerations of space do not permit this and in any event there are  numerous reports which catalogue the relevant issues.3 Rather we attempt  to identify the crux of the issues in the debate. In our view, the main issue is the point at which life commences. We offer some preliminary observations on this matter. This discussion appears in section four. In the next section, we provide a brief  overview of nature and potential benefits of stem cell  research. This is followed by a discussion of the current legal position. In the final section, we offer some concluding remarks including some  suggestions for law reform.

Principal selection: homosocialibility, the search for security and the production of normalized principal identities

Researchers investigating the decline of potential applicants for principalships have demonstrated that teachers perceive there to be a significant problem in current selection procedures. This article reports an investigation in two Australian states into principal selection. Drawing on a corpus of interviews, two case studies and administrative guidelines, we highlight five key problems in the interview process: (1) the dependence of selection panels on a written application; (2) the dilemma of experience versus potential; (3) the covert rule about the appointment of preferred applicants; (4) the quandary of panel competency; and (5) the evidence of inconsistency of decisions. We argue that the selection process amounts to a reproductive technology which, in the quest for certainty and safety, results in particular kinds of people being successful. This amounts we suggest, whether the selection process is managed by progressive or conservative personnel, to a form of homosociability the tendency to select people just like oneself.

Engagement and retention of participants in a physical activity website

Background: Websites have the potential to deliver enhanced versions of targeted and tailored physical activity programs to large numbers of participants. We describe participant engagement and retention with a stage-based physical activity website in a workplace setting. Methods:  We analyzed data from participants in the website condition of a randomized trial designed to test the efficacy of a print- vs. website-delivered intervention. They received four stage-targeted e-mails over 8 weeks, with hyperlinks to the website. Both objective and self-reported website use data were collected and analyzed. Results: Overall, 327 were randomized to the website condition and 250 (76%) completed the follow-up survey. Forty-six percent (n = 152) visited the website over the trial period. A total of 4,114 hits to the website were recorded. Participants who entered the site spent on average 9 min per visit and viewed 18 pages. Website use declined over time; 77% of all visits followed the first e-mail. Conclusions: Limited website engagement, despite the perceived usefulness of the materials, demonstrates possible constraints on the use of e-mails and websites in delivering health behavior change programs. In the often-cluttered information environment of workplaces, issues of engagement and retention in website-delivered programs require attention.

An ecobehavioural analysis of interactive engagement of children with developmental disabilities with their peers in inclusive preschools

Ecobehavioural analysis procedures were used to examine the interactive engagement of children with developmental disabilities due to Down syndrome who attended inclusive preschools for 2 years. Compared with typical children, the children with disabilities displayed infrequent interactions with peers for the duration of the study. For the children with disabilities, interactive engagement was largely unrelated to the characteristics of class activities, while typical children responded positively to activities expected to promote peer interaction. The results are discussed in terms of the inadequacy of informal strategies commonly applied in inclusive preschool settings to promote interactive engagement in children with disabilities.

Cross cultural engagement: teaching African music to Australian students

This paper reports on research that examined the effectiveness of introducing rhythmic concepts through an unfamiliar musical genre to Australian generalist prim my teacher education students. The genre selected was African music, in particular action songs, dance and instrumental improvisation. The methodologies of Orff, Kodaly and Dalcroze were taught through the repertoire of African music in order to foster a closer relationship between pedagogical theory and practice and to teach rhythm through cross-cultural engagement. Through analyses of questionnaire and interview data, it was demonstrated that African music had a positive effect on students' conjidence as non-specialists music teachers and enhanced their skills in staff, sol-fa, hand notation and performance. Also students were not only highly motivated to engage with this new musical genre, but also gained an increased understanding of African culture. It is argued that African music was perceived by students not so much as a "novelty", but as a source of genuine motivation, interest and enjoyment. Its potential for extending student understanding of rhythm as well as taking a significant step towards internationalizing the curriculum for a cohort of predominantly Anglo-Celtic, pre-service teachers is also explored.

Stakeholder engagement strategies : possibilities for the Internet?

The Internet offers companies new opportunities for engaging with stakeholders. This research examines the extent to which companies in Australia, Germany and the UK make use of their web sites to communicate both to and with their stakeholders. Particular attention is paid to the communication of ethical, social and environmental information on corporate web sites. Through a postal questionnaire and interviews, the research examines the drivers for web based reporting, the importance attached to stakeholder communication, complementary means of reporting to stakeholders and the perceived advantages and disadvantages of the web as a communication medium. Despite the technological capabilities of web sites as communication media, we found the main purpose of developing corporate web sites was to raise corporate awareness and improve corporate image and that this is a negative force in the further development of corporate web sites for reporting ethical, social and environmental issues and using web technologies to engage with a broad range of stakeholders.

Time to make a difference: using action research to foster student engagement

This paper reports on a project, funded by the Victorian Department of Education and Training (Australia), undertaken to explore the capacity for teachers to develop innovative teaching and learning strategies aimed at improving the educational experiences of students in the middle years. Central to this charter was the need for local schools to form Clusters, share ideas and develop strategies designed to improve student engagement and connection. In forming the Buxton (pseudonym) Cluster, four schools came together to declare their shared interest in improving student connection through the teaching and learning of mathematics. The 22 teachers involved in the project shared a broad concern that the traditional pedagogies built up around the maths discipline were contributing to the wider level of student disconnection observed in the middle years. In thinking about change, the group were attracted to constructivist approaches to pedagogy in which learning opportunities and tasks are varied sufficiently to appeal to the various learning styles and aptitudes of learners. Favouring an action research framework teachers involved in the project embarked on the implementation of pedagogic reforms aimed at improving levels of student engagement.

Leveraging the Commonwealth Games in Melbourne for community engagement: an examination of Equal First and the Adopt-a-Second-Team program

Event leverage provides information about what outcomes occur as a result of an event. Unlike event impact studies, event leverage analysis identifies why particular outcomes occurred, and the processes that can be used to optimise desired event outcomes. While research has been directed towards understanding how events can be leveraged to provide optimal economic outcomes for host communities, there is little research that examines social leverage within the context of events. The research presented in this paper is part of a larger study that investigated social leverage within the context of the 2006 Commonwealth Games, held in Melbourne, Australia. This paper presents preliminary results relating to two Victorian regions with regard to one the over-arching social policy, Equal First, and a subsidiary program called, Adopt-a-Second-Team. Participant observations and stakeholder interviews were employed to explore the development, operationalisation, implementation and outcomes of Equal First and Adopt-a-Second-Team. The results suggest that although each region achieved outcomes that were consistent with the directions of Equal First, each implemented the Adopt-a-Second-Team differently. The two case studies presented in this paper highlight that the model of implementation developed by the City of Port Phillip may provide a benchmark in social leverage of events. Implications for leveraging social impacts and managing social legacies of events through an approach that includes consideration of policy development and operationalisation from the event organising body and program implementation from the perspective of local community event organisers are discussed.

High stakes principalship-sleepless nights, heart attacks and sudden death accountabilities: reading media representations of the United States principal shortage

The possible shortage of applicants for principal positions is news in both Australia and abroad. We subject a corpus of predominantly United states (US) news articles to deconstructive narrative analysis and find that the dominant media representation of principals' work is one of long hours Iow salary high stress and sudden death from high stakes accountabilities. However, reported US policy interventions focus predominantly on professional development for aspirants. We note that this will be insufficient to reverse the lack of applications and suggest that the dominant media picture of completely unattractive principals work, meant to leverage a policy solution, will perhaps paradoxically perpetuate the problem. The dominant media picture is also curiously at odds with research that reports high job satisfaction among principals. We suggest that there is a binary of victim and saviour principal in both media and policy which prevents some strategic re-thinking about how the principalship might be different.

Informed principal, moral hazard, and the value of a more informative technology

We analyze a principal-agent model with moral hazard in which the principal has private information about the technology. We characterize Perfect Bayesian Equilibria of the contracting game that possess the following properties: (i) a principal with a more informative technology ends up earning less profits than a principal with a less informative one does; (ii) compared to the complete information case, the actions implemented by the privately informed principal can be distorted; (iii) the agent can end up being better off when the principal has private information.

Studying and working : a national study of student finances and student engagement

A key determinant of the new relationship between students and universities in Australia is the changing nature of higher education funding arrangements and the shift towards “user-pays”. In 2007, the Centre for the Study of Higher Education (CSHE) completed a commissioned national study, Australian University Student Finances 2006: Final Report of a National Survey of Students in Public Universities. Drawing on the project report, this article discusses selected findings relating to student expectations and engagement to present a worrying picture of financial duress and involvement in paid work and examines the possible effects on the quality of higher education.