Indigenous Australian accountants : why so few? A historical and cultural perspective

At a time when there is a growing call for Indigenous Australians to become self-sustainable and self-governing (Smith, 2002, Dodson & Smith, 2003, Martin, 2003) the very small number of Indigenous Australians in the accounting profession raises the question "why so few?" The number of Certified Practicing Accountants and Chartered Accountants of Australia is approximately 150,000 and to date only nine (9) qualified Indigenous Australian accountants have been located, representing 0.006%. This paper analyses the barriers faced by Indigenous Australians within the context of theories of cultral identity and colonisation of Australia. These theories are propounded as a means of exploring why there are so few Indigenous Australians represented in the accounting profession. An overview of colonial rule implemented by the British government from settlement of Australia in 1788, through to modern day Australia will be forwarded in an effort to draw out the implication of colonial rule on the development of Indigenous Australians whilst paying particular attention to the cultural identity of Indigenous Australians and the influence this has had on their career choices.

Does self-management lead to sustainable health benefits in people with arthritis? A 2-year transition study of 452 Australians.

Objective: To evaluate the Arthritis Self-Management Course (ASMC) when applied in a nationwide context.

Methods: Four hundred fifty-two people who participated in the ASMC across Australian states took part in a longitudinal followup study. ASMC is a 6 week, 2 h group educational program designed to assist people with chronic illness to better manage their condition. Measures of program effectiveness included health status and service utilization. Data were collected on 3 occasions: before intervention (baseline) and 6 months and 2 years after the program.

Results: Several indicators of health status showed improvement at 6 months following the ASMC. These included reduction in pain (4%; p < 0.001), fatigue (3%; p < 0.01), and health distress (12%; p < 0.001) as well as increase in self-efficacy (6%; p < 0.001). Increased self-efficacy was a significant predictor of positive change in health status. Health-related behaviors such as aerobic exercise also increased, with the proportion of people who did little or no exercise decreasing by up to 8%. These changes were sustained at 2 years. There was an increase in use of analgesics at 6 months and an increase in use of nonsteroidal antiinflammatory drugs at 2 years. No changes in healthcare utilization (physician visits, allied health visits, and hospitalizations) were observed.

Conclusion: The ASMC is a widely applied program in which participants benefit through a reduction in pain, fatigue, and health distress. Although the absolute changes in health status are small, the low cost and wide application of the intervention suggests the program may have a substantial public health effect.

Self-reflective practice in sustainable design

A range of personal self-transformation strategies that rest on empathy and certainty were identified as critical to sustainable design practice. The dynamic influences design as both praxis and a decision making process, yet praxis, as the intuitive dimension of design is overlooked for its strategic importance to this dynamic.

Value-change and self-reflective practice in ecologically sustainable design

Ecologically sustainable design is a transformative design paradigm based on the theory of interdependence. This theory requires that the transformative agenda of design is holistic in practice. In effect, the requirement is for value-change on the part of the designer along with transformation of the built environment. This paper, based on recently completed research into design practice, argues that value-change rests on certainties that are drawn on intuitively while designing, and that this intuitive process is characteristic of design as praxis. It is further argued that design, as praxis, requires a phenomenological approach for inculcating value-change. A phenomenological approach relies on self-reflective practices exemplified by meditation and yoga that can focus on the designer’s ethical know-how. A model for this approach to value-change, the biopsychosocial approach, already exists within clinical medicine. This paper presents findings from interviews with key architects practising self-reflection and/or ecologically sustainable design. These highlight the premium placed by these architects on both certainty and empathy, and how these values influence design as praxis. Formalising techniques for closer scrutiny of these values will highlight design as praxis. Doing so will critically strengthen ecologically sustainable design as holistic, transformative practice.

Sustainable consumption as a means to self-realization: a Hindu perspective on when enough is enough

In this paper, I investigate the religious notion of self-realization or self-actualization in the context of sustainability, and argue that sustainability is the means to this end. I am particularly interested in Hindu perspectives on self-realization or the Purusharthas. The Purusharthas provide an interesting sustainability critique because they consider the satisfaction of material want as an important step to self-actualization; the reconciliation of want and need is a fundamental sustainability tension. The issue of growing want is doubtless an important one, given the rapidly growing middle classes in the developing world that aspire to Western material dreams, as illustrated by the case of Delhi. The Purusharthas may be seen to give consumption legitimacy; however, I argue that it is the selective understanding and institutionalization of the religious message that causes the sustainability problem. Viewed in their entirety, the Purusharthas provide the correct prescriptions for the sustainable enjoyment of want, and take the adherent beyond sustainability into greater transcendence or self- awareness.

Chronic disease self-management in Aboriginal communities : towards a sustainable program of care in rural communities

The Chronic Disease Self-Management (CDSM) strategy for Aboriginal patients on Eyre Peninsula, South Australia, was designed to develop and trial new program tools and processes for goal setting, behaviour change and self-management for Aboriginal people with diabetes. The project was established as a one-year demonstration project to test and trial a range of CDSM processes and procedures within Aboriginal communities and not as a formal research project. Over a one-year period, 60 Aboriginal people with type-2 diabetes in two remote regional centres participated in the pilot program. This represents around 25% of the known Aboriginal diabetic population in these sites. The project included training for four Aboriginal Health Workers in goal setting and self-management strategies in preparation for them to run the program. Patients completed a Diabetes Assessment Tool, a Quality of Life Questionnaire (SF12), the Work and Social Adjustment Scale (WASAS) at 0, 6 and 12 months. The evaluation tools were assessed and revised by consumers and health professionals during the trial to determine the most functional and acceptable processes for Aboriginal patients. Some limited biomedical data were also recorded although this was not the principal purpose of the project. Initial results from the COAG coordinated care trial in Eyre suggest that goal setting and monitoring processes, when modified to be culturally inclusive of Aboriginal people, can be effective strategies for improving self-management skills and health-related behaviours of patients with chronic illness. The CDSM pilot study in Aboriginal communities has led to further refinement of the tools and processes used in chronic illness self-management programs for Aboriginal people and to greater acceptance of these processes in the communities involved. Participation in a diabetes self-management program run by Aboriginal Health Workers assists patients to identify and understand their health problems and develop condition management goals and patient-centred solutions that can lead to improved health and wellbeing for participants. While the development of self-management tools and strategies led to some early indications of improvements in patient participation and resultant health outcomes, the pilot program and the refinement of new assessment tools used to assist this process has been the significant outcome of the project. The CDSM process described here is a valuable strategy for educating and supporting people with chronic conditions and in gaining their participation in programs designed to improve the way they manage their illness. Such work, and the subsequent health outcome research planned for rural regions, will contribute to the development of more comprehensive CDSM programs for Aboriginal communities generally.

The effect of training in reduced energy density eating and food self-monitoring accuracy on weight loss maintenance

Background:
Failure to maintain weight losses in lifestyle change programs continues to be a major problem and warrants investigation of innovative approaches to weight control.
Objective:
The goal of this study was to compare two novel group interventions, both aimed at improving weight loss maintenance, with a control group.
Methods and Procedures:
A total of 103 women lost weight on a meal replacement–supplemented diet and were then randomized to one of three conditions for the 14-week maintenance phase: cognitive-behavioral treatment (CBT); CBT with an enhanced food monitoring accuracy (EFMA) program; or these two interventions plus a reduced energy density eating (REDE) program. Assessments were conducted periodically through an 18-month postintervention. Outcome measures included weight and self-reported dietary intake. Data were analyzed using completers only as well as baseline-carried-forward imputation.
Results:
Participants lost an average of 7.6 plusminus 2.6 kg during the weight loss phase and 1.8 plusminus 2.3 kg during the maintenance phase. Results do not suggest that the EFMA intervention was successful in improving food monitoring accuracy. The REDE group decreased the energy density (ED) of their diets more so than the other two groups. However, neither the REDE nor the EFMA condition showed any advantage in weight loss maintenance. All groups regained weight between 6- and 18-month follow-ups.
Discussion:
Although no incremental weight maintenance benefit was observed in the EFMA or EFMA + REDE groups, the improvement in the ED of the REDE group's diet, if shown to be sustainable in future studies, could have weight maintenance benefits.

Corporate sustainability : greenwash or a path to sustainable capitalism?

The problems of unsustainable development and the increased-awareness of corporate power in the global era have contributed to an agenda of corporate citizenship. This thesis explores the meanings and practices that fall under the banner of the triple bottom line of corporate citizenship through forty-two in-depth interviews with representatives from the corporate sector and NGO sector (including trade unions) in Australia. This purposive sample includes a specific range of corporate industries and NGO types, all of which have involvement with various areas of sustainability. Interviewees described their feelings and experiences in relation to the concept of the triple bottom line, the potential and limitations of this type of sustainability and the purpose and impacts of partnerships between NGOs and the corporate sector. On the basis of this research, this thesis argues that corporate citizenship is at best, a set of initiatives for making minor adjustments to the way companies perform their day-to-day operations and at worst, a program for improving corporate image rather than performance and for shifting the agenda of sustainable development toward corporate interests. While radical steps are required to achieve a sustainable society and environment, the terms of corporate citizenship offer very limited opportunities for change. The self-regulatory and market based model of citizenship does not challenge the impact of consumerism or the legitimacy of particular industry types and their products, except where threats are perceived to the longevity of the companies involved. Furthermore, while the exploitation of the environment and society has occurred as a result of corporate self-interest, corporate citizenship is justified on the same basis. The self-interest rationale and the tyranny of the economic bottom line in particular, substantially limit the fields of responsibility that can be included in the citizenship paradigm. While there are undoubtedly some well-intentioned corporate representatives who are working toward attaining a more sustainable corporate culture, the discourse is primarily used to shift the sustainable development agenda toward corporate paradigms and interests.

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

To integrate or not to integrate? Future considerations for chronic disease self-management programs in the health care system

Objective: The growing burden of chronic disease and the increasing realisation that the current health system is ill equipped to deal with this trend has resulted in a health policy shift away from the traditional medical model to a more patient centred approach. As such, chronic disease self-management programs (CDSMP) have emerged as a potentially important component within this approach. Policy and program trends at the international level highlight several critical factors that need to be considered by governments and health care providers alike if CDSMP are to be integrated within the broader health system. This study reviewed international and local policy literature and sought perspectives from key stakeholders to determine the value and potential for integrating a generic group-based CDSMP into the care continuum.
Method: Prominent self-management policies were identified through a comprehensive literature search. Interviews were conducted with policy makers across Australia (n=20), health practitioners (n=20) and consumers (n=42) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.
Results: Whilst CDSMP were viewed as having significant potential to be integrated into the health sector it was identified that the delivery and content of CDSMP needs to be flexible in order to address the needs of people across the disease, age and care continuums. Critical issues to be addressed if CDSMP are to be successfully integrated include increasing the profile of self-management; actively engaging and training health practitioners in self-management and overcoming system barriers such as lack of integrated referral pathways and networks.
Discussion: Policy directions at the national level suggest that self-management will be a centrepiece in forthcoming chronic disease initiatives. International evidence has highlighted the requirement for a ‘suite’ of programs to adequately cater to different stages of the disease continuum, age groups, ethnic backgrounds and sociogeographical areas. Furthermore engagement with key stakeholders (particularly GPs) is identified as critical to ensure the successful integration of CDSMP into the health system.
Conclusion: Evidence suggests that CDSMP is an important facet in improving care of people with chronic conditions. Findings from this study suggest that current infrastructure and policy direction, which have been found to be critical factors in facilitating integration of CDSMP into the health sector, are either absent or inadequate in Victoria. CDSMPs are currently lacking a sustainable workforce, referral infrastructure and specific policy. Such factors need to be addressed before the integration of CDSMP can be considered across the healthcare continuum in Victoria.

A parallel-group, randomised controlled trial of a multimedia, self-directed, coping skills training intervention for patients with cancer and their partners: design and rationale

Introduction:

Sustainable assessment revisited

Sustainable assessment has been proposed as an idea that focused on the contribution of assessment to learning beyond the timescale of a given course. It was identified as an assessment that meets the needs of the present in terms of the demands of formative and summative assessment, but which also prepares students to meet their own future learning needs. This paper reviews the value of such a notion for assessment; how it has been taken up over the past 15 years in higher education and why it might still be needed. It identifies how it has been a successful intervention in assessment discourse. It explores what more is needed to locate assessment as an intervention to focus on learning for the longer term. It shows how sustainable assessment can help bridge the gap between assessment and learning, and link to ideas such as self-regulation, students’ making judgements about their own work and course-wide assessment.