Parent-proxy and child self-reported health-related quality of life: using qualitative methods to explain the discordance

Background: Although parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL.

Method: The sample consisted of 15 parent–child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently.

Results: There was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly.

Discussion: This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.

Spontaneous comparisons with others in gay men´s judgements of HIV risk

In studies on ‘unrealistic optimism’ (UO), when people are asked questions designed to make them compare their risk of experiencing an undesirable event with that of the average person, they tend to respond that their risk is lower. This study investigated whether comparisons of own and others’ risk also occur spontaneously, unprovoked by such questions. Gay men uninfected with HIV (n¼50) were asked to think aloud about their risk of becoming infected; their comments were audiotaped and analysed. Over half the men added comments relating to others’ risk. The phrasing of these comments and the reported basis for them are described. The men represented others’ risk as relatively high, own risk as relatively low. In the case of onethird of the men, it seemed possible to be confident that a comparison was being made. The findings suggest that comparisons of own and others’ risk do occur spontaneously and that, while the judgements made in UO studies do not capture all the characteristics of those made spontaneously, they resemble them in important ways.

Using protocol analysis to explore the creative requirements engineering process

Protocol analysis is an empirical method applied by researchers in cognitive psychology and behavioural analysis. Protocol analysis can be used to collect, document and analyse thought processes by an individual problem solver. In general, research subjects are asked to think aloud when performing a given task. Their verbal reports are transcribed and represent a sequence of their thoughts and cognitive activities. These verbal reports are analysed to identify relevant segments of cognitive behaviours by the research subjects. The analysis results may be cross-examined (or validated through retrospective interviews with the research subjects). This paper offers a critical analysis of this research method, its approaches to data collection and analysis, strengths and limitations, and discusses its use in information systems research. The aim is to explore the use of protocol analysis in studying the creative requirements engineering process.

Developing a primary care patient measure of safety (PC PMOS): a modified Delphi process and face validity testing

BACKGROUND: Patients are a valuable source of information about ways to prevent harm in primary care and are in a unique position to provide feedback about the factors that contribute to safety incidents. Unlike in the hospital setting, there are currently no tools that allow the systematic capture of this information from patients. The aim of this study was to develop a quantitative primary care patient measure of safety (PC PMOS). METHODS: A two-stage approach was undertaken to develop questionnaire domains and items. Stage 1 involved a modified Delphi process. An expert panel reached consensus on domains and items based on three sources of information (validated hospital PMOS, previous research conducted by our study team and literature on threats to patient safety). Stage 2 involved testing the face validity of the questionnaire developed during stage 1 with patients and primary care staff using the 'think aloud' method. Following this process, the questionnaire was revised accordingly. RESULTS: The PC PMOS was received positively by both patients and staff during face validity testing. Barriers to completion included the length, relevance and clarity of questions. The final PC PMOS consisted of 50 items across 15 domains. The contributory factors to safety incidents centred on communication, access to care, patient-related factors, organisation and care planning, task performance and information flow. DISCUSSION: This is the first tool specifically designed for primary care settings, which allows patients to provide feedback about factors contributing to potential safety incidents. The PC PMOS provides a way for primary care organisations to learn about safety from the patient perspective and make service improvements with the aim of reducing harm in this setting. Future research will explore the reliability and construct validity of the PC PMOS.

An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration

AIM: The aim of this study was to examine the decision-making of nursing students during team based simulations on patient deterioration to determine the sources of information, the types of decisions made and the influences underpinning their decisions.

BACKGROUND: Missed, misinterpreted or mismanaged physiological signs of deterioration in hospitalized patients lead to costly serious adverse events. Not surprisingly, an increased focus on clinical education and graduate nurse work readiness has resulted.

DESIGN: A descriptive exploratory design.

METHODS: Clinical simulation laboratories in three Australian universities were used to run team based simulations with a patient actor. A convenience sample of 97 final-year nursing students completed simulations, with three students forming a team. Four teams from each university were randomly selected for detailed analysis. Cued recall during video review of team based simulation exercises to elicit descriptions of individual and team based decision-making and reflections on performance were audio-recorded post simulation (2012) and transcribed.

RESULTS: Students recalled 11 types of decisions, including: information seeking; patient assessment; diagnostic; intervention/treatment; evaluation; escalation; prediction; planning; collaboration; communication and reflective. Patient distress, uncertainty and a lack of knowledge were frequently recalled influences on decisions.

CONCLUSIONS: Incomplete information, premature diagnosis and a failure to consider alternatives when caring for patients is likely to lead to poor quality decisions. All health professionals have a responsibility in recognizing and responding to clinical deterioration within their scope of practice. A typology of nursing students' decision-making in teams, in this context, highlights the importance of individual knowledge, leadership and communication.

"I will start treatment when I think the time is right":HIV-positive gay men talk about their decision not to access antiretroviral therapy.

In a qualitative study, 20 HIV-infected Australian gay men were interviewed about their decision not to access antiretroviral drug therapy. The main reasons given for the decision were fear of side effects; fear of long-term damage to body organs; the inconvenience of the treatment regimens; belief that the regimen's demands would be a threat to morale; and belief that there was no reason to start therapy in the absence of AIDS-related symptoms. Actions taken by the men to monitor and maintain their health included seeing a doctor regularly; having regular T-cell and viral load tests; and trying to maintain a positive outlook by not letting HIV/AIDS 'take over' their lives. Almost half the men considered they had been subjected to unreasonable pressure to access therapy and there was considerable pride at having resisted this pressure. The findings suggest that the men disagreed with the biomedical model for managing HIV/AIDS only on the question of if and when to access therapy. They also suggest that underlying the men's dissent from the biomedical model was a different mode of thinking than is required by the model: while the model demands thinking that is abstract, the men focused strongly on factors close to the 'here and now' of immediate experience. The practical implications of the findings are explored.

Refugee law: time for a fundamental re-think: need as the criterion for assistance

Concern that the definition of refugee based on race, religion, nationality, membership of a particular social group or political opinion found in 1951 United Nations Convention relating to the Status of Refugees is unduly narrow and arbitrary and should be replaced by a definition reflecting the concept of deprivation and need.

Identity in multicultural societies: who do we think we are?

This paper examines identity issues in multicultural Australia. In its extreme, negative form, assumptions that certain characteristics apply to all members of an ethnic group can be attributed to racism. However, the belief that individuals who share the same ethnic background have similar needs, interests and perceptions is also reflected in business, government policy and academic research. Often, ethnic groupings used for research and policy formulation are very broad and fail to take into account within-group differences. The criteria used to assess an individuals membership of an ethnic group can be problematic. Criteria based purely on objective measures such as country of birth or ethnic ancestry do not take into account acculturation processes or the degree to which individuals consider themselves to be 'ethnic '. These objective measures are complicated further as individuals may have ethnic roots from multiple countries depending on their family composition over several generations. This theory-focused paper proposes that ethnic identity should be viewed as a subjective phenomenon where individuals are likely to align themselves with the ethnic background to which they most identify. This has implications for research and policy making in multicultural societies.

Student-engineered 'space to think'

The nature of creative and insightful thinking of Year 8 students in mathematics classes was studied through simultaneous examination of post-lesson video stimulated interviews and lesson video. One case is used to illustrate these findings. The concept of Space to Think emerged as a space manoeuvred by each of the five (out of eighty-six) students from Australia and the USA who creatively developed new knowledge. This Space to Think illuminates pedagogical moves that provide opportunities for creative thinking.

What are grade 5 and 6 children buying from school canteens and what do parents and teachers think about it?

Objective: The foods sold in school canteens have a significant role to play in ensuring children consume a healthy balance of nutritious foods. However, no research to date has described the foods that Australian children are purchasing at school canteens, or the perceptions held about school canteens by students, teachers and parents.
Design: An exploratory cross-sectional survey was used to obtain information from students, parents and teachers through self completion questionnaires.
Subjects: There were 384 children aged nine to 12 years, 404 parents and 41 teachers involved.
Settings: The study was conducted in 12 primary schools in Victoria, Australia.
Main outcome measures: Types of foods purchased at school canteens, school canteen usage, parents' and teachers' perceptions of the role of the school and canteen in influencing children's eating habits.
Results: More than 50% of the children surveyed used the school canteen at least once per week. Children identified preference for unhealthy alternatives and availability as key barriers to choosing healthy foods at the canteen and suggested increased availability, advertisements and cost reductions as aids to purchasing healthy foods. Teachers placed more importance on the role of the canteen than parents did.
Statistical analyses: Frequencies, cross-tabulation analyses and chi square tests were undertaken using the SPSS 11 computer program.
Conclusions: These Victorian primary school children and their teachers, and to a lesser extent parents, had a clear understanding of healthy foods. Children and teachers identified barriers that prevent school canteens
from providing healthy foods. There is likely to be strong support from these stakeholders for novel health promoting policies.

Think global, act local: from naive comparison to critical participation in the teaching of strategic international human resource management

In this paper, we examine the implications of ethnocentrism and paternalism in teaching approaches for the field of strategic international human resource management (SIHRM), as an example of management studies. We argue that the teaching of SIHRM has been approached in a colonizing fashion, joining and extending the territories of human resource management and organizational strategy through the definition and teaching of a new language and conceptual vocabulary. We explore philosophical approaches and processes involved in teaching SIHRM, and consider implications of pedagogical developments in this field of management education.

What do they think when we stack them in? A comparative analysis of student perceptions relating to large and small marketing subjects

University education is in a period of flux with emphasis being focused on quality education, competition for students both local and international as well as changes in governmental financial support and direction. It is with this scenario as a backdrop, that universities in an endeavour to obtain economies of scale offer subjects with large student enrolments. This study investigates marketing students’ perception of and participation in marketing subjects relating to teaching quality, staff availability and support, and individual student involvement in marketing education with large enrolments compared to subjects with small enrolments. This research builds on the investigations of effects of class size by Cuseo (2004) and Binney et al (2004). The study used a multi-method approach. Data from a sample of 621 students was analysed using Factor analysis, MANOVA and ANOVA. Students indicated that there was little difference in the quality of learning obtained in small or large classes. Of interest from a marketing perspective, however, is the perception by students that they are more likely to obtain practical assistance and support from tutors in smaller classes. Student perceptions generally show no major differences between large and small classes in relation to subject selection, ability to learn and lecture  attendance. Students expressed a preference for the opportunity to choose from a number of lecture streams available in subjects with large enrolments. Of interest, however is the student belief that they are less likely to actively participate in large lectures than in small lecture environments.