Comparison of the pre-post and transition question assessments in a health education setting

Objective : This study examined the classical pre-intervention/post-intervention assessment (pre–post) and the single post-intervention transition question assessment (transition question) to determine how well these methods reflected qualitative interview–based participant-reported outcomes from chronic disease self-management education programs (CDSMEPs).

Study Design and Setting : A mixed-method qualitative and quantitative approach was applied in 25 interviews with participants recruited from CDSMEPs within Australia. Qualitative interviews with participants were used as a relative “gold standard” and compared with questionnaire-based pre–post and transition question assessments.

Results : Comparison of the two questionnaire-based assessments showed that most of the individual paired responses were discordant (61%). Using participant's qualitative narratives as a “true” indicator, the pre–post assessment was found on more occasions to be discordant with participant-reported outcomes than the transition question. The origin of the inconsistency was largely because of a change in respondents' perspective that had occurred after pretest, which was mediated by CDSMEPs' experiences and insights.

Conclusion : This study suggests that the pre–post assessment has poor validity for the assessment of health education program outcomes. Alternative assessments, such as the transition question, may result in a more accurate reflection of the impact of such programs on participants.

Guideline-based programs in the treatment of complex PTSD

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

Nuclear rivalry in South Asia : an examination of post Cold War nuclear arms control initiatives

South Asia has emerged in the post-Cold War era as a region where ongoing nuclear rivalry has the potential to result in a nuclear exchange between India and Pakistan. The United States, together with the global community, is devoting considerable effort to prevent the further development and deployment of nuclear weapons by India and Pakistan. This thesis analyses the underlying reasons for the ongoing nuclear rivalry between India and Pakistan, details post-Cold War initiatives to end the nuclear rivalry and examines the prospect of United States efforts to cap, reduce and eventually eliminate the nuclear arsenals of India and Pakistan. The thesis finds that historical factors form the basis of the continuing hostility and animosity between the two nations. The two nations have been bitter rivals since the time of partition in 1947 and the disputed territory of Kashmir continues to be the manifestation of deep seated antagonism and hostility. Pakistan's geography leaves it extremely vulnerable to conventional Indian attack and possession of nuclear weapons is seen as a means to redress the imbalance. Strong domestic support together with fervent nationalism and international prestige will continue to drive the nuclear programs of each nation. This thesis concludes that the nuclear rivalry between India and Pakistan is regional in nature and the end of the Cold War has done little to improve the prospects for nuclear disarmament in the region. United States led efforts have failed to persuade India or Pakistan to either accede to the Non-Proliferation Treaty (NPT) or dismantle their nuclear weapons. The thesis also notes that the United States has failed to take account of China as a significant regional power and it's impact on the nuclear programs of India and Pakistan. A fresh approach (to include China) with more emphasis on regional dialogue is suggested as a first step to ending the nuclear rivalry.

Rebuilding regimes or rebuilding community? Teachers' agency for social reconstruction

Non-government organisations (NGOs) are playing an increasingly significant role in post-conflict situations as donor funding pours into rebuilding programs. Donor funding supports the development of a range of humanitarian and civic programs such as peace restoration, civic reconstruction and peace-keeping. This article is a case study of the rebuilding of the education system in post-conflict Iraq that contextualises the activities sanctioned by new regime and aid agencies in post-conflict Iraq. While the war and crisis in Iraq continues to fuel great debate, a full political discussion falls outside the scope of this paper. Instead, the intention is to unpack the way that the dominant regime rehabilitates the education system in a seemingly apolitical way. Attempts to rebuild the Iraqi education system appear to be a case of the separation of political rehabilitation and social reconstruction. As the need for the new regime to assert political legitimacy grows, an institution such as education experiences vast changes as local educational practices are restructured to complement the new regime. In this process, the local teachers and their cultural and educational expertise are overshadowed by the ‘neutral’ politics of reconstruction. However, the rebuilding of education systems is a political process, the politics of which are evident in the way that critical agents, such as teachers, are being reshaped in the image of the new regime. Teachers have the capacity to contribute to the long-term social and cultural rebuilding of post-conflict nations through their broad social and educational agency. However, the educational policy and plans of regime-sponsored funding effectively marginalise the important role of local educators in the civic rebuilding. Teachers’ agency in Iraq is being overlooked as a means of using educators as peace-keepers who can build long-term educational capacity and stability in the post-conflict situation.

Shared parenting

The thesis addresses shared parenting, an arrangement which emphasises the equal responsibility of both parents for children after separation, which is often assumed to ameliorate the supposed negative effects of parental separation. This study found that from children's perspective, the most important consideration was not the type of family they lived in but rather the quality of their relationship with each parent that impacted on their emotional adjustment. The portfolio focuses on the challenge of dealing with allegations of child sexual abuse in the context of the Family Court. The comples issues involved in these types of cases are illustrated by four case studies.

Do entrepreneurship programs matter? An analysis of North American university innovation systems

Are there differences in commercialization outcomes between universities in Canada and the USA? If so, why? We first examine the commercialization performance of universities on both sides of the 49th parallel through indicators of university spinouts generated. Secondly, we measure the presence and growth in numbers of entrepreneurship centers to determine if there are any parallels or discernable patterns that may be related to spinout performance. Based upon theories that suggest entrepreneurial culture plays a significant role in the spinout process, we then test the hypothesis that entrepreneurship education programs play a significant role in determining spinout performance. Our model assumes that the level and intensity of an academic entrepreneurship program/center is a valid indicator of “entrepreneurial culture” that may impact upon a universities propensity to spinout new knowledge intensive firms. Our results find that there is indeed a correlation between intensity of entrepreneurship program and commercialization outcomes.

The continued underrepresentation of girls in post-compulsory information technology courses : a direct challenge to teacher education

The participation rates of girls in post-compulsory information technology courses of Australian universities and high schools have remained low (less than 30%), despite three decades of research and analysis. In seeking to better understand this phenomenon, this paper draws upon data collected during an Australian Research Council Linkage project to investigate first, the reasons that teachers and students in contemporary Australian high schools put forward to account for girls' underrepresentation; second, the assumptions about gender that underpin these explanations; and third, the extent to which teachers appear able to respond to the full range of factors shaping girls' decision making. The paper argues that attempts to improve girls' participation rates might continue to falter unless teacher education programs explicitly prepare teachers to conceptualise educational reforms based on understandings of post-structural perspectives on gender; perspectives that challenge the more common explanations for girls' behaviour associated with both essentialist and socialisation mindsets.

Implementation of diabetes prevention programs in rural areas : Montana and south-eastern Australia compared

Objective: To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities.
Methods: Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators’ experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs.
Results: Four main themes emerged from the focus groups: establishing and implementing the diabetes prevention program in the community; strategies for recruitment and retention of participants; what works in lifestyle intervention programs; and rural-centred issues.
Conclusions: The results from this study have assisted in determining the factors that contribute to developing, establishing and implementing successful diabetes prevention programs in two rural areas. Recommendations to increase the likelihood of success of programs in rural communities include: securing funding early for the program; establishing support from community leaders and developing positive relationships with health care providers; creating a professional team with passion for the program; encouraging participants to celebrate their small and big successes; and developing procedures for providing post-intervention support to help participants maintain their success.

Evaluating the outcomes of adolescent day programs in an Australian child and adolescent mental health service

Adolescent day programs (ADPs) are an increasingly used approach to treating adolescents with mental health issues. However, there is a dearth of studies empirically examining the outcomes of adolescent day programs. This study retrospectively examined the mental health functioning of 84 adolescents, pre- and post-treatment, who in addition to their ongoing outpatient treatment had participated in an ADP during a five-year period. Their functioning was compared to matched adolescents who participated only in outpatient treatment during the same time period. Statistical and clinical examinations revealed the reported outcomes following ADP treatment were at least comparable, and sometimes significantly better, when compared to the reported outcomes following outpatient treatment excluding ADP involvement. This study, while having some methodological shortcomings, provides some evidence for the efficacy of ADPs.

The inclusion of ‘then-test’ questions in post-test questionnaires alters post-test responses: a randomized study of bias in health program evaluation

Objectives Program evaluations are frequently based on ‘then-test’ data, i.e., pre-test collected in retrospect. While the application of the then-test has practical advantages, little is known about the validity of then-test data. Because of the collection of then-test in close proximity to post-test questions, this study was aimed at exploring whether the presence of then-test questions in post-test questionnaires influenced subjects’ responses to post-test.
Patients and methods To test the influence of then-test questions, we designed a randomized three-group study in the context of chronic disease self-management programs. Interventions had comparable goals and philosophies, and all 949 study participants filled out identical Health Education Impact Questionnaires (heiQ) at pre-test. At post-test, participants were then randomized to one of the following three groups: Group A responded to post-test questions only (n = 331); Group B filled out transition questions in addition to post-test (n = 304); and Group C filled out then-test questions in addition to post-test (n = 314).
Results Significant post-test differences were found in six of eight heiQ scales, with respondents who filled out then test questions reporting significantly higher post-test scores than respondents of the other groups.
Conclusions This study provides evidence that the inclusion of then-test questions alters post-test responses,
suggesting that change scores based on then-test data be interpreted with care.

Aspects of parenting and family functioning associated with obesity in adolescent refugees and migrants from African backgrounds living in Australia

Objective: To investigate the relationship between parenting style and family functioning, and BMI, among adolescent migrants and refugees from African countries.

Method: A total of 104 parents and their adolescent offspring completed questionnaires assessing the variables of interest, and anthropometric data were collected from them.

Results: Parents reported higher maternal involvement, lower levels of paternal involvement, higher levels of positive parenting, greater use of ‘other’ (non-corporal) discipline styles, greater satisfaction and better communication than did their offspring. Parents also reported greater family cohesion and flexibility than adolescents, and saw their families as more enmeshed and more rigid. Parenting style and family functioning were not strong predictors of BMI according to either report. For adolescents, inconsistent discipline and lack of parental supervision accounted for significant variance in BMI.

Conclusions: Inconsistent discipline and lack of parental supervision may be related to adolescent BMI. Further studies with larger samples are required to confirm these relationships with the view to informing obesity prevention programs for this target population.

Implications: Prevention or intervention programs aimed at reducing the prevalence of overweight and obesity need to consider parenting style in their design.

Application of power functions to chromatographic data for the enhancement of signal to noise ratios and separation resolution

Chromatographic detection responses are recorded digitally. A peak is represented ideally by a Guassian distribution. Raising a Guassian distribution to the power ‘n’ increases the height of the peak to that power, but decreases the standard deviation by √n. Hence there is an increasing disparity in detection responses as the signal moves from low level noise, with a corresponding decrease in peak width. This increases the S/N ratio and increases peak to peak resolution. The ramifications of these factors are that poor resolution in complex chromatographic data can be improved, and low signal responses embedded at near noise levels can be enhanced. The application of this data treatment process is potentially very useful in 2D-HPLC where sample dilution occurs between dimension, reducing signal response, and in the application of post-reaction detection methods, where band broadening is increased by virtue of reaction coils. In this work power functions applied to chromatographic data are discussed in the context of (a) complex separation problems, (b) 2D-HPLC separations, and (c) post-column reaction detectors.

Obesity prevention programs and policies: practitioner and policy-maker perceptions of feasibility and effectiveness

Objectives:

The impact of racism on parenting and the outcomes of Victorian Aboriginal children and young people

 Commissioned by the Victorian Department of Education and Early Childhood Development