Identifying the barriers to implementing the Victorian Department of Education and Training guidelines regarding the provisions of nutrient dense food options in school canteens

Aims & rationale/Objectives : To identify barriers to the full implementation of new guidelines regarding school canteen menus launched by The Victorian Education Department in May 2004.
Methods : A self-administered questionnaire was sent to principals, business mangers and canteen managers of 13 secondary schools in South West Victoria covered by The Greater Green Triangle area (response rate 59%). The questions explored the canteen's role, operation, staffing and profits; existence and content of canteen policy; enablers and barriers to the sale of healthier foods; introduction and promotion of healthier foods; and perceived implications of banning less healthy foods.
Principal findings : The study identified several barriers to implementing healthy menus in school canteens, these being largely consistent with those found in other studies. The majority of schools reported they were making attempts to follow the guidelines for school food services, but were experiencing difficulty in proceeding to full implementation. The barriers identified through the study were student preference for less healthy options, concerns about profitability, lack of policy or its active communication and promotion at the school level and competition from other food outlets.
Discussion : There was evidence that healthy foods had not been actively promoted, suggesting that identification of student preferences as a barrier was based on perception rather than observation. The Victorian guidelines are effectively voluntary, with no accountability measures in place.
Implications : Research needs to be conducted to provide reliable and tested information about factors which impact on student choice. Schools would benefit from specialised assistance to formulate business plans for contemporary canteens selling healthy food and a clarification of government policy.
Presentation type : Poster

Barriers to continuing medical education in Australian prevocational doctors

To determine perceived barriers to continuing education for Australian hospital-based prevocational doctors, a cross sectional cohort survey was distributed to medical administrators for secondary redistribution to 2607 prevocational doctors from August 2003 to October 2004. Four hundred and seventy valid questionnaires (18.1%) were returned. Only seven per cent (33/470) did not identify any barriers to continuing education. Barriers identified the most were lack of time (85% [371/437]), clinical commitment (65% [284/437]), resistance from registrars (13% [57/437]) and resistance from consultant staff (10% [44/437]). Other barriers included workload issues (27% [27/98]), teaching program inadequacies (26% [25/98]), lack of protected time for education (17% [17/98]), motivational issues (11% [10/98]) and geographic remoteness (10% [10/98]). Australian graduates (87%) identified lack of time more frequently than international medical graduates (77%) (P=0.036). Perceived barriers did not differ significantly between doctors of differing postgraduate years.

Occupational health services in higher education : second annual report : summary

The second of three surveys of occupational health provision in UK higher education institutions was carried out in March 2003.

Information was collected on occupational health provision arrangements for all 193 members of UUK, other HEIs funded by HEFCE, constituent parts of the University of London and the University of Wales, and degree awarding bodies in the UK. There was a wide variety of arrangements. Thirty-eight percent had in-house services, 33% contracted with external providers for occupational health services, 13% made use of a local general practice or student health service, 6% had other or ad hoc arrangements and 9% had no occupational health service.

Community pharmacists' preferences for continuing education delivery in Australia

Introduction: New technologies such as the Internet offer an increasing number of options for the delivery of continuing education (CE) to community pharmacists. Many of these options are being utilized to overcome access- and cost-related problems. This paper identifies learning preferences of Australian community pharmacists for CE and identifies issues with the integration of these into contemporary models of CE delivery.
Methods: Four focus group teleconferences were conducted with practicing community pharmacists (n = 15) using a semistructured format and asking generally about their CE and continuing professional development (CPD) experiences.
Results: Pharmacists reported preferences for CE that were very closely aligned to the principles of adult learning. There was a strong preference for interactive and multidisciplinary CE. Engaging in CPD was seen as valuable in promoting reflective learning.
Discussion: These results suggest that pharmacists have a strong preference for CE that is based on adult learning principles. Professional organizations should take note of this and ensure that new CE formats do not compromise the ability of pharmacists to engage in interactive, multidisciplinary, and problem-based CE. Equally, the role of attendance-based CE in maintaining peer networks should not be overlooked.

The influence of Sport Education on student motivation in physical education

Background: Physical educators are faced with trying to provide motivating and enjoyable experiences in physical education. Sport Education is an instructional model that aims to provide positive motivational sport experiences by simulating the features of authentic sport. Research support for Sport Education is positive, however, the effects on student motivation and the motivational climate are not well understood.

Purpose: To investigate the influence of the Sport Education model on student motivation (intrinsic/extrinsic motivation, goal orientations, and perceived motivational climate) in secondary physical education.

Setting: Six classes were selected according to teacher and class availability in the sports of soccer, hockey, and football codes in a co-educational government school.

Participants: Participants were 115 (male = 97, female = 18) Year-8 students (aged 13-14 years), in a Sport Education condition (n = 41) and a Traditional condition (n = 74).

Measures: At pre- and post-test, all participants completed three questionnaires: the Intrinsic Motivation Inventory, the Task and Ego Orientation in Sport Questionnaire, and the Perceived Motivational Climate in Sport Questionnaire.

Intervention: Participants completed either a Sport Education condition or a Traditional condition for one double period (100 minutes) one day per week for 10 weeks (Sport Education condition) or for five weeks (Traditional condition). The Sport Education condition incorporated six distinctive features: seasons, affiliation, formal competition, record keeping, festivity, and a culminating event. The Traditional condition used whole-group instruction led by the teacher.

Research design: The study used a non-equivalent control group design with pre- and post-test procedures. The independent variable was teaching condition and the dependent variable was student motivation (assessed by intrinsic motivation, goal orientations, and motivational climate). The groups were already established and selected for convenience purposes.

Data collection and analysis: Participants completed pre-test measures and then participated in their pre-established classes. Post-test measures were completed in the last class in each condition. A reliability analysis on measures was conducted using Cronach's alphas. A pre-test manipulation check was performed to check for any initial differences in motivation. To compare the difference in changes between conditions on motivation, a series of 2 times 2 repeated measures analyses of variance were conducted. A comparison of the relationship between motivation measures was conducted using Pearson's product moment correlation coefficients.

Findings: There was a significant difference between the conditions on changes in perceived competence, task orientation, and mastery climate, with the Traditional condition decreasing significantly from pre- to post-test compared with the Sport Education condition. There were no significant differences on interest/enjoyment, effort/importance, pressure/tension, ego orientation, or performance climate. A mastery climate was positively related to task orientation and intrinsic motivation and a performance climate was related to ego orientation.

Conclusions: The Sport Education condition was more successful in maintaining high levels of intrinsic motivation, task orientation, and mastery climate than the Traditional condition. That is, the Traditional condition was associated with a decrease in adaptive aspects of motivation for students, whereas the Sport Education condition maintained existing levels of motivation.

Can we skill and activate children through primary school physical education lessons? "Move it Groove it" - a collaborative health promotion intervention

Background: Physical education (PE) lessons are an ideal setting to improve child fundamental movement skills (FMSs) and increase physical activity (PA) for optimal health. Despite this, few studies have assessed the potential to do both simultaneously. The “Move It Groove It” primary school intervention in New South Wales, Australia, had this opportunity.

Methods: A whole school approach to implementation included establishment of school project teams, a teacher “buddy” system, project Web site, teacher training workshops, and small grants for equipment. The quasi-experimental evaluation involved 1,045 year 3 and 4 children (aged 7 to 10 years) in nine intervention and nine control rural primary schools (53% boys/47% girls). It utilised pre- and postobservational surveys of (1) mastery or near mastery levels for each of eight FMSs, (2) proportion of PE lesson time spent in moderate to vigorous PA (MVPA) and vigorous PA (VPA), and (3) teacher- and lesson-related contextual covariates. Data were analysed by hierarchical logistic multiple regression.

Results: For FMSs, overall mastery or near mastery level at baseline was 47% ranging from 22.7% for the overarm throw among girls to 75.4% for the static balance among boys. The intervention delivered substantial improvements in every FMS for both genders ranging from 7.2% to 25.7% (13 of 16 comparisons were significant). For PA level, mean MVPA at baseline was 34.7%. Baseline MVPA for boys was 38.7% and for girls was 33.2%. The intervention was associated with a nonsignificant 4.5% increase in MVPA and a significant 3.0% increase in VPA. This translates to a gain of <1 minute of MVPA per average 21-minute lesson.

Conclusions: This is the first study to show that by modifying existing PE lessons, significant improvements in FMS mastery can be gained without adversely affecting children’s MVPA and VPA. To increase PA levels, we recommend increasing the number of PE lessons per week.

How active are rural children in Australian physical education

Physical education lessons offer a venue for children to accrue valuable and health-conferring time being physically active. The first Australian direct observational data are presented on activity of year 3 and 4 children during physical education. Analysis accounts for the nested nature of the data through multi level logistic regression using 13,080 records within 231 lessons within 18 randomly selected schools. Activity was analysed in relation to lesson context (focus of lesson), child gender, school year of child, teacher gender, lesson duration and start time. Children spent 36.7% of a lesson in moderate to vigorous and 12.9% in vigorous activity. Most of the lesson was spent in the context of management/instruction (37.4%), followed by games (25.0%), skill (21.4%), and fitness (14.7%). The highest level of moderate to vigorous activity was observed in the fitness lesson context (61.9%), followed by skill (46.4%), games (42.6%) and management/instruction (17.1%). Moderate to vigorous activity was significantly higher for boys than girls. There was no significant difference in moderate to vigorous activity in lessons led by male or female teachers. However vigorous activity was significantly higher for female led lessons. Children participated in less physical activity during physical education lessons timetabled in the afternoon, compared to physical education lessons time-tabled in the morning. Physical activity levels were not related to lesson duration. Physical education lessons can potentially be more active. However improvement rests on school capacity and may require a health promoting schools approach to implement curricular policy.

Funding special education provision by means of discriminant function analysis

This thesis is concerned with the development of a funding mechanism, the Student Resource Index, which has been designed to resolve a number of difficulties which emerged following the introduction of integration or inclusion as an alternative means of providing educational support to students with disabilities in the Australian State of Victoria. Prior to 1984, the year in which the major integration or inclusion initiatives were introduced, the great majority of students with disabilities were educated in segregated special schools, however, by 1992 the integration initiatives had been successful in including within regular classes approximately half of the students in receipt of additional educational assistance on the basis of disability. The success of the integration program brought with it a number of administrative and financial problems which were the subject of three government enquiries. Central to these difficulties was the development of a dual system of special education provision. On one hand, additional resources were provided for the students attending segregated special schools by means of weighted student ratios, with one teacher being provided for each six students attending a special school. On the other hand, the requirements of individual students integrated into regular schools were assessed by school-based committees on the basis of their perceived extra educational needs. The major criticism of this dual system of special education funding was that it created inequities in the distribution of resources both between the systems and also within the systems. For example, three students with equivalent needs, one of whom attended a special school and two of whom attended different regular schools could each be funded at substantially differing levels. The solution to these inequities of funding was seen to be in the development of a needs based funding device which encompassed all students in receipt of additional disability related educational support. The Student Resource Index developed in this thesis is a set of behavioural descriptors designed to assess degree of additional educational need across a number of disability domains. These domains include hearing, vision, communication, health, co-ordination (manual and mobility), intellectual capacity and behaviour. The completed Student Resource Index provides a profile of the students’ needs across all of these domains and as such addresses the multiple nature of many disabling conditions. The Student Resource Index was validated in terms of its capacity to predict the ‘known’ membership or the type of special school which some 1200 students in the sample currently attended. The decision to use the existing special school populations as the criterion against which the Student Resource Index was validated was based on the premise that the differing resource levels of these schools had been historically determined by expert opinion, industrial negotiation and reference to other special education systems as the most reliable estimate of the enrolled students’ needs. When discriminant function analysis was applied to some 178 students attending one school for students with mild intellectual disability and one facility for students with moderate to severe intellectual disability the Student Resource Index was successful in predicting the student's known school in 92 percent of cases. An analysis of those students (8 percent) which the Student Resource Index had failed to predict their known school enrolment revealed that 13 students had, for a variety of reasons, been inappropriately placed in these settings. When these students were removed from the sample the predictive accuracy of the Student Resource Index was raised to 96 percent of the sample. By comparison the domains of the Vineland Adaptive Behaviour Scale accurately predicted known enrolments of 76 percent of the sample. By way of replication discriminant function analysis was then applied to the Student Resource Index profiles of 518 students attending Day Special Schools (Mild Intellectual Disability) and 287 students attending Special Developmental Schools (Moderate to Severe Intellectual Disability). In this case, the Student Resource Index profiles were successful in predicting the known enrolments of 85 percent of students. When a third group was added, 147 students attending Day Special Schools for students with physical disabilities, the Student Resource Index predicted known enrolments in 80 percent of cases. The addition of a fourth group of 116 students attending Day Special Schools (Hearing Impaired) to the discriminant analysis led to a small reduction in predictive accuracy from 80 percent to 78 percent of the sample. A final analysis which included students attending a School for the Deaf-Blind, a Hospital School and a Social and Behavioural Unit was successful in predicting known enrolments in 71 percent of the 1114 students in the sample. For reasons which are expanded upon within the thesis it was concluded that the Student Resource Index when used in conjunction with discriminant function analysis was capable of isolating four distinct groups on the basis of their additional educational needs. If the historically determined and varied funding levels provided to these groups, inherent in the cash equivalent of the staffing ratios of Day Special Schools (Mild Intellectual Disability), Special Development Schools (Moderate to Severe Intellectual Disability), Day Special Schools (Physical Disability) and Day Special Schools (Hearing Impairment) are accepted as reasonable reflections of these students’ needs these funding levels can be translated into funding bands. These funding bands can then be applied to students in segregated or inclusive placements. The thesis demonstrates that a new applicant for funding can be introduced into the existing data base and by the use of discriminant function analysis be allocated to one of the four groups. The analysis is in effect saying that this new student’s profile of educational needs has more in common with Group A than with the members of Groups B, C, or D. The student would then be funded at Group A level. It is immaterial from a funding point of view whether the student decides to attend a segregated or inclusive setting. The thesis then examines the impact of the introduction of Student Resource Index based funding upon the current funding of the special schools in one of the major metropolitan regions. Overall, such an initiative would lead to a reduction of 1.54 percent of the total funding accruing to the region’s special schools.

Investigation into the diffusion of innovation in technical and further education : implementing e-mail through action research

This research project examined the diffusion of change within one Victorian TAFE Institute by engaging action research to facilitate implementation of e-mail technology. The theoretical framework involving the concepts of technology innovation and action research was enhanced with the aid of Rogers's (1983) model of the diffusion of the innovation process. Political and cultural factors made up the initiation phase of innovation, enabling the research to concentrate on the implementation phase of e-mail Roger's (1983) model also provided adopter categories that related to the findings of a Computer Attitude Survey that was conducted at The School of Mines and Industries Ballarat (SMB), now the University of Ballarat—TAFE Division since amalgamation on 1st January 1998. Despite management rhetoric about the need to utilise e-mail, Institute teaching staff lacked individual computers in their work areas and most were waiting to become connected to the Internet as late as 1997. According to the action research reports, many staff were resistant to the new e-mail facilities despite having access to personal computers whose numbers doubled annually. The action research project became focussed when action researchers realised that e-mail workshop training was ineffective and that staff required improved access. Improvement to processes within education through collaborative action research had earlier been achieved (McTaggart 1994), and this project actively engaged practitioners to facilitate decentralised e-mail training in the workplace through the action research spiral of planning, acting, observing and reflecting, before replanning. The action researchers * task was to find ways to improve the diffusion of e-mail throughout the Institute and to develop theoretical constructs. My research task was to determine whether action research could successfully facilitate e-mail throughout the Institute. A rich literature existed about technology use in education, technology teaching, gender issues, less about computerphobia, and none about 'e-mailphobia \ It seemed appropriate to pursue the issue of e-mailphobia since it was marginalised, or ignored in the literature. The major political and cultural influences on the technologising of SMB and e-mail introduction were complex, making it impossible to ascertain the relative degrees of influence held by Federal and State Governments, SMB's leadership or the local community, Nonetheless, with the implementation of e-mail, traditional ways were challenged as SMB's culture changed. E-mail training was identified as a staff professional development activity that had been largely unsuccessful. Action research is critical collaborative inquiry by reflective practitioners who are accountable for making the results of their inquiry public and who are self-evaluating of their practice while engaging participative problem-solving and continuing professional development (Zuber-Skerritt 1992, 1993). Action research was the methodology employed in researching e-mail implementation into SMB because it involved collaborative inquiry with colleagues as reflective practitioners. Thoughtful questions could best be explored using deconstructivist philosophy, in asking about the noise of silence, which issues were not addressed, what were the contradictions and who was being marginalised with e-mail usage within SMB. Reviewing literature on action research was complicated by its broad definition and by the variability of research (King & Lonnquist 1992), and yet action research as a research methodology was well represented in educational research literature, and provided a systematic and recognisable way for practitioners to conduct their research. On the basis of this study, it could be stated that action research facilitated the diffusion of e-mail technology into one TAFE Institute, despite the process being disappointingly slow. While the process in establishing the action research group was problematic, action researchers showed that a window of opportunity existed for decentralised diffusion of e-mail training,in preference to bureaucratically motivated 'workshops. Eight major findings, grouped under two broad headings were identified: the process of diffusion (planning, nature of the process, culture, politics) and outcomes of diffusion (categorising, e-mailphobia, the survey device and technology in education). The findings indicated that staff had little experience with e-mail and appeared not to recognise its benefits. While 54.1% did not agree that electronic means could be the preferred way to receive Institute memost some 13.7% admitted to problems with using the voice answering service on telephones. Some 43.3% thought e-mail would not improve their connectedness (how they related) to the Institute. A small percentage of staff had trouble with telephone voice-mail and a number of these were anxious computer users. Individualised tuition and peer support proved helpful to individual staff whom action researchers believed to be 'at risk', as determined from the results of a Computer Attitude Survey. An instructional strategy that fostered the development of self-regulation and peer support was valuable, but there was no measure of the effects of this action research program, other than in qualitative terms. Nevertheless, action research gave space to reflect on the nature of the underlying processes in adopting e-mail. Challenges faced by TAFE action researchers are integrally affected by the values within TAFE, which change constantly and have recently been extensive enough to be considered as a 'new paradigm'. The influence of competition policy, the training reform agenda and technologisation of training have challenged traditional TAFE values. Action research reported that many staff had little immediate professional reason to use e-mail Theoretical answers were submerged beneath practical professional concerns, which related back to how much time teachers had and whether they could benefit from e-mail. A need for the development of principles for the sound educational uses of e-mail increases with the internationalisation of education and an increasing awareness of cultural differences. The implications for conducting action research in TAFE are addressed under the two broad issues of power and pedagogy. Issues of power included gaining access, management's inability to overcome staff resistance to technology, changing TAFE values and using technology for conducting action research. Pedagogical issues included the recognition of educational above technological issues and training staff in action research. Finally, seventeen steps are suggested to overcome power and pedagogical impediments to the conduct of action research within TAFE. This action research project has provided greater insight into the difficulties of successfully introducing one culture-specific technology into one TAFE Institute. TAFE Institutes need to encourage more action research into their operations, and it is only then that -we can expect to answer the unanswered questions raised in this research project.

Global education : travel and new imaginaries for teachers' work

This workshop reports on Learning across Latitude - a trans-national collaborative project that joined teacher education students from Australia, Denmark and Malaysia. The project offered a unique opportunity for students to explore concepts and dialogue with their teacher education peers in three countries. Over a two week period, 116 students in 13 forums posted 365 messages into a forum space hosted by Deakin University. 
During week 1, students introduced themselves to each other and discussed their reasons to become teachers, qualities of a good teacher and the issues facing teaching in their country. Because many students life experiences are local in experience such a project expands notions of being a teacher in a global world. Student’s responses to qualities of a good teacher were analysed to build knowledge of global teacher identities.
During week 2 students discussed what it means to be a good citizen in their country. How is citizenship as a concept explained across three countries? In the virtual discussions for Malaysian and Danish students, English was a second language. These forums opened new awareness for all students of the challenges of conversing with English as second language students.
This project illustrated that the changing contexts of education and globalisation means new opportunities and challenges for teacher education at local and global levels. Implications from Learning across Latitudes suggest possibilities for teacher education to build global citizenship, and teacher identities as technology enables such possibilities.

Family-centred practice : empowerment, self-efficacy, and challenges for practitioners in early childhood education and care

Family-centred practice has been included in the Victoria, Australia Early Years Learning and Development Framework as a key practice principle for professionals working across all early years programs in that state. While this model of partnership for engaging and collaborating with families has long been used in the early intervention sector, the efficacy of adopting this model more widely across the wider early childhood education and care sector has not been explored. This article presents a discussion on family-centred practice as a model for engaging with families in the care and education of their children. Through an analysis of the underlying philosophy and an examination of the core principles and characteristics, the article explores family-centred practice as it sits within a broader theory of partnership. This analysis identifies that while there are essential principles and characteristics that position the model within a partnership framework, it is the notion of empowerment, an underpinning philosophy guiding the model, that adds another dimension to the way practitioners in early childhood education and care settings collaborate with families. In examining the broader early childhood context, the capacity of many early childhood practitioners to effectively implement empowering behaviours is challenged.

Osteo-cise : Strong bones for life': protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures

Background : Osteoporosis affects over 220 million people worldwide, and currently there is no 'cure' for the disease. Thus, there is a need to develop evidence-based, safe and acceptable prevention strategies at the population level that target multiple risk factors for fragility fractures to reduce the health and economic burden of the condition.

Methods : The 'Osteo-cise: Strong Bones for Life' study will investigate the effectiveness and feasibility of a multi-component targeted exercise, osteoporosis education/awareness and behavioural change program for improving bone health and muscle function, and reducing falls risk in community-dwelling older adults at an increased risk of fracture. Men and women aged 60 years or above will participate in an 18-month randomised controlled trial comprising a 12-month structured and supervised community-based program and a 6-month 'research to practise' translational phase. Participants will be randomly assigned to either the 'Osteo-cise' intervention or a self-management control group. The intervention will comprise a multi-modal exercise program incorporating high velocity progressive resistance training, moderate impact weight-bearing exercise and high challenging balance exercises performed three times weekly at local community-based fitness centres. A behavioural change program will be used to enhance exercise adoption and adherence to the program. Community-based osteoporosis education seminars will be conducted to improve participant knowledge and understanding of the risk factors and preventative measures for osteoporosis, falls and fractures. The primary outcomes measures, to be collected at baseline, 6, 12, and 18 months, will include DXA-derived hip and spine bone mineral density measurements and functional muscle power (timed stair-climb test). Secondary outcomes measures include: MRI-assessed distal femur and proximal tibia trabecular bone micro-architecture, lower limb and back maximal muscle strength, balance and function (four square step test, functional reach test, timed up-and-go test and 30-second sit-to-stand), falls incidence and health-related quality of life. Cost-effectiveness will also be assessed.

Discussion : The findings from the Osteo-cise: Strong Bones for Life study will provide new information on the efficacy of a targeted multi-modal community-based exercise program incorporating high velocity resistance training, together with an osteoporosis education and behavioural change program for improving multiple risk factors for falls and fracture in older adults at risk of fragility fracture. Trial Registration: Australian New Zealand Clinical Trials Registry reference ACTRN12609000100291

Am I able? Is it worth it? Adolescent girls' motivational predispositions to school physical education : Associations with health-enhancing physical activity

The study purpose was to investigate predictive associations between adolescent girls’ motivational predispositions to physical education (PE) and habitual physical activity. Two hundred girls (age 13.1 ± 0.6 years) completed the Physical Education Predisposition Scale and the Physical Activity Questionnaire for Older Children. ANCOVAs revealed that girls with the highest Perceived PE Worth and Perceived PE Ability scores were the most habitually active groups (p < .0001). Significant predictors of physical activity identified by hierarchical regression were Perceived PE Ability and body mass index, which accounted for 17% and 3% of variance, respectively. As Perceived PE Ability was strongly associated with physical activity, the correlates of this construct should be further established to inform future school and PE-based interventions.

An outdoor and environmental education community of practice : self stylisation or normalisation?

In this article, I draw on a qualitative longitudinal study to explore the influence of a tertiary Outdoor and Environmental Education (OEE) course on the formation of environmental ethics among students. In this task, I bring together Lave & Wenger (1991) and Wenger’s (1998) concept of communities of practice and Michel Foucault’s later work on ethics to underscore some of the difficulties of an OEE community of practice as a space for (environmentally) ethical self-stylisation. Bringing these theoretical ideas together is significant because my analysis suggests that the OEE community of practice (re)produces an environmental ethic based on normalised codes of conduct rather than a self-fashioning of an ethical existence as conceived by Foucault. I demonstrate that membership in overlapping communities of practice is influential in participants’ performance of environmental identities and normalising codes of conduct are particularly significant in the physical education/pre-service education communities of practice of which participants are members.

Does self monitoring of blood blucose as opposed to urinalysis provide additional benefit in patients newly diagnosed with type 2 diabetes receiving structured education? The DESMOND SMBG randomised controlled trial protocol

Background
The benefit of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes on diet or oral agents other than sulphonylureas remains uncertain. Trials of interventions incorporating education about self-monitoring of blood glucose have reported mixed results. A recent systematic review concluded that SMBG was not cost-effective. However, what was unclear was whether a cheaper method of self-monitoring (such as urine glucose monitoring) could produce comparable benefit and patient acceptability for less cost.

Methods/Design
The DESMOND SMBG trial is comparing two monitoring strategies (blood glucose monitoring and urine testing) over 18 months when incorporated into a comprehensive self-management structured education programme. It is a multi-site cluster randomised controlled trial, conducted across 8 sites (7 primary care trusts) in England, UK involving individuals with newly diagnosed Type 2 diabetes.

The trial has 80% power to demonstrate equivalence in mean HbA1c (the primary end-point) at 18 months of within ± 0.5% assuming 20% drop out and 20% non-consent. Secondary end-points include blood pressure, lipids, body weight and psychosocial measures as well as a qualitative sub-study.

Practices were randomised to one of two arms: participants attend a DESMOND programme incorporating a module on self-monitoring of either urine or blood glucose. The programme is delivered by accredited educators who received specific training about equipoise. Biomedical data are collected and psychosocial scales completed at baseline, and 6, 12, and 18 months post programme. Qualitative research with participants and educators will explore views and experiences of the trial and preferences for methods of monitoring.

Discussion
The DESMOND SMBG trial is designed to provide evidence to inform the debate about the value of self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes. Strengths include a setting in primary care, a cluster design, a health economic analysis, a comparison of different methods of monitoring while controlling for other components of training within the context of a quality assured structured education programme and a qualitative sub-study.