Incorporating an economic model in the health impact assessment approach

The current policy decision making in Australia regarding non-health public investments (for example, transport/housing/social welfare programmes) does not quantify health benefits and costs systematically. To address this knowledge gap, this study proposes an economic model for quantifying health impacts of public policies in terms of dollar value. The intention is to enable policy-makers in conducting economic evaluation of health effects of non-health policies and in implementing policies those reduce health inequalities as well as enhance positive health gains of the target population. Health Impact Assessment (HIA) provides an appropriate framework for this study since HIA assesses the beneficial and adverse effects of a programme/policy on public health and on health inequalities through the distribution of those effects. However, HIA usually tries to influence the decision making process using its scientific findings, mostly epidemiological and toxicological evidence. In reality, this evidence can not establish causal links between policy and health impacts since it can not explain how an individual or a community reacts to changing circumstances. The proposed economic model addresses this health-policy linkage using a consumer choice approach that can explain changes in group and individual behaviour in a given economic set up. The economic model suggested in this paper links epidemiological findings with economic analysis to estimate the health costs and benefits of public investment policies. That is, estimating dollar impacts when health status of the exposed population group changes by public programmes – for example, transport initiatives to reduce congestion by building new roads/ highways/ tunnels etc. or by imposing congestion taxes. For policy evaluation purposes, the model is incorporated in the HIA framework by establishing association among identified factors, which drive changes in the behaviour of target population group and in turn, in the health outcomes. The economic variables identified to estimate the health inequality and health costs are levels of income, unemployment, education, age groups, disadvantaged population groups, mortality/morbidity etc. However, though the model validation using case studies and/or available database from Australian non-health policy (say, transport) arena is in the future tasks agenda, it is beyond the scope of this current paper.

Understanding the psychosocial factors influencing the risky behaviour of young drivers

Young people aged 17–24 years are at high risk of being killed in road crashes around the world. Road safety interventions consider some influences upon young driver behaviour; for example, imposing passenger restrictions on young novice drivers indirectly minimises the potential negative social influences of peers as passengers. To change young driver risky behaviour, the multitude of psychosocial influences upon its initiation and maintenance must be identified. A study questionnaire was developed to investigate the relationships between risky driving and Akers’ social learning theory, social identity theory, and thrill seeking variables. The questionnaire was completed by 165 participants (105 women,60 men) residing in south-east Queensland, Australia. The sociodemographic variables of age, gender, and exposure explained 19% of the variance in self-reported risky driving behaviour, whilst Akers’ social learning variables explained an additional 42%. Thrill seeking and social identity variables did not explain any significant additional variance. Significant predictors of risky driving included imitation of the driving behaviours of, and anticipated rewards and punishments administered by, parents and peers. Road safety policy that directly considers and incorporates these factors in their design, implementation, and enforcement of young driver road safety interventions should prove more efficacious than current approaches.

Exploring how parents and peers influence the behaviour of young drivers

Despite ongoing enhancements to graduated licensing systems, young drivers continue to have a high risk of being killed or injured in car crashes. This study investigated the influence of parents and peers on the risky behaviour of young drivers, utilising Akers’ social learning theory. The specific factors examined related to parent and peer norms perceived by the young driver, and the rewards and punishments anticipated by the young driver from their parents and peers. A questionnaire was completed by 165 young drivers. Regression analysis revealed that these factors explained 54% of the variance in risky driving. The strongest predictor was anticipated parent rewards, followed by peer norms, and anticipated peer rewards. Exploratory analyses however revealed the profile of predictors varied for male and female participants, and for self-reported offenders and non-offenders. The results highlight the role of psychosocial factors in the risky behaviour of young drivers and the need for road safety policies and programs to consider the influence of both parents and peers upon this behaviour.

Clinical supervision in four mental health professions : a review of the evidence

Examines a range of theoretical issues and the empirical evidence relating to clinical supervision in 4 mental health professions: clinical psychology, occupational therapy, social work, and speech pathology. There is widespread acceptance of the value of supervision among practitioners and a large quantity of literature on the topic, but there is very little empirical evidence in this area. To date, there is insufficient evidence to demonstrate which styles of supervision are most beneficial for particular types of staff, in terms of their level of experience or learning style. The data suggest that directive forms of supervision, rather than unstructured approaches, are preferred by relatively inexperienced practitioners, and that experienced clinicians also value direct supervision methods when learning new skills or dealing with complex or crisis situations. The available evidence suggests that supervisors typically receive little training in supervision methods. However, there is little information to guide us as to the most effective ways of training supervisors. While acknowledging the urgent need for research, this paper concludes that supervision is likely to form a valuable component of professional development for mental health professionals.

The theory of planned behaviour applied to young people's use of social networking websites

Despite the increasing popularity of social networking websites (SNWs), very little is known about the psychosocial variables which predict people’s use of these websites. The present study used an extended model of the theory of planned behaviour (TPB), including the additional variables of self-identity and belongingness, to predict high level SNW use intentions and behaviour in a sample of young people aged between 17 and 24 years. Additional analayses examined the impact of self-identity and belongingness on young people’s addictive tendencies towards SNWs. University students (N = 233) completed measures of the standard TPB constructs (attitude, subjective norm and perceived behavioural control), the additional predictor variables (self-identity and belongingness), demographic variables (age, gender, and past behaviour) and addictive tendencies. One week later, they reported their engagement in high level SNW use during the previous week. Regression analyses partially supported the TPB, as attitude and subjective norm signficantly predicted intentions to engage in high level SNW use with intention signficantly predicting behaviour. Self-identity, but not belongingness, signficantly contributed to the prediction of intention, and, unexpectedly, behaviour. Past behaviour also signficantly predicted intention and behaviour. Self-identity and belongingness signficantly predicted addictive tendencies toward SNWs. Overall, the present study revealed that high level SNW use is influenced by attitudinal, normative, and self-identity factors, findings which can be used to inform strategies that aim to modify young people’s high levels of use or addictive tendencies for SNWs.

Does 'fit' matter in nonprofits? Exploring value congruence, role stressors and employee health

The number of employees working in nonprofit organisations has grown significantly. These employees are often motivated to join these organisations by a strong desire to fulfil the particular vision and mission of that nonprofit (such as helping the community). While the effects of employee organisation value congruence on job-related attitudes are reasonably well documented, little consideration has been given to the nonprofit context and also perceptions of work stressors and health outcomes. A sample on nonprofit employees from a human services organisation (N = 181) was surveyed with results suggesting that value congruence was related to lower perceptions of role stressors. The results further revealed that value congruence was related to less favourable employee health in some circumstances. Outcomes are discussed in terms of theoretical and practical importance.

Disclosing donation decisions : the role of organ donor prototypes in an extended theory of planned behaviour

This study explored the role of donor prototype evaluations (perceptions of the typical organ donor) in organ donation communication decisions using an extended theory of planned behaviour (TPB) model. The model incorporated attitude, subjective norm, perceived behavioural control, moral norm, self-identity, and donor prototype evaluations to predict intentions to record consent on an organ donor register and discuss the organ donation decision with significant others. Participants completed surveys assessing the extended TPB constructs related to registering (n = 359) and discussing (n = 282). Results supported a role for donor prototype evaluations in predicting discussing intentions only. Both extended TPB structural equation models were a good fit to the data, accounting for 74 and 76% of the variance in registering and discussing intentions, respectively. Participants’ self-reported discussing behaviour (but not registering behaviour given low numbers of behavioural performers) was assessed 4 weeks later, with discussing intention as the only significant predictor of behaviour (Nagelkerke R2 = 0.11). These findings highlight the impact of people's perceptions of a typical donor on their decisions to discuss their organ donation preference, assisting our understanding of the factors influencing individuals' communication processes in efforts to bridge the gap between organ supply and demand.

Intensive cognitive-behaviour therapy for depression : preliminary findings with four country residents

Describes a brief intensive program of cognitive therapy for depression that was designed for 4 adult residents of country towns in Australia, who resided some distance from treatment centers. Ss were assessed prior to treatment, at posttreatment, and at 4-wk, 8-wk, and 20-mo follow-ups. Treatments took place over 3 consecutive days for a total period of 15 hrs. Effects were highly consistent with the impact of group treatments delivered on a more traditional schedule. If confirmed in a controlled group study, these results suggest that cognitive therapy may be applied more economically and more widely than was previously realized.

Safeguarding rural Australia : addressing masculinity and violence in rural settings. Data report no. 5. Consequences of violence - juvenile offenders, long-term health consequences, anxiety and repression, other chronic disabilities

This report considers extant data which have been sourced with respect to some of the consequences of violent acts and incidents and risky behaviour for males living in regional and remote Australia . This has been collated and presented under the headings: juvenile offenders; long-term health consequences; anxiety and repression; and other chronic disabilities. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Wellness as higher education curriculum: A comprehensive framework for health education and promotion

A number of studies in relation to the place, impact and purpose of Wellness curricula provide insight into the perceived benefits of Wellness education in university environments. Of particular note is the recommendation by many authors that curriculum design fosters personal experiences, reflective practice and active self-managed learning approaches in order to legitimise (give permission for) the adoption of wellness as a personal lifestyle approach in the frenetic pace of student life. From a broader educational perspective, Wellness education provides opportunities for students to engage in learning self regulation skills both within and beyond the context of the Wellness construct.To realise the suggested potential of Wellness education in higher learning, it is necessary that curricula overlay the principles from the domains of both self-regulation and Wellness, to highlight authentic learning as a means to lifelong approaches. Currently, however, systematic development and empirical examination of the Wellness construct have received limited academic investigation. Despite having a multitude of intended purposes from the educative to the therapy oriented goals of the original authors, most wellness models appear to be limited to the “what” of Wellness. Investigations of the “how” and “why” aspects of Wellness may serve to enhance currently existing models by incorporating behaviour modification and learning approaches in order to create more comprehensive frameworks for health education and promotion.It is also important to note that none of the current Wellness models actually address the educative framework necessary for an individual to learn and thus become aware or understand and make choices about their own Wellness.The literature reviewed within this paper would suggest that learner success is optimised by giving learners authentic opportunities to develop and practice self regulation strategies. Such opportunities include learning experiences that: provide options for self determined outcomes; require skills development; recognise principles of successful learning as outlined by the APA; and are scaffolded according to learner needs rather than in generic ways. Thus, configuring a learner centred curriculum in Wellness Education would potentially benefit from overlaying principles from the domains of both SRL and Wellness to highlight authentic learning as a means to lifelong approaches, triggered by undergraduate experiences.Student perceptions are a rich and significant data base for the measurement of their experiences, activities, practices and behaviours. Wellness undergraduate education, such as the “Fitness, Health and Wellness” unit offered by Queensland University of Technology, offers a context in which to confirm possibilities suggested by the literature reviewed in this paper in a practical, Australian context.

A psychosocial approach to understanding young Australians' mobile phone behaviour

This thesis by publication contributes to our knowledge of psychological factors underlying a modern day phenomenon, young people’s mobile phone behaviour. Specifically, the thesis reports a PhD program of research which adopted a social psychological approach to explore mobile phone behaviour among young Australians aged between 15 and 24 years. A particular focus of the research program was to explore both the cognitive and behavioural aspects of young people’s mobile phone behaviour which for the purposes of this thesis is defined as mobile phone involvement. The research program comprised three separate stages which were developmental in nature, in that, the findings of each stage of the research program informed the next. The overarching goal of the program of research was to improve our understanding of the psychosocial factors influencing young people’s mobile phone behaviour. To achieve this overall goal, there were a number of aims to the research program which reflect the developmental nature of this thesis. Given the limited research into the mobile phone behaviour in Australia, the first two aims of the research program were to explore patterns of mobile phone behaviour among Australian youth and explore the social psychological factors relating to their mobile phone behaviour. Following this exploration, the research program sought to develop a measure which captures the cognitive and behavioural aspects of mobile phone behaviour. Finally, the research program aimed to examine and differentiate the psychosocial predictors of young people’s frequency of mobile phone use and their level of involvement with their mobile phone. Both qualitative and quantitative methodologies were used throughout the program of research. Five papers prepared during the three stages of the research program form the bulk of this thesis. The first stage of the research program was a qualitative investigation of young people’s mobile phone behaviour. Thirty-two young Australians participated in a series of focus groups in which they discussed their mobile phone behaviour. Thematic data analysis explored patterns of mobile phone behaviour among young people, developed an understanding of psychological factors influencing their use of mobile phones, and identified that symptoms of addiction were emerging in young people’s mobile phone behaviour. Two papers (Papers 1 and 2) emanated from this first stage of the research program. Paper 1 explored patterns of mobile phone behaviour and revealed that mobile phones were perceived as being highly beneficial to young people’s lives, with the ability to remain in constant contact with others being particularly valued. The paper also identified that symptoms of behavioural addiction including withdrawal, cognitive and behavioural salience, and loss of control, emerged in participants’ descriptions of their mobile phone behaviour. Paper 2 explored how young people’s need to belong and their social identity (two constructs previously unexplored in the context of mobile phone behaviour) related to their mobile phone behaviour. It was revealed that young people use their mobile phones to facilitate social attachments. Additionally, friends and peers influenced young people’s mobile phone behaviour; for example, their choice of mobile phone carrier and their most frequent type of mobile phone use. These papers laid the foundation for the further investigation of addictive patterns of behaviour and the role of social psychological factors on young people’s mobile behaviour throughout the research program. Stage 2 of the research program focussed on developing a new parsimonious measure of mobile phone behaviour, the Mobile Phone Involvement Questionnaire (MPIQ), which captured the cognitive and behavioural aspects of mobile phone use. Additionally, the stage included a preliminary exploration of factors influencing young people’s mobile phone behaviour. Participants (N = 946) completed a questionnaire which included a pool of items assessing symptoms of behavioural addiction, the uses and gratifications relating to mobile phone use, and self-identity and validation from others in the context of mobile phone behaviour. Two papers (Papers 3 & 4) emanated from the second stage of the research program. Paper 3 provided an important link between the qualitative and quantitative components of the research program. Qualitative data from Stage 1 indicated the reasons young people use their mobile phones and identified addictive characteristics present in young people’s mobile phone behaviour. Results of the quantitative study conducted in Stage 2 of the research program revealed the uses and gratifications relating to young people’s mobile phone behaviour and the effect of these gratifications on young people’s frequency of mobile phone use and three indicators of addiction, withdrawal, salience, and loss of control. Three major uses and gratifications: self (such as feeling good or as a fashion item), social (such as contacting friends), and security (such as use in an emergency) were found to underlie much of young people’s mobile phone behaviour. Self and social gratifications predicted young people’s frequency of mobile phone use and the three indicators of addiction but security gratifications did not. These results provided an important foundation for the inclusion of more specific psychosocial predictors in the later stages of the research program. Paper 4 reported the development of the mobile phone involvement questionnaire and a preliminary exploration of the effect of self-identity and validation from others on young people’s mobile phone behaviour. The MPIQ assessed a unitary construct and was a reliable measure amongst this cohort. Results found that self-identity influenced the frequency of young people’s use whereas self-identity and validation from others influenced their level of mobile phone involvement. These findings provided an important indication that, in addition to self factors, other people have a strong influence on young people’s involvement with their mobile phone and that mobile phone involvement is conceptually different to frequency of mobile phone use. Stage 3 of the research program empirically examined the psychosocial predictors of young people’s mobile behaviour and one paper, Paper 5, emanated from this stage. Young people (N = 292) from throughout Australia completed an online survey assessing the role of self-identity, ingroup norm, the need to belong, and self-esteem on their frequency of mobile phone use and their mobile phone involvement. Self-identity was the only psychosocial predictor of young people’s frequency of mobile phone use. In contrast, self-identity, ingroup norm, and need to belong all influenced young people’s level of involvement with their mobile phone. Additionally, the effect of self-esteem on young people’s mobile phone involvement was mediated by their need to belong. These results indicate that young people who perceive their mobile phone to be an integral part of their self-identity, who perceive that mobile phone is common amongst friends and peers, and who have a strong need for attachment to others, in some cases driven by a desire to enhance their self-esteem, are most likely to become highly involved with their mobile phones. Overall, this PhD program of research has provided an important contribution to our understanding of young Australians’ mobile phone behaviour. Results of the program have broadened our knowledge of factors influencing mobile phone behaviour beyond the approaches used in previous research. The use of various social psychological theories combined with a behavioural addiction framework provided a novel examination of young people’s mobile behaviour. In particular, the development of a new measure of mobile phone behaviour in the research program facilitated the differentiation of the psychosocial factors influencing frequency of young people’s mobile phone behaviour and their level of involvement with their mobile phone. Results of the research program indicate the important role that mobile phone behaviour plays in young people’s social development and also signals the characteristics of those people who may become highly involved with their mobile phone. Future research could build on this thesis by exploring whether mobile phones are affecting traditional social psychological processes and whether the results in this research program are generalisable to other cohorts and other communication technologies.

The impact of health information technology on the quality of medical and health care : a systematic review

Objective: To systematically review the published evidence of the impact of health information technology (HIT) on the quality of medical and health care specifically clinicians’ adherence to evidence-based guidelines and the corresponding impact this had on patient clinical outcomes. In order to be as inclusive as possible the research examined literature discussing the use of health information technologies and systems in both medical care such as clinical and surgical, and other health care such as allied health and preventive services.----- Design: Systematic review----- Data Sources: Relevant literature was systematically searched on English language studies indexed in MEDLINE and CINAHL(1998 to 2008), Cochrane Library, PubMed, Database of Abstracts of Review of Effectiveness (DARE), Google scholar and other relevant electronic databases. A search for eligible studies (matching the inclusion criteria) was also performed by searching relevant conference proceedings available through internet and electronic databases, as well as using reference lists identified from cited papers.----- Selection criteria: Studies were included in the review if they examined the impact of Electronic Health Record (EHR), Computerised Provider Order-Entry (CPOE), or Decision Support System (DS); and if the primary outcomes of the studies were focused on the level of compliance with evidence-based guidelines among clinicians. Measures could be either changes in clinical processes resulting from a change of the providers’ behaviour or specific patient outcomes that demonstrated the effectiveness of a particular treatment given by providers. ----- Methods: Studies were reviewed and summarised in tabular and text form. Due to heterogeneity between studies, meta-analysis was not performed.----- Results: Out of 17 studies that assessed the impact of health information technology on health care practitioners’ performance, 14 studies revealed a positive improvement in relation to their compliance with evidence-based guidelines. The primary domain of improvement was evident from preventive care and drug ordering studies. Results from the studies that included an assessment for patient outcomes however, were insufficient to detect either clinically or statistically important improvements as only a small proportion of these studies found benefits. For instance, only 3 studies had shown positive improvement, while 5 studies revealed either no change or adverse outcomes.----- Conclusion: Although the number of included studies was relatively small for reaching a conclusive statement about the effectiveness of health information technologies and systems on clinical care, the results demonstrated consistency with other systematic reviews previously undertaken. Widescale use of HIT has been shown to increase clinician’s adherence to guidelines in this review. Therefore, it presents ongoing opportunities to maximise the uptake of research evidence into practice for health care organisations, policy makers and stakeholders.

A qualitative investigation of sources of value in social marketing from the lens of a public health service

This paper seeks to identify the sources of value in a government health screening service. Consumers' use of such services for their won benefits demonstrates desirable behaviour and their continued use of these services indicates maintenance of the behaviour. There are also positive outcomes for society as the health of its members is improved overall through this behaviour. Individual-depth interview with 25 women who use breast cancer screening services provided by BreastScreen (BSQ) revealed five categories of sources of value. They are information sources, interaction sources, service, environment, and consumer participation. These findings provide valuable insights into the value construction of consumers and contribute towards our understanding of the value concept in social marketing.

A multilevel study of area socio-economic status and food purchasing behaviour

Objective: This study examined the association between area socioeconomic status (SES) and food purchasing behaviour.----- Setting: Melbourne city, Australia, 2003.----- Participants: Residents of 2,564 households located in 50 small areas.----- Design: Data were collected by mail survey (64.2% response rate). Area SES was indicated by the proportion of households in each area earning less than Aus$400 per week, and individual-level socioeconomic position was measured using education, occupation, and household income. Food purchasing was measured on the basis of compliance with dietary guideline recommendations (for grocery foods) and variety of fruit and vegetable purchase. Multilevel regression examined the association between area SES and food purchase after adjustment for individual-level demographic (age, sex, household composition) and socioeconomic factors.----- Results: Residents of low SES areas were significantly less likely than their counterparts in advantaged areas to purchase grocery foods that were high in fibre and low in fat, salt, and sugar; and they purchased a smaller variety of fruits. There was no evidence of an association between area SES and vegetable variety.----- Conclusions In Melbourne, area SES was associated with some food purchasing behaviours independent of individual-level factors, suggesting that areas in this city may be differentiated on the basis of food availability, accessibility, and affordability, making the purchase of some types of foods more difficult in disadvantaged areas.

Learning wellness : how ageing Australians experience health information literacy

Given identified synergies between information use and health status greater understanding is needed about how people use information to learn about their health. This article presents the findings of preliminary research into health information literacy which sought to explore how this is phenomenon is experienced among ageing Australians. Analysis of data from semi-structured interviews has revealed six different ways ageing Australians experience using information to learn about their health within one aspect of community life. Health information literacy is a new terrain for information literacy research endeavours and one which warrants further attention by the profession to foster and promote within the community.