Diabetes service provision : a qualitative study of the experiences and views of Pakistani and Indian patients with Type 2 diabetes

Aims To explore Pakistani and Indian patients' experiences of, and views about, diabetes services in order to inform the development of culturally sensitive services.

Design Qualitative, interview study involving 23 Pakistani and nine Indian patients with Type 2 diabetes recruited from general practices and the local community in Edinburgh, Scotland. Data collection and analysis occurred concurrently and recruitment continued until no new themes emerged from the interviews.

Results Respondents expressed gratitude for the availability of free diabetes services in Britain, as they were used to having to pay to access health care on the Indian subcontinent. Most looked to services for the prompt detection and treatment of complications, rather than the provision of advice about managing their condition. As respondents attached importance to receiving physical examinations, they could be disappointed when these were not offered by health-care professionals. They disliked relying on interpreters and identified a need for bilingual professionals with whom they could discuss their diabetes care directly.

Conclusions Gratitude for free services in Britain may instil a sense of indebtedness which makes it difficult for Pakistanis and Indians to be critical of their diabetes care. Health-care professionals may need to describe their roles carefully, and explain how different diabetes services fit together, to avoid Pakistani and Indian patients perceiving treatment as unsatisfactory. Whilst linkworker schemes may meet patients' need to receive culturally sensitive information in their first language, work is needed to assess their effectiveness and sustainability.

Young children’s understanding of photo self-representations

This experiment examined delayed self-recognition in 24 2.5-year-old and 24 3-year-old children. Children were marked covertly with a sticker on their forehead while playing a game, after which their photograph was taken. When show this photograph, the 3- but not the 2.5-year-olds reached to remove this sticker reliably. However, the older children reached reliably only when first shown how a recently taken photograph can be used to guide their search for an object in the testing room that was not directly visible to the unaided eye. Implications of the findings in terms of the development of a temporally extended sense of self are discussed.

Young children’s use of a delayed video representation to solve a retrieval problem pertaining to self

The experiments reported here were concerned with the development of delayed self-recognition. Children were videotaped playing a game and were marked covertly with a sticker on their forehead while doing so. The findings, of both a cross-sectional sample and a prospective longitudinal one, revealed that 3- but not 2.5-year-old children reached to remove this sticker reliably during video playback only after they had been trained to use the video to guide their search for an object that was not directly visible to the unaided eye. It appears that by 3 years of age children understand that their briefly delayed self video-representation is related to their present self. In contrast, while 2.5-year-olds can use delayed vid of information to locate objects in space that cannot be seen by the unaided eye, they cannot use this type of information to locate an object that pertains to a part of self that is not directly visible, such as a sticker on one’s hair. The findings are discussed in terms of the emergence of an extended
sense of self.

Does every child know they matter? : Pupil's views of one alternative to exclusion

Schools are now urged to make every child matter. In this paper we present the case of the Coalfields Alternatives to Exclusion (CATE) strategy in which pupils at risk of permanent exclusion are offered the opportunity to start afresh in a new school. Without the stigma of exclusion, pupils are able to develop new relationships with peers and teachers and enhance self-esteem. We argue that this system of managed moves, despite some difficulties and challenges, offers an insight into the ways in which feelings of mattering can be translated into new behaviours and intentions. This we suggest provides pupils with a positive opportunity to resume their education and to be genuinely included in the life of their new school.

Seeking the views of health professionals on translating chronic disease self-management models into practice

Abstract
Few studies have investigated the views of health professionals with respect to their use of chronic disease self-management (CDSM) in the workplace.
Objective
This qualitative study, conducted in an Australian health care setting, examined health professional's formal self-management (SM) training and their views and experiences on the use of SM techniques when working with people living with a chronic illness.
Methods
Purposive sample of 31 health care professionals from a range of service types participated in semi-structured interviews.
Results
The majority of participants (65%) had received no formal training in SM techniques. Participants reported a preference for an eclectic approach to SM, relying primarily on five elements: collaborative care, self-responsibility, client's individual situation, structured support and linking with community agencies. Problems with CDSM centred on medication management, complex measuring devices and limited efficacy with some patient groups.
Conclusion
This study provides valuable information with respect to the use of CDSM within the workplace from the unique perspective of a range of healthcare providers within an Australian health care setting.
Practice implications
Training implications, with respect to CDSM and patient care, are discussed, together with how these findings contribute to the debate concerning how SM principles are translated into healthcare settings.

Detecting and treating depression in people with mild intellectual disability : the views of key stakeholders

There is a pressing need for the development of programs for the early identification and treatment of depression in individuals with mild intellectual disability. The aim of this study was to ascertain the perspective of 64 key stakeholders (people with intellectual disability, healthcare professionals, family/caregivers & support workers) regarding the risk factors and characteristics of depression, the support and service needs of individuals with intellectual disability/depression and those who care for them. Findings enhance our understanding of depression and its risk factors in people with mild intellectual disability and endorse the need for the development of screening and intervention programs suitable for delivery by staff in agencies providing services to people with mild intellectual disability.

When do children begin to learn mathematics? Views of preschool practitioners in regional and rural Australia

Preschool directors, teachers, and assistants from regional and rural eastern Australia were interviewed in the autumn of 2008 to discover their knowledge and beliefs concerning whether young children had the capacity to solve mathematical problems, when young children begin to think mathematically, and their observations of children’s mathematics learning. Respondents overwhelmingly agreed that preschool children were capable of mathematical activity and thought. Fifty eight (88%) respondents believed that children had begun to exhibit mathematical thinking by age 3; 30 (46%) by their first birthday. Practitioners interviewed were able to provide examples of both incidental and planned mathematical activities across a breadth of content, including number and operations, measurement, geometry, and fundamental classifying and ordering activities. The practitioners also demonstrated a creditable awareness of children who seemed to have a good grasp of mathematics. Many practitioners realized that mathematical proclivity could be shown in the processes children use as they engaged in mathematical activity and solved mathematical problems.

Assessment of mathematical development in early childhood : some views of preschool practitioners in regional and rural Australia

As part of the project Mathematical Thinking of Preschool Children in Rural and Regional Australia: Research and Practice directors, teachers, and assistants in prior-to-school settings from regional and rural eastern Australia were interviewed to ascertain their beliefs and practices concerning early childhood mathematics. This paper reports the responses to  uestions about their assessment of children’s mathematical activity and development. The practitioners provided examples of both incidental and planned assessment activities, the different forms these took, methods of recording, and how the results were used.

Is dietary management a responsibility of general practitioners? The views of Victorian general practitioners

Rationale : Australia is experiencing an evolving healthcare system, resulting in an aim of systematic managed care for patients with chronic disease. One outcome has been debate on doctors' dietary management responsibilities.
Aim : To identify general practitioners' perceptions of their dietary management responsibilities for adult cardiac patients.
Methods : A Two phase study was conducted. First, semi-structured interviews with 30 Melbourne general practitioners were conducted to gather preliminary information about dietary management. The results informed a questionnaire for the second phase. This was completed by 248 general practitioners (30%) in Victoria.
Principal findings : Themes arising in interviews, and also supported by cross-sectional survey showed that doctors perceive themselves as filling one or more of three roles. The majority (87.4%) endorsed an 'Influencing' role, 27.4% endorsed 'Dietary Educator' and 44.0% a 'Coordinator' role. The Influencer role was characterised by encouragement of dietary behaviour change, such as discussing benefits and consequences of inaction to dietary change. The Educator role was characterised by the provision of a range of behaviour change strategies- 'how to' achieve change. 'Coordinators' reported the provision of dietary counselling belonged to dietitians alone.
Implications : The results indicate doctors' awareness of need for patients' dietary education should be increased. This could be accomplished by one-on-one education. Patients' access to dietary education should also be facilitated by doctors' referring on. Embedding dietary management protocols in doctors' managed care templates could improve patients' access to dietary education and enhance doctor's collaborative roles.
Presentation type : Paper
Session theme : Getting Evidence into Practice 2

The relevance of the Heart Foundation of Australia's dietary recommendations for adult Australians : a comparison of views of general practitioners, cardiologists and dietitians

PURPOSE: To compare the views of general practitioners, cardiologists and dietitians about the relevance of the Heart Foundation of Australia's dietary recommendations for adult cardiac patients.

BASIC PROCEDURES: Quantitative-cross sectional study. Postal questionnaires were self-completed by 248 Victorian general practitioners (30% response), 189 Australia-wide cardiologists (47% response) and 180 Victorian dietitians (45% response). Responses were represented as percentages and analyses of variance were conducted to explore the impact of the independent variables: age, work status and gender on the dependent variable: dietary recommendation.

MAIN FINDINGS: Approximately half of the recommendations were viewed as strongly important to implement; these related to lean meats, limiting takeaways and cakes/biscuits, and adjusting energy intake. Others of importance were eating fruits, vegetables and fish. However, most of these goals were seen as difficult to achieve. Dietitians appeared to share responses of doctors, except for greater importance of eating fruit and vegetables and a greater difficulty in limiting cakes and biscuits. There was a high level of agreement among the three groups (mean 87%) about patients having difficulty implementing adjusting energy intake.

CONCLUSIONS: There is agreement amongst these professionals that many of the recommendations lack importance, specifically those pertaining to unsaturated oils, low fat dairy products, cholesterol rich foods, intake of legumes and grains and the restriction of salt. This may reflect a need for further nutrition education.

It's not that bad : the views of consumers and carers about routine outcome measurement in mental health

The mandatory use of routine outcome measurement (ROM) has been introduced into all public sector mental health services in Australia over the past 6 years. Qualitative processes were used to engage consumers and carers in suggesting how the measures can be used in clinical practice. The project involved an audit by survey, followed by a range of interactive workshops designed to elicit the views of consumers, carers and clinicians, as well as to involve all parties in dialogue about ROM. In addition, there was engagement of consumers and carers in the training of clinicians in the clinical use of ROM, and in the production of promotional materials aimed at informing consumers and carers about ROM. When consumers and carers have had an opportunity to be involved in ROM they have found it a useful experience, and those who had not been involved can see the potential. Consumers and carers indicated that they believe the greatest opportunity arising from the suite of measures is the use of the consumer self-assessment measure the Behaviour and Symptom Identification Scale (BASIS-32).

Addressing the basics : academics' views of the purpose of higher education

A number of changes have occurred in the higher education sector under the auspices of quality and quality improvement. Much of this change has resulted in a compliance-driven environment (more measures, more meetings, more form-filling and less time for the core activities of teaching and research). It is an environment that seeks to assure all and sundry of the quality of academic programs. Anecdotally, many academics are not convinced that the current systems do, indeed, assure quality. The reasons for this may be many and varied. One suggestion is that differences in perceptions about the purpose of higher education inevitably lead to differences in the definition of quality itself and consequently, differences in systems designed to assure that quality. Understanding what academics think about the purpose of higher education may provide some clues about how they consider quality should be defined.

In this research, the focus is on the views of academic accountants in Australia, defined as: academics whose main discipline area is accounting and who are involved in accounting education at an Australian university. The findings of this research show that the respondent group do, in fact, view the purpose of higher education currently promoted in their schools/departments differently from the purpose that they consider ought to be promoted. Such fundamental differences have the potential to influence the motivation and effectiveness of staff undertaking core activities in Australian universities. In addition, articulating the views of this important stakeholder group also has the potential to ensure that their views are considered in the discussions around purpose, quality and performance measures in higher education – all of which impact on the working lives of academic accountants in Australian universities.

Changes in higher education and valuing the job : the views of accounting academics in Australia

In a previous article (Bellamy et al., 2003), the authors reported on survey research that investigated reasons why academics from business disciplines enter and remain in academia, and the conditions they deem necessary to creating ideal work satisfaction. For both entering and remaining, as well as in achieving ideal work satisfaction, the most important factors were found to be autonomy and flexibility, with teaching and research the next most important factors. In a subsequent analysis of the data, reported in this article, the authors identify and explore significant differences between accounting academics and other business academics in the relative importance placed on these key factors. The findings may be used to inform policy makers and university administrators of the importance of discipline differences when identifying key factors for recruitment and retention of accounting academics specifically, and business academics generally.