A mixed methods investigation of parental factors in non-attendance at general paediatric hospital outpatient appointments

Non-attendance at paediatric outpatient appointments results in delayed diagnosis and treatment, putting children at risk of avoidable ill health, and incurring considerable health service costs. Links between missed appointments and clinical, socio-demographic, and access-related factors have been indicated, but parental cognitions associated with non-attendance have yet to be investigated. The aims of this project were to evaluate the effectiveness and theoretical bases of existing interventions designed to reduce non-attendance; to consider the ways in which missed appointments are managed by healthcare providers; to explore parents’ beliefs and experiences of attending and missing appointments; and to investigate the factors underlying these beliefs. A systematic literature review focusing on non-attendance interventions was conducted Within a mixed methods framework, interviews were conducted with healthcare professionals, subsequent interviews were conducted with parents who had attended or missed a General Paediatric outpatient appointment, and a cross-sectional questionnaire study of parents’ beliefs was implemented. The systematic review revealed that text message appointment reminders are effective at reducing non-attendance rates, but that no interventions have thus far been developed using theories of behaviour. Healthcare professionals recognised both barriers and parents’ beliefs as influences on attendance, but also believed there were ‘types’ of families who miss appointments. Healthcare professionals disagreed somewhat about how non-attendance should best be managed. The parent interview study found six themes. The findings reflect parents’ perceptions about the importance of attending and of their ability to attend. The results of the questionnaire study corroborate this structure of beliefs as the analysis produced two factors, the perceived ‘worth’ of attending and anticipated ‘worry’ when attending. This thesis demonstrates an original approach to investigating non-attendance at children’s outpatient appointments, using mixed methods and adopting a psychological rather than service-use perspective. The findings contribute to Health Psychology theory and offer recommendations for healthcare providers.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

Personal Work Space and Content Analysis Functionality in a Cultural Heritage Digital Library

The paper presents a different vision for personalization of the user’s stay in a cultural heritage digital library that models services for personalized content marking, commenting and analyzing that doesn’t require strict user profile, but aims at adjusting the user’s individual needs. The solution is borrowed from real work and studying of traditional written content sources (incl. books, manuals), where the user mainly performs activities such as underlining the important parts of the content, writing notes and inferences, selecting and marking zones of their interest in pictures, etc. In the paper a special attention is paid to the ability to execute learning analysis allowing different ways for the user to experience the digital library content with more creative settings.

Fractal Analysis for Cancer Research: Case Study and Simulation of Fractals

2010 Mathematics Subject Classification: 65D18.

A meta -analysis of empirical research studies on resilience among students at -risk for school failure

Being at-risk is a growing problem in the U.S. because of disturbing societal trends such as unemployment, divorce, substance abuse, child abuse and neglect, and the new threat of terrorist violence. Resilience characterizes individuals who rebound from or adapt to adversities such as these, and academic resilience distinguishes at-risk students who succeed in school despite hardships. ^ The purpose of this research was to perform a meta-analysis to examine the power of resilience and to suggest ways educators might improve academic resilience, which was operationalized by satisfactory test scores and grades. In order to find all studies that were relevant to academic resilience in at-risk kindergarten through 12th-grade students, extensive electronic and hardcopy searches were conducted, and these resulted in a database of 421 articles. Two hundred eighty seven of these were rejected quickly, because they were not empirical research. Upon further examination, another 106 were rejected for not meeting study protocol criteria. Ultimately, 28 studies were coded for study level descriptors and effect size variables. ^ Protective factors for resilience were found to originate in physical, psychological, and behavioral domains on proximal/intraindividual, transitional/intrafamilial, or distal/extrafamilial levels. Effect sizes (ESs) for these were weighted and the means for each level or category were interpreted by commonly accepted benchmarks. Mean effect sizes for proximal (M = .27) and for transitional (M = .15) were small but significant. The mean effect size for the distal level was insignificant. This supported the hypotheses that the proximal level was the source of most protective factors for academic resilience in at-risk students followed by the transitional level. The distal effect size warranted further research particularly in light of the small number of studies (n = 11) contributing effect sizes to that category. A homogeneity test indicated a search for moderators, i.e., study variables affecting outcomes, was justified. “Category” was the largest moderator. Graphs of weighted mean effect sizes in the physical, psychological, and behavioral domains were plotted for each level to better illustrate the findings of the meta-analysis. Suggestions were made for combining resilience development with aspects of positive psychology to promote resilience in the schools. ^

A content analysis of food and nutrition television advertisements

Television (TV) reaches more people than any other medium which makes it an important source of health information. Since TV ads often offer information obliquely, this study investigated implied health messages found in food and nutrition TV ads. The goals were to determine the proportion of food and nutrition ads among all TV advertising and to use content analysis to identify their implied messages and health claims. A randomly selected sample of TV ads were collected over a 28-day period beginning May 8, 1987. The sample contained 3547 ads; 725 (20%) were food-related. All were analyzed. About 10% of food-related TV ads contained a health claim. Twenty-five representative ads of the 725 food ads were also reviewed by 10 dietitians to test the reliability of the instrument. Although the dietitians agreed upon whether a health claim existed in a televised food ad, their agreement was poor when evaluating the accuracy of the claim. The number of food-related ads dropped significantly on Saturday, but the number of alcohol ads rose sharply on Saturday and Sunday. Snack ads were shown more often on Thursday, but snack commercials were also numerous on Saturday morning and afternoon, as were cereal ads. Ads for snack foods accounted for the greatest proportion of ads (20%) while fast food accounted for only 7%. Alcohol constituted about 9% of all food and nutrition ads.

Computer Assisted Content Analysis of the print press coverarge of corruption in Hungary

Coverage of corruption in the Hungarian media was analyzed using four online news portals. Three of them, Magyar Nemzet Online (short name: MNO, web: mno.hu), Népszava (web: nepszava.hu) and Heti Világgazdaság (web: hvg.hu) are also available as newspapers but the content of these papers is different from the online form to a certain extent. The news portal Origo (web: origo.hu) has no print version.

Convergence-divergence of HRM in the Asia-Pacific:context-specific analysis and future research agenda

In this article, we highlight the significance and need for conducting context-specific human resource management (HRM) research, by focusing on four critical themes. First, we discuss the need to analyze the convergence-divergence debate on HRM in Asia-Pacific. Next, we present an integrated framework, which would be very useful for conducting cross-national HRM research designed to focus on the key determinants of the dominant national HRM systems in the region. Following this, we discuss the critical challenges facing the HRM function in Asia-Pacific. Finally, we present an agenda for future research by presenting a series of research themes.

Learning to 'understand backwards' in time: children's temporal cognition and the primary history curriculum

This study examines children’s temporal ways of knowing and it highlights the centrality of temporal cognition in the development of children’s historical understanding. It explores how young children conceptualise time and it examines the provision for temporal cognition at the levels of the intended, enacted and received history curriculum in the Irish primary school context. Positioning temporality as a prerequisite second-order concept, the study recognises the essential role of both first-order and additional second-order concepts in historical understanding. While the former can be defined as the basic, substantive content to be taught, the latter refers to a number of additional key concepts that are deemed fundamental to children's capacity to make meaningful sense of history. The study argues for due recognition to be given to temporality, in the belief that both sets of knowledge, the content and skills, are required to develop historical thinking (Lévesque, 2011). The study addresses a number of key research questions, using a mixed methods research design, comprising an analysis of history textbooks, a survey among final year student teachers about their teaching of history, and school-based interviews with primary school children: What opportunities are available for children to develop temporal ways of knowing? How do student teachers experience being apprenticed into the available culture for teaching history and understanding temporality at primary level? What insights do the cognitive-developmental and sociocultural perspectives on learning provide for understanding the dynamics of children’s temporal ways of knowing? The study argues that the skill of developing a deeper understanding of time is a key prerequisite in connecting with, and constructing, understandings and frameworks of the past. The study advances a view of temporality as complex, multi-faceted and developmental. The findings have a potential contribution to make in influencing policy and pedagogy in establishing an elaborated and well-defined curriculum framework for developing temporal cognition at both national and international levels.

Desenvolver a consciência fonológica na educação pré-escolar : potencialidades da exploração da diversidade linguística

O presente trabalho centra-se no desenvolvimento de um projeto de sensibilização à diversidade linguística e cultural, intitulado “Por ritmos nunca dantes navegados”, numa sala de um jardim de infância português, tendo como finalidade avaliar e compreender o desenvolvimento da consciência fonológica de um grupo de doze crianças entre os 3 e os 4 anos de idade. Para o efeito, recorremos a uma metodologia mista, que se traduziu em procedimentos de tipo quantitativo e qualitativo de recolha e análise de dados: no primeiro caso, recorremos a testes de consciência fonológica e de discriminação auditiva, aplicados a um grupo experimental e a um grupo de controlo de seis crianças antes e após as sessões de sensibilização; no segundo caso, recorremos à observação direta e à vídeo gravação das quatro sessões do projeto. A análise dos dados recolhidos, realizada através de análise estatística e de conteúdo, permitiu alcançar resultados relevantes, tendo-se registado um desenvolvimento significativo das capacidades de discriminação auditiva e de consciência fonológica (silábica e da palavra) do grupo experimental que esteve presente nas sessões de sensibilização. Os resultados da análise estatística parecem sugerir que o contacto com línguas diferentes, através de atividades de sensibilização, contribui para a descoberta de unidades segmentais das línguas, essenciais para realizar tarefas de discriminação auditiva e de consciência fonológica. A análise de conteúdo ajudou a corroborar os resultados obtidos nos testes de discriminação auditiva e de consciência fonológica, tendo as crianças do grupo experimental revelado, nas suas interações, ser capazes de discriminar sons, bem como segmentar e manipular palavras e sílabas. Estes resultados sustentam a importância das abordagens plurais na educação pré-escolar, pois o contacto com sonoridades, línguas e palavras diferentes faz com que a criança atente no objeto-língua, realizando sobre ele múltiplas e ricas atividades para o desenvolvimento de competências metalinguísticas e também sociais.

Self-management of coronary heart disease in angina patients after percutaneous coronary intervention: A mixed methods study.

After having elective percutaneous coronary intervention (PCI) patients are expected to self-manage their coronary heart disease (CHD) by modifying their risk factors, adhering to medication and effectively managing any recurring angina symptoms but that may be ineffective. Objective: Explore how patients self-manage their coronary heart disease (CHD) after elective PCI and identify any factors that may infl uence that. Design and method: This mixed methods study recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected using a survey and were subject to univariate, bivariate and multi-variate analysis. Qualitative data from participant interviews was analysed using thematic analysis. Findings: After PCI, 74% of participants managed their angina symptoms inappropriately. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. Few patients adopted a healthier lifestyle after PCI. Qualitative analysis revealed that intentional non-adherence to some medicines was an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management. Participants reported strong emotional responses to CHD and this had a detrimental effect on their self-management. Few patients accessed cardiac rehabilitation.

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

Towards an understanding of Pakistani undergraduates’ current attitudes towards learning and speaking English

The English language has an important place in Pakistan and in its education system, not least because of the global status of English and its role in employment. Realising the need to enhance language learning outcomes, especially at the tertiary level, the Higher Education Commission (HEC) of Pakistan has put in place some important measures to improve the quality of English language teaching practice through its English Language Teaching Reforms (ELTR) project. However, there is a complex linguistic, educational and ethnic diversity in Pakistan and that diversity, alongside the historical and current role of English in the country, makes any language teaching reform particularly challenging. I argue, in this thesis, that reform to date has largely ignored the issues of learner readiness to learn and learner perceptions of the use of English. I argue that studying learner attitudes is important if we are to understand how learners perceive the practice of learning and the use of English in their lives. This study focuses on the attitudes of undergraduate learners of English as a foreign language at two universities in the provinces of Sindh and Balochistan in Pakistan. These provinces have experienced long struggles and movements related to linguistic and ethnic rights and both educate students from all of the districts of their respective provinces. Drawing on debates around linguistic imperialism, economic necessity, and linguistic and educational diversity, I focus on learners’ perceptions about learning and speaking English, asking what their attitudes are towards learning and speaking English with particular reference to socio-psychological factors at a given time and context, including perceived threats to their culture, religion, and mother tongue. I ask how they make choices about learning and speaking English in different domains of language use and question their motivation to learn and speak English. Additionally, I explore issues of anxiety with reference to their use of English. Following a predominantly qualitative mixed methods research approach, the study employs two research tools: an adapted Likert Scale questionnaire completed by 300 students and semi-structured interviews with 20 participants from the two universities. The data were analysed through descriptive statistics and qualitative content analysis, with each set of data synthesised for interpretation. The findings suggest that, compared with the past, the majority of participants hold positive attitudes towards learning and speaking English regardless of their ethnic or linguistic backgrounds. Most of these undergraduate students do not perceive the use of English as a threat to their culture, mother tongue or religious values but, instead, they have a pragmatic and, at the same time, aspirational attitude to the learning and use of English. I present these results and conclude this thesis with reference to ways in which this small-scale study contributes to a better understanding of learner attitudes and perceptions. Acknowledging the limitations of this study, I suggest ways in which the study, enhanced and extended by further research, might have implications for practice, theory and policy in English language teaching and learning in Pakistan.

Shifts in media images of women appearance and social status from 1960 to 2010: a content analysis of beauty advertisements in two Australian magazines

Ageing well and successful ageing have become important themes to describe how older individuals should keep ageing at bay. Products and services aimed at controlling ageing have become associated with ageing well. In this study we aimed to analyse the representation of older women in advertisements specific to appearance and ageing. In particular, we sought to explore how ageing for women was presented in the media over a period 50 years and when advertisements began to use the term 'anti-ageing'. A content analysis of 710 advertisements from two prominent Australian women's magazines, from 1960 to 2010, was conducted. Analyses showed that advertisements provided a narrow range of images representing women's physical appearance. The underlying messages were that ageing is problematic and that it had become unforgivable to show any signs of ageing. Text contained in advertisements for beauty products from the two chosen Australian magazines often gave specific and prescriptive advice to women on ways to avoid losing their youthful appearance. It was concluded that media relay powerful messages to spread and modify cultural beliefs informing individuals of a range of options that propose liberation from the problem of ageing.