A qualitative study of the clinical practice of graduates of a problem-based physical therapy program

The purpose of this study was to examine the perspectives of three graduates of a problem-based leaning (PBL) physical therapy (PT) program about their clinical practice. The study used the qualitative methods of observations, interviews, and journaling to gather the data. Three sessions of audiotaped interviews and two observation sessions were conducted with three exemplars from Nova Southeastern University PBL PT program. Each participant also maintained a reflective journal. The data were analyzed using content analysis. A systematic filing system was used by employing a mechanical means of maintaining and indexing coded data and sorting data into coded classifications of subtopics or themes. All interview transcripts, field notes from observations, and journal accounts were read, and index sheets were appropriately annotated. From the findings of the study, it was noted that, from the participants' perspectives, they were practicing at typically expected levels as clinicians. The attributes that governed the perspectives of the participants about their physical therapy clinical practice included flexibility, reflection, analysis, decision-making, self-reliance, problem-solving, independent thinking, and critical thinking. Further, the findings indicated that the factors that influenced those attributes included the PBL process, parents' value system, self-reliant personality, innate personality traits, and deliberate choice. Finally, the findings indicated that the participants' perspectives, for the most part, appeared to support the espoused efficacy of the PBL educational approach. In conclusion, there is evidence that the physical therapy clinical practice of the participants were positively impacted by the PBL curriculum. Among the many attributes they noted which governed these perspectives, problem-solving, as postulated by Barrows, was one of the most frequently mentioned benefits gained from their PBL PT training. With more schools adopting the PBL approach, this research will hopefully add to the knowledge base regarding the efficacy of embracing a problem-based learning instructional approach in physical therapy programs. ^

Leadership power bases related to satisfaction, compliance, and program quality

The dissertation examined prekindergarten teachers' perceptions of their supervisory relationship with their educational specialist, and the effect of the prekindergarten teachers' perceptions on the quality of the High/Scope prekindergarten program. The High/Scope educational specialists use their leader power bases (reward, coercive, legitimate, referent, expert and informational) to influence teachers' perceptions of satisfaction and compliance, as well as teachers' actual compliance with the High/Scope prekindergarten program standards. The correlational relationships between the variables were examined using Analysis of Variance and Multivariate Analysis of Variance. Path Analysis was utilized to analyze variables to determine the validity of the correlational model. Expert, legitimate, referent, and informational power bases of the High/Scope educational specialist were found to be the most influential on attitudinal and behavioral compliance of teachers. ^

A worksite nutrition education program increased firefighters' knowledge and resulted in healthier attitudes toward fad diets

The effectiveness of a worksite nutrition education program to improve firefighters' knowledge and weight management strategies was evaluated. One hundred fifty Miami-Dade Fire Rescue workers recruited for the study were randomly assigned to an intervention or a control group. The intervention group attended four 30-minute worksite nutrition education sessions. A nutrition knowledge test completed by both groups before and after the intervention showed no significant differences between groups for pre-intervention nutrition knowledge. The post-intervention increase in nutrition knowledge was significantly greater (p < 0.001) for the intervention group (16.8% ± 8.2) compared to the control group (4% ± 8.9). No significant pre-intervention difference was found between the groups' predilection toward a ketogenic diet. A statistically significant (p < 0.01) reduction was seen in the intervention group's willingness (0.57 ± 1.06) to use this diet compared to the control group (0.02 ± 0.99). Results indicate that worksite nutrition education can improve firefighters' knowledge and weight reduction strategies. ^

The effect of a breakfast program on nutritional status, quality of life, and health care use among frail homebound older adults

The population of older adults is rapidly increasing, creating a need for community services that assist vulnerable older adults in maintaining independence and quality of life. Recent evidence confirms the importance of food and nutrition in reaching this objective. The Elderly Nutrition Program (ENP) is part of a system of federally funded community based programs, authorized through the Older Americans Act. ENP services include the home-delivered meals program, which targets frail homebound older adults at nutritional risk. Traditionally, ENP services provide a noon meal 5 days/week. This study evaluated the impact of expanding the home-delivered meals service to include breakfast + lunch, on the nutritional status, quality of life and health care utilization of program participants. ^ This cross-sectional study compared 2 groups. The Breakfast group (n = 167) received a home-delivered breakfast + lunch, 5 days/week. The Comparison group (n = 214) received lunch 5 days/week. Participants, recruited from 5 ENP programs, formed a geographically, racially/ethnically diverse sample. Participants ranged in age from 60–100 years, they were functionally limited, at high nutritional risk, low income, and they lived alone and had difficulty shopping or preparing food. Participant data were collected through in-home interviews and program records. A 24-hour food recall and information on participant demographics, malnutrition risk, functional status, health care use, and applicable quality of life factors were obtained. Service and cost data were collected from program administrators. ^ Breakfast group participants had greater energy/nutrient intakes (p < .05), fewer health care contacts (p < .05), and greater quality of life measured as food security (p < .05) and fewer depressive symptoms (p < .05), than comparison group participants. These benefits were achieved for $1.30/person/day. ^ The study identified links from improvements in nutritional status to enhanced quality of life to diminished health care utilization and expenditures. A model of health, loneliness, food enjoyment, food insecurity, and depression as factors contributing to quality of life for this population, was proposed and tested (p < .01). ^ The breakfast service is an inexpensive addition to traditional home-delivered meals services and can improve the lives of frail homebound older adults. Agencies should be encouraged to expand meals programs to include a breakfast service. ^

Student perceptions of the school physical fitness testing program: The Fitnessgram

The purpose of this study was to determine fifth grade students' perceptions of the Fitnessgram physical fitness testing program. This study examined if the Fitnessgram physical fitness testing experience promotes an understanding of the health-related fitness components and examined the relationship between individual fitness test scores and time spent participating in out-of-school physical activity. Lastly, students' thoughts and feelings concerning the Fitnessgram experience were examined. ^ The primary participant population for the study was 110 fifth grade students at Redland Elementary School, a Miami-Dade County Public School (M-DCPS). Data were collected over the course of 5 months. Multiple sources of data allowed for triangulation. Data sources included Fitnessgram test scores, questionnaires, document analysis, and in-depth interviews. ^ Interview data were analyzed qualitatively for common broad themes, which were identified and defined. Document analysis included analyzing student fitness test scores and student questionnaire data. This information was analyzed to determine if the Fitnessgram test scores have an impact on student views about the school fitness-testing program. Data were statistically analyzed using analysis of frequency, crosstabulations (Bryman & Duncan, 1997), and Somers'd Correlation (Bryman & Duncan, 1997). The results of the analysis of data on student knowledge of the physical fitness components tested by each Fitnessgram test revealed students do not understand the health-related fitness components. ^ The results of determining a relationship between individuals' fitness test scores and time spent in out-of-school physical activity revealed a significant positive relationship for 2 of the 6 Fitnessgram tests. ^ The results of examining students' thoughts and feelings about each Fitnessgram test focused around 2 broad themes: (a) these children do not mind the physical fitness testing and (b) how they felt about the experience was directly related to how they thought they had performed. ^ If the goal of physical fitness was only to get children fit, this test may be appropriate. However, the ultimate goal of physical fitness is to encourage students to live active and healthy lifestyles. Findings suggest the Fitnessgram as implemented by M-DCPS may not be the most suitable measurement instrument when assessing attitudinal changes that affect a healthy lifelong lifestyle. ^

Truancy reduction: Extension of a county program

The primary purpose of this research was to examine the effect of the Truancy Intervention Program (TIP) on attendance patterns of elementary school students. Longitudinal archival data were used from Miami-Dade County Public School system's data system, ISIS. Data included the students' school information from fifth through ninth grade for attendance, academic grades, referral information, and referral consequences. The sample for this study was drawn from students at TIP-participating M-DCPS elementary schools in Miami-Dade County. Data collected spanned five years for each participant from the fifth grade to the ninth grade. To examine the effect of TIP on attendance, participation in middle school TIP was compared with non-TIP participation. In addition to immediate effects on attendance, the durability of the effects of TIP was studied through an analysis of attendance at the ninth grade level. A secondary purpose was to examine the relation of TIP participation to Grade Point Average (GPA). ^ The data were analyzed using 2 (group) x 3 (grade) Repeated Measures Analysis of Variance (ANOVA) on yearly attendance (number of absences), and grade point average for each year. The interaction between group and grade was significant. Post hoc tests indicated that absences were not significantly different in the two programs in seventh, eighth or ninth grade. Students enrolled in a middle school with TIP showed a significantly higher number of absences in ninth grade than for seventh or eighth grade. There were no differences by grade level for students enrolled in non-TIP middle schools. GPA analysis indicated that students enrolled in a non-TIP middle school had a significantly higher GPA across seventh, eighth, and ninth grades when compared to students enrolled at a TIP middle school. ^ An examination of attendance disciplinary referrals and consequences further revealed that the referral rates for students enrolled at a TIP middle school were higher at the seventh, eighth, and ninth grade level, then for students enrolled at a non-TIP middle school. This pattern was not readily apparent at non-TIP middle schools. Limitations of the research were noted and further research regarding program implementation (process evaluation) was suggested. ^

Effectiveness of the Teaching Enrichment Activities to Minorities (TEAM) program at increasing underrepresented students in gifted programs

This study examined the effectiveness of the TEAM (Teaching Enrichment Activities to Minorities) program in preparing and identifying underrepresented students for entrance into the gifted program. Miami-Dade County Public Schools (M-DCPS) developed the TEAM program as an intervention program aimed at developing student's thinking skills and critical thinking skills in all subject areas and prepare students for possible placement into the gifted program. ^ A systematic sampling strategy was utilized to select three TEAM schools from each of the six regions in M-DCPS for the sample, for a total of 18 schools. A pool of the students that participated in the TEAM program in 2003-2004 in the 18 schools selected were identified as the TEAM Sample students. A matching sample was created from 18 public schools in Miami-Dade County that did not implement the TEAM program in 2003-2004. The Matching Sample created a match for 806 students in the TEAM sample, for a total of 1612 subjects for the study. ^ This study used a logistical regression design to analyze the relationships of multiple independent variables, including: ethnicity, limited English proficiency, gender, free/reduced lunch status, grade level, reading achievement, mathematics achievement, and participation TEAM on the dependent variables of referral for the gifted program and eligibility into the gifted program. The first analysis found the variables of grade level, participation in TEAM, reading achievement, and mathematics achievement were all significant variables in determining if a student was referred for the gifted program. The second analysis found the variables of grade level, gender, free/reduced lunch status, reading achievement, and mathematics achievement were all significant variables in determining if a student was eligible for the gifted program. ^ Recommendations based on the results of this study include the expansion of the TEAM program in M-DCPS to include additional grade levels and schools. Additionally, adopting a broadened definition of giftedness and reviewing the screening and placement policies for potentially gifted students is recommended. Adopting multicultural and broader definitions of giftedness and constructing better tools and programs, such as TEAM, for assessing and identifying potential gifted students, represent small steps towards creating equitable education for all students. ^

Cognitive and noncognitive variables that predict Florida community college radiography program graduates' success on the Registry

This study examined the predictive merits of selected cognitive and noncognitive variables on the national Registry exam pass rate using 2008 graduates (n = 175) from community college radiography programs in Florida. The independent variables included two GPAs, final grades in five radiography courses, self-efficacy, and social support. The dependent variable was the first-attempt results on the national Registry exam. The design was a retrospective predictive study that relied on academic data collected from participants using the self-report method and on perceptions of students' success on the national Registry exam collected through a questionnaire developed and piloted in the study. All independent variables except self-efficacy and social support correlated with success on the national Registry exam ( p < .01) using the Pearson Product-Moment Correlation analysis. The strongest predictor of the national Registry exam success was the end-of-program GPA, r = .550, p < .001. The GPAs and scores for self-efficacy and social support were entered into a logistic regression analysis to produce a prediction model. The end-of-program GPA (p = .015) emerged as a significant variable. This model predicted 44% of the students who failed the national Registry exam and 97.3% of those who passed, explaining 45.8% of the variance. A second model included the final grades for the radiography courses, self efficacy, and social support. Three courses significantly predicted national Registry exam success; Radiographic Exposures, p < .001; Radiologic Physics, p = .014; and Radiation Safety & Protection, p = .044, explaining 56.8% of the variance. This model predicted 64% of the students who failed the national Registry exam and 96% of those who passed. The findings support the use of in-program data as accurate predictors of success on the national Registry exam.

Graduate program culture and intention to persist: Working adults in cohort and non-cohort programs

Cohort programs have been instituted at many universities to accommodate the growing number of mature adult graduate students who pursue degrees while maintaining multiple commitments such as work and family. While it is estimated that as many as 40–60% of students who begin graduate study fail to complete degrees, it is thought that attrition may be even higher for this population of students. Yet, little is known about the impact of cohorts on the learning environment and whether cohort programs affect graduate student retention. Retention theory stresses the importance of the academic department, quality of faculty-student relationships and student involvement in the life of the academic community as critical determinants in students' decisions to persist to degree completion. However, students who are employed full-time typically spend little time on campus engaged in the learning environment. Using academic and social integration theory, this study examined the experiences of working adult graduate students enrolled in cohort (CEP) and non-cohort (non-CEP) programs and the influence of these experiences on intention to persist. The Graduate Program Context Questionnaire was administered to graduate students (N = 310) to examine measures of academic and social integration and intention to persist. Sample t tests and ANOVAs were conducted to determine whether differences in perceptions could be identified between cohort and non-cohort students. Multiple linear regression was used to identify variables that predict students' intention to persist. While there were many similarities, significant differences were found between CEP and non-CEP student groups on two measures. CEP students rated peer-student relationships higher and scored higher on the intention to persist measure than non-CEP students. The psychological integration measure, however, was the strongest predictor of intention to persist for both the CEP and non-CEP groups. This study supports the research literature which suggests that CEP programs encourage the development of peer-student relationships and promote students' commitment to persistence.

The impact of a family home-learning program on levels of parental/caregiver efficacy

This study sought to determine if participation in a home education learning program would impact the perceived levels of parental self-efficacy of parents/caregivers who participate in the completion of home-learning assignments and increase their levels of home-learning involvement practices. Also, the study examined the relationship between the parental involvement practice of completing interactive home-learning assignments and the reading comprehension achievement of first grade students. A total of 146 students and their parents/caregivers representing a convenience sample of eight first grade classes participated in the study. Four classes (n=74) were selected as the experimental group and four classes (n=72) served as the control group. There were 72 girls in the sample and 74 boys and the median age was 6 years 6 months. The study employed a quasi-experimental research design utilizing eight existing first grade classes. It examined the effects of a home-learning support intervention program on the perceived efficacy levels of the participating parents/caregivers, as measured by the Parent Perceptions of Parent Efficacy Scale (Hoover-Dempsey, Bassler, & Brissie, 1992) administered on a pre/post basis. The amount and type of parent involvement in the completion of home assignments was determined by means of a locally developed instrument, the H.E.L.P. Parent Involvement Home-learning Scale, administered on a pre/post basis. Student achievement in reading comprehension was measured via the reading subtest of the Brigance, CIB-S pre and post. The elementary students and their parents/caregivers participated in an interactive home-learning intervention program for 12 weeks that required parent/caregiver assistance. Results revealed the experimental group of parents/caregivers had a significant increase in their levels of perceived self-efficacy, p<.001, from the pre to post, and also had significantly increased levels of parental involvement in seven home-learning activities, p<.001, than the control group parents/caregivers. The experimental group students demonstrated significantly higher reading levels than the control group students, p<.001. This study provided evidence that interactive home-learning activities improved the levels of parental self-efficacy and parental involvement in home-learning activities, and improved the reading comprehension of the experimental group in comparison to the control.

Impact of a cognitive-behavioral weight control program on body weight, diet quality, and smoking cessation in weight-concerned female smokers

Many people use smoking as a weight control mechanism and do not want to quit because they fear weight gain. These weight-concerned smokers tend to be female, are significantly less likely to stop smoking, are less likely to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman’s confidence in her ability to control her weight after quitting relates positively with her intention to quit smoking. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. It has been shown that success in changing one negative health behavior may trigger success in changing another, causing a synergistic effect. Recently research has focused on interventions for weight-concerned smokers who are ready to quit smoking. The present study investigated the effect of a cognitive based weight control program on self-efficacy for weight control and the effect on smoking behavior for a group of female weight concerned smokers. Two hundred and sixteen subjects who wanted to lose weight but who were not ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of twelve one-hour sessions. Subjects were randomly assigned to either (1) the weight-control program (intervention group), or (2) the control group. Results of this study demonstrated that subjects in the intervention group increased self-efficacy for weight control, which was associated with improved healthy eating index scores, weight loss, increased self-efficacy for quitting smoking, a decrease in number of cigarettes smoked and triggered positive movement in stage of change towards smoking cessation compared to the control subjects. For these subjects, positive changes in self-efficacy for one behavior (weight control) appeared to have a positive effect on their readiness to change another health behavior (smoking cessation). Further study of the psychological variables that influence weight-concerned female smokers’ decisions to initiate changes in these behaviors and their ability to maintain those changes are warranted.

Pressure ulcers and nutritional deficits in elderly long-term care patients: Effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: (1) pressure ulcer wound healing (2) length of hospital stays, and (3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SID-12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

An investigation of the strategies used by organizations participating in the welfare-to-work network program and correlation of the strategies with the retention data to determine best practices for job retention among former welfare recipients

This ex post facto study (N = 209) examined the relationships between employer job strategies and job retention among organizations participating in Florida welfare-to-work network programs and associated the strategies with job retention data to determine best practices. ^ An internet-based self-report survey battery was administered to a heterogeneous sampling of organizations participating in the Florida welfare-to-work network program. Hypotheses were tested through correlational and hierarchical regression analytic procedures. The partial correlation results linked each of the job retention strategies to job retention. Wages, benefits, training and supervision, communication, job growth, work/life balance, fairness and respect were all significantly related to job retention. Hierarchical regression results indicated that the training and supervision variable was the best predictor of job retention in the regression equation. ^ The size of the organization was also a significant predictor of job retention. Large organizations reported higher job retention rates than small organizations. There was no statistical difference between the types of organizations (profit-making and non-profit) and job retention. The standardized betas ranged from to .26 to .41 in the regression equation. Twenty percent of the variance in job retention was explained by the combination of demographic and job retention strategy predictors, supporting the theoretical, empirical, and practical relevance of understanding the association between employer job strategies and job retention outcomes. Implications for adult education and human resource development theory, research, and practice are highlighted as possible strategic leverage points for creating conditions that facilitate the development of job strategies as a means for improving former welfare workers’ job retention.^

Understanding the relationship between the Talented Twenty program and college aspirations for high ranking students at a high priority school

Percentage plans such as the Talented Twenty program purport to assist and motivate high ranking students to attend college and grant access to higher education. This type of plan is particularly important to students enrolled in high priority schools who might not view themselves as potential college students. This study examined the relationship between Florida’s Talented Twenty program that begins intervention with juniors and the college aspirations for high ranking students at a high priority school. Numerous studies have established that increased levels of education lead to higher salaries, career mobility, and an increased quality of life (e.g., Bowen, 1997; Leslie & Brinkman 1988; Pascarella & Terenzini, 1991, Swail, 2000). Given the importance of students’ decisions regarding whether or not they will attend college, understanding how and when they make decisions about attending college is important for them, their parents, advisors, and educational administrators. This research examined students’ perceptions and insights via interviews. The overarching research question was: How do high ranking high school students attending a high priority school in a south Florida district perceive their college opportunities? Sixteen high ranking students, grades nine – 12 from a high priority school in Miami-Dade County participated in the study. Participants were identified by a school counselor and individual semi structured interviews were conducted at the school. Utilizing a student development theoretical framework developed by Hossler and Gallagher (1987) that centered on students’ predisposition, search strategies and choices, data were organized and emergent themes analyzed. The analysis of the data revealed that in alignment with the framework (a) parents were the strongest influence in the development of these students’ college aspirations, (b) these students formalized their higher education plans between eighth and 10th grade, (c) these students actively engaged in academic searches and learning opportunities that increased their chances to be admitted into college, and (d) there was no relationship between knowledge regarding the Talented Twenty program and their educational decisions. This study’s findings suggest that interventions and programs intended to influence the educational aspirations of students are more likely to succeed if they take place by the eighth or ninth grade.

Swimming against the tide: A study of a youth enrichment program seeking to empower inner-city Black youth

Serious inequities in our K-12 public education system, particularly in regard to the quality of education in predominately Black inner-city schools, are well-documented in the literature (Freeman, 1998; Ross, 1998). Moreover, there is general agreement that the most effective means of ameliorating that situation is through well-thought-out after-school programs and partnership initiatives (Beck, 1993; Gardner et al., 2001). ^ The purpose of this qualitative study was to examine the programmatic interventions of a youth enrichment program for inner-city Black youth currently in place at the Overtown Youth Center (OYC) in Miami, Florida, in order to: (a) discern those factors that support its claim that it is making a difference in students’ lives, (b) explore how any such factors are implemented, and (c) determine whether its interventions have served to equalize the playing field for these youth. ^ Two primary methods of data collection were used for this study. The first was participant observation conducted over the course of two years through a partnership initiative established and led by this author. The second was through in-depth interviews of the Center’s founder, staff, and students. Secondary methods used were the recording of informal conversations and the analysis of written documents. ^ Analysis of the data yielded four features of the Center that are indispensible to the students’ growth. The center provides the youth with (a) physical and psychological safety, (b) supportive relationships, (c) exposure to cultural and educational opportunities, and (d) assistance in building self-esteem. ^ The most significant finding of the study was that OYC has been successful at making a difference in students’ lives and at increasing their aspirations to attend college. By addressing the full spectrum of their needs, the Center has given them many of the necessary tools with which to compete and thereby helped equalize their opportunities to succeed in school and in life. ^ The study also noted a number of challenges for the Center to examine. The main issues that need to be addressed more seriously are staff turnover, staff indifference, nepotism, inconsistent student attendance, and insufficient focus on racial issues and African-American-centered education. Meeting those challenges would engender even greater positive outcomes.^