Validation of the WHOQOL-BREF among women following childbirth

Background: There is an increasing interest in measuring quality of life (QOL) in clinical settings and in clinical trials. None of the commonly used QOL instrument have been validated for use postnatally. Aim: To assess the psychometric properties of the 26-item WHOQOL-BREF among women following childbirth. Methods: Using a prospective cohort design we recruited 320 women within the first few days of childbirth. At six weeks postpartum, participants were asked to complete the WHOQOL-BREF, the Edinburgh Postnatal Depression Index and the Australian Unity Wellbeing Index. Validation of the WHOQOL-BREF included an analysis of internal consistency, discriminate validity, convergent validity and an examination of the domain structure. Results: 221 (69.1%) women returned their six-week questionnaire. All domains of the WHOQOL-BREF met reliability standards (alpha coefficient exceeding 0.70). The questionnaire discriminated well between known groups (depressed and non-depressed women. P = <0.000) and demonstrated satisfactory correlations with the Australian Unity Wellbeing index (r = >0.45). The domain structure of the WHOQOL-BREF was also valid in this population of new mothers, with moderate to high correlation between individual items and the domain structure to which the items were originally assigned. Conclusion: The WHOQOL-BRF is well-accepted and valid instrument in this population and may be used in postnatal clinical settings or for assessing intervention effects in research studies.

Students as decoders of graphics in mathematics

This paper reports on students’ ability to decode mathematical graphics. The findings were: (a) some items showed an insignificant improvement over time; (b) success involves identifying critical perceptual elements in the graphic and incorporating these elements into a solution strategy; and (c) the optimal strategy capitalises on how information is encoded in the graphic. Implications include a need for teachers to be proactive in supporting students’ to develop their graphical knowledge and an awareness that knowledge varies substantially across students.

The risky behaviour of young drivers : developing a measurement tool

The contribution of risky behaviour to the increased crash and fatality rates of young novice drivers is recognised in the road safety literature around the world. Exploring such risky driver behaviour has led to the development of tools like the Driver Behaviour Questionnaire (DBQ) to examine driving violations, errors, and lapses [1]. Whilst the DBQ has been utilised in young novice driver research, some items within this tool seem specifically designed for the older, more experienced driver, whilst others appear to asses both behaviour and related motives. The current study was prompted by the need for a risky behaviour measurement tool that can be utilised with young drivers with a provisional driving licence. Sixty-three items exploring young driver risky behaviour developed from the road safety literature were incorporated into an online survey. These items assessed driver, passenger, journey, car and crash-related issues. A sample of 476 drivers aged 17-25 years (M = 19, SD = 1.59 years) with a provisional driving licence and matched for age, gender, and education were drawn from a state-wide sample of 761 young drivers who completed the survey. Factor analysis based upon a principal components extraction of factors was followed by an oblique rotation to investigate the underlying dimensions to young novice driver risky behaviour. A five factor solution comprising 44 items was identified, accounting for 55% of the variance in young driver risky behaviour. Factor 1 accounted for 32.5% of the variance and appeared to measure driving violations that were transient in nature - risky behaviours that followed risky decisions that occurred during the journey (e.g., speeding). Factor 2 accounted for 10.0% of variance and appeared to measure driving violations that were fixed in nature; the risky decisions being undertaken before the journey (e.g., drink driving). Factor 3 accounted for 5.4% of variance and appeared to measure misjudgment (e.g., misjudged speed of oncoming vehicle). Factor 4 accounted for 4.3% of variance and appeared to measure risky driving exposure (e.g., driving at night with friends as passengers). Factor 5 accounted for 2.8% of variance and appeared to measure driver emotions or mood (e.g., anger). Given that the aim of the study was to create a research tool, the factors informed the development of five subscales and one composite scale. The composite scale had a very high internal consistency measure (Cronbach’s alpha) of .947. Self-reported data relating to police-detected driving offences, their crash involvement, and their intentions to break road rules within the next year were also collected. While the composite scale was only weakly correlated with self-reported crashes (r = .16, p < .001), it was moderately correlated with offences (r = .26, p < .001), and highly correlated with their intentions to break the road rules (r = .57, p < .001). Further application of the developed scale is needed to confirm the factor structure within other samples of young drivers both in Australia and in other countries. In addition, future research could explore the applicability of the scale for investigating the behaviour of other types of drivers.

Evolution of vocational rehabilitation competencies in Australia

Over the past decade, there has been growth in the delivery of vocational rehabilitation services globally, as countries seek to control disability-related expenditure, yet there has been minimal research outside the United States on competencies required to work in this area. This study reports on research conducted in Australia to determine current job function and knowledge areas in terms of their importance and frequency of use in the provision of vocational rehabilitation. A survey comprising items from the Rehabilitation Skills Inventory-Amended and International Survey of Disability Management was completed by 149 rehabilitation counselors and items submitted to factor analysis. T-tests and analyses of variance were used to determine differences between scores of importance and frequency and differences in scores based on work setting and professional training. Six factors were identified as important and frequently used: (i) vocational counseling, (ii) professional practice, (iii) personal counseling, (iv) rehabilitation case management, (v) workplace disability case management, and (vi) workplace intervention and program management. Vocational counseling, professional practice and personal counseling were significantly more important and performed more frequently by respondents in vocational rehabilitation settings than those in compensation settings. These same three factors were rated significantly higher in importance and frequency by those with rehabilitation counselor training when compared with those with other training. In conclusion, although ‘traditional’ knowledge and skill areas such as vocational counseling, professional practice, and personal counseling were identified as central to vocational rehabilitation practice in Australian rehabilitation agencies, mean ratings suggest a growing emphasis on knowledge and skills associated with disability management practice.

Validation of the Algase Wandering Scale (Version 2) in a cross cultural sample

This study examined the psychometric properties of an expanded version of the Algase Wandering Scale (Version 2) (AWS-V2) in a cross-cultural sample. A cross-sectional survey design was used. Study subjects were 172 English-speaking persons with dementia (PWD) from long-term care facilities in the USA, Canada, and Australia. Two or more facility staff rated each subject on the AWS-V2. Demographic and cognitive data (MMSE) were also obtained. Staff provided information on their own knowledge of the subject and of dementia. Separate factor analyses on data from two samples of raters each explained greater than 66% of the variance in AWS-V2 scores and validated four (persistent walking, navigational deficit, eloping behavior, and shadowing) of five factors in the original scale. Items added to create the AWS-V2 strengthened the shadowing subscale, failed to improve the routinized walking subscale, and added a factor, attention shifting as compared to the original AWS. Evidence for validity was found in significant correlations and ANOVAs between the AWS-V2 and most subscales with a single item indicator of wandering and with the MMSE. Evidence of reliability was shown by internal consistency of the AWS-V2 (0.87, 0.88) and its subscales (range 0.88 to 0.66), with Kappa for individual items (17 of 27 greater than 0.4), and ANOVAs comparing ratings across rater groups (nurses, nurse aids, and other staff). Analyses support validity and reliability of the AWS-V2 overall and for persistent walking, spatial disorientation, and eloping behavior subscales. The AWS-V2 and its subscales are an appropriate way to measure wandering as conceptualized within the Need-driven Dementia-compromised Behavior Model in studies of English-speaking subjects. Suggestions for further strengthening the scale and for extending its use to clinical applications are described.

The first Australian nurse practitioner census : a protocol to guide standardized collection of information about an emergent professional group

Internationally, collection of reliable data on new and evolving health-care roles is crucial. We describe a protocol for design and administration of a national census of an emergent health-care role, namely nurse practitioners in Australia using databases held by regulatory authorities. A questionnaire was developed to obtain data on the role and scope of practice of Australian nurse practitioners. Our tool comprised five sections and included a total of 56 questions, using 28 existing items from the National Nursing and Midwifery Labour Force Census and nine items recommended in the Nurse Practitioner Workforce Planning Minimum Data Set. Australian Nurse Registering Authorities (n = 6) distributed the survey on our behalf. This paper outlines our instrument and methods. The survey was administered to 238 authorized Australian nurse practitioners (85% response rate). Rigorous collection of standardized items will ensure health policy is informed by reliable and valid data. We will re-administer the survey 2 years following the first survey to measure change over time.

Maternal feeding practices and feeding behaviors of Australian children aged 12 to 36 months

Objectives To explore parents' perceptions of the eating behaviors and related feeding practices of their young children. Methods Mothers (N=740) of children aged 12 to 36 months and born in South Australia were randomly selected by birth date in four 6-month age bands from a centralized statewide database and invited to complete a postal questionnaire. Results Valid completed questionnaires were returned for 374 children (51% response rate; 54% female). Although mothers generally reported being confident and happy in feeding their children, 23% often worried that they gave their child the right amount of food. Based on a checklist of 36 specified items, 15% of children consumed no vegetables in the previous 24 hours, 11% no fruit and for a further 8% juice was the only fruit. Of 12 specified high fat/sugar foods and drinks, 11% of children consumed none, 20% one, 26% two, and 43% three or more. Six of eight child-feeding practices that promote healthy eating behaviors were undertaken by 75% parents 'often' or 'all of the time'. However, 8 of 11 practices that do not promote healthy eating were undertaken by a third of mothers at least ‘sometimes’. Conclusions In this representative sample, dietary quality issues emerge early and inappropriate feeding practices are prevalent thus identifying the need for very early interventions that promote healthy food preferences and positive feeding practices. Such programs should focus not just on the 'what', but also the 'how' of early feeding, including the feeding relationship and processes appropriate to developmental stage. Key words: Maternal feeding practices, infants, obesity

Adherence to medicines in the older-aged with chronic conditions : does an intervention concerning adherence by an allied health professional help?

Adherence to medicines is a major determinant of the effectiveness of medicines. However, estimates of non-adherence in the older-aged with chronic conditions vary from 40 to 75%. The problems caused by non-adherence in the older-aged include residential care and hospital admissions, progression of the disease, and increased costs to society. The reasons for non-adherence in the older-aged include items related to the medicine (e.g. cost, number of medicines, adverse effects) and those related to person (e.g. cognition, vision, depression). It is also known that there are many ways adherence can be increased (e.g. use of blister packs, cues). It is assumed that interventions by allied health professions, including a discussion of adherence, will improve adherence to medicines in the older aged but the evidence for this has not been reviewed. There is some evidence that telephone counselling about adherence by a nurse or pharmacist does improve adherence, short- and long-term. However, face-to-face intervention counselling at the pharmacy, or during a home visit by a pharmacist, has shown variable results with some studies showing improved adherence and some not. Education programs during hospital stays have not been shown to improve adherence on discharge, but education programs for subjects with hypertension have been shown to improve adherence. In combination with an education program, both counselling and a medicine review program have been shown to improve adherence short-term in the older-aged. Thus, there are many unanswered questions about the most effective interventions to promote adherence. More studies are needed to determine the most appropriate interventions by allied health professions, and these need to consider the disease state, demographics, and socio-economic status of the older-aged subject, and the intensity and duration of intervention needed.

Psychometric analysis of the Brisbane Practice Environment Measure (B-PEM)

Purpose: To undertake rigorous psychometric testing of the newly developed contemporary work environment measure (the Brisbane Practice Environment Measure [B-PEM]) using exploratory factor analysis and confirmatory factor analysis. Methods: Content validity of the 33-item measure was established by a panel of experts. Initial testing involved 195 nursing staff using principal component factor analysis with varimax rotation (orthogonal) and Cronbach's alpha coefficients. Confirmatory factor analysis was conducted using data from a further 983 nursing staff. Results: Principal component factor analysis yielded a four-factor solution with eigenvalues greater than 1 that explained 52.53% of the variance. These factors were then verified using confirmatory factor analysis. Goodness-of-fit indices showed an acceptable fit overall with the full model, explaining 21% to 73% of the variance. Deletion of items took place throughout the evolution of the instrument, resulting in a 26-item, four-factor measure called the Brisbane Practice Environment Measure-Tested. Conclusions: The B-PEM has undergone rigorous psychometric testing, providing evidence of internal consistency and goodness-of-fit indices within acceptable ranges. The measure can be utilised as a subscale or total score reflective of a contemporary nursing work environment. Clinical Relevance: An up-to-date instrument to measure practice environment may be useful for nursing leaders to monitor the workplace and to assist in identifying areas for improvement, facilitating greater job satisfaction and retention.

Optimism about safety and group-serving interpretations of safety among pedestrians and cyclists in relation to road use in general and under low light conditions

Drivers are known to be optimistic about their risk of crash involvement, believing that they are less likely to be involved in a crash than other drivers. However, little comparative research has been conducted among other road users. In addition, optimism about crash risk is conceptualised as applying only to an individual’s assessment of his or her personal risk of crash involvement. The possibility that the self-serving nature of optimism about safety might be generalised to the group-level as a cyclist or a pedestrian, i.e., becoming group-serving rather than self-serving, has been overlooked in relation to road safety. This study analysed a subset of data collected as part of a larger research project on the visibility of pedestrians, cyclists and road workers, focusing on a set of questionnaire items administered to 406 pedestrians, 838 cyclists and 622 drivers. The items related to safety in various scenarios involving drivers, pedestrians and cyclists, allowing predictions to be derived about group differences in agreement with items based on the assumption that the results would exhibit group-serving bias. Analysis of the responses indicated that specific hypotheses about group-serving interpretations of safety and responsibility were supported in 22 of the 26 comparisons. When the nine comparisons relevant to low lighting conditions were considered separately, seven were found to be supported. The findings of the research have implications for public education and for the likely acceptance of messages which are inconsistent with current assumptions and expectations of pedestrians and cyclists. They also suggest that research into group-serving interpretations of safety, even for temporary roles rather than enduring groups, could be fruitful. Further, there is an implication that gains in safety can be made by better educating road users about the limitations of their visibility and the ramifications of this for their own road safety, particularly in low light.

Mentors report on their own mentoring practices

There are only two ways to implement reform in an education system, namely through inservice education of existing teachers and preservice teacher education. Implementing the Australian Curriculum will require targeting both teachers and preservice teachers. Classroom teachers in their roles as mentors have a significant role to play for developing preservice teachers. What mentors do in their mentoring practices and what mentors think about mentoring will impact on the mentoring processes and ultimately reform outcomes. What are mentors’ reports on their mentoring of preservice teachers in science and mathematics? This mixed-method study presents mentors’ reports on their mentoring of primary preservice teachers (mentees) in mathematics (n=43) and science (n=29). Drawing upon a previously validated instrument (Hudson, 2007), this instrument was amended to allow mentors to report on their perceptions of their mentoring. A questionnaire elicited extended written responses that focused on: (1) the mentors’ rapport with their mentees, (2) successful mentoring strategies, (3) aspects that may lead the mentee to feel unsuccessful, and (4) ways to enhance their mentoring skills. Mentors claimed they mentored teaching mathematics more than science. However, 20% or more indicated they did not provide mentoring practices for 25 out of 34 survey items in the science and 9 out of 34 items in the mathematics. Educational reform will necessity mentors to be educated on effective mentoring practices so the mentoring process can be more purposeful. Indeed, mentors who have knowledge of such practices may address the potential issues of more than 20% of mentees not receiving these practices. These mentors also claimed that professional development on effective mentoring can enhance their skills. To ensure the greatest success for an Australian Curriculum will require targeting mentors for professional development in order to assist mentees’ development into the profession.

Preservice teachers’ memories of their secondary science education experiences

Understanding preservice teachers’ memories of their education may aid towards articulating high-impact teaching practices. This study describes 246 preservice teachers’ perceptions of their secondary science education experiences through a questionnaire and 28-item survey. ANOVA was statistically significant about participants’ memories of science with 15 of the 28 survey items. Descriptive statistics through SPSS further showed that a teacher’s enthusiastic nature (87%) and positive attitude towards science (87%) were regarded as highly memorable. In addition, explaining abstract concepts well (79%), and guiding the students’ conceptual development with practical science activities (73%) may be considered as memorable secondary science teaching strategies. Implementing science lessons with one or more of these memorable science teaching practices may “make a difference” towards influencing high school students’ positive long-term memories about science and their science education. Further research in other key learning areas may provide a clearer picture of high-impact teaching and a way to enhance pedagogical practices.

Safety in occupational driving : development of a driver behaviour scale for the workplace context

International statistics indicate that occupational, or work-related driving, crashes are the most common cause of workplace injury, death, and absence from work. The majority of research examining unsafe driver behavior in the workplace has relied on general road safety questionnaires. However, past research has failed to consider the organizational context in the use of these questionnaires, and as such, there is ambiguity in the dimensions constituting occupational driving. Using a theoretical model developed by Hockey (1993, 1997), this article proposes and validates a new scale of occupational driver behavior. This scale incorporates four dimensions of driver behavior that are influenced by demanding workplace conditions; speeding, rule violation, inattention, and driving while tired. Following a content validation process, three samples of occupational drivers in Australia were used to assess the scale. Data from the first sample (n=145) were used to reduce the number of scale items and provide an assessment of the factorial validity of the scale. Data from the second sample (n=645) were then used to confirm the factor structure and psychometric properties of the scale including reliability and construct validity. Finally, data from the third sample (n=248) were used to establish criterion validity. The results indicated that the scale is a reliable and valid measure of occupational driver behavior.

Improving governance : practical methods and an analytic framework for the enhancement of democracy

Seven endemic governance problems are shown to be currently present in governments around the globe and at any level of government as well (for example municipal, federal). These problems have their roots traced back through more than two thousand years of political, specifically ‘democratic’, history. The evidence shows that accountability, transparency, corruption, representation, campaigning methods, constitutionalism and long-term goals were problematic for the ancient Athenians as well as modern international democratisation efforts encompassing every major global region. Why then, given the extended time period humans have had to deal with these problems, are they still present? At least part of the answer to this question is that philosophers, academics and NGOs as well as MNOs have only approached these endemic problems in a piecemeal manner with a skewed perspective on democracy. Their works have also been subject to the ebbs and flows of human history which essentially started and stopped periods of thinking. In order to approach the investigation of endemic problems in relation to democracy (as the overall quest of this thesis was to generate prescriptive results for the improvement of democratic government), it was necessary to delineate what exactly is being written about when using the term ‘democracy’. It is common knowledge that democracy has no one specific definition or practice, even though scholars and philosophers have been attempting to create a definition for generations. What is currently evident, is that scholars are not approaching democracy in an overly simplified manner (that is, it is government for the people, by the people) but, rather, are seeking the commonalities that democracies share, in other words, those items which are common to all things democratic. Following that specific line of investigation, the major practiced and theoretical versions of democracy were thematically analysed. After that, their themes were collapsed into larger categories, at which point the larger categories were comparatively analysed with the practiced and theoretical versions of democracy. Four democratic ‘particles’ (selecting officials, law, equality and communication) were seen to be present in all practiced and theoretical democratic styles. The democratic particles fused with a unique investigative perspective and in-depth political study created a solid conceptualisation of democracy. As such, it is argued that democracy is an ever-present element of any state government, ‘democratic’ or not, and the particles are the bodies which comprise the democratic element. Frequency- and proximity-based analyses showed that democratic particles are related to endemic problems in international democratisation discourse. The linkages between democratic particles and endemic problems were also evident during the thematic analysis as well historical review. This ultimately led to the viewpoint that if endemic problems are mitigated the act may improve democratic particles which might strengthen the element of democracy in the governing apparatus of any state. Such may actively minimise or wholly displace inefficient forms of government, leading to a government specifically tailored to the population it orders. Once the theoretical and empirical goals were attained, this thesis provided some prescriptive measures which government, civil society, academics, professionals and/or active citizens can use to mitigate endemic problems (in any country and at any level of government) so as to improve the human condition via better democratic government.

Predictors of future falls in Parkinson disease

Background: Falls are a major health and injury problem for people with Parkinson disease (PD). Despite the severe consequences of falls, a major unresolved issue is the identification of factors that predict the risk of falls in individual patients with PD. The primary aim of this study was to prospectively determine an optimal combination of functional and disease-specific tests to predict falls in individuals with PD. ----- ----- Methods: A total of 101 people with early-stage PD undertook a battery of neurologic and functional tests in their optimally medicated state. The tests included Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk; the latter assessment includes physiologic tests of visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway. Falls were recorded prospectively over 6 months. ----- ----- Results: Forty-eight percent of participants reported a fall and 24% more than 1 fall. In the multivariate model, a combination of the Unified Parkinson's Disease Rating Scale (UPDRS) total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction produced the best sensitivity (78%) and specificity (84%) for predicting falls. From the UPDRS items, only the rapid alternating task category was an independent predictor of falls. Reduced peripheral sensation and knee extension strength in fallers contributed to increased postural instability. ----- ----- Conclusions: Falls are a significant problem in optimally medicated early-stage PD. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with PD.