Impact evaluation of a five-day short course in health promotion: workforce development in action

Issue addressed: This paper reports on impact evaluation of a series of five-day Short Courses in Health Promotion that have been delivered to more than 2,000 people since 2002 as part of a statewide workforce development strategy.

Methods: A triangulated mixed methods research design was selected for the evaluation. Data were collected through a mail survey, key informant interviews, focus groups and organisational case studies. Stakeholder and participant involvement were central to the evaluation.

Results: Organisational change emerged as a key theme. Impacts of the short course were felt in relation to health promotion practice and on organisational capacity to conduct health promotion, while the development of confidence and skills of participants to engage in collaborative opportunities was a not unexpected, but important, benefit of the course.

Conclusions: A short course is effective if attention is given to quality delivery, adult learning methods, participant involvement, appropriate targeting, good planning, and adequate funding. However, respondents commonly report the need for organisational change in order for health promotion practice to be embedded into organisations and for practitioners to be supported in their efforts to re-orient services towards health promotion.

General practitioners’ decision to refer patients to dietitians : insight into the clinical reasoning process

The aim of this project was to describe general practitioners’ (GPs’) decision-making process for reducing nutrition risk in cardiac patients through referring a patient to a dietitian. The setting was primary care practices in Victoria. The method we employed was mixed methods research: in Study 1, 30 GPs were interviewed. Recorded interviews were transcribed and narratives analysed thematically. Study 2 involved a survey of statewide random sample of GPs. Frequencies and analyses of variance were used to explore the impact of demographic variables on decisions to refer. We found that the referral decision involved four elements: (i) synthesising management information; (ii) forecasting outcomes; (iii) planning management; and (iv) actioning referrals. GPs applied cognitive and collaborative strategies to develop a treatment plan. In Study 2, doctors (248 GPs, 30%) concurred with identified barriers/enabling factors for patients’ referral. There was no association between GPs’ sex, age or hours worked per week and referral factors. We conclude that a GP’s judgment to offer a dietetic referral to an adult patient is a four element reasoning process. Attention to how these elements interact may assist clinical decision making. Apart from the sole use of prescribed medications/surgical procedures for cardiac care, patients offered a dietetic referral were those who were considered able to commit to dietary change and who were willing to attend a dietetic consultation. Improvements in provision of patients’ nutrition intervention information to GPs are needed. Further investigation is justified to determine how to resolve this practice gap.

Neighbourhood environments and children's social capital : investigating the pattern of relationships

The main purpose of this work was to investigate the pattern of relationships among three constructs: neighbourhood socio-physical environment, children's social interactions and their social capital. This work was designed as a two-phase mixed-methods research. Phase I included several qualitative studies to develop a scale of neighbourhood socio-physical environment, a scale of children's social interactions and a scale of children's social capital. Phase II was a cross-national survey that used these three scales to collect information from high school students in Beijing and Sydney. The main finding of this work was that there were strong and significant correlations among the three constructs. Children's assessment of their neighbourhood socio-physical environment was positively correlated with their social interactions and social capital, which indicated that children who lived in better neighbourhoods had more social interactions and larger volumes of social capital. Strong positive relationship was also found between children's social interactions and social capital, which implied that better-connected children interacted with their friends more.

Communities of inquiry: developing digital literacies in teachers and students

Teachers’ and students’ classroom work is increasingly described as knowledge work conducted in a in a rapidly changing globalised, digital world. To enable teachers to effectively support students in the shifting contexts created by constantly emerging new technologies, teacher professional learning has gained prominence as a priority area in education (Yates, 2007). This paper reports on research into teacher and student learning of digital literacies within the context of a project undertaken by a university and an educational authority. The professional learning project was designed to enable practising teachers to engage their students with digital literacies.The project seeks to offer innovative, differentiated professional learning by combining the concept of a collaborative learning community with structures of distributed leadership and processes of inquiry learning. The mixed methods research explored teacher and student learning through online surveys and case studies. Initial findings indicate that teacher agency, knowledge creation and commitment to sustained pedagogical change were fostered through inter- and intra-school communities of inquiry. Purposeful development of digital tools, within the context of teacher inquiry, collaboration and distributed leadership, led to increased and discerning use of these tools by teachers. As a result students had greater school-based access to digital tools and teachers and students worked collaboratively to develop their digital literacies.

The implementation of effective dual-language programs

[EN]This research investigates the ways of implementing dual-language programs and the schools’ internal procedures of evaluating them. Previous studies have examined the effectiveness of bilingual programs (Genovesee et al. 2005; Howard et al. 2005; Krashen 2004). However, there is little still known about schools’ procedures that systematize the organizational aspect of such programs. The Mixed Methods Research (MMR) approach was applied in this study to analyze data collected through questionnaires, interviews, and case studies.

Enhancing Workers’ Well-Being. Scientific and social relevance of managing stress in the workplace

Purpose. Despite work-related stress is one of the most studied topic in organizational psychology, many aspects as for example the use of different measures (e.g. subjective and objective, qualitative and quantitative) are still under debate. According to this, in order to enhance knowledge concerning which factors and processes contribute to create healthy workplaces, this thesis is composed by four different studies aiming to understand: a) the role of relevant antecedents (e.g. leadership, job demands, work-family conflict, social support etc.) and outcomes (e.g. workplace phobia, absenteeism etc.) of work-related stress; and b) how to manage psychosocial risk factors in the workplace. The studies. The first study focused on how disagreement between supervisors and their employees on leadership style (transformational and transactional) could affect workers well-being and work team variables. The second and third study used both subjective and objective data in order to increase the quality of the reliability of the results gained. Particularly, the second study focused on job demand and its relationship with objective sickness leave. Findings showed that despite there is no direct relationship between these two variables, job demand affects work-family conflict, which in turn affect exhaustion, which leads to absenteeism. The third study analysed the role of a new concept never studied before in organizational settings (workplace phobia), as a health outcome in the JD-R model, demonstrating also its relationship with absenteeism. The last study highlighted the added value of using the mixed methods research approach in order to detect and analyse context-specific job demands which could affects workers’ health. Conclusion. The findings of this thesis answered both to open questions in the scientific literature and to the social request of managing psychosocial risk factors in the workplace in order to enhance workers well-being.

Certificación medioambiental, competitividad y resultado empresarial: un estudio híbrido en el sector hotelero

La Responsabilidad Social en general, y la Gestión Medioambiental en particular, pueden influir sobre el resultado y la competitividad de las empresas. El objetivo principal de este trabajo es analizar la relación entre certificación medioambiental, rendimiento medioambiental, competitividad y resultado empresarial en el sector hotelero español. Además, también se analizan y comparan los niveles alcanzados de proactividad medioambiental para el grupo de hoteles certificados y no certificados. El método de investigación utilizado es híbrido, combinando una parte cualitativa con otra cuantitativa. Los resultados indican que los hoteles que tienen certificado su sistema de Gestión Medioambiental alcanzan mayores niveles de resultado en términos de porcentaje de ocupación e ingresos por habitación disponible (RevPAR). Además, los hoteles certificados obtienen un mejor rendimiento medioambiental. Con relación a la ventaja competitiva, los hoteles certificados desarrollan una ventaja en diferenciación significativamente superior.

Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

Extreme weather events and construction SMEs:vulnerability, impacts and responses

Purpose – The UK experienced a number of Extreme Weather Events (EWEs) during recent years and a significant number of businesses were affected as a result. With the intensity and frequency of weather extremes predicted in the future, enhancing the resilience of businesses, especially of Small and Medium-sized Enterprises (SMEs), who are considered as highly vulnerable, has become a necessity. However, little research has been undertaken on how construction SMEs respond to the risk of EWEs. In seeking to help address this dearth of research, this investigation sought to identify how construction SMEs were being affected by EWEs and the coping strategies being used. Design/methodology/approach – A mixed methods research design was adopted to elicit information from construction SMEs, involving a questionnaire survey and case study approach. Findings – Results indicate a lack of coping strategies among the construction SMEs studied. Where the coping strategies have been implemented, these were found to be extensions of their existing risk management strategies rather than radical measures specifically addressing EWEs. Research limitations/implications – The exploratory survey focused on the Greater London area and was limited to a relatively small sample size. This limitation is overcome by conducting detailed case studies utilising two SMEs whose projects were located in EWE prone localities. The mixed method research design adopted benefits the research by presenting more robust findings. Practical implications – A better way of integrating the potential of EWEs into the initial project planning stage is required by the SMEs. This could possibly be achieved through a better risk assessment model supported by better EWE prediction data. Originality/value – The paper provides an original contribution towards the overarching agenda of resilience of SMEs and policy making in the area of EWE risk management. It informs both policy makers and practitioners on issues of planning and preparedness against EWEs.

The role of wisdom in organisational leadership

This thesis begins with a review of the literature on wisdom models, theories of wise leadership, and existing wisdom measures. It continues with a review of how the concept of wisdom may add value to existing leadership models, highlighting the need to empirically identify the characteristics of wise leaders and develop a wise leadership measure. A nomological framework for wise leadership is then presented. Based on a review of the wisdom and leadership paradigms, a mixed-methods research design is described for three studies to define the characteristics of wise leadership in organisations; identify specific leadership challenges that might require wise responses; and to develop the wise leadership measure comprising of vignettes. The first study involves critical incident interviews with 26 nominated wise leaders and 23 of their nominators, which led to the identification of nine wise leadership dimensions which include Strong Ethical Code, Strong Judgement, Optimising Positive Outcomes, Managing Uncertainty, Strong Legacy, Leading with Purpose, Humanity, Humility, and Self-Awareness. The second study includes critical incident interviews with 20 leaders about organisational challenges associated with the nine dimensions, to elucidate the wise leadership measure. The third study includes the design of 45 vignettes based on organisational challenges that measure the nine wise leadership dimensions. The measure is then administered to 250 organisational leaders to establish its construct validity, leading to the selection of 18 vignettes forming the final wise leadership measure. Theoretical, methodological and practical implications of this research are then discussed with recommendations for future research.

Community Development Districts: The entrepreneurial side of government

In an effort to reduce the cost and size of government public service delivery has become more decentralized, flexible and responsive. Public entrepreneurship entailed, among other things, the establishment of special-purpose governments to finance public services and carry out development projects. Community Development Districts (CDDs) are a type of special-purpose governments whose purpose is to manage and finance infrastructure improvements in the State of Florida. They have important implications for the way both growth management and service delivery occur in the United States. This study examined the role of CDDs for growth management policy and service delivery by analyzing the CDD profile and activity, the contribution of CDDs to the growth management and infrastructure development as well as the way CDD perceived pluses and minuses impact service delivery. The study used a mixed methods research approach, drawing on secondary data pertaining to CDD features and activity, semi-structured interviews with CDD representatives and public officials as well as on a survey of public officials within the counties and cities that have established CDDs. Findings indicated that the CDD institutional model is both a policy and a service delivery tool for infrastructure provision that can be adopted by states across the United States. Results showed that CDDs inhibit rather than foster growth management through their location choices, type and pattern of development. CDDs contributed to the infrastructure development in Florida by providing basic infrastructure services for the development they supported and by building and dedicating facilities to general-purpose governments. Districts were found to be both funding mechanisms and management tools for infrastructure services. The study also pointed to the fact that specialized governance is more responsive and more flexible but less effective than general-purpose governance when delivering services. CDDs were perceived as being favorable for developers and residents and not as favorable for general-purpose governments. Overall results indicated that the CDD is a flexible institutional mechanism for infrastructure delivery which has both advantages and disadvantages. Decision-makers should balance districts’ institutional flexibility with their unintended consequences for growth management when considering urban public policies.

A study of the relationship between educational placement and the achievement of urban low socioeconomic Hispanic middle school students with and without specific learning disabilities

Public schools traditionally have been held accountable for educating the majority of the nation’s school children, and through the years, these schools have been evaluated in a variety of ways. Currently, evaluation measures for accountability purposes consist solely of standardized test scores. In the past, only test scores of general education students were analyzed. Laws governing the education of students with disabilities, however, have extended accountability measures not only to include those students, but to report their scores in a disaggregated form (No Child Left Behind Act, 2001). The recent emphasis on accountability and compliance has resulted in the need for schools to carefully examine how programs, services, and policies impact student achievement (Bowers & Figgers, 2003). ^ Standard-based school reform and accountability systems have raised expectations about student learning outcomes for all students, including those with disabilities and minority students. Yet, overall, racial/ethnic minority students are performing well below their White non-Hispanic peers in most academic areas. Additionally, with respect to special education, there exists an enduring problem of disproportionate representation of racial/ethnic minority students (National Research Council, 2000). ^ This study examined classroom placement (inclusive versus non-inclusive) relative to academic performance of urban, low socioeconomic Hispanic students with and without disabilities in secondary content area classrooms. A mixed method research design was used to investigate this important issue using data from a local school district and results from field observations. The study compared performance levels of four middle school Hispanic student subgroups (students with disabilities in inclusive settings, students without disabilities in inclusive settings, students with disabilities in resource settings, and student without disabilities in general education settings) each in their respective placements for two consecutive years, exploring existing practices within authentic settings. ^ Significant differences were found in the relationship of educational placement and achievement between grade level and disability in the areas of math and reading. Additionally, clear and important differences were observed in student-teacher interactions. Recommendations for further researchers and stakeholders include soliciting responses from teams at the schools composed of general education and special education teachers, administrative personnel, and students as well as broadening the study across grade levels and exceptionalities. ^

Sustainable rural development through alternative economic networks: Redefining relations in the commodity chain for export vegetables in western Guatemala

The current research considers the capacity of a local organic food system for producer and consumer empowerment and sustainable development outcomes in western Guatemala. Many have argued that the forging of local agricultural networks linking farmers, consumers, and supporting institutions is an effective tool for challenging the negative economic, environmental, and sociopolitical impacts associated with industrial models of global food production. But does this work in the context of agrarian development in the developing world? Despite the fact that there is extensive literature concerning local food system formation in the global north, there remains a paucity of research covering how the principles of local food systems are being integrated into agricultural development projects in developing countries. My work critically examines claims to agricultural sustainability and actor empowerment in a local organic food system built around non-traditional agricultural crops in western Guatemala. Employing a mixed methods research design involving twenty months of participant observation, in-depth interviewing, surveying, and a self-administered questionnaire, the project evaluates the sustainability of this NGO-led development initiative and local food movement along several dimensions. Focusing on the unique economic and social networks of actors and institutions at each stage of the commodity chain, this research shows how the growth of an alternative food system continues to be shaped by context specific processes, politics, and structures of conventional food systems. Further, it shows how the specifics of context also produce new relationships of cooperation and power in the development process. Results indicate that structures surrounding agrarian development in the Guatemalan context give rise to a hybrid form of development that at the same time contests and reinforces conventional models of food production and consumption. Therefore, participation entails a host of compromises and tradeoffs that result in mixed successes and setbacks, as actors attempt to refashion conventional commodity chains through local food system formation.^