Factors limiting participation in arthritis self-management programmes : an exploration of barriers and patient preferences within a randomized controlled trial

Objective. To improve understanding of barriers to participation in community-based arthritis self-management programmes and patient preferences for self-management education.

Methods. Individuals with hip or knee OA referred to orthopaedic surgeons or rheumatologists at six public and private hospitals in Victoria, Australia, were recruited for a randomized controlled trial (RCT) of the Stanford Arthritis Self-Management Programme (ASMP). As part of the study design, potential participants were asked during the screening and recruitment process about reasons for being unable to attend the course, reasons for not participating in the study and individual preferences for course scheduling.

Results. Of 1125 individuals assessed, 216 (19%) were unable to attend six ASMP sessions. This was commonly due to physical limitations, including illness, restricted mobility and pain (22%), difficulty getting to or from courses (22%), work commitments (22%), the time commitment required (17%) and family roles (12%). Among those who did not want to participate in the study (n = 258), the overwhelming reason was disinterest (74%). Specific preferences for course scheduling were frequent, confirming the practical challenges faced in organizing courses for the RCT.

Conclusion. Incorporating patients from public and private settings, this study has elicited new insights into barriers to ASMP participation. Many people with hip or knee OA have limited capacity and motivation to attend community-based group programmes. Future self-management programmes and research should include more accessible options for those who cannot attend group-based programmes.

Is e-governance a function of government or media? Some directions for future research and development of electronically mediated citizen participation

Citizen participation, enabled by electronic means, grows, in parallel with government's apparent failure to promote it. Organisations such as Getup and Moveon flourish; the BBC announced in 2003 that 'Internet-based political activism is happening...The BBC wants to help a wider audience find their voice by tackling obstacles to greater participation' (http://www.opendemocracy.net). (Kevill, 2003). Such actions echo, perhaps, the enthusiastic adoption of the Internet by activist media groups, particularly Indymedia. This paper presents a response to this situation. It provides a richer account of the contradictory rise of e-government without e-governance, and examines the potential for media-based participatory engagement to complement e-government. It presents two models of the future of electronically mediated citizen engagement: the first involving agonistic relations between government and citizenry, with civic participation occurring outside of government-approved forums; the second involving the intimate linking of governmental transactions to participation by those citizens engaged in them. Finally it will outline mechanisms for researching the capacity of either or both models to sustain effective participation.

Actively disadvantaged : a foucauldian perspective of rural adolescent girls' participation in sport and physical activity

The illustriousness of sport to Australian culture has often been discussed and in rural communities it could be argued that community sporting clubs are integral, and often unparalleled, in the development of collective community identities and individual subjectivities (Tonts, 2005). Sport is considered a way of life for many rural Australians, yet social, climatic and economic factors have resulted in vast changes to the sporting landscape in rural communities, particularly for adolescent females. With the amalgamation of many community sporting clubs due to declining populations and the rationalisation of Government funding, fewer opportunities for participation in organised physical activity now exist for rural adolescent girls (Tonts & Atherley, 2005). Compounding this lack of opportunity, are questions around the types of physical activity experiences available to rural adolescent females and the impact this has on the way that rural adolescent females construct ideas around being physically active. This paper is concerned with the ways in which prevalent cultural and institutional discourses mediated through community sport and school-based physical activity impact the construction of female physically active subjectivities in rural communities.

Stakeholder participation in estuary management: the development of Victoria's Estuary Entrance Management Support System

Stakeholder involvement in the management of estuaries is a necessary element of good environmental governance. In Victoria, Australia, a key challenge for estuary managers is whether or not estuaries should be artificially opened since many river mouths close ‘naturally’ from time to time. Estuary closure resulting in raised estuarine water levels leads to economic and social impacts on local communities. In the past these effects have been addressed by artificial river mouth openings, often without reference to associated environmental impacts. This article discusses the development and features of an Estuary Entrance Management Support System and considers its performance against principles of effective environmental management. It concludes that, in bringing together technical information with stakeholder input through a structured process, such a system makes a useful contribution to improving estuary entrance management.

Understanding the contexts of adolescent female participation in sport and physical activity

Purpose: Participation in physical activity (PA) is reported to decline in adolescence, particularly for girls. However, we do not know if this decline in PA is consistent across modes and settings or whether there are transfers of participation between modes and settings. Nor do we understand the changes in specific types of PA or the interaction between types of participation and different modes/settings. This study investigated contexts of PA participation for female adolescents at two life transition points.

Method: A survey of 489 Year 7 and 243 Year 11 adolescent girls was conducted, incorporating a measure of overall PA level and participation rates in seven modes/settings and in specific types of sport and PA.

Results: Less than half of the respondents met or exceeded the recommended level of moderate or vigorous PA—60 min or more—on the previous day, and there was no statistically significant difference in the proportions in Years 7 and 11 (39.5% vs. 45.9%; p>.05). However, older adolescents shifted their participation away from organized, competitive modes and settings toward nonorganized and noncompetitive modes and settings and individual types of PA.

Conclusions: An understanding of the changes in PA modes and settings identified here can inform the planning of policies and implementation of programs for the promotion of PA by adolescent girls.

Sex-differences in reasons for non-participation at recruitment : Geelong Osteoporosis Study

Background : Understanding reasons for non-participation in health studies can help guide recruitment strategies and inform researchers about potential sources of bias in their study sample. Whilst there is a paucity of literature regarding this issue, it remains highly plausible that men and women may have varied reasons for declining an invitation to participate in research. We aimed to investigate sex-differences in the reasons for non-participation at baseline of the Geelong Osteoporosis Study (GOS).

Methods : The GOS, a prospective cohort study, randomly recruited men and women aged 20 years and over from a region in south-eastern Australia using Commonwealth electoral rolls (2001–06 and 1993–97, respectively). Reasons for non-participation (n=1,200) were documented during the two recruitment periods. We used the Pearson’s chi squared test to explore differences in the reasons for non-participation between men and women.

Results : Non-participation in the male cohort was greater than in the female cohort (32.9% vs. 22.9%; p<0.001). Overall, there were sex-differences in the reasons provided for non-participation (p<0.001); apparent differences related to time constraints (men 26.3% vs. women 10.4%), frailty/inability to cope with or understand the study (men 18.7% vs. women 30.6%), and reluctance over medical testing (men 1.1% vs women 9.9%). No sex-differences were observed for non-participation related to personal reason/disinterest, and language- or travel-related reasons.

Conclusions : Improving participation rates in epidemiological studies may require different recruitment strategies for men and women in order to address sex-specific concerns about participating in research.

The new higher education reality: what is an appropriate model to address the widening participation agenda?

Along with the massification of higher education comes a need for new models to support the success of greater numbers of diverse students. A greater proportion of these students are ‘non-traditional’ in terms of preparedness, socioeconomic status  and geography. This paper introduces an Associate Degree model designed to support this new higher education reality of broader student cohorts, thin regional markets and cross-sectoral collaboration. Background literature on challenges facing the higher education sector and its prospective students is presented, with a particular focus on regionality. An argument is made for the role of curriculum and pedagogy as enablers of non-traditional student success. This is supported by the results of a mixed-methods exploratory study. This Associate Degree model was attractive to students and institutes. Students experienced similar levels of challenge, workload and progress to their traditional peers. While technology was essential for the success of the model, it played a supporting role to the relationships and multiple modes of learning it facilitated. This article provides insights for institutions seeking to address the broadening participation agenda.

Quantifying the profile and progression of impairments, activity, participation, and quality of life in people with Parkinson disease : protocol for a prospective cohort study

Background Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD.
Methods and design This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD. One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn & Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia. When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis.
Discussion This study has the potential to identify baseline characteristics of PD for different Hoehn & Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD. Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified.