Geelong community's priorities and expectations of public health care

Abstract This thesis set out to achieve the following objectives: (1) To identify the priorities and expectations that the Geelong community has of its public health care system. (2) To determine if there is a common view on the attributes of a just health system. (3) To consider a method of utilising the data in the determination of health care priority setting in Barwon Health. (4) To determine a model of community participation which enables ongoing input into the decision making processes of Barwon Health. The methodology involved a combination of qualitative and quantitative research. The qualitative work involved the use of focus groups that were conducted with 64 members of the Geelong community. The issues raised informed the development of the interview schedule that was the basis of the quantitative study, which surveyed a representative sample of 400 members of the Geelong community. Prior to reporting on this work, the areas of distributive justice, scarcity and community participation in health care were considered. The research found that timely access to public hospitals, emergency care and aged care services were the major priorities; for many people, the cost was less relevant than a quality service. Shorter waiting times and increased staffing levels were strongly supported. Increased taxes were nominated as the best means of financing the health system they sought. Community based services were less relevant than hospital services but health education was supported. An egalitarian approach to resource distribution was favoured although the community was prepared to discriminate in favour of younger people and against older people. There was strong support for the community to be involved in decision making in the public health care system through surveys or focus groups but very little support was given to priorities being determined by politicians, administrators and to a lesser extent, medical professionals.

Quality as the criterion for delivered information systems effectiveness

One of the major challenges of MIS activities is the difficulty in measuring the effectiveness of delivered systems. The principal purpose of my research is to explore this field in order to develop an instrument by which to measure such effectiveness. Conceptualisation of Information System (IS) Effectiveness has been substantially framed by DeLone and McLean's (1992) Success; Model. But with the innovation in Information Technology (IT) over the past decade, and the constant pressure in IT to improve performance, there is merit in undertaking a fresh appraisal of the issue. This study built on the model of IS Success developed by DeLone and MeLean, but was broadened to include related research from the domains of IS, Management and Marketing. This analysis found that an effective IS function is built on three pillars: the systems implemented; the information held and delivered by these systems; and, the service provided in support of the IS function. A common foundation for these pillars is the concept of stakeholder needs. In seeking to appreciate the effectiveness: of delivered IS applications in relation to the job performance of stakeholders, this research developed an understanding of what quality means in an IT context I argue that quality is a more useful criterion for effectiveness than the more customary measures of use and user satisfaction. Respecification of the IS Success Model was then proposed. The second phase of the research was to test this model empirically through judgment panels, focus groups and interviews. Results consistently supported the structure and components of the respecified model. Quality was determined as a multi-dimensional construct, with the key dimensions for the quality of delivered IS differing from those used in the research from other disciplines. Empirical work indicated that end-user stakeholders derived their evaluations of quality by internally evaluating perceived performance of delivered IS in relation to their expectations for such performance. A short trial explored whether, when overt measurement of expectations was concurrent with the measurement of perceptions, a more revealing appraisal of delivered IS quality was provided than when perceptions alone were measured. Results revealed a difference between the two measures. Using the New IS Success Model as the foundation, and drawing upon the related theoretical and empirical research, an instrument was developed to measure the quality/effectiveness of delivered IS applications. Four trials of this instrument, QUALIT, are documented. Analysis of results from preliminary trials indicates promise in terms of business value: the instrument is simple to administer and has the capacity to pinpoint areas of weakness. The research related to the respecification of the New IS Success Model and the associated empirical studies, including the development of QTJALIT, have both contributed to the development of theory about IS Effectiveness. More precisely, my research has reviewed the components of an information system, the dimensions comprising these components and the indicators of each, and based upon these findings, formulated an instrument by which to measure the effectiveness of a delivered IS.

Insights from research on cross-cultural validation of health-related questionnaires : the role of bilingual project workers and lay participants

This article discusses the recruitment and training of bilingual project workers and their role in data gathering; the level of comprehension of the interviewees with regard to the nature of the task and its alien nature; the contribution of social customs and expectations; the vagaries of language; the researchers' level of comprehension of data collected across a range of languages; the feelings of loss of control by the researchers over the research process; and issues of communication with bilingual project workers. The authors draw on two studies designed to assess the adequacy of questionnaire translations from English into four ethnic minority languages: Cantonese, Punjabi, Urdu and Sylheti. Bilingual project workers were recruited to carry out interviews and focus groups with the lay communities and to feed back results in English to the researchers. The authors conclude that researchers should be aware of the influence of social and contextual factors when carrying out research with ethnic minority participants mediated by bilingual project workers.

Addressing declining metropolitan park use : a case study of Melbourne, Victoria, Australia

One might expect natural area visitation to offer time-conscious leisure seekers a competitive, low-cost alternative to the vast array of activities available in a major metropolitan area. However, data obtained by Parks Victoria revealed that there has been a decline in the number of regional visitors to Melbourne's metropolitan parks over the past few years. Interviews with regional visitors highlighted the importance of the role that their Melbourne-based friends and relatives were as an information resource. This article investigates the reasons for the decline in park visitation by incorporating the viewpoints of both regional visitors and residents of Melbourne. Focus groups and in-depth interviews provided useful information about pull factors of metropolitan parks and how these parks should be promoted to attract more visitors.

Staff perceptions of the implementation of enterprise resource planning systems in three Australian universities

This chapter reports a study that examined the staff perceptions of the implementation of an Enterprise Resource Planning system (ERPs) in three Australian universities. The literature on issues impacting on effective Enterprise Resource Planning (ERP) implementations identified a number of issues that translate from the corporate sector to the higher education sector and included a number that require particular focus in this sector. Case study methodology is used to examine the staff perceptions of the management of ERP implementations in three Australian universities in the process of implementing ERP systems. The study was conducted in two phases. The first phase of the study obtained data through a series of focus groups at one university and, combined with an analysis of the relevant literature served as a framework for the development of the research process in the second phase of the study. This phase involved in depth interviews with staff that enabled the researcher to undertake a more detailed exploration of the staff perceptions of influences affecting ERP system implementations at three Australian universities. This chapter reports that staff perceptions of the process of ERP implementations are central to their efficacious implementations in Australian universities. Staff perceptions demonstrate that particular consideration of organisational influences related to their context and the perceptions of the users of the systems must be factored into the planning for ERP implementations in Universities.

Study protocol for the translating research in elder care (TREC): Building context through case studies in long-term care project (project two)

Background: The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use.
Aim: To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities.
Design: This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time. An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.

Scale development of individual and organisation infrastructure for heart health promotion in regional health authorities

Objective : The purpose of this study was to validate measures of individual and organisational infrastructure for health promotion within Alberta's (Canada) 17 Regional Health Authorities (RHAs).

Design : A series of phases were conducted to develop individual and organisational scales to measure health promotion infrastructure. Instruments were designed with focus groups and then pre-tested prior to the validation study.

Setting : In 1993 all hospitals and Public Health Units in the province of Alberta were regionalised into 17 RHAs, with responsibility for public health, community health, and acute and long-term care. While regionalisation may offer more opportunity for community participation, reorganisation of the public health system may have fragmented and diluted resources and skills for heart health promotion in some RHAs. Infrastructure (for example, human and financial resources), amongst other items, is believed to contribute to the capacity to promote health.

Method : All 17 RHAs participated in the study, yielding a total of 144 individuals (that is board members, senior/middle management, and front line staff). These representative employees completed a self- administered questionnaire on individual- and organisational-level infrastructure measures.

Results : Psychometric analyses of survey data provided empirical evidence for the robustness of the measures. Principal component analyses verified the construct validity of the scales, with alpha coefficients ranging from 0.75 to 0.95.

Conclusion : The scales can be used by health professionals and researchers to assess individual- and organisational-level infrastructure, and tailor interventions to increase infrastructure for health promotion in health organisations.

Evaluating the impact of an environmental education programme; an empirical study in Mexico.

This study draws on information from 11 in-depth interviews, two focus groups and 72 written questionnaires to evaluate an extra-curricular environmental education programme on forestry designed for preparatory school students from a small rural community in Mexico. Specifically, the study assessed the impact of the programme on the ecological knowledge of 72 students. Qualitative feedback suggests that students learnt about forestry, acquired greater awareness of the importance of conservation for the local environment and enjoyed the participatory teaching methods used in the programme. Quantitative results show a positive and significant association between the number of times a student participated in the programme and the student’s ecological knowledge. Students who participated in the programme once had a 16.3% higher knowledge on ecological concepts and knew, on average, 1.5 more local forest plants than students who never attended it (p<.001). Findings suggest that the inclusion of participatory environmental education programmes in preparatory schools would improve the acquisition of ecological knowledge. Further research could consider the consistency of the findings by replicating participatory methods presented here and by using an experimental research design.

Rural primary health care workers and research : what is their present capacity?

Aims & rationale/Objectives : The main objectives of this project were to:
- conduct an audit of research skills and experience of primary health care staff in nine south western Victorian not-for-profit agencies
- identify capacity for research in five pre-identified areas
- investigate unpublished research endeavours/innovative projects taking place in the linked community organisations.
Methods : A 9-item survey was developed and will be distributed to all primary health care staff at the nine agencies via the internal email system of each organisation. The survey was developed after consultation with several agency directors, to obtain an organisational perspective on research capacity issues. Staff were also invited to take part in informal focus groups exploring key themes.
Principal findings : This study is in progress, and is expected to be completed at the end of March, 2007. Expected findings are the identification of primary health care staff's capacity for research, and discussion of relevant organisational assistance which would develop their research skills or enable continued participation in research.
Discussion : Phase 2 of the Australian PHC Research, Evaluation and Development Strategy aims to support the development and expansion of the primary health care research workforce. Findings from the current study will support this goal by assisting rural primary health care workers to identify the training and support they need to undertake quality research. The data could also be used to: a) assist the consortium to identify common research interests; b) to inform the consortium regarding the potential for collective research efforts; and c) to support funding submissions from the consortium or from individual agencies.
Implications : These findings will help to inform improved strategic planning in relation to building research capacity. The data could also be used by participating agencies to support applications for research grant funding.
Presentation type : Poster
Session theme : Building research capacity

Keeping all students on the learning path

A powerful notion to guide thinking about whole-class mathematics teaching is Vygotsky’s zone of proximal development (ZPD). Our research with primary and secondary teachers over the last six years has identified roles of teachers in relation to the ZPD, and ways of overcoming some typical barriers to students’ movement through their zones. Methods have included focus groups of experts, video analysis of classroom interactions, classroom observation, and analysis of lesson plans and teachers’ reflections teaching processes their outcomes. The research has involved the gradual development, trailing, evaluation, and adjustment of a six-component model for planning and teaching mathematics. The focus of this paper is on the use of one of its components, “differentiated learning trajectories”.

Redesigning science teacher education to reflect the nature of contemporary science

Evidence that many students are not being captivated by school science has led to advocacy of revising the science curriculum. However, there need to be accompanying changes in science teacher education. This study is designed to lay foundations for innovation in the pre-service education of secondary science teachers, involving a reconceptualisation of the nature of contemporary science and a course structure that links science teaching with broader science public reform initiatives. We held a series of Focus Groups, built around Government Research Priority areas, which brought together people from industry, government, research organisations, and community groups involved in science and its applications. In the groups the participants discussed how science currently operates in their area, ways in which the area will develop in the coming decade, and what implications there are for the nation and its citizens and for science education. What emerged was a concern for public responses to science at a range of levels, and a very different view of science practice and community involvement with science to that represented in current university and school science courses. This was confirmed in interviews with science graduates working in disparate fields, and also focus groups of school students. The paper will report on the insights generated, and explore the implications for redesigning the pre-service education of science teachers.

Researching bullying with students : a lens on everyday life in an innovative school.

Bullying is a serious problem in schools. This paper reports on a project in which the authors worked with a group of secondary students in an innovative school in the north of England to research issues of bullying and safety. The student researchers used photographs to stimulate conversations with focus groups of their peers. The data showed that while there was little serious bullying in the school, there was an everyday practice of name-calling, isolation, and physical hassling associated with the formation and maintenance of a hierarchy of sub-cultural groupings in the school. The students’ research not only challenges the notion of bullying as necessarily involving a perpetrator and victim, but also offers a lens through which to examine the imbrication of educational differentiation via setting, testing and choice with youth identification practices. It is suggested that this project also has implications for the ways in which one understands and works for inclusion.

Kiwi ACE

This study used a RCT to determine the efficacy of a school-based indicated preventive depression programme with adolescents identified as experiencing depressive symptoms. At one-year follow-up students had significantly improved scores effective across gender and ethnicity. Findings were supported by data from teachers and student focus groups.

Contextualising learning through the participatory construction of an environmental education programme

Strengthening links between school and community is critical for improving people's participation in environmental issues. However, Mexican education programmes are generally unrelated to rural students' life experience and are planned without considering either teachers' or students' opinions. This article describes the participatory construction of a preparatory school environmental education (EE) programme in Ixtlan de Juarez, a Mexican indigenous community internationally recognised for sustainable forest management. The qualitative research methods used are based on the action research methodology. Results from interviews conducted with the preparatory school's headmaster, the coordinator, and nine teachers provided the needed documentation of the school site for contextualising learning activities. Feedback during focus groups with six students, three teachers, five local communal authorities, and two researchers highlighted that all participants perceived the need for creating an educational programme focused on local forest management. The contents and activities of the programme were designed by the focus group's participants. The programme has been continuously taught by teachers and forest workers since 2005 and was officially integrated with the preparatory school science curriculum in 2006. This participative educational experience has thus transformed the mandatory school curriculum in Ixtlan.

An evaluation of a wellness guide for older carers living in the community

Objective: To assess the usefulness and effectiveness of a wellness guide and to identify whether its use by a group of older ‘‘new’’ carers would make them healthier and knowledgeable of community resources. Design and Sample: Pretest, posttest measures of physical and mental health and a questionnaire with associated focus groups. A purposive sample of 21 older carers who were ‘‘new’’ carers was selected for the study. Measures: Locus of control (LOC), Short Form 12, depression anxiety stress scale, and questionnaire. Results: Participants embraced the wellness guide as an excellent resource. It
changed their behavior and improved their health on LOC measures, although changes in physical and mental health were not statistically significant. Conclusions: The wellness guide assisted carers’ preparedness for their role and enhanced their sense of personal control over demanding situations.