Chronic disease self-management education programs: challenges ahead

♦ Chronic disease self-management education programs aim to empower patients through providing information and teaching skills and techniques to improve self-care and doctor–patient interaction, with the ultimate goal of improving quality of life.

♦ The recent 2006–07 federal budget allocated an unprecedented $515 million over 5 years for activation of patient self-management activities, commencing this financial year.

♦ Previous attempts in other countries to incorporate self-management education activities into the health care sector have faced setbacks because of inadequate integration into primary care.

♦ Engagement of health care professionals and their endorsement of self-management activities is critical to success.

The Health Education Impact Questionnaire (heiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions

Objective: This paper describes the development and validation of the Health Education Impact Questionnaire (heiQ). The aim was to develop a user-friendly, relevant, and psychometrically sound instrument for the comprehensive evaluation of patient education programs, which can be applied across a broad range of chronic conditions.

Methods: Item development for the heiQ was guided by a Program Logic Model, Concept Mapping, interviews with stakeholders and psychometric analyses. Construction (N = 591) and confirmatory (N = 598) samples were drawn from consumers of patient education programs and hospital outpatients. The properties of the heiQ were investigated using item response theory and structural equation modeling.

Results: Over 90 candidate items were generated, with 42 items selected for inclusion in the final scale. Eight independent dimensions were derived: Positive and Active Engagement in Life (five items, Cronbach's alpha (α) = 0.86); Health Directed Behavior (four items, α = 0.80); Skill and Technique Acquisition (five items, α = 0.81); Constructive Attitudes and Approaches (five items, α = 0.81); Self-Monitoring and Insight (seven items, α = 0.70); Health Service Navigation (five items, α = 0.82); Social Integration and Support (five items, α = 0.86); and Emotional Wellbeing (six items, α = 0.89).

Conclusion:The heiQ has high construct validity and is a reliable measure of a broad range of patient education program benefits.

Practice Implications: The heiQ will provide valuable information to clinicians, researchers, policymakers and other stakeholders about the value of patient education programs in chronic disease management.

'The Other Within' : race/gender disruptions to the professional learning of white educational leaders

Leslie Roman states 'white is a colour too'. Yet the whiteness of educational leaders is rarely questioned, although masculinism—the enduring capacity of different masculinities to remain the norm in leadership—is increasingly under scrutiny. Rarely do white men or women leaders question their whiteness, whereas indigenous and other minority groups, as a consequence of their being 'other than white', are expected to explain their exclusion. Instead, the 'problem' is depicted as the lack of 'the Other', and therefore a problem for and of 'the Other'. This article confronts normative whiteness in educational administration from the perspective of feminist and critical race theory, considering how foregrounding whiteness in leadership is a necessary condition of inclusive education and leadership.

Learning 'through' or learning 'about'? The ridiculous and extravagant medium of opera : Gardner's multiple intelligences in pre-service teacher education

In recent years, pre-service teacher education has attempted to incorporate into programs an understanding of Gardner’s theory of multiple intelligences as it applies to schools. In this paper the tension between ‘learning about’ multiple intelligences and ‘learning through’ multiple intelligences supports Gardner’s (1993) distinction between ‘understanding’ and ‘coverage’. This paper examines the use of the performing arts in the professional studies component of our teacher education program. During 2002 at The University of Melbourne, a group of education students were offered the opportunity to develop an opera in order to learn about assessment and curriculum. Thirty-seven of the students volunteered to be involved and over a period of six months met this challenge. Our action research study asked two critical questions. To what extent is the understanding of multiple intelligences by pre-service teachers improved by ‘learning through’? Can pre-service teachers address fundamental issues in curriculum and assessment through the development of a performance? This experience would be of value to other teacher educators.

Learning 'through' or learning 'about'? The ridiculous and extravagant medium of opera: Gardner's multiple intelligences in pre-service teacher education

In recent years, pre-service teacher education has attempted to incorporate into programs an understanding of Gardner's theory of multiple intelligences as it applies to schools. In this paper the tension between 'learning about' multiple intelligences and 'learning through' multiple intelligences supports Gardner's (1993) distinction between 'understanding' and 'coverage'. This paper examines the use of the performing arts in the professional studies component of our teacher education program. During 2002 at The University of Melbourne, a group of primary and secondary students were offered the opportunity to develop an opera in order to learn about assessment and curriculum. Thirty-seven of the students volunteered to be involved and over a period of six months met this challenge. Our action research study asked two critical questions. To what extent is the understanding of multiple intelligences by pre-service teachers improved by 'learning through'? Can pre-service teachers address fundamental issues in curriculum and assessment through the development of a performance? This experience would be of value to other teacher educators.

Education and training institutions : building social capital for regional development

Education and training institutions from schools through to universities have a vital role in supporting development in regional Australia. The interaction between these institutions and their rural communities influences the social capital of the community and the extent to which the community is a learning community, willing and able to manage change to the community’s advantage.

There are benefits to be had from a collaborative approach to planning and delivering training. This approach is consistent with theories of social capital that emphasise the crucial part played by networks, values and trust in generating superior outcomes for individuals, communities and regions. Research has found that education and training is most effective in building social capital and learning communities were there is attention to customising or targeting education and training provision to local needs. The key to matching provision with local needs, particularly in the more rural and remote areas, is collaboration and partnerships. Partners can be regional organisations, other educational institutions, businesses and government. The factors that enhance the effectiveness of the collaborations and partnerships are the elements of social capital: networks, shared values and trust, and enabling leadership.

Networks are most effective where there were opportunities and structures for interaction, which can be termed interactional infrastructure, that foster networks within the region, and networks that extended outside the region. Interactional infrastructure includes regional forums, committee structures, consultative processes and opportunities for informal discussion addressing the issues of education, training and employment in a community or region. Better outcomes are evident when there is an interactional infrastructure that is resourced with financial, physical and human resources of sufficient quantity and quality. Collaborations provide access to a greater range of external resources through extended external networks. Effective networks and shared visions, values and trust among the partners in a collaboration, are fostered by enabling leaders. Educational institutions are well placed to supply the ‘human infrastructure’ that makes collaborations and partnerships work, including enabling leadership.

Attention to factors associated with the quality of social capital, especially interactional infrastructure including leadership, shared vision and values and networks within and external to the community, can be expected to improve the effectiveness of education and training outcomes. More importantly, a collaborative approach to planning for education and training in rural regions will build the capacity of regions and their constituent communities to develop and change by building social capital resources. Leadership is an important driver of processes that build community and regional capacity and ultimately produce social and economic benefits through regional development. Educational providers in rural regions are well placed to act as enabling leaders.

Developing effective learning programs : what extension can learn from the fields of adult education and learning communities

Learning is an investment in capacity building that has and will continue to reap rewards for primary producers and government in terms of increased sustainable production, profitability, exports, jobs and sustainable rural communities. Primary production operates in a context of continual change and requires up to date, complex and varied skills of primary producers and land managers.

A recent national research project funded by the Department of Agriculture, Forestry and Fisheries Australia confirmed that application of best practice from the theory of adult education in designing and developing learning programs in primary industry results in learning activities that provide information that is relevant to farmers’ needs, delivered in an entertaining way, and that draws on examples directly relevant to the participants. As a result, the training often exceeds the expectations of the participants.

The project produced a self-assessment checklist to identify ways of improving the development and delivery of training for extension practitioners and training providers. The key issues include continuous monitoring of client’s needs, and actively seeking opportunities to meet and work with industry organisations, other training providers and funding bodies.

There appear to be two drivers for the development of learning programs. One is problems or opportunities identified by people and organisations that could be termed ‘scanners’ and who tend not to be potential participants, the other is learning needs expressed by individuals or enterprises who want to participate in learning activities (participants). Scanners are typically industry organisations, government agencies and researchers, but may include providers and participants. Extension practitioners are well-placed to act as scanners.

It is very important that farmers and farmer organisations contribute to the development of new learning programs. Without industry input and support, extension practitioners and training providers cannot be expected to ensure they meet client needs. In other words, to develop effective learning programs, there must an industry learning community of producers, industry organisations, extension practitioners and training providers and other stakeholders such as supply chain enterprises, government and researchers.

Responding to rural skills shortages : innovations using vocational education and training

Aims & Rationale/Objectives
To locate, analyse and make accessible innovative models of health training and service delivery that have been developed in response to a shortage of skills.

Methods
Drawing on a synthesis of Australian and international literature on innovative and effective models for addressing health skill shortages, 50 models were selected for further study. Models were also identified from nominations by key health sector stakeholders. Selected models represent diversity in terms of the nature of skill shortage addressed, barriers overcome in developing the model, health care specialisations, and customer groups.

Principal Findings
Rural and remote areas have become home to a set of innovative service delivery models. Models identified encompass local, regional and state/national responses. Local responses are usually single health service-training provider partnerships. Regional responses, the most numerous, tend to have a specific focus, such as training young people. A small number of holistic state or national responses, eg the skills ecosystem approach, address multiple barriers to health service provision. Typical barriers include unwillingness to risk-take, stakeholder differences, and entrenched workplace cultures. Enhancers include stakeholder commitment, community acceptance, and cultural fit.

Discussion
Of particular interest is increasing numbers of therapy assistants to help address shortages of allied health professionals, and work to formalise their training, and develop standards of practice and policy. Other models likely to help address skill shortage amongst VET health workers focus on recruiting, supporting and training employees from a range of disadvantaged target groups, and on providing career paths with opportunities for staff to expand their skills. Such models are underpinned by nationally recognised qualifications, but each solution is targeted to a particular context in terms of the potential workforce and local need.

Skill shortages in health : innovative solutions using vocational education and training

Introduction: This article reports findings of a project funded by the Australian National Council for Vocational Education Research. The project explores solutions to current and projected skills shortages within the health and community services sector, from a vocational education and training perspective. Its purpose is to locate, analyse and disseminate information about innovative models of health training and service delivery that have been developed in response to skill shortages.

Methods: The article begins with a brief overview of Australian statistics and literature on the structure of the national health workforce and perceived skill shortages. The impact of location (state and rurality), demographics of the workforce, and other relevant factors, on health skill shortages is examined. Drawing on a synthesis of the Australian and international literature on innovative and effective models for addressing health skill shortages and nominations by key stakeholders within the health sector, over 70 models were identified. The models represent a mixture of innovative service delivery models and training solutions from Australia, as well as international examples that could be transposed to the Australian context. They include the skill ecosystem approach facilitated by the Australian National Training Authority Skill Ecosystem Project. Models were selected to represent diversity in terms of the nature of skill shortage addressed, barriers overcome in development of the model, healthcare specialisations, and different customer groups.

Results: Key barriers to the development of innovative solutions to skills shortages identified were: policy that is not sufficiently flexible to accommodate changing workplace needs; unwillingness to risk take in order to develop new models; delays in gaining endorsement/accreditation; current vocational education and training (VET) monitoring and reporting systems; issues related to working in partnership, including different cultures, ways of operating, priorities and timelines; workplace culture that is resistant to change; and organisational boundaries. For training-only models, additional barriers were: technology; low educational levels of trainees; lack of health professionals to provide training and/or supervision; and cost of training. Key enhancers for the development of models were identified as: commitment by all partners and co-location of partners; or effective communication channels. Key enhancers for model effectiveness were: first considering work tasks, competencies and job (re)design; high profile of the model within the community; community-based models; cultural fit; and evidence of direct link between skills development and employment, for example VET trained aged care workers upskilling for other health jobs. For training only models, additional enhancers were flexibility of partners in accommodating needs of trainees; low training costs; experienced clinical supervisors; and the provision of professional development to trainers.

Conclusions: There needs to be a balance between short-term solutions to current skill shortages (training only), and medium to longer term solutions (job redesign, holistic approaches) that also address projected skills shortages. Models that focus on addressing skills shortages in aged care can provide a broad pathway to careers in health. Characteristics of models likely to be effective in addressing skill shortages are: responsibility for addressing skills shortage is shared between the health sector, education and training organisations and government, with employers taking a proactive role; the training component is complemented by a focus on retention of workers; models are either targeted at existing employees or identify a target group(s) who may not otherwise have considered a career in health.

Occupational health services in higher education : third annual report

Occupational health services can make a valuable contribution to the performance of HEIs, yet a pilot study in 1999 suggested that occupational health provision in the HE sector lags behind other sectors, with some noticeable gaps. This project will:

* survey all UK HEIs to establish a baseline and identify examples of good practice in occupational health provision
* disseminate benchmarking information and case studies
* establish a collaborative network to encourage the development, sharing and implementation of recognised good practice and ensure the sustainability of improvements resulting from the project
* evaluate the outcomes of the above work.

Occupational health services in higher education : second annual report : summary

The second of three surveys of occupational health provision in UK higher education institutions was carried out in March 2003.

Information was collected on occupational health provision arrangements for all 193 members of UUK, other HEIs funded by HEFCE, constituent parts of the University of London and the University of Wales, and degree awarding bodies in the UK. There was a wide variety of arrangements. Thirty-eight percent had in-house services, 33% contracted with external providers for occupational health services, 13% made use of a local general practice or student health service, 6% had other or ad hoc arrangements and 9% had no occupational health service.

Declining foreign enrollment at higher education institutions in the United States : a research note

When the Institute of International Education reported a drop of 2.4% in international student enrollment in the United States in 2003/2004, the first absolute decline in foreign enrollments since 1971/1972 (Open Doors, 2004), many were quick to point fingers at visa policies instituted after the September 11, 2001 attacks. The "Visas Mantis" review—a security clearance required for foreign students studying any of roughly 200 scientific fields—was blamed for tarnishing the view of the United States as a welcoming place for international students. Although the review has certainly been the cause of increased visa delays and rejections, this article takes the view that it is not the only cause for the dip in foreign enrollments in the United States. Through econometric analyses, it is shown that other than the visa quagmires, improved access to domestic education opportunities and tuition fee increases can indeed explain the drop in foreign enrollments.

Applying self-determination theory to understand the motivation for becoming a physical education teacher

This study explored the reasons people choose physical education teaching as a profession and investigated the relationship of these choices with motivation. Physical education pre-service teachers (n = 324) completed the Academic Motivation Scale (AMS) and a measure of reasons for choosing physical education teaching. Confident interpersonal service reasons were linked with intrinsic motivation; whereas sport and physical activity reasons were related to extrinsic motivation. Enrolling because teaching seemed easy was linked with amotivation. Motivation was similar for different course entry methods, however, females were more intrinsically motivated than males and third year students were lower in motivation than other year levels.

The impact of RICS education reform on building surveying

Purpose – It is of major concern to the surveying profession that the seven years between 1994 and 2001 witnessed a decline in the numbers of UK student surveyors of nearly 50 per cent. This was significant, especially when considered in the context of rising student numbers overall. The RICS decided to implement an education policy with the aim of increasing graduate quality. Changes were introduced in UK universities from September 2001. A number of universities saw their professionally accredited courses withdrawn as the RICS imposed  academic entry standards and research output based on the UK Government's Research Assessment Exercise (RAE) criteria on which to base their “partnership” relationships. Figures released by the RICS in 2003 indicated that surveying student numbers increased by 17 per cent in all areas except building surveying, where they fell by just under 25 per cent to 445 in 2001. The paper seeks to answer a number of questions. Why were building surveying courses failing to recruit students whereas other surveying courses have increased their numbers? If the figures continue to decline or remain at these low levels, what is the future for the BS? In short, could building surveying become an endangered profession?
Design/methodology/approach – All UK university BS course leaders were approached by questionnaire and approximately half responded. The study was partly funded by the RICS Education Trust.
Findings – The small amount of quantitative data collected suggests that recruitment is static at a time when other built environment courses are recruiting well. Course leaders expressed strong views about the impact of the education reforms.
Research limitations/implications – Failure by some BS course leaders to provide some statistical data prevented completion of the quantitative part of the study.
Originality/value – Key recommendations have been made to the BS Faculty Board of the RICS about the future of BS education.

Blended learning in entrepreneurship education in the Asia-Pacific : a grounded theory approach to entrepreneurship pedagogy

Using a grounded theory approach, this pedagogical study explores “What are the key content areas and pedagogical interventions around which to build a blended learning method for Generation Y (also known as the Net Generation) entrepreneurship students (as opposed to other business students)?” The study uses a variety of “information-rich cases” and presents the argument that entrepreneurs learn
differently from other students. The author develops the Etappe Method of Training Entrepreneurs, a blended learning approach for the technology-savvy generation under the motto “Teaching is best done online and learning is best done in the classroom”. Drawing upon the theory of experiential learning as concretised by learning styles inventories, this learning method provides entrepreneurs, in their unique teachable moments, with active and concrete pedagogical interventions that can be enhanced through a blended learning environment of online and face-to-face modalities leading them step-by-step through deepening learning in the theory, process and practice of entrepreneurship. In conclusion, the author presents suggestions for further research that can verify this emerging theory in an empirical fashion.