Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

Background: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored.

Methods/design: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.

Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.

Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP.

Discussion: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

Enhancing patient engagement in chronic disease self-management support initiatives in Australia : the need for an integrated approach

♦ Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition.

♦ Self-management support is provided by health care and community services to enhance patients’ ability to care for their chronic conditions in a cooperative framework.

♦ In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training).

♦ To date, there has been little coordination or integration of these self-management initiatives to enhance the patient–health professional clinical encounter.

♦ If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders — patients, carers, health professionals, and health care organisations.

♦ A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

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.

Restructuring of education and training in Vietnam : a development and application of arts management training in Australia to Vietnam

The adoption of a more market-oriented economy under doi moi has paved the way for Vietnam to record remarkable human development achievements in the past decades. The Vietnamese education system has been undergoing continuous changes for almost twenty years. Key reforms have been implemented in the education and training sector such as privatising the sector; expanding the schooling system, the vocational education and training (VET) system, and higher education. This paper examines: (1) key reforms implemented in the education and training sector, placed in a broader context of economic reforms in Vietnam; (2) a development of arts management training courses in Vietnam to assist cultural organisations to adjust to social changes, as Vietnamese education institutions have not had much experience in designing training courses in arts and culture management; (3) several arts management training courses in Australian institutions to see the possibility to apply training in arts management in Australia to Vietnam. The findings indicate that a variety of management training modes in Australia can be adapted and applied to the Vietnamese training context. Some factors such as differences in culture, education and training systems, shortages in training staff and resources are also considered in this paper.

International education and challenges for Australia (case study)

The content of this 3rd edition marketing research textbook is practical and up to date and is based on an applied and managerially focused approach. Australian an New Zealand research and examples have been thoroughly intergrated into every chapter.

Community pharmacists' preferences for continuing education delivery in Australia

Introduction: New technologies such as the Internet offer an increasing number of options for the delivery of continuing education (CE) to community pharmacists. Many of these options are being utilized to overcome access- and cost-related problems. This paper identifies learning preferences of Australian community pharmacists for CE and identifies issues with the integration of these into contemporary models of CE delivery.
Methods: Four focus group teleconferences were conducted with practicing community pharmacists (n = 15) using a semistructured format and asking generally about their CE and continuing professional development (CPD) experiences.
Results: Pharmacists reported preferences for CE that were very closely aligned to the principles of adult learning. There was a strong preference for interactive and multidisciplinary CE. Engaging in CPD was seen as valuable in promoting reflective learning.
Discussion: These results suggest that pharmacists have a strong preference for CE that is based on adult learning principles. Professional organizations should take note of this and ensure that new CE formats do not compromise the ability of pharmacists to engage in interactive, multidisciplinary, and problem-based CE. Equally, the role of attendance-based CE in maintaining peer networks should not be overlooked.

Music needs no visa : insights from three South African voices on teaching African music in Melbourne, Australia

As Australia becomes increasingly multicultural, there are many that would argue that the teaching and learning of music at educational settings can be carried out in a number of ways where cultural context and authenticity is imperative. This paper discusses the main arguments of teaching and learning in music education and provides some theoretical perspectives of teaching African music as groundwork for the discussion and findings. This paper is part of a wider study called 'Smaller steps in longer journeys' and. provides insight into the teaching of South African music in Melbourne. Three South African voices (my own as tertiary music educator, an artist in schools and a primary music specialist) through reflection and interview data considers 'how' and 'why' African music is taught The discussion presents an openmindedness of music when it travels to a new country where the pedagogy is the process of production and exchange, a social-discursive practice whereby process and understanding is more important than just product. As music requires no visa it will continue to travel and be shared in different context where pedagogical practice considers teacher, learner and knowledge.

'The C Words': clitorises, childhood and challenging compulsory heterosexuality discourses with pre-service primary teachers

This paper reports on accidental ethnographic research. It arose unexpectedly out of the everyday teaching of first-year pre-service primary teachers at an Australian university. Via narrative, self-reflexivity, and student responses, we explore the interwoven workings of heteronormative, gendernormative and misogynist discourses when a chapter from Queering Elementary Education in the Course Reader created controversy, moral panic and resistance among students. The paper then charts the implementation of various strategies and interventions by the three authors of the paper: Greg, the lecturer; Maria, the Reading's author; and Steph, the Reading's protagonist. While outlining the subsequent shifts in student responses and discourses, we also problematise particular aspects of the processes of intervention where they still point to the insidious power and overarching framework of heteronormativity and gendernormativity that require ongoing challenges.

Improving primary school health education through action research : a case study

Limited research has been conducted concerning the actual practice of health education in Victorian schools. This study investigates the health education curriculum at a large primary school in the south-eastern suburbs of Melbourne. The investigation involves a critical analysis of current practices in health education in the upper school through the development of a ‘small’ action research group. Data were gathered through document collection, questionnaires, interviews, discussions, diary and reflective journal entries. The action research group, consisting of the teacher-researcher and upper school teachers, developed, implemented and reflected upon units of work piloted with upper school students. Alternative approaches to health education were explored. The aim was to accommodate critically informed discourse amongst colleagues to promote self-reflective enquiry and facilitate improvements to existing pedagogic practices. During the course of the investigation, factors limiting and facilitating action research and curriculum change in health education, became evident. These included personal, practical, curriculum and organisational constraints operating externally and internally on the school and classroom environments. Despite these constraints, it was demonstrated in this study, that action research can contribute to the improvement of pedagogic practices in health education. Small ‘authentic’ action research projects may provide alternative internal professional development structures for teachers and consequently improve learning opportunities for students.

Effectiveness of recording in primary science : a study of the ability of junior primary school pupils to use drawing as an effective method of communication in science lessons

Drawing as a means of recording is a very common practice in junior primary science lessons. This is largely due to the availability of necessary materials. Also, most youg children have some degree of drawing skill and enjoy drawing activities. Since 1956 the science curriculum to be implemented in primary classrooms in Victoria has changed from one that was based largely on nature study (biological) to one that includes physical and technological aspects. Further, there have been changes in the teaching methodologies advocated for use in science lessons. A modified Interactive Teaching Approach was used for the studies. Drawing was the main means by which the children recorded information. The topic of 'shells' was used to enable collection of data about the children's enjoyment of the activity and satisfaction with their achievement. This study was replicated using the topic 'rocks'; again data were collected concerning satisfaction and enjoyment. During a series of lessons on 'snails' data were collected concerning the achievement of 'process' and 'objective' purposes that teachers might have in mind when setting a drawing activity. In addition to providing data about purposes the study stimulated some questions regarding the techniques the children had used in their drawings. Accordingly, data concerning the use of graphic techniques by the children were collected during a series of lessons on 'oils'. The data collected and analysed in the various studies highlighted the value of drawing in junior primary school science lessons. It also validated strategies developed by the author and designed to help teachers and children use drawing effectively in science activities.

Studies in supervisory practice : the effectiveness of the practicum in teacher education in the Northern Territory

In this thesis we descend into the swampy lowlands to meet with student-teachers and their supervisors and observe them working together at different sites across the Top End of Australia. In the process we discover the multiple relationships that comprise the practicum text and the discomforting untidiness and unwieldiness, as well as the awkwardness of complexity, which surrounds research into supervisory practice. The thesis demonstrates the need to attend to the subjectivities of the participants and highlights the conflicting attitudes, beliefs, interests, and desires which are only partially realised or understood. It moves us beyond language to the sentient world of anger, love, disgust, hope, fear, despair, joy, anguish, and pain and we become immersed in a murky, incoherent, interior world of hints, shadows, and unfamiliar sounds, a world of lost innocence and conflict in which knowledge is truly embodied. Encompassing a view of supervision as moral praxis, particular attention was given to the care and protection of the self and a romanticist conception of the self was seen to predominate. The thesis demonstrates the part played by positioning and agency in the process of subjectification, the importance of emotional and relational bonding in the emergence of collegiality, the tactics of power employed by supervisors, the struggle for personal autonomy, the presence of anxiety induced by failure to pro vide feedback, the inculcation of guilt, and the complex interplay of age-related and gender effects. Attention is also given to the degree to which supervisors adopt reflective and constructivist approaches to their work. The stories reveal that supervision is much more than advising student-teachers on curriculum content, resource availability and lesson presentation. It is a process of interiority in which supervisors may need to provide emotional support in the face of displacement and disorientation, and assume the role of an abiding presence, someone capable of imaginative introjection, someone who ‘knows’. Particular attention is paid to the language of supervision which was marked by indirection, diffidence, imprecision, irony, and understatement. At the same time, the agonistic nature of language associated with the politics of the personal is made apparent. Whilst in the opinion of Liaison Lecturers, context-of-site did not appear to matter as far as acquiring teaching competence was concerned, the failure to attend to context-of-site affected how student-teachers engaged with difference and diversity. In spite of attempts to contest the myths of Aboriginal education and interrupt the discourse of impoverishment, colonialist attitudes and resistance to liberatory education persisted. The thesis ends with suggestions for alternatives to the traditional practicum and discusses the introduction of Field-Based Teacher Education into Northern Territory schools.

Science education in primary schools in a state of change

Through a longitudinal study of one teacher's science teaching practice set in the context of her base school, this thesis records the effects of the structural and policy changes that have occurred in Victorian education over the past 6-7 years - the 'Kennett era'. Initially, the purpose of the study was to investigate the teacher's practice with the view to improving it. For this, an action research approach was adopted. Across the year 1998, the teacher undertook an innovative science program with two grades, documenting the approach and outcomes. Several other teachers were involved in the project and their personal observations and comments were to form part of the data. This research project was set in the context of a single primary school and case study methodology was used to document the broader situational and daily influences which affected the teacher's practice. It was apparent soon after starting the action research that there were factors which did not allow for the development of the project along the intended lines. By the end of the project, the teacher felt that the action research had been distorted - specifically there had been no opportunity for critical reflection. The collaborative nature of the project did not seem to work. The teacher started to wonder just what had gone wrong. It was only after a break from the school environment that the teacher-researcher had the opportunity to really reflect on what had been happening in her teaching practice. This reflection took into account the huge amount of data generated from the context of the school but essentially reflected on the massive number of changes that were occurring in all schools. Several issues began to emerge which directly affected teaching practice and determined whether teachers had the opportunity to be self-reflective. These issues were identified as changes in curriculum and the teaching role, increased workload, changed power relations and changed security/morale on the professional context. This thesis investigates the structural and policy changes occurring in Victorian education by reference to documentation and the lived experiences of teachers. It studies how the emerging issues affect the practices of teachers, particularly the teacher-researcher. The case study has now evolved to take in the broader context of the policy and structural changes whilst the action research has expanded to look at the ability of a teacher to be self-reflective: a meta-action research perspective. In concluding, the teacher-researcher reflects on the significance of the research in light of the recent change in state government and the increased government importance placed on science education in the primary context.