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.

Body image and body change strategies among adolescent males and females from Fiji, Tonga and Australia

The current study was designed to investigate the body image and body change strategies of adolescents from Fiji, Tonga and Australia. Participants were 628 Fijians, 463 Indo-Fijians, 598 Tongans and 535 European Australians. Adolescents completed measures of height, weight, body dissatisfaction, strategies to lose weight, increase weight and increase muscles. The results demonstrated that overweight adolescents were more dissatisfied with their bodies than those who were normal weight. Overweight Fijians and Tongans were more satisfied with their body than Indo-Fijian or Australian adolescents. Tongans, followed by Fijians and Indo-Fijians, were more likely to engage in strategies to lose weight, increase weight and increase muscles. These results are consistent with the focus in Fiji and Tonga on the value of the large body ideal, but may also reflect the recent focus on the attainment of a healthy body size.

Sociocultural influences on body dissatisfaction and body change behaviors among Malaysian adolescents

Little research on body dissatisfaction and body change behaviors, and the sociocultural influences on them, has been undertaken in non-Western contexts. The current study investigated these variables and the relationships between them among a sample of 529 Malaysian high school students (103 Malays, 344 Chinese and 82 Indians), who completed a set of measures in classroom settings. Chinese girls were more dissatisfied with their bodies than Chinese boys, but no gender difference was found for Malay and Indian participants. Girls were more likely to engage in behaviors to lose weight, and boys were more likely to engage in behaviors to increase muscle. The influence of sociocultural factors on body dissatisfaction and body change behaviors was limited and varied across both sex and ethnicity. Findings are discussed in relation to Western research, and it is concluded that cultural nuances need to be considered when investigating these phenomena.

Social capital : an analytical tool for exploring lifelong learning and community development

In her recent contribution to the British Educational Research Journal, Pauline McClenaghan identified the link between social capital and community development, particularly community development education, as a core area where scholarly and policy interests overlap. She concluded that the concept of social capital is unable to grapple with the complex social divisions that characterise contemporary Europe. The authors of this article question her account on three main grounds: the definition of social capital, which they hold is overly narrow, and does not deal with what Woolcock calls the ‘linking’ role of social networks; the presentation of the theoretical foundations of community development, which they believe is flawed in certain key respects; and a lack of clarity in the relationship between the research and the findings reported. The authors then present their own theoretically informed account of social capital as a means of understanding the role of community development, the challenges that it can face and the role of adult education for community development.

Prolactin, body condition and the cost of good parenting: an interyear study in a long-lived seabird, Gould's Petrel (Pterodroma leucoptera)

1. The pituitary hormone prolactin is thought to play an important role in the promotion of parental care in birds and mammals. The level of care parents provide is, however, likely to be influenced by additional factors, such as their physiological condition at the time of breeding.

2. We examined relationships between parental body condition, plasma prolactin levels and reproductive performance in Gould's Petrels (Pterodroma leucoptera), a long-lived seabird. We predicted that parental body condition would correlate positively with both prolactin level and parenting intensity, as measured by the quality of the chick they produced. We also examined the effects of parenting intensity on parental body condition and reproductive success in the subsequent breeding season.

3. Body condition of male parents positively correlated with prolactin levels at the start of their second protracted incubation bout. The body condition of both parents correlated positively with the body condition of their chick at its peak mass. However, producing a good-quality chick did not negatively affect parental body condition or reproductive success the following year.

4. These results suggest that prolactin reinforces parental behaviour in parents in good body condition, which facilitates production of good-quality chicks. Moreover, good-quality parents consistently produce good-quality chicks with no apparent trade-off to their physical condition.

Identifying linkages between generations and community development: the effect on residential and retail property

In the analysis of property markets, especially the retail and residential sectors, increasing importance is being given to the role of demography. The impact of economic influences such as interest rate movements, inflation and changes in the labour market are well documented and although these variables are clearly important, they do not incorporate the changing characteristics of the local inhabitants who actually provide the demand. However, demography can provide an invaluable insight into retail and residential property trends, especially over the long term, and are assisted by reliable population datasets with a relatively high level of detail. For example, the emergence of the 'baby boom' generation shift had a substantial effect on demand for retail and housing products, although little consideration has been given to the effect from the subsequent cohorts, namely generations X, Y and Z.

This paper examines the role of demography when researching property markets, with the focus placed on demographic shifts. It discusses trends in a range of demographic variables that have been observed in society. In addition, it highlights linkages with property markets, especially residential and retail property, and draws inferences for long term trends. The study concludes that when conducting research into property markets, it is essential to have a thorough understanding of various demographic variables to predict how they affect demand. An appreciation of the drivers behind generations will assist property researchers to identify future needs, and the subsequent effect this will have on community development involving retail and residential property.

Acculturation, body image, and eating behaviours in Muslim-Australian women

The relationship between western acculturation, body dissatisfaction, and eating behaviours was examined in a sample of 101 Muslim-Australian women between 18 and 44 years of age (M=27.3, SD=7.5). A questionnaire was completed containing measures of cultural identification (heritage and mainstream), body dissatisfaction and disordered eating (dietary control, bingeing and purging), internalization of the thin ideal, and self-esteem. A series of path analyses identified significant positive relationships between mainstream identification and the measures of body dissatisfaction and disordered eating that were mediated by thin-ideal internalization. Path analyses also identified significant negative relationships between heritage identification and the measures of body dissatisfaction and disordered eating that were mediated by self-esteem. These results are indicative of the potential risks to body image incurred by women who adopt Western values, and of the benefits in retaining heritage cultural values that promote a positive self image.

Occupational health and safety management systems : system types and effectiveness

The aim of this thesis is to develop a framework to evaluate the relative performance of different types of health and safety management system. This objective is an analytical one, but it stems from a policy issue of public importance. Over the past decade Australia, like other countries, has seen the emergence and growth of interest in developing health and safety management systems. But are they all the same, and if not, do they differ in their effectiveness? The thesis does not seek to give a definitive answer to these questions. Given the novelty of the phenomenon and the lack of research on this subject, the research is exploratory. An hypothesis about the effectiveness of different health and safety management systems is developed rather than tested. The thesis proceeds by first defining health and safety management systems as a combination of the planning and review, the management arrangements, the consultative arrangements and the specific program elements that work together in an integrated way to improve health and safety performance. A research procedure is described involving twenty exploratory case studies. The thesis then - develops - from the literature and the case study research - an analytical framework to evaluate the performance of different health and safety management systems. That framework has two parts. First is a typology of health and safety management systems. This is constructed from two distinctions - between 'safe place' and 'safe person' approaches to health and safety; and between 'innovative' and traditional' management methods and structures. These distinctions yield four types of system. The typology was applied to the case studies which yielded a reasonable fit in most instances. The second part of the framework is a 'process evaluation' technique akin to Quality standards. Derived from the Victorian SafetyMAP audit criteria, the "e;process evaluation tool "e; is preferred to traditional outcome measures such as incident or claim rates. Using this measure, the twenty case study enterprises were classified as above average, average or below average in performance. These results correlated poorly with traditional incident trend and benchmark measures. The two elements of the framework are then combined to explore the relationship between the different types of system and their performance. Evidence from the twenty case studies showed a tendency for innovative/safe place firms to perform better than traditional/safe person firms. This finding can form the basis for a hypothesis that may be subject to statistical testing on a generalisable sample. In addition five 'best practice' cases were selected and subjected to a cross case analysis to search for common characteristics that might explain their performance. This analysis suggests the importance of a number of factors: senior managers who drive health and safety change and mobilise all possible resources in the pursuit of change; health and safety representatives who work with managers in a 'joint regulatory relationship' across system activities; the involvement of employees more generally, but not as a substitute for action by managers and health and safety representatives; a comprehensive approach to elimination of all hazards; and the introduction of innovative programs to continually improve systems and facilitate employee involvement in health and safety.

Body dissatisfaction and body change strategies among adolescents : a longitudinal investigation

This thesis examined body dissatisfaction and body change behaviors among adolescent girls and boys from a biopsychosocial framework. The contribution of biological, psychological and sociocultural factors were examined in relation to body dissatisfaction, weight loss, weight gain and increased muscle tone behaviors among early adolescent girls and boys. In particular, pubertal maturation, body mass index (BMI), perception of body shape and size and psychological factors, such as depression, anxiety, ineffectiveness, self-esteem and perfectionism, were examined as possible factors that may precipitate or maintain body dissatisfaction and engagement in body change strategies. The sociocultural factors evaluated were the quality of family and peer relationships, as well as the influence of family and peers in predicting the adoption of specific body change strategies. The specific mechanisms by which these influences were transmitted were also examined. These included perceived discussion, encouragement and modelling of various body change strategies, as well as perceived teasing about body shape and size. A number of separate cross-sectional and longitudinal studies were conducted to examine the above relationships and identify the factors that contribute to weight loss, weight gain and increased muscle tone behaviors in adolescents. Study 1 examined the psychometric properties and principal components structure of the Bulimia Test Revised (BULIT-R; Thelen, Farmer, Wonderlich, & Smith, 1991) to assess its applicability to adolescent samples. Study 2 investigated the nature of body dissatisfaction and weight loss behaviors among 603 adolescents (306 girls and 297 boys) using a standardised questionnaire. This preliminary study was conducted to ascertain whether variables previously found to be relevant to adolescent girls, could also be related to the development of body dissatisfaction and weight loss behaviors among adolescent boys. Studies 3 and 4 described the development and validation of a body modification scale that measured weight loss, weight gain and increased muscle tone behaviors. Studies 5 and 6 were designed to modify an Excessive Exercise Scale developed by Long, Smith, Midgley, and Cassidy (1993) into a shorter form, and validate this scale with an adolescent sample. Study 7 investigated the factors that contribute to weight loss, weight gain and increased muscle among adolescent girls and boys both cross-sectionally and longitudinally (over one year). Structural equation modelling was used to examine associations among self-reported body dissatisfaction, body change strategies and a range of biological, psychological and sociocultural variables both cross-sectionally and longitudinally. Overall, the results suggested that both girls and boys experience body dissatisfaction and engage in a number of different body change strategies in order to achieve an ideal size. A number of gender similarities and differences were identified in the expression of body dissatisfaction and the adoption of body change strategies for both girls and boys. Girls were more likely than boys to report body dissatisfaction and engage in weight loss behaviors, while boys were more likely than girls to engage in weight gain and increased muscle tone behaviors. Generally, the same factors were found to contribute to weight loss, and more specifically, bulimic symptomatology, ad weight gain in both adolescent girls and boys. While a combination of biological, psychological and sociocultural factors contributed to bulimic symptomatology, only biological and psychological factors were found to contribute to weight gain in adolescents. The most notable gender differences were found in the model of increased muscle tone. Sociocultural and biological factors contributed to increased muscle tone behaviors in girls, while sociocultural and psychological factors were implicated in these behaviors in adolescent boys. With the exception of the model of increased muscle tone for boys, body dissatisfaction was a consistent factor in the adoption of body change behaviors. Consistent with previous investigations, the present thesis provides empirical support for the need to examine the etiology and maintenance of such concerns and behaviors from a multifaceted perspective.