Understanding the role of mediating risk factors and proxy effects in the association between socio-economic status and untreated hypertension

The association between socio-economic status (SES) and untreated hypertension varies according to a country's level of development and racial/ethnic group. We sought to confirm this variation in women from China and the United States (US) as well as to investigate the impact of SES on several mediating risk factors. We also investigate the extent to which SES explains racial/ethnic differences in untreated hypertension in the US. We used cross-sectional data from 1814 non-pregnant women in China (China Health and Nutrition Survey (CHNS), 1997) and 3266 non-pregnant women in the United States (National Health and Nutrition Examination Survey (NHANES III), 1988–1994) respectively. A variety of statistical modelling techniques was used to predict untreated hypertension as a function of several mediating factors and to simulate the impact of changes in SES. The age-adjusted prevalence of untreated hypertension was significantly higher (p<0.01) for low-income White and Black women compared to Mexican American or Chinese women. Untreated hypertension was not significantly associated with income or education in Mexican Americans or women in China. Obesity and light physical activity had the largest mediating effect on the association between SES and untreated hypertension for all racial/ethnic groups. However, this effect was not as strong as the proxy effect of income and education. SES did not completely explain racial/ethnic differences in hypertension in the US. While SES was more strongly associated with hypertension in Blacks than Whites, Blacks were still 1.97 (95% CI 1.47–2.64) times more likely to have untreated hypertension than Whites after adjusting for SES differences. The association between SES and untreated hypertension varied by country and racial/ethnic group. An important explanation for this variation was the differential effect of SES on mediating risk factors. SES disparities between Whites and Blacks in the US partly explain differences in the prevalence of untreated hypertension between these racial/ethnic groups.

Consumer satisfaction and post-purchase intentions: an exploratory study of museum visitors

This paper examines the relationship between consumer satisfaction and subsequent intentions in the museum context, as well as the moderating influence of demographic characteristics such as gender, age and education in that relationship. The relationship between satisfaction and a range of service elements, overall satisfaction with the experience and intentions was investigated. Museum marketers can profit by examining the "value chain" of museum experience outlined in the model presented, especially the greater likelihood of consumers recommending the experience to others than making a repeat visit themselves, and by investigating segment differences beyond those reported here.

Australians' organic food beliefs, demographics and values

Purpose – To examine consumers' beliefs about organic foods and their relationship with socio-demographics and self-transcendence (universal, benevolence) personal values.

Design/methodology/approach – A random questionnaire-based mail survey of 500 Australian (Victorian) adults (58 per cent response) was used. The questionnaire included items on organic food beliefs, the importance of self-transcendence values as guiding principles in life, and socio-demographics. Statistical analyses included cross-tabulations of organic food beliefs by socio-demographics and multiple regression analyses of positive organic food beliefs with personal value and socio-demographic items as the independent variables.

Findings – The majority of participants believed organic food to be healthier, tastier and better for the environment than conventional food. However, expense and lack of availability were strong barriers to the purchasing of organic foods. Generally, women were more positive about organic food than men (e.g. women were more likely to agree that organic food has more vitamins/minerals than conventional food). The personal value factor related to nature, environment and equality was the dominant predictor of positive organic food beliefs, followed by sex. These predictors accounted for 11 per cent of the variance.

Research limitations/implications – A survey response bias needs to be taken into account. However, the response rate was adequate for reporting and differences in age and education between participants and the Victorian population were taken into account in data presentation. Future understanding of consumers' use of organic foods will require the inclusion of a fairly extensive set of potential influences.

Practical implications – Communication appeals based on psychographics may be a more effective way to alter consumers' beliefs about organic foods than those based on demographic segmentation.

Originality/value – To the best of one's knowledge, this is the first study to examine the relationship between personal values, socio-demographics and organic food beliefs in a random population sample. This study is relevant to producers, processors and retailers of organic food and those involved with food and agricultural policy.

The experiences and adjustments of women following their first acute myocardial infarction

Very little is known about cardiovascular disease (CVD) in women and their specific needs throughout their recovery process. This study aimed to explore the experiences and adjustments of women following their first AMI. Naturalistic inquiry was used and six women were interviewed post their first AMI. Two major themes were identified: (1) 'the initial experience/event' which identifies events and emotions leading up to, and during, the hospital admission; and (2) 'support: for who and how' exploring the importance of support throughout the recovery process.

The women in this study did not see themselves at risk of an AMI regardless of their lifestyles and when it did occur they adopted a variety of coping mechanisms in order to adjust to their trauma. The findings highlight the need for an increase in community awareness and education surrounding the risk factors of heart disease and its signs and symptoms, to minimize delayed hospital presentations.

Public views of the benefits and barriers to the consumption of a plant-based diet

Objective: The aim of this study was to examine consumers' perceived benefits and barriers to the consumption of a plant-based diet. Design: Mail survey that included questions on perceived benefits and barriers to the consumption of a plant-based diet. Setting: Victoria, Australia. Subjects: Four hundred and fifteen randomly selected Victorian adults. Results: The main perceived barrier to adoption of a plant-based diet was a lack of information about plant-based diets (42% agreement). Sex, age and education differences were present in over a quarter of the barrier items. For example, non-university-educated respondents and older people were less willing to change their current eating pattern than were university educated and younger respondents. The main benefits associated with plant-based diets were health benefits, particularly decreased saturated fat intake (79% agreement), increased fibre intake (76%), and disease prevention (70%). Age, sex and education differences with regard to benefits were apparent, although sex differences were more important than age or education differences. Conclusions: The majority of respondents perceived there to be health benefits associated with the consumption of a plant-based diet. Compared with the proportion of respondents who agreed that there were particular benefits of eating a plant-based diet, perceived barriers were relatively low. An understanding of the perceived benefits and barriers of consuming a plant-based diet will help formulate strategies that aim to influence beliefs about plant foods, plant food consumption, and, ultimately, public health.

The influence of patient complexity and nurses` experience on haemodynamic decision-making following cardiac surgery

Critical care nurses’ haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. The aim of this study was to describe variability of nurses’ haemodynamic decision-making in the 2-hour period after cardiac surgery as a function of interplay between decision complexity, nurses’ levels of experience, and the support provided. A descriptive study based on naturalistic decision-making was used. Data were collected using continuous non-participant observation of clinical practice for a 2-hour period and follow-up interview. Purposive sampling was used to recruit 38 nurses for inclusion in the study. The quality of nurses’ decision-making was influenced by interplay between the complexity of patients’ haemodynamic presentations, nurses’ levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses’ utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses’ professional development and education.

The dynamics of adult education : effectiveness of financial education seminars

This study examines the impact of adult education seminars in superannuation investments for retirement has on the investment intentions and decision making of those adults attending the seminars.  The socio-political context of the data is that of an aging population and a future government being unable to afford the current level of age pensions being paid, and attempting to encourage individuals to plan and provide for their own financial well-being in retirement.  Three themes emerged from the data and were seen to be representative of the major issues found in adult education for financial self-sufficiency: education for knowledge, education for decision making, and education for action.  In an attempt to measure the immediate impact of the seminar on the attendees decision making, the investment intentions of seminar attendees were captured at the start and end of the seminar. This was followed up three months later to see whether the intentions expressed at the end of the seminar had been implemented.  The immediate impact of the seminar was to encourage the respondents to express an intention to increase their investment strategy, however when the follow-up was done three months later, the results were mixed. Some respondents who did not express an intention to change their investment strategy actually made changes, and other respondents who did express an intention to make a change, did not do so.

Science in school and society

This article describes the insights generated from a series of focus groups conducted around significant areas of science research and development, with practitioners of science and technology, and policy and education people from industry and government. The participants in these groups had a great deal to say about how important the understandings and attitudes of members of the community were to their field of activity, as well as the way science is practiced in contemporary settings. On the basis of the evidence we argue that school science should take as its focus the development of understandings of, and attitudes to, science for citizens generally. We suggest that this means, for both future citizens and scientists, that practice in school science needs to change to better represent contemporary science practice.

Evaluating health promotion in schools: a case study of design, implementation and results from the Hong Kong Healthy Schools Award Scheme

Health promoting schools (HPS) and Healthy Schools Award Schemes from a number of countries have demonstrated positive changes in children’s health behaviours and the culture and organisation of the school. The Hong Kong Healthy Schools Award Scheme (HKHSA) aims to promote staff development, parental education, involvement of the whole school community, and linkage with different stakeholders to improve the health and well-being of the pupils, parents and staff, and the broader community, supported by a system to monitor the achievement. This concept is very much in line with the research literature on school effectiveness and improvement. The indicators examined to evaluate the success of the HKHSA reflect outcomes related to both health and education and are not limited to changes in population health status. The early results demonstrated significant improvements in various aspects of student health and also improvement in school culture and organisation. The evaluation framework described in this paper and data collected to assess how schools perform in the HKHSA scheme, provides insight into how HPSs could lead to better outcomes for both education and health.

Consumer satisfaction and post-purchase intentions: an exploratory study of museum visitors

This paper examines the relationship between consumer satisfaction and future intentions in the museum context, and the role that demographic characteristics such as gender, age and education play. The variables Expectations Met, Satisfaction, Value, Intention to Return, and Recommendation to Others, were all found to be correlated. However, although it is often assumed that the level of educational attainment, gender and age correlate strongly with arts and cultural usage, this research found that the only statistically significant differences were that females had a higher mean Intention to Return, and there was a weak positive association between Age and Satisfaction, and weak negative associations between Education and Expectations Met, Satisfaction, and Recommendation to Others. Museum marketers may profit from examining the "value chain" of museum experience outlined in the model presented, especially the greater likelihood of positive recommendations to others than individual intention to revisit, and by investigating segment differences beyond those reported here.

Policy, preparation, prevention and punishment: one faculty's holistic approach to minimising plagiarism

Most Australian universities have made attempts of various kinds to address plagiarism. Some have responded in recent times with a primary focus on catching and punishing plagiarists, often assisted by computer software packages. Others have taken a more holistic approach incorporating foci on policy, assessment regime and student preparation and education as well as on ensuring appropriate consequences for plagiarists. This paper outlines one example of the latter approach in one Australian university faculty and details the outcomes in terms of policy recommendations and resources to support the approach. The necessity of evidence-based evaluation of attempts to reduce plagiarism in higher education is argued.

The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey

Objective
To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.

Methods
People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES ≥ 0.5), minimal/no change (ES −0.49 to 0.49) and substantial decline (ES ≤ −0.5).

Results
On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.

Conclusion
While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage.

Practice implications
These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.

Re-badged environmental education: is ESD more than just a slogan?

In the field of environment-related education, the period from the early 70s to the present is marked by continuity and contestation. There has been a remarkable continuity of environmentrelated practice; and there has also been contestation in the language of the field, with terms like ecology education, environmental education and education for sustainable development becoming highly visible at different times. Presently, the environment-related work formerly known as ‘environmental education&rsquo; (EE) is being aggressively and extensively ‘re-badged’ as ‘education for sustainable development’ (ESD). This paper explores the role of slogans in the fields of environmental education and education for sustainable development.

The status of health-promoting schools in Hong Kong and implications for further development

An evaluation framework, called the Hong Kong Healthy Schools Award, has been developed to enable comprehensive collection and analysis of data reflecting the status of health-promoting schools (HPS) in Hong Kong. The key findings revealed a high prevalence of emotional problems, unhealthy eating habits, physical inactivity and risk-taking behaviours, leading to both intentional and unintentional injuries among students with higher prevalence among secondary school students. The results indicated a substantial lack of health policies in schools; it also indicated health services in schools not readily accessible to students and staff, and insufficient staff training in health promotion and education. However, most schools have made initiatives in environmental protection, established safety guidelines and strategies for managing students with emotional problems. The success of HPS depends largely on teachers' understanding of its building blocks. Evidence from the comprehensive mapping of the status of HPS in Hong Kong and from student surveys does show encouraging outcomes as well as identifying priority issues to be addressed in the next 5 years.

A role for workforce competencies in evidence-based health promotion education

Education programs should be based on research about the knowledge and skills required for practice, rather than on intuition or tradition, but there is limited published curriculum research on health promotion education. This paper describes a case study of how workforce competencies have been used to assist evidence-based health promotion education in the areas of curriculum design, selection of assessment tasks and continuous quality assurance processes in an undergraduate program at an Australian university. A curriculum-competency mapping process successfully identified gaps and areas of overlap in an existing program. Previously published health promotion workforce competencies were effectively used in the process of selecting assessment items, providing clear guidelines for curriculum revision and a useful method to objectively assess competency content in an evidence informed framework. These health promotion workforce competencies constituted an additional tool to assess course quality. We recommend other tertiary institutions consider curriculum-competency mapping and curriculum based assessment selection as quality and evidence based curriculum review strategies.