Chronic disease self-management programs : perspectives on enablers and barriers to GP and patient engagement

Aims & rationale/Objectives : Chronic disease self-management programs (CDSMP) are increasingly being integrated into the health system to improve the care of people with chronic conditions. Despite activity at both policy and program levels, GPs as the 'gatekeepers' to the health system have generally not been well informed or engaged in this process. This study, in collaboration with 3 Victorian Divisions of General Practice, sought both GP and patient perspectives on enablers and barriers to engagement in self-management programs.
Methods : Interviews were conducted with GPs (n=20) and consumers (n=45) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.
Principal findings : Lack of education/information and uncertainty about the effectiveness of self-management programs were key barriers for both GP and patient engagement. Programs that were sustainable and utilised existing community resources were viewed as enablers to increase uptake. GP and patient preferences for disease specific or generic CDSMP differed.
Discussion : Outcomes from the recent Council of Australian Governments' meeting suggest that self-management will be a centerpiece in forthcoming chronic disease initiatives. International evidence has highlighted the need for GP and patient engagement as critical in ensuring the recruitment of a critical mass of individuals to participate in CDSMP to ensure the sustainability of such initiatives. Insight from this study indicates that GPs and patients are not well informed about self-management, have different preferences to current policy trends and identifies several other barriers which need to be addressed if CDSMP are to be successful.
Implications : Identification of barriers and enablers of GP and patient engagement in self-management is essential in shaping current policy initiatives and delivery of future programs. This is supported by international evidence which indicates strongly that GP engagement in particular is crucial to the success of these programs.
Presentation type : Paper

Familial and genomic analyses of postural changes in systolic and diastolic blood pressure

The physiological adaptation to the erect posture involves integrated neural and cardiovascular responses that might be determined by genetic factors. We examined the familial- and individual-specific components of variance for postural changes in systolic and diastolic blood pressure in 767 volunteer nuclear adult families from the Victorian Family Heart Study. In 274 adult sibling pairs, we made a genome-wide scan using 400 markers for quantitative trait loci linked with the postural changes in systolic and diastolic pressures. Overall, systolic pressure did not change on standing, but there was considerable variation in this phenotype (SD=8.1 mm Hg). Familial analyses revealed that 25% of the variance of change in systolic pressure was attributable to genetic factors. In contrast, diastolic pressure increased by 6.3 mm Hg (SD=7.0 mm Hg) on standing and there was no evidence of contributory genetic factors. Multipoint quantitative genome linkage mapping suggested evidence (Z=3.2) of linkage of the postural change in systolic pressure to chromosome 12 but found no genome-wide evidence of linkage for the change in diastolic pressure. These findings suggest that genetic factors determine whether systolic pressure decreases or increases when one stands, possibly as the result of unidentified alleles on chromosome 12. The genetics of postural changes in systolic blood pressure might reflect the general buffering function of the baroreflex; thereby, the predisposition to sudden decreases or increases in systolic pressure might cause postural hypotension or vessel wall disruption, respectively.

Intellectual capital reporting : an examination of local government in Victoria

The objective of this research is to examine how Victorian local government annual reports disclose information on intellectual capital. The idea of intellectual capital has become part of the working organisational vocabulary, and is widely held in management literature to be the pre-eminent economic resource and a key driver of efficiency, effectiveness and continual improvement in the private and public sectors. Under the recent Best Value Victoria policy, local governments are under increasing pressure to acquire and apply intellectual capital to improve responsiveness to community needs and meet cost and quality criteria. Annual reports exist as vehicles for communication, accountability and decision making. This study examines how the internal, external and human categories of intellectual capital are represented in the annual reports for the 2000 year for 77 of the 78 Victorian local
governments.

Using a matrix approach derived from Petty and Guthrie's (2000) framework, content analysis is employed to examine the incidence and intensity with which specific elements of intellectual capital are reported. This research indicates that generally the content of annual reports have not provided clear and coherent representations of how local government in Victoria are developing, applying and measuring intellectual capital. The nature and extent of intellectual capital reporting varies considerably between councils, and the disclosure of the human elements of intellectual capital is particularly underdeveloped. The findings suggest that more research in this area is needed to determine the extent to which intellectual capital should be disclosed and whether the current paucity of disclosure stems from disinterest or technical problems. There is also the need for further research into the need to identify and describe elements of intellectual capital, and into effective
reporting strategies and techniques. This may lead to the development of a 'best practice' reporting model for intellectual capital. Furthermore, the preliminary investigations indicate a perceived need to raise the consciousness of public sector
managers as to the existence of intellectual capital within their organisations, and ultimately lead to more informed and effective management of this asset.

Adventurous girls of the empire : the pre-war novels of Bessie Marchant

Historically, the genre of adventure fiction most readily recalls books for boys and male heroes rather than girl readers and protagonists. These include enduringly well-known works such as H. Rider Haggard's King Solomon's Mines (1885) and She (1887), the early to mid-Victorian boys' stories of Frederick Marryat, W. H. G. Kingston, and R. M. Ballantyne and the late-Victorian G. A. Henty's tales (his more than one hundred adventure stories sold in excess of 25 million copies). The novel of adventure at the conclusion of the nineteenth century recounted tales of male exploration on land or sea, and quests or conquests in real or imagined lands removed from the gentility of civilized England. These generic features were aligned with masculine traits of activity and strength, and while girls could and did indeed read boys' adventure books, examples with female protagonists were uncommon in the Victorian period. Joseph Bristow argues that between 1870 and 1900, "narratives celebrating empire and techniques in teaching reading and writing gradually converged . . . [B]oth inside and outside the classroom, there was more and more emphasis on heroic adventure, and this involved a number of shifts in attitude towards juvenile publishing and curriculum design" (20–21). The works Bristow refers to were, of course, written by male authors about masculine adventurers.

The novels of Bessie Marchant—sometimes called "the girls' Henty" —began to be published as the nineteenth century drew to a close. Her girl heroines act independently in isolated areas in Australia, New Zealand, Canada, India, South America, India, South Africa, Siberia, and Central America. From 1894 until her death in 1941, Marchant wrote more than a 130 novels, many of which celebrated the capacity of British or colonial girls to rise to any challenge set before them in rugged.

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

Do we challenge students enough? Model Solar vehicle project challenges potential engineers.

A major challenge to Australia and New Zealand is the perceived need to develop "knowledge economies" based on the expertise of university graduates,  especially engineers. However, many countries are finding less students are choosing to study engineering. At the same time, there is increasing concern about increased levels of greenhouse gases leading to global warming with species loss, rising sea levels and desertification being likely outcomes. Numerous competitions have been established aimed at attracting school students into science and engineering careers. Environmental groups have also sponsored educational activities to increase student awareness of alternative energy technologies. One activity which provides both a science and engineering challenge while also raising awareness of alternative energy and more efficient conversion of that energy for transport is the Model Solar Vehicle Challenge (MSVC). The Challenge, which provides a solar powered boat competition for younger students and a car race for the older ones, has involved thousands of Victorian school students since 1990 and students from all Australian states since 1993. Boats race in 2 or 3 lanes guided by an overhead wire in a 10 metre pool, and cars race 100 metres around a figure 8 track. Top boats average over 7 kph and cars reach speeds of 25 kph at the finish line. This paper will discuss the conduct of the Challenge, motivation of participants, the depth of learning which can be achieved and the effectiveness of the Challenge in encouraging students to continue with science subjects through school and to select engineering at university. It will also briefly discuss the lessons that can be learnt from the MSVC and applied to first year university courses.

Registered and enrolled nurses : experiences of ethical issues in nursing practice

Research aims:
To explore and describe registered and enrolled nurses’ experiences of ethics and human rights issues in nursing practice in the Australian State of Victoria.

Method:
Descriptive survey of 398 Victorian nurses using the Ethical Issues Scale (EIS) survey questionnaire.

Major findings:
The most frequent and most disturbing ethical issues reported by the nurses surveyed included: protecting patients’ rights and human dignity, providing care with possible risk to their own health, informed consent, staffing patterns that limited patient access to nursing care, the use of physical/chemical restraints, prolonging the dying process with inappropriate measures, working with unethical/impaired colleagues, caring for patients/families who are misinformed, not considering a patient’s quality of life, poor working conditions.

Conclusions:
Nurses in Victoria frequently experience disturbing ethical issues in nursing practice that warrant focussed attention by health service managers, educators and policy makers.

In the tracks of Blinky Bill : How Sam the koala led news journalists into an Australian literary tradition

The world was captivated when footage of a badly burnt koala taking water from a Victorian Country Fire Authority volunteer was taken with a mobile phone and broadcast to the world on YouTube in February 2009. When the story of ‘Sam the Koala’ was subsequently adopted by traditional broadcast and print media, recombinant themes were used to construct her story – from heroism, patriotism, villain v victim - even romance was incorporated to entertain and create audience appeal. This paper explores how ‘Sam the Koala’ became a defining news story in the coverage of Victoria’s Black Saturday bushfires and examines the power of narrative when cross pollination occurs between new and traditional media in the production of news. It is argued that Sam’s story is evidence of journalists adopting new approaches to storytelling in a bid to retain their legitimacy as the authoritative voice of news and information in an increasingly technologically driven society.

Burnout and the conservation of resources theory

This thesis examines, within the framework of the Conservation of Resources Theory, the development of burnout in a sample of Victorian nurses over a nine-month period. Results showed that work characteristics demonstrated different associations with burnout and that COR theory was partially successful as an explanatory framework.

Physical activity, dietary change and weight control : a public health perspective

This study examined weight-control behaviour among Victorian adults, focusing specifically on physical activity and dietary fat-related behaviour and beliefs. It also explored barriers to changing diet and physical activity, and used common theories of behaviour change to identify factors that influence weight-control behaviour, weight change and perceived weight-control success.

Interrupted cadence : the mismatch of the school music curriculum and the intercultural understandings of pre-service teachers in Victoria, Australia

In Victoria, Australia, the curriculum framework for schools, Victorian Essential Learning Standards (VELS) stipulates multiculturalism as an integral part of the education of students. This encompasses knowledge, skills, values and behaviours (Victorian Curriculum Assessment Authority, 2009). In this curriculum framework, teachers must consider ‘intercultural understanding’. It seems logical that, to teach this, preservice teacher education students should be able to embrace this idea. VELS addresses multicultural understanding and the development of thinking skills. The Arts domain specifically provides diverse opportunities for students to “develop aesthetic and critical awareness … of arts works from different social, historical and cultural contexts”. In this research, undertaken between 2005 and 2008, semi-structured interviews were completed with final year pre-service music education students about their intercultural understandings in music education. Interpretative phenomenological analysis of the data showed that, although many feel confident including music of other cultures, having had some experience in their tertiary education, some have pursued other ways to inform themselves about music of other cultures. There appears to be a mismatch between curricular expectations and the limited time and resources available in tertiary education programs for music. The disparity between the school music curriculum framework and the preparation of teachers requires attention and resolution.

Building the perfect beast : scientific romance and Jewish representations 1880-1914

Various cultural mediums portrayed Jews in Britain in the late Victorian and Edwardian periods. Scientific romance harnessed past communicative 'discourses' such as history, folklore, theology, and mythology and was an innovative form of literature that heralded a new era in the construction of Jewish identity between 1880 to 1914.