Lay perceptions of type 2 diabetes in Scotland:bringing health services back in

The growing prevalence of type 2 diabetes is placing Scottish health services under considerable strain. Consequently, diabetes services are undergoing a major process of reorganisation, including the devolvement of routine diabetes care/diabetic review from secondary to primary healthcare settings. This qualitative study was devised to explore newly diagnosed type 2 diabetes patients' perceptions of their disease and the health services they receive at a time when this restructuring of services is taking place. The sample comprised 40 patients resident in Lothian, Scotland, who had diverse experiences of services, some receiving GP-based care only, others having varying contact with hospital diabetes clinics. In-depth interviews were undertaken with patients, three times at six monthly intervals over 1 year, enabling their experiences to be tracked at critical junctures during the post-diagnostic period. Disease perceptions and health service delivery were found to be mutually informing and effecting. Not only did (different types of) health service delivery influence the ways in which patients thought about and self-managed their disease, over time patients' disease perceptions also informed their expectations of, and preferences for, diabetes services. We thus argue that there is a need for a reconceptualisation within the medical social sciences to take into account the context of healthcare and the economic/policy factors that inform health service delivery when looking at patients' disease perceptions. We also discuss the logistical and ethical challenges of drawing upon patients' perspectives, preferences and views in the design and delivery of future health services. © 2004 Elsevier Ltd. All rights reserved.

Cross-cultural dimensions of meaning in the evaluation of events in world history? Perceptions of historical calamities and progress in cross-cultural data from 30 societies

The universality versus culture specificity of quantitative evaluations (negative-positive) of 40 events in world history was addressed using World History Survey data collected from 5,800 university students in 30 countries/societies. Multidimensional scaling using generalized procrustean analysis indicated poor fit of data from the 30 countries to an overall mean configuration, indicating lack of universal agreement as to the associational meaning of events in world history. Hierarchical cluster analysis identified one Western and two non-Western country clusters for which adequate multidimensional fit was obtained after item deletions. A two-dimensional solution for the three country clusters was identified, where the primary dimension was historical calamities versus progress and a weak second dimension was modernity versus resistance to modernity. Factor analysis further reduced the item inventory to identify a single concept with structural equivalence across cultures, Historical Calamities, which included man-made and natural, intentional and unintentional, predominantly violent but also nonviolent calamities. Less robust factors were tentatively named as Historical Progress and Historical Resistance to Oppression. Historical Calamities and Historical Progress were at the individual level both significant and independent predictors of willingness to fight for one’s country in a hierarchical linear model that also identified significant country-level variation in these relationships. Consensus around calamity but disagreement as to what constitutes historical progress is discussed in relation to the political culture of nations and lay perceptions of history as catastrophe.

Public perceptions of the causes and prevention of obesity among primary school children

OBJECTIVE: To investigate lay perceptions of the causes and prevention of obesity among primary school children.

DESIGN: A cross-sectional survey of randomly selected sample of adults in a shopping centre.

SUBJECTS: 315 adults in Melbourne, Australia.

MEASUREMENTS: Subjects completed a self-completion questionnaire, in which they rated the importance of 25 possible causes of obesity and the importance of 13 preventive measures on four-point scales: not important; quite important; very important; extremely important. Demographic information about the respondents' age, sex, marital status, education level and parental status was also collected.

RESULTS: The most important reported causes of childhood obesity were related to overconsumption of unhealthy food, parental responsibility, modern technology and the mass media. The most popular prevention activities were associated with specific actions aimed at children. Principal components analysis of the causes data revealed eight factors, provisionally named: parental responsibility, modern technology and media, overconsumption of unhealthy food, children's lack of knowledge and motivation, physical activity environment, lack of healthy food, lack of physical activity and genes. Two prevention factors were also derived, named government action and children's health promotion. Parents saw modern technology and media, and government activities as more important causes, and government policy as a more important means of prevention than nonparents and men. Women's responses tended to be similar to those of parents. There were few educational differences, although nontertiary educated respondents reported that modern technology and media were more important causes of obesity than did the tertiary educated.

CONCLUSION: The findings suggest that the public appears to hold quite sophisticated views of the causes and prevention of children's obesity. They suggest that a number of prevention strategies would be widely supported by the public, especially by parents.

Identifying solutions to increase participation in physical activity interventions within a socio-economically disadvantaged community: a qualitative study

Background: There is an urgent need to increase population levels of physical activity, particularly amongst those who are socio-economically disadvantaged. Multiple factors influence physical activity behaviour but the generalisability of current evidence to such ‘hard-to-reach’ population subgroups is limited by difficulties in recruiting them into studies. Also, rigorous qualitative studies of lay perceptions and perceptions of community leaders about public health efforts to increase physical activity are sparse. We sought to explore, within a socio-economically disadvantaged community, residents’ and community leaders’ perceptions of physical activity (PA) interventions and issues regarding their implementation, in order to improve understanding of needs, expectations, and social/environmental factors relevant to future interventions.

Methods: Within an ongoing regeneration project (Connswater Community Greenway), in a socio-economically disadvantaged community in Belfast, we collaborated with a Community Development Agency to purposively sample leaders from public- and voluntary-sector community groups and residents. Individual semi-structured interviews were conducted with 12 leaders. Residents (n=113), of both genders and a range of ages (14 to 86 years) participated in focus groups (n=14) in local facilities. Interviews and focus groups were recorded, transcribed verbatim and analysed using a thematic framework.

Results: Three main themes were identified: awareness of PA interventions; factors contributing to intervention effectiveness; and barriers to participation in PA interventions. Participants reported awareness only of interventions in which they were involved directly, highlighting a need for better communications, both inter- and intra-sectoral, and with residents. Meaningful engagement of residents in planning/organisation, tailoring to local context, supporting volunteers, providing relevant resources and an ‘exit strategy’ were perceived as important factors related to intervention effectiveness. Negative attitudes such as apathy, disappointing experiences, information with no perceived personal relevance and limited access to facilities were barriers to people participating in interventions.

Conclusions: These findings illustrate the complexity of influences on a community’s participation in PA interventions and support a social-ecological approach to promoting PA. They highlight the need for cross-sector working, effective information exchange, involving residents in bottom-up planning and providing adequate financial and social support. An in-depth understanding of a target population’s perspectives is of key importance in translating PA behaviour change theories into practice.

Understanding women's breast screening behaviour: a study carried out in South East London, with women aged 50-64 years

Objective To understand low uptake of breast cancer screening through exploring the personal reasoning underlying women's attendance or non-attendance, and identifying differences between those who attend and those who decline.

Design Cross-sectional survey.

Setting Community and home environments of women eligible for breast screening aged 50—64 years, living in South East London. Method Structured, self-completed or assisted-completion questionnaires.

Results The decision to attend or decline screening is rational and personally justifiable, engaging factors linked to emotions and attitude. Attitudes about breast screening and perceived personal importance of breast screening are the strongest predictors of attendance and non-attendance. There are differences between ethnic groups in perceptions of breast screening. Regular attendance at screening is associated with ethnicity, although consistent avoidance of mammography is not. Inconvenience is an important factor in missing appointments, and tends to be prolonged rather than specific to the time or day of the pre-booked invitation. GP and health worker advice are good persuaders towards attendance. Pain and anxiety during mammography are notable dissuaders against re-attending.

Conclusion Appropriate service provision requires consideration of local factors, as well as the medical needs of the population eligible for breast screening. Lay perceptions of potential personal costs of attending or not attending breast screening are important for guiding health promotion. Information providers should consider the language needs of a culturally and educationally mixed community. Health care professionals are well placed to encourage uptake of breast screening through disseminating information that promotes attendance, both within and outside the breast screening service.

The decline of experts in the Age of web 2.0 : lay blogger perceptions of experts

With the advent of Web 2.0 tools such as Weblogs (blogs), lay people can more easily share knowledge with the public and have far greater reach and impact. At the same time a literature review reveals that experts have been criticised on many fronts. This paper explores key criticisms of experts using 1) a literature review and 2) an interpretive study of lay blogger perceptions of experts. The paper provides important insights into lay blogger criticisms of experts. Findings indicate that a major lay blogger criticism of experts is class-based and powerbased. Experts are perceived as elitists who wish to control the flow of knowledge. Interestingly, many of the lay bloggers studied held mixed feelings about experts and the value of lay knowledge on the internet. Implications for theory and practice are discussed.

The decline of experts in the age of Web 2.0: Lay blogger perceptions of experts

With the advent of Web 2.0 tools such as Weblogs (blogs), lay people can more easily share knowledge with the public and have far greater reach and impact. At the same time a literature review reveals that experts have been criticised on many fronts. This paper explores key criticisms of experts using 1) a literature review and 2) an interpretive study of lay blogger perceptions of experts. The paper provides important insights into lay blogger criticisms of experts. Findings indicate that a major lay blogger criticism of experts is class-based and powerbased. Experts are perceived as elitists who wish to control the flow of knowledge. Interestingly, many of the lay bloggers studied held mixed feelings about experts and the value of lay knowledge on the internet. Implications for theory and practice are discussed. © 2009 Sharman Lichtenstein.

What Matters? : the full-time graduate students' perceptions of teacher effectiveness

The purpose of this qualitative study was to explore the full-time graduate students' perceptions of teacher effectiveness at the graduate school level, to identify how graduate students perceive effective and ineffective teachers, and specifically to discover the main dimensions of teacher effectiveness that graduate students perceive as most significant. This topic was investigated because, although the teacher has been deemed as a crucial component in the teaching process, there is no common agreement on the definition and measure of teacher effectiveness. Graduate students' perceptions of teacher effectiveness have not been given much attention. The research design was based on a ground theory approach. It utilized qualitative data through interviews, field notes, andjournals. The findings ofthis study revealed that teacher effectiveness is markedly influential to graduate students. There is no universally consented definition or measure of teacher effectiveness due to the multidimensionality of teaching and learning. Nevertheless, several major dimensions ofteacher effectiveness were discovered and highlighted in this study. Such dimensions include good command of subject matter, presentation skills, challenging and motivating students, rapport with students, learning environment, course demands, as well as assessment and feedback. It was hoped that the study would move towards developing a theory that contributes to the knowledge base of graduate students' perceptions of teacher effectiveness. It was anticipated that the results would provide first-hand information for the instructor to improve teaching; for the administrator to promote the effective educational experiences and student achievements. It was intended that the findings would lay a theoretical and empirical groundwork for future research.

Lay definitions of ideal weight and overweight

OBJECTIVE: To describe lay definitions of ideal weight and overweight, to determine whether they correspond with current health definitions, and to examine the relationship between lay definitions and weight-control behaviour.

DESIGN: Cross-sectional survey of a representative sample of adults from Victoria, Australia.

SUBJECTS: 1342 men and women, aged 18 y and older from across the weight spectrum.

MEASURES: Questionnaire-based measures of current height and weight to determine body mass index (BMI); weight that is considered to be ideal; weight that is considered to be overweight; current weight-control behaviour.

RESULTS: The BMI at which women considered themselves to be at their ideal weight was significantly lower than that for men. For both men and women, the BMI defined as ideal increased with age and with current weight. The average BMI at which women considered themselves to be overweight was significantly lower than that for men, and was well within the acceptable BMI range. Just over two-thirds of men, defined overweight at a level higher than the current cutoff of 25 kg/m2. For both men and women, the BMI defined as overweight increased with age and with current weight.

CONCLUSION: Lay definitions of ideal weight and overweight deviate substantially from health definitions. Public health initiatives should stress that many women are already a healthy weight, and encourage these women to focus their efforts on weight maintenance rather than weight loss. Since so few men have weight goals that are consistent with current health recommendations, it will be important to raise their awareness of what constitutes a healthy weight.

Voices of lay principals: Promoting a Catholic character and culture in schools in an era of change

This paper reports a qualitative study of the practice of leadership in Catholic schools to ascertain the perceptions of lay principals, who as positional leaders play a critical role in embracing and creatively rebuilding the Catholic vision of life within the reality that the Catholic school principalship is now a ministry of the laity. The methodology included semi-structured interviews, field notes, reflexive journals, direct observation, and document nalysis. The study examined both individual human behaviour and the structure of the social order in Catholic schools. The findings point towards successful leadership in Catholic schools being highly influenced by the cultural and spiritual capital that a principal brings to a school signifying a fundamental importance of appointing principals who are not only professionally competent but spiritually as well. In an era of unprecedented social, educational and ecclesial change, and with an ever widening role description, lay principals are challenged to redefine and re-articulate their Catholic character and identity, and will need to look for new ways to make this explicit. Embracing a new leadership paradigm of shared leadership, the preparation and on-going formation of lay principals were identified as critical for the continuance of the Catholic school’s distinctive mission in the future.

Illness perceptions, beliefs and prevention of Type 2 Diabetes among British Pakistani mothers and young British Pakistani women

The prevalence rates of type2 diabetes mellitus (T2DM) continues to rise among British Pakistanis. The aim of this project was to explore T2DM perceptions and any preventative intentions among British Pakistani women and to discover whether they are doing anything to prevent the onset in themselves and their families. Initially a systematic review was conducted to investigate 20 existing prevention interventions and to assess their effectiveness (n=12,419). Mixed methods approach was adopted and three studies were conducted. The first study consisted of two focus groups with T2DM mothers (n=8) and three focus groups with non-T2DM mothers (n=17). The second study consisted of four focus groups young British Pakistani females (n=11). All focus groups were transcribed verbatim and analysed using thematic analysis. Following these a quantitative study was undertaken comprising of a questionnaire survey; 12 prevention-perception items (derived from the qualitative data) and the Illness-Perception Questionnaire Revised (IPQ-R) using participants from the same populations: T2DM mothers (n=41), non-T2DM mother (n=47) and young women (n=42). Results were analysed using multiple/hierarchical regression. The systematic review highlighted that the most effective prevention programmes focussed on behaviour and lifestyle with a combination of support and education to participants. The research studies demonstrated that T2DM was seen as an older person’s disease to be dealt with if/when it happens. T2DM mothers demonstrated knowledge and prevention understanding. There were non-significant relationships between prevention perceptions and T2DM illness perceptions across all three groups. The finding of this thesis emphasised that lifestyle interventions are crucial to aiding T2DM preventions as a good healthy diet and regular physical activity are the key components to T2DM prevention, and the importance of personal experience in perceived severity and lay-beliefs regarding T2DM and on family/cultural influences in British-Pakistanis. The findings of this project can be used to design culturally specific interventions towards preventing T2DM in the British Pakistani community.

How do practitioners understand? Practitioner perceptions of an object-oriented programming.

In the computer science community, there is considerable debate about the appropriate sequence for introducing object-oriented concepts to novice programmers. Research into novice programming has struggled to identify the critical aspects that would provide a consistently successful approach to teaching introductory object-oriented programming. Starting from the premise that the conceptions of a task determine the type of output from the task, assisting novice programmers to become aware of what the required output should be, may lay a foundation for improving learning. This study adopted a phenomenographic approach. Thirty one practitioners were interviewed about the ways in which they experience object-oriented programming and categories of description and critical aspects were identified. These critical aspects were then used to examine the spaces of learning provided in twenty introductory textbooks. The study uncovered critical aspects that related to the way that practitioners expressed their understanding of an object-oriented program and the influences on their approach to designing programs. The study of the textbooks revealed a large variability in the cover of these critical aspects.

Territoriality and Migration in a Divided Society: Lay Theories of Citizenship and Place in Northern Ireland

The study of citizenship has increasingly focused on the ways in which spatialized understandings of the concept can be used to marginalise and exclude social groups: exclusive constructions of national boundaries, local neighbourhoods and public spaces can deny marginalised groups their social and political rights. Less attention has been paid to how constructions of place can accommodate different groups’ rights and promote peaceful coexistence. This is particularly important in locations where migration disrupts existing understandings (‘lay theories’) of the relationship between residency, identity and collective rights. The present research examines how spatialized understandings of citizenship shape perceptions of intergroup mixing in previously segregated areas of a post-conflict society. Critical Discursive Social Psychological (CDSP) analysis of 30 interviews with long-term residents and recent migrants to increasingly mixed areas of Belfast shows that, while all pa
rticipants acknowledged Northern Ireland’s territorialisation, different lay theories of citizenship underpin the possibility and desirability of intergroup coexistence. Long-term residents drew upon understandings of the negative citizenry of the outgroup to argue against the possibility of peaceful coexistence within their locale, while recent incomers gave evidence of their own experiences of good citizenship within the shared spaces of neighbourhood to demonstrate that this could and should be achieved. The implications of lay theories of citizenship for the study of residential migration and mixing are discussed