Acceptability, impact and sustainability of the national pilot quality assurance system for self management programs

Chronic condition self-management education and training interventions such as the Stanford Self Management Programs (SMP) have the capacity to improve health and quality of life of people with chronic conditions whilst reducing the use of health services. This is in line with the outcomes from the recent Council of Australian Governments’ meeting where it was indicated that self-management will be a centrepiece in forthcoming chronic disease initiatives.
Aim: report on a large national pilot quality assurance program involving the implementation and of an evaluation and quality monitoring system for SMPs including the provision of structured feedback to courses course leaders and service providers. During 2005/06 the quality assurance program was implemented at 11 diverse organisations across Australia. The program involved assisting organisations apply the 42-item Health Education Impact Questionnaire (HEIQ), a chronic disease health education outcome measure, and then observe and evaluate the value and impact of the quality program. Interviews with course leaders (n=60) and course participants (n=35) have elicited views about course quality and feedback processes.
Results: The evaluation revealed enablers and barriers to effective implementation and sustainability. Important enablers were:
- Course Leaders and organisations valued an Australia-wide system that provided feedback on course
quality and the impact on participants.
- Course Leaders were strongly personally motivated to respond appropriately to HEI-Q course
report feedback.
- Completing the questionnaire provided participants with the opportunity to reflect on issues that
emerge in the course content and reflect on their progression at the end of the SSMP.
Sustainability issues included:
- Organisations and course leaders require support, training and flexibility on how to administer and
manage the use of the HEI-Q.
- Availability of administrative resources in organisations to support the quality assurance activities.
- The requirement that course leaders are trained in interpreting HEI-Q course report data.
A quality improvement framework was developed which identified the actions required of key stakeholders to
support effective implementation.
Discussion: With the increasing endorsement of SMP across sectors it is important that course quality is known, is acceptable, and is communicated to stakeholders to inform and engender confidence in the SSMP. To effectively implement and sustain a quality improvement program for SMP, the processes and tools for measuring outcomes need to be responsive, flexible and easily integrated into the organisation and delivery of programs.

Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients – a realist evaluation

Objectives: The Liverpool Care Pathway for the dying patient (LCP) was designed to improve end-of-life care in generalist health care settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation.

Method: An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semi-structured interviews were conducted with two policy makers and twenty two participants with experience and/or involvement in management of the LCP during 2011 and 2012.

Results: Key resource inputs included facilitation with a view to maintaining LCP ‘visibility’, reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care.

Conclusion: There is a need to appreciate the organizationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives.

Slow fashion and sustainability in Spain: How can local manufacturing improve sustainability and how do consumers respond?

"Slow Fashion" attempts to offset the demand for fast fashion and mass production (Fletcher, 2007). Consumers' response to sustainability-based practices is a limited discourse and studies for slow fashion concept are scarce. This study thus aims to enlighten the subject of how slow fashion concept could improve local economies and how Spanish consumers respond to such initiatives. This paper is based on an exploratory qualitative research for which focus group interviews including three group discussions with Spanish consumers were held. The data was examined by constant comparison analysis to present consumer insights. Moreover, a case study was conducted with a Spanish apparel brand. Saint Brissant was chosen since it manufactures in Spain to (i) ensure its products? high quality and (ii) to empower Spanish economy. This paper provides empirical insights. Even though local manufacturing was perceived to have a higher quality, Spanish consumers? behavioural intentions of using local brands were not high.Self-interest, mainly price and design, was recorded as the most influential purchase criteria. Furthermore, Saint Brissant case demonstrated that local manufacturing could boost local economies by creating workforce. However, governmental subsidies should be rearranged and consumers? perceptions should be improved to support local manufacturers in Spain.

Integrating health and sustainability in life cycle assessment

Until now health impact assessment and environmental impact assessment are two different issues, often not addressed together. Both issues have to be dealt with for sustainable building. The aim of this paper is to link healthy and sustainable housing in life cycle assessment. Two strategies are studied: clean air as a functional unity and health as a quality indicator. The strategies are illustrated with an example on the basis of Eco-Quantum, which is a Dutch whole-building assessment tool. It turns out that both strategies do not conflict with the LCA methodology. The LCA methodology has to be refined for this purpose.

The city, self, and connections : transyouth and urban social networking in Seoul

The end of the Korean War in 1953 marked the beginning of Seoul’s transformation from the shattered capital city of South Korea to one of the most connected, populous, and fast-changing hubs of global economy. Seoul’s technosocial development has been celebrated nationally and internationally. To the outside, young Koreans’ swift and extensive adoption and adaptation to digital technologies has been a subject of exotification; to adults in Korea, it has been a subject of criticism (see Yoon in this volume). With the understanding that ‘the city is connections,’ it is crucial to study not only the macro-level design of the city as a network (through policy, for example), but also its micro-level construction at the intersection of people, place, and technology. Accordingly, this chapter explores this exact intersection to comprehensively portray the constant renewal of the city as imagined and experienced by young Koreans. The chapter is based on fieldwork conducted in Seoul, South Korea, from 2007 to 2008 as part of a research project on the mobile play culture of Seoul transyouth, the transitional demographic situated between youth and adulthood, and the pioneers of the Korean ‘broadband miracle’ (Hazlett, 2004). The study draws upon transdisciplinary research data including interviews, questionnaires, diaries, and Shared Visual Ethnography (SVE) to render the everyday urban social networking of young Seoulites with and through which they interact to constantly (re)create the city and the self.

Sustainable construction for the future - the role of government in energy efficiency and sustainability in buildings

This paper will summarise the findings from a study that explored the link between dwelling design, or type, and energy efficiencies in sub-tropical climates. An increasing number of government and private sector development companies are initiating projects that aim to deliver enhanced environmental outcomes at both sub-divisional and dwelling levels. The study used AccuRate, a new thermal modelling tool developed by CSIRO that responds to the need to improve ventilation modelling. The study found that dwellings developed in conjunction with the Departments of Housing and Public Works have set the benchmark. It provides a snapshot of the energy efficiency of a range of dwelling types found in recent subdivisions. However, the trend toward increasing urban densities may reduce the likelihood that cooling breezes will be available to cool dwellings. The findings are relevant to regulators, designers and industry in all states interested in reducing the energy used to cool dwellings in summer.

Needing to connect : The effect of self and others on young people’s involvement with their mobile phones

The present research was a preliminary examination of young Australians’ mobile phone behaviour. The study explored the relationship between, and psychological predictors of, frequency of mobile phone use and mobile phone involvement conceptualised as people’s cognitive and behavioural interaction with their mobile phone. Participants were 946 Australian youth aged between 15 and 24 years. A descriptive measurement tool, the Mobile Phone Involvement Questionnaire (MPIQ), was developed. Self-identity and validation from others were explored as predictors of both types of mobile phone behaviour. A distinction was found between frequency of mobile phone use and mobile phone involvement. Only self-identity predicted frequency of use whereas both self-identity and validation from others predicted mobile phone involvement. These findings reveal the importance of distinguishing between frequency of use and people’s psychological relationship with their phone and that factors relating to one’s self-concept and approval from others both impact on young people’s mobile phone involvement.

The Tension between a constructed self and universal reason in considerations of elective death

Review of Coping with Choices to Die, by C. G. Prado. Cambridge: Cambridge University Press, 2011.