Claire Budge

Taking the PACIC back to basics: the structure of the Patient Assessment of Chronic Illness Care

RATIONALE, AIMS AND OBJECTIVES The Patient Assessment of Chronic Illness Care (PACIC) is a widely used 20-item measure consisting of five subscales. Published factor analyses of PACIC scores have produced conflicting results on the measures factorial validity, and therefore some confusion as to the utility of its subscales. We aim to reduce this confusion by reviewing the evidence on the PACICs factorial validity, exploring the statistical issues it raises, and considering more broadly what such analyses can reveal about the validity of the PACIC. METHODS To achieve these aims we review six published studies on the PACICs factorial validity, present confirmatory factor analyses of our own PACIC data from 251 chronic care patients, and assess the PACIC with respect to its status as a reflective or a formative measure. RESULTS Our statistical analyses support the view that a 5-factor model does not fit the structure of the PACIC, and highlight a variety of technical issues that confront researchers who wish to factor analyse the measure. However, we argue that, as the PACIC is more accurately seen as a formative measure, such analyses do not provide information that should be used to assess the PACICs validity. CONCLUSIONS We conclude that, while it is important to continue examining the reliability and validity of the PACIC in a variety of ways, traditional analyses of its factorial validity (and internal consistency) are inappropriate. Meanwhile, use of the subscales is defensible as long as they continue to meet other types of reliability and validity requirements.

To have or to take: discourse, positioning, and narrative identity in women's accounts of HRT.

Using ‘social cognitive’ frameworks, attitudes to HRT have been examined as if they were stable entities located within individuals. However, qualitative studies have revealed variations and contradictions in women’s ‘attitudes’. We seek to explain these apparent contradictions by using a social constructionist approach to the analysis of qualitative data from 7 focus group discussions about HRT with 48 women in New Zealand. A discourse analysis of ‘interpretative repertoires’, subject positions and narrative identity was undertaken to explain the construction of HRT in situated practice, and the negotiation and accomplishment of a unitary orientation to HRT across situations. The results summarize the interpretative repertoires used by the women, and one example of a subject position negotiated at a moment of patently problematic intersecting interpretative repertoires, to highlight the construction of subject positions using discursive resources. The importance of the study of subjectivity in applied areas of psychology is discussed.

The influence of companion animals on owner perception: gender and species effects

ABSTRACTThere is some evidence that the presence of a companion animal influences perceptions of the psychological attributes of its owner. The present study investigated how these effects vary by pet species and owner gender. A sample of 542 students rated slides of a man or woman accompanied by a cat, a dog or alone using 36 adjectives. These adjectives were subsequently grouped into four clusters labelled ‘Nice’, ‘Nasty’, ‘Style’ and ‘Action’. Statistical analyses revealed that the female target person was rated as significantly nicer, more stylish and more active with the dog than with the cat. The male target person was rated as nicer, more stylish and more active with the cat than the dog. This pattern was contrary to that hypothesized, which was based on traditional gender and human-pet stereotypes. Discussion focuses on the changing nature of gender stereotypes and the resulting complexity of owner-pet perceptions.

Compatibility Stereotypes of People and Pets: A Photograph Matching Study

ABSTRACTCompatibility is an important aspect of the relationship between people and their pets as it is likely to influence both the quality and the longevity of the relationship. Perceived compatibility is also important since the stereotypical views we hold of particular person-pet combinations are likely to affect our pet selections. So far, little research has been carried out in this area. The present study investigated the existence and nature of pet-owner stereotypes with respect to male and female target persons in combination with cats and dogs. A sample of 102 students paired up photographs of ten people with photographs of ten pets and provided reasons for their pairings. Chi square analyses demonstrated significant pairing trends for nine of the ten target persons and thus evidence for pet-owner stereotypes. They also suggest that, as with human stereotypes, sex is a major component, specifically, males were associated with larger dogs and females with smaller dogs and cats. Qualitative analys...

New Zealand patients’ perceptions of chronic care delivery

Purpose – Care coordination for patients with chronic conditions is one aim of an integrated health care delivery system. The purpose of this paper is to compare findings from two separate New Zealand studies and discusses the implications of the results. Design/methodology/approach – The paper describes and discusses the use of Patient Assessment of Chronic Illness Care Measure in two different geographic areas of New Zealand and at different times. Findings – The studies suggest that, despite the time that has elapsed since government investment in care coordination for long-term conditions, there has been little change in the nature of service delivery from the patient perspective. Originality/value – The paper highlights the shortcomings of simply providing additional funding for care coordination, without built in accountabilities, no planned evaluation and no concerted focus on what the model of care should look like.

An Investigation of the Complexities of Successful and Unsuccessful Guide Dog Matching and Partnerships

Matching a person who is blind or visually impaired with a guide dog is a process of finding the most suitable guide dog available for that individual. Not all guide dog partnerships are successful, and the consequences of an unsuccessful partnership may result in reduced mobility and quality of life for the handler (owner), and are costly in time and resources for guide dog training establishments. This study examined 50 peoples’ partnerships with one or more dogs (118 pairings) to ascertain the outcome of the relationship. Forty-three of the 118 dogs were returned to the guide dog training establishment before reaching retirement age, with the majority (n = 40) being categorized as having dog-related issues. Most (n = 26) of these dogs’ issues were classified as being behavioral in character, including work-related and non-work-related behavior, and 14 were due to physical causes (mainly poor health). Three dogs were returned due to matters relating to the handlers’ behavior. More second dogs were returned than the handlers’ first or third dogs, and dogs that had been previously used as a guide could be rematched successfully. Defining matching success is not clear-cut. Not all dogs that were returned were considered by their handlers to have been mismatched, and not all dogs retained until retirement were thought to have been good matches, suggesting that some handlers were retaining what they considered to be a poorly matched dog. Almost all the handlers who regarded a dog as being mismatched conceded that some aspects of the match were good. For example, a dog deemed mismatched for poor working behavior may have shown good home and/or other social behaviors. The same principle was true for successful matches, where few handlers claimed to have had a perfect dog. It is hoped that these results may help the guide dog industry identify important aspects of the matching process, and/or be used to identify areas where a matching problem exists.

Accounting for differences in cognitive health between older adults in New Zealand and the USA.

BACKGROUND National differences in cognitive health of older adults provide an opportunity to shed light on etiological factors. We compared the cognitive health of older adults in New Zealand and the USA, and examined differences in known risk factors. METHODS Two nationally representative samples were derived from the 2010 waves of the New Zealand Longitudinal Study of Ageing (n = 953) and the US Health and Retirement Study (HRS) (n = 3,746). Data from comparable measures of cognitive function, gender, age, income, education, prevalence of cancer, diabetes, heart disease, hypertension and stroke, exercise, alcohol consumption, smoker status, depression, and self-reported health were subjected to hierarchical regression analysis to examine how national differences in cognitive function might be explained by differences in these risk factors. RESULTS The New Zealand sample scored 4.4 points higher on average than the US sample on the 43 point cognitive scale. Regression analyses of the combined samples showed that poorer cognitive health is more likely in those who are male, older, less educated, have suffered a stroke, consume alcohol less frequently, are more depressed, and report worse overall health. Controlling for age and sex reduced the mean difference to 2.6 and controlling for risk factors further reduced it to 2.3. CONCLUSIONS Older New Zealand adults displayed better cognitive function than those in a US sample. This advantage can be partially explained by age and sex differences and, to some extent, by differences in known risk factors. However, the national advantage remained even when all measured risk factors are statistically controlled.

Impact of postgraduate education on advanced practice nurse activity - a national survey

BACKGROUND There is a wealth of international evidence concerning the contribution post-registration masters level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken masters level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. OBJECTIVES To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. METHOD A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. RESULTS A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. CONCLUSIONS There is an additional contribution made to the work environment by nurses with masters level education which occurs even when they are not employed in an advanced practice role. IMPLICATIONS FOR NURSING POLICY These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources.