Ej Bell

Relationship between participants' level of education and engagement in their completion of the Understanding Dementia Massive Open Online Course.

BackgroundThe completion rates for Massive Open Online Courses (MOOCs) generally are low (5-10%) and have been reported to favour participants with higher (typically tertiary-level) education. Despite these factors, the flexible learning offered by a MOOC has the potential to provide an accessible educational environment for a broad spectrum of participants. In this regard, the Wicking Dementia Research and Education Centre has developed a MOOC on dementia that is evidence-based and intended to address this emerging major global public health issue by providing educational resources to a broad range of caregivers, people with dementia, and health care professionals.MethodsThe Understanding Dementia MOOC was designed specifically to appeal to, and support, adult learners with a limited educational background. The nine-week course was presented in three units. Participants passed a quiz at the end of each unit to continue through the course. A series of discussion boards facilitated peer-to-peer interactions. A separate “Ask an Expert” discussion board also was established for each unit where participants posted questions and faculty with expertise in the area responded.ResultsAlmost 10,000 people from 65 countries registered; 4,409 registrants engaged in the discussion boards, and 3,624 (38%) completed the course. Participants’ level of education ranged from postgraduate study to a primary (elementary) school education. Participants without a university education (vocational certificate and below) were as likely as those with a university education to complete the course (χ2 = 2.35, df = 6, p = 0.88) and to engage in the online discussions (F[6, 3799] = 0.85, p = 0.54). Further, participants who completed the MOOC engaged in significantly more discussion board posts than participants who did not complete the course (t = 39.60, df = 4407, p <0.001).ConclusionsThe high completion rate and level of engagement of participants across a broad spectrum of levels of education suggest that MOOCs can be successfully developed and delivered to students from diverse educational backgrounds. The high participation rate also highlights the combination of MOOC design as well as the scale of unmet need for quality dementia education.

Climate change and Australian agriculture: a review of the threats facing rural communities and the health policy landscape.

Population health is a function of social and environmental health determinants. Climate change is predicted to bring significant alterations to ecological systems on which human health and livelihoods depend; the air, water, plant, and animal health. Agricultural systems are intrinsically linked with environmental conditions, which are already under threat in much of southern Australian because of rising heat and protracted drying. The direct impact of increasing heat waves on human physiology and survival has recently been well studied. More diffusely, increasing drought periods may challenge the viability of agriculture in some regions, and hence those communities that depend on primary production. A worst case scenario may herald the collapse of some communities. Human health impacts arising from such transition would be profound. This article summarizes existing rural health challenges and presents the current evidence plus future predictions of climate change impacts on Australian agriculture to argue the need for significant augmentation of public health and existing health policy frameworks. The article concludes by suggesting that adaptation to climate change requires planning for worst case scenario outcomes to avert catastrophic impacts on rural communities. This will involve national policy planning as much as regional-level leadership for rapid development of adaptive strategies in agriculture and other key areas of rural communities.

Climate change: what competencies and which medical education and training approaches?

BackgroundMuch research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change.DiscussionThe paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training.SummaryThe health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

Readying Health Services for Climate Change: A Policy Framework for Regional Development

Climate change presents the biggest threat to human health in the 21st century. However, many public health leaders feel ill equipped to face the challenges of climate change and have been unable to make climate change a priority in service development. I explore how to achieve a regionally responsive whole-of-systems approach to climate change in the key operational areas of a health service: service governance and culture, service delivery, workforce development, asset management, and financing. The relative neglect of implementation science means that policymakers need to be proactive about sourcing and developing models and processes to make health services ready for climate change. Health research funding agencies should urgently prioritize applied, regionally responsive health services research for a future of climate change.

Climate change: could it help develop ‘adaptive expertise’?

Preparing health practitioners to respond to the rising burden of disease from climate change is emerging as a priority in health workforce policy and planning. However, this issue is hardly represented in the medical education research. The rapidly evolving wide range of direct and indirect consequences of climate change will require health professionals to have not only broad content knowledge but also flexibility and responsiveness to diverse regional conditions as part of complex health problem-solving and adaptation. It is known that adaptive experts may not necessarily be quick at solving familiar problems, but they do creatively seek to better solve novel problems. This may be the result of an acquired approach to practice or a pathway that can be fostered by learning environments. It is also known that building adaptive expertise in medical education involves putting students on a learning pathway that requires them to have, first, the motivation to innovatively problem-solve and, second, exposure to diverse content material, meaningfully presented. Including curriculum content on the health effects of climate change could help meet these two conditions for some students at least. A working definition and illustrative competencies for adaptive expertise for climate change, as well as examples of teaching and assessment approaches extrapolated from rural curricula, are provided.

The evidence-policy divide: a 'critical computational linguistics' approach to the language of 18 health agency CEOs from 9 countries

BackgroundThere is an emerging body of literature suggesting that the evidence-practice divide in health policy is complex and multi-factorial but less is known about the processes by which health policy-makers use evidence and their views about the specific features of useful evidence. This study aimed to contribute to understandings of how the most influential health policy-makers view useful evidence, in ways that help explore and question how the evidence-policy divide is understood and what research might be supported to help overcome this divide.MethodsA purposeful sample of 18 national and state health agency CEOs from 9 countries was obtained. Participants were interviewed using open-ended questions that asked them to define specific features of useful evidence. The analysis involved two main approaches 1)quantitative mapping of interview transcripts using Bayesian-based computational linguistics software 2)qualitative critical discourse analysis to explore the nuances of language extracts so identified.ResultsThe decision-making, conclusions-oriented world of policy-making is constructed separately, but not exclusively, by policy-makers from the world of research. Research is not so much devalued by them as described as too technical— yet at the same time not methodologically complex enough to engage with localised policy-making contexts. It is not that policy-makers are negative about academics or universities, it is that they struggle to find complexity-oriented methodologies for understanding their stakeholder communities and improving systems. They did not describe themselves as having a more positive role in solving this challenge than academics.ConclusionsThese interviews do not support simplistic definitions of policy-makers and researchers as coming from two irreconcilable worlds. They suggest that qualitative and quantitative research is valued by policy-makers but that to be policy-relevant health research may need to focus on building complexity-oriented research methods for local community health and service development. Researchers may also need to better explain and develop the policy-relevance of large statistical generalisable research designs. Policy-makers and public health researchers wanting to serve local community needs may need to be more proactive about questioning whether the dominant definitions of research quality and the research funding levers that drive university research production are appropriately inclusive of excellence in such policy-relevant research.

An evidence-based framework to measure quality of allied health care

BackgroundThere is no standard way of describing the complexities of allied health (AH) care, or its quality. AH is an umbrella term which excludes medicine and nursing, and variably includes disciplines which provide therapy, diagnostic, or scientific services. This paper outlines a framework for a standard approach to evaluate the quality of AH therapy services.MethodsA realist synthesis framework describing what AH does, how it does it, and what is achieved, was developed. This was populated by the findings of a systematic review of literature published since 1980 reporting concepts of quality relevant to AH. Articles were included on quality measurement concepts, theories, debates, and/or hypothetical frameworks.ResultsOf 139 included articles, 21 reported on descriptions of quality potentially relevant to AH. From these, 24 measures of quality were identified, with 15 potentially relating to what AH does, 17 to how AH delivers care, 8 relating to short term functional outcomes, and 9 relating to longer term functional and health system outcomes.ConclusionsA novel evidence-based quality framework was proposed to address the complexity of AH therapies. This should assist in better evaluation of AH processes and outcomes, costs, and evidence-based engagement of AH providers in healthcare teams.

Residents with mild cognitive decline and family members report health students ‘enhance capacity of care’ and bring ‘a new breath of life’ in two aged care facilities in Tasmania

Care provided by student doctors and nurses is well received by patients in hospital and primary care settings. Whether the same is true for aged care residents of nursing homes with mild cognitive decline and their family members is unknown.

Great 21st Century Debates About The Usefulness Of Research: Can They Help Rural Research?

Abstract This paper aims to contribute to reflection on how rural research can better serve rural communities. Using the results of literature searches across the disciplines, it explores some major 21st Century debates about improving the usefulness of research for policy and practice. The paper begins with an examination of different debates in biomedical and health research, moving on to other debates in the social sciences and humanities, particularly in sociology, political science, and history. Powerful critiques of the relevance of research are provided by case-based analysis, which raises the question of whether we need new forms of research evidence that reflect the configurational, synergistic complexity of policy and practice. The paper concludes with directions for what these debates collectively suggest for making rural research more useful to policy and practice. It also suggests how research methodology may be a political battlefield for democratic accountability in the 21st Century.

Nursing identity and patient-centredness in scholarly health services research: a computational text analysis of PubMed abstracts 1986–2013

BackgroundThe most important and contested element of nursing identity may be the patient-centredness of nursing, though this concept is not well-treated in the nursing identity literature. More conceptually-based mapping of nursing identity constructs are needed to help nurses shape their identity. The field of computational text analytics offers new opportunities to scrutinise how growing disciplines such as health services research construct nursing identity. This paper maps the conceptual content of scholarly health services research in PubMed as it relates to the patient-centeredness of nursing.MethodsComputational text analytics software was used to analyse all health services abstracts in the database PubMed since 1986. Abstracts were treated as indicative of the content of health services research. The database PubMed was searched for all research papers using the term “service” or “services” in the abstract or keywords for the period 01/01/1986 to 30/06/2013. A total of 234,926 abstracts were obtained. Leximancer software was used in 1) mapping of 4,144,458 instances of 107 concepts; 2) analysis of 106 paired concept co-occurrences for the nursing concept; and 3) sentiment analysis of the nursing concept versus patient, family and community concepts, and clinical concepts.ResultsNursing is constructed within quality assurance or service implementation or workforce development concepts. It is relatively disconnected from patient, family or community care concepts.ConclusionsFor those who agree that patient-centredness should be a part of nursing identity in practice, this study suggests that there is a need for development of health services research into both the nature of the caring construct in nursing identity and its expression in practice. More fundamentally, the study raises questions about whether health services research cultures even value the politically popular idea of nurses as patient-centred caregivers and whether they should.