Tag Archive: Health

Stakeholders’ Perceptions of Physical Education at a Selected Elementary School (Education Papers posted on May 13th, 2014 )

The motivation for this study stemmed from a lack of understanding of why members of an elementary school community did not support the physical education program. The purpose of this study was to understand teachers’, administrators’, and parents’ perceptions about the value and importance of physical education at the school. Guided by the transtheoretical and cognitive evaluation theories, both of which focus on the motivation to change, this qualitative case study explored the perceptions of members of an elementary school community in the southern United States about the value and importance of the school’s physical education program. Twelve stakeholders (teachers, administrators, and parents of children enrolled at the school) participated in interviews for the study. Typological and inductive analyses of the data yielded emergent themes on communication, Health, lifelong learning of physical education, positive experiences of physical education, scheduling, and Social aspects of physical education. The key finding was that communication is necessary for an effective physical education program. This finding would advance practice by improving communications between the physical education teacher and members of the elementary school community. The implication for positive Social change comes from guidelines about improved communications between the physical education teacher and administration, school personnel, parents, and students at the participating elementary school. This improved communication will increase the support for the physical education program, and in turn, will benefit the students who participate in a more effective physical education program.

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An investigation of a theoretical model of health-related outcomes of resilience in middle adolescents (Education Papers posted on April 12th, 2014 )

The purpose of this study was to develop a theory-based just-identified model to better understand resilience and its direct and indirect effects on theorized Health outcomes in middle adolescents. The study empirically tested the direct effects of resilience on a) hope, b) well-being, and c) Health-promoting lifestyles, and the direct effects of hope on d) well-being and e) Health promoting lifestyles. The indirect effects of resilience on a) well-being, and b) health-promoting lifestyle through hope were also examined. The final sample of 311 of middle-adolescents, aged 15 to 17, was recruited at a northern New Jersey public high school. Participants completed the demographic data sheet and four instruments measuring the study variables during their regularly scheduled health classes. The structural equation model was tested with the LISREL 8.80 software program. Results indicated that resilience had a direct effect on hope Gamma = .66, p < .001), well-being Gamma = .44, p < .001), and health-promoting lifestyles Gamma = .56, p < .001). Hope also had a direct effect on well-being Beta = .42, p < .001), and health-promoting lifestyle Beta =.26, p < .001). Resilience had an indirect effect on both well-being and health-promoting lifestyle through hope. The unhypothesized correlated error term between well-being and health-promoting lifestyle, the two dependent variables, was psi = 0.13, p < .001. All of the seven hypotheses in this study were derived from theory and were supported empirically, providing evidence of the predictive power of the theoretical propositions tested. Therefore, it can be concluded that resilience has direct positive effects on hope, well-being, and health-promoting lifestyle in middle adolescents, and that hope had direct positive effects on well-being and health-promoting lifestyle. Additionally, resilience has an indirect effect on well-being and health-promoting lifestyle through hope in middle adolescents. Finally, it can be concluded that resilience is a strong predictor of hope and that resilience is a better predictor than hope for the two health-related outcomes, well-being and health-promoting lifestyle.

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Youth Taking Action to Improve their Sex Education at Bellman Secondary (Education Papers posted on April 11th, 2014 )

Educational decision-makers rarely legitimize youths perspectives in constructing “effective” sex education. In this study, I concentrated on what students have to say about this aspect of their educational experience, and learned how decision-makers respond to youths perspectives. I draw on Michel Foucaults notions of discourse, power, and resistance to understand the importance of listening to students marginalized voices and legitimizing their subjugated knowledges. I then discuss the UN Convention on the Rights of the Child, drawing attention to its assertion that youth have rights to learn about sexual Health and to participate in sex education. I also draw on constructs of democratic education and student empowerment to argue that youth have expertise and so can express “what is” and “what must be” in dialogue with decision-makers. With the goal of initiating and facilitating Youth Participatory Action Research, I entered Bellman Secondary where I mobilized a research collective with youth partners. The youth learned about research ethics and the interview method prior to addressing the following questions: 1) What are students perspectives of their sex education at Bellman? 2) How would students change the sex education offered at Bellman, if they could? The youth interviewed Grade 12 students, inviting them to problematize their sex education experiences, critique the curricular rules, and cross the disciplinary limits with the aim of identifying transformative possibilities that would satisfy their sexual Health needs. The collective analyzed the data and showcased our findings in an action plan, titled Sex-E-cation. In order to incite and inform curricular change, the team presented Sex-E-cation to students and two decision-makers—a Health Teacher and School Administrator—with the aim of informing dialogue. Given that these decision-makers failed to participate in the study, it is unclear if they took students perspectives into consideration to make sex education more relevant to their lives. While those inside Bellman never participated by responding to the action plan, two outsider decision-makers—a School Nurse and Learning Coordinator—did participate in this way. They planned to take transformative action to rectify problems, and thereby improve students sex education so it satisfies their expressed needs. Keywords: sexual health education, youth, Foucault, democratic education, expressed needs.

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Training law enforcement in mental health: A broad-based model (Education Papers posted on April 11th, 2014 )

Police officers respond to many calls involving people suffering from a mental illness; yet many law enforcement training programs and workshops do not include mental Health training. A literature review was conducted to explore the problems resulting from the lack of mental Health training available for law enforcement officers and identify specialized training programs currently being implemented to address those problems. The review identified several program models being implemented throughout the United States including: Joint Police/Mental Health Team Model, Mobile Crisis Unit Model, Crisis Intervention Team Model, and the Broad-Based Training Model. These models include empirically supported components used to increase learning and decrease stigma and result in significantly reduced arrest rates of the mentally ill and increase the safety of interactions between law enforcement and the mental health community. A broad-based training seminar was presented to volunteers from local policing agencies. A pre and posttest analysis revealed significant positive changes in attitude, behavior, and improved knowledge of mental health issues as a result of the training. The limitations of the current research and the future implications in regard to the safety of law enforcement and the safety of those affected by mental illness are discussed.

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A process evaluation of nurses’ implementation of an infant feeding counseling protocol for HIV-infected mothers: The Breastfeeding, Antiretroviral and Nutrition (BAN) Study in Lilongwe, Malawi (Education Papers posted on March 27th, 2013 )

In prevention of mother to child HIV transmission programs, nurses are responsible for counseling HIV-infected mothers about infant feeding. Studies of nurses infant feeding counseling in African countries suggest that counseling quality is often poor and may be associated with nursing culture, inadequate training, and Health system factors. Few studies, however, have conducted theory-informed process evaluations to assess nurses implementation of an infant feeding counseling protocol. This study conducted the process evaluation of an infant feeding counseling protocol for the Breastfeeding, Antiretroviral and Nutrition BAN) Study, an ongoing clinical trial in Lilongwe, Malawi. Six nurses, trained on World Health Organization recommendations, counseled HIV-infected mothers to exclusively breastfeed for 6 months and stop breastfeeding at 6 months. This study adapted and applied patient-provider communication theoretical concepts to assess nurses counseling behaviors through: 1) direct observation and audio-taping of 123 infant feeding counseling sessions 30 antenatal and 93 postnatal) using a checklist to document nurses adherence to specific protocol items; and 2) in-depth interviews with each nurse to document adherence perceptions and attitudes toward the protocol. Analysis included calculating a percent adherence of checklists and constant comparison techniques and visual display matrices for the observation and interview data. Results indicate that nurses were implementing the protocol at an average adherence level of 90% or above. Adherence to protocol items during the antenatal sessions was 100%. During postnatal sessions, adherence ranged from 92.7% to 97.8%. Nurses implementation inconsistencies occurred when addressing breast health and breastfeeding cessation issues. An unexpected finding was nurses counseling mothers on proper infant formula preparation, although not detailed in the protocol. Interviews revealed a high nurse to mother ratio and additional counseling training on infant formula and complementary feeding preparation as perceived barriers toward complete protocol adherence. Findings illustrate that with minimal training, nurses implemented the BAN Study infant feeding counseling protocol as designed. The process evaluation results will help to interpret the BAN Studys impact and health outcomes related to evaluating mothers feasibility to follow infant feeding recommendations. The implication for HIV/AIDS clinical trials is to conduct process evaluations to identify and address potential implementation inconsistencies and, thereby, improve protocol implementation adherence.

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Attitudes of health and physical education teachers: Student obesity and educator roles for its amelioration (Education Papers posted on March 25th, 2013 )

This study determines if the Health and physical education teachers in an urban Pennsylvania high school have positive or negative attitudes toward obese individuals and the factors that contribute to obesity. It also uncovers how they feel about the school setting as the primary location for combating obesity through prevention programs. Methodology: Data was collected using three survey instruments: a demographic survey, the Attitudes Toward Obese Persons Scale (ATOP) and the Attitudes Toward Obesity Issues (ATOI) survey. Analysis included descriptive statistics and correlations between factors in the three instruments. Results: The BMIs of majority of the male HPE teachers fell into the category of overweight, while most of the female HPE teachers were categorized as normal weight. The participants responded similarly to most of the ATOI statements, at 81-100% unanimity for agreement or disagreement, with the exception of one statement. Results for statement 14 of the ATOI found forty-nine percent of HPE teachers agree that high school would be the ideal place to address obesity. Twenty-seven percent disagreed and 24 percent were unsure. The mean ATOP score was 66. Thirty-five percent of the respondents received scores indicating negative attitudes toward obese persons, ATOP < 60. The median score was 68. Conclusion: There was no profile discovered for a HPE teacher who would express negative attitudes toward obese adolescents. Urban high school HPE teachers respond similarly to many statements about obesity issues, however they are diverse in their responses about high school being the ideal place to address obesity.

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The quest for autonomy: Patient decision-making behaviors in type 2 diabetes (Education Papers posted on March 25th, 2013 )

The purpose of this study was to examine the phenomenon of decision-making about exercise from the perspective of the patient with type 2 diabetes. Through the use of participant observation, semi-structured interviews, and the analysis of the Stages of Behavior Change Scale, the Diabetes Empowerment Scale, and the Cooper Clinic Physical Activity Questionnaire, this comparative cross-case analysis explored the Social, clinical and contextual factors, as well as the barriers that influence patient decision-making. The relationship between autonomous regulation of exercise behavior and perceived competence to follow through with ones decisions to exercise by patients, and the concept of autonomy support on the part of healthcare practitioners were also established as important components to consider in the development of an effective diabetes patient education curriculum. The analysis of the data is presented in qualitative, narrative form, using the voices of the participants and first-person accounts of the researcher in an effort to portray the challenges and emotion-filled meanings associated with the lived experience of daily decision-making in type 2 diabetes. The major findings of the study suggest that exercise decision-making is a complex process of interplay between a logical, rational, cognitive approach, and a more dynamic, unconscious, affective process of balancing reasons for exercise choices with ones values, beliefs, experiences and meanings about Health, diabetes and exercise. There appears to be a relationship between the stage of behavior change and the degree to which one is a cognitive or affective decision-maker in type 2 diabetes. Cognitive factors such as ones perception regarding the threat of diabetes, having and positive exercise schema, and the degree of internal versus external motivation impact exercise decision-making. Social-contextual factors such as exercise group support, family or Social support, and having a positive exercise role model or expert leader/teacher influence adoption and adherence to an exercise habit by those with diabetes. Affective factors such as the meaning-making associated with having diabetes, locus of control and coping behavior have an emotional impact on the person with diabetes, and often unconsciously influence decision-making and autonomous behavior. Barriers to following through with exercise decisions include conflicts with time management, patient fatigue that interferes with exercise tolerance, ease of access to exercise equipment or facilities, boredom with the exercise regimen, and interference with leisure-time television viewing. Abstract shortened by UMI.)

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Comprehension of health-related written materials by older adults (Education Papers posted on March 24th, 2013 )

Purpose. This study examined two sets of factors that may affect older adults comprehension of common Health-related written materials. One set was related to text difficulty: the Flesch Reading Ease index and text cohesion. The other set was related to older adults reading ability: age, education, Health conditions, verbal ability measured by AMNART), working memory measured by Digits Forward, Digits Backward, and reading span), and health literacy measured by S-TOFHLA). Method. 200 short passages that described common senior health issues were collected from websites, health education brochures, and magazines. 16 experiment health passages were selected from the 200 passages based on quartile scores of the Flesch Reading Ease index and text cohesion. Text cohesion was indicated by referential cohesion and latent semantic analysis measures retrieved from the Coh-Metrix software. 124 older adults Age: M = 77.6; SD = 6.93; Years of education: M = 15.08; SD = 2.94) completed the study and 98% showed adequate health literacy. Results. Comprehension increased with older adults working memory gamma01 = .18, p < .001) and verbal ability gamma04 = .02, p < .05) but decreased with age gamma06 = -.01, p = .06). Surprisingly, increasing Flesch Reading Ease impaired comprehension in older adults with working limitations gamma11 = .06, p < .05). When text cohesion was high, older adults, especially young-old adults, benefited from increasing Flesch Reading Ease. When the text cohesion was low, older adults, especially high verbal older adults and young-old adults, benefited from reducing Flesch Reading Ease gamma 34 = .007, p < .05; gamma36 = -.006, p < .05, respectively). Conclusion. Increasing Flesch Reading Ease by using short words or short sentences may result in leaving out connections among ideas and impair older adults comprehension. Increasing text cohesion by repeating similar words and ideas through out the text may reduce the challenges created by using short words and sentences alone. In a text low in cohesion, the use of long sentences may clarify relationships among ideas or concepts, making the text more comprehensible than one using short sentences. Text cohesion should be included in addition to readability formulas to evaluate text difficulty for older adults.

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The school nutrition environment in North Carolina’s public schools (Education Papers posted on March 24th, 2013 )

The purpose of the research was to explore and describe the current school nutrition environment in North Carolinas public schools. Current practices to increase the availability of healthful foods and beverages in the school breakfast and lunch programs were analyzed. Barriers that limit the availability of healthful foods and beverages in school meals programs were identified and strategies to overcome the barriers were described. A survey instrument was administered to all Child Nutrition Directors and Supervisors in North Carolina. Of 239 instruments distributed, 211 were returned resulting in an 88.3% response rate. The research found that Child Nutrition Directors and Supervisors were keenly aware of the serious public Health problems posed by the epidemic of childhood overweight and recognized that poor food and beverage choices and inadequate physical activity contribute to weight gain among children and adolescents. While healthful foods and beverages were available to students in the school breakfast and lunch programs, competitive foods, which undermined the nutritional and financial integrity of the school meals programs, were also available in approximately one-fourth of elementary schools, half of middle schools and three-fourths of high schools. The leading barrier that limited the availability of more healthful foods and beverages in school meals programs was school finances; financial goals for the programs outweighed nutritional goals for students. Other barriers included lack of support from school administrators and local Boards of Education, principals, teachers and parents. Student taste preferences for foods high in fat, sugar and calories was also a barrier. Other barriers included too little nutrition education in the classroom to influence students food choices, conflicting nutrition messages on school campuses, limited time and space for school meals and the perception that school meals were not a valued part of the instructional day. Multiple strategies were recommended to overcome and/or minimize the barriers.

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If you build a plan, will they join? Examining small business employer attitudes towards Association Health Plans (H.R. 525, S. 1955) (Education Papers posted on March 24th, 2013 )

The purpose of this study was to examine the attitudes of small businesses towards association Health plans, a proposed legislation aimed at providing affordable, quality Health care through the small business entity. This study addressed the question of small business participation in Association Health Plans AHP) by breaking small firms those with 50 or fewer employees) into 4 categories: firms that currently offer health coverage and support joining AHP Coverage/AHP) n=79); firms that currently do not offer coverage and support joining AHP No coverage/AHP) n=39); firms that offer coverage and do not support joining AHP Coverage/AHP) n=21); and firms that do not offer coverage and are against joining AHP No coverage/No AHP) n=27). Three Midwestern communities were sampled using local Chamber of Commerce memberships: one representing a rural community with little industry n=31, 12.4%); one as an example of a medium sized city with a predominantly manufacturing industry n=65, 26%); and the last community represents a medium sized city with diverse industries n=96, 10.9%). Random samples of 250 firms were selected for the first two communities. The final community served as the pilot study, and involved the total membership of 850 firms. The survey instrument was adapted from the Kaiser Foundations Employer Based Insurance Survey 2002). Additional questions were added involving awareness of AHP, and intent to join an AHP. Several major results were found: 1) there was no significant difference in firm size in those who indicated intent to join an AHP. 2) Coverage/No AHP firms offered a higher range of benefits than other firms. 3) No coverage/No AHP were motivated primarily by cost concerns for initial and future premiums. 4) the relationship between intent to join an AHP and quality of physician services offered by plans, and cost concerns, respectively, was statistically significant. The results suggest that business response will not be homogeneous, signaling the need for further research, such as a price sensitivity analysis to have a better understanding of firm and employee reactions to costs, a key concern for all firms in the current study.

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