Knowledge, Beliefs, and Preventive Behaviors Regarding Osteoporosis among University Students: Scoping Review

Context: Osteoporosis is a universally growing health problem. Adequate calcium intake and physical activity, alongside a high level of knowledge and health beliefs, play a crucial role in preventing or delaying diseases. Aim: This scoping review provides an overview of university students' prevailing knowledge, beliefs, and behaviors regarding osteoporosis. Methods: CINHAL, PubMed, and MEDLINE databases were searched to cover the period between 2014 to 2019. Twenty-seven articles were selected out of 4078 were retrieved. The following searching terms were used: (osteoporosis knowledge OR osteoporosis awareness) AND osteoporosis beliefs AND (osteoporosis practices OR osteoporosis behaviors OR calcium intake OR physical activity) AND (osteoporosis OR bone mineral density) AND (nursing students OR university students OR undergraduate students OR college-age students OR young adults). Finally, the level of osteoporosis knowledge, health beliefs, preventive behaviors, the relationship between practices/behaviors and lifestyle with bone health, and the educational intervention's significant/nonsignificant positive effect on the students' osteoporosis knowledge, the prevailed beliefs, and the level of engagement in the osteoporosis preventive behaviors were documented. Results: Most articles demonstrate that the students' osteoporosis knowledge was insufficient and seriously lacking in osteoporosis's perceived susceptibility and severity. This finding clarified that most students were not adequately engaging in the osteoprotective preventive behaviors (Physical activity ad Ca intake). Also, the finding indicates that following a healthy lifestyle and engaging in osteoprotective behaviors positively affect BMD and vice versa. Conclusion: The lack of osteoporosis awareness among the university students and the low perception of osteoporosis susceptibility and severity explains why most participants are not engaged in osteoporosis preventive behaviors due to the strong influence of personal beliefs, perceptions, and misconceptions. Therefore, it is important to design educational programs targeting these groups to raise awareness and change their subsequent beliefs

RELATIONSHIP OF HELP-SEEKING BEHAVIORS AND ACADEMIC PERFORMANCE IN FIRST YEAR PHYSICIAN ASSISTANT AND DENTAL STUDENTS

Background: Individual coping and stress management skills influence rates of burnout, substance abuse, and other untoward situations for medical professionals. Ideally, underdeveloped coping mechanisms and at-risk behaviors are identified early in students’ professional education. Utilization of support services and coping strategies have been shown to correlate with academic success in undergraduate and graduate education. Data regarding coping strategies, academic performance, and help-seeking behaviors is scant in the Physician Assistant (PA) and Dental student literature. Purpose: A portion of physician assistant (PA) and Dental students underperform academically. This study is designed to answer questions by the review of the related literature and analysis of coping and support strategies in minimally competent, barely passing students (MCBPs) first year PA and Dental students. The following research questions are the focus of this study: 1. What are the coping mechanisms and support services used by first year PA and Dental students? 2. What is the relationship between coping mechanisms and academic performance among first year PA and Dental students? 3. What is the relationship between utilization of support services and academic performance among first year PA and Dental students? 4. What are the coping mechanisms of minimally competent, barely passing (MCBP) first year PA and Dental students? Methods: Brief COPE and support service usage surveys were administered online after each of three exams. An online End of Course Survey was administered online for qualitative data collection. Control group received no intervention. The experimental group received three additional emails containing information about available support services. Results: 1. The control group Brief COPE responses, academic performance, and poor coping behaviors revealed self-criticism and blaming correlated with poor exam grades. Analysis of the experimental group did not show strong relationships between Brief COPE items and academic performance. 2. The majority of students utilized support from family, peers, and upperclassmen. MCBPs tended to use less tutoring and less formal academic support than their higher performing peers. Both groups have low percentages of students utilizing formal on-campus services. 3. Both experimental and control groups utilized non-academic support services at higher percentages than formal academic supports. MCBPs in the experimental group utilize formal academic supports at much lower percentages than higher performing peers. 4. Self-criticism and self-blaming Brief COPE items are seen in correlation with decreased exam grade performance. Differences in overall exam grades were not observed between the two groups. Control group MCBPs report significant negative coping strategies of denial, self-blame, and disengagement. MCBPs in the experimental group did not demonstrate no significant trends in coping mechanisms. The small numbers of responses reporting self-blame and anxiety in regard to ineffective study skills somewhat limits the qualitative data. No significant impact from the intervention of email providing information about support services is seen in exam scores, Brief COPE responses, support service usage, or End of Course Survey responses. This is consistent with the literature. Future Implications: The Brief COPE may have potential use to identify poor coping strategies in MCBPs. Student support service usage data can evaluate effectiveness of services and aid strategic planning. Qualitative student feedback can be implemented for continued course and program improvement. Conclusion: Experimental and control groups have similar academic performance, support service usage, and Brief COPE responses. This is consistent with broader public health research which finds that an increase in educational efforts does not translate into behavioral changes. In both groups, students with lower exam scores reported using fewer academic supports and poor coping behaviors. Key words: Brief COPE, student services, Minimally Competent Barely Passing (MCBP), physician assistant student, dental student, educatio

Sex Trafficking Assessment Protocol for Medical Professionals in the Emergency Department.

D.N.P. Thesis. University of Hawaiʻi at Mānoa 2018

Healthcare Access

Adequate healthcare access not only requires the availability of comprehensive healthcare facilities but also affordability and knowledge of the availability of these services. As an extended responsibility, healthcare providers can create mechanisms to facilitate subjective decision-making in accessing the right kind of healthcare services as well various options to support financial needs to bear healthcare-related expenses while seeking health and fulfilling the healthcare needs of the population. This volume brings together experiences and opinions from global leaders to develop affordable, sustainable, and uniformly available options to access healthcare services

Longitudinal clinical assessment of undergraduate dental students: building an argument for its validity

Background: Assessment of healthcare professionals plays a pivotal role in safeguarding patients by ensuring practitioners have been appropriately trained before being permitted onto professional registers. This prevents the public from being treated by those who are not fit to practise healthcare subjects, including dentistry. In the UK, dental schools must provide the General Dental Council (GDC) with evidence that students have attained the necessary educational outcomes and are suitable to join the professional register. The GDC delegates responsibility of choosing appropriate assessment methods to obtain such evidence to the dental schools themselves. As part of their undergraduate assessment repertoire, some UK dental schools have adopted longitudinal assessment methods to measure development and consistency of competent performance in clinical environments. Although these longitudinal methods create a rich database of multiple points of evaluation over the duration of the Bachelor of Dental Surgery (BDS) curriculum, there is currently little evidence to support their use for assessing development of clinical competence. Therefore, there is a need to conduct thorough analyses of longitudinal clinical data using robust statistical methods and create evidence to support their validity for this purpose. Aims: This thesis aims to investigate the content and criterion validity and reliability of longitudinal clinical assessment, which will contribute towards a validity argument on its use in assessing the development of clinical competence among undergraduate dental students. It will also explore how the evidence for validity could be used to enhance assessment within dental education. Research design: A mixed methods approach, with quantitative and qualitative approaches, was adopted to address the study aims. For the quantitative component, statistical escriptions, and group-based trajectory models (GBTMs) tracking individual undergraduate’s clinical performance over time were produced from longitudinal clinical assessment (LIFTUPP©) data for three dental student cohort’s (2017-19; n=234). Content validity was investigated using LIFTUPP© performance indicator 4 as the threshold for competence. Distinct trajectories were created using a performance indicator 5 as the threshold, which were then used to investigate the concurrent and predictive subtypes of criterion validity. Concurrent validity was investigated by linking and cross-tabulating LIFTUPP© trajectory group memberships with BDS examination performance (mean scores and a “top 20%” performance in each BDS year). Predictive validity was investigated by linking and cross-tabulating undergraduate LIFTUPP© trajectory group memberships with postgraduate clinical performance trajectory group memberships generated from Longitudinal Evaluations of Performance (LEPs). Reliability was calculated using Cronbach’s alpha. For the qualitative component of the study, a series of online focus groups with key stakeholders within dental education were conducted. Participants were presented with the results of the quantitative analyses and their opinions on how these data could be used to enhance assessment within dental education were canvassed. Transcripts of the focus group discussions were analysed using thematic analysis to identify themes (i.e., patterns) of interest within the data. Results: LIFTUPP© GBTMs with a threshold performance indicator of 4 resulted in all students following a single trajectory in all three cohorts and showed progressive development of clinical competence over three BDS clinical years, satisfying criteria for content validity. GBTMs with a threshold performance indicator of 5 provided at least two distinct trajectories of student clinical performance. According to the Bayesian information criterion (BIC), models with two distinct trajectories fitted the data best and a “better” performing trajectory was identifiable in each cohort. In the two most recent cohorts, students who were more likely to belong to the “better performing” LIFTUPP© trajectory scored higher (on average) in the undergraduate examinations for each BDS year. This association was not observed for cohort 1. Students allocated to “better performing” LIFTUPP© trajectories were more likely to also be assigned to “better performing” LEP trajectories in all three cohorts. Reliability for the undergraduate examinations was high in all three cohorts (>0.88) and did not change substantially when longitudinal clinical assessment data were included. Comments from focus group participants appeared to provide further support for content validity. However, quantitative results were met with a degree of mistrust that seemed to stem primarily from previous experiences of operational issues associated with the LIFTUPP© assessment process and the absence of contextual data within the quantitative analyses. Conclusions: The upward trend of LIFTUPP© trajectory patterns suggested there is evidence that longitudinal clinical performance data have content validity for the assessment of clinical competence. Associations between better LIFTUPP© performance and better undergraduate examination outcomes and better postgraduate clinical performance in the two most recent cohorts were indicative of criterion validity. The lack of association in cohort 1 may have been due to poorer calibration among assessors following the initial adoption of LIFTUPP© into the BDS curriculum. Evidence for LIFTUPP© data reliability was inconclusive. This uncertainty may have resulted from using probabilities of student trajectory group membership as the metric for longitudinal clinical assessment in the calculation of Cronbach’s alpha. Therefore, further investigations on LIFTUPP© data reliability are required. Data processing procedures and suggestions from focus group participants revealed there is a need to improve current assessment practices and data collection to allow other investigations on validity to be pursued and to further increase confidence in the results produced by this study. Some data collection issues encountered in relation to LIFTUPP© and undergraduate examinations have since been resolved, meaning studies involving subsequent student cohorts should seek to incorporate LIFTUPP© communication, management and leadership, and professionalism data as well data from clinical case presentation examinations and one-off clinical competence tests. Overall, the study provides an early contribution towards a validity argument on the use of longitudinal clinical assessment in assessing development of competence in undergraduate dentists and provides a starting point from which consequent studies can be based. The study should now be expanded into different settings, e.g., other dental schools and disciplines (such as medicine, nursing, and veterinary medicine), to confirm and build upon these initial findings

Digital assessment in the clinical workplace : Design, implementation, opportunities, challenges

Peer reviewe

Designing and implementing online assessment in the clinical workplace

Peer reviewe