Negotiating information literacy pathways : learner automony in higher education

This study examines ways in which the practice of information literacy is experienced by undergraduate students in Biology and Social Sciences, using a learner-centred, phenomenographic approach. It challenges simplistic connections which are made between availability of information, learning and learner autonomy in the contemporary information environment. Variations in the experience of information literacy practice in relation to academic assignments are presented. Four distinctive information literacy pathways, or ways of experiencing the process, are identified. The learner-centred perspective has enabled clear distinctions to be made between information literacy pathways, in particular clarifying the concept of focus which has been problematic in earlier work. The Minimalist pathway was associated with poor academic performance. The other three, Gathering, Pinpointing and Connecting, enabled students to be successful in their courses but differed in terms of the development of: subject-matter autonomy; confidence and a sense of competence as a learner; and personal engagement with academic work. The student experience is viewed as a negotiation of ways to act involving the study context, subject knowledge and the student's own role. A key differentiating factor is the student's ability to discern subject knowledge as something which exists outside its embodiment in study tasks. A further factor is the position of the student in relation to both the subject and the study context. This is associated with differences in the sense of control and students' perceptions of themselves as learners. Suggestions are made for educational practice. Attention must be given to the processes of learning and not just its products, such as assignments. A developmental approach towards all students is needed. Even students who appear to be doing well may need guidance to develop autonomy in relation to subject matter. The electronic information environment can provide opportunities and tools but it is interpersonal interaction, between lecturers and students and amongst students, that builds the bridge between information, learning and learner autonomy.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The expert patient: an exploration of self-management in long term conditions

Chronic disease is the major challenge facing global health care. In tandem there has been the emergence of active and informed patients in western society, with the contemporary patient increasingly involved in decisions about their treatment and care. However, while it is acknowledged that the vast majority of chronic disease management is via self-care and effective self-management has a potentially significant effect on reducing resource demand, there has been comparatively little research on the concept of the expert self-managing patient within chronic disease. The aims of this study were therefore to: " Investigate how patient expertise is viewed, interpreted, defined and experienced by patients and clinicians. " Understand how patient expertise is promoted and enabled through the self-management process. " Discover how patient expertise is enhanced or impeded by other mechanisms. Adopting a grounded theory approach underpinned by critical realism, the study commenced with three focus groups with patients and seven focus groups conducted with nurses and physiotherapists. Using the emergent themes as a starting point for constant comparative analysis, concurrent data collection via semi-structured interviews and observation was conducted. This included interviews with twenty two patients, twelve clinicians including doctors, nurses and physiotherapists and two Expert Patients Programme lay tutors. Observation was undertaken with ten consultant and nurse-led clinics, a six week Expert Patients Programme and an eight week Back Fitness Course. A storyline is described that illustrates the journey of the expert patient and the thesis explores the barriers and enablers on this journey. A typology of the expert patient is developed in which it is shown that expert patients fall into four quadrants with overt acceptors as the idealized patient within medical consultations. The findings suggest that many expert patients learned characteristics of being succinct and non-emotional when communicating with clinicians, but at the cost of not being able to articulate the emotional consequences of living with chronic disease. Variance from this idealized type leads to conflict which is explored through theories of the medical division of labour. It is concluded that the typology of the expert patient should be widely discussed and acknowledged as a framework for professional and lay practice. In particular, there should be explicit recognition of the emotional needs of people with chronic illness. Recommendations for policy and practice are generated that include acknowledgement of the expert patient beyond the medically idealised type. It is suggested that within the Expert Patients Programme there should be a move away from the current rigid content and delivery style and a greater focus on the subjective experience of chronic illness. Lay tutors would benefit from developing skills to support the psychological needs of participants. Furthermore, it is suggested that the behaviours and working environment that characterised nurse specialists should be used as a template for good practice to enable clinicians to meet the needs of expert patients. Finally, recommendations are made for inter-professional education. It is suggested that the skills of a variety of expert patients beyond the idealized overt-acceptor type are utilised in order to expose clinicians to a fuller range of patient narratives surrounding the experience of chronic disease