Evaluation methodologies in multisector community change initiatives: The missing role of indigenous knowledge systems

Comprehensive or multisector community change initiatives (CCIs) represent a promising approach to address the overrepresentation of Indigenous children and families in Canada’s child welfare systems. However, such initiatives are difficult to establish and sustain – in part due to the difficulty of evaluating their impacts and outcomes using standardized Western evaluation methodologies. Consequently, over the past 20 years there have been extensive efforts to develop evaluation principles, methodologies, methods, and tools that are more able to illustrate the benefits of these kinds of initiatives. A systematic review of the CCI evaluation literature found that while many of these principles, methodologies, methods and tools show considerable promise, there has been limited attention to or incorporation of Indigenous ways of knowing or approaches to research with Indigenous peoples. This paper presents two examples of Indigenous led multisector community change initiatives to enhance Indigenous well-being and notes the importance of evaluating their impacts. It argues that collaborative research is needed with participants in Indigenous led multisector collaborations to advance knowledge of culturally relevant approaches to their evaluation

Attitudes towards deprescribing and the influence of health literacy among older Australians

Aim This study aimed to explore attitudes, beliefs and experiences regarding polypharmacy and discontinuing medications, or deprescribing, among community living older adults aged ≥65 years, using ≥5 medications. It also aimed to investigate if health literacy capabilities influenced attitudes and beliefs towards deprescribing. Background Polypharmacy use is common among Australian older adults. However, little is known about their attitudes towards polypharmacy use or towards stopping medications. Previous studies indicate that health literacy levels tend to be lower in older adults, resulting in poor knowledge about medications. Methods A self-administered survey was conducted using two previously validated tools; the Patients’ Attitude Towards Deprescribing (PATD) tool to measure attitudes towards polypharmacy use and deprescribing and the All Aspects of Health Literacy Scale (AAHLS) to measure functional, communicative and critical health literacy. Descriptive statistical analysis was conducted. Findings The 137 responses showed that 80% thought all their medications were necessary and were comfortable with the number taken. Wanting to reduce the number of medications taken was associated with concerns about the amount taken (P\u3c0.001), experiencing side effects (P\u3c0.001), or believing that one or more medications were no longer needed (P\u3c0.000). Those who were using ten or more medications were more likely to want to reduce the number taken (P=0.019). Most (88%) respondents would be willing to stop medication/s in the context of receiving this advice from their doctor. Willingness to consider stopping correlated with higher scores on the critical health literacy subscale (P\u3c0.021) and overall AAHLS score (P\u3c0.009). Those with higher scores on the overall AAHLS measure were more likely to report that they understood why their medications were prescribed (P\u3c0.000) and were more likely to participate in decision-making (P=0.027). Opportunities to proactively consider deprescribing may be missed, as one third of the respondents could not recall a recent review of their medications

Dietary and physical activity behaviors among adults successful at weight loss maintenance

BACKGROUND: There is limited population-based data on behavioral factors found to be important for successful weight loss maintenance among adults. METHODS: Data from the 2004 Styles surveys, mailed to U.S. adults aged ≥18 years were used to examine the difference in selected weight loss strategies and attitudes among persons who reported successful weight loss attempts (lost weight and able to keep it off) and persons who were not successful (previous attempts to lose weight were unsuccessful or they could not keep the lost weight off). Behaviors examined included modification of diet, leisure-time and sports activities, and self-monitoring, and barriers to weight management. RESULTS: Among adults who reported losing weight or trying to lose weight, 31.0% had been successful at both losing weight and maintenance after weight loss. Successful weight loss status differed by sex, age, and current weight status. Assessment of reported weight loss strategies, found that exercising ≥30 minutes/day and adding physical activity to daily life were significantly higher among successful versus unsuccessful weight losers. Individuals who were successful at weight loss and maintenance were less likely to use over-the-counter diet products than those who were unsuccessful at weight loss. Significantly more successful versus unsuccessful weight losers reported that on most days of the week they planned meals (35.9% vs. 24.9%), tracked calories (17.7% vs. 8.8%), tracked fat (16.4% vs. 6.6%), and measured food on plate (15.9% vs. 6.7%). Successful losers were also more likely to weigh themselves daily (20.3% vs. 11.0%). There were a significantly higher proportion of successful losers who reported lifting weights (19.0%) versus unsuccessful (10.9%). The odds of being a successful weight loser were 48%–76% lower for those reporting exercise weight control barriers were influencing factors (e.g., no time, too tired to exercise, no one to exercise with, too hard to maintain exercise routine) compared to those who reported little or no influence of exercise; similarly, the odds were 48–64% lower for those who found certain dietary barriers to be influential (e.g., eat away from home too often, diet/health food costs too much). CONCLUSION: Self-monitoring strategies such as weighing oneself, planning meals, tracking fat and calories, exercising 30 or more minutes daily, and/or adding physical activity to daily routine may be important in successful weight loss maintenance. Leisure-time activities such as lifting weights or cooking/baking for fun are common strategies reported by those who were successful weight losers

Effective Teaching and Learning in Interprofessional Education in Child Welfare

This article reports on research regarding interprofessional education (IPE) in child welfare conducted in 2009 and 2010. Pre service nursing, social worker and teacher education candidates participated in a workshop that “exposed” (Charles, Bainbridge & Gilbert, 2010) students to IPE in child welfare. This paper addresses a gap in literature in IPE in child welfare.   Literature in IPE precedes a description of the workshop followed by an explanation of the integrated expert presentation, case study, modeling, reflection and small and large group processes. Results of the survey administered to workshop attendees are presented. Likert scaled questions indicate a high degree of satisfaction with the workshop organization, pedagogy and objectives. Responses to the open-ended questions align closely with the Thistlethwaite and Moran (2010) learning outcomes framework. It is clear that pre-service students learned with, from and about each other’s discipline. 2 tables and an extensive reference list are included

Medication Management for People Living with Dementia: Development and Evaluation of a Multilingual Information Resource for Family Caregivers of People Living with Dementia

The aim of this chapter is to describe the development and evaluation of an online multilingual information resource focused on medication management, targeting people living with dementia and their family caregivers. Maintaining effective medication management is important to allow ongoing quality of life within the community setting and avoiding medication-related preventable hospitalisations for the person living with dementia. Family caregivers are likely to assume the role of medication management on behalf of the person in their care as dementia progresses. Little training or information is available to family caregivers to assist them with this role. A pilot online information resource was developed and evaluated. Responding to the evaluation, this resource was improved, and a more extensive evaluation process was undertaken. The development and evaluation process are outlined with a view to guiding the development of similar resources, especially those targeting linguistically diverse family caregivers and those with dementia. This is especially important given that many older adults will migrate during their lifetime, often to a country where they are not familiar with the language or health services. Extra support is needed to assist older immigrants who are themselves at risk or are caring for someone with dementia

Mechanism for microbial population collapse in a fluctuating resource environment.

Managing trade-offs through gene regulation is believed to confer resilience to a microbial community in a fluctuating resource environment. To investigate this hypothesis, we imposed a fluctuating environment that required the sulfate-reduce

Bomb-produced radiocarbon validation of growth-increment crossdating allows marine paleoclimate reconstruction

The bivalve Pacific geoduck (Panopea generosa) has been used in the eastern North Pacific Ocean to create proxies for environmental factors such as temperature and oceanographic conditions. This type of research depends upon accurate age determination of Pacific geoducks, which historically was based on shell growth-increment counts. A recent study comparing age estimates generated by the dendrochronology (tree-ring science) procedure of crossdating to those estimated from growth-increment counts found a significant difference between the methods for geoduck older than 30 years. Compared to the traditional age determination method of counting growth increments, the crossdating method estimates a greater longevity in this species, with some individuals living in excess of 150 years. In the present study, the accuracy of each method was independently assessed using bomb-produced radiocarbon (C-14) techniques. Specimens whose birth years were estimated to be within the era of the bomb-produced marine C-14 increase and where the differences between ages estimated by the two methods were greatest were selected for C-14 analysis. The difference between age estimates from traditional growth-increment counts and those from crossdating was evaluated using their respective C-14 chronologies in comparisons to a reference chronology as a standard. The comparisons relied on Bayesian nonlinear models using Markov Chain Monte Carlo simulation. This method of analysis showed that with a 50% probability geoducks were aged correctly when using the crossdating method, compared to the growth increment counts which had a 50% probability of underestimating the age by 4 years. Therefore, the crossdated age estimates were found to be more accurate than increment counts. Furthermore, these results provide new confidence in using Pacific geoduck biochronologies for paleoclimate and paleoenvironmental reconstruction. Published by Elsevier B.V.Keywords: Age determination, Pacific geoduck, Bomb-produced radiocarbon, Bayesian models, Shell growth-increment counts, Crossdating, Panopea generos