Evolution of the concepts and methods associated with exploring and measuring the impact of aphasia - Volume 1

This thesis investigates healthcare measurement for people who live with the language disability, aphasia. It describes how a tool was developed to investigate the impact of living with aphasia. The first chapter describes why healthcare measures are necessary. It describes some of the complexities associated with measurement when working with people who have traditionally been excluded from health care measurement. It discusses different types of measures currently available and why they are often inadequate for investigating the impact of aphasia. The second chapter details the initial stages of development of a new tool, undertaken from a professional viewpoint. This chapter describes the rationale behind the items and methods used in the instrument. It details the changes that were made to the tool as a result of pilot and field testing. The third chapter describes the conceptual and methodological issues that informed the next stages of the development process. There is a discussion of the current issues in healthcare that are seen as pertinent to the development of a tool to explore the impact of aphasia. There is consideration of the relative strengths of qualitative and quantitative research methods, and the tension that can exist between ensuring a tool is psychometrically robust whilst still being accessible and acceptable to the client group for whom it is intended. Chapters four and five detail how conceptual considerations led to changes in the methodology employed in the next stage of development. They describe two methods of collaborative working; individual in-depth interviews and working with an advisory group of people with aphasia. They detail the changes made to the tool as a result of the consultation processes. Chapter six explores how these inclusive methods led to examination of the social relations of research practice. It discusses the challenges and benefits presented by this way of working, and the personal effects of inclusive research practices. It investigates these in the light of what has been learnt through the development of the instrument described. This thesis therefore presents the CDP, a new way of exploring and measuring the impact of aphasia on someone’s life. It considers the purpose of healthcare measurement. It exemplifies participatory research with people who have aphasia, including a reflection on the tension that can exist between qualitative and quantitative methodologies when developing a new tool. By doing so, it offers guidance on research practice for those wishing to conduct inclusive research with people traditionally excluded from health care measurement including people with aphasia

Evolution of the concepts and methods associated with exploring and measuring the impact of aphasia - Volume 2

This thesis investigates healthcare measurement for people who live with the language disability, aphasia. It describes how a tool was developed to investigate the impact of living with aphasia. The first chapter describes why healthcare measures are necessary. It describes some of the complexities associated with measurement when working with people who have traditionally been excluded from health care measurement. It discusses different types of measures currently available and why they are often inadequate for investigating the impact of aphasia. The second chapter details the initial stages of development of a new tool, undertaken from a professional viewpoint. This chapter describes the rationale behind the items and methods used in the instrument. It details the changes that were made to the tool as a result of pilot and field testing. The third chapter describes the conceptual and methodological issues that informed the next stages of the development process. There is a discussion of the current issues in healthcare that are seen as pertinent to the development of a tool to explore the impact of aphasia. There is consideration of the relative strengths of qualitative and quantitative research methods, and the tension that can exist between ensuring a tool is psychometrically robust whilst still being accessible and acceptable to the client group for whom it is intended. Chapters four and five detail how conceptual considerations led to changes in the methodology employed in the next stage of development. They describe two methods of collaborative working; individual in-depth interviews and working with an advisory group of people with aphasia. They detail the changes made to the tool as a result of the consultation processes. Chapter six explores how these inclusive methods led to examination of the social relations of research practice. It discusses the challenges and benefits presented by this way of working, and the personal effects of inclusive research practices. It investigates these in the light of what has been learnt through the development of the instrument described. This thesis therefore presents the CDP, a new way of exploring and measuring the impact of aphasia on someone’s life. It considers the purpose of healthcare measurement. It exemplifies participatory research with people who have aphasia, including a reflection on the tension that can exist between qualitative and quantitative methodologies when developing a new tool. By doing so, it offers guidance on research practice for those wishing to conduct inclusive research with people traditionally excluded from health care measurement including people with aphasia

How children eat may contribute to rising levels of obesity children's eating behaviours: An intergenerational study of family influences

The term ‘obesogenic environment’ is rapidly becoming part of common phraseology. However, the influence of the family and the home environment on children's eating behaviours is little understood. Research that explores the impact of this micro environment and intergenerational influences affecting children's eating behaviours is long overdue. A qualitative, grounded theory approach, incorporating focus groups and semi-structured interviews, was used to investigate the family environment and specifically, the food culture of different generations within families. What emerged was a substantive theory based on ‘ordering of eating’ that explains differences in eating behaviours within and between families. Whereas at one time family eating was highly ordered and structured, typified by the grandparent generation, nowadays family eating behaviours are more haphazard and less ordered, evidenced by the way the current generation of children eat. Most importantly, in families with an obese child eating is less ordered compared with those families with a normal weight child. Ordering of eating' is a unique concept to emerge. It shows that an understanding of the eating process is crucial to the development and improvement of interventions targeted at addressing childhood obesity within the family context

Healthy together Victoria and childhood obesity: a methodology for measuring changes in childhood obesity in response to a community-based, whole of system cluster randomized control trial

BACKGROUND: Healthy Together Victoria (HTV) - a complex \u27whole of system\u27 intervention, including an embedded cluster randomized control trial, to reduce chronic disease by addressing risk factors (physical inactivity, poor diet quality, smoking and harmful alcohol use) among children and adults in selected communities in Victoria, Australia (Healthy Together Communities). OBJECTIVES: To describe the methodology for: 1) assessing changes in the prevalence of measured childhood obesity and associated risks between primary and secondary school students in HTV communities, compared with comparison communities; and 2) assessing community-level system changes that influence childhood obesity in HTC and comparison communities. METHODS: Twenty-four geographically bounded areas were randomized to either prevention or comparison (2012). A repeat cross-sectional study utilising opt-out consent will collect objectively measured height, weight, waist and self-reported behavioral data among primary [Grade 4 (aged 9-10y) and Grade 6 (aged 11-12y)] and secondary [Grade 8 (aged 13-14y) and Grade 10 (aged 15-16y)] school students (2014 to 2018). Relationships between measured childhood obesity and system causes, as defined in the Foresight obesity systems map, will be assessed using a range of routine and customised data. CONCLUSION: This research methodology describes the beginnings of a state-wide childhood obesity monitoring system that can evolve to regularly inform progress on reducing obesity, and situate these changes in the context of broader community-level system change