Paediatrics (RCH) - Theses
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ItemWhen adolescents are both students and patients with chronic health conditions: perspectives of parents, education and health personnel( 2014)Chronic health conditions in adolescents (10 - 19 years of age) are a major cause of disrupted education. Education disruption can result in long-lasting consequences for peer relationships, a sense of normal living, and career development. Adolescents with chronic health conditions benefit from the support of their parents, as well as health and education sector professionals. Previous research has examined school-based support for students with chronic health conditions. Research has largely examined the perspectives and experiences of teachers and parents of primary school children (6 – 12 years of age) with complex and chronic health conditions, as well as profound disability. However, little is known about how the health-education interface functions for adolescents with chronic health conditions. The views of health professionals regarding school-based support for adolescents with chronic health conditions are largely missing from the literature. Additionally, what research has been conducted has either combined highly disparate disorders under the label of chronic health conditions, or has concentrated on a single condition. The current study aimed to respond to fundamental gaps in the literature through investigating the perceptions and experiences of parents of adolescents diagnosed with cancer, anorexia nervosa, or cystic fibrosis at the health-education interface. The adolescents were enrolled in years 10 - 12 of secondary school in Victoria, Australia. The perceptions and experiences of health and education sector professionals were also sought with regard to school-based supports for adolescents with chronic health conditions. The overarching objective of the study was to construct an understanding of the health-education interface and how it functions for parents of adolescents in the final years of secondary education. The study achieved this through interpreting the lived experiences of parents, health and education sector professionals via in-depth interviews. Sixty-five in-depth interviews across five cohorts were completed. Thirty-eight parents of adolescents with one of three chronic health conditions were interviewed: cystic fibrosis, as a congenital condition diagnosed in early life (n=16); anorexia nervosa, as a mental health condition with physiological complications (n=11); and cancer, as a condition diagnosed in adolescence (n=11). Health personnel (n=11) and education personnel (n=16) were also interviewed. Thematic analysis of the qualitative data revealed six overarching themes that characterised the lived experience of the health-education interface for parents, health and education sector professionals. These were: (1) Keeping life normal: linking health and education through diagnosis disclosure; (2) Managing disclosure timing and disclosure behaviour at the health-education interface; (3) Protecting identity through non-disclosure, misdirection and escape; (4) Trust and collaboration: key workers and parents at the health-education interface; (5) Experts and novices: trust and confidence at the health-education interface; and (6) Cogs, conduits, links and keys: navigating the health-education interface. The findings highlighted the value of comparative data when examining perceptions of the health-education interface. Significant differences emerged in disclosure experiences and behaviour between conditions. Additionally, significant differences were apparent in the help-seeking behaviour of parents and access to support for students between those with mental health, congenital and later onset conditions. Health and education professionals also held differing views of their roles in support of adolescents with chronic health conditions. Within this thesis, the implications of these findings for both the health and education systems are discussed in detail. Predominately, these findings reveal a failure of equitable practice within the education sector in relation to the implementation of support for students with a range of chronic health conditions. How policy and practice across different chronic health conditions and schools at the health-education interface may be delivered with greater consistency of service is the current challenge. Recommendations for more equitable support processes are offered.
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ItemAcademic failure, truancy and low school commitment: patterns, correlates and links with antisocial behaviour during adolescence( 2014)Ensuring that individuals complete secondary school emerges as an important priority across the developed world as it is understood to be important for national development and for individual, social, emotional, and economic growth. Despite the priority given to school completion, sizable numbers of adolescents do not finish secondary school (referred to as school dropout). Some young people who do not complete secondary school have previously experienced conduct problems and some of these young people continue to engage in antisocial behaviours once leaving school, which is costly to individuals and society. Thus, encouraging more adolescents to complete secondary school is a major societal challenge. Improving understanding of the factors that lead to school dropout is important to address this challenge. Three school adjustment problems associated with school dropout are truancy, academic failure, and low school commitment. These factors also predict engagement in antisocial behaviour. Subsequently, participation in antisocial behaviour can affect learning and connections to school. This study examined a selection of adolescent self-reported factors that are indicators of poor school adjustment and are associated with school dropout. The present study was based on a longitudinal research design which followed a large group of adolescents to examine indicators of poor school adjustment from age 10 years to age 16 years using quantitative analysis. The current research longitudinally examined truancy, academic failure, and low school commitment, as well as the relationship between low school commitment and antisocial behaviour during adolescence. Initially, rates of these school adjustment indicators were explored. Intraindividual change patterns in low school commitment and academic failure were then examined during adolescence. In addition, the longitudinal relationship between low school commitment and antisocial behaviour was investigated, based on the Interactional Theory of Delinquency, which proposes that antisocial behaviours (and factors associated with antisocial behaviour) are reciprocally associated with school commitment. Data were drawn from the International Youth Development Study (IYDS), a longitudinal study involving 5,769 students recruited in three state-representative grade cohorts from Victoria, Australia and Washington State, USA. The current study focused on one IYDS cohort of 927 Victorian students who were recruited in Grade 5 (age 10-11 years) and were longitudinally surveyed across five occasions until Grade 10 (age 15-16 years). Participants completed a self-report survey in their classrooms in each year of the study. The results showed that the percentage of participants reporting low school commitment and academic failure increased from age 10 to age 16 years, with rates highest at age 16 (25% low school commitment and 11% academic failure). Males reported higher rates of low school commitment and academic failure than females in early adolescence. Rates of academic failure differed by socioeconomic level at ages 12, 14, 15 and 16 years. Truancy rates ranged from 5% (age 12) to 19% (age 14) and were similar across gender and socioeconomic groups. Latent growth curve models demonstrated that the rate of change in low school commitment and academic failure from age 10 to 16 years was nonlinear, with low school commitment and academic failure lowest in early adolescence and highest in the later years. Gender differences were found in the low school commitment trajectory, and in the intercept for the academic failure trajectory. The relationship between change in low school commitment relative to change in five concomitant processes (i.e., antisocial behaviour, family attachment, belief in the moral order, association with antisocial friends, and favourable attitudes to antisocial behaviour) from age 10 to 16 years was assessed using parallel process latent growth curve modelling. Relationships between the growth trajectories of low school commitment and antisocial behaviour, family attachment, and belief in the moral order were found. The findings have implications for advancing theoretical models of school adjustment. Findings from this study can also be used to inform policy and practice interventions to interrupt pathways to school dropout. It is recommended that implementing timely and appropriate prevention and intervention efforts that focus on reducing antisocial behaviour and enhancing family attachment and moral beliefs may be important for enhancing healthy school adjustment trajectories.