Faculty of Education - Research Publications
Permanent URI for this collection
Search Results
1 - 4 of 4
-
Item
-
ItemHealth equity in the New Zealand health care system: a national survey(BIOMED CENTRAL LTD, 2011-10-20)INTRODUCTION: In all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable. METHODS: A national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes. RESULTS: Survey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or by geography. Populations that conventional practitioners find hard to reach, despite recognized needs, are often underserved. Nurses and community health workers carried a disproportionate burden of care. Cultural and diversity training is not a condition of employment. CONCLUSIONS: There is a struggle to put equity principles into practice, indicating will without enactment. Equity is not addressed systematically below strategic levels and equity does not shape funding decisions, program development, implementation and monitoring. Equity is not incentivized although examples of exceptional practice, driven by individuals, are evident across New Zealand.
-
ItemTesting of a synthetic phonics-based targeted reading intervention for students with reading difficulties in Year 1: protocol for an efficacy randomised controlled trial(BMJ PUBLISHING GROUP, 2018-01)INTRODUCTION: Literacy is fundamental for educational achievement, and in the longer term contributes substantially to a range of life skills. Literacy difficulties during the early years of school are associated with long-term impacts on academic success, with differences in academic achievement sustained through children's schooling. Therefore, addressing literacy difficulties during the early years of school is essential in reducing the risk of children progressing onto negative academic, psychosocial and vocational trajectories. This trial will determine whether a phonics-based reading intervention can improve the reading comprehension of students identified as low-progress readers in the second year of primary school. METHODS/DESIGN: We recruited 236 students fromnine schools after screening for reading difficulties in the second year of primary school (Year 1). Schools in Sydney and Central Coast of New South Wales will be invited to participate via an opt-out consent process. All children identified as being in the bottom 25th percentile using the Wheldall Assessment of Reading Lists will be eligible for the trial. These children will be randomised into either 'usual teaching' or 'intervention' groups. Trained school support teachers will deliver the MiniLit intervention. Intervention: In groups of four, children will complete a daily 1-hour lesson with their MiniLit teacher over 20 school weeks. Follow-up: Immediately after intervention completion and 6 months later using child face-to-face assessments. Primary outcome: Reading comprehension at 6 months after intervention completion. The study will have an embedded process and cost-effectiveness evaluation. DISCUSSION: The Building Better Readers trial will be the first efficacy randomised controlled trial comparing usual teaching with a phonics-based reading intervention for children with reading difficulties in Year 1 of primary school in Australia. The randomised design will limit the effect of bias on outcomes seen in other studies. TRIAL REGISTRATION NUMBER: ACTRN12617000179336.
-
ItemCan a teacher-led mindfulness intervention for new school entrants improve child outcomes? Protocol for a school cluster randomised controlled trial(BMJ PUBLISHING GROUP, 2020-05)INTRODUCTION: The first years of school are critical in establishing a foundation for positive long-term academic, social and well-being outcomes. Mindfulness-based interventions may help students transition well into school, but few robust studies have been conducted in this age group. We aim to determine whether compared with controls, children who receive a mindfulness intervention within the first years of primary school have better: (1) immediate attention/short-term memory at 18 months post-randomisation (primary outcome); (2) inhibition, working memory and cognitive flexibility at 18 months post-randomisation; (3) socio-emotional well-being, emotion-regulation and mental health-related behaviours at 6 and 18 months post-randomisation; (4) sustained changes in teacher practice and classroom interactions at 18 months post-randomisation. Furthermore, we aim to determine whether the implementation predicts the efficacy of the intervention, and the cost effectiveness relative to outcomes. METHODS AND ANALYSIS: This cluster randomised controlled trial will be conducted in 22 primary schools in disadvantaged areas of Melbourne, Australia. 826 students in the first year of primary school will be recruited to detect between groups differences of Cohen's d=0.25 at the 18-month follow-up. Parent, teacher and child-assessment measures of child attention, emotion-regulation, executive functioning, socio-emotional well-being, mental health-related behaviour and learning, parent mental well-being, teacher well-being will be collected 6 and 18 months post-randomisation. Implementation factors will be measured throughout the study. Intention-to-treat analyses, accounting for clustering within schools and classes, will adopt a two-level random effects linear regression model to examine outcomes for the intervention versus control students. Unadjusted and analyses adjusted for baseline scores, baseline age, gender and family socioeconomic status will be conducted. ETHICS AND DISSEMINATION: Ethics approval has been received by the Human Research Ethics Committee at the University of Melbourne. Findings will be reported in peer-review publications, national and international conference presentations and research snapshots directly provided to participating schools and families. PRE-RESULTS TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12619000326190).