This mixed-methods study was situated within one Florida county and investigated the impact of a newly initiated end-of-course Civics examination upon middle school teachers’ instruction and student learning. High-stakes testing is often a polarizing issue regarding the perceived benefits and challenges for both students and teachers. Participating teachers completed surveys comprised of Likert-type items and short-answer questions inquiring about their instructional choices and resulting student learning with and without the presence of the Civics EOC examination. A subset of department instructional leaders were interviewed providing additional qualitative data with a wider scope due to their dual positioning as teachers and as links between the social studies teachers at their school and the School District of Sunshine County. The analysis of the data reveals that while civics teachers value the increased prestige brought to the subject area with the introduction of the end-of-course examination, the heightened importance of standards has a resulted in a focus on breadth of content coverage rather than depth of learning, leading to content-centered rather than student-centered classroom environments and subsequent loss of voice and choice in curricular decisions for teachers and students. Teachers feel intense pressure to cover the curriculum, raise test scores and engage in test preparation; they question the soundness of the examination to adequately assess the learning of all students and to capture the essence of civics education: active engagement. Teachers’ perspectives on the effect of the examination on teacher practice and student learning were framed within contextual factors that emerged in the analysis: the abandonment of the policy to introduce foundational content at the elementary level; a lack of communication among stakeholders, but particularly between state-level decision makers and local educators; and an absence of the ongoing scaffolding required to create a strong foundation of knowledge and skills to foster continued growth. Consequently, the recommendations of this study of educators’ voices on the policies that impact their profession are directed primarily at state level policy makers and future researchers regarding the flow of communication, inclusion of teacher feedback, continued teacher development, addition of a participatory component, and curricular alignment. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

The Patient-Centered Medical Home (PCMH) is a new model for primary care delivery intended to improve the care experience for both patients and providers, improve the health of populations, and reduce health care costs. Adopting the PCMH model into practice requires considerable investment of time and resources which often act as barriers for many small primary care practices; especially in rural areas. Few studies have examined performance of the PCMH model in rural clinics that have successfully implemented the model. It is important to obtain a comprehensive understanding of how context from the surrounding environment relates to implementation and performance of the model and whether there are differences between rural and urban primary care clinics. This study used a sequential explanatory mixed methods approach to assess differences in performance of the Patient Aligned Care Team (PACT) model between rural and urban primary care clinics within the Veterans Health Administration (VHA). Generalized Estimating Equations with repeated measures were used to estimate associations between rurality and five process-oriented endpoints among a national sample of 891 VHA primary care clinics. Results indicate that, after adjusting for patient characteristics and clinic structural capacity, clinics located in large rural or small/isolated rural areas demonstrated difficulty with enhancing access through use of non-traditional encounters (i.e. telephone visits, group visits, or secured messaging) and facilitating care coordination through post-discharge follow-up compared to urban clinics. Findings also suggest that rural clinics were more likely to struggle to meet system-wide performance standards for these same two PACT-related processes than their urban counterparts. A multiple-case study of five VHA primary care clinics was conducted to obtain a contextual understanding of the relationships between rurality and performance of PACT processes from the perspective of primary care staff engaged in PACT implementation. A comparison of the experiences of staff across the five cases revealed cross-cutting themes that are important to understanding the implementation and performance of PACT-related processes within these clinics. These themes included: both rural and urban clinics experience distance-related barriers; patient preferences and behavior impact performance of PACT-related processes; and primary care clinics experience frequent change. Findings from this qualitative assessment highlight the importance of understanding the unique context and circumstances experienced by each clinic and how they relate to performance and implementation of the PACT model. Insights gained through the qualitative assessment revealed that performance of PACT is influenced by complex relationships with both internal and external context. Combination of both quantitative and qualitative methods provided a more comprehensive understanding of these relationships beyond what could have been learned from a solitary assessment of standardized metrics by gaining additional context directly from the voices of those engaged in PACT care delivery. Identifying differences in PACT performance between rural and urban clinics calls attention to the possibility of unique advantages and challenges for PACTs delivering care to rural patients which need further exploration. Findings from this study contribute to the current understanding of PCMH implementation in rural settings by moving beyond the barriers related to structural capacity to performance of processes aligned with PCMH principles. More widespread implementation of PCMH will require additional attention to the complex relationships between the PCMH and surrounding context in order for primary care practices to successfully implement the model.

This study aimed at investigating the attitudes of English language teachers in Turkey toward computer technology and the extent to which they use technology in language instruction. The data were collected from a sample of English teachers working at public schools all throughout Turkey. In order to ensure triangulation and complementarity, mixed methods research was used combining both quantitative and qualitative research methods. A questionnaire and semi-structured, face-to-face interview were used in order to collect the data. Both descriptive and inferential statistics as well as content analysis were conducted so as to analyze the data. The results of the data analysis yielded positive findings regarding English teachers

Gait disturbances such as slow walking speed and step-to-step variability have been reported among people with mild Alzheimer’s disease (AD) and as risk factors for functional decline, dependency, and falls. Additionally, AD-related emotional reactions and decreased initiative can lead to physical inactivity. The aims of this thesis, therefore, were to explore how the ability to be physically active is affected in the early years of AD, and how people with mild AD and their cohabitants reason about physical activity as part of their everyday life. To meet the aims, an approach inspired by mixed methods research was used, covering measurements, observations and subjective experiences. Data were collected from different sources in parallel. Participants with mild AD were recruited at the Memory Clinic, Uppsala University Hospital. In Study I, a case study with two couples in which one member had AD, in-depth interviews and participating interviews were performed. Physical activity such as walking was viewed as a meaningful routine improving well-being. Participants were positive about making adjustments to enable physical activity. In Study II, the 25 participants with AD showed a significant lower walking capacity (10 m comfortable walk test, 6-minute walk test, Timed-up-and-Go test) at baseline compared to controls. The decline continued during the subsequent two years. The influence of a cognitive task on walking was distinct, despite this, participants maintained a health-promoting level of physical activity during the two-year study-period. In Study III, gait testing in the motor laboratory of 21 participants with AD showed a marked impact on gait parameters (e.g. slowed speed, decreased step length) by a cognitive task. Additionally, specific dual-task gait disturbances were frequent. In Study IV, in-depth interviews with 14 participants with AD indicated that physical activity was viewed as a meaningful activity, used as a means to maintain well-being and selfhood, and contributed to continuity in life. In conclusion, walking capacity deteriorates and declines in the early stages of AD. A simple cognitive task can have a substantially negative impact on walking already in mild AD. In contrast, people with AD can also gain “self-promoting benefits” from physical activity beyond the common health-promoting benefits.

There is a growing recognition of the role that walking and cycling can make in reducing traffic congestion and air pollution whilst also contributing to improved personal health and wellbeing. While studies suggest that infrastructure is required to promote walking and cycling, there is a lack of evidence at the micro level on how interventions aimed at improving connectivity for walking and cycling influence travel behaviour and whether they promote a modal shift away from short car journeys. The aim of this study was to investigate the extent to which the implementation of a high quality traffic free route, delivered by a recent programme targeted at everyday walking and cycling in the UK - the Sustrans Connect2 Programme - influenced individuals' day-to-day travel decisions, changed the spatial and temporal nature of their journeys and impacted on overall carbon emissions from motorised travel. To achieve this aim an in-depth longitudinal panel study of a community of residents living next to a totemic Connect2 scheme in Penarth, Cardiff, was conducted. A panel of purposively selected participants (N=50) were interviewed and asked to record their travel behaviour using personal GPS devices and travel diaries over two seasonally matching 7-day time periods in 2011 and 2012. This novel GPS based mixed-method approach provided a detailed account of participants' travel behaviour in the local area (n=2664 journeys) and a comprehensive understanding of how, why and for whom the Connect2 intervention was likely to influence travel behaviour and the longevity of effects. The findings revealed that participants used the new Connect2 scheme regularly during the period of the study (36% in 2011; 26% in 2012); however, the new scheme was likely to have a greater impact for recreational journeys rather than for everyday travel. Spatial data provided new insights into the complexities of walking behaviour and factors influencing cycling for everyday travel or recreation, including route choice decisions, destinations where activities were conducted and the role of the new Connect2 infrastructure in supporting this. Further findings support the potential of active travel in replacing short car trips (20%) and its impact on carbon emissions from personal travel (4.9% among the study sample). However, results suggest that the new Connect2 scheme alone was unlikely to promote a significant change in travel behaviour and carbon emissions from (displaced) car journeys. The study contributes to the debate on the effectiveness of interventions targeted at promoting walking and cycling and the importance of wider infrastructural improvements that may be required to encourage their wider uptake. The combination of methods for data collection developed and employed in this study also helps to inform future travel behaviour research.

The study was an investigation into the teaching decisions that mathematics teachers make over time. I view a mathematics classroom as a didactical system of teacher, learners and content within an educational institution, where content is the material that brings teachers and learners together. Within such a system I view the teacher's role as making content available to learners. Prior research has often investigated the teacher's role by comparing teaching practices nationally or internationally, but these comparisons have tended to use the lesson as the unit of analysis. I propose that how teachers make content available can change over the course of a series of lessons and so my study used the lesson series as the unit of analysis. I purposefully designed the study so that it involved four cases, which allowed me to explore the role of the teacher and the topic in how content was made available. To investigate how teachers made content available to learners in each case, I developed an analytical approach from which I could study the modes of teacher interaction that featured across the lesson series, the forms of mathematical content made available and the sequencing of these forms. Attending to forms of content - rather than content itself - allowed for comparison of teaching of different topics. This original analytical approach represents a contribution to both mathematics education and mixed methods research. Within this small sample of cases, quantifiable differences were identified in how content was made available between classwork and seatwork, from lesson to lesson and between cases. Between-case differences in the nature of teaching 'between-the-desks' during seatwork were also identified. These differences illuminated teaching decisions to which teachers and classroom researchers may not routinely attend. The findings therefore contribute - and identify additional lines of enquiry that might contribute further - to a more extensive understanding of teaching practices.

abstract: A defining feature of many United States (U.S.) doctoral engineering programs is their large proportion of international students. Despite the large student body and the significant impacts that they bring to the U.S. education and economy, a scarcity of research on engineering doctoral students has taken into consideration the existence of international students and the consequential diversity in citizenship among all students. This study was designed to bridge the research gap to improve the understanding of sense of belonging from the perspective of international engineering doctoral students. A multi-phase mixed methods research approach was taken for this study. The qualitative strand focused on international engineering doctoral students’ sense of belonging and its constructs. Semi-structured interview data were collected from eight international students enrolled at engineering doctoral programs at four different institutions. Thematic analysis and further literature review produced a conceptual structure of sense of belonging among international engineering doctoral students: authentic-self, problem behavior, academic self-efficacy, academic belonging, sociocultural belonging, and perceived institutional support. The quantitative strand of this study broadened the study’s population to all engineering doctoral students, including domestic students, and conducted comparative analyses between international and domestic student groups. An instrument to measure the Engineering Doctoral Students’ Quality of Interaction (EDQI instrument) was developed while considering the multicultural nature of interactions and the discipline-specific characteristics of engineering doctoral programs. Survey data were collected from 653 engineering doctoral students (383 domestic and 270 international) at 36 R1 institutions across the U.S. Exploratory Factor Analysis results confirmed the construct validity and reliability of the data collected from the instrument and indicated the factor structures for the students’ perceived quality interactions among domestic and international student groups. A set of separate regression analyses results indicated the significance of having meaningful interactions to students’ sense of belonging and identified the groups of people who make significant impacts on students’ sense of belonging for each subgroup. The emergent findings provide an understanding of the similarities and differences in the contributors of sense of belonging between international and domestic students, which can be used to develop tailored support structures for specific student groups. / Dissertation/Thesis / Doctoral Dissertation Engineering Education Systems and Design 2020

Introduction: Education of physiotherapists still fails to meet the health and social needs of society. One instrument to steer change in health sciences education is a re-designed curriculum. The overall intent of this study was to develop standards of competencies, teaching and learning strategies, and assessment, for an undergraduate community physiotherapy curriculum in South Africa. The grounding for this research was pragmatism. The Six-step model for curriculum development and the Clinical Prevention and Population Health Curriculum framework guided the research process and main analysis. Methods : A sequential mixed method design was used. First, a two-phase parallel situation analysis was conducted which included a qualitative document analysis of community physiotherapy curricula of the eight physiotherapy university departments in South Africa and a review of health policy documents. The experience of 12 purposively selected physiotherapists who had completed a compulsory community service year was qualitatively explored through interviews within an appreciative inquiry stance. In phase 2, input was gained from physiotherapists, from all ecological levels, on the community physiotherapy curriculum through a Delphi study. Three rounds were used. Round 1 explored the roles of physiotherapy in community health, round 2 quantified consensus in overarching competency domains, and round 3 gathered learning and teaching, and assessment, strategies to gain these competencies. Results : All eight universities had gaps in their community physiotherapy curriculum and were variedly aligned with South African health policies and health profile. Graduates need to be able to provide physiotherapy over the lifespan, to conditions mirroring the quadruple burden of disease, in settings varying from hospitals to homes of clients, with emphasis on health education and promotion within an interprofessional team. They must be prepared for suboptimal practice environments and to utilise the compulsory community service year as a gateway in professional development. Graduates need resilience to cope during the year and awareness about the importance of identifying a mentor in the frequent absence of a profession-specific supervisor. Community physiotherapy needs three core knowledge and skill sets; i.e. clinical physiotherapy, population health and community development. Consensus of 70%+ was gained on competency criteria in the domains of the following professional roles: clinician, professional, communicator and collaborator, scholar, health promoter, public health practitioner, community developer (change agent), and manager/leader. Service-learning was identified as a strategy to develop these roles supported by learning and assessment portfolios. Reflection in different formats – essays, presentations, case analysis, projects such as community wellness programmes, diaries - is a core activity to facilitate learning. A range of complementary strategies were suggested that included direct observation, role-play, and journal clubs. Core to assessment for professional competencies is for the students to be able to give evidence of their own learning (e.g. in a portfolio or oral examination) and to get frequent formative feedback. Conclusion : The physiotherapy profession is important for improving the health status of the South African population. Physiotherapy students should be educated to take on relevant professional roles through the application of appropriate educational standards. The study recommends that the curriculum standards be implemented and evaluated and that the application of complex theory in the further development and implementation of the curriculum be investigated. Lastly, future research in the generic professional domains, such as public health and community development, should be interprofessional in nature. / Thesis (PhD)--University of Pretoria, 2013. / gm2013 / Physiology / Unrestricted

abstract: Background – Among influential education reports, there is clear consensus that an expansive range of intrapersonal (e.g. self-regulation) and interpersonal competencies (e.g. empathy) highly influence educational and career success. Research on teaching and learning these competencies is limited in engineering education. Purpose/Hypothesis – This dissertation study explores the impacts of a mindfulness training program on first-year engineering students and aims to understand potential impacts on the development of intrapersonal and interpersonal competencies. Design/Method – A four-session mindfulness-based training program was designed, developed, and facilitated to cultivate intrapersonal and interpersonal competencies. This study employed a multiphase mixed method design in which quantitative and qualitative data was collected from a total of 35 different students through a post survey (n=31), 3-month follow-up survey (n=29), and interviews (n=18). t-tests were used to evaluate the statistical significance of the program and a rigorous thematic analysis process was utilized to help explain the quantitative data. Results – The results suggest that the majority of students became more mindful, which led to improved intrapersonal competencies (i.e. self-management, critical-thinking, focus, resilience, and well-being) and interpersonal competencies (i.e. empathy, communication, teamwork, and leadership). Discussion / Conclusions – The study provides compelling evidence that mindfulness training can support the development of intrapersonal and interpersonal skills among engineering students, which can support their overall academic experience, as well as personal and professional development. Future design and development work will be needed to evaluate the integration and scalability potential of mindfulness training within engineering programs. / Dissertation/Thesis / Doctoral Dissertation Engineering Education Systems and Design 2019

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