In South Africa today, the challenge is to redress past inequalities and to transform the higher education system. This transformation of the higher education system is necessary in order to serve a new social order. The introduction of outcomes-based education and training requires a new approach to education, including the process of assessment. An outcomes-based approach to education and training focuses on continuous assessment through the use of a range of assessment methods. The Ministry of Education tasked the National Department of Education to embark on a review of their academic programmes. This review has been in response to register programmes on the National Qualifications Framework. This review has also been part of an attempt to improve the quality of qualifications. In most learning organisations, assessment and learning have always been closely related. If assessment has not simply been seen as the end point in learning but has been an important component in the design of the learning process itself, this statement will be severely tested by the movement towards an outcomes model for education and training. The primary aim of the study was to develop a conceptual model for the management of the impleme tation of a continuous assessment plan in a university of technology by means of aliterature study and an empirical investigation. Currently, information regarding the conceptualisation of this topic is inadequate and vague. If the nature of the complexities involved in the management and implementation of CASS at universities of technology are known, a conceptualised model can be developed for the effective management of the implementation thereof. The implementation of an integrated model of assessment requires the creation of an enabling environment in which the model can be implemented. This study has found that this is not true for many universities of technology, as: • programme design still rests on subjects that are not aimed at outcome-based models; • administrative systems are not designed to accommodate the recording of continuous assessments; • students, lecturers and other stakeholders have not undergone the necessary training regarding the change in paradigm from content-based to outcomebased education; and • policy regarding modularisation and continuous assessment has not yet been defined and implemented. The study serves to present a useable model for the management of the implementation of continuous assessment at universities of technology. The study is based on a balanced opinion as the experiences of both lecturers and students were investigated by means of structured questionnaires. The findings were verified by means of a focus group interview with administrative staff involved with continuous assessment. The model that was developed is a usable model as it was subjected to a number of verification tests. / Thesis (Ph.D. (Teaching and Learning))--North-West University, Vaal Triangle Campus, 2008.

In South Africa today, the challenge is to redress past inequalities and to transform the higher education system. This transformation of the higher education system is necessary in order to serve a new social order. The introduction of outcomes-based education and training requires a new approach to education, including the process of assessment. An outcomes-based approach to education and training focuses on continuous assessment through the use of a range of assessment methods. The Ministry of Education tasked the National Department of Education to embark on a review of their academic programmes. This review has been in response to register programmes on the National Qualifications Framework. This review has also been part of an attempt to improve the quality of qualifications. In most learning organisations, assessment and learning have always been closely related. If assessment has not simply been seen as the end point in learning but has been an important component in the design of the learning process itself, this statement will be severely tested by the movement towards an outcomes model for education and training. The primary aim of the study was to develop a conceptual model for the management of the impleme tation of a continuous assessment plan in a university of technology by means of aliterature study and an empirical investigation. Currently, information regarding the conceptualisation of this topic is inadequate and vague. If the nature of the complexities involved in the management and implementation of CASS at universities of technology are known, a conceptualised model can be developed for the effective management of the implementation thereof. The implementation of an integrated model of assessment requires the creation of an enabling environment in which the model can be implemented. This study has found that this is not true for many universities of technology, as: • programme design still rests on subjects that are not aimed at outcome-based models; • administrative systems are not designed to accommodate the recording of continuous assessments; • students, lecturers and other stakeholders have not undergone the necessary training regarding the change in paradigm from content-based to outcomebased education; and • policy regarding modularisation and continuous assessment has not yet been defined and implemented. The study serves to present a useable model for the management of the implementation of continuous assessment at universities of technology. The study is based on a balanced opinion as the experiences of both lecturers and students were investigated by means of structured questionnaires. The findings were verified by means of a focus group interview with administrative staff involved with continuous assessment. The model that was developed is a usable model as it was subjected to a number of verification tests. / Thesis (Ph.D. (Teaching and Learning))--North-West University, Vaal Triangle Campus, 2008.

The thesis reports on the evaluation of a digital information literacy program (DILP) to determine the program’s effectiveness in enhancing students’ digital information literacy skills. The program was originally designed and developed for the South African student, as member of Generation Y, but was adapted to suit the demographics and characteristics of Generation Z. New learning technologies were incorporated to enhance students’ learning experience. One of the characteristics of information literacy programs that illustrate best practice is the evaluation of the program itself to judge it’s effectiveness and validate the program as a learning tool. A review of the literature confirmed the paucity of the evaluation of such programs using assessment of student learning through outcomes assessment instruments, based on information literacy competency standards, designed with proven validity and reliability. The literature review found no evidence of the evaluation of the effectiveness of such programs through meaningful assessment of student learning using outcomes assessment in South Africa. For these reasons, the evaluation of the DILP was undertaken. To evaluate the effectiveness of the DILP, a non-randomised quasi-experimental research design, focusing on a single-group pre-test/post-test design which incorporated a combined quantitative and qualitative research approach was used. The primary research instrument was a pre- and post-test. A group of students, belonging to Generation Y and Z, completed a pre-test, worked through the DILP and completed a post-test. Telephonic and e-mail interviews were used to collect further data. The statistical analysis is presented by using descriptive statistics (stacked bar charts for the quantitative data and pie charts for the qualitative data). Inferential statistics were used to reach conclusions beyond the immediate data presented in the charts. The final step was to judge the overall effectiveness of the DILP. The difference between the means was statistically significant, indicating that the DILP was effective in enhancing the digital information literacy skills of students. Based on this research, additional research could be the evaluation of a DILP designed specifically for “digital natives”; the development of online outcomes assessment instruments for web-based tutorials with proven validity and reliability and research in the area of integrating emerging learning technologies with such programs, evaluating their effectiveness. / Information Science / D. Litt. et Phil. (Information Science)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction. Aging favors the appearance of propitious clinical conditions to a high use of medicines, a reality in the elderly over 65 years of age. However, the number of medicines used should not be the only predictor of a medication regimen complexity, other factors may increase the complexity of pharmacotherapy leading to possible problems related to pharmacotherapy. In this perspective, there are few national studies that evaluate the medication regimen complexity in the elderly, especially those that evaluate outcomes influenced by this complexity, so as to allow interventions for its optimization. Thus, the objective of this dissertation was to evaluate the pharmacotherapeutic profile and the health outcomes associated with the medication regimen complexity. Methods. This study was carried out in two stages. In the first stage, a descriptive cross-sectional study was performed to evaluate the medication regimen complexity of elderly patients in three long-term care facilities using the Medication Regimen Complexity Index (MRCI). This study was conducted for 12 months in three long-term care facilities in the state of Sergipe. In the second stage, a systematic review was performed to identify in the literature which outcomes were influenced by the medication regimen complexity, using the MRCI. We analyzed all study designs published until February 2017 who met the following eligibility criteria: using the MRCI instrument to measure the medication regimen complexity, assessing the medication regimen complexity for global regimens, related the medication regimen complexity with clinical and/or humanistic and/or economic outcome, was written in English, Spanish or Portuguese. Results. In the first stage, the evaluation of the medication regimen complexity obtained an average of 15.1 points (± 9.8), with a minimum of two and a maximum of 59 points. The highest levels of complexity were associated with the dose frequency, with a mean of 5.5 (± 3.6) points. A significant relationship between the medication regimen complexity and the variables polypharmacy, drug interaction, drug potentially inappropriate for the elderly and therapeutic duplicity was found (p <0.001). In the second stage, of the 610 studies evaluated, 20 met the eligibility criteria. The health outcomes most influenced by the medication regimen complexity were the clinical outcomes: hospitalization, hospital readmission and adherence to pharmacotherapy, most of the studies presented satisfactory results to association the outcomes with the complexity and obtained good methodological quality. Conclusion. This dissertation made it possible to evaluate the pharmacotherapeutic profile of elderly patients, showed that besides polypharmacy, potential drug interaction, therapeutic duplicity and potentially inappropriate medicines for the elderly are risk factors for the increased medication regimen complexity in these patients. Furthermore, identified that the health outcomes most influenced by the medication regimen complexity were ones clinical: hospitalization, hospital readmission and adherence to the pharmacotherapy. / Introdução. O envelhecimento favorece o aparecimento de condições clínicas propícias para o elevado uso de medicamentos, observado principalmente em pacientes acima de 65 anos de idade. Entretanto, o número de medicamentos utilizados não deve ser o único preditor de uma farmacoterapia complexa, pois outros fatores podem elevar a complexidade, conduzindo a possíveis problemas relacionados à farmacoterapia. Nesta perspectiva, são escassos os estudos nacionais que avaliam a complexidade da farmacoterapia em idosos, principalmente os que analisam desfechos influenciados por essa complexidade, de modo a permitir intervenções para sua otimização. Assim, o objetivo desta dissertação foi avaliar o perfil farmacoterapêutico e os desfechos em saúde associados à complexidade da farmacoterapia. Metodologia. Este estudo foi realizado em duas etapas. Na primeira, foi realizado um estudo transversal descritivo para avaliar a complexidade da farmacoterapia de idosos atendidos em três instituições de longa permanência para idosos (ILPIs), por meio do instrumento Medication Regimen Complexity Index (MRCI). Este estudo foi conduzido por 12 meses em três instituições no Estado de Sergipe. Na segunda etapa, foi realizada uma revisão sistemática, a fim de identificar, na literatura, quais desfechos estão associados à complexidade da farmacoterapia, medida pelo instrumento MRCI. Foram analisados todos os delineamentos de estudos publicados até fevereiro de 2017 que atenderam aos seguintes critérios de elegibilidade: usar o instrumento MRCI para medir a complexidade da farmacoterapia; avaliar a complexidade da farmacoterapia para os regimes globais dos pacientes; e relacionar a complexidade da farmacoterapia com desfechos clínicos e/ou humanísticos e/ou econômicos, publicados em inglês, espanhol ou português. Resultados. Na primeira etapa, a avaliação da complexidade da farmacoterapia obteve média de 15,1 pontos (± 9,8), com mínimo de dois e máximo de 59 pontos. Os níveis mais altos de complexidade foram associados à frequência de dose, com uma média de 5,5 (± 3,6). Além disso, foi identificada relação significativa entre a complexidade da farmacoterapia e as variáveis polifarmácia, interação medicamentosa, medicamento potencialmente inapropriado para idosos e duplicidade terapêutica (p< 0,001). Na segunda etapa, dos 610 estudos avaliados, 20 preencheram os critérios de elegibilidade. Os desfechos em saúde mais influenciados pela complexidade da farmacoterapia foram os desfechos clínicos: hospitalização, readmissão hospitalar e adesão à farmacoterapia. A maioria dos estudos apresentou resultados satisfatórios para associação dos desfechos com a complexidade e obtiveram boa qualidade metodológica. Conclusão. Esta dissertação possibilitou avaliar o perfil farmacoterapêutico de pacientes idosos e identificar que, além da polifarmácia, interação medicamentosa potencial, duplicidade terapêutica e medicamentos potencialmente inapropriados para idosos são fatores de risco para o aumento da complexidade da farmacoterapia nestes pacientes. Além disso, identificou-se que os desfechos em saúde mais influenciados pela complexidade da farmacoterapia foram os clínicos: hospitalização, readmissão hospitalar e adesão a farmacoterapia. / Aracaju, SE

Transitioned perinatally HIV-infected patients may be at increased risk for poor outcomes, yet the impact of transition and of transition programs on health are not well understood. This research examined: (1) post-transition mortality, (2) engagement in adult HIV care, (3) transition experiences, and clinical and sociodemographic influences, including transition program exposure. Data were collected from patients who had transitioned from a Florida pediatric clinic to adult HIV care between January 2003 and September 2012. Post-transition mortality and care engagement were assessed in a retrospective analysis of medical record data. Fisher exact and Kruskal-Wallis tests were used for significance testing. Risk ratios (RRs) were calculated to assess strength of associations. Stratified analysis controlled for confounding. Transition experiences were examined in a mixed-methods study, with qualitative data from a computer-assisted survey subjected to thematic analysis. Of 51 transitioned patients, nine (18%) had died by May 2014, five (56%) in the first post-transition year. Of 42 survivors, 33 were eligible; 27 (82%) provided consent. Post-transition mortality was high, particularly in those severely immunosuppressed (CD4 count <100/mm3; RR =6.0, 95% CI =1.88-19.19 [P=.005]) at transition. When controlled for CD4 count, employment was associated with decreased (adjusted RR= 0.19; 95% CI=0.04-0.88 [P=.02]), and high school non-completion with increased (adjusted RR= 3.0; 95% CI=1.37-6.40 [P=.07]) mortality risk. The number of kept HIV appointments decreased from last pre-transition (Median = 5, IQR 4-6) to first post-transition (Median = 2, IQR 1-10; P=.002) year; the proportion of poorly engaged increased from 3% to 35% (P=.006), with no significant changes between first and second post-transition years. Non-Hispanic black and low-income participants were less likely to be regularly engaged in adult HIV care one year post-transition. Transition program exposure did not significantly affect mortality or care engagement. Most of 27 received transition services, but 59% had trouble doing well in adult care. Needs for patient-centered care, with caring, personal patient-provider relationships and accessible HIV care, characterized post-transition experiences. This research suggested that transitioned perinatally HIV-infected young adults are at risk for poor health outcomes. Systematic programs using a socio-ecological framework to include multi-level interventions and post-transition support may improve outcomes.

Background Health education programs that are aimed at improving individuals' skills to self-manage are increasingly recognised as a critical component of chronic disease management. Despite the apparent need for such interventions, current studies show inconsistent results regarding program effectiveness, with meta-analyses indicating only marginal effects for some disease groups. A closer examination of these studies however suggests that the magnitude and inconsistency of the findings may be related to the types of outcomes that were assessed rather than specific disease groups. Where self-report measures were used, results tended to be smaller and inconsistent. It is therefore possible that current studies do not adequately reflect program effects because self-report outcomes have a high risk to be confounded by a range of potential biases. Objective The aim of this thesis was to identify and quantify the potential influence of biases in the measurement of change in chronic disease self-management interventions using self-report. Methods The research design targeted the processes that individuals undergo when filling out questionnaires and whether this has an influence on their self-report outcomes. This was achieved by developing a three-group research design. The Health Education Impact Questionnaire (heiQ) was used to collect outcomes data. While pretest questionnaires were identical across groups, three questionnaire versions were randomly distributed at posttest. One of the groups filled out traditional posttest questions (n=331), whereas the other two groups were asked to provide data in addition to posttest questions, with one group providing transition questions (n=304) and one providing retrospective pretest data (n=314). Resulting datasets were further examined for possible confounding effects through response shift and social desirability bias. Through the random allocation of the heiQs it was ensured that data were not influenced by potential intra-group effects. Results The thesis revealed that the design of the posttest questionnaire significantly influenced people's ratings of their posttest levels. In particular, when participants were asked to provide ratings of their retrospective pretest levels in addition to their posttest levels, the latter scores were significantly higher than those of participants who did not perform this additional task. Subsequent analyses however suggested that these differences could neither be explained by response shift nor by social desirability bias. Conclusions This research has provided important insight into the measurement of outcomes of chronic disease self-management interventions. While the threat to the validity of traditional pretest-posttest data due to confounding effects through response shift and social desirability biases could not be supported, the thesis has highlighted that the cognitive task that subjects are asked to perform when providing data at posttest significantly influenced their self-reported outcomes. Given that previous research has predominantly focused on other aspects of validity - such as applying control group designs to circumvent common threats to internal and external validity - this study suggests that more attention must be paid to the design of questionnaires. The thesis concludes that further research, in particular into the influence of cognitive tasks on obtained scores, is important to improve the interpretation of self-report outcomes data derived from participants of self-management interventions.