This thesis offers a rethinking of the role for education as critical workplace pedagogy in complex problems of health care. Taking the case of paediatric diabetes, the study explored how health-care professionals learn the work of supporting children, and their parents, to self-manage the condition. By reconceptualising work problems as sociomaterial learning struggles, this research contributes new understandings of informal professional learning in everyday health-care provision. Data were generated through fieldwork in an outpatient clinic. Particular challenges of supporting self-management in this case were the difficulties of balancing policy aspirations for empowerment with biomedical knowledge about risks to immediate and long-term health. Tracing the materialisation of learning as it unfolded in moments of health-care practice showed professionals handling multiple and contradictory flows of information. Particular challenges were posed by insulin-pump technologies, which have specific implications for professional roles and responsibilities, and introduce new risks. A key insight is that professionals were concerned primarily with the highly complicated perpetual discernment of safe parameters within which children and their parents might reasonably be allowed to contribute to self-management. Such discernment does not readily correspond to the notion of empowerment circulating in the policies and guidelines intended to enable professionals to accomplish this work. As a result, this thesis argues that the work of discernment is obscured. Learning strategies evolve, but could be supported and extended by explicit recognition of the important work of learning as it unfolds in everyday practices of supporting self-management in paediatric diabetes. Most importantly, workplace pedagogies could be developed in ways that attune to the profound challenges and uncertainties that are at stake in these practices.

M.A. (Psychology) / Please refer to full text to view abstract

Photocopy of typescript. / Digitized by Kansas Correctional Industries

The education of looked-after children (LAC) in the care of the Local Authority (LA) is supported by government initiatives to reduce the attainment gap that exists between LAC and their peers. Long-term outcomes for LAC pupils are poor (Sebba et al. 2015). The Virtual School (VS) has a statutory role in the education of LAC (DfE, 2014a) and aims to encourage stringent monitoring and intervention for LAC pupils, for example via a personalised education plan (PEP) outlining attainment, strategies intended to accelerate progress, and resources needed for doing so. The PEP process involves termly meetings between pupil, Social Worker and school's designated teacher. The current study uses Actor-Network Theory (ANT) (Latour, 1999) as a lens through which to conceptualise change for LAC pupils during the PEP process. Data was collected from three PEP meetings and accompanying documentation in one LA setting, using ethnomethodology, in order to explore the human and non-human actors in the PEP network which are active in creating change for LAC. The analysis made visible the strong role of the PEP document in providing structure for the meeting, along with the instrumental role of the designated teacher and their knowledge of the pupil embodied in non-human entities such as resources, timetabling and grades. The Social Worker influence on the network was less visible. ANT is explored as a material semiotic tool for analysis through a conceptual review of current literature within educational research, with a focus on the construction of research questions. The review demonstrates that ANT can attempt to answer questions about 'how' things came to be and 'who' and 'what' they are composed of. The current research also incorporates an appraisal of evidence-based practice, and a consideration of the implications and dissemination of the findings of the study at LA level and beyond.

Thesis (MA.(Theology)Trauma)-University of Pretoria, 2007. / Includes bibliographical references (leaves 83-88)

published_or_final_version / Public Health / Master / Master of Public Health

Early childhood caries is a condition of rapidly progressing rampant dental caries in infants and young children. It is considered as a major public health problem affecting pre-school children and it is the most common dental disease which affects 28% of children within two to five years of age. ECC not only induces pain and discomfort, but can also affect communication, nutrition status, learning abilities, speech and quality of life, which may progress into adulthood and pose a heavy burden on the healthcare system in long-term. In Hong Kong, over 50% of children were affected by dental caries in 2001 but over 70% of children had never been to a dentist for a regular check up at age five. Thus, much of the tooth decay was remained undetected and untreated. Dental caries can be preventable and achievable. Collaboration between families, early care and health care professionals is required to promote effective oral health care. Numerous studies have found that educational programs and workshops are effective in promoting oral health and can provide children a lifelong opportunity to be free from preventable oral disease. In order to promote oral health to achieve the mission of the Department of Health in Hong Kong- at least 65% of 5 years old children are free from caries by the year 2020, an evidence-based guideline for a community-based programme in oral health education was developed in the proposed setting after a critical appraisal of the reviewed evidence. The comprehensive intervention plan, including communication plan with stakeholders, training of staffs and pilot testing will be carried out to facilitate the implementation of the innovation. The oral health programme will be evaluated for its effectiveness in achieving the patient outcomes, health providers’ outcomes and system outcomes in the proposed settings. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Systematic reviews were conducted to investigate the relationships between anthropometric assessments of nutritional status (adiposity) and caries experience among preschool and school-age (aged 6-12 years) children. Four relevant databases were searched for publications up to December 2011. Qualitative assessments were conducted and rated according to STROBE statement. Where feasible, quantitative syntheses were conducted. From a total of 2013 studies, 39 effective studies were identified for preschool children and 53 effective studies for school-age children. The mean ‘quality of reporting’ were 20.4 (SD 3.8) for the preschool studies and 21.4 (SD 3.9) for school-age studies. Qualitative syntheses were inconclusive about their relationships. Meta-analyses identified that preschoolers with high BMI had a greater dmfs/defs than those with normal BMI: pooled mean difference 0.93, 95% CI 0.65, 1.22, P < 0.05; and that children with low BMI had a lower dmft than those with normal BMI: pooled mean difference - 0.29, 95% CI -0.42, -0.15, P < 0.05. Among school-age children meta-analyses failed to identify any significant association. Among a random sample of 5-year-old children in Hong Kong, with a response rate of 83.1% (324/390), caries experience was associated with general adiposity (as assessed by W/H) and central adiposity (as assessed by WC). Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that W/H z-score was associated with having caries, OR 1.41, 95% CI1.04, 1.91, P = 0.03; and ‘very high’ caries OR 1.62, 95% CI 1.05, 2.50, P = 0.03. WC z-score was associated with ‘very high’ caries experience, OR 1.72, 95% CI 1.06, 2.81, P = 0.03. Oral hygiene status was not associated with adiposity. Among a random sample of 12-year-old children in Hong Kong, with a response rate of 76.9% (514/668), oral health status was associated with adiposity. Regression analyses (adjusted for oral health behaviours and socio-demographic factors) identified that WHR z-score was associated with caries experience: ‘high’ (OR 1.33, 95% CI 1.05, 1.70, P = 0.02), and ‘very high’ (OR 1.52, 95% CI 1.10, 2.11, P = 0.01). TRSKF z-score was associated with ‘very high’ caries experience (OR 1.47, 95% CI 1.10, 1.96, P = 0.01). WC z-score was associated with ‘unhealthy’ periodontal status (OR 1.33, 95% CI 1.01, 1.76, P = 0.04). Infant growth during the first year of life was associated with oral health at 12-year-old. Accounting for birth characteristics, socio-demographics and oral health behaviours, those with slow growth trajectories (Ⅰ- smallest birth weight and slow weight gain; and Ⅱ- smallest birth weight and average weight gain) had a greater likelihood of having a ‘high’ caries experience: OR 2.68, 95% CI 1.00, 7.16, P < 0.05 and OR 3.03, 95% CI 1.22, 7.51, P < 0.05, respectively, compared to average growth trajectory subjects. In addition, those with the fastest growth trajectory (heaviest birth weight and accelerated weight gain) had a greater likelihood of having a ‘high’ caries experience, OR 2.64, 95% CI 1.01, 6.91, P <0.05. Growth trajectories were not associated with periodontal health status at 12-year-old (P > 0.05). / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

BACKGROUND: Researchers in the fields of health, education and psychology have established a causal relationship between levels of education and both health status and its management amongst adults and children. This has resulted in largescale ‘health literacy’ intervention programmes. The relationship between oral health literacy (OHL), health status and management is less understood. Indeed, ‘OHL’ is a relatively new field with limited research to date in Asia. Measurements of OHL on the whole have focused on the match or mismatch between reading fluency, vocabulary, background knowledge, and oral and written communication demands. While it may be difficult or impractical to comprehensively capture and measure all possible dimensions of OHL, several instruments have been developed to date, albeit mostly in English dominant contexts. OBJECTIVES: The major objectives of this study were to: a) to describe the relationship between caregiver reading habits and their OHL, and their child’s oral health status; b) assess the functional OHL levels of primary caregivers in an Asian population using two new instruments; c) to describe the relationship between caregiver OHL and the oral health status of their children. METHODS: A cross-sectional study using two locally-developed and validated OHL instruments; Hong Kong Rapid Estimate of Adult Literacy in Dentistry-30 (HKREALD-30) and Hong Kong OHL Assessment Task for Paediatric Dentistry (HKOHLAT-P) was adopted. A random sample of 301 child/caregiver dyads was recruited from kindergartens in Hong Kong Island. Data included: socio-demographic information; caregivers’ self-reported reading habits and OHL levels; and child oral health status as a) dental caries experience - number of decayed, missing and filled teeth (dmft); and b) oral hygiene status - by the Visible Plaque Index (VPI). RESULTS: Caregivers’ reported reading of print Chinese was significantly associated with their OHL scores: HKREALD-30 and HKOHLAT-P (p<0.01). No associations were found between caregiver’s reading habits and their children’s oral health status (p>0.05). Both OHL assessment tasks were associated with children’s oral health status. Both HKOHLAT-P and HKREALD-30 remained associated with dmft in the adjusted negative binomial regression models (accounting for socio-demographics), but HKOHLAT-P had a stronger association (IRR 0.97, P=0.02 versus 0.96, P=0.03). HKOHLAT-P was associated with VPI in the adjusted model (IRR 0.90, P<0.05), but no significant association between HKREALD-30 and VPI was evident. CONCLUSIONS AND IMPLICATIONS: Caregivers’ habits of reading print and digital texts were significantly associated with their OHL scores. No significant associations were found between caregivers’ reading habits and their children’s oral health status, indicating that reading habits is a different attribute that may not directly affect their child’s oral health. Caregivers’ functional OHL was associated with their children’s oral health status in Hong Kong. A comprehension task tool (HKOHLAT-P) was more robust in determining such associations when compared to a simple word recognition based test (HKREALD-30). / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

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