There is no abstract available for this dissertation. / Department of Educational Leadership

This thesis describes research carried out to explore the needs, expectations and experiences of the increasing number of women with a family history of breast cancer who present to primary care. This work was intended to inform clinical practice and policy, and to directly address women's needs where possible. Although a great deal of research has looked at the experiences of women with a family history of breast cancer in a specialist setting, when this work began, no research had yet been published on women's needs in primary care. This is particularly important, as general practitioners (GPs) are the first port of call, and often the main source of information, advice and support. A qualitative interview study was used for the preliminary work exploring women's subjective experiences of consulting primary care about a family history of breast cancer and understanding their primary care consultation needs (Chapter 2). This work was further elaborated upon using a prospective descriptive study to quantify the extent to which women shared the same views or experiences, and therefore, would benefit from certain changes in health care provision (Chapter 3). The qualitative and quantitative research showed that women's main primary care consultation needs were to discuss their risks of breast cancer with their GP and to receive verbal as well as take-home information. When this work was being carried out, no patient information was available suitable for a general population of women with breast cancer in the family who present to primary care. For this reason, a leaflet was developed based on women's information needs and the best available evidence (Chapter 4). The leaflet entitled Breast and/or Ovarian Cancer in the Family: Learning More about Your Risks and Options was evaluated with almost 200 women to ensure that it met their needs (Chapter 5). Over 90% of women were glad to have received the leaflet and felt that it provided the information they wanted to know. The implications of the work described in this thesis are that GPs could greatly assist their patients by acknowledging family history concerns as a legitimate reason for presenting to primary care, by providing verbal and take-home information and by inviting patients to return for future discussions if needed. Nationally accepted management guidelines for breast cancer family history and accompanying educational materials for use in primary care will also be instrumental in meeting patient needs and promoting informed choice in this new and difficult area of medicine.

Doctor-patient partnership has been advocated for achieving effective diabetes management. Such a partnership requires empowering patients with proper knowledge and skills so they are capable of participating in decision-making, effective communication with health professionals and successful diabetes self-management. Although it is well known that patient education should be tailored and prioritised, little research on Computer-based Patient Education Systems (CPESs) has aimed at customising information that is flexible enough to adapt to firstly, the dynamic nature of patients' ongoing information needs and secondly, changes in their personal health and social circumstances. Moreover, except for indirect support for doctor-patient communication through tailored information, current CPESs do not aid patients in formulating their questions. / This thesis targets limitations of current CPESs and explores approaches for using information technology (IT) to support the doctor-patient partnership. Two approaches used to achieve the research goal are 1) providing essential information to individual patients - information that is not only relevant, but also prioritised; and 2) providing direct support for patients to generate personalised agendas prior to scheduled health visits. The innovative technologies that have been developed for implementing these two approaches include a comprehensive Diabetes Information Profile (DIP) for each patient, information tailoring and prioritisation algorithms (information algorithms), quiz tailoring and prioritisation algorithms (quiz algorithms), and agenda personalisation algorithms (which serve to populate an agenda question pool). The DIP includes data elements on a patient's lifestyle, diet profile, psychosocial profile, risk factors of diabetic complications, behaviour change profile, self-management profile, and clinical status. The information algorithms take into account these DIP elements, as well as patients' diabetes knowledge level (based on educational exposure) and individual information preferences. Collectively, the implementation of these approaches, using an extensible architecture based on Extensible Mark-up Language (XML) and Java technologies, is called “Violet Technology” (VT). A VT-based web portal has been developed and evaluated. / A two-phase evaluation was conducted through the Diabetes Centre of a metropolitan hospital. The first study evaluates the validity of the information algorithms through patient and healthcare provider assessment of prioritised information topics. The participants of the first study include 11 patients with diabetes, one General Practician (GP), one endocrinologist, two diabetes nurse educators and one dietician. The second trial evaluates the VT-based portal overall - including information, quiz and agenda personalisation algorithms - through a field trial of the portal with random selection of patients to treatment and control groups. In total, 27 patients, one GP, one endocrinologist, two nurse educators, and one dietician were involved in the second trial. The evaluations provide qualitative support for the relevance of information prioritisation by VT, and show acceptable consumer usability, as well as healthcare provider support, for the portal. The evaluations also revealed further incremental refinements to the information algorithms. / This thesis contributes a specific framework for the use of IT to support the doctor-patient partnership through prioritised information and integrated agenda formulation services. While a larger scale of evaluation is needed to establish patient health benefits, the results of the two initial studies are encouraging. This framework could be adapted for other chronic diseases, such as depression or asthma. It could also be used for other purposes, such as an intelligent information searching facility. A future VT framework should provide more explicit representation of patients' emotional supports and have further mechanisms for promoting patient behaviour changes. / Thesis (PhDInformationTechnology)--University of South Australia, 2005.

Thesis (Ed. D.)--Georgia Southern University, 2007. / "A dissertation submitted to the Graduate Faculty of Georgia Southern University in partial fulfillment of the requirements for the degree Doctor of Education." Under the direction of Rosemari Stallworth-Clark. ETD. Electronic version approved: May 2007. Includes bibliographical references (p. 110-125).

Diss. Linköping : Univ.

Thesis (Ph. D.)--University of Missouri--Columbia, 1996. / "December 1996." Typescript. Vita. Includes bibliographical references (leaves 107-109). Also available on the Internet.

Thesis (Ed.D.)--Teachers College, Columbia University, 1992. / Includes tables. Typescript; issued also on microfilm. Sponsor: Victoria J. Marsick. Dissertation Committee: Jack Mezirow. Includes bibliographical references (leaves 199-209).

Thesis (Ph. D.)--University of Missouri-Columbia, 2004. / Typescript. Vita. Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2004. / Typescript. Vita. Includes bibliographical references. Also available on the Internet.

Thesis (M.S.)--Ohio University, November, 2003. / Includes bibliographical references (p. 87-93).