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BACKGROUND:Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately.METHODS:From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation.RESULTS:The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains.CONCLUSIONS:This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.

BACKGROUND:Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews.METHODS:We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire.RESULTS:The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience.CONCLUSIONS:We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population.

Since 1997, curriculum implementation was introduced in South African schools. A timetable was given to all schools to implement C2005 in each grade for each year. The study had attempted to identify major factors that hindered or promoted the implementation of C2005 in two schools in Mpumalanga. A case study was conducted where one learning area, namely, natural science was investigated. Each school was visited for an entire week by the researcher. During the visit, the researcher conducted individual interviews with principal, two science teachers and two focus group interviews composed of five learners. Observations of natural science lesson were made of which two of them were recorded on video camera for further analysis. Practices, which were captured in classes, were compared to Rogan and Grayson (2001) model of curriculum implementation. In the final analysis, the study compiled a profile for each school. Both schools rated poorly (level one) in the implementation of C2005. The capacity to support innovation was poor in one school. The study also found that teachers in their attempt to implement C2005 were actually moving from 'frying pan into fire'. Lack of resources and intensive training was creating stress and making most of teachers want to leave the profession. Recommendations were also provided by the study for short and long-term considerations. / Dissertation (MA (Research Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Van der Horst, H van R. / With the introduction in 1998 of Outcomes-Based Education in South Africa, educators will no longer be passive recipients of a curriculum developed within the ivory towers of a Department of Education. Curriculum development will be the task of every educator at the site of delivery. Media articles have painted a gloomy picture of the calibre of educator expected to manage the demands of Outcomes-Based Education. The researcher is of the opinion that there are many dedicated educators willing to accept the historic nature of the journey which lies ahead of them, and who, with the adoption of an encouraging, supportive approach to professional development, will be willing to work with, adapt, modify and improve the Outcomes-Based curriculum presented to them. Educators need to assume responsibility for the professional development of Learning Programmes and the learner support materials to ensure that learners get to grips with the new curriculum. This task can be achieved through high-quality in-service education, training and re-training of educators. This study describes workshops developed by the researcher to familiarise the educators with the Specific Outcomes Framework of Curriculum 2005, and to develop an in-depth understanding of the Specific Outcomes without which, the educators would be at a loss to develop meaningful Learning Programmes. Examples of Learning Programmes developed by some of the participating educators over a period of twelve months indicate the levels of proficiency attained through close monitoring and assistance offered by the researcher. Outcomes-Based Education has been successful where all involved have taken on the challenge to do their best and as we collectively strive to improve the standard of education in South Africa, let us, in the words of Jane Hofmeyer (Article (b),Sunday Times, 25/10/98), "look forward to the day when every child as an educational birthright, can claim access to competent, caring and committed teachers and schools that are organised for success." / Curriculum and Instructional Studies / D. Ed. (Didactics)

Van der Horst, H van R. / With the introduction in 1998 of Outcomes-Based Education in South Africa, educators will no longer be passive recipients of a curriculum developed within the ivory towers of a Department of Education. Curriculum development will be the task of every educator at the site of delivery. Media articles have painted a gloomy picture of the calibre of educator expected to manage the demands of Outcomes-Based Education. The researcher is of the opinion that there are many dedicated educators willing to accept the historic nature of the journey which lies ahead of them, and who, with the adoption of an encouraging, supportive approach to professional development, will be willing to work with, adapt, modify and improve the Outcomes-Based curriculum presented to them. Educators need to assume responsibility for the professional development of Learning Programmes and the learner support materials to ensure that learners get to grips with the new curriculum. This task can be achieved through high-quality in-service education, training and re-training of educators. This study describes workshops developed by the researcher to familiarise the educators with the Specific Outcomes Framework of Curriculum 2005, and to develop an in-depth understanding of the Specific Outcomes without which, the educators would be at a loss to develop meaningful Learning Programmes. Examples of Learning Programmes developed by some of the participating educators over a period of twelve months indicate the levels of proficiency attained through close monitoring and assistance offered by the researcher. Outcomes-Based Education has been successful where all involved have taken on the challenge to do their best and as we collectively strive to improve the standard of education in South Africa, let us, in the words of Jane Hofmeyer (Article (b),Sunday Times, 25/10/98), "look forward to the day when every child as an educational birthright, can claim access to competent, caring and committed teachers and schools that are organised for success." / Curriculum and Instructional Studies / D. Ed. (Didactics)

The introduction of Outcomes-Based Curriculum 2005, has meant that the learning area of Life Orientation has undergone significant changes. These changes encompass both the scope of the learning area of Life Orientation, and the implementation of Life Orientation. The aim of this investigation has been to examine the implications of Outcomes-Based Curriculum 2005, for Life Orientation as well as to propose a method of assisting this implementation. The training of facilitators has met with mixed results and there is still confusion surrounding Curriculum 2005, and the learning area of Life Orientation. The development of an implementation model was therefore proposed and developed to assist Life Orientation facilitators to make the transition from a theoretical understanding to the practical implementation. The results of the study determined that the facilitators were overwhelmingly in support of the implementation model. They found it provided a logical and comprehensive framework, which would be helpful in assisting them with planning their learning programmes. In order to understand more fully the effectiveness of the implementation model in the classroom reality, it will however be necessary to undertake a study over a longer term with participating facilitators. A number of other issues also were investigated as part of this study. From this it was determined that facilitators feel they require more training to implement an Outcomes-Based appro'ach particularly with regard to assessment. Facilitators have also not yet fully understood what constitutes the learning area of Life Orientation, nor their tasks as a facilitator. / Psychology of Education / D. Ed. (Psychology of Education)

Summaries in English and Afrikaans / Life skills are coping skills taught to learners, with the purpose of developing self-reliant and confident people with skills, to cope with important life's challenges in times of change. Where life skill education initiatives are being set up, much time and resources are channelled into training teachers, promoting, disseminating and implementing life skill education. For life skill education to be effective and continue to be relevant, research needs to be undertaken as an integral part of the whole process. This study focuses on the 'Life Skills Train the Trainer Programme'. The aim being to evaluate the success of this programme in empowering teachers to teach life skills. It was found that although life skill education has been found to be an important area in every learner's life, there are obstacles that may affect an effective implementation of life skill education in schools. These obstacles need to be attended to. / ewensvaardighede word aan leerlinge onderrig met die doe! om selfstandigheid en selfversekerdheid te ontwikkel, sodat hulle in staat is om lewenseise te midde van veranderende tye te kan hanteer Wanneer lewensvaardighede-onderrig gelnisieer word, word baie tyd en hulpbronne gekanaliseer in die opleiding van onderwysers, asook in die promovering, verspreiding en implementering van sodanige onderwys. Vir lewensvaardighede-onderrig om effektief te wees en relevant te bly, moet navorsing 'n integrale dee! van die hele prose vorm. Hierdie studie is gerig op die "Life Skills Train the Trainer Programme". Die doe! was om vas te stel tot watter mate hierdie program bydra tot die bemagtiging van onderwysers in die onderrig van lewensvaardighede. Die bevinding was dat alhoewel erkenning gegee word aan die belangrikheid van lewensvaardighede-onderrig, daar tog struikelblokke is wat effektiewe implementering in skole kan belemmer Hierdie struikelblokke moet aangespreek word. / Educational Studies / M.Ed.

The introduction of Outcomes-Based Curriculum 2005, has meant that the learning area of Life Orientation has undergone significant changes. These changes encompass both the scope of the learning area of Life Orientation, and the implementation of Life Orientation. The aim of this investigation has been to examine the implications of Outcomes-Based Curriculum 2005, for Life Orientation as well as to propose a method of assisting this implementation. The training of facilitators has met with mixed results and there is still confusion surrounding Curriculum 2005, and the learning area of Life Orientation. The development of an implementation model was therefore proposed and developed to assist Life Orientation facilitators to make the transition from a theoretical understanding to the practical implementation. The results of the study determined that the facilitators were overwhelmingly in support of the implementation model. They found it provided a logical and comprehensive framework, which would be helpful in assisting them with planning their learning programmes. In order to understand more fully the effectiveness of the implementation model in the classroom reality, it will however be necessary to undertake a study over a longer term with participating facilitators. A number of other issues also were investigated as part of this study. From this it was determined that facilitators feel they require more training to implement an Outcomes-Based appro'ach particularly with regard to assessment. Facilitators have also not yet fully understood what constitutes the learning area of Life Orientation, nor their tasks as a facilitator. / Psychology of Education / D. Ed. (Psychology of Education)

Summaries in English and Afrikaans / Life skills are coping skills taught to learners, with the purpose of developing self-reliant and confident people with skills, to cope with important life's challenges in times of change. Where life skill education initiatives are being set up, much time and resources are channelled into training teachers, promoting, disseminating and implementing life skill education. For life skill education to be effective and continue to be relevant, research needs to be undertaken as an integral part of the whole process. This study focuses on the 'Life Skills Train the Trainer Programme'. The aim being to evaluate the success of this programme in empowering teachers to teach life skills. It was found that although life skill education has been found to be an important area in every learner's life, there are obstacles that may affect an effective implementation of life skill education in schools. These obstacles need to be attended to. / ewensvaardighede word aan leerlinge onderrig met die doe! om selfstandigheid en selfversekerdheid te ontwikkel, sodat hulle in staat is om lewenseise te midde van veranderende tye te kan hanteer Wanneer lewensvaardighede-onderrig gelnisieer word, word baie tyd en hulpbronne gekanaliseer in die opleiding van onderwysers, asook in die promovering, verspreiding en implementering van sodanige onderwys. Vir lewensvaardighede-onderrig om effektief te wees en relevant te bly, moet navorsing 'n integrale dee! van die hele prose vorm. Hierdie studie is gerig op die "Life Skills Train the Trainer Programme". Die doe! was om vas te stel tot watter mate hierdie program bydra tot die bemagtiging van onderwysers in die onderrig van lewensvaardighede. Die bevinding was dat alhoewel erkenning gegee word aan die belangrikheid van lewensvaardighede-onderrig, daar tog struikelblokke is wat effektiewe implementering in skole kan belemmer Hierdie struikelblokke moet aangespreek word. / Educational Studies / M.Ed.