An urgent need exists for balance between students learning the theory of clinical practice and becoming an expert. While theory is taught in the didactic setting, it is the experiential setting where the mastery of the clinical teacher is demonstrated. What does the master clinical teacher do that makes the student's learning experience so significant? One must recognize the moment, capture the learning opportunity, and draw the student in so that learning can occur. Effective clinical teaching is paramount in creating empowered students and practitioners. This qualitative case study of a doctoral pharmacy program identified two master clinical preceptors and shadowed one in a hospital and the other in a retail pharmacy. Interactions between clinical preceptors and students were captured through direct observation, audio-tape, and complemented with in-depth interviews. Content analysis identified emerging themes yielding an emerging model of master clinical teaching, illuminating teachable moments between student and clinical preceptor, and the manner in which they interacted with each other and the clinical environment. The model highlights an approach for making the critical time on clinical rotations as effective as possible and offers a practical means to study interactions between students and preceptors, discerning those that lead to teachable moments. Features of the teachable moments are identified. Although expertise cannot be taught, current and future clinical teachers can use this study to improve their teaching and effectiveness in clinical teaching practice. The methodology of this study can be applied to future studies in the same discipline, other rotations, or other disciplines. This study augmented the literature in qualitative research in pharmacy education for clinical practice by 1) utilizing a methodology that could be used in future studies 2) identifying features of teachable moments in the interactions of clinical preceptors and students 3) exploring how the clinical preceptors dealt with the changing environment of their clinical teaching 4) offering an emerging model to guide clinical preceptors for making the critical clinical teaching time as effective as possible. Future studies could utilize this emerging model to gain further insight on clinical teaching practices thus increasing the expertise of clinical teaching. / Ph. D.

Background: There are naturally occurring health events, such as illness diagnosis, that motivate people to spontaneously adopt healthy behaviours. Such events are often re-ferred to as teachable moments. They have the potential to increase the effectiveness of behaviour change interventions, when people are already motivated to change behaviour. However, it is unclear what makes illness diagnosis a teachable moment for some people but not for others. This project aims to identify the factors determining whether and for whom diagnosis of type 2 diabetes is a teachable moment, and to explore the components of a potential intervention to reduce the risk of type 2 diabetes among high-risk groups. Method: A mixed-methods design, divided into two studies, was employed. The first study was a qualitative study and used semi-structured interviews (n=10 patients and n=13 relatives). It explored the changes occurring in people after diagnosis of type 2 diabetes in oneself or a family member in an effort to identify what factors make diagnosis a teachable moment. The study also explored people's suggestions for a potential diabetes prevention intervention. The second study was a quantitative study and used postal questionnaires (n=85 patients and n=55 relatives). It investigated the relationship between potential teachable moment factors and primary outcomes (physical activity, diet, interest in diabe-tes-related information and education course). Results: This mixed-methods study suggests that the factors that may make diagnosis of type 2 diabetes a teachable moment for patients are outcome expectancy, perceived con-trol, severity, self-concept or social role, gender and time since diagnosis; and for relatives: perceived risk, severity, self-concept or social role, and gender. Although there was lack of complete alignment in factors identified through different methods, this study advances understanding of when interventions may be more (or less) successful. The study makes recommendations for potential interventions to capitalise on the teachable moment crite-ria. Conclusion: The current project highlights the complexity of teachable moment criteria and their relationship with behaviour change. Future research is required to further uncov-er these criteria and their utility for health promotion.

In medical settings, a teachable moment (TM) has been described as an event which may lead to psychological changes prompting individuals to engage in health promoting behaviors. A cancer screening (CS) has been suggested as a potential TM because several types of positive health behavior change (HBC), ranging from dietary changes to smoking cessation, have been linked to CS. However, most research has examined the TM in CS settings using cross-sectional and prospective methodologies and has lacked a theory-driven model. Moreover, few intervention studies have attempted to capitalize on the potential TM in CS settings. In light of this, the primary purpose of this study was to examine the potential for routine ovarian CS to serve as a TM to enhance the potential for HBC using a theory-driven conceptual model of a TM. A prospective, longitudinal design was used to track changes in positive affect, self-efficacy (SE), HBC intentions and HBC following participation in routine ovarian CS. The impact of a brief, written intervention intended to enhance SE to engage in HBC was also examined. There were three total study assessments: the baseline (T1), 24-hour follow-up (T2), and one month follow-up (T3) assessment. Results indicated positive affect and positive consequences of screening increased over time (p’s<.01) and increases in positive affect were positively associated with greater healthy diet HBC. Additionally, greater positive consequences of screening at T2 predicted greater exercise HBC. No significant changes were observed in exercise or healthy diet intentions over time; there were no differential effects based upon the intervention for positive affect, SE, HBC, or HBC intentions (p’s>.05). Healthy diet SE and exercise SE remained stable (p>.05) but were found to be a robust predictor for both exercise and healthy diet HBC intentions. While several of our hypotheses were supported, the brief health information intervention did not appear to impact SE, HBC intentions, or actual HBC. To better equip health providers in CS settings, studies should continue examining both the potential for CS settings to serve as a TM to enhance HBC and how receipt of a normal test result impacts this potential.

The term "teachable moment" (TM) has been used to describe a life transition or event which motivates an individual to change a behavior or presents an opportunity to intervene to prompt behavior change. We examined whether receipt of a false positive ovarian cancer (OC) screening result may represent a TM. 403 women participating in an OC screening program completed questionnaires assessing demographic, clinical, behavioral, and psychosocial information. The TM was operationalized as expressed interest in receiving health-related information. We hypothesized that among women receiving a false positive screening test result, those women who had experienced greater personal perceived risk for OC as well as distress would be more interested in receiving health-related information than women receiving a normal result. Analyses revealed that women receiving a false positive screening result were less interested in receiving health-related information than women receiving a normal screening result. For women receiving a false positive result, expressed interest in receipt of health-related information was only modestly related to distress and related even less to perceptions of OC risk. Our data do not support viewing a false positive OC screening result as a TM. Potential explanations for the current findings as well as recommendations for future research investigating the TM are discussed.

Motorised countries have more fatal road crashes in rural areas than in urban areas. In Australia, over two thirds of the population live in urban areas, yet approximately 55 percent of the road fatalities occur in rural areas (ABS, 2006; Tziotis, Mabbot, Edmonston, Sheehan & Dwyer, 2005). Road and environmental factors increase the challenges of rural driving, but do not fully account for the disparity. Rural drivers are less compliant with recommendations regarding the “fatal four” behaviours of speeding, drink driving, seatbelt non-use and fatigue, and the reasons for their lower apparent receptivity for road safety messages are not well understood. Countermeasures targeting driver behaviour that have been effective in reducing road crashes in urban areas have been less successful in rural areas (FORS, 1995). However, potential barriers to receptivity for road safety information among rural road users have not been systematically investigated. This thesis aims to develop a road safety countermeasure that addresses three areas that potentially affect receptivity to rural road safety information. The first is psychological barriers of road users’ attitudes, including risk evaluation, optimism bias, locus of control and readiness to change. A second area is the timing and method of intervention delivery, which includes the production of a brief intervention and the feasibility of delivering it at a “teachable moment”. The third area under investigation is the content of the brief intervention. This study describes the process of developing an intervention that includes content to address road safety attitudes and improve safety behaviours of rural road users regarding the “fatal four”. The research commences with a review of the literature on rural road crashes, brief interventions, intervention design and implementation, and potential psychological barriers to receptivity. This literature provides a rationale for the development of a brief intervention for rural road safety with a focus on driver attitudes and behaviour. The research is then divided into four studies. The primary aim of Study One and Study Two is to investigate the receptivity of rural drivers to road safety interventions, with a view to identifying barriers to the efficacy of these strategies.