Peer Education and Peer Counselling for Health and Well-Being: A Review of Reviews.

Peer education and peer counselling for health and wellbeing have been recognized as complementary approaches to professional intervention for over 50 years, but it is relatively recently that research into effects has become adequate. Potentially, they have advantages in reaching where professionals cannot, but it has not been clear if that potential is fulfilled, although the measurement of effects is difficult. The present paper examines 58 narrative and systematic reviews and meta-analyses on the topic. In peer education, there were many reviews of sexual health and of HIV/AIDS interventions, followed by reviews of various medical conditions and in the context of prisons. More general reviews covered a wider field. In peer counselling, there were several reviews of breast-feeding and mental health. Many early reviews complained of the lack of evaluation; then, later reviews found knowledge gains but not behavior gains; then, still later reviews found both knowledge and behavior gains. Thus, peer education and counselling appear effective but only if organizational factors are well managed and the cultural context of the country respected. The implications for future practice, policy and research were outlined.

Evaluating language environment analysis system performance for Chinese: a pilot study in Shanghai.

PURPOSE: The purpose of this study was to evaluate performance of the Language Environment Analysis (LENA) automated language-analysis system for the Chinese Shanghai dialect and Mandarin (SDM) languages. METHOD: Volunteer parents of 22 children aged 3-23 months were recruited in Shanghai. Families provided daylong in-home audio recordings using LENA. A native speaker listened to 15 min of randomly selected audio samples per family to label speaker regions and provide Chinese character and SDM word counts for adult speakers. LENA segment labeling and counts were compared with rater-based values. RESULTS: LENA demonstrated good sensitivity in identifying adult and child; this sensitivity was comparable to that of American English validation samples. Precision was strong for adults but less so for children. LENA adult word count correlated strongly with both Chinese characters and SDM word counts. LENA conversational turn counts correlated similarly with rater-based counts after the exclusion of three unusual samples. Performance related to some degree to child age. CONCLUSIONS: LENA adult word count and conversational turn provided reasonably accurate estimates for SDM over the age range tested. Theoretical and practical considerations regarding LENA performance in non-English languages are discussed. Despite the pilot nature and other limitations of the study, results are promising for broader cross-linguistic applications.

Exploratory evaluation of a school-based child sexual abuse prevention program.

Internationally, efficacy studies of school-based child sexual abuse prevention programs display a series of methodological shortcomings. Few studies include adolescent participants, recording of disclosures has been inconsistent, and no studies to date have assessed presenter adherence to program protocols or summated the costs of program implementation. A pretest-posttest waitlist control design was used to evaluate the Tweenees program delivered to grade 6 (n = 88) and grade 7/8 students (n = 117) compared to a control (n = 185). Outcome measures included a knowledge/skills questionnaire, systematic coding of disclosures, and video interaction analysis of lessons. Costs were calculated per student, class, and school. Adolescents made small knowledge and skills gains indicating a program ceiling effect. Implementation analysis suggests low levels of adult control facilitated disclosures. Program costs were relatively inexpensive. Recommendations are made for future research.

Survivor experience of a child sexual abuse prevention program: a pilot study.

Addressing gaps in the research, the current study assesses the impact of a community-based child sexual abuse prevention program on known survivor knowledge/skills, disclosures, and subjective experience. Methodologically, novel measures of program fidelity and implementation cost are applied. A pre- posttest wait-list control design was utilized with intervention (n = 10) and comparison groups (n = 10). Measures included a standardized knowledge/skill questionnaire, coding of disclosures, subjective experience questionnaires, in-depth interviews, video analysis of program adherence, and a measure of cost. Analysis involved nonparametric tests and thematic analysis of interview and video data. Cost was calculated for the group and per survivor. Survivors achieved significant gains in knowledge/skills, made further disclosures, and were positive about their program experience. No gains were identified in the control group. Costs were small. Future studies need to explore survivor experience of programs delivered in classrooms.

Fitness for practice in nursing and midwifery education in Scotland, United Kingdom.

AIM: The aim of this paper is to report findings from a major study that evaluated the Fitness for Practice nursing and midwifery curriculum in Scotland, UK. BACKGROUND: The competence of student nurses and midwives at the point of registration has been the focus of debate and research. However, no major study, on such a large scale, had specifically evaluated pre-registration programmes to determine whether they enabled students to achieve 'fitness to practice'. DESIGN: The study had a broad evaluation design conducted in three phases using a mixed methodology. METHOD: Phase 1 involved questionnaires, Objective Structured Clinical Examination's (OSCE) and curriculum evaluation. Phase 2 involved semi-structured interviews (some telephone) and focus groups across main stakeholders: students (n = 78), mentors (n = 78), practice-education facilitators (n = 24), academics (n = 59), senior clinical (n = 46) and education managers (n = 16), service users and carers (n = 10). RESULTS: The findings suggest that the Fitness for Practice curriculum model in Scotland has on the whole been successful. The key finding is the predominant opinion of stakeholders that newly qualified nurses and midwives are perceived as being fit for practice at the point of registration. A perceived lack of confidence is, as with all transitions to new roles, an understandable outcome. CONCLUSIONS: Previous concern that student nurses and midwives are not 'fit for practice' has focused on the perceived lack of clinical skills at the point of registration, not on competence to practice in general. This study demonstrates that this is an important distinction and recognises that registration is only the beginning of a life long learning experience. RELEVANCE TO CLINICAL PRACTICE: Students need to be supported to develop their confidence following registration as well as additional skills in their chosen field of practice. Appropriate mentorship and a period of preceptorship should be in place to accommodate this.

Peer tutoring in reading: the effects of role and organization on two dimensions of self-esteem.

BACKGROUND: Paired reading (PR) is an application of peer tutoring. It has been extensively researched, and its efficacy across a range of outcomes has been established. Benefits include improvements in key reading skills, and also in affective aspects of learning. Several studies have shown gains in self-esteem, although measurement methods have varied, and the model of self-esteem has rarely been clearly articulated. AIMS: To investigate the changes in self-esteem of children participating in a randomized trial of PR over a 15-week treatment period. To investigate the relative contribution of self-worth and self-competence to any gains in self-esteem. To investigate whether the pattern of change differs in children who take on different roles in the PR process. PARTICIPANTS: The participants comprised a subset of a large-scale randomized trial of peer learning (The Fife Peer Learning Project). Four schools were randomly selected from schools allocated to the same-age PR condition, and four schools from those allocated to the cross-age PR condition. The same-age group consisted of 87 primary 6 children (10-11 years old). The cross-age group consisted of 81 primary 6 children. The controls, from schools randomly selected from a neighbouring authority, consisted of 92 primary 6 children. METHOD: A pre-post design employing self-report measures of self-esteem. Rosenberg's Self-Esteem Scale was used, with scores analysed for worth and competence. The treatment period was 15 weeks, with the participants following a prescribed PR process. RESULTS: Significant pre-post gains were noted in self-esteem, driven predominantly by improved beliefs about competence, in both same-age and cross-age conditions, but not for controls. Gains were also seen in self-worth in the cross-age condition. Further analyses of the influence of organizational condition (same-age or cross-age) and role played (tutor vs. tutee) showed significant differences between same-age tutors and cross-age tutors in relation to self-worth. Effect sizes were generally small or moderate. CONCLUSIONS: The findings provide further support for the belief that PR can enhance self-esteem. Importantly, the use of a two-dimensional model provides extra information about self-perceptions in PR contexts: first, the central role of self-competence; and second, the gains in self-worth which are associated with tutoring younger children (but not same-age peers). This new information has educational significance for schools considering the potential of peer tutoring and the benefits of different organizational conditions.

School-based Abuse Prevention: Effect on Disclosures.

This paper focuses specifically on the analysis of disclosures and forms part of a wider study which evaluated the effectiveness of the Violence is Preventable program. Participants included a survivor group, grade 6 group, and a grade 7/8 group with equivalent waiting-list comparison groups. Lessons were delivered either by voluntary organization workers or class teachers. Disclosures were systematically recorded by presenters. Video was used to analyze interactions around disclosures. Substantial numbers of disclosures occurred when lessons were delivered by survivor organisation presenters. Video analysis suggested this was partly due to adult-student interactions characterized by low levels of adult control. Studies on a larger scale are needed particularly comparing outcomes from different presenters with an analysis of what leads to disclosure in and beyond the classroom.

Early findings from an evaluation of a post-registration staff development programme: The Flying Start NHS initiative in Scotland, UK.

The first year post-qualifying as a nurse or midwife is often seen as a key transitional period. Flying Start NHS is the national development programme for all newly qualified nurses, midwives and allied health professionals in NHS Scotland. It is designed to support the transition from student to newly qualified health professional through supporting learning in everyday practice. It is a web-based or CD-ROM programme which seeks to increase the confidence and competence of newly qualified nurses and midwives during their first year of employment following registration. The aims of this study were to establish levels of self-report competency, self-efficacy, job demands and career intentions in newly qualified nurses undertaking Flying Start NHS programme in Scotland. The aims were met by conducting a cross-sectional survey of Flying Start NHS students. Newly qualified nurse participants (n=97) comprised a convenience sample of newly qualified nurses who were registered as undertaking the Flying Start NHS on-line programme during Autumn-Winter 2007. Most newly qualified nurses intend to remain in the NHS although a small but important number may leave.

An evaluation of fitness for practice curricula: self-efficacy, support and self-reported competence in preregistration student nurses and midwives.

AIMS AND OBJECTIVES: This element of the larger Scottish evaluation aimed to explore differences between access routes, cohorts and higher education institutes (HEI) (universities and colleges) in levels of self-efficacy, student support and self-reported competence in a nationally representative sample of student nurses and midwives. BACKGROUND: This paper reports findings from the National Review of Pre-Registration Nursing and Midwifery Programmes in Scotland. Fitness for practice curricula have been the heart of many recent developments in nurse and midwifery education. Fitness for practice set out to map out the future direction of preregistration nursing and midwifery education with the aim of ensuring fitness for practice based on healthcare need. There have been no national evaluations of the effectiveness of this strategic objective. Previous major evaluations in the 1990s suggested that students may not have had the skills needed to be fit for practice. DESIGN: The study design was a cross-sectional survey of a stratified random sample of student nurses and midwives (n = 777). Data collected included demographic information, generalised perceived self-efficacy, student support and self-reported competency. RESULTS: Students reported high levels of self-reported competency. There were no significant differences between two cohorts or between students with different access routes. Students rated support from family and friends highest and support from HEI lowest. There was a significant difference in support levels between HEI. Self-efficacy scores were similar to other population means and showed small-moderate correlations with self-report competence. Similarly, self-reported competency appears to be at the higher end of the spectrum, although older students may have a more realistic perception of their competence. However, support from HEI was seen as less satisfactory and varied from one institution to another. CONCLUSIONS: This study portrays a relatively positive picture of preregistration fitness for practice curricula. Questions are raised about the relative value students place on support from educationalists and mentors and whether support from family and friends and from peers needs to feature more prominently in curricula. The study provides modest support for social cognitive theory. RELEVANCE TO CLINICAL PRACTICE: The major drivers for changes in preregistration curricula stemmed from fears about the competence of students. This study did not provide support for this viewpoint, and students' self-reports suggest that curricula are, in this respect, meeting their objectives. Nevertheless support from mentors and from educational institutes may need to be improved.

A review of curriculum evaluation in United Kingdom nursing education.

Recently we have witnessed several significant changes to the nursing curriculum in the United Kingdom (UK). This review forms part of a larger study evaluating the 'fitness for practice' elements of the nursing curriculum in Scotland. Systematic review methods were used including the following databases: CINAHL and BNI. Twenty six papers were retrieved and 14 remained after applying the review criteria, the main rationale being the empirical focus. It appears that there is a paucity of research in this area in the UK and papers dealt exclusively with either content, process or outcome evaluation of the nursing curriculum. National, well funded, multi-centre studies tended to be more rigorous. Results, where they were positive about curricular changes, tended to be limited. There is clearly a need for rigorous research into curriculum evaluation, both at the micro and macro level, which investigates content, process and outcome. Without such research, curriculum change will be uninformed.

Measuring competence, self-reported competence and self-efficacy in pre-registration students.

AIM: To measure competence, self-reported competence and self-efficacy; explore any differences between cohorts and student entry criteria; and explore the relationship between competence, self-reported competence, support and self-efficacy. METHOD: All students undertook a three-station objective structured clinical examination (OSCE) and had previously completed a questionnaire, which included measures of self-reported competence, support and self-efficacy. The performance of two single year cohorts enabled measurement of competence development and progression. RESULTS: Students were competent in the core generalist skills of communication and hand decontamination but demonstrated low levels of numeracy. CONCLUSION: Doubts are raised about the explanatory value or practical use of social cognitive theory in pre-registration curricula and questions are raised about the value of self-reported competence. This has implications for nursing and midwifery curricula, which emphasise the importance of self-assessment.