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The marked increase in transnational higher education third party arrangements in recent years represents globalizing forms of education. Third party arrangements involve a partner institution being approved to deliver the primary institution's government-accredited courses. The primary institute is accountable for monitoring and documenting quality assurance and the third party is responsible to the primary institute for meeting the required higher education standards. This arrangement is particularly attractive for students who want to undertake an accredited degree from overseas, while retaining close relational, industry and cultural links in the home country. There has been some recent examination of higher education third parties focused on equity, transcultural pedagogy, and quality assurance. However, little research has been done regarding the Australian context. Alphacrucis College is one of the largest non-university, faith-based independent higher education institutes in Australia with three onshore third party arrangements in Sydney and Melbourne, as well as two offshore in Finland and the Philippines. Based on a case study including participant observation and a staff survey, this research argues that the success of faith-based third parties is largely a result of shared values and collaborative relationships. These are outworked in professional development and mentoring in learning and teaching, joint research and scholarship projects, equity of student experience through resourcing, and effective governance and quality assurance built on trust. While other higher education institutes may not have faith-based approaches, these findings can serve to produce successful onshore and offshore third parties in a broad range of contexts.

Optimal use of goal-setting strategies in self-management efforts with high-risk individuals with asthma is not well understood. This study aimed to describe factors associated with goal attainment in an asthma self-management intervention for African American women with asthma and determine whether goal attainment methods proved beneficial to goal achievement and improved asthma outcomes. Data came from 212 African American women in the intervention arm of a randomized clinical trial evaluating a telephone-based asthma self-management program. Telephone interview data were collected to assess goals and goal attainment methods identified, asthma symptoms, asthma control, and asthma-related quality of life at baseline and 2-year follow-up. Generalized estimating equations were used to assess the long-term impact of goal setting and goal attainment methods on outcomes. The average age of the sample was 42.1 years (SD = 14.8). Factors associated with goal attainment included higher education (p < 0.01) and fewer depressive symptoms (p < 0.01). Using a goal attainment method also resulted in more goals being achieved over the course of the intervention (Estimate [SE] = 1.25 [0.18]; p < 0.001) when adjusted for clinical and demographic factors. Use of and types of goal attainment methods and goals were not found to significantly affect asthma control, quality of life, or frequency of nighttime asthma symptoms at follow-up. Using a method to achieve goals led to greater goal attainment. Goal attainment alone did not translate into improved asthma outcomes in our study sample. Further studies are warranted to assess the challenges of self-management in chronic disease patients with complex health needs and how goal setting and goal attainment methods can be strategically integrated into self-management efforts to improve health endpoints.

Background: Asthma is a chronic health condition that has a disproportionate effect on low-income minority children who reside in large urban areas. African American children report significantly higher rates than the general population of children and have more-severe asthma and poorer outcomes. This article describes the prevalence of asthma in a particularly vulnerable group: children aged 2-5 participating in Detroit Head Start programs. Methods: Health screens were distributed to caretakers of all children attending 6 Head Start agencies. Caretakers of children identified with active asthma symptoms were asked to complete an in-depth phone interview regarding their child's asthma. Results: Data collected from 3,254 children (78% African American) revealed that 27% met criteria for probable asthma. Of those with persistent symptoms, 26% were undiagnosed, and 21% were untreated. Baseline data (n = 675) showed that 95% had a regular doctor, but 36% had had no health care visit for asthma in the previous year. Of children with a history of asthma episodes, more than half reported 3 or more episodes in the preceding year. Forty-three percent of caretakers had discussed their child's asthma with Head Start, and 31% had an asthma action plan on file with Head Start. Conclusions: Asthma remains a significant problem in this population, especially for African Americans, as evidenced by high levels of undiagnosed children with persistent symptoms and questions regarding the care they receive. Head Start is a way to reach young children with asthma, but may need help to develop the capacity to assist families. (Contains 5 tables.)

The Early Childhood Asthma Project involved asthma case identification in 35 Head Start centers in Detroit, MI, and attempted implementation of an intervention designed to help families manage a child's asthma more effectively. Surveys were distributed to the parents of all Head Start children (3408), and 2198 complete surveys were returned. Case detection found probable asthma in 30% of the children whose parent returned a sufficiently complete survey. Implementation of the intervention was unsuccessful in this setting. Obstacles to effective implementation included the sample's low participation and high attrition, limited involvement of Head Start personnel, factors related to the program approach, and the target population's beliefs about asthma.

Abstract Background Among adults in the United States, asthma prevalence is disproportionately high among African American women; this group also experiences the highest levels of asthma-linked mortality and asthma-related health care utilization. Factors linked to biological sex (e.g., hormonal fluctuations), gender roles (e.g., exposure to certain triggers) and race (e.g., inadequate access to care) all contribute to the excess asthma burden in this group, and also shape the context within which African American women manage their condition. No prior interventions for improving asthma self-management have specifically targeted this vulnerable group of asthma patients. The current study aims to evaluate the efficacy of a culturally- and gender-relevant asthma-management intervention among African American women. Methods/Design A randomized controlled trial will be used to compare a five-session asthma-management intervention with usual care. This intervention is delivered over the telephone by a trained health educator. Intervention content is informed by the principles of self-regulation for disease management, and all program activities and materials are designed to be responsive to the specific needs of African American women. We will recruit 420 female participants who self-identify as African American, and who have seen a clinician for persistent asthma in the last year. Half of these will receive the intervention. The primary outcomes, upon which the target sample size is based, are number of asthma-related emergency department visits and overnight hospitalizations in the last 12 months. We will also assess the effect of the intervention on asthma symptoms and asthma-related quality of life. Data will be collected via telephone survey and medical record review at baseline, and 12 and 24 months from baseline. Discussion We seek to decrease asthma-related health care utilization and improve asthma-related quality of life in African American women with asthma, by offering them a culturally- and gender-relevant program to enhance asthma management. The results of this study will provide important information about the feasibility and value of this program in helping to address persistent racial and gender disparities in asthma outcomes. Trial Registration ClinicalTrials.gov: NCT01117805

Objective: African American women are disproportionately burdened by asthma morbidity and mortality and may be more likely than asthma patients in general to have comorbid health conditions. This study sought to identify the self-management challenges faced by African American women with asthma and comorbidities, how they prioritize their conditions and behaviors perceived as beneficial across conditions. Methods: In-depth interviews were conducted with 25 African-American women (mean age 52 years) with persistent asthma and at least one of the following: diabetes, heart disease or arthritis. Information was elicited on women's experiences managing asthma and concurrent health conditions. The constant-comparison analytic method was used to develop and apply a coding scheme to interview transcripts. Key themes and subthemes were identified. Results: Participants reported an average of 5.7 comorbidities. Fewer than half of the sample considered asthma their main health problem; these perceptions were influenced by beliefs about the relative controllability, predictability and severity of their health conditions. Participants reported ways in which comorbidities affected asthma management, including that asthma sometimes took a 'backseat' to conditions considered more troublesome or worrisome. Mood problems, sometimes attributed to pain or functional limitations resulting from comorbidities, reduced motivation for self-management. Women described how asthma affected comorbidity management; e.g. by impeding recommended exercise. Some self-management recommendations, such as physical activity and weight control, were seen as beneficial across conditions. Conclusions: Multiple chronic conditions that include asthma may interact to complicate self-management of each condition. Additional clinical attention and self-management support may help to reduce multimorbidity-related challenges. [ABSTRACT FROM AUTHOR]

The article focuses on the Alliance to Reduce Disparities in Diabetes, an initiative launched by the Merck Company Foundation, in support of evidence-based means to reduce inequity in health status. An overview of the collaborative projects across the U.S. as part of the Alliance effort is presented. The three-element strategy in adapting evidence-base means to reduce inequity is discussed.

Although many asthma patients experience their first attack after age 40, the experiences and concerns of older adults with asthma remain largely unknown. We conducted six focus groups, each consisting of participants over the age of 65 with a physician diagnosis of asthma. Semistructured questions regarding asthma education, symptoms, and management were used. A total of 46 adults participated in the six focus groups. The mean age of the participants was 72.6 years, and 43.5% were African American. The majority of participants had coexisting cardiac disease or hypertension. Major age-specific domains identified in all focus groups were atypical asthma symptoms, inability to distinguish asthma from other medical conditions, use of complementary and alternative therapies, desire for independence in asthma management, and a lack of participation in asthma education. Participants acknowledged that they did not commonly address these issues with their physicians or with family members. Optimal care will require physicians and researchers to explicitly address these issues unique to the geriatric asthmatic population. [ABSTRACT FROM AUTHOR]