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Teachers' Participation in Decision-Making, Professional Growth, Appraisal, and Behavioral Intentions in the Promotion System Reform in Chinese Universities

ABSTRACT: The promotion system in Chinese universities has been undergoing a reform since 2017. This study employed an online survey validated by confirmatory factor analysis with 372 Chinese teachers to investigate the extent to which they were empowered by the two practices of participation in decision-making and professional growth in the reform and level of their appraisal of and behavioral intentions toward the new promotion system. Structural equation modeling was used to measure how the two empowerment practices influenced the teachers' appraisal of and behavioral intentions toward the new system. The findings suggest that the Chinese teachers had low participation in decision-making and medium institutional support for professional growth, relatively low nonmonetary cost-benefit appraisal and medium practicality and fairness appraisal of the new system, and relatively high behavioral intentions to increase efforts according to the new system. Besides, participation in decision-making had a significantly direct effect on practicality and nonmonetary cost-benefit appraisal. Professional growth had a significantly direct effect on practicality, fairness, and nonmonetary cost-benefit appraisal and behavioral intentions. Nonmonetary cost-benefit appraisal had a significantly direct effect on behavioral intentions. The implications are that, in promotion system reforms, the two empowerment strategies of shared decision-making and professional growth can help establish a new promotion system with high nonmonetary cost-benefits for teachers and raise teachers' behavioral intentions to develop and pursue promotion. They can also contribute to the formulation of a new promotion system that effectively evaluates individual teacher's achievements according to the characteristics of the specific university, teacher type, and discipline. This study had the limitations of using convenience sampling, collecting cross-sectional data through self-administered questionnaires, and reporting only teachers' side of the story. Therefore, it is recommended that future studies target both teachers and administrators, employ a mixed-method design, collect quantitative data through random sampling, and take a longitudinal view.

SUBMITTER: Peng W

PROVIDER: S-EPMC9281619 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundShared decision-making is the gold standard for good clinical practice, and thus, psychometric instruments have been established to assess patients' generic preference for participation (e.g., the Autonomy Preference Index, API). However, patients' preferences may vary depending on the specific disease and with respect to the specific decision context. With a modified preference index (API-Uro), we assessed patients' specific participation preference in preference-sensitive decisions pertaining to urological cancer treatments and compared this with their generic participation preference.MethodsIn Study 1, we recruited (N = 469) urological outpatients (43.1% urooncological) at a large university hospital. Participation preference was assessed with generic measures (API and API case vignettes) and with the disease-specific API-Uro (urooncological case vignettes describing medical decisions of variable difficulty). A polychoric exploratory factor analysis was used to establish factorial validity and reduce items. In Study 2, we collected data from N = 204 bladder cancer patients in a multicenter study to validate the factorial structure with confirmatory factor analysis. Differences between the participation preference for different decision contexts were analyzed.ResultsStudy 1: Scores on the specific urooncological case vignettes (API-Uro) correlated with the generic measure (r = .44) but also provided incremental information. Among the disease-specific vignettes of the API-Uro, there were two factors with good internal consistency (α ≥ .8): treatment versus diagnostic decisions. Patients desired more participation for treatment decisions (77.8%) than for diagnostic decisions (22%), χ2(1) = 245.1, p ≤ .001. Study 2: Replicated the correlation of the API-Uro with the API (r = .39) and its factorial structure (SRMR = .08; CFI = .974). Bladder cancer patients also desired more participation for treatment decisions (57.4%) than for diagnostic decisions (13.3%), χ²(1) =84, p ≤ .001.ConclusionsThe desire to participate varies between treatment versus diagnostic decisions among urological patients. This underscores the importance of assessing participation preference for specific contexts. Overall, the new API-Uro has good psychometric properties and is well suited to assess patients' preferences. In routine care, measures of participation preference for specific decision contexts may provide incremental, allowing clinicians to better address their patients' individual needs.

Project description:BackgroundThere is a longstanding concern about the accuracy of surrogate consent in representing the health care and research preferences of those who lose their ability to decide for themselves. We sought informed, deliberative views of the older general public (?50 years old) regarding their willingness to participate in dementia research and to grant leeway to future surrogates to choose an option contrary to their stated wishes.Methodology/principal findings503 persons aged 50+ recruited by random digit dialing were randomly assigned to one of three groups: deliberation, education, or control. The deliberation group attended an all-day education/peer deliberation session; the education group received written information only. Participants were surveyed at baseline, after the deliberation session (or equivalent time), and one month after the session, regarding their willingness to participate in dementia research and to give leeway to surrogates, regarding studies of varying risk-benefit profiles (a lumbar puncture study, a drug randomized controlled trial, a vaccine randomized controlled trial, and an early phase gene transfer trial). At baseline, 48% (gene transfer scenario) to 92% (drug RCT) were willing to participate in future dementia research. A majority of respondents (57-71% depending on scenario) were willing to give leeway to future surrogate decision-makers. Democratic deliberation increased willingness to participate in all scenarios, to grant leeway in 3 of 4 scenarios (lumbar puncture, vaccine, and gene transfer), and to enroll loved ones in research in all scenarios. On average, respondents were more willing to volunteer themselves for research than to enroll their loved ones.Conclusions/significanceMost people were willing to grant leeway to their surrogates, and this willingness was either sustained or increased after democratic deliberation, suggesting that the attitude toward leeway is a reliable opinion. Eliciting a person's current preferences about future research participation should also involve eliciting his or her leeway preferences.

Project description:ObjectiveThe aim of the study was to describe and explore patient agency through resistance in decision-making about cardiovascular preventive drugs in primary care.DesignSix general practitioners from the southeast of Sweden audiorecorded 80 consultations. From these, 28 consultations with proposals from GPs for cardiovascular preventive drug treatments were chosen for theme-oriented discourse analysis.ResultsThe study shows how patients participate in decision-making about cardiovascular preventive drug treatments through resistance in response to treatment proposals. Passive modes of resistance were withheld responses and minimal unmarked acknowledgements. Active modes were to ask questions, contest the address of an inclusive we, present an identity as a non-drugtaker, disclose non-adherence to drug treatments, and to present counterproposals. The active forms were also found in anticipation to treatment proposals from the GPs. Patients and GPs sometimes displayed mutual renouncement of responsibility for decision-making. The decision-making process appeared to expand both beyond a particular phase in the consultations and beyond the single consultation.ConclusionsThe recognition of active and passive resistance from patients as one way of exerting agency may prove valuable when working for patient participation in clinical practice, education and research about patient-doctor communication about cardiovascular preventive medication. We propose particular attentiveness to patient agency through anticipatory resistance, patients' disclosures of non-adherence and presentations of themselves as non-drugtakers. The expansion of the decision-making process beyond single encounters points to the importance of continuity of care. KEY POINTS Guidelines recommend shared decision-making about cardiovascular preventive treatment. We need an understanding of how this is accomplished in actual consultations.This paper describes how patient agency in decision-making is displayed through different forms of resistance to treatment proposals. •The decision-making process expands beyond particular phases in consultations and beyond single encounters, implying the importance of continuity of care. •Attentiveness to patient participation through resistance in treatment negotiations is warranted in clinical practice, research and education about prescribing communication.

Project description:Aims and objectivesThe aim was to explore and describe the child's active participation in daily healthcare practice at children's hospital units in Sweden.Objectives(a) Identify everyday situations in medical and nursing care that illustrate children's active participation in decision-making, (b) identify various ways of active participation, actual and optimal in situations involving decision-making and (c) explore factors in nursing and medical care that influence children's active participation in decision-making.BackgroundDespite active participation being a fundamental right for children, they are not always involved in decision-making processes during their health care. There still remains uncertainty on how to support children to actively participate in decisions concerning their health care.DesignA qualitative study with overt, nonparticipant observations fulfilling the COREQ checklist criteria.MethodsObservations of interactions between children aged 2 and 17 years with both acute and chronic conditions, their parents, and healthcare professionals were conducted at three paediatric hospitals in Sweden. The Scale of Degrees of Self Determination was used to grade identified situations. The scale describes five levels of active participation, with level one being the least and level five being the most active level of participation. Normative judgements were also made.ResultsChildren's active participation was assessed as being generally at levels four and five. Children demonstrated both verbal and nonverbal ways of communication during decision-making. Findings indicated that children's, parents' and healthcare professional's actions influenced children's active participation in decision-making processes involving healthcare.ConclusionsHealthcare professionals specialised in paediatrics need to embrace both a child perspective and a child's perspective, plan care incorporating key elements of a child-centred care approach, to ensure children's active participation at a level of their choosing.Relevance to clinical practiceThere is a need for awareness creation to help healthcare professionals facilitate children's active participation in their care and decision-making.

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Teachers' Participation in Decision-Making, Professional Growth, Appraisal, and Behavioral Intentions in the Promotion System Reform in Chinese Universities

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