Secondary mathematics teachers' descriptions of student engagement.

There is a need for a more robust conceptualization of engagement in mathematics education research. Investigating how teachers describe engagement can provide insight into relationships between purposes of engagement and dimensions of engagement. In this exploratory study, we examined how 28 secondary mathematics teachers in two states in the USA talked about their students' engagement. During interviews, we asked teachers to provide their definitions for engagement, describe their teaching strategies for engaging students, and describe their observations of engagement during a video clip from their own classroom. We interpreted teachers' talk to identify how they described the nature of mathematics engagement (dimensions such as behavioral, cognitive, affective, and/or social engagement) and purposes of engagement (engagement in learning or in schooling [Harris, 2011]). When teachers described the purpose of engagement as engagement in learning, they also tended to describe the nature of engagement with cognitive and social dimensions and with multiple dimensions of engagement.

Facilitators of health systems change for tobacco dependence treatment: a qualitative study of stakeholders' perceptions.

BACKGROUND: Health systems play key roles in identifying tobacco users and providing evidence-based care to help them quit. Health systems change - changes to health care processes, policies and financing - has potential to build capacity within these systems to address tobacco use. In 2010, ClearWay MinnesotaSM piloted a health systems change funding initiative, providing resources and technical assistance to four health care systems. This paper presents findings from a process evaluation, describing key stakeholders' views on whether changes to how health systems treat tobacco use resulted from this initiative and what may have facilitated those changes. METHODS: A process evaluation was conducted by an independent evaluation firm. A qualitative case study approach provided understanding of systems change efforts. Interviews were conducted with key informants representing the health systems, funder and technical assistance providers. Core documents were reviewed and compared to thematic analysis from the interviews. Results were triangulated with existing literature to check for convergence or divergence. A cross-case analysis of the findings was conducted in which themes were compared and contrasted. RESULTS: All systems created and implemented well-defined written tobacco use screening, documentation and treatment referral protocols for every patient at every visit. Three implemented systematic follow-up procedures for patients referred to treatment, and three also implemented changes to electronic health records systems to facilitate screening, referral and reporting. Fax referral to quitline services was implemented or enhanced by two systems. Elements that facilitated successful systems changes included capitalizing on environmental changes, ensuring participation and support at all organizational levels, using technology, establishing ongoing training and continuous quality improvement mechanisms and leveraging external funding and technical assistance. CONCLUSIONS: This evaluation demonstrates that health systems can implement substantial changes to facilitate routine treatment of tobacco dependence in a relatively short timeframe. Implementing best practices like these, including increased emphasis on the implementation and use of electronic health record systems and healthcare quality measures, is increasingly important given the changing health care environment. Lessons learned from this project can be resources for states and health systems likely to implement similar systems changes.

The Wiidookowishin program: results from a qualitative process evaluation of a culturally tailored commercial tobacco cessation program.

Commercial tobacco use rates remain disproportionately high among American Indians (AIs). Tailored cessation programs such as the Wiidookowishin (Help Me) program implemented at the Fond du Lac Reservation in Minnesota have demonstrated that such programs can be successful and achieve quit rates similar to mainstream programs. This paper presents findings from a qualitative process evaluation of the Wiidookowishin program and discusses elements that underlie its success at recruiting and enrolling participants, including individualization, flexibility, accessibility, ongoing outreach, and inclusion of traditional tobacco teachings. Lessons learned can be applied to the development of tailored programs to reduce tobacco-related disparities among AIs.