developing collaborative gerontology programs ...

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DEVELOPING COLLABORATIVE GERONTOLOGY PROGRAMS OFFSHORE: A CASE STUDY Irene Coulson, Victor Minichiello, Rosann Santora Kao, Fernina Lin, C. C. Wan a

University of New England

b

Chinese University of Hong Kong Published online: 11 Nov 2010.

To cite this article: Irene Coulson, Victor Minichiello, Rosann Santora Kao, Fernina Lin, C. C. Wan (2000) DEVELOPING COLLABORATIVE GERONTOLOGY PROGRAMS OFFSHORE: A CASE STUDY, Educational Gerontology, 26:4, 387-400, DOI: 10.1080/036012700407866 To link to this article: http://dx.doi.org/10.1080/036012700407866

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Educational Gerontology, 26 : 387–400, 2000 Copyright Ó 2000 Taylor & Francis 0360-1277 / 00 $12.00 1 .00

DEVELOPING COLLABORATIVE GERONTOLOGY PROGRAMS OFFSHORE : A CASE STUDY


Irene Coulson University of New England, School of Health, Armidale, New South Wales, Australia

Victor Minichiello University of New England, School of Health, Armidale, New South Wales, Australia

Rosann Santora Kao Fernina Lin School of Continuing Studies, Chinese University of Hong Kong, Kowloon, Hong Kong

C. C. Wan School of Continuing Studies, Chinese University of Hong Kong, Kowloon, Hong Kong

With the number of older persons in Hong Kong and the need for improved standards of care and aged care policy increasing, gerontologists will continue to play a signiücant role in providing gerontological education on an international level. Over the next 2 decades, the older population in Hong Kong is projected to increase signiücantly. Individuals 65 years and over are anticipated to number about 1,067,300 by 2016. This article describes a unique collaboration between the University of New England, School of Health (Armidale, New South Wales, Australia), and Chinese University of Hong Kong, School of Continuing Studies, in which the Graduate Diploma and Master of Health Science (gerontology) proAddress correspondence to Dr. Irene Coulson, University of New England, School of Health, Armidale, NSW, 2351, Australia. E-mail : [email protected] 387

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grams are presented through mixed-mode and on-line education using the World Wide Web. The curriculum was developed with consideration of the Hong Kong health care system and cultural context. The curriculum is multidisciplinary in nature, and students represent a wide range of professions. This article discusses the methodology used to develop this collaborative project and to ensure that the course is relevant for students in Hong Kong.

Quality assurance and public accountability in promoting health and well-being for older persons in Hong Kong demand that professionals work in and inýuence a range of care environments. Clinicians are now expected to be accountable for outcomes of care and to take a greater role in teamwork and benchmarking, and evaluating programs in the pursuit of best practices (Ringsven & Bond, 1997). Countries throughout the world are experiencing a signiücant increase in the number older persons, and this growth clearly calls for attention to teaching gerontology (Rowland, 1991). However, some countries have not yet clearly recognized the need for gerontological education, which has resulted in a shortfall of adequately trained gerontologists. The challenge for educational gerontologists is to promote collaborative partnerships with countries in which there is a growing population of older persons and a corresponding need to develop gerontological expertise. The purpose of this article is to describe a unique collaborative partnership that was formally developed in 1998 between the Chinese University of Hong Kong (CUHK), School of Continuing Studies, and the University of New England (UNE), School of Health, to provide gerontological education to professionals working in aged care in Hong Kong.

THE AGING PROFILE OF HONG KONG Projections of the population of Hong Kong, by age and sex, are made every 5 years by the Census and Statistics Department at the time of the Census and Bycensus. The projected population covers both persons normally living in Hong Kong and those living there temporarily. Over the next 2 decades, Hong Kong ’s population is projected to increase at an annual average rate of 1.3%, from 6.29 million in mid-1996 to 8.21 million in mid-2016. The proportion of those aged 65 years and over is expected to rise to 11% in 2006 and 13% in 2016.


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Those aged 65 or over are anticipated to number approximately 1,067,300 by 2016. The 1996 Bycensus also indicated that those aged 85 years and over comprised 42,700 people, or 0.7% of the population. By 2016, this number is projected to have grown to 129,600, or 1.6% of the population. In his review of Hong Kong ’s geriatric health services, Lawson (1995) indicated that age-speciüc mortality rates among Hong Kong residents are lower than in many western societies. Hong Kong ’s population also enjoys increasing life expectancy at birth. According to Phillips (1995), in 1971 men in Hong Kong could expect to live 68 years and women 75.6 years. By 1993, these ügures were 75.1 years for men and 80.8 years for women. Nevertheless, it has been suggested that the Hong Kong elderly population will face some health challenges . For example, Woo, Ho, Kay, & Lau, (1994) showed from community-based studies that rates of cognitive impairment and cardiovascular risk factors are currently comparable to those observed in many Caucasians, including Australians. Other signiücant problems are osteoporosis, atherosclerotic heart disease, diabetes, and stroke. The incidence of all of these conditions is increasing gradually in Hong Kong. It is interesting to note the role of lifestyle in many of these diseases. Osteoporosis leads to loss of bone density and subsequent fractures, all of which are common in Hong Kong. It is predominantly a condition found in women, and it is widely associated with low calcium levels and low exercise rates, which may reýect dietary and other lifestyle activities . Atherosclerotic heart disease is associated with high consumption of fatty foods and tobacco. A Census and Statistics Department Special Report from the 1996 General Household Survey indicated that daily smoking is more common among older persons, with 55.7% of daily smokers aged 40 years and over (Census and Statistics Department, 1997). In the 50– 59 age group, the rate per 1,000 persons who smoked on a daily basis was 209, although this was reduced in those aged 60 years or more to 161 per 1,000 persons. Men of all ages were more likely than their female counterparts to smoke daily. Although the diminution in rates for those aged over 60 years is important, risk factors for heart disease are cumulative, and the damage to the cardiovascular system that leads to disease in the elderly occurs in early and middle life. Health statistics also reveal that suicide is a common cause of death among elderly people in Hong Kong. Lawson (1995) reported that in 1989, suicide rates were 45.3 per 100,000 for men aged 65– 74 years and 48.9 per 100,000 for those aged 75 years and older. Australian men aged 65– 74 experienced 27.7 suicides per 100,000, and 39.8 per 100,000 for those aged 75 and over. Rates for women were lower,


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but much higher for Hong Kong women than for their Australian counterparts. Hong Kong women aged 65 – 74 years had 23.1 suicides per 100,000 and 44.6 per 100,000 for those aged 75 years and older. In common with their Australian contemporaries, the elderly of Hong Kong are heavy users of the health care system. For example, according to Fung (1992), about one quarter of patients admitted into public acute hospitals are aged 65 years or over, and the rate of usage is about 2.5 times that of the general population. In addition, an active policy of community-based care ensures that the local physician plays a signiücant role in the achievement and maintenance of healthy older people. In May and June 1996, the Census and Statistics Department conducted a General Household Survey that, in part, surveyed the health status of residents (Census and Statistics Department, 1997). Of the 1,244,800 people who reported health problems in the 2 weeks before the survey, 18.8% were aged 65 years old or older. Over three quarters of those who reported health problems (76.4%) stated that they consulted practitioners of western medicine for treatment. Among those aged 65 or older, 93% sought treatment from practitioners of western medicine. Other sources of treatments for all age groups included medicine purchased from pharmacies (11.1%), herbalists or acupuncturists (5%), and Chinese medicines (2%). Community-based care has been adopted as the major method of service provision for the elderly in Hong Kong (Wong, 1994). Despite the availability of resources such as home help and day centers, family members continue to provide the bulk of care (Ngan & Cheng, 1992). In their survey of caregivers, Ngan and Cheng found that the principal characteristics of caregivers were as follows. Their mean age was 53.3 years, but 46.7% were aged 60 years or older. They were predominantly women (73.3%), with one half being the spouse of the care recipient and the next largest category being adult daughters (26.7%). One half had only primary levels of education, and over one half were unemployed. The average period of care was 3.3 years. However, the longest period of care reported was 8 years. Qureshi and Walker (1989) indicated that, despite the spouse being the preferred attendant in a hierarchy of caregivers, 90% of spouses claimed that they received very little support from other family members. It is often taken for granted among Chinese communities that wives should care for frail, aging husbands. There are also economic challenges. The Hong Kong Social Security Allowance Scheme consists of two components: an Old Age Allowance (OAA) and a Disability Allowance (DA). The Scheme provides a means-tested, noncontributory allowance to persons aged 65 years and over, and severely disabled persons of any age, to meet



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special needs arising from old age and/or disability. During the ünancial year 1987–1988, 252,256 people received OAA payments valued at $HK700.2 million, and 56,051 people received $HK322.6 million in DA payments. A decade later, OAA payments were made to 437,827 people who collectivel y received $HK3,005.0 million. In the same ünancial year (1996– 1997), 72,264 individuals received $HK1,036.6 million in DA payments. The size of the retired population more than doubled in the 10 years between the 1986 Bycensus and the 1996 survey. Among people aged 65 years and older still in the workforce in 1986, the median monthly income was $HK2,000 for men and $HK1,200 for women. This had risen in 1996 to $HK5,600 for men and $HK4,000 for women. In both years and for both genders, this represented about one half of the overall median income for all age groups.

PROGRAM DESCRIPTION The graduate diploma and the master of health science (gerontology) awards (degrees) were designed to provide up-to-date knowledge in research and practice emerging in Hong Kong and other overseas regions. Both gerontology awards aim to provide advanced postgraduate learning to nurses, physicians, allied health professionals, policymakers, medical practitioners, and health managers working across the continuum of aged care. The graduate diploma aims to upgrade and extend the knowledge, skills, and attitudes of professionals working with older adults. The master of health science (gerontology) equips students with the knowledge required for providing leadership in clinical practice, management, and research positions. Whereas the graduate diploma can be completed in 1 12 years on a part-time basis and consists of 6 core units (unit is deüned to mean a subject within a degree award), the master of health science (gerontology) requires 10 core units that are completed in 2 12 years of part-time study. On completion of the graduate diploma, all 6 units may be fully credited toward the master of health science (gerontology). The interdisciplinary curriculum provides students with a range of knowledge including concepts and theories from sociology, psychology, and biology ; research methods ; basic principles of management and their application to clinical gerontology ; complementary therapies ; and counseling theories. Prospective students must show evidence of a professional qualiücation and/or a previous degree as well as extensive experience in aged care or working with older people. The enrollment in the ürst

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year of this collaborative project was 60 students and included social workers, physiotherapists, occupational therapists, registered nurses, clinical educators, accountants, and managers working in community care, aged care, government offices, and education.


INTERNATIONALIZATION The most important aspect of the gerontology awards is the internationalization of the curriculum to ensure that learning needs of students are congruent with the values, beliefs, and health care needs of people in Hong Kong. Internationalization is deüned as a process of cross-border operations when a business headquartered in one country inýuences the strategic decision making of at least one affiliate in another country (Yeung, 1999). The CUHK School of Continuing Studies and the UNE School of Health work closely together to review unit content to ensure that it is continually updated to meet the changing and evolving needs of the population of Hong Kong and that it supports the strategic plan for the development of social and health services for older people in Hong Kong (Social Welfare Department, 1998). A systematic review of research on the Hong Kong elderly, geriatric services, and the health care system was conducted, and the published material was collected and analyzed. This material was then incorporated into unit material to ensure that the lectures contained Hong Kong-speciüc data. Diþerences between Hong Kong and Australia had to be acknowledged and reýected in the curriculum. For example, a unique feature associated with aging in Asia is the preeminence of the notion of community-based care (Ngan & Kuan, 1995). Chow (1992) argued that, although community-based care has strengthened the bond between older people and the people surrounding them, it has resulted in the underdevelopmen t of formal support services. For those without families, this situation has the potential to result in hardship or even suþering. Another feature of aging highlighted by Ngan and Wong (1993) is that an increase in the size of the older population is frequently accompanied by a decline in the functions of the family. Chow (1996) noted that the traditional Chinese family system not only provides support for its members but also confers on them a sense of identity. Within this context, the potential changing role of the family may deprive older people of physical care and also deny them the esteemed status they once possessed. And, of course, the health care systems in



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Australia and Hong Kong reýect a diþerent history and emphasis on the role of the welfare system and political and cultural contexts. In addition to conducting a comprehensive literature review, information and consultation were sought from professional health associations. The goals of the consultation were to identify current education and in service programs available for gerontology training, become more familiar with available health care services and current issues being faced by the various professions, seek views about training and education needs of the current and future workforce, and identify local expertise that could be used to enrich the teaching program. Members of the aged care workforce were surveyed to collect extensive data on their employment experiences, training, and current working environment as well as the challenges they believed the aged care sector would face in the future. Survey results indicated that members of the Hong Kong aged care workforce generally were satisüed in their work and conüdent about their future in the industry (Minichiello, Wan, Spencer, Coulson, & Lin, 1999). The study found that, among all categories of aged care workers, there was a universal demand for training beyond the basics in the üeld of gerontology and geriatrics. Furthermore, the majority of respondents in all occupations considered that eligibility for employment in aged care should be conditional on potential workers attaining some level of gerontological training. In addition, the study revealed that, although the present labor force had sufficient numbers of professional and personal care staþ to meet current demands, respondents did not consider that this situation would continue. The study also suggested ways in which the content of the curriculum of a postgraduate course could be made more relevant to the Hong Kong situation.

USE OF TECHNOLOGY The use of technology in the gerontology program promotes communication between administrators, instructors, and students. Students have 24-hour access to staþ members through e-mail, fax, telephone, and video teleconferencin g as necessary. Students also have access to computers for their own use from the CUHK School of Continuing Studies, subject to availability. Students can access the UNE electronic library databases to conduct literature searches. Wolpert (1998) noted that computer technology has not only transformed the way education is provided, but also the way in which library resources are administered to students,

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such as the use of digital resources, network-accessible databases, and electronic document delivery. Access to electronic literature is important to students because interlibrary loans are expensive and take considerable time. Students also are encouraged to use the CUHK library. Gerontology programs are being considered in other parts of Asia, and it is envisioned that electronic bulletin board discussions between students and instructors in various Asian countries would promote discussion of comparative best practices in aged care.

COURSE DELIVERY : MIXED MODE AND ON-LINE EDUCATION The delivery of the graduate diploma in gerontology and the master of health science (gerontology) program is unique because it is interdisciplinary and can be oþered through mixed-mode with intensive on-site residential schools to enhance the overall quality and ensure satisfactory student progress. In addition, the graduate diploma in gerontology is also oþered on-line through the World Wide Web with on-site extensive residential schools. Regardless of the mode, 4 days of intensive face-to-face lectures and activities are provided to students at residential schools for each unit by the UNE School of Health academic staþ in Hong Kong. Instruction is in English, and all lesson notes, textbooks, and unit content must conform to the requirements and standards set by the UNE. Students are provided with the names of prescribed textbooks for each unit, and the CUHK School of Continuing Studies arranges to have these books available for students to purchase. Each student receives a comprehensive package of self-contained distance education learning materials that consist of a unit guide, a study guide, and a reader containing selected readings. The unit guide includes a unit outline, unit aims and objectives, assessments, and the regulations established by the UNE. Most assessments consist of two or three extensive written assignments per unit or an assignment with an examination. The CUHK School of Continuing Studies negotiates with the UNE School of Health to establish due dates for written assignments for the two semesters each year. A reasonable amount of time is provided to allow students to prepare for each examination. The CUHK School of Continuing Studies arranges for the location and monitoring of the examination. There is a written code of practice for monitoring to ensure that the examination process is well supervised and that UNE examination standards are met.


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The study guide includes several modules related to the unit content. A set of comprehensive selected readings are also included for each student. Each package is internationalized to ensure that written material is consistent with the health needs of the Hong Kong people with consideration of the health care industry and the Hong Kong Social Welfare Plan (Social Welfare Department, 1998). The study guide provides students with an overview of the program and their assignments, whereas the unit guide contains unit content and activities in which students have the opportunity to participate. For example, students completing the Clinical Field Study unit are expected to demonstrate that they have improved their knowledge, skills, and clinical practice in at least one practice area. In this unit, students are expected to establish their personal and professional learning goals in a clinical setting and set out to undertake a clinical project in an area agreed on by the instructor and an industry partner in Hong Kong. To date, students have undertaken projects in evaluation, development of programs, extensive literature reviews, and design of various client assessment tools. In 2000, student projects, will be presented at an aged care seminar for clinicians and managers who work in aged care facilities across the continuum of care in Hong Kong. Continuous quality improvement is built into the program as it is recognized that high standards and program outcomes must be met at all times. This is accomplished through identiüed outcomes indicators, regular student evaluations of units, and meetings between the universities. The three major challenges to ensuring successful outcomes are the following : a successful partnership between the CUHK School of Continuing Studies and the UNE School of Health to ensure that high standards are met in the administration, marketing, delivery, and evaluation of the program in accordance with the formal agreement ; internationalization of curriculum content by ensuring that activities presented to students are sensitive to the values, beliefs, and health care needs of older people and society in Hong Kong, with consideration of the current political system and the Social Welfare Development Plan 1998 ; and adequate counseling and support for students throughout the program through the use of residential schools and technology. d

d

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The use of technology such as e-mail has improved the speed of information sharing and communication between the two countries,

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thereby improving relationships between students, administrators, and instructors.


OFFERING INTERACTIVE ON-LINE EDUCATION The new generation of distance education is known as on-line education, and it clearly stresses the importance of the computer network in the learning process. Participants interact in a full-ýedged learning community, which encourages individuals to overcome their isolation and acknowledges their contribution to the group (Briano, 1997). The graduate diploma in gerontology is also delivered to students on-line through the World Wide Web. To pursue this method, the student must have access to a computer and the World Wide Web. Students have a choice of units, allowing them to specialize in aging, health management, or dementia care. All unit materials, except the readings, are provided to students on-line. One of the most important characteristics of on-line classes is that they emphasize social interaction among students and nullify the authoritarian role of the instructor or subject matter (Firdyiwek, 1999). The instructor must shift from being a lecturer/entertainer to a facilitator. The literature supports that the key to success in delivering successful on-line units is interactivity (Black & Goldstein, 1998 ; Boshier et al., 1997 ; Hackley, 1997 ; Lohmann, 1998). Interactive learning aþords students the opportunity to view each other’s contributions (Chapman, 1998). Figure 1 provides an example of the UNE School of Health’s WebCT unit page and the options students use in promoting interactivity on-line. WebCT is a software package that provides a platform for educational units oþered over the World Wide Web. The graduate diploma in gerontology on-line program is provided through the use of bulletin boards, high-quality worldwide sites related to unit content, chat rooms, and on-line group presentations. For example, on-line students in the Clinical Gerontology unit are expected to form a group in which the instructor coordinates assignments for each student. Each student is charged with the task of investigating speciüc websites related to various clinical programs for persons with dementia or aging. Each student must then report his or her ündings and critical analysis about the clinical care program on the bulletin board. In addition, each student is expected to respond to other student ündings about each program investigated. Clinical practitioners located throughout the world also provide input to students by posting their comments on bulletin boards. In addition, students who are enrolled in other parts of the world are



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FIGURE 1 University of New England WebCT course page.

able to communicate with students about clinical problems and possible solutions. In another unit, Research Topic, students are expected to work through the development of a research proposal. Speciüc questions are presented each week. Students are expected to explore each question as it relates to his or her chosen research project. Researchers provide ongoing input to enable students to more critically evaluate their research question, study aims, conceptual framework, and proposed methodology. The on-line gerontology educational program continues to evolve and improve as more interesting sites are found and interactivity is improved for both students and instructors.

COLLABORATION : DIFFERENT ROLES AND RESPONSIBILITIES The UNE School of Health and the CUHK School of Continuing Studies each have diþerent roles and responsibilities in the program. Whereas the major responsibility of the UNE School of Health is to select students into the program, develop units, teach the program, and evaluate student assessments, the CUHK School of Continuing Studies is responsible for marketing the program, administering the


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program, and managing student aþairs. For example, the CUHK School of Continuing Studies submits prospective student applications to the UNE School of Health, and the UNE School of Health gerontology program director, in collaboration with the gerontology course team, determines which prospective students meet admission requirements. The major role of the gerontology course team is to ensure that the awards are being oþered in accordance with UNE standards and protocols. Two full-time administrative staþ members are employed by the CUHK to administer the program. The roles of the Hong Kong administration staþ are to manage the day-to-day operations of the program, which include the following : (a) answer prospective and existing students’ inquiries regarding the program ; (b) promote and market the program ; (c) accept the process students’ applications ; (d) arrange sites for the intensive on-site residential schools : (e) provide audiovisual equipment necessary for the residential schools ; (f ) print unit materials provided by the UNE School of Health and distribute these to students ; (g) photocopy instructors’ lecture notes ; (h) collect assignments from students ; (i) courier assignments to UNE for grading ; and ( j) record grades and return assignments to students. In addition, the UNE employs an oþshore program manager who works directly with staþ members at the CUHK School of Continuing Studies to ensure a smooth and efficient customer-service oriented operation. The CUHK School of Continuing Studies has a major responsibility in the marketing of the awards in major Hong Kong newspapers and responds to student inquiries on an ongoing basis. A brochure detailing the gerontology program, including the curriculum, mode of delivery, duration, and admission requirements, is distributed to major public and private hospitals and homes for the elderly. In addition, information sessions targeting professionals who might be interested in expanding their knowledge in gerontology are held. Gerontologists from the UNE conduct information sessions in Hong Kong to answer prospective students’ questions regarding the program. Posters are also mailed to all public and private hospitals, homes for the elderly, and community agencies to announce the information sessions and the dates of the next student enrollment. There are at least two enrollments per year.

CONCLUSION The unique collaboration between the UNE School of Health and the CUHK School of Continuing Studies has provided not only an



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increase in gerontological expertise across all professional disciplines in Hong Kong, but more important, a way to continue to improve standards of aged care and health care policy. What is even a greater challenge to educational gerontologists throughout the world is the continued upgrading of technology that will enable new knowledge and practices to be shared among students and practitioners. Globalization is becoming a reality, and educational gerontologists are developing programs that foster collaboration between countries. The sharing of resources and expertise through collaboration will facilitate the availability of up-to-date and relevant gerontological education programs throughout the world. It takes signiücant resources and expertise to produce an excellent educational gerontological program that spans across many disciplines. We believe that shared resources and expertise and collaboration have enabled the development of a best practice–based educational gerontological program.

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