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Examiner Approved for Publication Thesis Jan 21 2020

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Examiner Approved for Publication Thesis Jan 21 2020 Factors That Influence the Development of Interprofessional Education and One Health for Medical, Veterinary and Dual Degree Public Health Students at an Offshore Medical School Thesis submitted in accordance with the requirements of the University of Liverpool for the Degree of Doctor of Education Rohini Roopnarine October 2019 INTERPROFESSIONAL EDUCATION 2 Table of Contents Dedication and Acknowledgments ......................................................................................... 7 List of Figures ........................................................................................................................... 8 List of Tables ............................................................................................................................ 9 List of Abbreviations ............................................................................................................. 11 Abstract ................................................................................................................................... 12 Chapter 1: Introduction ........................................................................................................ 14 1.1. Background ............................................................................................................... 16 1.2. Location of the Study .................................................................................................... 18 1.3. Practitioner-based problem ........................................................................................... 20 1.4. Purpose Statement ......................................................................................................... 20 1.5. Organisation of the Study ............................................................................................. 21 Chapter 2: Literature Review ............................................................................................... 23 2.1. Search Criteria for Selection of the Literature .............................................................. 23 2.2. One Health (OH) ........................................................................................................... 26 2.2.1. The Origins of One Medicine and One Health (OH) ........................................ 26 2.2.2. Defining One Health ............................................................................................ 26 2.2.3. The relevance of OH to global health and health policy .................................. 29 2.2.4. One Health to address gaps in medical and veterinary education. ................. 30 2.3 Interprofessional Education (IPE) .................................................................................. 32 2.3.1. Definitions and relevance of IPE ........................................................................ 32 2.3.2. IPE versus OH ...................................................................................................... 33 2.3.3. History of IPE internationally ............................................................................ 34 2.3.4. Barriers to developing IPE .................................................................................. 35 2.3.5. IPE and OH programs ........................................................................................ 36 2.3.6. Student experiences of IPE and OH ................................................................... 38 2.4. Student Readiness for IPE and Faculty Attitudes to IPE .............................................. 39 2.4.1. Student readiness for IPE. .................................................................................. 39 2.4.2 Measuring student readiness for IPE .................................................................. 40 2.4.2.1 Quantitative methods of measurement for student readiness for IPE .................. 40 2.4.2.2. Previous studies on readiness for IPE and defining OH ........................................ 42 2.4.2.3. Variables influencing readiness ............................................................................... 44 2.4.3. Qualitative methods of measurement for student attitudes to IPE and OH .. 45 2.4.4. Faculty attitudes to IPE ....................................................................................... 46 2.4.4.1. Qualitative studies to assess faculty attitudes to IPE ............................................. 47 INTERPROFESSIONAL EDUCATION 3 2.5. Mixed Methods Research (MMR) to Assess Student Readiness for IPE and Faculty Attitudes to IPE .................................................................................................................... 47 2.6. Theoretical Frameworks Underpinning the Study ........................................................ 48 2.6.1 Role theory ............................................................................................................. 49 2.6.2 Social identity theory (SIT) .................................................................................. 50 2.6.3 The theory of planned behaviour (TPB) and SIT .............................................. 53 2.7. Summary ....................................................................................................................... 54 Chapter 3: Methodology ........................................................................................................ 56 3.1 Researcher Paradigm and Positioning ........................................................................... 57 3.2 Steps to the MMR Approach ......................................................................................... 58 3.2.1. Step 3: Mixing rationale MMR design ............................................................... 58 3.2.2. Step 4: Purpose for mixing .................................................................................. 58 3.2.3. Step 5: Research questions .................................................................................. 58 3.2.4. Step 6: Sampling design ..................................................................................... 59 3.2.4.1 Quantitative phase using the RIPLS scale ............................................................... 60 3.2.4.2. Qualitative phase ....................................................................................................... 61 3.2.4.2.1. Survey open ended questions ............................................................................... 61 3.2.4.2.2. Rationale for the use of focus groups ................................................................... 61 3.2.4.2.3. Rationale for the use of the interview ................................................................... 63 3.2.5. Step 7: MMR design selection ............................................................................. 64 3.2.5.1 Ethical considerations ................................................................................................ 66 3.2.6. Step 8: Data collection ......................................................................................... 68 3.2.6.1 RIPLS .......................................................................................................................... 68 3.2.6.1.2 The RIPLS domains explained .............................................................................. 70 3.2.6.1.3. Administration of the RIPLS pilot ........................................................................ 71 3.2.6.1.4. Conducting the survey .......................................................................................... 72 3.2.6.1.5. Limitation for the survey phase ........................................................................... 73 3.2.6.2. Focus group and interview data collection .............................................................. 74 3.2.6.2.1. Preparing the Initial Data Analysis for the Focus groups and Interview ............ 75 3.2.6.2.3. Limitations of the focus groups and interview ..................................................... 76 3.2.7. Step 9: Data analysis ............................................................................................ 77 3.2.7.1 Survey including RIPLS ............................................................................................ 78 3.2.7.2. Assessment for normality distribution of the data ................................................. 79 3.2.7.2.1. Box plots, histograms and Q-Q plots ................................................................... 79 3.2.7.2.2. Homogeneity of variance ..................................................................................... 79 3.2.7.3. Qualitative data analysis .......................................................................................... 79 INTERPROFESSIONAL EDUCATION 4 3.2.7.3.1. Survey Open-ended questions on One Health ...................................................... 80 3.2.7.3.2. Analysis of the focus groups and interview .......................................................... 80 3.2.7.3.3. Integration ............................................................................................................ 81 3.2.8. Step 10: Data validation ...................................................................................... 81 3.2.8.1. Quantitative phase .................................................................................................... 82 3.2.8.2. Qualitative Phase .....................................................................................................
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