HENNESSY-HICKS

TRAINING NEEDS
ANALYSIS
QUESTIONNAIRE AND
MANUAL
For use at a local level to identify
training and development needs

Professor Carolyn Hicks, BA, MA, PhD, PGCE, CPsychol.

School of Health and Population Sciences,
College of Medicine and Dentistry
University of Birmingham, UK

Dr Deborah Hennessy BA, PhD, RN, RM, Diploma Public Health Nursing, HV, FRSM
Consultant to World Health Organisation
5 Westfield House,80 Westgate
Chichester United Kingdom, UK

Copyright of University of Birmingham Licensed to WHO for On-line use

 SECTIONS IN MANUAL

3
1. Overview
6-9
2. Instructions to the Researcher
3. Basic Questionnaire: assessing training needs
10-14
alone
4. Basic questionnaire: Assessing training
15- 20
needs and the preferred approach to performance
improvement
21-25
5. An example of adjusting
the questionnaire for a Specific Purpose, or Specific
area of Care or Health Provider
26-40
6. Two Different Methods of Manual
Analysis
7. How the Questionnaire has been used in
41-49
a large survey (using Indonesia as an example)
8. A Battery of Questionnaire Items used
50-55
in other studies
9. Publications using the Hennessy-Hicks
56-59
Questionnaire

2
 SECTION 1

OVERVIEW

The aims of the Hennessy-Hicks Training Needs Assessment Questionnaire are:

To identify training needs at the individual, group or organisational level
To prioritise these training needs

The development of the assessment instrument

The development stages of the instrument followed formal psychometric principles.
Thematic analysis of the available literature, together with data obtained from focus
groups and semi-structured interviews, were analysed and synthesised into themes to
provide construct validity. From each theme a range of items was developed into
questionnaire format, informed by the previous stage, to ensure a degree of content
validity. The pilot questionnaire was administered to health care professionals from all
disciplines; their responses were analysed using a variety of multivariate techniques. This
stage allowed refinement of the instrument into its most reliable and valid items. The
final questionnaire has since been used with over 7000 health care professionals
globally, providing a robust data-base.

The structure of the instrument

The instrument comprises five sub-sections –
• research/audit,
• communication/teamwork,
• clinical tasks,
• administration
• management/supervisory tasks

3
These allow measurement of training needs within broad categories, as well as affording
comparisons between categories. Each category can therefore be used independently of
the others, or in any combination to provide the information required by the researcher.
The instrument is semi-opaque, which means that respondents are less likely to be able
to distort their responses and therefore, that the data obtained will be a more accurate
reflection of the training requirements. In this way, the instrument has an advantage
over other similar ones.

The data which emerge from the instrument have the capacity to:
Identify training needs at the individual, team, group or organisational levels
Inform educational and training packages at the individual, group or
organisational levels
Evaluate educational outcomes
Customise training to meet local needs
Aid priority setting
Inform policy development

The instrument is unique in that it is tailored for use specifically with health care
teams, but can easily be adapted to meet the particular objectives of a clinical
specialty, management or organisation. For example, the instrument has been used to
identify training requirements to upgrade general nurses working in primary care to
specialist nurse status, informed the training required and was also used to assess the
effectiveness of that training. The instrument has been successfully used in developed
and developing countries, with equal success.

It can be adapted to meet the requirements of any given health care setting, team or
group without compromising its validity and reliability. By following the basic
processes outlined and highlighted under the ‘development’ section, up to 8 of the 30
existing items can be replaced, thereby enabling the instrument to be customised for a

4
specified purpose. In addition, up to a further 10 additional items can be added
without compromising the psychometric properties, but these must be developed in
accordance with basic principles of questionnaire design - briefly described above.
Examples of the way in which the questionnaire has been used will be found in
Sections 5, 7 and 9.

Further advice and assistance may be negotiable by contacting

Dr Deborah Hennessy : [email protected]

THE UNIVERSITY OF BIRMINGHAM AND AUTHORS, HOWEVER CANNOT TAKE

RESPONSIBILITY FOR HOW THIS TOOL IS USED, ADAPTED, APPLIED OR INTERPRETED

5
 SECTION 2

HENNESSY-HICKS TRAINING NEEDS ANALYSIS QUESTIONNAIRE:

INSTRUCTIONS TO THE RESEARCHER

The intellectual property of the Hennessy-Hicks Training Needs Analysis questionnaire

belongs to the University of Birmingham (UoB) but the questionnaire has been
licensed to the World Health Organisation (WHO) for on-line use. Please reference
the authors of the questionnaire (Hennessy, D.A. and Hicks, C.M.), the UoB and WHO
when using or publishing work related to this questionnaire

The basic questionnaire 1: assessing training needs alone

The full details of the basic questionnaire are provided in Section 3, but an
introductory outline will be given here.

Each item in the basic questionnaire is rated along a 7-point scale in 2 different ways -
how important a task is to the respondent’s job (Rating A); and how well the task is
currently performed (Rating B).
Interpreting the ratings:
Rating A provides an index of how important the task is to the respondent’s
job, while Rating B provides an index of how well it is currently being
performed. Comparing the scores for importance/performance provides an
assessment of where the greatest training needs lie1. The greater the
difference in scores, the greater the training need.

1. Martilla,J and James, J (1977) Importance performance analysis. Journal of Marketing 41(1) 77 - 79

6
 • Where a task gets a high rating on A but a low rating on B, the training need is
high and should be the top priority for training (important task, not well
performed).

• Where the task is rated low on A and low on B, then the task could be
considered for training, but as a lower priority (unimportant task, not well
performed)

• Where the task is rated high on A and high on B then there is no training need
(important task, well performed)

• Where the task is rated low on A and high on B there is no training need
(unimportant task, well performed).

Various comparisons and analyses may be performed depending on the purpose of

the study e.g.: different groups of staff may be compared on their performance of any
given task; or they may be compared on the differences between rating A and B (their
training needs); or the differences between Ratings A and B can be calculated before
a training programme and again afterwards to assess whether the training has
reduced the training need. Alternatively, rather than getting individuals to assess
themselves on the items, colleagues can be asked to complete the questionnaire
instead. So – if you wanted to find out what the perceived development needs of
Nurse A are, you could ask one (or more) of Nurse A’s colleagues to assess her using
the questionnaire.

7
The basic questionnaire 2: assessing training needs and
preferred performance-improvement approaches

Clearly where training needs have been identified, there will be a requirement for
performance development and enhancement. The way in which this is done will vary
according to the situation, the personnel involved, the resources and what needs to
be developed. Development programmes usually fall into two main categories –
organisational change programmes and specific training courses. Therefore, a second
version of the questionnaire can be used to identify how best to implement
performance improvement programmes. So - in addition to Ratings A and B
(importance and performance measures), each item can also be rated along a 7-point
scale according to how far the respondent believes that the training need can be
addressed by organisational changes (Rating C) or training courses (Rating D).
Comparison of the scores for each item shows which of these is the preferred method
of development. This version of the questionnaire is discussed in detail in Section 4.

It should also be noted that the 30 tasks in the Basic Questionnaire belong to one of
five super-ordinate categories – research/audit (items 3, 6, 7, 9, 15, 21, 25, 26, 27 ),
communication/teamwork (items 1, 5, 8, 13, 14, 27 ), clinical tasks (items 10, 12, 17,
18, 22, 24 ), administration (items 2, 20, 29) and management/supervisory task (items
4, 11, 16, 19, 23, 30). The training needs for each category can therefore be compared,
if desired.

In addition to these basic questionnaires, an open response section has been included
so that respondents can record any training needs they have which have not been
covered by the questionnaire.

8
Finally, because the instrument is psychometrically robust, up to 25% of the items (up
to a maximum of 8) may be swapped for items of the researcher’s choice without
invalidating the questionnaire and another 10 items may be added. However, these
new items should have been obtained via thematic reviews of the literature, focus
groups or interviews, in order to ensure that they have some validity. The biographical
questions on the front sheet may also be adapted to suit the research.

9
 SECTION 3
BASIC QUESTIONNAIRE:
ASSESSING TRAINING NEEDS ALONE

10
 HENNESSY-HICKS
ASSESSMENT OF
TRAINING NEEDS

Before reading the instructions please complete the following*:

Job title:

Gender:

Age:

Number of years in post:

[*Please note that this biographical section can be adapted to collect any information
considered to be relevant to the study, for example, educational qualifications,
professional qualifications, previous training etc could be included here]

INSTRUCTIONS FOR COMPLETION:

This questionnaire comprises two sections that are to do with your training needs.
Please answer all the questions as honestly as possible to enable us to compile a
complete picture of your training requirements. Each section is prefaced by
instructions for completion. Please read and follow these carefully.
11
 SECTION 1: Training needs

In order to perform your job effectively you need relevant skills. You will see listed
below a range of skilled activities many of which you undertake in performing your
job. Look at each of these activities and then rate each one by writing the appropriate
number in the box. The first rating (A) is concerned with how important the activity is
to the successful performance or your job; the second rating (B) is concerned with
how well you currently perform that activity.

B: How well do you consider that you currently perform this activity?
Rating of 1- 7 - not well = 1; very well = 7

A: How important is this activity to the successful

performance of your job? Rating of 1- 7 - not at all
important = 1; very important = 7

A B
1. Establishing a relationship with patients
2. Doing paperwork and/or routine data inputting
3.Critically evaluating published research
4. Appraising your own performance
5. Getting on with your colleagues
6. Interpreting your own research findings
7. Applying research results to your own practice
8. Communicating with patients face-to-face
9. Identifying viable research topics
10. Treating patients
11. Introducing new ideas at work

12
12.Accessing relevant literature for your clinical work
13. Providing feedback to colleagues
14. Giving information to patients and/or carers
15. Statistically analyzing your own data
16. Showing colleagues and/or students how to do things
17. Planning and organizing an individual patient’s care
18. Evaluating patients’ psychological and social needs
19. Organising your own time effectively
20. Using technical equipment, including computers
21. Writing reports of your research studies
22. Undertaking health promotion studies
23. Making do with limited resources
24. Assessing patients’ clinical needs
25. Collecting and collating relevant research information
26. Designing a research study
27. Working as a member of a team
28. Accessing research resources (e.g. time, money,
Information, equipment)
29. Undertaking administrative activities
30 personally coping with change in the health service

13
SECTION 2: Specific training needs

Please specify the areas of your job in which you would like to receive further
training or instruction. List these in order of importance:
1.

2.

3.

4.

5.

6.

7.

8.

9.

10

14
 SECTION 4

ASSESSING TRAINING NEEDS AND PREFERRED

APPROACH TO PERFORMANCE-IMPROVEMENT

15
 HENNESSY-HICKS ASSESSMENT OF
TRAINING NEEDS AND APPROACHES TO
PERFORMANCE IMPROVEMENT

Before reading the instructions please complete the following*:

Job title:

Gender:

Age:

Number of years in post:

[*Please note that this section can be adapted to collect any information considered to
be relevant to the study, for example, educational qualifications, professional
qualifications, previous training etc could be included here]

16
INSTRUCTIONS FOR COMPLETION:
This questionnaire comprises four sections that are to do with your training needs.
Please answer all the questions as honestly as possible to enable us to compile a
complete picture of your training requirements. Each section is prefaced by
instructions for completion. Please read and follow these carefully.

SECTION 1: Training needs

In order to perform your job effectively you need relevant skills. You will see listed
below a range of skilled activities many of which you undertake in performing your
job. Look at each of these activities and then rate each one by writing the appropriate
number in the box. The first rating (A) is concerned with how important the activity is
to the successful performance or your job; the second rating (B) is concerned with
how well you currently perform that activity. However, in order to perform well at
work, you also require suitable work circumstances (eg other people’s approach,
compatible work practices, lack of practical constraints etc). In other words, your
working environment should allow you to exercise your skills appropriately.
Therefore, the second two ratings (C and D) are concerned with the scope for
improving performance either through training alone or through changes in your work
situation.

17
 A B C D
1. Establishing a relationship with patients

2. 2. Doing paperwork and/or routine data inputting

3. Critically evaluating published research

4. Appraising your own performance

5. Getting on with your colleagues

6. Interpreting your own research findings

7. Applying research results to your own practice

8. Communicating with patients face-to-face

9. Identifying viable research topics

10. Treating patients

11. Introducing new ideas at work

12.Accessing relevant literature for your clinical work

13. Providing feedback to colleagues

14. Giving information to patients and/or carers

15. Statistically analyzing your own research data

16. Showing colleagues and/or students how to do things

18
17. Planning and organizing an individual patient’s care

18. Evaluating patients’ psychological and social needs

19. Organizing your own time effectively

20. Using technical equipment, including computers

21. Writing reports of your research studies

22. Undertaking health promotion activities

23. Making do with limited resources

24. Assessing patients’ clinical needs

25. Collecting and collating relevant research information

26. Designing a research study

27. Working as a member of a team

28. Accessing research resources (e.g. time, money, information,

equipment)
29. Undertaking administrative activities

30 personally coping with change in the health service

19
SECTION 2: Specific training needs

Please specify the areas of your job in which you would like to receive further
training or instruction. List these in order of importance:
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

20
 SECTION 5

AN EXAMPLE OF ADJUSTING THE QUESTIONNAIRE FOR A

SPECIFIC PURPOSE, OR SPECIFIC AREA OF CARE OR HEALTH
PROVIDER

The Hennessy-Hicks Training Needs Assessment questionnaire can be adapted for many
different purposes. This section will explain how it can be adapted to identify the
training needs of staff for a new policy.

The Sexual and Reproductive Health Department in the World Health Organisation has
developed an integrated list of Sexual and Reproductive Health (SRH) skills for use in
Primary Health Care. This list has 12 domains: one that relates to the attitudes that staff
should have to sexual and reproductive health care and 11 competencies required by
staff to provide high quality sexual and reproductive health care.

The list is based on the most up-to-date knowledge sourced from literature surveys,
research and advice from international experts around the world. The list has taken
more than two years to develop with extensive consultation and is expected to be
published shortly.

Many countries may wish to introduce these competencies into their SRH services. As
part of their planning to do so, they may decide to clarify the role of different cadre who
provide SRH in primary health care and to assess their training needs.

21
 The Hennessy-Hicks questionnaire can be adapted to identify the Family Planning and
Fertility Care training needs. A comparison with the 30 items in the basic Hennessy-
Hicks questionnaire and the tasks in the WHO Family Planning Competencies is shown
below. You will see that 5 of the original items have been omitted and an additional 10
items, developed from the core competency framework, have been included. Therefore,
this application conforms to the requirement that up to 25% of the basic items can be
changed or omitted and a further 10 added, without compromising the validity of the
questionnaire.

Standard TNA Questionnaire Adaptation for Assessing the

Family Planning Training Needs of
Staff in Primary Health Care

1. Establishing a relationship with patients 1. Establishing a supportive relationship

with patients

2. 2. Doing paperwork and/or routine data 2. Inputting accurate family planning data
inp inputting into written or computerized records
3. Critically evaluating published research 3. Assessing the value of publications in the
area of sexual health
4. Appraising your own performance 4. Appraising your own performance in
family planning
5. Getting on with your colleagues 5. Getting on with primary health care
colleagues
6. Interpreting your own research findings OMITTED
7. Applying research results to your own practice OMITTED
8. Communicating with patients face-to-face 6. Communicating with patients
appropriately and effectively
9. Identifying viable research topics 7. Identifying areas of clinical practice that
should be systematically investigated
10. Treating patients 8. Carrying out family planning procedures

22
 e.g. giving injections, inserting and removing
IUDs, male or female sterilization
11. Introducing new ideas at work 9. Introducing new ideas into your own family
planning work
12.Accessing relevant literature for your clinical 10. Finding information that can inform your
work clinical work
13. Providing feedback to colleagues 11. Providing feedback to other colleagues
working in sexual health
14. Giving information to patients and/or carers 12. Providing correct information on Family
Planning Methods to individuals, couples and
groups
15. Statistically analyzing your own research OMITTED
data
16. Showing colleagues and/or students how to 13. Instructing or training students/ junior
do things staff/community health workers in family
planning tasks
17. Planning and organizing an individual 14. Advising an individual or couple on family
patient’s care planning
18. Evaluating patients’ psychological and social 15. Assessing family planning patients’
needs psychological and social needs
19. Organizing your own time effectively 16. Organizing own time as a family planning
carer effectively
20. Using technical equipment, including 17. Knowing how to use equipment and
computers explain family planning methods
21. Writing reports of your research studies OMITTED
22. Undertaking health promotion activities 18. Undertaking family planning health
promotion and prevention activities
23. Making do with limited resources 19. Making do with limited resources
24. Assessing patients’ clinical needs 20. Assessing patients’/ couples’ family
planning needs
25. Collecting and collating relevant research OMITTED

23
information
26. Designing a research study 21. Identifying areas worthy of investigation
in family planning or fertility problems in your
local area
27. Working as a member of a team 22. Working as a member of a primary health
care team
28. Accessing research resources e.g. time, 23. Locating and accessing relevant
money, information, equipment equipment, resources and supplies for your
family planning work
29. Undertaking administrative activities 24. Undertaking administrative duties
30 Personally coping with change in the health 25. Personally coping with change in sexual
and reproductive and family planning care
service

26. Developing a shared respect in your

primary health care team for individual
dignity, including marginalized and vulnerable
populations
27. Planning patients’ referral for further
investigations or treatment
28. Respecting knowledge and learning styles
of individuals when undertaking family
planning teaching
29. Respecting client’s choices as well as their
right to refuse physical examination, testing
and interventions
30. Assisting patients in making informed
Family planning choices

31.Reviewing other family planning options

when the client’s current method is
unsatisfactory’
32. Interpreting your own patient data about
medical conditions that would contra-
indicate use of specific contraceptive
methods

24
33. Interpreting results from laboratory and
clinical investigations and physical
examination of patients
34. Recognising and managing risk in family
planning care
35. Assessing satisfaction with and correct
use of method with return family planning
clients

25
 SECTION 6:

TWO DIFFERENT METHODS

OF MANUAL ANALYSIS

Making sense of your findings

Depending on the purpose of your study, there are several ways in which you can
analyse the results from the TNA. Remember that high scores on an item’s importance
together with low scores on its performance are indicative of a training need.

IDENTIFYING TRAINING NEEDS – AN INTRODUCTION

Training needs are identified where there are the biggest gaps are between the
importance attributed to an task/item (Rating A on the questionnaire) and how well the
person believes they perform this task (Rating B on the questionnaire). The biggest gaps
indicate the greatest training need. This can be done for an individual or for groups.

You will also need to bear in mind, however, the absolute degree of importance
attributed to a given item, since you might observe a training need on an activity that is
not considered to be particularly important; for example, an item may be given a score
of 4 for importance, but only 1 for performance. This would suggest a training need, but
not an urgent one, as the actual task is perceived to be of only moderate importance.
Training needs can be plotted according to their importance and performance as
illustrated in Figure 1.

26
Figure 1: Example of Presenting Training Needs Scores in a Quadrant Graph Format

Critical to success
7
High Performance
intervention satisfactory –
P priority no G
o intervention o
6
o required o
r d

c c
5
u u
Monitor Monitor
r r
r r
e e
1 2 3 4 5 6 7
n n
t t

p Monitor Monitor p
r 3 r
a a
c c
t t
i Performance i
2
c satisfactory – c
e Low no e
intervention intervention
priority required
1

Not critical to success

IDENTIFYING APPROACHES TO PERFORMANCE IMPROVEMENT

Secondly, the way in which a particular training need could best be addressed may be
identified by the scores given to the relevance of organisational change and
development (Rating C) and specific training courses (Rating D) for improving
performance on that item. If a higher score has been given for organisational
development than for a training course, then this would mean that the respondent
thinks that this training need would be better managed through organisational
development. If a higher score has been given to a training course than to organisation
development for the item, this means that the respondent believes that the training

27
need would be better addressed by a specific training course than by organisational
development. This point is illustrated in Figure 2.

Figure 2: Example of Presenting Preferred Intervention Scores in Quadrant Graph Format

High OD Need
7
Investigate Mixed
OD Solutions Programme

6 H
L
i
o
g
w
h
5
T Review Review T
r Priority Priority r
a
a
i
1 2 3 4 5 6 7 i
n
n
i
i
n
n
g Review Review
g
Priority Priority
3
N
N
e
e
e
e
d
2 d
Consider
Other Investigate
Intervention Training
Strategy Solutions
1

Low OD Need

This can be done for an individual or for groups.

COMPARING DIFFERENT GROUPS ON THEIR TRAINING NEEDS

You may wish to compare different professional groups on their training needs, to see
where the areas of difference and similarity are. Where there are similarities, this might
open up the possibility of shared learning when developing training. Where there are
differences between groups in terms of their training needs, then this may reflect

28
differences in professional roles and requirements; this in turn could mean that
development customised for specific groups might be required.

COMPARING DIFFERENT SUB-CATEGORIES OF ITEM

The items in the questionnaire fall into 5 sub-categories - research/audit,
communication/teamwork, clinical tasks, administration and management/supervisory
tasks. You might wish to compare the training needs for these sub-categories - for
example, are there greater training needs on the sub-category of research items,
compared with the sub-category of clinical items?

APPROACHES TO ANALYSIS
The following guidelines look at individual and group questionnaire analysis, using either
graphs or inferential statistics. We will use the following data from just 5 questionnaire
tasks/items to illustrate the different approaches.
(A = importance of the task, B = performance on the task, C = relevance of
organisational development to improving performance on this task, D = relevance of
training course to improving performance on this task).

Table 1: a sample of hypothetical data

QUESTIONNAIRE ITEM RATINGS
A B C D
1. establishing a relationship with patients 7 5 2 7
2. doing paperwork and/or routine data inputting 3 4 5 3
3. critically evaluating published research, in order 6 2 1 7
to inform standards/protocols in your clinical area
4. appraising your own and other’s performance 4 4 1 5
5. recognising and managing risk in clinical care 7 2 2 7

29
1. Individual questionnaire analysis
Sometimes you might want to look at the training needs of a particular individual. For
example, an annual performance review as part of a staff development programme
might consider the particular development needs of individual members of staff. The
following suggest some ways of analysing the results from a single person’s
questionnaire:

SIMPLE SUBTRACTION: you can subtract the performance score (Rating B) from the
importance score (Rating A) for each individual questionnaire item. This will give
you a difference score which reflects the degree of training need – high scores on
importance and low scores on performance indicate a training need. The bigger the
difference score, the greater the training need. You can rank order the training
needs by the size of these differences. This means, for example, that limited training
budgets could be focused on the top-ranking items. For each of the training needs
you can look to see whether the respondent considers organisational development
(Rating C) or a training course (Rating D) would be more effective in enhancing
performance on that task, depending on which of these has a higher score.

Using the sample data above, the following difference scores are obtained for items
1 – 5 (Rating A – Rating B):
Item 1 = +2
Item 2 = -1
Item 3 = +4
Item 4 = 0
Item 5 = +5

This means that item 5 has the greatest training need, followed by items 3 and 1.
Items 2 and 4 have no training need. Looking at the scores given to the relevance of
organisational development (Rating C) vs training courses (Rating D) for developing

30
these training needs, it can be seen that for all three items with identified training
needs (5, 3 and 1), that training courses are considered to be more useful than
organisational development in improving performance on these.

GRAPHS: alternatively, you can plot an individual’s scores on a graph, illustrated by

Figure 3 below. The vertical axis represents the scores (from 1 – 7), while the
horizontal axis represents the questionnaire items. You can plot the individual’s
score on both the performance and importance scores (Ratings A and B), so that you
can see, at a glance, where the biggest gaps are between the two sets of scores. You
can add the organisational development and training course scores to the graph
(Ratings C and D), so that you can also see how a particular training need would be
better addressed. Therefore, you would look at an item that had a big gap between
performance (B) and importance (A) and then see whether the organisational
development (C) or training course (D) score for this item was greater. The bigger
the score, the more valuable the respondent considers this approach to managing
the training need and enhancing performance.

Using the sample data given in Table 1 above, if these scores were plotted on a
graph we would have the following graph (dark blue line = Rating A - importance,
pink line = rating b - performance; yellow line = Rating C - organisational
development; light blue line = Rating D - training course):

31
Figure 3: Graph to show individual training needs and preferred performance
development options (scores along the vertical axis)

Graph to show individual training

needs and preferred development
options

0
1 2 3 4 5
questionnaire items

Analysing training needs for each sub-category of item

You will remember that the questionnaire items fall into 5 different sub-categories -
research/audit, communication/teamwork, clinical tasks, administration and
management/supervisory tasks. You might want to compare the training needs for
each sub-category. The easiest way to do this is to calculate the differences between
performance and importance (Ratings A and B) for each item and then taking the
items in each category (see section 2 for which items come into which category)
calculate the average difference score, You will end up with 5 average scores – one
for each sub-category. The average scores for each of the 5 sub-categories can then
be plotted on a graph, like the one shown in Figure 4 below:

32
Figure 4: Graph to show training needs for each of the five sub-categories in the
questionnaire

Graph to show training needs for each

sub-category of task

4
average training need
(Rating A - Rating B)

0
1 2 3 4 5
sub-category

You can also present the information in a quadrant graph with the vertical central
line representing the importance scores (top of the line = very important, bottom of
the line = not very important), and the horizontal central line representing
performance scores (left hand pole = poor performance, right hand pole = good
performance – see Figure 1). This means that any items located in the top left hand
quadrant represent the greatest training need (ie: high importance and poor
performance), those items located in the top right-hand quadrant represent no
training need (ie: high importance and good performance); those in the bottom left-
hand quadrant represent minimal training need (ie: low importance, poor
performance), and those in the bottom right hand corner represent no training need
(ie low importance, good performance).

A further alternative is to present all the scores graphically, item by item like Figure
5 on the next page:

33
Figure 5: Graph to show training needs and preferred intervention item by item

1 2 3 4 5 6 7
Establishing a relationship with patients

Doing paperwork and/or routine data inputting

Critically evaluating published research

Appraising your own performance

Getting on with colleagues

Interpreting your own research findings

Applying research results in your own practice

Communicating with patients face-to-face

Identifying viable research topics

Treating patients

Introducing new ideas at work

Accessing relevant literature for your clinical work

Providing feedback to colleagues

Giving information to patients and/or their carers

Statistically analysing your own research data

Showing colleagues and/or students how to do things

Planning and organising an individual patient’s care

Evaluating patients’ psychological and social needs

Organising your own time effectively

Using technical equipment (including computers)

Writing reports of your research studies

Undertaking health promotion activities

Making do with limited resources

Assessing patients’ clinical needs

Collecting and collating relevant research information

Designing a research study

Working as a member of a team

Accessing research resources (e.g. time, money, information & equipment)

Undertaking administrative activities

Personally coping with change in the Health Service

Rating A Rating B Rating C Rating D

34
2. Group questionnaire analysis
The aims of group analysis are comparable to those of the individual analysis and
therefore, the basic principles of analysing the data are similar. However, rather
than using individual scores, you will need to calculate the average scores for the
group. The sorts of analysis you might wish to undertake for groups are as follows:

SIMPLE SUBTRACTION: for every respondent and each item in turn, you would first
subtract the performance score (Rating B) from the importance score (Rating A) to
obtain the difference, or training need. For instance, if you had 100 respondents and
the basic 30-item questionnaire, you would have 100 difference scores for each of
the 30 items in the questionnaire. You would then calculate the average difference
score for each item, giving you an average score for each of the 30 items. The bigger
the average difference score, the greater the group’s training need; these averaged
difference scores can then be rank ordered to establish what the training priorities
are for the group. For each of the training needs you can also see whether the
group generally considers organisational development (Rating C) or training courses
(Rating D) to be more effective at improving performance on tasks showing a clear
training need. This would be established by which of these two options (C or D) has a
higher average score. As with the individual analysis, the training needs scores can
be rank ordered by size to provide a list of priorities for training and development.

USING GRAPHS: again, you will need to use average scores, rather than individual
scores. For each item, calculate the group average. Therefore, for a group of 100
respondents and the basic 30-item questionnaire, you would need to calculate the
average score for the 100 respondents for:
• The importance scores on each item (Rating A)
• The performance scores on each item (Rating B)
• The importance of organisational development in enhancing performance on
each item (Rating C)

35
 • The importance of training courses in enhancing performance on each item
(Rating D)

So, if we take the same five questionnaire items as an example and some
hypothetical data, the average scores on Ratings A, B, C and D, for 100 respondents
might be as shown in Table 2 below:

Table 2 a sample of hypothetical group data

QUESTIONNAIRE ITEM AVERAGED GROUP RATINGS

A B C D
1. establishing a relationship with patients 6.2 4.7 3.9 5.9
2. doing paperwork and/or routine 2.1 3.2 3.8 4.7
data inputting
3. critically evaluating published research 3.4 1.3 2.3 5.4
in order to inform standards/protocols in
your clinical area
4. appraising your own and 3.2 4.7 2.7 6.1
performance
5. recognising and managing risk 6.5 3.9 3.1 5.8
in clinical care

These average scores can then be plotted on a graph as suggested in Figure 6 below.
The vertical axis represents the scores from 1 - 7, while the horizontal axis
represents the 30 (or however many items you have included in your questionnaire)
items. You can plot the group’s average scores on each of the 30 items, so that you
have four distinct lines on the graph, one representing the average importance score
(Rating A), one the average performance score (Rating B), one the importance of
organisation development in performance enhancement (Rating C) and one for the
36
role of training courses in performance enhancement (Rating D). By plotting these
four lines you can see, at a glance, where the biggest gaps are between the
performance and importance scores, which indicate where the main training needs
are for the group. By looking at these training needs in relation to the importance of
either organisational development or training courses in enhancing task
performance, you can also see how best to address the training requirement.
Therefore, you would look at an item that had a big gap between performance and
importance and then see whether the organisational development or training need
score for this item was greater. The bigger the score, the more valuable the group
considers this approach to managing the training need. If we drew a graph of these
averaged scores from Table 2, we would get the following (dark blue line = Rating A
– importance; pink line = rating b - performance; yellow line = Rating C -
organisational development; light blue line = Rating D - training course):

Figure 6: Graph to show group training needs and preferred development options

Graph to show group training needs

and preferred development options

7
6
average scores

5
4
3
2
1
0
1 2 3 4 5
questionnaire items

37
Alternatively, you might want to look at the relative training needs for each of the 5
sub-categories of task. In this case you would calculate the average difference scores
for the items in each of the given sub-categories and plot these (see the bar graph in
Figure 4 above).

You can also present the group averages in a quadrant graph with the vertical
central line representing the average importance scores (top of the line = very
important, bottom of the line = not very important), and the horizontal central line
representing average performance scores (left hand pole = poor performance, right
hand pole = good performance – see Figure 1). This means that any items located in
the top left hand quadrant represent the greatest overall training need for the group
(ie: high importance and poor performance), those items located in the top right-
hand quadrant represent no overall training need for the group (ie: high importance
and good performance); those in the bottom left-hand quadrant represent overall
minimal training need (ie: low importance, poor performance), and those in the
bottom right hand corner represent overall no training need (i.e. low importance,
good performance). Likewise, the preferred interventions obtained by averaging the
scores across the group can be presented in a quadrant graph like Figure 2.

38
USING INFERENTIAL STATISTICS
You can also analyse group data using inferential statistics. If you wanted to compare
the training needs of various professional groups to see whether the groups had
significantly different training requirements on each item, then you would do the
following:
• For each respondent, calculate the difference between their importance and
performance scores on each item (Rating A – Rating B).
• Taking each item in the questionnaire separately, you would then use either an
unrelated t-test if you are comparing just two groups of respondents, or a 1-way
anova for unrelated designs, if you have more than two groups (it is permissible
to use parametric tests on the multiple-point ordinal data obtained, as long as
there is no gross inequality between intervals1,2). This would give you 30
separate statistical t-test or anova calculations if you are using the standard 30-
item questionnaire.

1. Andersen, NH (1961) Scales and statistics: parametric and non-parametric. Psychological Bulletin 58(4) 305
– 316
nd
2. Kerlinger, FN (1973) Foundations of Behavioural Research: 2 edition. New York, Holt

39
If you wanted to see whether a single group had different training requirements for
each sub-group of items, then you would:
• Calculate the difference scores (Rating A – Rating B) for each respondent on
each of the questionnaire items
• Taking all the items in each sub-category and for each respondent, you would
calculate the average difference score for each sub-category. So – for the
research category, there are 9 items; for each respondent you would average
their difference scores for the 9 items in this category to give you a single
average score for research tasks; you would repeat this for each of the other
4 sub-categories. This would mean that every respondent would have 5
average scores, one for each of the sub-categories of items.
• You would then compare the training needs of the group on these sub-
categories using a 1-way anova for related designs.

If you wanted to see whether different groups had different training needs on each
of the sub-categories, then using the average scores for each sub-category, you
would compare the different professional groups using a mixed between/within
anova (the different groups would be the between factor, and the average training
needs for the sub-categories would be the within factor).

All these graphs described above can be drawn by hand or by using a software
package such as SPSS or Excel. The inferential calculations can be undertaken using a
software package, such as SPSS, or by hand. The following texts provide the formula
and the probability tables:

Greene, J and D’Oliveira, M (2005) Learning to use statistical tests in psychology.

Open University Press, Buckingham
Hicks, C (2009) Research methods for clinical therapists: project design and analysis.
5th edition. Edinburgh, Churchill Livingstone, Elsevier

40
 SECTION 7
AN EXAMPLE OF HOW THE HENNESSY- HICKS
QUESTIONNAIRE HAS BEEN USED IN A LARGE SURVEY:
INDONESIA

Application of the instrument in Indonesia

This section describes the use of the Hennessy-Hicks TNA tool in a large survey of the

training needs of nurses and midwives in hospitals and primary health care in Indonesia.

The Department of Nursing in the Ministry of Health (MOH) of the Republic of Indonesia

requested international technical assistance from the World Health Organisation to

assess the role and job function of nurses and midwives. A National Working Group

(NWG) was appointed to work with the WHO technical assistant.

A literature search of studies about the performance of nurses and midwives in

Indonesia from 1990 - 2000 was undertaken and a number of issues and gaps were

highlighted. This was followed up by a scoping study in both hospitals and primary

health care to explore further some of these issues. The scoping study confirmed the

issues identified in the literature search, some other concerns about the basic

preparation and ongoing education of nurses and midwives and also their performance

and management (Hennessy, 2001). The MOH agreed that a national survey should be

41
conducted to explore the role, job function and performance of nurses and midwives in

Indonesia.

One of the tools suggested for use in the survey was the valid and reliable TNA tool

developed by Hicks, Hennessy and Barwell (1996) at the University of Birmingham

(UOB). The tool had been used in other countries and found to be transferable

(Hennessy and Hicks, 1998 and see other references in Section 9 for articles reporting

some of these studies). This tool was explored by the NWG for suitability for collecting

information from providers and their managers in Indonesia. The UoB tool has 30 basic

tasks, which identify respondents’ perceptions of the importance of each task as well as

how well the respondents believe they perform the task. The NWG team scrutinized

every task for relevance to the issues identified in the Indonesian context; the questions

required minor adaptation and the addition of another 9 items (the adaptation will be

found at the end of this section), so that the instrument would address the aims of the

study. The additional items were compiled following a thematic review of a) the

relevant literature, b) interviews with health care providers and c) focus groups with

health care providers. The format of these items was kept as similar as possible to the

basic questionnaire items. These were translated by the NWG, following a

forward/back/forward translation process, according to recommended practice.

The survey plan included collecting administering the TNA questionnaire to two groups:

• individual health care providers (HCPs)

• Their managers

42
In summary, each HCP and their manager completed a TNA, in order to ensure that the
information reflected the views of providers and their managers.

Survey Location

Indonesia is a very large country geographically and also in population size. The MOH

wanted the sample population to come from a widely dispersed area. Therefore, the

only way to collect the data was through using specially trained workers – see later

section. The process of the research and exactly how to administer the tools, once they

had been translated into Indonesian, had to be tested. The process of completion led to

detailed planning, which is described in the following paragraphs.

Sample Size

A stratified sampling method was used to ensure that the TNA information was

collected from as representative a group as possible. Therefore, the design of the main

study required groups of 25 nurses for each grade, and 25 midwifery respondents for

each grade, working in hospitals and community health; their managers were also

recruited. The survey took place in four provinces in different geographical areas. The

HCPs and their managers were represented by samples from two districts in each of the

4 provinces. There was a planned total sample size of midwives, nurses and managers,

of between 800 and 1000 providers or 200 per province. Clearly it is no simple matter

removing large numbers of front-line staff of provider nurses and midwives from the

service to collect the TNA data. Very careful planning was essential.

43
The sampling processes had to be opportunistic as random sampling was not feasible

because of the geographical and practical complexity of the country. The provincial

offices were invited to identify the groups of 25 nurses and midwives from a number of

providers in the two districts so as to spread out the effects on the service of staff

absences during the survey. In the planning stage, it was unclear whether the ambitious

design could be completed successfully.

Pilot Study

A pilot study assesses the feasibility both of completing the tools and the processes of

data collection. It can also establish whether the data would actually address the

research question. The pilot study conducted here showed that access to the providers

was possible; and although the tools took time to complete, the respondents found it

rewarding to do so, which was an unexpected and positive result.

The tools clearly had face value and demonstrated that they could be completed. A

preliminary analysis showed interesting results, which led to much discussion and

excitement in the NWG about the potential outcomes of the main study. With this result

from the pilot study, permission was given by the Ministry of Health and WHO to

proceed with the main study.

44
Preparation for data collection in the main study

Members of the NWG made preliminary visits to the four provinces chosen for the study

(see above) to prepare the field for the rapid needs assessment. Support and co-

operation from staff in provinces, districts, health centres as well as hospital

management and clinicians was established to ensure the success of the data collection

process. In each province, the key stakeholders appreciated the involvement in the

study and welcomed and supported the data collection. These stakeholders asked for

the results of the study to assist them with staffing strategies for the pending

decentralization of regulations.

Training of data collectors

In each province, the data collection team included national data collectors and also a

provincial coordinator, either from the nursing or the midwifery association, as well as

five local facilitators, who were either senior provincial health office managers or

nursing academics or both. A four-day workshop for training data collectors was held in

the centre for those members of the NWG who would travel to different provinces to

collect data. During this workshop the trainers participated in a simulation exercise,

which clarified the nature of the research tools and the process of the data collection

required. They also learnt how to distribute the tools to the survey participants, that is,

both HCPs and managers. Finally, they learnt how to handle and record the completed

responses before returning them to Jakarta, where they were analysed.

45
Data collection

Each grade group of 25 and one first-line manager (one manager for 25 participants in

each grade) completed a questionnaire and participated in a focus group. The entire

process provided an extraordinary and unique opportunity for all participants. They

were able to think deeply about the content of their own job roles, their own

performance and productivity and to discuss this with their peers. The process was

empowering and was greatly valued by all participants. A team from NWG planned the

statistical analysis framework for the data from the UOB questionnaire. Three papers

have been published on the results from this survey (Hennessy, et al 2006a, 2006b,

2006c).

Summary

A total of 856 nurses and midwives from hospitals and community settings, 40 first-line

managers from hospitals and community settings (the functional managers who manage

or co-ordinate a specific grade in hospital wards or health centres) and 54 senior

managers in district offices, health centres and hospital management participated in the

study. The UoB TNA tool was used for this survey and the tasks were adapted and

tested for use in Indonesia. How this was done is explained above and the end result is

shown on the next page. The adapted tool was found to be valid and reliable.

46
 A Standard UoB TNA Questionnaire Adaptation of UoB TNA Questionnaire
For Indonesia Survey

1. Establishing a relationship with patients Establishing a relationship with patients

2. 2. Doing paperwork and/or routine data inputting Inputting data into written or computerized
records
3. Critically evaluating published research Critically evaluating published research
4. Appraising your own performance Appraising your own and other's performance
5. Getting on with your colleagues Getting on with your colleagues
6. Interpreting your own research findings Interpreting your own patient data
7. Applying research results to your own practice Interpreting results from clinical
investigations
8. Communicating with patients face-to-face Undertaking clinical examination of patients
9. Identifying viable research topics Recognising and managing risk in clinical care
10. Treating patients Undertaking technical nursing or midwifery
procedures
11. Introducing new ideas at work Introducing new ideas into your own clinical
work
12.Accessing relevant literature for your clinical Requesting laboratory investigations and
work results
13. Providing feedback to colleagues Developing joint work arrangements with
others
14. Giving information to patients and/or carers Showing patients and their families how to do
things
15. Statistically analyzing your own research Analysing patient data
data
16. Showing colleagues and/or students how to Instructing or training students/ junior
do things staff/TBA
17. Planning and organizing an individual Prioritising your work according to patient's

47
patient’s care needs
18. Evaluating patients’ psychological and social Assessing patients psychological and social
needs needs
19. Organizing your own time effectively Planning/organizing patients' treatment
20. Using technical equipment, including Using technical equipment
computers
21. Writing reports of your research studies Writing clinical, shift and other reports
22. Undertaking health promotion activities Undertaking health promotion and
prevention activities
23. Making do with limited resources Assessing costs and outcomes of procedures
24. Assessing patients’ clinical needs Assessing patients physical needs
25. Collecting and collating relevant research Collecting your own
information clinical/patients/surveillance data
26. Designing a research study Identifying area worthy of investigation in
your practice
27. Working as a member of a team Working as a member of a team
28. Accessing research resources e.g. time, Locating and access relevant equipment for
money, information, equipment your clinical work
29. Undertaking administrative activities Undertaking administrative duties
30 Personally coping with change in the health Actively assisting in change management
activities
service

31. Developing a shared mission of clinical

area goals
32. Planning patients discharge
33. Making appropriate patient referrals
34. Making decisions about patients clinical
problems
35. Assisting patients in making informed
choices

36. Designing systems for patient

monitoring/observation

48
 37. Undertaking budget planning activities

38. Showing patients and their families how

to do things

39. Consulting with colleagues about care

options

References

1. Hennessy, D. A. (2001) Assessment of Role, Job Function and Performance of Nurses and
Midwives in Community and Hospital Settings. Assignment Report SEA-NURS-429. 12
April 2001. Restricted.

2. Hennessy, D. and Hicks, C. (1998). The use of a cross culturally validated training needs
analysis instrument to identify the nature of continuing professional development in
three different countries. International Nursing Review 45(4) Issue 340, pp. 109-114

3. Hennessy, D., Hicks, C., Hilan, A and Kawonal, J ( 2006a) A methodology for assessing
the professional development needs of nurses and midwives in Indonesia. Human
Resources for Health Vol 4 (10)

url: http://www.human-resources-health.com/content/4/1/8

4. Hennessy, D., Hicks, C., and Koesno, H (2006b) The training and development needs of
Midwives in Indonesia. Human Resources for Health Vol 4 (9)

url: http://www.human-resources-health.com/content/4/1/9

5. Hennessy, D., Hicks, C., and Hilan, A and Kawonal, J. (2006c) The training and
Development Needs of Nurses in Indonesia. Human Resources for Health Vol 4 (11).

url: http://www.human-resources-health.com/content/4/1/10

49
 SECTION 8
ITEM BANK: A LIST OF QUESTIONNAIRE ITEMS
USED IN OTHER STUDIES

Basic questionnaire items

The basic questionnaire comprises 30 items; of these 8 can be replaced and a further 10
added without compromising the psychometric properties of the instrument. In this
section are the basic items, plus additional item banks that have already been used in
other studies. These can either replace 8 of the original items and/or a further 10 items
can be added from this item-bank.

BASIC ITEMS
1. Establishing a relationship with patients
2. . 2. Doing paperwork and/or routine data inputting
3. Critically evaluating published research
4. Appraising your own performance
5. Getting on with your colleagues
6. Interpreting your own research findings
7. Applying research results to your own practice
8. Communicating with patients face-to-face
9. Identifying viable research topics
10. Treating patients
11. Introducing new ideas at work
12.Accessing relevant literature for your clinical work
13. Providing feedback to colleagues
14. Giving information to patients and/or carers
15. Statistically analyzing your own research data
16. Showing colleagues and/or students how to do things

50
17. Planning and organizing an individual patient’s care
18. Evaluating patients’ psychological and social needs
19. Organizing your own time effectively
20. Using technical equipment, including computers
21. Writing reports of your research studies
22. Undertaking health promotion activities
23. Making do with limited resources
24. Assessing patients’ clinical needs
25. Collecting and collating relevant research information
26. Designing a research study
27. Working as a member of a team
28. Accessing research resources eg time, money, information,
equipment)
29. Undertaking administrative activities
30 personally coping with change in the health service

Additional items
EXTENDED NURSING ROLE
Recognizing and managing risk in clinical care
Making appropriate patient referrals
Undertaking patient consultations
Applying pharmacology to practice according to defined clinical guidelines
Undertaking technical nursing, clinical or medical procedures
Enabling patients to make informed choices about their care
Managing other staff
Requesting clinical investigations for identified patients eg: haematology tests
Making decisions about the clinical problems of identified patients
Developing systems for patient recall
Planning and conducting health promotion and other clinics

51
 Interpreting and using the results from clinical investigations of identified
patients
Assessing and making a preliminary diagnosis of clinical problems
Undertaking comprehensive clinical examinations of patients
Surveying patients’ needs
Using different techniques for obtaining information
Weighing up clinical evidence
Justifying your clinical practice
Justifying changes to your clinical practice
Asking relevant questions about the effectiveness of your clinical practice
Reflective decision-making
Monitoring your clinical practice
Assessment of clinical costs and benefits
Reviewing patterns of care
Experimenting with different treatments
Investigating the effectiveness of treatments
Evaluating professional practice

CHILD ABUSE/CHILD PROTECTION

Detecting non-accidental injury in children
Communicating with at-risk families
Probing unexplained injuries, bruising or bedwetting
Having a clear understanding of your appropriate role in prevention of child
abuse and neglect
Deciding whether to intervene or not in cases of suspected abuse
Observing interactions of both parents and siblings with at-risk children
Recognising inconsistencies in parents’ descriptions of their child’s accidents
Dealing with parents attending case conferences
Liaising/communicating with the police and other authorities

52
 Understanding your responsibilities when dealing with at-risk children
Using approved guidelines on referral procedures
Being aware of different types of child abuse
Identifying child neglect or failure to thrive
Being able to recognize good and bad practice when dealing with child abuse
Discussing potential further action with other care workers
Coping with stress when questioning a family about child abuse
Trying to make an early identification of child abuse
Detecting persistent injuries
Understanding child protection legislation
Providing on-going support for families connected with child abuse
Coping with the emotional reaction of other care workers when faced with child
abuse
Distinguishing between neglect, physical, sexual and emotional abuse
Knowing when to alert the authorities
Discussing individual children with a paediatrician
Coping with the conflict between need to intervene and loyalty to the family
Obtaining ‘clues’ to potentially harmful substances
Having a clear understanding of your legal responsibilities for protecting at-risk
children

MANAGEMENT
Dealing with personnel management issues
Providing performance feedback to staff
Controlling financial resources
Planning and organizing workload
Writing management reports
Generating income for your organization
Designing and implementing an audit

53
 Accessing available resources for organizational development
Developing joint working arrangements with others
Actively facilitate organizational improvements
Undertaking business planning activities
Developing a shared vision of organization goals
Converting organization goals into personal action plans
Consulting with colleagues to discuss service provision

NURSE PRESCRIBING
Providing patients with instructions on the correct use of drugs
Providing patients with information on the significant side-effects of drugs
Discussing with patients the risks and benefits of suitable drugs
Understanding your own practice in relation to legal issues
Recommending and discussing with patients the most suitable drugs for their
condition
Accurate and safe dispensing of drugs
Deciding which drugs are most suitable for a patient and his/her condition
Obtaining a full history of the patient’s health/sickness

SPECIALIST CARE
Promoting risk reduction of lymphodoema in the arms
Promoting breast awareness as a health promotion activity
Understanding and identifying the implications for individuals/friends/family
Recognising the risk factors for developing cancer
Understanding the reasons for breast screening
Providing patients with instructions on the correct use of contraceptive devices
Providing patients with information on the significant side-effects of
contraceptive devices
Discussing with patients the risks and benefits of suitable contraception

54
Understanding your own practice in relation to legal, religious and cultural
issues
Recommending and discussing with patients the most suitable contraception for
their needs and lifestyle
Accurate and safe dispensing of contraceptive devices and drugs
Deciding which contraceptives are most suitable for a patient
Obtaining a full sexual health history from the patient
Applying the principles of legal and ethical consent when dealing with vulnerable
client groups
Knowing the statutory legislation relating to your work
Understanding how recently developed contraception works physiologically
Knowing the appropriate techniques for taking swabs for sexually transmitted
infections
Understanding the implications of cervical cytology reports
Contributing to the activities of your local professional interest group
Undertaking appropriate health education with individuals and small groups
Setting up and running clinics
Being able to provide counseling for patients and their families
Being able to provide teaching and training

55
 SECTION 9

PUBLICATIONS REPORTING EARLIER STUDIES THAT HAVE USED THE

HENNESSY-HICKS QUESTIONNAIRE

For details on the psychometric procedure adopted in developing the

questionnaires in this document see:

Hicks, C , Hennessy, D and Barwell, F. (1996) The development of a psychometrically

valid training needs analysis instrument for use with primary health care

teams. Health Services Management Research 9 262 -272

Other publications:

Hennessy D, Hicks C, Kawonal Y and Hilan A (2006) A methodology for assessing the

professional development needs of nurses and midwives in Indonesia: paper

1 of 3. Human Resources for Health 4(8)

url: http://www.human-resources-health.com/content/4/1/8

Hennessy D, Hicks C, and Koesno H (2006) The training and development needs of

midwives in Indonesia: paper 2 of 3. Human Resources for Health 4(9)

url: http://www.human-resources-health.com/content/4/1/9

56
Hennessy D, Hicks C, Hilan A and Kawonal Y (2006) The training and development

needs of nurses in Indonesia: paper 3 of 3. Human Resources for Health

4(10)

url: http://www.human-resources-health.com/content/4/1/10

Hicks C and Fide J (2003) The educational needs of non-specialist breast care nurses.

Nurse Education Today 23(7) 509 - 521

Hicks C and Tyler C (2002) Assessing the skills for family planning nurse prescribing:

development of a psychometrically sound training needs analysis instrument.

Journal of Advanced Nursing 37(6) 518 - 531

Tyler, C and Hicks C (2001) The occupational profile and associated training needs of

the nurse prescriber: an empirical study of family planning nurses. Journal of

Advanced Nursing 35(5) 644 - 653

Hicks, C and Hennessy, D (2001) An alternative technique for evaluating the

effectiveness of continuing professional development courses for health care

professionals: a pilot study with practice nurses. Journal of Nursing

Management 9 39 - 49

Hicks, C and Hennessy, D (2000) An alternative methodology for skill mix review: a

pilot case study with a primary health care team. Journal of

Interprofessional Care 14(1) 59 - 74

57
Hicks, C and Hennessy, D (1999) Evidence-based educational commissioning and

policy making: a case for the prospective use of a psychometric approach in

defining the role and preparation of the nurse practitioner in Australia.

Collegian 6 (3) 29 - 34

Hicks, C and Hennessy, D (1999) Quality in post-basic nurse education: the need for

evidence-based provision. Journal of Nursing Management 7 215 - 224

Bannon, M, Carter, Y, Barwell, F, and Hicks, C (1999) perceptions held by General

Practitioners in England regarding their training needs in child abuse and

neglect. Child Abuse Review 8(4) 276 - 283

Hicks, C and Hennessy, D (1999) A task-based approach to defining the role of the

nurse practitioner: the views of UK acute and primary sector nurses. Journal

of Advanced Nursing 29(3) 666 - 673.

Hennessy, D and Hicks, C (1998) A cross-cultural tool to identify continuing

education needs. International Nursing Review 45 (4) issue 340

109 - 114

Hicks, C. and Hennessy, D. (1998) A triangulation approach to the identification of

the training needs for Nurse Practitioners. Journal of Advanced Nursing 27

117 - 131

58
Hicks, C. and Hennessy, D. (1997) Mixed messages in nursing research: their

contribution to the persisting hiatus between evidence and practice.

Journal of Advanced Nursing 25 595 - 601

Hicks, C M (1997) The dilemma of incorporating research into clinical practice.

British Journal of Nursing 6 (9) 511 - 515

Hicks, C. and Hennessy,D. (1997) The use of a customised training needs analysis

tool for nurse practitioner development. Journal of Advanced Nursing 389

- 398

Hicks, CM and Hennessy, D (1997) Identifying training objectives: the role of

negotiation. Journal of Nursing Management 5 263 - 265

Hennessy, D. and Hicks, C. (1996) From supposition to science; the need for a more

systematic approach to education and training. British Journal of Health

Care Management 2(1) 40 - 44

Hicks, C. and Hennessy, D. (1996) Applying the principles of psychometrics to the

development of a training needs analysis questionnaire for use with health

visitors, district and practice nurses. NT Research 1(6) 442 - 454

Hicks, C M, Hennessy, D, Cooper, J and Barwell F (1996) Investigating attitudes to

research in primary health care teams. Journal of Advanced Nursing 24

1033 -1041

59