Melbourne School of Population and Global Health - Theses

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Start date: 2010 × End date: 2019 × Type: Masters Coursework thesis ×

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    EndoNeeds Phase 1: a protocol for research exploring the physical, psychological and social needs of Australian women with endometriosis.
    Steele, Emma ( 2017)
    Endometriosis is a chronic gynaecological condition that causes pain and infertility and can have a significant impact on the physical, psychological and social wellbeing of women. This thesis outlines the protocol for exploratory qualitative research that is required to develop a survey for women with endometriosis that will measure the things they need to improve their wellbeing – their unmet needs. If unmet needs can be measured, targeted interventions can be designed to meet these needs, and ultimately improve quality of life. The aim of this research is to identify key needs and domains of needs in this population. The research will be conducted using focus group discussions, and data will be analysed using a grounded theory approach to identify needs to include in the unmet needs survey. An important way of enhancing the content validity of survey instruments is through the involvement of patients in their development, through exploratory qualitative research. In this case, the identification of a broad range of needs in this population will aid in the development of a robust, easy to use instrument that can be used to inform clinical practice at an individual and population level.
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    Incidence and environmental risk factors of hospitalisation in a large cohort of ex-prisoners from Queensland, Australia
    Love, Alexander ( 2016)
    Introduction: Australians enjoy relatively good health compared to the rest of the world. However, not all Australians share the same experience when it comes to health. People who have been released from prison and Indigenous Australians experience poorer health compared to the broader Australian population. Features of the natural, built and social environment determine what we are exposed to and have access to. Thus, the environment is central in shaping our health needs and outcomes. Remoteness describes where a person is situated relative to urban centres, goods, services and opportunities for social interaction; and area disadvantage measures the material and social resources of a place. This research aimed to test if two environmental factors, remoteness and area disadvantage, have an impact on the rate of hospitalisation for a cohort of ex-prisoners from Queensland, Australia. It was hypothesised that remoteness and area disadvantage will be associated with an increased incidence and increased risk of hospitalisation. Methods: This research used baseline data from the Passports study. Probabilistic linkage was used to match baseline data with hospital records from Queensland Hospital Admitted Patient Data Collection and death records from the National Death Index, and deterministic linkage was used to match baseline data with incarceration records from Queensland Corrective Services. Remoteness and area disadvantage data were obtained from the Australian Bureau of Statistics, and each participant was matched with a remoteness and area disadvantage category according to their postcode. Incidence rates were calculated and stratified by remoteness and area disadvantage, and survival analysis was used to determine risk of hospitalisation according to remoteness, area disadvantage and a range of socio-demographic and health variables. Interaction between Indigenous status, remoteness and area disadvantage was also tested in predicting risk of hospitalisation. Results: The incidence rate was 41.45 hospitalisations per 100 person years for the study group. The incidence rate of hospitalisation differed according to remoteness and area disadvantage. Incidence rates of 39.60 and 53.16 hospitalisations was observed for those who lived urban areas and rural or remote areas respectively. Incidence rates of 39.41 and 48.49 s was observed for those who experienced not-severe and severe levels of area disadvantage respectively. The incidence rate was highest for those who experienced both increased remoteness and severe area disadvantage, at 65.43. Remoteness was associated with an increased risk of hospitalisation, but this disappeared after adjusting for other factors. Area disadvantage was not associated with an increased risk of hospitalisation. No interactions were observed to modify the effect of remoteness or area disadvantage on risk of hospitalisations. Discussion/conclusions This study achieved it’s aim of testing whether two environmental factors, remoteness and area disadvantage, have an impact on the rate of hospitalisation for a cohort of ex-prisoners. Findings indicate that there is a higher incidence of hospitalisation in areas characterised by remoteness or severe disadvantage. Prior to adjusting for covariates, remoteness predicted an increased risk of hospitalisation. However, neither remoteness nor area disadvantage independently predicted increased risk of hospitalisation. Some factors such as tobacco dependence may mediate the relationship between environmental exposures and hospitalisation. The findings of this study may be generalised to other Australian states.