Melbourne School of Population and Global Health - Theses
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ItemScience Communication for Public Health: Public Consultations, News Media Representations and Public Experts( 2023-09)This thesis is focused on the intersection of science communication and public health. The COVID-19 pandemic (which was declared a pandemic by the World Health Organization (WHO) in 2020 and as of writing this thesis in 2023, it is ongoing) has highlighted how crucial effective science communication is during a public health crisis. Natural sciences have been heavily influenced by the school of thought known as positivism, which involves the methodological pursuit of knowledge through empirical observations and the quest for universally applicable scientific laws. Many public health disciplines follow the principles of positivist natural science. However, the concept of positivism is subject to debate, as critics suggest its focus on objective truths disregards the influence of social, cultural, and historical factors on knowledge generation. Furthermore, social scientists view the media, and other information dissemination activities, as socially constructed rather than purely objective. The task of communicating natural science to the public via media and engagement activities such as public consultations involves translating intricate scientific information into narratives that resonate with the public. This translation process involves professionals such as scientific experts, science communicators and journalists who must balance understandability, relevance to the audience, and factual correctness. Key theoretical frameworks used in the science communication literature include the ‘public understanding of science’ (PUS) framework and ‘public engagement with science and technology’ (PEST) framework. The PUS framework assumes that the public's doubt or scepticism about science is linked to a deficiency in their understanding of science. The PEST framework has a focus on conveying diverse perspectives and critical reflections about science and involving the public in scientific dialogues and active participation. Whilst some science communication scholars have argued that there should be a shift from the PUS to PEST frameworks, there is acknowledgement that the PUS framework is still widely in use. Related to the PUS and PEST frameworks is medialisation theory, which describes the relationship between science and the media. This involves the mutually beneficial relationship between scientists and journalists and the overall orientation of science toward the media. Medialisation can result in increased media coverage of science but can also lead to the distortion of scientific reporting which can be a threat to scientific integrity. My thesis aimed to address the gap in knowledge regarding the stakeholders of science communication in socially constructed public health contexts and the applicability of science communication theoretical frameworks. Therefore, the overarching aim of this thesis was to explore the roles, tensions and experiences of the stakeholders involved in the communication of public health science in socially constructed environments. To achieve this, I conducted three separate case studies of public health-related science communication in socially constructed contexts in Australia. The first case study used qualitative content and thematic analysis to examine the written submissions to an Australian government-led public consultation run by the Therapeutic Goods Administration covering the regulation of autologous stem cell therapy. The findings showed that there was a divergence of opinion among stakeholders, with some advocating for unregulated ASCT (patients and providers) while others pushed for greater regulation (scientist and scientific organisations). This public consultation had the potential to strengthen prevailing power relationships and exacerbate social inequalities. The PUS framework appeared to underpin the approach to this Australian government-led public consultation, with disproportionate influence of scientists and scientific institutions over patients and providers. The second case study used qualitative content and thematic analysis to examine the translation of journal article to press release and the subsequent news media reporting of an Australian study on vitamin supplementation and risk of birth defects. The findings showed that, replicated from the press release to the news media reporting were issues such as sensationalism, misrepresentation, inappropriate clinical recommendations, and subjectivity. Additionally, pressures faced by journalists, scientists, and their institutions created a mutually beneficial relationship that prioritised newsworthiness over scientific integrity, with the potential to harm public health. The PUS framework and medialisation theory can help to explain the distortion of information about this Australian scientific study, including misrepresentation within the institution press release and whether independent views were sought by journalists. The third case study used a thematic analysis of in-depth qualitative interviews with public experts acting as science communicators during the COVID-19 pandemic to understand their motivations, responsibilities, impacts, and experiences. Findings showed that public experts received negative feedback from the public. However, difficult interactions for public experts extended beyond members of the public and involved journalists. Additionally, public experts had positive experiences, such as making a tangible impact on public health, alleviating community anxiety, and democratising research by making it accessible beyond academic audiences. Furthermore, public experts were not talking about their own research but were talking about the work of other scientists and how this related to society in general. From a theoretical perspective, the motivations, responsibilities, impacts and experiences of public experts who spoke in the media during the COVID-19 pandemic were explained by aspects of both the PUS and PEST frameworks. Additionally, medialisation may have equipped scientists to serve as public experts during the COVID-19 crisis, ultimately benefiting society. In conclusion, this thesis explored the roles, tensions and experiences of the stakeholders involved in the communication of public health science in socially constructed environments in Australia via three separate case studies. The findings revealed that the public consultation had the potential to strengthen prevailing power relationships and exacerbate social inequalities. Pressures faced by journalists, scientists, and their institutions created a mutually beneficial relationship that prioritised newsworthiness over scientific integrity. Public experts had negative but also notable positive experiences from engaging with the media including having a translatable impact on public health. Additionally, my three case studies demonstrated the value of the theoretical frameworks in understanding the relationships between science and society, and science and the media.
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ItemThe development, implementation and evaluation of first few X household transmission studies in Australia( 2023-04)New or re-emerging infectious diseases pose a serious threat to public health. First Few X (FFX) studies provide a platform for the rapid collection of detailed epidemiological data and specimens from cases and their close contacts to understand the potential impact of such diseases. When activated in the early epidemic stages, the data collected from FFX studies can be used to produce estimates of key transmissibility and severity parameters to inform public health and social measures. The Australian Government Department of Health recognise the value of FFX studies, however, detailed protocols in the Australian context were not finalised at the start of my doctoral research in 2019. This thesis documents my experience contributing to the development of a global FFX protocol for pandemic influenza in 2019, as part of my internship at the World Health Organization. The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the advent of the global coronavirus disease (COVID-19) pandemic during the first year of my studies rapidly pivoted my PhD focus from piloting a FFX study during the 2020-2021 influenza seasons to implementation in a global health emergency. As such, I detail my role coordinating the design and implementation of the Australian FFX Project for COVID-19 – a national study of confirmed cases of COVID-19 and household contacts conducted between April-October 2020. Using a contact-level mixed-effects logistic regression model, I estimated the household secondary attack rate to be 12% (95%CI 7–17%), which aligned with the estimate produced by my collaborators (15%, 95%CrI 8–25%) using a mathematical model. As this was the first project of its kind in Australia, there were many challenges encountered with respect to logistics, ethics, governance, and data management. I subsequently led a qualitative evaluation of stakeholders involved in the project to consolidate on lessons learnt to inform future FFX platform development in Australia. Four main recommendations were developed from the series of modified Delphi surveys and interviews with key stakeholders, including: forming strong partnerships between health departments and researchers; developing FFX protocols that can be easily adapted for different pathogen contexts; investing in data infrastructure, and; having broad ethical approvals in place before a study begins. The learnings presented in this thesis have significant implications for pandemic planning in Australia, by reinforcing the need for pre-determined and pandemic-ready FFX protocols. The development of a fit-for-purpose FFX protocol in Australia, in advance of the next infectious disease emergency, will enable better understanding of the epidemiology in the early and subsequent epidemic phases of a novel or re-emerging pathogen and help inform a proportionate public health response.
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ItemPreventing violence-related death and morbidity among people who have had contact with the criminal justice system( 2022)Although rates of violence globally have been decreasing in recent decades, the risk of experiencing violence remains disproportionally concentrated among people who experience marginalisation and disadvantage. Many of the health and social inequities that predispose people to experiencing violence are highly prevalent among those who have had contact with the criminal justice system. However, there is little evidence on the risk of violence victimisation in this population. This constrains our ability to design effective violence prevention strategies that can meet and respond to the needs of those who have had contact with the criminal justice system. My thesis aimed to fill this gap in the literature by generating novel evidence on the epidemiology of violence-related death and morbidity among young people and adults who have had contact with the criminal justice system. I conducted a narrative review of the literature, five discrete original research studies, and I produced a protocol for a systematic review and meta-analysis, and a letter to the Editor. I also extended the Public Health Approach to Violence by applying it, for the first time, to those who have had contact with the criminal justice system. My thesis findings indicate that young people and adults who have had contact with the criminal justice system have a risk of violence-related death and morbidity that is far greater than that of the general population. Among people who have had contact with the criminal justice system, women, Indigenous people, and those with mental health and/or substance use issues are particularly at risk. Evidence-informed violence prevention strategies are urgently needed in this population. The findings of my thesis can be used to inform the development of such strategies. Taken together, the evidence suggests that in order to be effective, a violence prevention approach for this population should address the health and social inequities that are both drivers of violence and disproportionately impact people who have had contact with the criminal justice system. Effective responses must also take into consideration the sex- and culturally-specific needs of those who have had contact with the criminal justice system. Until such action is taken, people who have contact with the criminal justice system will continue to experience violence victimisation at a rate that far exceeds that in the general population.
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Item"Place" and sexual and reproductive health in Australia( 2020)Sexual and reproductive health are significant public health concerns, and come with considerable costs to be individuals and the public, whether physical, emotional, mental or financial. There have been calls, particularly internationally, for responses to sexual and reproductive health issues to take an ecological perspective, addressing the multiple levels of influence on people’s health outcomes, such that interventions may potentially be more effective and enduring. ‘Place based’ approaches to health engage with ecological understandings of health, and a small body of literature has applied this framework to sexual and reproductive health. Few have done so within the Australian context, however. The aim of this thesis was to improve understanding of whether and how geographic location may be impacting on the sexual and sexual and reproductive health of Australians. In order to do so, three objectives were addressed: 1 - to explore associations between geographic location and sexual and reproductive health outcomes in Australia; 2 - to explore associations between geographic location and sexual and reproductive health risk behaviours in Australia; and 3 - explore the mechanisms by which geographic location may be affecting sexual and reproductive health behaviours and outcomes. Chapters 1 to 3 are introductory chapters, including a review of relevant literature pertaining to both sexual and reproductive health, and to conceptual frameworks which may inform place-based approaches to understanding health. Chapters 4, 5 and 6 present analyses of associations between ‘place’ and sexual and reproductive health outcomes and behaviours. Chapter 4 comprises a publication in analysing associations between country-level income inequality and notifications of Neisseria gonorrhoea in females. It finds that higher levels of income inequality were significantly associated with higher rates of notification for gonorrhoea. Chapters 5 and 6 report on analyses of a national dataset of prescribing data for the subdermal contraceptive implant and the levonorgestrel intra-uterine device, respectively, finding associations between living outside major cities and higher rates of prescription of long-acting contraceptives. The analyses also tested associations between proximity to specialist health services, such as Aboriginal Medical Services and Family Planning Clinics, but found little evidence of significant association. Chapter 7 presents the finding of a qualitative analysis of interviews with key informants in rural and regional areas of Australia, exploring mechanisms though which characteristics of their local communities may be affecting the sexual and reproductive health of young people. Participants were able to articulate a broad range of factors related to their location that were affecting these – and other – outcomes, including: the social context, broader social and political structures, local structural elements, and geographic location. Informed by findings from the qualitative analysis, Chapter 8 explores associations between alcohol availability and prevalent chlamydia at the level of postcode, multilevel analyses, finding no evidence of significant associations. Together, these analyses have contributed to a small body of Australian literature which takes a place-based approach to sexual and reproductive health outcomes. Showing associations at various levels, it emphasises the potential utility of taking an ecological approach to interventions designed to improve sexual and reproductive health – from the national level to the level of individuals.