Melbourne School of Population and Global Health - Theses
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ItemFirst Nations fathering: A model to support the early formation of Aboriginal and Torres Strait Islander male-led families( 2021)Have previously submitted this
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ItemThe relevance of perseverative cognition for Aboriginal Australians( 2020)Aboriginal and Torres Strait Islander people are the most marginalised and disadvantaged group in Australia, experiencing measurably worse health and social outcomes than do other Australians. A substantial body of evidence suggests that perseverative cognition – a psychological state characterised by excessive worry, rumination, and anticipatory stress – increases the risk of psychological and physical ill-health through extending the stress response. Historical and contemporary experiences of structural, cultural, and individual race-related violence and discrimination may leave Aboriginal and Torres Strait Islander people particularly vulnerable to perseverative cognition and its long-term effects on physical and psychological health. This takes the form of conditions such as depression, anxiety, and cardiovascular disease, all of which are highly prevalent among this minority. This study applied critical race theory and participatory action research approaches to explore experiences and responses to racism with 39 Aboriginal adults from a regional urban context in 2015. Thematic analysis of seven discussion groups identified three major themes in the data including 1) The nature, sites and normalisation of racism and discrimination; 2) Anti-racism, redress, and reconciliation mechanisms; and 3) Predicting, protecting, and preserving self and others. Findings indicate study participants experience multiple forms of societal racism that promotes sustained cognitive vigilance or ‘action readiness’ for race-related threat and an array of adaptive context-driven and dynamic cognitive, emotional, and behavioural responses. This result supports the relevance of the perseverative cognition hypothesis in this context and recommends a more comprehensive mixed-methods investigation, broad-ranging structural, cultural, and individual anti-racism education, and effective redress mechanisms for Aboriginal and Torres Strait Islander people.
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ItemEngaging men in conversations about masculinity and suicide – An evaluation of the Man Up social media campaign( 2020)Male suicide continues to be a major public health concern both internationally and in Australia. While a number of factors have been found to contribute to high suicide rates, little is known about what drives the much higher rates in men compared to women. Mostly, risk factors for suicide are considered in isolation, with little regard for the mechanisms that may underpin them. In more recent discussions on male health, masculinity has been highlighted as a potential driving force underpinning unhealthy male behaviors. In Australia, the “dominant masculinity” is one that endorses the norms of stoicism, independence, invulnerability and avoidance of negative emotions. Conformity to these masculine norms has been associated with suicidal thinking, poor mental health and reduced and delayed help-seeking. Men also describe experiencing stigma and how the fear of being alienated prevents them from seeking help for mental health issues. For these reasons, men are often described as a “hard-to reach” population group when it comes to mental health messaging. Suicide prevention interventions are needed that adopt a gendered approach and attend to the influence of masculine norms on mental health and suicide. The Man Up intervention was an innovative media-based male health promotion and suicide prevention intervention that featured a three part television documentary and digital campaign delivered via a website and five social media platforms (Facebook, Twitter, Instagram, YouTube and tumblr). It was funded by the Movember Foundation in Australia and its aim was to address the high suicide rate among men by promoting help-seeking for personal or emotional problems via an exploration of Australian masculinity. The documentary and digital campaign examined how society shapes the way men and boys see themselves and explored how this might affect mental health and, potentially, lead to thoughts of suicide. It was aired by the Australian Broadcasting Corporation (ABC), Australia’s national public free-to-air broadcaster, in October 2016. This thesis explores the potential for social media to be used in health promotion with the view to generate and increase engagement and influence conversations on the issue of male suicide and its link to masculinity. As such, this thesis focuses on the evaluation of the social media components of the digital campaign. The thesis is based on the idea that masculinity, the rules prescribed by society about how men should live their lives, is a fundamental determinant influencing how men negotiate their health throughout life. Following social constructionist theory, this thesis proposes that by challenging dominant masculinity social learning processes can take place that will support redefining restrictive behavior patterns and opening up alternative behaviors which in turn will help reducing stigma for men facing mental health problems, increasing male help-seeking and ultimately reducing male suicide rates. The above aim was addressed through two empirical studies that analyzed various data sources collected through two social media platforms: Facebook and Twitter. In Study 1, Twitter Insights data were used to assess reach and engagement with the campaign and to determine highest and lowest performing tweets. We also analyzed the volume of conversations over time by tracking the use of common campaign hashtags and conducted thematic analysis on a sub-set of tweets to determine most engaging campaign content themes. Study 2 was a qualitative study of comments published on the Man Up Facebook page with the aim to provide further insight into the conversations that were instigated by the campaign. Both studies have been published as peer-reviewed journal articles and together they demonstrated that the Man Up social media campaign was able to generate an impressive reach and exposure to campaign messages in the Australian population and beyond. Overall, the studies showed that the Man Up campaign messages were perceived positively across both Twitter and Facebook. Campaign content was widely shared on social media and positive feedback showed endorsement for the campaign. It highlighted the need to openly talk about male suicide and the stigma introduced by gendered practices. The increased use of the hashtag keywords of the Man Up campaign in line with the campaign phases and the fact that the hashtag MANUP was trending during the campaign signaled a strong uptake and sharing of campaign messages. Despite this, the hashtag analysis could not find a lasting increase of engagement. The analysis of Facebook comments confirmed that the social media campaign triggered conversations about masculinity and suicide that might otherwise not have happened. For some, this may have led to shifting attitudes towards expressing emotions and reaching out to others for help, however, this could not be formally investigated based on social media data alone. This thesis concludes that social media interventions can be used successfully in engaging men in discussions about male mental health, suicide and gender norms and therefore demonstrate potential for suicide protective properties of social media. However, more research is needed to better understand how and where on the internet to best engage men, particularly men at high risk of suicide. While gender-transformative campaigns such as Man Up can help to further destigmatize help-seeking for men, the longevity of changes needs further consideration. Addressing these issues will require high quality interventions and evaluation designs for social media campaigns which follow a systematic framework for measuring effectiveness.
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ItemMedia reporting of Robin Williams’ suicide( 2020)Background Irresponsible media reporting of suicide can lead to suicidal acts, particularly if the subject of the reporting is a celebrity. When Robin Williams took his own life on 11 August 2014, media reporting in the United States was less than optimal, with many reports detailing the suicide method Williams used, romanticising his suicide, and failing to provide information on sources of help. The reporting was followed by an increase in suicides in the United States, as well as an increase in helpline calls. In Australia, the Mindframe guidelines provide media professionals with advice on ways to safely report on suicide. This thesis set out to determine whether the Australian reporting of Williams’ suicide adhered to the recommendations in the Mindframe guidelines and whether there were increases in suicides or calls to helplines in Australia following the media reporting of Williams’ suicide. Method The thesis involved three studies. In Study 1, relevant newspaper articles were identified through a systematic search process, and trained coders rated the articles for quality against criteria in the Mindframe guidelines. In Study 2, suicide data were extracted from the National Coronial Information System for the period 2001 to 2016 and interrupted time series regression analyses were conducted to determine whether there were changes in the number of suicides in the five month period immediately following Williams’ suicide. In Study 3, weekly calls data for the period 2013 to 2015 were provided by Australia’s two most prominent helplines, Lifeline and Beyond Blue. Again, interrupted time series regression analyses were conducted, this time to determine whether there was an increase in the average weekly number of calls received by each helpline one week and one month after the news of Williams’ suicide broke. Results Study 1 identified 303 newspaper articles, 67% of which adhered to at least eight of the 10 Mindframe guidelines. Study 2 found an 11% increase in suicides in the five month period following Williams’ death, largely accounted for by men aged 30-64 years and by people who died by hanging (the method Williams used). Study 3 provided strong evidence of an increase in calls to Lifeline and Beyond Blue in the week after Williams’ suicide was reported. This levelled out over the ensuing month. Conclusion Australian newspaper reporting of Williams’ suicide was largely consistent with the Mindframe guidelines. Despite this, there were increases in suicides in the immediate aftermath of his death, which is obviously a negative outcome. There were also increases in calls to helplines, which may be interpreted either as negative (i.e., suggesting that people’s levels of distress and feelings of suicidality were heightened) or positive (i.e., suggesting that people who might have otherwise been influenced to harm themselves called a helpline instead). It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media and social media or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided.
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ItemQuantification of the dynamics of antibody response to malaria in pregnant women( 2020)Malaria remains a major public health threat with pregnant women and young children the most vulnerable populations. Approximately 125 million pregnant women are at risk of malaria infection every year. Immunity to malaria can significantly reduce the severity of malaria symptoms. This has long motivated efforts to better understand the immune response to malaria in order to develop an efficacious antimalarial vaccine. However, the complex behaviour of the immune system, particularly in pregnant women, has hindered identifying the underpinning mechanisms of the immune response to malaria infection. This project investigates antibody-mediated immunity in pregnant women who attended antenatal clinics located at the Thai-Myanmar border, where malaria transmission is low and P. falciparum and P. vivax (the most prevalent malaria species globally) coexist. Antibody responses during pregnancy to six parasite antigens were measured for 250 pregnant women in a median of 7 samples per woman (range 2 to 13) over the gestation period. A multivariate mixture linear mixed model was fitted to longitudinal antibody data of 250 pregnant women to characterise the highly dynamic antibody responses using a Bayesian approach. The posterior distribution of the parameters estimated via Markov chain Monte Carlo (MCMC) simulations were used to classify the antibody responses. The results show that the infectious status of a woman during follow-up is a key factor influencing the classification of the joint behaviour of the antibody responses. Hence, the two malaria exposure categories (exposed to infection during pregnancy defined as a case and those non-exposed defined as controls) were represented by the two antibody profile clusters. Using a manually developed code, entropy values were computed for each antibody, with which, the contribution made by each antibody on the classification was assessed. The antibodies PfMSP3 and PvAMA1 which maintained less dynamic antibody profiles significantly influenced the classification. However, these antibodies identified controls exceptionally well but did not perform well for the cases. For sero-surveillance, antibodies which best identify the cases are required, hence, the study was extended in performing classification based on all possible univariate and multivariate combinations of the six antibodies. The bivariate combination PfAMA1 and PfVAR2CSA resulted in identifying the majority of cases by contributing towards identification of potential biomarker(s) for sero-surveillance of recent exposure to malaria during pregnancy. Therefore, the bivariate combination of antibodies, PfAMA1 and PfVAR2CSA should be used in the field, particularly for accurate malaria surveillance of pregnant women living in low malaria transmission settings. This could lead to the early detection and treatment of malaria infections in pregnant women, reducing transmission and thereby progressing towards elimination of malaria.
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ItemAn exploration of key informant perspectives on factors influencing settlement of male Hazara youth who migrated to Melbourne as unaccompanied minors( 2020)Background: Globally, there has been an extraordinary growth in refugees and asylum-seekers in the past two decades. Australia experienced a dramatic increase in boat-arrivals in 2008–2013, with many being Afghan Hazara including unaccompanied asylum-seeker minors (UAMs). Global and Australian studies highlight the significance of providing UAMs with appropriate settlement services during their adjustment period, yet few ethno-specific studies have to date sought service provider perspectives on support provided to male Hazara UAMs pre-18 years and former UAMs (fUAMs) post-18 years. Methods: This qualitative study addressed this research gap using ecological systems theory and social networks theory in a dual-sector case study design to explore the perceptions of professional case workers (n=6) and voluntary English language teachers (n=6). Based on key informant views, this study focused on the expectations and experiences of male Hazara UAMs’ compared to fUAMs’ select settlement services during their early adjustment period (2015–2016) in Melbourne, Australia and how this support influences their settlement and wellbeing. Results: The findings indicate UAMs’ three-part migration trajectory (from Afghanistan, via transit countries to Australia) was perceived to be driven by classic push and pull factors and shaped by family separation. Following arrival, Australia’s immigration and settlement policies determined the type and level of support provision, with UAMs in community detention receiving maximum services while fUAMs in mainstream community being offered highly reduced services and temporary visas. English language was perceived to have strong influence on their early adjustment, and different forms of social networks could promote their socioeconomic participation. Despite UAMs experiencing potential risks pre-arrival, protective factors post-arrival, especially support services, could rebuild their resilience. Conclusion: This study has implications for asylum-seeker and settlement policies, casework practice, and researchers to leverage settlement process and wellbeing outcomes of this group of unaccompanied youths in Australia.