Melbourne School of Population and Global Health - Theses
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ItemKoori kids and otitis media prevention in Victoria( 2007)Otitis media and consequent hearing loss are known to be high in Koori communities. Previous research on otitis media in Koori communities has focused on its identification, treatment and management. Little research has focused on the prevention of otitis media. Victorian Aboriginal communities often have small populations which result in small sample sizes for research projects. Consequently use of traditional quantitative methods to measure of change arising from health interventions can be problematic. The aim of the research was to describe Koori children’s otitis media risk factors using a Koori research method in order to develop, implement and evaluate preventative interventions.
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Item'Weapons of mass destruction': the health impact of human rights violations in the context of Austalian asylum policies( 2007)Over the past decade, scholars from the disciplines of both public health and law have increasingly acknowledged that health and human rights are inextricably linked. Perhaps most significant in the evolution of the health and human rights paradigm is the recognition that violations of human rights have adverse consequences for health. While this is most apparent in relation to, for example, torture, the empirical evidence for the health impact of other rights violations has, to date, been scarce. This study aimed to investigate the relationship between current Australian asylum policies, which arguably represent human rights violations, and the health and wellbeing of refugees who have been subject to these policies. A mixed-methods study design was undertaken to address the study aim. A comparative cross-sectional survey of 71 Iraqi Temporary Protection Visa (TPV) holders and 60 Iraqi Permanent Humanitarian Visa (PHV) holders, residing in the Northern suburbs of Melbourne, Australia, was conducted. A purposive sampling frame was utilised owing to the fact that a random selection of participants was not feasible. Iraqi temporary and permanent refugees surveyed were comparable across key demographic criteria, and were also broadly representative of the wider Iraqi refugee population in the study site, according to available data. The survey included standardised self-report measures assessing psychosocial constructs which were hypothesised to be significant in the experience of TPV holders (e.g. perceived life constraints, social support, and sense of injustice), and health outcomes, both physical and psychological. Socioeconomic stressors were also measured.
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ItemMarkers of midlife: interrogating health, illness and ageing in rural Australia( 2007-06)The aim of this thesis is to explore rural women’s midlife experiences and interrogate the roles of health, social and community factors in these. In the cultural imagination, midlife signifies the onset of ageing and is thus framed in a discourse of decline. For women, it is often considered in terms of menopause and the end of fecundity and fertility. I propose that women’s experience of midlife is much broader than this; instead, it is characterised by transformation in multiple domains and health status is important. I suggest that the continuity theory of ageing is useful when conceptualising the life course. The concept of habitus enables exploration of how identity is re/constructed during the ageing process in response to changing bodily circumstances, such as health problems. (For complete abstract open document)
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ItemHobson's choice: dialysis or the coffin: a study of dialysis decision-making amongst older people( 2007-10)Introduction: Forty years ago the life saving and life prolonging therapy of dialysis was rationed. It was extremely unlikely that people aged over 50 years would be offered treatment. Today, those aged over 65 years are becoming the fastest growing group of patients on dialysis. Changing population demographics and referral patterns, the opening up of eligibility for dialysis to high risk individuals, refinement and developments in dialysis technology and its ‘success’ in keeping more patients alive for longer periods, along with rising public expectation, are just some of the reasons behind this change in the age profile of those being currently treated for kidney failure. Older people are likely to have multiple co-morbidities and decreased functional status that may complicate their decision-making about dialysis and limit their treatment options. Enhancing choice and involvement in treatment decision-making to the patient’s satisfaction is a central theme of health care ethics. Current national and international ethical guidelines about the initiation of dialysis recommend shared or joint decision-making and discuss patient ‘benefit’ and patient ‘need’. This project sought to determine how these recommendations, and other ethical issues related to informed consent, possible withdrawal of treatment and quality of life, were embodied in the personal experiences of a group of older people facing dialysis decisions. Aim: The general aim of this research was to follow the dialysis decision-making process over time amongst a group of people aged 65 years and older. More specifically, this research sought to explore with the participants the following issues: what factors impacted on their dialysis decision-making; how they understood both what was happening to them and the goals of treatment; their preferences for information seeking; how they perceived any future decision-making; how or whether the commencement and experience of dialysis influenced their decision-making; and once treatment had been initiated, how they felt about their initial decisions. Method: A predominantly longitudinal qualitative study was undertaken. Meetings were conducted prior to the potential initiation of dialysis with 21 participants. These meetings involved a semi-structured interview and the administration of three questionnaires focusing on preferences for decision-making, information seeking and quality of life. Data was also collected from the participants’ health records. For those participants who commenced dialysis a further two meetings were undertaken one month and then six months after treatment was instigated. The qualitative data was analysed thematically using concepts that had either been pre-determined and explored within the interviews or, had emerged from the participants’ stories. Findings: Findings from this study include: participants not feeling that they had a choice about dialysis; a mismatch between theoretical expectations of informed consent and shared decision-making and the ‘actor centred experiential’ model of decision-making adopted by participants; a need to re-evaluate the balance and relationships between physiological measures of effectiveness emphasised by health professionals, and psychosocial and functional markers valued by participants; and treatment goals not being individually negotiated. Conclusion: An interest in remaining alive was the driving force behind why participants chose to have dialysis. Other factors impacting on decisions about dialysis were multi-faceted and were based on priorities other than what health professionals consider important. Shared decision-making, as described in the literature, is not unproblematic. However, health professionals need to accept the underlying premises on which shared decision-making is based so that they can find out what expectations patients have of treatment, beyond that of saving life. Such expectations need to be discussed with patients and the various treatment options need to be negotiated in an attempt to achieve patients’ goals. Patients should be encouraged however to be involved in decision-making to the extent to which they desire.
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ItemEffectiveness of influenza and pneumococcal vaccination against hospitalisation for community-acquired pneumonia among persons >=65 years( 2007)Although there are well-documented benefits from influenza vaccine and 23-valent pneumococcal polysaccharide vaccine (23vPPV) against invasive pneumococcal disease and laboratory confirmed influenza, their effectiveness against pneumonia remains controversial for community-based persons aged >=65years. At the time of this research, within Australia, only the government of Victoria publicly funded these vaccines for elderly persons. With continued growth of the elderly population, the subsequent adoption of an Australia-wide program, and increasing uptake of similar programs in other countries, there is a need for data clarifying the impact of vaccination on pneumonia. This research estimates incremental vaccine effectiveness of 23vPPV over and above influenza vaccine against hospitalisation with community-acquired pneumonia (CAP) in the elderly.
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ItemMental health care roles and capacities of non-medical primary health and social care services: an organisational systems analysis( 2007-05)Top-down, centralised approaches to reform of mental health services implemented over the past 15 years in Australia have failed to achieve the widely shared aim of comprehensive, integrated systems of care. Investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain however in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Intersectoral collaboration that includes the diverse range of non-medical primary health and social care services is one of the most fundamental remaining challenges facing mental health system reform.
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ItemHepatitis C testing among young people who experience homelessness in Melbourne( 2007-05)Despite the large number of hepatitis C tests performed in Australia each year and the effort expended on developing and implementing policies to regulate this practice, very little research has been undertaken on the human factors associated with hepatitis C testing. This thesis aims to: 1) examine patterns (prevalence and incidence) of hepatitis C testing among young people who experience homelessness in Melbourne, Australia, and how they relate to behavioural and contextual factors, and 2) examine the contexts in which hepatitis C testing occurs for these young people. Two studies were undertaken to address these aims. The first employed longitudinal panel surveys collected from young people who had recently become homeless for the first time (N=165) over three waves: baseline, 12-month and 24-months. The second employed semi-structured qualitative interviews 24-months after baseline with 20 young people recruited from the longitudinal cohort.
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ItemStudies on prevention and management of HIV/AIDS in the era of highly active antiretroviral therapy (HAART)( 2007-03)More than 25 years have passed since the first cases of HIV/AIDS were reported and a decade since highly active antiretroviral therapy (HAART) was introduced as part of the continuum of care for people living with HIV/AIDS (PLWHA). The introduction of HAART as a continuum of care for PLWHA positively changed the characteristics of HIV/AIDS epidemic, contributing for significant declines of HIV/AIDS-related morbidity and mortality rates. Thus, a new era began with HAART, often referred as the “HAART era”. However, HAART also brought with it new challenges and issues for researchers working in the field of HIV/AIDS. This thesis comprises several studies that were designed to gain understanding of some issues on prevention and management of HIV/AIDS that emerged in the current HAART era. The review of the literature points out for many emergent issues in HAART era, but only some issues were researched and presented in this thesis.
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Item‘Art is us’: Aboriginal art, identity and wellbeing in Southeast Australia( 2007)Aboriginal arts practices in the southeast of Australia have, since the early years of colonisation, been rarely considered within the realm of authentic Aboriginal arts practices. Such attitudes were a reflection of the colonial encounter and associated attempts to assimilate the Aboriginal population with the White. This thesis explores Aboriginal arts practices and asserts that there has always been Aboriginal art in the southeast and that, despite the overwhelming effects of colonisation, the work of Aboriginal artists provides a distinct and definite counter-history to that endorsed by the dominant culture. Using published historical and contemporary accounts and recent interviews from Aboriginal artists and arts workers, this thesis investigates the continuation of the knowledge and practice of southeast Australian Aboriginal art and its connection to culture, identity and wellbeing. It explores the corresponding adaptations and changes to these practices as Aboriginal people contended with the ever-expanding European occupation of the region from 1834 onwards. This project adopted a collaborative research methodology, where members of the Aboriginal arts community were consulted throughout the project in order to develop a study which had meaning and value for them. The collaborative approach combined an analysis of historical data along with the stories collected from participants. By privileging the Aboriginal voice as legitimate primary source material, alternative ways of exploring the history of Aboriginal art were possible. Although the story of Aboriginal art in the southeast is also one of tensions and paradoxes, where changes in arts practices frequently positioned art, like the people themselves, outside the domain of the ‘real’, the findings of this project emphasise that arts practices assist people with connecting and in some cases reconnecting with their communities. Aboriginal art in the southeast is an assertion of identity and wellbeing and reflects the dynamic nature of Aboriginal culture in southeast Australia.