Melbourne School of Population and Global Health - Theses
Permanent URI for this collection
Search Results
1 - 10 of 50
-
ItemIndividual and environmental determinants of fast food purchasing(University of Melbourne, 2008)
-
ItemDiasporas of medical beliefs : a multi-ethnic clinic and the experience of tuberculosis in a low incidence country(University of Melbourne, 2006)This thesis reports on a qualitative, ethnographic study of a multicultural migrant population in a tuberculosis clinic in Melbourne, Australia. The thesis focuses on two groups of people and their interaction � health professionals who work with tuberculosis, and patients who have, or have had, the disease. My focus in interviewing the health professionals is on their management of disease in the face of widely different patient beliefs. In analysing interviews with patients and their families, I focus on narrative and conceptual syncretisms, where a partially assimilated explanatory framework of western medicine coexists with other traditional or personal models about tuberculosis. For none of the patients interviewed, was is it the case that these alternative models blended together without friction, nor was there evidence of one idea or component over-riding or replacing another. Rather, it was repeatedly found that ideas or models, which outwardly appear inconsistent and contradictory, appeared to fit together quite comfortably. While nearly everyone who goes through the clinic already has (or has recently acquired) a good understanding of their infection, disease and treatment from a biomedical perspective, this does not lead to a rejection of preexisting models. For example, the two apparently contradictory statements that "TB is caused by a pathogen" and that "TB is caused by the supernatural" regularly co-occur within the narratives I collected. A deeper analysis of what is being said indicates that in cases of this type, people are presenting information on different, though parallel, levels. This results in a multitude of discrepant assessments that are somehow commensurate, resulting in a functioning clinic where treatment is extremely successful despite the great diversity surrounding the two groups and health models. The individual's comfort with incommensurable models is thus a central interest in the thesis. Importantly for health professionals, this research shows that the impact of non-western models of disease aetiology on TB treatment regimes may be far less than it appears at first sight. Contrary to expectations, even seemingly incompatible propositions held by patients rarely cause problems of compliance, or otherwise hinder the patient's integration into the biomedical treatment regime presented to them in the course of their dealings with the clinic.
-
ItemThe spirit of emancipation and the struggle with modernity : land, art, ritual and a digital knowledge documentation project in a Yolnu community, Galiwin'ku, Northern Territory of Australia(University of Melbourne, 2008)This thesis concerns Indigenous knowledge systems, agency, technology and modernity. It presents an ethnographic study of a contemporary Yolrp documentation project devised in a remote township in north-eastern Arnhem Land, in the Northern Territory of Australia, in order to produce meaningful representations of modernity for the young generations. The study sets out the possibility to rethink the implications of the digitisation of Aboriginal knowledge within the broader theoretical frame of cultural transmission. It draws on the dynamic tension between structure, performance and agency to transcend common views of what culture is in order to investigate the performative aspects of knowledge production. In other words, the ethnography tracks the social life of Yolnu culture, from the field to the archive (ethnographic, digital) and back again and describes how these trajectories are inscribed in multi-sited knowledge systems which in turn inform contemporary meaning making practices and strategics of representation and becoming. Research questions were originally framed around the changing status of images in Yolrju society, a people who have a long tradition of anthropological dealings and whose material collections can be found in numerous archival institutions. In these times of rapid change, I was and am particularly interested in examining the use Yolnu made of Information and Communication Technologies (ICT) in cultural resource management projects and the ways in which these experiments influenced contemporary approaches to knowledge transmission. For this purpose, fieldwork undertaken on Elcho Island between February 2003 and December 2004, revolved around the Caliwin'ku Indigenous Knowledge Centre, a community organisation which, as part of a state wide strategy to support "sustainable" communities, had just received seed funding from the Northern Territory Libraries to build a digital cultural archive. In this thesis, I document how this digital experiment evolved in the community, further departing from the original project-plan as it was gradually being appropriated by the local actors and fitted into Yolgu reality of being in the modern world. While the "knowledge centre" concept itself became increasingly entangled in a web of controversies and strategically reconfigured at the local level, the organisation was taken over by a group of senior Yolnu men whose primary concern lay with the recognition of their ancestral law and historical agency, the transmission of knowledge to the young generations and the projection of meaningful representations into the future.
-
ItemDo growth monitoring and promotion programs motivate mothers to change behaviour? A systematic review using a combination of Cochrane-style systematic reviews and realist reviews( 2008)Background: The failure of GMP for not achieving its intended outcomes is in part due to the lack of implementation quality. A systematic review on how to maximise the potential of GMP services to improve child nutrition status is needed. The question is to go beyond whether GMP programs work (or do not work), but on how and why GMP programs work (or do not work). There is, however, no single agreed method for synthesising diverse forms of evidence on social interventions such as GMP. This thesis argues that combining Cochrane-style systematic reviews and realist reviews to synthesise the evidence in GMP is feasible and able to produce credible information for decision makers. Objectives: This paper aims to explore how a systematic review combining both Cochrane-style systematic reviews and realist reviews can help explain one aspect of the GMP program theory and to use this information to inform the evaluation process of the Indonesian Management Malnutrition Program. Methods: To combine Cochrane-style review and the realist review, the realist review is first used to identify the review focus. The Cochrane approach then is applied to guide the searching process for high quality evidence. After finishing the quality appraisal, the realist approach will be applied in the data extraction and synthesis stages. Main Results: There is weak evidence that use GMP as a tool to personalise risk information alone motivates mothers’ to change behaviour in improving caring practices. Incorporating multiple theoretical concepts, including HBM, tailoring intervention strategies, self-efficacy, and role modelling enhance the likelihood of behaviour change. In addition, this review identified contextual factors that need to be taken into account in applying the mechanisms in different settings. It is clear that the incorporation of multiple theoretical concepts combined with addressing the contextual constraints is important to gain positive outcomes. The nature of these results will be useful to policy makers who need to know not merely whether GMP programs work but these supplies practical theories on what needs to be attended to in constructing better GMP programs. Conclusion: The review demonstrates that combining Cochrane-style reviews and realist reviews is feasible and helpful as an alternative method to synthesise a complex social intervention where only few evidence on the related topic available such as GMP. The review emphasises the importance of incorporating multiple theoretical concepts and of addressing contextual constraints to maximise the implementation of the GMP activities.
-
ItemKanyirninpa : health, masculinity and wellbeing of desert Aboriginal men( 2004)Kanyirninpa, or holding, exists as a deeply embedded value amongst desert Aboriginal peoples (Puntu). It is disclosed as authority with nurturance, where older generations assume the responsibility to care for and look after younger people. Kanyirninpa also holds in balance two other key cultural patterns of desert life, autonomy and relatedness. These values are transmitted across generations where they provide desert society with identity, cohesion and strength. While kanyirninpa can be identified in the nurturance provided a child after birth, its presence and power is particularly disclosed at ceremonial time. Here, the meanings of the ancestral tjukurrpa (dreaming) are celebrated and renewed. Desert society is reproduced as the deeper, social and cosmic meanings around ngurra (land), walytja (family) and tjukurrpa are gathered, ritualised and re-enacted. The older generations of men and women enable this holding to occur. When boys (marnti) become men (wati) the manner of kanyirninpa changes. No longer do young men seek to be held by their mothers and female relations. Instead, they seek to be held by older men: brothers, uncles and other males. By holding them older men induct younger men into the social meanings and behaviours of desert, male adulthood. A generative and generational male praxis is disclosed. Colonialism and mission activity in the south-east Kimberley severely impacted desert society. Puntu were dislocated from their traditional lands as a sedentary life in Balgo mission was accompanied by a dormitory, rations and labour system that effectively and forcibly separated generations of men and women. The research that conducted in this desert region investigated how Puntu perceived kanyirninpa, its transmission and how this transmission had been affected by colonial history and experience. Male and female Puntu emphasised that, despite the effects of seventy years of colonial contact, they continued to value holding as an essential ingredient for social and emotional wellbeing (palya). They also revealed that young men continued to explore experiences that offered the possibility of kanyirninpa. Within the social contexts of petrol sniffing, football and prison particular aspects of male holding could be identified as could risks to men's health. Finally, the research led to an elucidation of the social circumstances that have been inscribed on the contemporary Puntu male and social body (yarnangu). They reveal the effects of colonisation on transgenerational processes and key social relationships. The Puntu social body can be understood as traumatised. Transgenerational trauma describes how separation has wounded the transmission of kanyirninpa within key social relationships. While desert people have worked to protect the value and continuity of kanyirninpa, expressions of social trauma continue to seriously affect the health and wellbeing of all, particularly young men.
-
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.
-
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.
-
ItemGonna drink, get drunk: a history and ethnography of alcohol in Rarotonga, Cook Islands( 2002-11)This thesis describes the place of alcohol in the lives of people from Rarotonga, Cook Islands. It incorporates historical and ethnographic analyses to provide the broad context of drinking by people aged from their teens to late thirties. The historical component of this study describes specific accounts of alcohol consumption, and situates these with regard to changes that occurred in Rarotonga from the early 19th century. Prior to contact with Papa’a (Europeans), people of Rarotonga neither produced nor consumed alcoholic beverages. Thus, the use of alcohol was a phenomenon intimately bound up with global exploration, proselytisation and trade. I trace historical changes in the distribution of power, resources, religious practice, and social discourse, and show how alcohol practice, distribution, and trade was linked to these changes from missionary contact onward. This history informs the ethnography of contemporary drinking practices. Individual and group practices and understandings of alcohol are described. I also describe the contribution of state policy, commercial interests, government institutions, and religious organisations to the place of alcohol in Rarotonga. Alcohol is a transformative substance that changes the comportment of drinkers. But its effect is ambiguous, and recognised as such. ‘Drunken’ behaviours are often explained as originating in concerns and desires that pertain in sobriety. Thus, the status of alcohol consumption as an explanation for specific behaviours is equivocal, and contested. Drinking is a means by which relationships between friends, kin and strangers are initiated and/or maintained. The particular significance of alcohol to the maintenance of (drinking) relationships is not only due to social constructions of meanings and practices associated with drinking; pharmacological effects of alcohol increase the social salience of drinking. Drinking both alters bodies and alters relationships between drinkers. In this sense, it embodies social meanings and understandings of drinking practice. Finally, I suggest that in Rarotonga, the association of drinking with emotional experience and behaviour is also, in part, attributable to the ‘embodied’ experience of alcohol. The form of emotional experience, and the form of embodied experience of alcohol, are similar. These are associated with one another through analogy (and so by the social construction of each) by embodied experience.
-
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)
-
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.
- 1 (current)
- 2
- 3
- 4
- 5