Melbourne School of Population and Global Health - Theses
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ItemEndoNeeds Phase 1: a protocol for research exploring the physical, psychological and social needs of Australian women with endometriosis.( 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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ItemNo Preview AvailableIncidence and environmental risk factors of hospitalisation in a large cohort of ex-prisoners from Queensland, Australia( 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.
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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.
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ItemThe usage of psychotropic medications by family caregivers( 1996-07)This is a randomly selected, cross-sectional, population based study of women caring for family or friends who are elderly or have a long-term illness or disability. The purpose of the study was to investigate the usage of psychotropic medications by carers in order to identify predictors of usage of these medications relating to the caring situation. Data collected in 1993 by the Carers’ Program in the state of Victoria, Australia was used for statistical and qualitative analysis. The data base consisted of 157 carers and 219 non-carers. Women who had the main caring role for a relative or friend with a disability for at least 4 hours per week were selected for the study. Women who were living with a partner or children or both and had the main responsibility for household tasks but were not caring for someone with special needs were selected as the comparison group. Using this group of non-carers allowed direct comparison of carers and non-carers to be made and to identify the difference that the role of caregiving to someone with special needs makes when compared with usual family care responsibilities.
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ItemThe anatomy lesson: an examination of the medical body as represented in contemporary anatomical art( 2005)In this thesis I examine issues raised by works of contemporary art that depict the anatomically dissected body. In recent centuries representations of the anatomical body have become synonymous with the medical body. This analysis of contemporary artworks reclaiming the trope of the anatomical body thus allows room for critical reflection on the culturally constructed nature of the modern medical body. Discussion centers around three pieces in particular: Body Worlds, an exhibition of plastinated corpses by Gunther von Hagens; Hymn, an enlarged dissected torso sculpture by Damien Hirst; and Science of the Heart, a video installation by Bill Viola incorporating a projection of a surgically dissected heart. In each chapter I explore how the artwork reveals, reflects, reproduces and contests current conceptualisations of the medical body, often in problematic ways. Issues of commodification, gender and technology are examined through detailed textual analysis of each artwork, the discussion drawing upon a range of critical theories including postmodern, feminist and phenomenological theory. The thesis acknowledges the dialectic between medicine and art surfacing from the artworks and aims to extend this into the medical humanities by recognising the pieces as engaged and potentially powerful critical discourses on the state of the body in medical culture today.