General Practice and Primary Care - Theses
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ItemRedefining the measurement of technology-facilitated abuse in relationships: The TAR Scale( 2021)Technology-facilitated abuse in relationships (TAR) is a growing health and social issue across the globe, yet TAR research in the Australian context is limited. Affecting people of all ages, TAR is posited as highly prevalent among young people for whom it may be particularly pervasive and pernicious. Limited scholarship on the effects of TAR suggest impacts are wide-ranging and at times serious. Young women are thought to be more negatively impacted than young men. However, robust TAR assessment tools are yet to emerge, bringing the accuracy of prevalence and gender findings into question. Further, TAR assessment tools are yet to include validated measures of impact, so existing impact findings are also vulnerable to inaccuracy. Finally, scholars assert that TAR mostly manifests as patterns of behaviour in young people’s lives, yet this potentiality has received limited research attention. To address these gaps, this PhD had two aims. First, to make a step-change in the measurement of TAR among young people by developing a robust scale that simultaneously measures TAR victimisation and impact. Second, among a sample of young Australians, to investigate the prevalence and impact of TAR and how it manifests as patterns of behaviour, across gender. Observing best-practice steps of scale development, the research used a mixed-methods approach involving consultation with young people (n = 38), topic experts (n = 33) and frontline practitioners (n = 171), followed by a large-scale youth survey (n = 527) for the application of exploratory factor analysis. Victimisation frequency and impact were also explored, including an analysis of TAR patterns. The original contributions made by this thesis include a new simple definition of TAR and a new robust assessment tool that measures TAR victimisation and impact. The new TAR Scale yields sound reliability and validity evidence and gendered TAR victimisation findings. Contributing the first validated measure of TAR impact and the only robust TAR measure developed among Australians aged 16 to 24 years, the scale enabled the first comprehensive study of TAR among this population. A further innovation of the thesis includes an analysis of multi-dimensional patterns of TAR, demonstrating the importance of moving beyond aggregate measures that focus solely on the presence or absence of single TAR dimensions. The Humiliation pattern was experienced more frequently by young men than young women, the Sexual Coercion pattern more frequently by young women than young men, and the Monitoring, Control and Threats pattern equally across gender. Some TAR behaviours had greater impact on young women, while others had greater impact on young men. Finally, the thesis contributes new knowledge regarding the potential roles of reputation and humiliation in young men’s experiences of TAR, and unique insights regarding some young men’s misconception of the severity of the impact of TAR on young women. Implications for future research include supplementary validation of the TAR Scale, further exploration of TAR impacts across gender, and additional investigation into how TAR manifests as patterns of behaviour. Furthermore, the new insights into TAR and its gendered impact hold implications for practitioners and policymakers, including the potential for enhanced support services for young people and the development of gender-nuanced TAR education and prevention programs.
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ItemThe gender-sensitive care project: Exploring sexual violence in psychiatric inpatient units( 2020)Sexual violence is a major global public health issue. There are strong associations between sexual violence victimisation and mental illness, with one in three women presenting at mental health services have experienced domestic violence, including sexual violence. Women often report feeling disempowered and re-victimised while in psychiatric inpatient units, especially in mixed-gender wards. The biomedical model has been the dominant model of care in psychiatric inpatient units. Recent years have seen a global movement towards gender-sensitive and trauma-informed models of care for those with mental illness. To date, there is limited extant research focused on understanding health professionals' experiences and practices of these care models. This research aimed to understand how trauma-informed care or gender-sensitive care is experienced and enacted by health professionals’ for women victim-survivors of sexual violence across acute psychiatric inpatient units. To address this aim, the research was divided into two phases and four research questions. The first phase answered research questions one and two through a scoping review of the literature. The first research question explored health professionals' experiences of providing trauma-informed care in acute psychiatric inpatient settings. The second research question explored health professionals' awareness of the gendered impacts of trauma and how this impacts the care provided. The second phase included a qualitative case study, including stakeholder interviews, observations, and document analysis. The second phase answered research questions three and four. The third research question explored health professionals' perceptions of providing care for women who are victim-survivors of sexual violence in psychiatric inpatient units. The fourth research question explored health professionals' experiences in providing care for women who are victim-survivors of sexual violence in psychiatric inpatient units. The researcher also conducted a policy review of current mental health and violence against women policy and procedures to understand the context of health professionals' experiences and practices. The findings of these studies are presented in three peer-reviewed published articles. The findings suggest that trauma-informed and gender-sensitive care are inconsistently understood and enacted in practice. A more comprehensive care model, which is gender-trauma and-violence informed, is suggested to address the identified barriers in acute psychiatric inpatient units. This research contributes to improving care provision for women who are victim-survivors of sexual violence during their admissions to psychiatric inpatient units.